SCC Member, Dave Gordon MD, was recently invited to review a middle school cannabis curriculum. Read below to see how education for this population has evolved since the DARE Program days.

How would I educate middle school students about cannabis?

I’d want balanced, honest, accurate information that reflects the real-life experiences students have themselves or witness in others.

I’d want opportunities for them to discuss, ask questions, and share experiences in a safe, non-judgmental environment.

I’d want cannabis discussed in context, understanding societal factors, one’s mindset, and the circumstances around consumption that often play larger roles in adverse outcomes than cannabis itself.

Those are just a few of the thoughts that floated through my mind as I opened up a white, three-ring binder to review a cannabis education curriculum designed for individuals in grades 6-8 with a mission to “educate youth about the marijuana issues they are (or will be) confronting and equip them with tools to address these challenges.” I was encouraged that the group behind this program reached out to me, a cannabis clinician, educator and advocate, for input. Historically, those who deeply understand cannabis science from a balanced perspective were not invited to collaborate on such educational projects.

Born and raised in Los Angeles, I was 11 years old in September 1983 when officers of the Los Angeles Police Department (LAPD) took to classrooms like my own to teach students about the dangers of substance abuse and to help us practice “just saying no,” the unforgettable refrain, and for years, the only message of adolescent substance education. The Drug Abuse Resistance Education (DARE) Program, at its peak, was taught to 75% of American students (Griffith, 1999), and has been the blueprint for adolescent substance education throughout the past 40 years. Sadly, but not unsurprisingly, the DARE program itself, and its model for educating youth, has been a failure (West and O’Neil, 2004). Included amongst the many reasons for these failures has been the use of moralistic and fear-based messaging, alongside incomplete, and often blatantly inaccurate, information. Further, these programs typically provided an abstinence-only message that has been shown to be ineffective in reducing consumption, while also having other harmful consequences (Rosenbaum and Hanson 1998).

So, I was hopeful, as I began my initial read through, that a modern curriculum, created by those that passionately care about youth well-being, would not repeat the well documented mistakes and inaccuracies of the past.

I did find many positives with this curriculum, and definitely see it as an improvement. It was designed to be delivered by a trained facilitator, using interactive activities and it encouraged open dialogue. It presented information, and attempted to guide students towards making their own decisions, rather than directly telling them what their decision had to be. The materials covered a wide range of areas that included factual information about the plant, overviews of physiology and pharmacology appropriate for age level, laws and legal ramifications for consumption, as well as activities on problem solving, making choices, and increasing self-confidence. While limited, and often imprecise, there was information presented about medicinal cannabis consumption, the interaction of cannabis policy and social/racial inequity, and the role of low-THC cannabis (hemp) for industrial purposes, which are topics historically omitted from cannabis education programs.

It was undeniably a step in the right direction, yet as I read through it, remnants of the DARE program model lingered and evoked several exasperated sighs and frequent cringing. Phrases like “brain damage,” and other scary terminology were all too common. THC was generally demonized without acknowledgment of its positive effects. Potential risks of cannabis consumption were discussed as definitive fact, even where the research is mixed, or supports less alarming conclusions. Adverse effects, and the even rarer “worst case scenarios,” with consumption were made to seem as they were the norm. Potentially most troubling to me was that I felt certain sections inferred that those who choose to consume are bad, cause other problems, and should be avoided/ostracized.

Through an optimistic lens, it was encouraging to see an evolution from traditional fear-based programs. Still, the curriculum’s wording, tone, emphasis and accuracy clouded that view. There were also several topics and themes that were absent, which would have made for a more robust and valuable program. While the focus was obviously on cannabis, I wanted to see a wider lens acknowledging the world in which these students live, where substances are everywhere, and widely accepted. Youth get constant messaging and reinforcement that substances, be they pharmaceuticals, nutraceuticals, caffeine, cannabis (in legal states), alcohol, etc., should be part of everyday life for adults. The contention that they are completely taboo, and then magically acceptable at a given age doesn’t inspire trust. This is especially true for those exposed to cultures where the arbitrary ages of 18 and 21 have less meaning. Of course, neurologic development impacts safety of substances in adolescence, but a more open discussion and acknowledgement of how substances intermix with culture and community is warranted. There was also no discussion of why youth are interested in substances, and what short-term benefits they report from them. No doubt, educators do not want to glorify cannabis, but students are going to get this information from their peers that do consume, regardless. Withholding this information in an educational program, while hyperbolizing harms, causes students to lose trust, and likely not be receptive to other valuable information the curriculum provides (Beck 1998). This is a great opportunity to have an open discussion about the positives of substances, and then explore how to achieve these positives through other means. The context around which substances are consumed and the spectrum of consumption patterns was also absent. Certainly, amongst middle school aged adolescents, abstinence and primary prevention are higher priorities than in older ages where harm reduction models have been shown to be more effective. Still, I feel even in this age group, we lose credibility if we don’t distinguish use from abuse (Nicholson 2002). Furthermore, acknowledging that societal factors in one’s life are a larger determinant for poor outcomes than cannabis consumption itself, and exploring those factors, can help students understand if they’re at higher risk.

