Addictions Final: cannabis and opioid addictions

CBD as treatment for addiction

-has been shown to reduce symptoms of cannabis withdrawal -might reduce likelihood of relapse among those with opioid use disorders -people with comorbid ADHD and cocaine use disorder are more likely to seek treatment if they use cannabis

Outcomes of cannabis legalization in Uruguay

-lifetime prevalence of marijuana use quadrupled -45% of men and women use marijuana 5 or more days per week

Which two medications are the main opioid addiction treatments in the USA?

1. buprenorphine products.(a combination of buprenorphine and naloxone) 2. methadone

Three treatment choices for people addicted to opioids in the action stage of change

1. detoxification 2. psychosocial treatment 3. medication assisted therapy (MAT)

Five essential principles of motivational enhancement therapy

1. display empathy 2. create discrepancies 3. avoid arguments 4. allow resistance to occur 5. support client self-efficacy

What two things contribute to high risk of impulsive decision making in adolescence? (neuroscience)

1. mesolimbic systems respond especially well to reward 2. prefrontal cortexes not fully developed

3 fundamental principles of contingency management

1. monitoring 2. immediate reinforcers 3. withholding reinforcers when needed

The endogenous opioid system consists of which 4 components?

1. mu opioid receptors 2. kappa opioid receptors 3. delta opioid receptors 4. endorphins

What are the two best indicators of someone being intoxicated or experiencing withdrawal from opioids?

1. pupil constriction 2. respond to naloxone

3 possible motivators for pot smokers

1. stress release 2. social purposes 3. psychological reasons - they are experiencing diagnosable psychiatric disorders

two medical conditions that most often co-occur with OUD, especially among intravenous users

1. viral infections (HIV, Hepatitis C) 2. bacterial infections

After 12 months since the beginning of treatment, what percentage of cannabis users will still be abstaining?

10-30%

In the US, Percentage of THC in marijuana has risen from 4% in 1995 to an average of __________

12%

Earliest recorded reference to marijuana use (time and place)

12,000 years ago in China

What percentage of American adolescents have misused prescription opioids? (give the range)

15%-20%

What is the peak age for starting to use prescription opioids, stimulants, sedatives, and anxiolytics? (medically and nonmedically)

16

About ________% of teenage cannabis users will develop CUD by age 24

17%

When, where, and why was heroin synthesized from morphine?

1874, England, with the hopes that it would be free from abuse liability

When was heroin marketed, and by whom?

1898 by the Bayer company in Germany

Over how many Americans suffer from prescription opioid abuse?

2 million

compared to those who have been consistently employed, people who have been unemployed for at least 3 months are __________ times more likely to experience cannabis dependency

2.87

among people with chronic pain, rates of opioid use are between _______% and ______%

21% and 29%

Opium may have been used as early as _______________, by whom?

2100 BC, by the Sumerians

About how many individuals abuse opioids worldwide?

26 to 36 million

cannabis has been used medicinally since at least _________________

2700 BC

Having nonopioid substance use disorders may increase the odds of opioid addiction by _____________ times

28

Poorer cognitive performance following cannabis use may persist for up to _________________

28 days

inhaled/smoked THC appears in the blood between ________ and ________ minutes

3 and 10

Heroin use can increase one's risk of dying prematurely by _______________ times

3 to 4

In cannabis users younger than 17, decreased processing speed and impaired executive function remain for at least ___________ following cessation

3 years

Stable abstinence from opioid use is less than _________% after 10-30 years

30

orally ingested THC appears in the blood between ________ and ________ minutes

30 and 60

In Sweden, it was found that people who had used cannabis heavily since adolescence were _________% more likely to be on disability pension

30%

Cannabis withdrawal begins occurring ______________ after abrupt termination and typically lasts _________________

4-8 hours; 3-4 weeks

In 2013, around ___________ Americans had used heroin at some point in their lives, which is _________% of all people aged 12 or older in the country

4.8 million 1.8%

About what percent of Americans have tried cannabis?

48%

teens, on average, become addicted to cannabis within the first _______ years of use

5

regular and heavy cannabis use in adolescence may lower IQ by ____________ IQ points

5-8

The mortality rate of opioid addicts is _____ to ______ times greater than that of the general population

6 to 20

What percent of high school seniors admit to using marijuana daily?

6.5%

hash oil may have THC percentages as high as ________ to _________%

60 to 75%

In a nationally representative sample of the US population, what percent of men and what percent of women ever received treatment for NMPOU?

7.6% of men, 8.2% of women

Nearly _______% of cannabis users also smoke tobacco; an estimated _______________ Americans smoke both

75% 7 million

among people with chronic pain, rates of opioid addiction are between ____% and ___%

8% and 12%

When/why did opium use spread to India and China?

