Final Exam Review
Long term effects of cannabis exposure during pregnancy- preschool children (3-4 years)
- Decrease verbal and perceptual skills - decrease verbal and visual reasoning - decrease short-term memory - increase hyperactivity, attention deficits, and impulsivity - unaffected intelligence scores
Long term effects of cannabis exposure during pregnancy- young adults (18-22 years)
- Deficit in certain executive functioning, response inhibition, and visual spatial working memory - increased rates of smoking, substance use, and early initiation of substance use
Long term effects of cannabis exposure during pregnancy- teenagers (13-16 years)
- Deficits in executive functions, visual memory, visual cognitive functioning, academic achievement, information processing speed, and visual motor coordination - increased delinquency and inattention
what is it about cannabis that makes (some) people want to use it often?
- THC - CBD - Terpenes
anxiety and cannabis
- a meta-analysis with 112000 individuals found the odds ratio of anxiety and Cannabis used to be 1.24 and the odds ratio of anxiety and cannabis use disorder to be 1.68 - individuals with a lifetime of anxiety disorders were two to three times more likely to have lifetime cannabis use, and more likely to develop cannabis use disorder after initial use than those without any psychiatric disorder - however, an additional study found that cannabis users are at no further risk for developing anxiety disorder, suggesting anxiety may cause cannabis use instead of cannabis use causing anxiety
short term effects of consuming cannabis during pregnancy
- cannabis decreases blood sugar, which may cause dizziness or fainting, potentially resulting in an injury to mother or fetus - may cause anxiety, paranoia, confusion or forgetfulness
long term effects of consuming cannabis during pregnancy
- increases odds of anemia - may increase odds of precipitous labour and manual placenta removal - Long term use of cannabis during pregnancy can increase the odds of the labour lasting more than 3 hours
Behavioural component of addiction
- loss of control - compulsive use - negative consequences - 'habit forming' - functional impairment
individuals should avoid cannabis if they have severe cardiopulmonary disease with:
- occasional hypertension (low blood pressure) - possible hypertension (high blood pressure) - syncope (loss of consciousness) or - tachycardia (rapid heart rate) - risk factors for cardiovascular disease heart disease and stroke show that it does not mix well with cannabis
Long term effects of cannabis exposure during pregnancy- preteens (9-12 years)
- reduced cortical grey matter and parenchymal volume - deficits in executive functioning, reading, spelling, abstract and visual reasoning - increase hyperactivity, depressive and anxious symptoms, inattention and impulsivity
Long term effects of cannabis exposure during pregnancy- children (5-6 years)
- short term memory deficits - increase hyperactivity and impulsivity - impaired vigilance - unaffected intelligence scores
vulnerable populations (2)
- those at greater risk for the detrimental effects of cannabis - do statistically more likely to use and abuse cannabis
medical position states that cannabis use is not appropriate when a patient is
- under 25 years old - personal or family history of strong psychosis - past or current cannabis use disorder (dependency), or other substance use disorder - cardiovascular or respiratory disease - pregnant (or planning to) or breastfeeding
Long term effects of cannabis exposure during pregnancy- Toddlers (9-18 months)
- worst mental scores and developmental test at nine months, although difference disappeared by 18 months - increase aggression - decreased attention in females
Potential for addiction
1 in 6 teens who use cannabis during their teen years will experience problematic use, physical dependence, and symptoms of withdrawal in young people, problems with cannabis can develop more quickly than with tobacco or alcohol
What counts as cannabis intoxication
1.) recent use of cannabis 2.) clinically significant problematic behavioral or psychological changes (e.g., impaired motor coordination, euphoria, anxiety, a sensation of slowed time, impaired judgment, social withdrawal) that developed during, or shortly after, cannabis use 3.) at least two of the following signs, developing within 2 hours of cannabis use: conjunctival injection (red eyes), increased appetite, dry mouth, tachycardia (increased heart rate) 4.) symptoms due to a general medical condition and not better accounted for by another mental disorder 5.) specify if perceptual disturbances are present: hallucinations with intact reality testing or auditory, visual, or tactile illusions occur in the absence of delirium
how was use affected by legalization?
