While cannabis is the most common illicit drug in the Western world,1 its impacts on mental and physical health and psycho‐social functioning of young people are often under‐recognised. There are numerous missed opportunities for health promotion and early interventions for those who experience difficulties related to cannabis use.1

Cannabis is regarded by many as a ‘soft drug’ with minimal negative impact. Such views ignore significant changes in the patterns of cannabis use among young people over the past 40 years, including a decline in the age of initiation of use, an increase in potency and availability of the drug, and use with peers and when alone. Early onset, and frequent and heavy use of cannabis, can affect cognitive functioning and respiratory function and can exacerbate mental health conditions, including schizophrenia. There is a six times greater risk of schizophrenia in vulnerable young people if they use cannabis more than three times per week prior to the age of 15.1

Since the 2011 report by Howard, Ali and Roberts2 on alcohol, cannabis and amphetamine use among young people in the Western Pacific Region (WPR), more recent data has become available, allowing a clearer picture of cannabis use in the region's Pacific Island Countries and Territories (PICTs). Surveys in the WPR have primarily used three standardised instruments: the youth risk behaviour survey (YRBS);3 WHO's global school‐based student health survey (GSHS);4 and the second generation behaviour surveillance survey (BSS)5. Data on cannabis use was extracted from these three surveys from the PICTs. Data from Australia and New Zealand – where secondary school surveys (SSS) are used6, 7 – and the United States was also extracted for comparison.

Available data on ‘ever use’ and ‘current use’ of cannabis in PICTs, and Australia, New Zealand, Malaysia and the US for comparison, are presented in Table 1. The rates of both ‘ever use’ and ‘current use’ vary greatly between different countries of the region. More than 50% of young males were reported to have ever used cannabis in Guam (2007, 2011); Northern Mariana Islands (2003); and Palau (2007, 2011); more than 50% of young females in Northern Mariana Islands (2003); and Palau (2007, 2011) reported ever use of cannabis. These rates are far higher than those for Australia for both ever and recent use, for ever use in Malaysia, and from other surveys conducted in the PICTs (e.g. Samoa).