I prefer that middle school students abstain from unmonitored or social cannabis consumption, though acknowledge it will still always occur. While causal links have never firmly been established, there is a large, albeit biased, body of evidence correlating higher rates of negative outcomes for those that begin regular consumption at younger ages (Levine 2017). Primary prevention is a goal, and for the most part it’s a goal that we’re doing pretty well with. Rates of cannabis consumption in middle school students are low and have stayed consistent (or declined), during the legalization era (National Survey on Drug Use and Health – samhsa.gov). While rates of negative outcomes are higher for those that consume early in adolescence, they still affect a minority of younger consumers. Put simply, only a small fraction of middle school students develops adverse outcomes associated with cannabis consumption, and one goal should be to maintain this. However, I believe we should also use this time to develop trust within this age group about substances, and provide them balanced, accurate information that reflects their real-world knowledge and experiences. This will keep them more receptive to our messaging throughout their adolescence, where risk taking behaviors, such as cannabis consumption, escalate, and more detailed harm reduction education becomes imperative.

I feel fortunate to have had this opportunity and I appreciate the group’s interest in seeking my opinions. Since turning in my report, I haven’t received any feedback other than a thanks for my contributions, so cannot gauge how my more progressive views were taken, or whether any of my suggestions might be incorporated in the future. While cannabis has been decriminalized in many parts of the world, there remains a pervasive fear surrounding its consumption, especially younger consumers. While concerns are warranted and educations programs necessary, this intense fear, along with the unbalanced messaging and draconian policies that often follow, are unnecessary. Thankfully, there has been progress in recent years, such as the Drug Policy Alliance’s Safety First Substance Education Program, which has been effective in high school students (Fischer 2022). The curriculum I reviewed, that was designed for middle school students, is a step forward from traditional cannabis education models, and hopefully it and others will further evolve into even more accurate, balanced, and contextual programs.

Dave Gordon MD, IFMCP, ABoIM
Adjunct Instructor, Cannabis Sciences – Community College of Denver
Owner, Clinician – 4 Pillars Health & Wellness

References
Jerome E. Beck, “100 Years of ‘Just Say No’ versus ‘Just Say Know’: Reevaluating Drug Education Goals for the Coming Century,” Evaluation Review 22, no. 1 (1998): 15-45
Fischer, N.R. School-based harm reduction with adolescents: a pilot study. Subst Abuse Treat Prev Policy 17, 79 (2022).
Griffith, J.S. (1999). Daring to be different? A drug prevention and life skills education programme for primary schools. Early Child Development and Care, 158, 95-105.
Levine, A., Clemenza, K., Rynn, M., & Lieberman, J. (2017). Evidence for the Risks and Consequences of Adolescent Cannabis Exposure. Journal of the American Academy of Child and Adolescent Psychiatry, 56(3), 214–225.
Nicholson T, et al., “Focusing on Abuse, Not Use, in Drug Education”; Robin Room, “Preventing Youthful Substance Use and Harm – Between Effectiveness and Political Wishfulness”; Julian Cohen, “Drug Education or Drug Propaganda?”; David Hawks et al., Prevention of Psychoactive Substance Use: A Selected Review of What Works in the Area of Prevention, Department of Mental Health and Substance Dependence (Switzerland: World Health Organization, 2002)
Rosenbaum, D. P., & Hanson, G. S. (1998). Assessing the Effects of School-Based Drug Education: A Six-Year Multilevel Analysis of Project D.A.R.E. Journal of Research in Crime and Delinquency, 35(4), 381–412.
West S and O’Neil K. O’Neal, 2004: Project D.A.R.E. Outcome Effectiveness Revisited; American Journal of Public Health 94, 1027_1029,
Marijuana use by age group: KIDS COUNT Data Center
https://datacenter.kidscount.org/data/line/40-marijuana-use-by-age-group?loc=1&loct=1#1/any/false/1696,1603,1381,1124,909,105,104,22,20/asc/30/317