2018 to 2019 use increase: the corresponding rates for 15 to 24-year-olds (27.6%-26.4%) and females (12.3-13.4%) remained constant. whereas you 15 to 17-year-olds declined (19.8-10.4%) the decline may in fact be due to legalization, just a continuation of the steady decrease that has been happening since the 2010s
ADHD and cannabis
studies suggest that there is a comorbidity rate of 20 to 30% between ADHD and cannabis use disorder - prevalence of cannabis use among ADHD patients depends on the ADHD subtype (inattentive, hyperactive-impulsive or combined) - a US study found a 30% lifetime cannabis use among ADHD patients, as opposed to 5% for those without ADHD The effects of cannabis on ADHD are currently unknown. Some suggest that it may be used to combat the anxiety and insomnia of ADHD medication, although the combination of the drugs together has not been studied However, a study found that 25% of ADHD related online discussion posts discussed its benefits, with only 8% and 2% of posts discussing negative outcomes and no/neutral outcomes respectively. The public opinion seems to think cannabis is therapeutic.
cannabis use disorder - treatment
the treatment for cannabis use disorder is typically either: - sustained abstinence from cannabis - harm reduction Coalition reduce use that ameliorates cannabis-associated problems reducing frequency of use is associated with greater Improvement than reducing the quantity of use treatment for cannabis use disorder is rare
how does cannabis use affect youth?
the use of cannabis on a developing brain is not recommended, as shown by the laws protecting minors in the Cannabis act. Most people think cannabis use is harmless, however, there are specific risks for people under age 25
DSM-5 criteria for cannabis withdrawal
there are four conditions required to qualify as cannabis withdrawal according to the DSM-5 A: cessation of use that has been heavy/prolonged (i.e., near-daily over a period of a few months) B: 3 (or more) signs/symptoms develop within approx. a week of Criterion A - irritability, anger, or aggression - nervousness or anxiety - sleep difficulty (e.g., insomnia, disturbing dreams) - decreased appetite or weight loss - restlessness - depressed mood - at least one of these physical symptoms causing significant discomfort: abdominal pain, shakiness/ tremors, sweating, fever, chills, or headache C: the signs/symptoms in Criterion B caused significant distress impairment in social/occupational/other important areas of functioning D: the signs/symptoms are not attributable to another medical condition and not better explained by another mental disorder, including intoxication or withdrawal from another substance
individuals that are recommended to avoid cannabis
these vulnerable populations include pregnant women, babies, couples trying to conceive, and those with certain physical and mental health complications
pharmacological treatments
treating cannabis addiction with Pharmaceuticals is very different from treating other substance addictions. The medications used to help opioid or nicotine addicts have not been found to be effective. N-acetylcysteine and gabapentin are two drugs that have shown promising results, but no medications are approved by the US FDA
true or false: Cannabis Use is Increasing
true studies show that both adults and adolescents increasingly view cannabis as a drug that "some" can use without harm however, there are still significant risks associated with cannabis use - increase in the use - the adverse consequence of use
true or false: data suggests: cognitive performance may improve in cannabis users following a period of abstinence
true but this depends on age of onset, frequency, dose of cannabis use, impact cognitive performance before age 16 (early onset), after age 16 (late onset)
expert recommendations for cannabis and driving
wait several hours before driving avoid combining alcohol and cannabis risk of using both higher than either alone risk of using one or the other or higher than none
Cannabis Use Disorder- Patterns of Use - greater risk of cud?
