clevenger-marijuana
Psychiatric use as an
"add-on" treatment Examples: schizophrenia, anxiety, depression, addiction, post-concussion syndrome & posttraumatic stress disorders
treatment-Gabapentin
(an anticonvulsant used for pain & anxiety) Dosing: 400mg three times day In some clinical trials (weak evidence): Decreased dysphoria (depression), insomnia, cravings
treatment-Quetiapine (Seroquel)
(an atypical neuroleptic mood-stabilizer) Has been shown to increase cravings & use of cannabis
Sinsemilla
(without seeds), "hydro" (grown in water), kind bud, dro, 30s, AK-47, and blueberry (more recent names of popular types of marijuana) Average concentration of THC is 7.5% and higher
psychosis risk of daily use of high potency cannabis
1. Contributed to striking variation in incidence of psychotic disorder across 11 studied sites 2. Associated with increased odds of psychotic disorder compared with never users (ave 2x greater odds) 3. Risk increased to nearly 5 x greater odds for daily use of high-potency types of cannabis
The groups in the study started using marijuana daily between
16 to 17 years of age for about three years. At the time of the study, they had been marijuana-free for about two years.
bowl (0.25 g of flower)
18% potency, 45 mg of THC content
Federal and state regulation of marijuana began in the
1930s; penalties for possessing and selling marijuana escalated during the 1940s and 1950s.
The emergence of marijuana on American college campuses and among American youth in general during the late
1960s, however, forced a reexamination of public policy regarding this drug, leading to a more lenient approach in the 1970s.
joint (0.32 g of flower)
20% potency, 38.4mg of THC content
As of Dec. 2019, use of vaping increased from
21.7 to 25.0% among 10th graders and from 26.7 to 30.9% among high school seniors—that means 1:4 10th graders and 1:3 12th graders qualify as current users of vaping products
dab (0.5 g of wax concentrate)
70% potency, ~235 mg of THC content
A study from New Zealand conducted by researchers at Duke University showed that people who started smoking marijuana heavily in their teens & had an ongoing marijuana use, lost an average of
8 IQ points between ages 13 to 38. The lost mental abilities didn't fully return in those who quit marijuana as adults.
Of the 15 marijuana smokers who had schizophrenia in the study,
90% were heavy cannabis users before they developed schizophrenia.
DSM 5 criteria for cannabis withdrawal
A. Cessation of cannabis use that has been heavy and prolonged B. 3 or more of the following develop within several days after Criterion A 1. Irritability, anger or aggression 2. Nervousness or anxiety 3. Sleep difficulty (insomnia) 4. Decreased appetite or weight loss 5. Restlessness 6. Depressed mood 7. Physical symptoms causing significant discomfort: must report at least one of the following: stomach pain, shakiness/tremors, sweating, fever, chills, headache C. The symptoms in Criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning D. The symptoms are not due to a general medical condition and are not better accounted for by another disorder
DSM 5 criteria for cannabis intoxication
A. Recent use of cannabis. B. Clinically significant maladaptive behavioral or psychological changes (e.g., impaired motor coordination, euphoria, anxiety, sensation of slowed time, impaired judgment, social withdrawal) that developed during, or shortly after, cannabis use. C. Two (or more) of the following signs, developing within 2 hours of cannabis use: (1) conjunctival injection (2) increased appetite (3) dry mouth (4) tachycardia D. The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder. Specifier "With Perceptual Disturbances": This specifier may be noted when hallucinations with intact reality testing or auditory, visual, or tactile illusions occur in the absence of a delirium. Intact reality testing means that the person knows that the hallucinations are induced by the substance and do not represent external reality. When hallucinations occur in the absence of intact reality testing, a diagnosis of Substance-Induced Psychotic Disorder, With Hallucinations, should be considered.
how it works
Acts on cannabinoid receptors & triggers DA release in the pleasure center
Bhang
Average concentration of THC is 1% to 2%
Hashish
Average concentration of THC is 3.6% to 28%
Studies have found that the ingredient in cannabis that has the best effect for medical reasons is
CBD, not THC.
