Okie Tokie Talk: Adolescent Cannabis Use in Oklahoma, the Sooner State

OG article by Grace Thetford-Harvey, MD Tessa Manning, MD

December 3, 2025

Adolescent cannabis use in Oklahoma has surged by 73% since the 2018 State Question 788 (SQ 788), which established a permissive medical marijuana program allowing minors access with guardian consent and two physician recommendations, ranking the state third nationally in past-month youth marijuana use—44% above the average. Senate Bill 1033 (2021) legalized delta-8 and delta-10 THC products, leading to widespread availability of high-potency vapes (60-95% THC) in retail outlets with minimal restrictions, contributing to oversupply (64 times local demand) and illicit markets linked to organized crime, as per the 2025 Oklahoma HIDTA report. Nationally, 64.2 million used marijuana in 2024 (NSDUH), with 35% of 18-25-year-olds affected, low perceived risk (25% view weekly use as high risk vs. higher for alcohol/tobacco), and THC potency rising from 4% in 1995 to 90% today, often vaped (71% of adolescent users). Risks include neurodevelopmental disruptions (prefrontal cortex impairment affecting executive function), increased odds of major depressive disorder (OR ~2.5), anxiety, suicidality, psychosis (especially with high-potency/daily use), academic decline (lower performance, higher dropout), cannabis use disorder (risk rises from 2.0 yearly to 17.0 daily), and doubled motor vehicle collision risk (pooled OR 1.92). Interventions emphasize routine screening for use/red flags (e.g., mood changes, odor), treating comorbidities, motivational interviewing (1-2 sessions, 15-30 minutes) in schools/primary care, first-line therapies like CBT, family therapy, motivational enhancement; adjuncts include contingency management (benefits not sustained post-cessation) and digital tools (screen via APA App Advisor). No FDA-approved medications exist, but trials show promise for N-acetylcysteine, topiramate, gabapentin, varenicline; investigational CB1-targeted agents continue. Oklahoma psychiatrists address this via a 2024 AACAP grant-funded video for teen education on social media, shared with organizations, alongside SAMHSA’s “Talk. They Hear You” app, urging coordinated clinical, educational, community, and policy efforts to counter low risk perception and vulnerabilities.