while patterns of cannabis use vary widely across individuals, most cannabis users who develop cannabis use disorder do so after several years of use and with at least weekly use - increased frequency of cannabis use - use of more potent cannabis products ^ are associated with a greater risk of cannabis use disorder
cannabis and driving
while the danger of driving while high on cannabis is not isolated to adolescence, as discussed, teenagers have many misconceptions about the activity. It is an issue that affects every age group, especially as it is often touted as safer than drinking drunk. in reality, driving while under the influence of any substance is incredibly irresponsible and endangered the lives of the driver, the passenger, and strangers - 50% of cannabis users don't think that it affects their driving much, while 1 in 5 don't think it has any negative effect at all - 2 in 5- 39% of those who have used cannabis in the past year have driven within 2 hours of consuming cannabis - 3489- numbers of DID violations reported in Canada in 2017 - 149- number of fatally injured Canadian drivers who tested positive for cannabis in 2014 - 2 in 5- approximate number of people who were a passenger in a vehicle driven by someone who had recently used cannabis
Cannabis and youth: Medical
with proper research and regulations, there are benefits to underage medical cannabis use the majority of the research regarding pediatric medical cannabis use highlight its impacts on epilepsy While there are plenty of anecdotal claims that medical cannabis can help the suffering of children, the research is not yet developed about the long-term dangers and effects
schizophrenia and cannabis
42.2% of schizophrenic patients reported lifetime use, with 27.1% reporting lifetime cannabis use disorder 23.1% reporting using within the past six months, with 16.0% reporting current cannabis use disorder there is considerable comorbidity between schizophrenia and cannabis use - many experts believe cannabis use may cause schizophrenia cross-sectional studies reveal a 22 3 * increase of developing schizophrenia in cannabis users when compared to non users - increased chances are correlated with early-onset, regular use and high THC content however, causality tests reveal that schizophrenia most likely has a causal effect on cannabis use, meaning current/developing schizophrenia increases the individuals odds of trying cannabis
motor vehicle safety
In Canada, teens between the ages of 15-19 are most likely to drive after using cannabis cannabis can increase the risk of car accidents by impairing the driver's reaction time, coordination, and concentration
Why do youth use cannabis?
In Canada? 19% of 15 to 19-year-olds report past-year use, with first use occurring at the average age of 15/16 why do young people use cannabis recreationally? Generally, - to relieve boredom - to satisfy curiosity - to experiment - to feel good/better - to fit in it is thought that generally, males are more likely to use key substances for the positive reward, or the high experience, whereas females use substances to avoid a negative feeling, to cope, or self-medicate
what does the Cannabis Act do to protect youth?- Possession
Individuals under the age of 18 years would not face criminal prosecution for possessing or sharing a very small amount of cannabis (up to 5 grams) provinces and territories have the flexibility to prohibit the possession of any amount of cannabis by youth, thereby permitting police to seize any cannabis that a youth may possess. All provinces and territories will be including such prohibitions in their cannabis legislation possession over 5 grams is subject to criminal code
why do youth self-administer cannabis?
Many youths reports using cannabis to "feel better", and not for the high self-medicated users (ages 16-24) have been found to have lower mental health, higher psychopathology, more psychosocial distress, and more stressful life events than non-cannabis-using youth reasons behind use ranged from childhood trauma, ADHD, depression, insomnia, to stress while self-medicated users did have measured doses, they lacked a lot of knowledge about medical cannabis, despite presenting themselves as sophisticated cannabis users
how do youth perceive cannabis use?
Overall, young people seem to be misinformed about cannabis. In many studies the express perceptions that: - cannabis is not harmful, especially when compared to other drugs, because it is a natural plant - cannabis improves driving because it heightens Focus - cannabis is not addictive and does not cause withdrawal - the effects of cannabis depend more on the person than on the substance - that all youth use cannabis, with their estimated rates ranging from 30 - 98.8%
in what proportions are Canada's youth using recreational cannabis?
Past year use of cannabis is highest among young people ages 15 to 19 (19%) end ages 20 to 24 (33%) 2.3% of users aged 12 to 17 have a cannabis use disorder, while 7.5% of users aged 18 to 29 have a cannabis use disorder first use occurs on average at age 15 to 16
what are the consequences of damage to a developing brain?
Regular cannabis use in Youth and Young adults can affect aspects of cognition, including attention, memory, processing speed, visual-spatial functioning, and overall intelligence cannabis use in teenage years is associated with a disruption to the brain's reward system, impaired memory and cognition, and the potential for structural brain changes cannabis is suggested to negatively affect IQ, although this is difficult to prove because the earlier onset of use is associated with lower baseline IQ
Links to mental illness
Regular cannabis use may be linked to depression and anxiety associated with psychosis, especially for youth who have a parent or sibling who has been affected by schizophrenia
How does THC exposure affect babies?
