The Changing Landscape of Teenage Substance Use in the Cayman Islands

The Developing Brain

To understand the effect of substance use on the developing brain, it’s important to grasp how brain development unfolds from birth.

The brain develops from the back to the front, reaching full maturity when one is in their mid-to-late 20s. Maturing first, the back of the brain governs our basic functions, such as vision, fine motor skills and balance. Conversely, the front of the brain—the prefrontal cortex—is responsible for executive functions, including logic, reasoning, emotional regulation and reward processing, and is among the last areas of the brain to develop. This is particularly important for teens.

During adolescence, the prefrontal cortex is still in its early stages of development, while the limbic system—the area associated with emotion and reward—has reached full maturity. This results in an imbalance in the brain, with the limbic system becoming far more dominant. Emotions, behaviour and motivation become prioritised over reasoning, decision-making and emotional intelligence. This imbalance is why teens are more prone to taking risks, heightened emotional responses and impulsive behaviours.

What’s more, this heightened sensitivity to rewards and lack of impulse control makes teens more likely to try drugs, and continue to take them.

Adolescents & Addiction

Introducing drugs during this critical period of brain development in adolescence can lead to long-term changes in brain chemistry. This can have profound consequences affecting a person’s ability to experience pleasure without the use of drugs.

The healthy brain naturally rewards us by releasing 'feel good' neurotransmitters or chemicals, such as dopamine, when we engage in behaviours that aid our survival. This process, developed through evolution, ensures that we become more inclined to repeat the behaviours that help us survive. At the most basic level, these include eating, reproductive efforts and social interaction.

We spoke to researchers at the National Drug Council (NDC) who, using nicotine as an example, explained that “drugs like nicotine can release anywhere from two to ten times the amount of dopamine than what is naturally released when we engage in normal behaviours.” This shock of dopamine hijacks the brain’s reward process, making the user want more and more.

What's worse is that these pleasure circuits in the adolescent brain are already operating in overdrive due to the aforementioned developmental imbalances, making drug and alcohol use even more rewarding and enticing.

Over time, this hijacking causes the brain to start producing lower dopamine levels when engaging in behaviours that used to please us. “This creates a cycle where a person begins to struggle to feel pleasure without the use of drugs”, explained researchers at the NDC, “because the chemical structure of the brain has changed, making the chemical release of neurotransmitters, like dopamine, reliant on nicotine use.”

Naturally, this results in a person being less driven to engage in social behaviour and instead seek out the substance that provides the greater dopamine reward.

Worse, repeated substance use in adolescents harms the development of the brain’s prefrontal cortex, the very region that should help you recognise the harms of using addictive substances in the first place. Thus creating a lasting negative impact.

The Changing Landscape of Teen Substance Use

Similar to global trends, the NDC has found that alcohol, e-cigarettes and marijuana are the top three substances used by teens in the Cayman Islands. Though recently there has been a decline in local teen alcohol use, the use of e-cigarettes and marijuana products has remained stable, as measured by the last several Cayman Islands Student Drug Use Surveys (CISDUS), demonstrating their popularity and attraction.

As trends in youth substance taking have changed, with the introduction of new ingredients and manufacturing processes, we’re seeing more significant concern over the impact of nicotine and THC on teen health. This concern is, in part, related to the manufacture and chemicals used in products as industry trends have changed.

Nicotine Products

According to the 2024 CISDUS, more than 80% of students who vaped in the previous year knew that nicotine was present in the devices they used. But e-cigarettes aren’t the only modern nicotine product raising concern. There has been a global boom in the use of other nicotine products, from oral nicotine pouches (e.g. Zyn) to nicotine-infused toothpicks.

Oral nicotine pouches are extremely popular due to their discreet nature. These small, white pouches are designed to sit inside the mouth between your upper lip and gum. The pouch settles and absorbs the moisture from your mouth, allowing nicotine to be released and then absorbed directly into the bloodstream through the soft tissue in the mouth. Available in various flavours, the brand Zyn has gained significant attention online, partly due to the rise of 'Zynfluencers' who promote the product on social media.

It's worth noting that Zyn is a subsidiary of Philip Morris International, a multinational tobacco company whose most recognised brands include Marlboro cigarettes. It's a sad reality that the same companies that hooked generations of people onto traditional cigarettes continue to trap future generations in the cycle of addiction under the new guise of smoking cessation.

Though not as widespread as e-cigarettes, oral nicotine pouches are rapidly growing in popularity, with Zyn sales in the US increasing by 305% between 2016 and 2020. This global market is projected to reach US$33 billion by 2026.

One of the biggest concerns relating to these products is the marketing strategy. Promoted as tobacco-free, they often contain synthetic nicotine, which is chemically produced rather than extracted from the tobacco plant. While the absence of tobacco is better for your body’s organs, the health risks associated with nicotine use, including its impact on the developing brain, remain significant.

Nicotine, no matter the source—traditional cigarettes, e-cigarettes, hookah, oral pouches—harms the brain. Therefore the risk of addiction remains.

Semi-Synthetic THC

Though data from the latest CISDUS doesn’t indicate a rise in the use of marijuana among teens, it does demonstrate that the method of consumption has shifted significantly. NDC data confirms that the dominant methods of consumption among users include manufactured edibles (58%) and vaping (38%), as opposed to smoking the marijuana plant.

This manufacturing process allows the industry to manipulate the potency of THC in the product, often resulting in products that contain extremely high concentrations of THC that far exceed what is found in the traditional marijuana flower.

The modern marijuana flower may contain THC concentrations ranging from 15-30%, whereas many edibles boast concentrations of semi-synthetic THC as high as 60-90%.

These high concentration levels have been associated with severe physical and mental health consequences, including extreme drowsiness, confusion, respiratory issues, worsening anxiety and depression over time, seizures, cannabis-induced psychosis, loss of consciousness and suicide ideation.

As with many modern substances, what’s worse is that the long-term health consequences are still unknown, since the chemical content of semi-synthetic THC is not always known.

While these substances remain illegal in the Cayman Islands, the latest CISDUS is evidence that these high-potency products are still being accessed by local teens; data that is further supported by reports from late 2024 that two local teens in the Cayman Islands were found unconscious and later hospitalised after consuming high-potency THC gummies.

Identifying Products

It can be challenging to identify what THC-laced products might look like, since they’re made to look like regular gummies. Without the packaging to identify the THC variant (e.g. Delta-8 THC, THCA, etc.), it can be impossible to tell whether your child’s sweets are laced with THC or not.

Again, what’s worse is that the lack of regulation surrounding the manufacturing process of these products means that there is no guarantee that the process ensures an even distribution of THC across all edibles in a single packet. Meaning one gummy could contain relatively low levels of THC, while another from the same packet could be extremely high.

What Can You Do?

Every generation brings change, and by doing some research you can feel confident and informed enough to have conversations with your teen about substance use. Ensure they know the associated risks with substances such as nicotine and THC products.

Explore what safe and healthy decisions look like. Talk about their thoughts and feelings towards substances, how they can make choices that are right for them instead of choices they think they 'should' make, and what they can do if they end up in a situation which makes them feel uncomfortable or unsafe.

If you do find suspicious items, such as candy that appears to be tampered with or unknown substances, talk to your child and report their source to the police. If you suspect that your child may have consumed THC-laced gummies, contact your healthcare provider immediately.