8th century AD due to the Arab Trade

It is estimated that _________% of cannabis users will become addicted, but perhaps as high as ________% for those who begin in their teens

9% 17%

Which racial/ethnic group is most likely to use alcohol and marijuana concurrently, compared to other youth groups?

African American

What are natural opioids derived from?

Asian poppy

Adolescent cannabis users have higher _________________ than nonusers

Body Mass Index

Which prescription drug has been found to worsen symptoms of cannabis withdrawal?

Bupropion - an antidepressant

synthetic cannabinoids mostly affect which receptors?

CB-1 receptors

__________ has been used to treat acute schizophrenia

CBD

the amount of __________ in street cannabis is decreasing, whereas the amount of ______________ is increasing dramatically

CBD; THC

What is the most frequently used illicit drug by pregnant women?

Cannabis

A recent study showed that, among opioid users, cannabis use may have this effect

Cannabis may act as a gateway drug to nonmedical prescription opioid use

CRAFFT Inventory

Car Relax Alone Forget Friends Trouble

Cannabis is controlled under what act in the US?

Comprehensive Drug Abuse Prevention and Control Act of 1970

Which precontemplation strategies for cannabis addiction does the text recommend?

Documentaries, videos, and movies about cannabis. Also one book called the Secret Addiction

For intravenous users of opioids, _________ was a significant cause of mortality until 1996. What then took its place?

HIV; Hepatitis C took its place

___________________ adolescents report greater use of most major drugs compared to non-Hispanic Whites and African American teens

Hispanic

Which natural hallucinogen may reduce opioid cravings and withdrawal symptoms, but may cause mania or death? Where is this medicinal drug found?

Ibogaine, found in roots of an African rainforest shrub

For many opioid addicts, the action stage of change begins where?

In a detox or treatment facility

Cannabis is currently used in religious ceremonies in which countries?

India, Jamaica, and certain parts of South and North America

Early and regular use of cannabis leads to greater suicidality among which group of adolescents?

Mexican adolescents (based on study in Mexico)

Two primary methods that seems most helpful in treating CUD

Motivational enhancement therapy (MET) and CBT

Which counseling method may be employed for clients in the contemplation stage of addiction?

Motivational interviewing

Which racial/ethnic group is likely to begin using substances earlier than other racial/ethnic groups?

Native Americans

Is regular, even daily, use of hash oil associated with an increased risk of psychosis?

No

Has the FDA approved any medication for CUD?

No!

Does sport participation seem to predict adolescent illicit opioid use?

No, it is more likely that sport participation protects against NMPOU

For veterans in residential care, does continuing to use cannabis provide more respite from PTSD symptoms?

No, nonusers experience more respite from PTSD symptoms

Is medical marijuana considered safe by the FDA?

No. It has not been subjected to any of the 12 stages of drug testing required for that qualification

History of opium addiction: who, when, and why?

Opium addiction has been documented ever since the 16th century in countries such as Turkey, Egypt, Germany, England, and China, where opium became the "new tobacco"

Cannabis became criminalized in most countries following what?

Single Convention on Narcotic Drugs in 1961

Which prescription drugs may be prescribed to help with a major symptom of cannabis withdrawal? Give 3 examples

Sleep aids such as: -Ambien -buspirone -gabapentin

Why are opioids called depressants?

They slow down the functioning of the central nervous system

The only country that has legalized possession, selling, cultivation, and transport of marijuana

Uruguay

THC can be detected in the users body for up to __________________

a month

What are the two main reasons individuals may switch from prescription opioids to heroin?

accessibility and cost

which factor of impulsivity is most associated with later problems with cannabis and alcohol?

acting carelessly when experiencing negative emotions

In which stage of change should CUD clients consider making a love list?

action

The greatest negative psychosocial impacts of cannabis occur with what population of users?

adolescent heavy users

In a study of abstinent heroin-dependent patients, oxytocin was linked to _________________

aggression

Youths (14-25) with cannabis dependence have higher-than-average rates of _________________. What is the implication of this?

alexithymia This means they have great difficulty identifying and expressing emotions

naloxone

an opioid antagonist that can prevent death in the event of an overdose, if taken early enough

acute effects of opioids include... (name 4)

analgesia, respiratory depression, miosis (excessive contraction of the pupil), euphoria

opioid withdrawal AND withdrawing from depressants may lead to which two symptoms

anxiety and restlessness

Opioid users may have _______________________ dysfunction, which would impact learning and memory

basal ganglia

What race/ethnicity characteristic among adolescents predicts greater risk of substance use?

being immigrants or born to immigrants

Marijuana was first brought to the west, when and by whom?

between 1845 and 1919 by East Indian emigrants who moved to Trinidad to work on sugarcane plantations