Secondhand cannabis exposure is an independent risk factor for sudden infant death syndrome - a positive test for THC in a child's system may have negative legal implications, especially in certain States - additionally, babies may be indirectly affected by THC if their caregiver is impaired and unable to properly care for them
as you saw the video medical marijuana for kids, cannabis is also being dos two children for variety of ailments, including:
cancer treatment (high THC) autism ADHD however, there has not been enough research to substantiate these anecdotal claims that medical cannabis is purely beneficial and safe for children
People taking other medications
cannabis can have potential reaction with many prescription drugs, non-prescription drugs, and herbal products individuals should be especially careful if they are taking any of the following: - sleeping pills - high doses of opioids - tranquilizers (specifically benzodiazepines) - some pain medications - some allergy or cold medications - anti-seizure medications other products that may interact with cannabis include antiretroviral drugs used to treat HIV / AIDS, certain antidepressants, stomach acid Inhibitors, certain antibiotic and anti-fungal medications, certain heart medications, and Saint John's Wort
cannabis and motor vehicle impairment
cannabis can impair each person differently the impairment on individuals can depend on: - the method of consumption, for example, how cannabis was consumed (smoked, inhaled, ingested) - the quantity of cannabis consumed the variety of cannabis and its THC levels, including cannabis prescribed for medical use - cannabis use in any amount can: - affect motor skills - slow reaction time - impair short-term memory and concentration - cars drivers to very speed and to wander - reduce the ability to make decisions quickly or handle unexpected events evidence suggests resuming smoking and/or blood THC concentrations 2-5 ng/mL are associated with substantial driving impairment, particularly in occasional smokers
individuals should avoid cannabis if they have severe liver or renal disease, including chronic hepatitis C- why?
cannabis has been found to worsen conditions for patients with chronic hepatitis C virus (HCV) use should be carefully monitored for those with chronic kidney disease (CKD) and smoking should be avoided - cannabis use medal a kidney transplant candidate listing or contribute to inelligbility
Couples trying to conceive: women
cannabis may disrupt menstrual cycles or decrease egg implantation
bipolar disorder and cannabis
cross-sectional Studies have found that the Comorbidity rate of bipolar disorder and lifetime cannabis use is 70%, with the rate of bipolar disorder and CUD as 30% - cannabis use is associated with higher levels of mood symptoms - Studies have found that cannabis use has a three-fold increase risk for a new onset of manic symptoms - current cannabis users had a lower remission, recovery, higher recurrence and greater impairment from a manic episode
treatment for cannabis use disorder is rare
current DSM-5 cannabis use disorder diagnosis: 7.2% lifetime DSM cannabis use disorder diagnosis: 13.7% despite the overall increase in cannabis use, the proportion of adults who have received treatment for cannabis use has not changed since 2003 treatment for cannabis use disorder typically occurs on an outpatient basis for many occur in an inpatient setting if a patient is acutely psychotic, suicidal, or requires hospitalization to treat a concurrent substance use or psychiatric disorder. evidence indicates that psychosocial interventions for cannabis use disorder are most effective, while trials of medication treatments have inconsistent or weak results
Prevalence of underage use
despite the laws, we know that both young adults and underage minors use cannabis in Canada. In what proportions are they using cannabis? In 2010, Canadian youth reported the highest cannabis use out of 43 countries across Europe and North America
High vs. drunk driving
drunk drivers are involved in 25% of Motor Vehicle fatalities - many drivers from alcohol-related accidents also test positive for cannabis - cannabis and alcohol acutely impair several driving-related skills in a dose-related fashion the effects of cannabis vary more between individuals than they do with alcohol due to: - tolerance - differences in smoking techniques - different absorption of THC
prevalence of motor vehicle incidents and cannabis
every 3 hours- how often drug-impaired driver incident is recorded in Canada $1000+ a one-year driving prohibition- minimum penalty if you're caught driving impaired increase the likelihood- Recent research shows a 1.3 to 3.0 fold increase in the risk of motor vehicle collisions after cannabis use - among those who have used cannabis, 28% reported they have operated a vehicle while under the influence - one in three Canadians (33%) report that they have ridden in a vehicle operated by a driver who was under the effects of cannabis
true or false: most common substance abused is cannabis