Marijuana is one of several products of
Cannabis sativa or indica, grown abundantly throughout the world.
Early records of marijuana use:
China 2737 B.C., India (religious ceremonies), Ancient Greeks, Colonial settlements
The earliest records of marijuana come from
Chinese writings nearly five thousand years ago; the use of hashish originated in North Africa and Persia in the ninth or tenth century A.D.
Ganja
Consists of the dried tops of female plants Term is also used as a slang term for marijuana (pot, weed, reefer)
treatment-NAC (n-Acetyl Cysteine)
How it works: Glutamate receptor modulator Reverses drug-induced down-regulation of the cysteine-glutamate exchanger Allows for regulation of glutamate release reducing compulsive drug-seeking behaviors Dosing: 500-600mg 2-3 times daily
treatment-Cannabidiol (CBD)
In a randomized clinical trial of CBD for cannabis use disorder, doses of 400 & 800mg was found to be safe & more efficacious than placebo at reducing cannabis use
the 0.3% does not apply to the
OIL itself
Marijuana - Cannabis sativa or Cannabis indica
Street names-420, Blunt, Bud, Doobie, Dope, Ganja, Grass, Green, Herb, Joint, Mary Jane, Pot, Reefer, Sinsemilla, Skunk, Smoke, Stinkweed, Trees, Weed, Hashish: Boom, Gangster, Hash, Hemp Concentrates: Budder, Crumble, Shatter, Wax
It may require days or weeks (in the case of extensive exposure to marijuana) for
THC to leave the body completely.
Extracts can deliver extremely large amounts of
THC to the body, and their use has sent some people to the emergency room.
A total of 97 subjects participated, including matched groups of healthy controls, subjects with
a marijuana use disorder, schizophrenia subjects with no history of substance use disorders, and schizophrenia subjects with a marijuana use disorder.
Researchers found that teens who were heavy marijuana users (smoking it daily for about three years) had
abnormal changes in their brain structures related to working memory and performed poorly on both long- and short-term memory tasks.
The Northwestern Medicine study found the brain
abnormalities and memory problems persisted two years after the individuals had stopped smoking marijuana.
The subjects who used marijuana did not
abuse any other drugs.
There is growing evidence that marijuana use is
associated with increased risk for testicular cancer.
There are impairments in
attention, concentration, complex visual-motor skills (like driving), altered senses (seeing brighter colors), altered sense of time, mood changes, reduced motivation, impaired muscle movement, difficulty with problem-solving, impaired memory/memory recall. With high doses: hallucinations, delusions and psychosis.
Of great concern is the greater potency of marijuana that is now
available and the continuing potential risk of marijuana adulteration, especially in vape products.
The acute effects of marijuana are now known to be due to the
binding of THC at special receptors in the brain.
If a pregnant woman uses marijuana, the drug may affect
certain developing parts of the fetus's brain. Children exposed to marijuana in the womb have an increased risk of problems with attention, memory, and problem-solving.
Over the past decade, Northwestern University scientists, along with scientists at other institutions, have shown that
changes in brain structure may lead to changes in the way the brain functions.
Chronic use of marijuana may contribute to
changes in brain structure that are associated with schizophrenia.
"Amotivational syndrome,"
characterized by general apathy and an indifference to long-range planning, is a result of the pharmacological effects of chronic marijuana use.
Various cannabis products are distinguished in terms of the
content of cannabis resin and, in turn, the concentration of THC, the active psychoactive agent.
tolerance
depressed mood, irritability, altered psychomotor performance, sleep disruption
Daily use of marijuana for an extended period appears to
detrimentally change brain structures and cause memory impairments.
Colorado is seeking to eliminate the
diagnosis of PTSD from medically approved uses due to increased paranoia from cannabis use.
