Systemic factors driving adolescent cannabis use and neurocognitive risks: structural inequities, policy gaps, and prevention gaps

Indigenous traditions often frame cannabis as a sacred plant with spiritual and medicinal roles, governed by protocols that prioritize collective well-being over individual risk. Western biomedical models pathologize cannabis use without acknowledging how colonialism disrupted traditional knowledge systems, leading to intergenerational trauma and substance use as a coping mechanism. The erasure of these perspectives reinforces a deficit-based narrative that ignores resilience and cultural adaptation.

The criminalization of cannabis in the early 20th century was rooted in racist policies targeting Mexican immigrants and Black communities, with propaganda linking the plant to 'degeneracy.' Prohibitionist frameworks have persisted despite evidence of cannabis’s therapeutic benefits, creating a legacy of stigma and disproportionate policing. Historical trauma in marginalized communities has normalized substance use as a response to systemic oppression, yet this context is rarely addressed in public health discourse.

In India, cannabis (bhang) is used in religious festivals like Holi for its euphoric and meditative properties, reflecting a cultural acceptance absent in Western contexts. In Jamaica, Rastafarian communities use ganja in rituals to foster communal bonds and spiritual connection, contrasting with the individualistic, risk-focused framing in U.S. media. These traditions highlight how cannabis use is deeply tied to social cohesion and cultural identity, which are often overlooked in biomedical narratives.

Neuroimaging studies show that adolescent cannabis use can disrupt prefrontal cortex development, affecting executive function and increasing psychosis risk in vulnerable individuals. However, these studies often conflate correlation with causation, ignoring confounding factors like socioeconomic status, trauma exposure, and polysubstance use. The scientific consensus emphasizes harm reduction over abstinence-only approaches, yet public health messaging rarely reflects this nuance.

Artists and musicians have long used cannabis to enhance creativity and introspection, framing it as a tool for cultural expression rather than a public health threat. Spiritual traditions across the world, from Sufi mysticism to Hindu tantra, incorporate cannabis in rituals to deepen meditative states and foster communal bonds. This artistic and spiritual lens challenges the biomedical reductionism that dominates mainstream discourse, offering a more holistic understanding of cannabis’s role in human experience.

If current trends continue, adolescent cannabis use will likely rise due to normalization in media, corporate marketing, and the erosion of public health infrastructure. Future scenarios suggest that without structural interventions, disparities in cannabis-related harms will widen, particularly in low-income and marginalized communities. However, decriminalization and equitable access to mental health resources could mitigate these risks, shifting the focus from punishment to harm reduction.

Adolescents in low-income neighborhoods report using cannabis to self-medicate for stress, trauma, and lack of recreational alternatives, yet their experiences are rarely centered in policy discussions. Black and Latino youth face disproportionate criminalization for cannabis possession, despite similar usage rates to white peers, highlighting racial biases in enforcement. Indigenous youth, who experience higher rates of suicide and substance use, are often excluded from harm reduction programs due to cultural insensitivity and lack of culturally tailored interventions.