false. - The most common substance abused is alcohol, followed by cannabis
complexities with cannabis use in youth
heavy marijuana use in adolescence or early adulthood has been associated with a dismal set of Life outcomes including poor school performance, higher dropout rates, increased welfare-dependent, greater unemployment, and lower life satisfaction this seems extremely condemning, HOWEVER: research acknowledges that those predisposed to try and enjoy cannabis in the first place may be predisposed to a variety of vulnerability factors - correlation does not equal causation
CBT for cannabis addiction
helps individuals identify and cope with the overwhelming emotions that encourage substance abuse. CBT encourages replacing negative thoughts with healthier alternatives. research shows that even one session of CBT can help those with cannabis use disorder abstain CBT has the most robust evidence of efficacy for this disorder
MET for cannabis addiction
helps to motivate individuals to abstain by providing personalized and pathetic, educational support alongside motivational interviewing (MI). the patient is encouraged to explicitly identify the pros and cons of their cannabis use and balance them MET lessens cannabis use and cannabis use disorder severity the combination of MET and CBT is more helpful than either alone MI: a directive, patient-centered Psychotherapy approach that helps individuals resolve ambivalence and increase motivation to reduce substance use through an empathic, supportive counseling Style
Pregnancy and cannabis
in Western societies, pregnant women consume cannabis more frequently than any other illicit drug (at 2-6%) - An estimated 4.0% of women use cannabis in the first trimester, 3.5% in the second, and 2.7% in the third - cannabis is mostly used during pregnancy to treat morning sickness, despite lack of research - Pregnant women using cannabis are also more likely to use other substances, which can create a synergistic effect
major depression and cannabis
in comparison to light / non-users,Heavy cannabis users had an odds ratio of 1.62 for developing clinically diagnosed major depression or depressive symptoms - however, cannabis use does not seem to be a causal factor in depression - a twin study found concluded that they comorbidity was most likely due to genetic and environmental factors that predispose individuals comorbidity - found concluded that the comorbidity was most likely due to genetic and environmental factors that predispose individuals to both smoking and depression - A different study found no correlation between depression and cannabis use
Entourage Effect
increased effectiveness of one chemical when accompanied by other chemicals synergy among compounds to enhance effects of THC/CBD
Physical health complications
individuals with the following conditions are statistically more likely to have adverse effects when using cannabis: 1.) have respiratory diseases such as asthma or chronic obstructive pulmonary disease (COPD) 2.) individuals should avoid cannabis if they have severe cardiopulmonary disease with: 3.) individuals should avoid cannabis if they have severe liver or renal disease, including chronic hepatitis C 4.) People taking other medications
is cannabis withdrawal and use disorder heritable?
it is mildly heritable, with genetic and environmental factors affecting the experience and intensity
Can CUD cause mood disorders? Can mood disorders cause CUD?
major depression genetic studies find an underline comorbidity between depression and CUD psychosis: strongly associated with CUD end cannabis use in general. Research isn't sure if it is causal or a predictor psychological problems are a symptom of CUD and withdrawal, indicating cannabis users should be wary of inducing/exacerbating mental health issues through cannabis
youth epilepsy and cannabis
most of the research about underage medical cannabis use has revolved around epilepsy more specifically, Dravet Syndrome - the famous case of young Charlotte Figi who used high-CBD low-THC cannabis to find relief from 300 seizures a week - with CBD, she was down to once a week seizures - Charlotte was a Pioneer, and now many epileptic children are treated with CBD - Growers named a strain after her, called Charlotte's Web. It is 13% CBD and 1% THC
Couples trying to conceive: in vitro
smoking at least 90 times over a lifetime resulted in 27% fewer oocytes retrieved and one fewer embryo transferred - smoking one year before IVF resulted in 25% fewer oocyte retrieved and 28% fewer oocytes fertilized - smoking cannabis reduces IVF success chances by 25%
Couples trying to conceive: men
sperm concentration (28% lower), count (28% lower), motility, and percentage of morphologically normal forms were all decreased in men who reported smoking more than once per week - CB1 receptors have been identified in the testis, vas deferens, and human sperm cells - however, men who smoke more cannabis tend to lead less healthy lifestyles
cannabis withdrawal- when is it most intense? when do they have a hard time quitting?
