(Reuters Health) - In Washington state, where recreational marijuana has been legal since 2012, cannabis companies are forbidden by law from making social media posts that appeal to youngsters, that encourage overconsumption and that suggest the drug has curative properties.

But a new study finds those rules are being flouted by some companies. Researchers scrutinizing 1,027 posts by marijuana companies in Washington discovered that 137 promoted cannabis as having therapeutic benefits, while 17 encouraged overconsumption and nine used images that appeal to teens.

“We are in the early days with marijuana legalization and are figuring out what policies will be, particularly with respect to advertising and promotion,” said the study’s lead author, Dr. Megan Moreno, a professor of pediatrics at the University of Wisconsin, Madison. “The goal is to prevent teen marijuana use. And we know its use is linked to marijuana exposure. So we’re trying to limit their exposure to content that promotes or glorifies marijuana use.”

As reported in JAMA Network Open, Moreno and her colleagues analyzed posts on Facebook and Twitter from the business pages of six recreational marijuana companies in Washington to see how often they adhered to state regulations. The companies had between 374 and 2915 Twitter followers and between 342 and 1592 Facebook followers.

Although there were 38 companies selling cannabis in the state, the researchers excluded businesses from their study if, for example, there was less than a year of posts to evaluate or the company wasn’t a retail seller.

The posts were all evaluated by human coders, Moreno said, since it can be complicated to rate a site in certain areas such as appeal to young people, because that involves analyzing images, for example. Included in the analysis were posts from December 1, 2015 through November 30, 2016.

Most posts followed the regulations, but 13.3 percent promoted curative or therapeutic benefits, such as “#Cannabis Used to Ease PTSD” and “MJ can literally improve your pet’s health.” Most of the posts touting medicinal benefits (69 percent) came from a single company. Some of the messaging in the posts was subtle, conveying a therapeutic suggestion via the hashtags that were included, such as #wellness or #health, Moreno said.

Companies are required by state regulations to include warnings about negative health effects of cannabis, such as possibly affecting concentration, coordination and judgment, as well as a chance that the user could become addicted. Two of the six companies did not have any warnings.

A very small percentage of the posts (0.9 percent) appeared to be directly targeting teens. One actually showed a young person, while eight showed cartoon characters known to appeal to teens and young adults, such as Scooby-Doo. “These characters are considered retro and cool to teens,” Moreno said.

The most “disturbing” aspect of the findings was the percentage of posts touting health benefits, said Dr. Antoine Douaihy, the senior academic director of Addiction Medicine Services for the University of Pittsburgh Medical Center’s Western Psychiatric Hospital. “The reason is they’re promoting cannabis as having really good effects for pain, mood and anxiety, when in fact if you used it to consistently self-medicate for anxiety you could end up with a full-blown anxiety disorder.”

Douaihy is also concerned that health messaging will appeal to teens who have more vulnerable, developing brains. “Keep in mind that medical marijuana is never a first-line treatment for anything. It’s always a last resort,” said Douaihy, who was not affiliated with the new research. “This kind of messaging suggests it could be a first line approach for someone who is really stressed out and anxious, like someone dealing with school issues or their parents. Saying it can have medical benefits kind of gives teens permission.”

The new study is important because “it raises the issue of treating social media as a form of advertising and it begins to question how that advertising should be regulated,” said Dr. Ryan Vandrey, an associate professor in the department of psychiatry and behavioral sciences at the Johns Hopkins School of Medicine.

And it highlights the fact that states will be the ones regulating cannabis advertising, “whereas regulations for comparable markets - tobacco and alcohol - are done by federal agencies,” said Vandrey, who was not involved in the new research. “So states that have legalized cannabis for either medicinal or nonmedicinal purposes have to create regulatory bodies from scratch.”

What makes things especially hard is that cannabis falls in a zone between recreational drugs like alcohol and tobacco and actual pharmaceuticals, because there are actually medicinal uses for cannabis, Vandrey said. Because of that, Vandrey believes that any cannabis ads need to carry the same kind of warnings that pharmaceutical ads do.

The findings of the new paper may be just the tip of the iceberg, said Sean Young, founder and director of the Center for Digital Behavior at the University of California, Los Angeles and the University of California Institute for Prediction Technology. Young notes that some of his research has been funded by marijuana companies.

More people get their cannabis information from websites devoted to the promotion of marijuana than from Facebook and Twitter, explained Young, who was not affiliated with the new research. “These sites . . . are much more within the grey zone than companies like Facebook and Twitter which are publicly traded and which face much more scrutiny.”

SOURCE: bit.ly/2Bby1qV JAMA Network Open, online November 16, 2018.