New research shows that the percentage of 12- to 21-year-olds who start using marijuana before other substances has increased significantly over the past decade

More young people are turning to marijuana as their first substance of choice, rather than smoking cigarettes or drinking alcohol. This pattern is especially prevalent among young men of specific racial and ethnic groups in the US, says Brian Fairman of the National Institute of Child Health and Human Development in the US, in Springer's journal Prevention Science. He says that young people who start off on marijuana before alcohol or tobacco are more likely to become heavy users and have cannabis-related problems later in life.

The research team analyzed nationally-representative, cross-sectional survey data available as part of the US National Survey on Drug Use and Health. This data draws on information from more than 275,500 individuals aged 12 to 21 and was collected between 2004 and 2014. Survey respondents were asked about their use of marijuana, cigarettes, alcohol, and other forms of tobacco or illegal drugs. Those who used these substances provided further information about which they started using first, and at what age.

The researchers found that 8 per cent of participants reported in 2014 that marijuana was the first drug they ever used. This percentage had almost doubled from 4.8 per cent in 2004. According to Fairman, this could be related to a concurrent decline in those who start smoking cigarettes first, which dropped from about 21 per cent in 2004 to 9 per cent in 2014.

"We also observed a significant increase in youth abstaining from substance use altogether, which rose from 36 per cent to 46 per cent, and therefore, it is unclear the degree to which increases in those initiating marijuana first could be due to youth abstaining or delaying cigarettes," says Fairman.

Fairman and his colleagues further found that those using marijuana first, rather than alcohol or cigarettes, were more likely to be male, and Black, American Indian/Alaskan Native, multiracial, or Hispanic. The researchers established that youths who used marijuana first were more likely to become heavy users later in life, and to develop a cannabis use disorder.

"Our findings suggest important targets for public health intervention and prevention of marijuana use, especially among American Indian/Alaska Native and Black youth, who are less likely to have access to treatment or successful treatment outcomes," says Fairman, who believes that drug prevention strategies could be improved by targeting to groups differently, based on their risk of initiating tobacco, alcohol, or marijuana first.

"To the degree these trends continue and greater numbers of youth start with marijuana as their first drug, there may be an increasing need for public interventions and treatment services for marijuana-related problems," Fairman explains.

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Reference: Fairman, B.J., Johnson, R.M. & Furr-Holden, D. (2018). When Marijuana is Used Before Cigarettes or Alcohol: Demographic Predictors and Associations with Heavy Use, Cannabis Use Disorder, and Other Drug Outcomes, Prevention Science DOI: 10.1007/s11121-018-0908-3