Randomly tested CBD oils contained fraction of labeled amount, were
diluted or contained unreported THC & other contaminants
behavioral
euphoria, panic, paranoia, relaxation, altered time perception, decreased concentration, impaired memory & learning
Use Caution if using CBD for any condition because of
extreme variability in constituent ingredients, contaminants & quality control
Dr. Volkow strongly recommends
family interventions.
However, because it is absorbed into
fatty tissue, its elimination is slow.
Cannabis has been useful in the treatment of
glaucoma and asthma, but its most effective application to date has been in the use of high cannabidiol (CBD) content marijuana for nausea, seizures and weight loss.
Researchers have concluded that early exposure to psychoactive substances will lead to a
greater chance of exposure to psychoactive substances later in life.
Maternal cannabis use was associated with
greater offspring psychopathology characteristics (psychotic-like experiences), attention, thought & social problems, sleep problems, lower body mass index, lower cognitive function & lower gray matter volume
Carcinogenic effects are suspected because marijuana smoke contains many of the same
harmful components that tobacco smoke does, and in the case of marijuana smoking, inhalation is deeper and more prolonged.
These extracts come in various forms, such as:
hash oil or honey oil—a gooey liquid, wax or budder—a soft solid with a texture like lip balm, shatter—a hard, amber-colored solid
A cannabis plant is
hemp "as long as no part of the plant exceeds THC concentration of >0.3 % on a dry weight basis."
All researchers believe that it is critical to use the most
intensive interventions with adolescents including support from family, therapists and groups.
withdrawal
irritability, anxiety, craving & insomnia reported in 61-96% of users
Medical/neurological use includes
it as an "add-on" treatment Examples: malignant brain tumors, Parkinson's disease, Alzheimer's disease, multiple sclerosis, neuropathic pain, & childhood seizure disorders (Lennox-Gastaut & Dravet syndromes)
risk
known to worsens or mask psychiatric symptoms, decreases motivation & slows cognitive processing
Altered brain development with long-term problems with
learning, problem-solving and memory.
Any plant with > 0.3% THC is
marijuana & remains on Schedule 1 under Federal law.
What is interesting, is that the Netherlands, a country that has had controlled, legal use of marijuana, has recently passed laws making
marijuana illegal again after experiencing many problems related to the use of this drug.
Research studies since 2011 have shown that the use of alcohol and cigarettes precedes
marijuana use, and that marijuana use precedes the use of other illicit drugs
There are an estimated 850 brands of
marijuana-derived CBD products & 150 hemp-derived products in the marketplace, making universal dosing recommendations nearly impossible
THC acts on specific brain cell receptors that ordinarily react to
natural THC-like chemicals. These natural chemicals play a role in normal brain development & function.
Any CBD purchased through Amazon has
no actual CBD due to licensing restrictions
The brain abnormalities and memory problems were
observed during the individuals' early 20s, which could indicate the long-term effects of chronic use.
Smoking THC-rich resins extracted from the marijuana plant is
on the rise. People call this practice dabbing.
Heavy or chronic use by teens with an
ongoing marijuana use disorder had an average loss of 8 IQ points between ages 13 & 38. The lost mental abilities didn't fully return in those who quit marijuana as adults
physical
palpitations, blood pressure (high or low), reddened eyes, dry mouth & throat, nausea, vomiting, increased appetite, vasodilatation, decreased immune function & respirations
In the United States, marijuana was available in
patent medicines during the late 1800s, but its popularity did not become extensive until the 1920s.
Prior to 2011, there was little evidence that some inherent property of marijuana exposure itself led to
physical or psychological dependence on other drugs (gateway drug).
Present public policy in the United States toward marijuana smoking has evolved to the
point of essentially decriminalizing the possession of marijuana in small amounts.
A poor working memory predicts
poor academic performance and everyday functioning.
dependance
preoccupation & compulsion to use with relapse/recurrent use, >50% of cannabis users have 'impaired control' over-use
THC (delta-9-tetrahydrocannabinol) is the
primary mind-altering ingredient in marijuana.
CBD (cannabidiol) is the
primary non-mood-altering ingredient with medical properties.
