Why cannabis poses real risks to teenage brains

This commentary, authored by members of the Working Group on Social Pediatrics of the European Pediatric Association, Union of National European Pediatric Societies and Associations, briefly discusses the biological impact of widely consumed psychoactive substances in adolescents and the pivotal role of pediatricians in prevention and intervention. Adolescence is a multifaceted, developmental stage marked by profound neurobiological, psychological, and behavioral change. During this transitional period, the brain undergoes extensive structural and functional remodeling, particularly in regions responsible for executive functioning, impulse control, and reward sensitivity. This phase constitutes a critical window of vulnerability, often accompanied by heightened risk-taking and experimentation with psychoactive substances, making it a pressing global public health issue1. Traditionally, both scientific debates and popular understanding have divided substances into "soft" and "hard" drugs, a distinction shaped more by sociocultural norms and legal classifications than by consistent pharmacological evidence. Current views, however, challenge the validity of this binary framework, especially in the context of adolescent development. Substances commonly labeled as "soft," including alcohol, nicotine, and cannabis, can exert significant biological effects on the developing brain, with potential long-term consequences that may rival or even exceed those associated with so-called "hard" drugs.2 This persistent ambiguity in terminology suggests adoption of a more refined approach to substance use classification, one that accounts for the heightened neurobiological sensitivity of the adolescent brain. Although drugs such as heroin and cocaine are widely acknowledged for their acute toxicity and overdose risk, legally accessible substances like alcohol and nicotine warrant equal concern due to their widespread use and substantial impact on neurodevelopment. Cannabis, often perceived by young people as relatively benign, remains the most commonly used illicit substance worldwide. The increasing availability of high-potency formulations and emerging delivery methods, such as vaping, further complicate its risk profile3. Within this evolving landscape, pediatricians play a crucial role in early detection, prevention, and the delivery of evidence-based interventions4, positioning them at the forefront of efforts to mitigate substance-related harm during this vulnerable stage of life.