studies found that withdrawal symptoms when the most intense the week after cessation, and could continue for as long as a month users that experience withdrawal will have a hard time quitting with worsened treatment outcomes
True or false: Fetal exposure to cannabis use during pregnancy does not affect the intelligence scores in children ages 3 to 6 years
True
Obsessive compulsive disorder and cannabis
a cross-sectional Australian study found that 19.9% of individuals with cannabis use disorder had obsessive compulsive disorder, that 4.6% of cannabis users have OCD and that only 2.4% of non-users had OCD - however, the odds ratios for having OCD did not change depending on cannabis use a sibling study found that OCD patients experienced higher Cravings than their siblings - this may suggest that individuals with OCD may crave cannabis more due to their symptoms - cannabis may offer relief for OCD symptoms, as the endocannabinoid system may have a role in OCD
Gateway drug
a habit-forming drug that, while not itself addictive, mainly to the use of other addictive drugs
antisocial personality disorder and cannabis
a study found that respondents with lifetime cannabis use disorder where 10 times more likely to have lifetime antisocial personality disorder than those without cannabis use disorder - a twin study found that genetics explain 32 to 60% of the difference in cannabis use/ cannabis use disorder for personality disorders (APD and BPD) - antisocial personality disorder has been found to be one of the most common psychiatric disorders among substance abusers
finding alternatives for treatment of CUD
adoption of stable roles at school or work is associated with a reduction in or cessation of cannabis use spending more time with friends and family, exploring passions, curating your hobbies, focussing on work or school, etc. are all great ways to reduce the use
what does the Cannabis Act do to protect youth?
age restrictions Restricting promotion and enticement Possession
cannabis withdrawal - prevalence
among cannabis users in the general population: ⅓ among heavy users: 50 to 95% approximately half of patients in treatment for cannabis use disorder experience a withdrawal syndrome an Abrupt reduction or cessation of heavy or prolonged cannabis use - negative reinforcement to begin cannabis use again
drugs impair your:
balance and coordination motor skills judgment reaction time attention decision-making skills
DSM-V Criteria for CUD
A Problematic pattern of cannabis use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period 1.) taken in larger amounts/over longer periods than intended 2.) persistent desire/unsuccessful efforts to cut down/ control use 3.) a great deal of time spent in activities necessary to obtain, use, or recover from its effects 4.) craving, or a strong desire or urge to use 5.) recurrent use resulting in failure to fulfill major role obligations at work, school, or home 6.) continued use despite having persistent/recurrent social interpersonal problems caused/ exacerbated by the effects 7.) important social/occupational/recreational activities given up/reduced because of use 8.) recurrent use in situations in which it is physically hazardous 9.) continued use despite persistent/ recurrent physical/psychological problems likely to have been caused/exacerbated by cannabis 10.) tolerance (i.e. need for increased amounts to achieve intoxication/desired effects or markedly diminished effect with continued use of the same amount of cannabis 11.) withdrawal (i.e. defined by the characteristic withdrawal syndrome or cannabis/closely related substance is taken to relieve/avoid withdrawal symptoms)
Is the damage permanent?
Abstinence following regular used May improve some, but not all, of cognitive consequences a study reported that having greater days of abstinence from alcohol and drugs was associated with improved executive functioning continued absence is expected to improve attention, verbal memory, and neuronal processing speed the most important thing is prevention, with the key detrimental factors being high-frequency, high THC content, and young age of onset
addiction
Addiction is a loaded construct with a complex history it involves two components: - biological component - behavioural component
respiratory diseases such as asthma or chronic obstructive pulmonary disease (COPD)
Bramnes & Soest (2019) found that cannabis is a risk factor for bronchial asthma or use of asthma medication the association between smoking cannabis and cancer, specifically lung cancer, remains unclear
What affects the proportion of recreational use of cannabis among youth?