Legalization is still highly controversial, although
public support has gradually increased in recent years.
The health and psychological effects of chronic heavy cannabis use appear to be:
respiratory diseases associated with smoking such as chronic bronchitis, the occurrence of histopathological changes that may be precursors to the development of emphysema, COPD and malignancy; increased risk of lung cancer, oral cavity, pharynx, and esophagus; development of cannabis dependence syndrome, characterized by an inability to abstain from, or to control, cannabis use. Decreased neurocognitive function including decreased IQ by up to 20 points when used before age 25.
Memory-related structures in their brains appeared to
shrink and collapse inward, possibly reflecting a decrease in neurons
In 2019, 30% of high school seniors reported
smoking marijuana in the past year, down from 33% in 2009.
The study also is unique in that it looked at the shapes of certain brain structures like the
striatum, globus pallidus and thalamus, structures in the subcortex that are critical for motivation and working memory.
Marijuana use, and the subsequent use of other illicit drugs, are
strongly statistically associated.
"The study links the chronic use of marijuana to these concerning brain abnormalities
that appear to last for at least a few years after people stop using it," said lead study author Matthew Smith.
Researchers say this is the first study to target key brain regions in
the deep subcortical gray matter of chronic marijuana users with structural MRI and to correlate abnormalities in these regions with an impaired working memory.
Marijuana consists of
the dried and crushed leaves, flowers, stems, and seeds of the Cannabis sativa or Cannabis indica plant.
Interestingly, in some double-blind placebo controlled clinical trials evaluating
the efficacy of THC for nausea there was no difference between THC and "sham/placebo" cannabis with no active ingredients.
Working memory is the ability to remember and process information in
the moment and — if needed — transfer it to long-term memory.
The younger the individuals were when they started chronically using marijuana,
the more abnormally their brain regions were shaped, the study reports
Chronic marijuana use could add to or augment the
underlying disease process associated with schizophrenia.
"This study reveals that
use of marijuana may contribute to changes in brain structure associated with having schizophrenia."
Marijuana has historically been a
valued crop. The woody fibers of the stem yield a fiber that can be made into cloth and rope.
"With the movement to decriminalize marijuana,
we need more research to understand its effect on the brain."
Another idea that has been related to chronic marijuana use is the "gateway" hypothesis
which asserts that marijuana inherently sets the stage for future patterns of drug abuse.
Because marijuana is almost always consumed through smoking, the acute effects are rapid:
within 6 secs!
"The abuse of popular street drugs, such as marijuana, may have dangerous implications for
young people who are developing or have developed mental disorders"
The major acute adverse psychological & health effects of cannabis intoxication are:
●anxiety, dysphoria, panic & paranoia (especially in naive users); ●cognitive impairment, especially attention & memory; ●psychomotor impairment (increased risk of injury or accident if driving a motor vehicle or operating machinery); ●increased risk of experiencing psychotic symptoms among those vulnerable because of personal or family history of psychosis; ●increased risk of low-birth-weight babies with developmental problems if cannabis is used during pregnancy and; ●Significantly decreased testosterone production (can result in erectile dysfunction, poor muscle tone and low sex drive).
how is marijuana used
◼Hand-rolled cigarettes (joints), in pipes or water pipes (bongs), ◼Smoked in blunts (cigars packed with marijuana), ◼Vaporizers, ◼Pull active ingredients from extracts or plant materials into a vapor storage unit, ◼The person inhales the vapor, not the smoke., ◼Edibles: brownies, cookies, candy, or brewed as a tea, ◼Extracts: Smoked or eaten forms of THC-rich resin extracts., ◼hash oil or honey oil, ◼wax or budder (dabs): a soft solid with a texture like lip balm, ◼Shatter: hard, amber-colored solid. Extracts deliver extremely large amounts of THC causing severe symptoms & ER visits, Preparing extracts usually involves butane (lighter fluid), Use of butane or accelerants has caused fires, explosions, & serious burns