When did opium use spread to Europe?

between the 10th and 13th centuries AD

effects of THC

can create psychotic symptoms, anxiety, and impaired learning

effects of CBD

can reduce psychotic symptoms and anxiety, can enhance learning

CBT for CUD involves teaching clients what kind of skills? What does this skillset include?

cannabis refusal skills this includes verbal and nonverbal communication

what is the "reverse gateway" theory of cannabis

cannabis users may segue into using tobacco products

The most potent opioids like ________________ are only approved in a veterinary practice

carfentanil

CB-1 receptors are mostly located in what? What is the implication of this?

central nervous system - they are related to functioning and development of the brain

Cochrane review on cannabis products

concluded that cannabis might have benefits for chronic neuropathic pain that outweigh its potential harms

Which CBT technique has been found to be effective in treating opioid and other addictions?

contingency management

statistical correlations between cannabis use and depression

correlations exist but the strength of these associations is somewhat weak

Cannabis use has been ________________ among adolescents over the past few years

decreasing

What is the most typical symptom of quitting cannabis?

difficulty sleeping

When was morphine discovered, and what was its eventual use?

discovered in 1803, used as an anesthetic during surgery decades later

American veterans may use medical marijuana at ________________ the rate of the general population

double

When one is high on cannabis, the likelihood of having a serious motor vehicle accident almost ______________

doubles

When did therapeutic communities become prominent in the US?

during the heroin crisis of the 1960s

It is likely that the _________________ system plays a main role in OUD

endogenous opioid system

Longterm use of opioids causes a deficiency of _______________, which contributes to opioid cravings

endorphins

Which chemicals are the brain's natural narcotics?

endorphins

THC stores in the body's ___________________, including the brain

fatty tissues

compared to tobacco smoke, cannabis smoke causes greater __________ damage to the lungs

fine

daily use of "skunk weed" and small amounts of CBD is associated with a ______________ greater chance of having schizophrenia

fivefold

frequent marijuana use and depression, among adolescents

frequent use of marijuana doubles a teenagers risk of having anxiety and/or depression, depressed adolescents are at least twice as likely to become addicted to cannabis

What are therapeutic communities?

group-based approaches to drug addiction that were usually residential where clients and counselors lived together

What are the most addictive and second most addictive opioid?

heroin, morphine

Which two characteristics among high schoolers predicts use of tobacco, marijuana, and alcohol?

high impulsivity and history of behavioral addictions

women with opioid addiction score higher on which two personality traits, and lower on which two personality traits, compared to controls and alcoholics?

higher on neuroticism and extraversion lower on agreeableness and conscientiousness

chronic use of cannabis is associated with what two issues?

hostility and anxiety disorders

neonatal abstinence syndrome is primarily caused by maternal use of which two forms of opioids

illicit opioids, methadone

CB-2 receptors are mostly located in what? What is the implication of this?

immune cells- researchers speculate that cannabinoids may modulate the immune system

decision-making chart

in the cannabis chapter, this is presented as a specific contemplation strategy that involves the client making a chart of benefits and drawbacks of their substance use

When did methadone maintenance treatment emerge and why?

in the late 1960s and early 1970s in reaction to the heroin wave

unlike marijuana, methamphetamine, and cocaine, heroin use often _________________ with age

increases

endocarditis what is it, what could cause this?

inflammation of heart's inner lining a serious complication of injection drug use

Why is Naloxone added to Buprenorphine?

it is believed that this decreases abuse potential

What practice is avoided in MET?

labeling the client

Maternal use of methadone may cause what two effects in the infant

lower birth weight, smaller head circumference

A study of 30-day prevalence found that cannabis use was lowest among which racial/ethnic group, and highest among which racial/ethnic group?

lowest among Asians, highest among Native Americans

the integrative approach mixes ______________________ with _____________________

mainstream therapies (psychological, pharmacological) with complementary and alternative therapies

Are males or females more likely to use, abuse, and become addicted to cannabis?

males

Adolescents with OUD often use which other drug, and initiate opioid use while under the influence of this drug?

marijuana

_______________ is the most prevalent illicit drug around the world

marijuana

Is a PTSD diagnosis significantly associated with greater use of marijuana and depressants, or greater use of cocaine and amphetamines?

marijuana and depressants

Opioids mask the emotional reaction to _________________ while simultaneously producing __________________

mask the emotional reaction to pain while simultaneously producing euphoria

When were methadone and fentanyl created?

methadone in 1946, fentanyl in 1959

cannabinoid receptors (CB-1 and CB-2) are more or less prevalent than opioid receptors? What is the implication of this?

more - it is believed that they affect more regions of the brain

In treatment of CUD, the most effective and efficient treatment consists of a combination of what three approaches/methods?

motivational enhancement therapy, CBT, and a 12 step program

a 2017 study found that ________________ of patients in drug treatment programs for opioid abuse were first exposed to the drugs through a prescription to treat pain

nearly half

teenagers and young adults who use cannabis frequently are more likely to experience increase in ________________________

negative affect

opioid addiction is associated with decreased levels of __________________ as well as ___________________ levels in the nucleus accumbens

neuropeptide Y; alpha-5 receptor

Spice drugs contain what amount of CBD?

no CBD!