CUD in Fathers is correlated with earlier age of use in daughters (14.6 vs 17.2 years) but not sons conduct problems predict peer cannabis use, which predicts increasing levels of youth cannabis use, which ultimately predicts CUD other important factors that increase use include availability, mental disorders, trauma, parental absence, or divorce positive parental relationships and peer relationships that avoid cannabis are associated with at least two times lower prevalence of past-month cannabis use among adolescents a higher frequency of use is associated with the male gender, lower economic status, maternal effective problems, and openness towards/consumption of other drugs
Cannabis Use Disorder (CUD)
Cannabis Use Disorder describes patterns of cannabis use that lead to some form of life impairment or hindrance, such as health problems, persistent/increasing use, failure to meet daily responsibilities; these hindrances are generally brought on by one or more of the withdrawal symptoms
Cannabis can lower motivation in young people and can lead to lower grades and school attendance
Cannabis use before the age of 16 is associated with the use of other drugs later in life
Cannabis Use Disorder- Predisposition
Cannabis use is an obvious precursor for CUD, but there is much more that goes into determining who is more likely to develop disordered use - genetic predisposition to have disordered use - environmental predisposition: availability desirability social factors
How does cannabis exposure by the pregnant mother affect the newborn?
Cannabis use negatively affects birth weight, neonatal length, head circumference at birth and size for gestational age - cannabis use increases the odds of fetal low birth weight (LBW), preterm birth (PTB), and placement in ICU/NICU - at least weekly cannabis use during pregnancy resulted in a lighter birth weight of an average of 84.2 G when compared to offspring of women who did not use cannabis - newborns demonstrated withdrawal like symptoms - however, studies are often confounded by polysubstance use
can cannabis cause mental disorders?
Earlier and higher frequency of use increases the risk of developing mental health disorders in vulnerable individuals high THC content is strongest related to mental disorders the onset of many mental disorders occur before the brain is done developing anxiety, depression, bipolar disorder, psychosis/schizophrenia using cannabis could increase the risk for predisposed illnesses
the main draws to cannabis are
THC the main draws to cannabis are the cannabinoids that create physical and mental effects, the primary two being THC and CBD
How does cannabis exposure by way of the pregnant mother affect the fetus?
THC is lipophilic, resulting in an estimated one-third of THC in the plasma crossing the fetal placental barrier A study found that the placentas of cannabis users were heavier, suggesting more grams of placental/gram fetal tissue or needed to support development
How does cannabis exposure affect the developing brain?
The brain is still maturing, driven by changes in brain grey matter (GM) due to synaptic pruning, until the mid-20s cannabinoid receptors modulating neurotransmitters that have significant effects on the brain. As such, they are susceptible to THC the frontal cortex is going through Rapid change and more susceptible to THC "structural changes on MRI have also been documented in youth who use cannabis regularly. They show lower brain volumes, different folding patterns and thinning of the cortex, less neural connectivity, and lower white matter integrity, all of which indicate damage by THC"
What is cannabis withdrawal?
The last symptom outlined by the DSM-5 is cannabis withdrawal however, cannabis is often referred to as a drug that does not have physical withdrawals like those of opioids or amphetamines is cannabis withdrawal a real thing?
is cannabis a gateway drug
most of the research in the last 10-15 years suggests unlikely that cannabis is a gateway drug but there has been a research study recently, that raises some concern = those who use recreational marijuana, showed an increased risk of using other drugs at least a few years later includind opioids = but there other factors needed to be considered There's been some interesting epidemiological studies looking at death certificates over the course of 10 years after the legalization of medical marijuana,Which found that there were very dramatic reductions in opioid-related deaths - Might be that medical cannabis reduces the effects of withdrawal due to opioids which makes it a lot easier to get off opioids and less opioid-related deaths - There has been some studies that show that CBD can actually reduce the effects of withdrawal in cannabis users
Cannabis Use Disorder- prevalence
nearly 4% of the global population was using cannabis in 2015 Hasin et al (2017) estimate that 20-30% of cannabis users qualify for CUD "studies done over 25 years ago indicated that cannabis users rarely become dependent, leading to a present-day common misconception that the risk of developing CUD among cannabis users is low" - however, recent national data indicate that approximately one out of five-lifetime cannabis users meet the criteria for DSM-V CUD, and 23% are considered symptomatically severe
what does the Cannabis Act do to protect youth?- age restrictions
