Teens favor honest, flexible cannabis conversations with clinicians

Youth-directed cannabis messaging is often generic, adult-centered, and does not reflect contemporary patterns of cannabis use. This study examined adolescents' perceptions of cannabis-related messaging and identified messaging strategies they find relevant. The authors conducted qualitative interviews with adolescents aged 14-17 years with past 30-day cannabis use. Interviews were analyzed using thematic analysis with constant comparison. Data collection continued until no new themes were identified (N = 7). Adolescents reported that fear-based and abstinence-only messaging were ineffective. They viewed nonjudgmental, autonomy-supportive, and youth-centered messaging as more credible. Participants emphasized that clinicians should acknowledge the perceived benefits of cannabis to build trust and credibility. Messages that focused on immediate consequences of cannabis use, such as brain fog and memory impairment, were more effective than generalized long-term harms. Adolescents expressed greater trust in harm reduction messaging and communication strategies that integrate real-world adolescent experiences with clinician expertise. These preliminary findings suggest that clinicians should consider framing cessation messaging around cognition and memory. Although the long-term goal is cannabis cessation, clinicians should remain ready to transition toward harm reduction guidance, based on adolescents' receptiveness and their response to initial abstinence-focused conversation, reflecting an adaptive framework that shifts in intensity and orientation with the patient's response rather than following a static treatment algorithm. Although these strategies may enhance engagement and mitigate treatment dropout, larger-scale studies are needed before these strategies can be broadly recommended for clinical practice. Ethical incorporation of peer-lived experiences to support harm reduction and cessation should be considered.