Greater use of alcohol and marijuana is associated with worse academic performance for all youth, especially which population of youth?

non-White youth

striatal dopamine transporter (DAT) is linked to which two qualities/behaviors?

novelty-seeking behavior and cognitive flexibility

CBD can ___________ many of the harmful effects of THC

offset

This form of cannabis usually has the highest THC content

oil - but potency of marijuana has increased since the creation of hydroponics

What are the two most commonly misused controlled drugs?

opioids and benzodiazepines

drug addiction in general has been linked to _____________________ dysfunction, making drug users more prone to maladaptive decisions

orbitofrontal cortex

opioid withdrawal - when do symptoms tend to peak, when do they tend to gradually diminish?

peak after 2-5 days gradually diminish over 7-10 days

compared to controls, male users of cannabis have a smaller ____________________

prefrontal cortex

In what stage of change should the client be encouraged to attend Narcotics Anonymous or Marijuana Anonymous meetings?

preparation

In what stage of change should the client be encouraged to eliminate paraphernalia and reduce contact with substance-using acquaintances?

preparation

Today's opioid crisis consists primarily of what 3 forms of opioids?

prescription drugs, heroin, and fentanyl

amotivational syndrome

prolonged motivations deficits caused by longterm cannabis use

Cannabis users with a _______________________ are more likely to develop CUD

psychiatric disorder

A Netherlands study found that cannabis use at age 16 predicted ___________________ 3 years later, and a reverse relationship was also found

psychosis

longterm effects of most hallucinogens are ___________________, whereas cannabis is known to have __________________ on longterm physical health

purely psychological; negative effects

The number of overdose deaths from prescription opioids in the USA has _______________ since 1999

quadrupled

marijuana ___________ the heart rate by 20-100% after about 20 minutes

raises

Maintenance strategies and relapse prevention for CUD are, for many people, partly facilitated by what?

regular attendance at relevant mutual support groups

maintenance and relapse prevention are, for many people, partly facilitated by what?

regular attendance at relevant self-help groups

Individuals with schizophrenia are likelier to ____________ if they use cannabis

relapse

Individuals who quit cannabis are more likely to have taken what two actions?

relied on positive social influences and made use of mutual support groups

opioid overdoses are characterized by what two symptoms

respiratory depression and lack of consciousness

opioid withdrawal, but NOT sedative withdrawal, results in which two symptoms

rhinorrhea (nasal cavity fills with mucus) lacrimation (flow of tears)

compared to controls, female users of cannabis have a larger _____________________

right amygdala

chronic users who begin using cannabis in adolescence may experience these changes to the structure and function of their brains

smaller volume of cortical grey matter and reduced activation in prefrontal brain regions

Smoking a single joint reduces breathing capacity to a similar degree as what?

smoking 5 cigarettes

What is considered the most efficient way to produce the effects of cannabis?

smoking it with a bong

More people fail at abstaining from _____________________ than any other illegal drug combined

smoking marijuana

What support exists for the idea that cannabis acts as a "gateway drug"

some cannabis users segue into harder drugs, especially heavy users and those who begin in adolescence

Which are the widest class of new drugs being monitored by the European Monitoring Centre on Drugs and Drug Abuse?

spice drugs

most common reason that people smoke pot?

stress release

metanoia

substantial change in the way one thinks and/or lives, a transformative change of the heart

medical uses for opioids (other than pain relief and anesthesia)

suppress a cough, suppress diarrhea

Levels of _________________ are suppressed in male opioid users, but unaffected in female users

testosterone

What can be taken to suppress withdrawal symptoms and cravings in cannabis dependent individuals?

the cannabis extract nabiximols (Sativex)

Cannabis most closely identifies with what neurotransmitter?

the fatty acid neurotransmitter anandamide

How are opioids used?

they can be smoked, taken orally or across a mucus membrane, or injected intravenously

When individuals quit cannabis, they become less likely to do what?

use other substances

In treatment of cannabis withdrawal, what are the uses of orally administered THC?

uses are to decrease the physiological and subjective effects of cannabis withdrawal

fine damage to the lungs makes it more difficult to what?

utilize oxygen efficiently

Cannabis and memory

working memory and episodic memory are impaired from cannabis use, which in turn impairs the encoding of new memories