no person may sell or provide cannabis to any person under the age of 18. There are two criminal offenses related to providing cannabis to youth, with maximum penalties of 14 years in jail: - giving or selling cannabis to youth - using a youth to commit a cannabis-related offence underage by Province Alberta: under 18 Quebec under 21 all other provinces and territories: under 19
some properties of Cannabidiol include (CBD)
non-psychoactive anxiolytic (reduces anxiety) anti-psychotic anti-inflammatory neuroprotective anti-epileptic
Other concerns: cannabis as a gateway drug
one reason that parents or programs advise use against cannabis use is that it is supposedly a "gateway drug" and that it can lead to more intense and dangerous experimentation - the gateway drug hypothesis is a general causal model. - The correlation between cannabis use and later substance use is significant, but we cannot be sure that it is cannabis use that causes other drug use
cannabis use effect on the developing brain
our brains are not fully developed until around the age of 25 - early and frequent cannabis use can hurt the brain's prefrontal cortex which can impair memory, decision-making, and problem-solving - we cannot predict if these effects are permanent and who they can affect - Cannabis can lower motivation in young people and can lead to lower grades and school attendance - Links to mental illness - Potential for addiction - motor vehicle safety
Biological component of addiction
physiological dependence - tolerance/ withdrawal - changes in brain-reward circuitry - cravings
some properties of Delta-9-tetrahydrocannabinol include (THC)
psychoactive euphoric, reinforcing, rewarding anxiety-inducing psychosis-inducing
populations that are statistically more likely to consume cannabis
research has found that individuals with certain mental health afflictions are more likely to consume cannabis potential reasons for increased use may be that they are self-medicating, that the drug and disorder have a positive feedback loop, or that the individual was predisposed to it - bipolar disorder - depression - anxiety - schizophrenia - ADHD - OCD - ASPD
How does cannabis exposure by way of the pregnant mother's milk affect the baby?
research shows that 0.8 to 2.5% of the mothers THC dose enters the breast milk - in chronic heavy users the milk to plasma ratio can be as high as 8:1 and metabolic rates of cannabis are found in infant feces and urine, suggesting that it may have been absorbed and metabolized by the infant - THC exposure in babies may result and drowsiness and poor cycling, impeding breastfeeding and nutrient intake - THC may impede lactation by stopping prolactin secretion - The pump-and-dump method does not seem to be helpful with cannabis because the pharmacokinetics of THC / CBD do not suggest a practical way to eliminate the cannabinoids from breast milk
The difficulty of testing for cannabis
testing at the side of the road for impairment is not a simple of cannabis as it is with alcohol - when ingesting cannabis, THC is distributed to body tissue, where it is absorbed and still detectable even after impairment has resolved - due to the accumulation of THC in body tissue, drivers (especially frequent cannabis users) will test positive for cannabis even if they are not impaired at the time of driving, and for example, had smoked the day before driving - the law requires less than two nanograms of THC per milliliter of blood within 2 hours of driving for reference, blood THC levels peak around 50 ng/mL after smoking (10 mins) - frequent users will often have 2 ng/mL lingering in their system
what does the Cannabis Act do to protect youth?- Restricting promotion and enticement
the Cannabis Act helps discourage youth cannabis use by prohibiting: - products that are appealing to youth - packaging or labeling cannabis in a way that makes it appealing to youth - selling cannabis through self-service displays or vending machines - promoting cannabis, except in narrow circumstances where young people could not see the promotion penalties for violating these prohibitions include a fine of up to $5 million or 3 years in jail
psychosocial interventions
the best results come from: increasing awareness of cannabis' negative effects Enhancing motivation to decrease the use managing painful feelings improving social skills improving social support improving interpersonal functioning either cognitive-behavioural treatment (CBT), motivational enhancement Theory (MET), or a mixture of the two has been proven effective
research shows that there are three reasons that cannabis may be seen as a gateway drug:
the desire to use cannabis may have a pre-existing (potentially genetic) trait that would predispose them to use other drugs as well as cannabis that using cannabis makes the individual more likely to be with peers and in settings that "provide more opportunities to use other illicit drugs at an early age" that "socialization into an illicit drug subculture" could promote favorable attitudes towards the use of other drugs
Adolescence
the transitional stage from childhood to adulthood that occurs between ages 13 and 19 starts in puberty and ends in when individuals become independent the brain during adolescence undergoes neuromaturation- a period of "fine-tuning" particularly in areas of the brain involving cognition, emotional regulation, and decision-making white matter volume increases grey matter volume Peaks late childhood then decreases - "pruning" - numbers of dendritic trees - number of synapses - mesolimbic circuit - prefrontal cortex
