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Cannabis and Mental Health

Cannabis and Mental Health. Through the Smokescreen?. Cannabis sativa. Marijuana Number of active ingredients Main psychoactive ingredient -9-tetrahydrocannibinol. Cannabis. Resin Dried leaves, seeds and flowers (sinsemilla – dried female head no seeds) Also in oil form. Usually smoked

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Cannabis and Mental Health

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  1. Cannabis and Mental Health Through the Smokescreen?

  2. Cannabis sativa • Marijuana • Number of active ingredients • Main psychoactive ingredient -9-tetrahydrocannibinol

  3. Cannabis Resin Dried leaves, seeds and flowers(sinsemilla – dried female head no seeds) Also in oil form

  4. Usually smoked • Or eaten

  5. CANNABIS (pot, dope, blow, grass, marijuana, ganga, weed, skunk, hash, draw, puff) • Acute Effects:Talkative, hilarity, well-being, self-confidence, appreciation of sound & colour, “munchies”Poor concentrationImpaired drivingAnxiety, agitation, paranoia (some people describe a feeling of impending death)Dry mouth, red conjunctivaeTachycardia, hypertension, postural hypotension

  6. Just say no spider Spider on hash

  7. Chronic effects: • Amotivational syndrome Reduced sperm count in menReduced fertility in women Bronchitis & emphysema? Lung cancer

  8. Withdrawal: Aggression, anger, anxiety, decreased appetite, decreased body weight, irritability, restlessness, shakiness, sleep problems, and stomach pain Onset typically occurred between days 1-3, peak effects between days 2-6, and most effects lasted 4-14 days. Affects 50-75% treatment seekers Budley, AJ, et. al., (2003)

  9. "Marijuana inflames the erotic impulsesand leads to revolting sex crimes"Daily Mirror (1924)

  10. 1935 In “Bulldog Drummond at Bay” the villains attempt to extract information by administering Cannabis. “…’that drug; what is it that ghastly drug?’ moaned the prisoner.‘Haven’t they told you?’ asked Veight. ‘It’s not a nice one, Waldron, and its result in time is to send you mad. It is a Mexican drug called Marihuana. It installs such fear into the mind of the taker that he ceases to be a man. He is mad with terror over nothing at all; his brain refuses to function; his willpower goes. And finally he finishes up in a suicide’s grave or a lunatic asylum.”

  11. Legal status • 1924 - At the second International Opiates Conference the Egyptian delegate claims that serious problems are associated with hashish use and calls for immediate international controls. A sub-committee is formed and listens to the Egyptian and Turkish delegations while Britain abstains. The conference declares cannabis a narcotic and recommends strict international control.

  12. 1968 A Home Office select committee, chaired by Baroness Wootton, looks at the 'cannabis question'. Its report concluded that cannabis was no more harmful than tobacco or alcohol, and recommended that the penalties for all marijuana offences be reduced. Campaign against cannabis use by US Troops in Vietnam - Soldiers switch to heroin. • 1969Incoming Labour minister Jim Callaghan rejects the Wootton recommendations and introduces a new Misuse of Drugs Act, which prescribes a maximum five years' imprisonment for possession. The Act remains in force to this day.

  13. 2001 The government sets up a Select Committee to look at drugs policy. When giving evidence the Home Secretary (David Blunkett) announces his intention to move cannabis from class B to class C, making possession a non-arrestable offence. • 2005 Having been asked byCharles Clarke to reconsider the classification of cannabis, ACMD (Advisory Council on the Misuse of Drugs) recommends that the classification remains the same. They further recommend more research into treatment and the links between cannabis and mental health problems.

  14. 2006 – Guardian reports that that the accepted limits for personal use are to be significantly reduced • From a recommended 133g to 5g for cannabis (10 joints or just over an eighth for any old hippies) • Penalty 14 yrs & £5k fine

  15. Because it is unlawful to possess or supply cannabis, it is difficult to obtain precise estimates about the extent of its use. The most reliable information comes from self-reported use in the British Crime Survey. Data from the 2003/04 survey suggest that over 3.3 million people used cannabis in the preceding year (2). As discussed in our previous report (1), cannabis use is particularly prevalent among people aged 16 to 24 years. Recent trends in reported use (3) among this age group are shown in Table 1. It should be noted that interviews for the 2004/05 report were carried out in April 2004 (corresponding to the March 2004 to March 2005 survey period). Consequently, respondents’ recall for “use in the past year” will include periods both before and after reclassification. However, the recall period for “use in the past month” covers only the post-reclassification period. The slow decline in cannabis use since 1998 has been sustained following reclassification and there is no evidence at present of any short-term increase in consumption among young people since reclassification. ADVISORY COUNCIL ON THE MISUSE OF DRUGS

  16. The Evidence • Dual Diagnosis (Mostly alcohol and cannabis) • ↑ Rates of homelessness • ↑ Rates of parasuicide and suicide • ↑ Rates of violence • Worsening of psychiatric symptoms • Poor adherence with medication • ↑ Rates of HIV • Greater contact with criminal justice • ↑ Use of services • (Banerjee et al. 2002)

  17. Veen, N, et. al. (2004) • Dutch cohort study (n=133)_ • Strong link between cannabis use and earlier onset in male patients with schizophrenia • Ferdinand, RF, et. al. (2005) • 1,580 young Dutch people for 14 yrs • Cannabis use and psychosis inextricably linked – two-way causality

  18. Fergusson, DM, et. al. (2005) • 1,265 NZ children – 25 yr study • Cannabis users 1.6 to 1.8 times more likely to develop psychotic symptoms – one-way causality • Newcombe, RD, (2004) • Statistical review • Argues that for a causal relationship to exist increases should vary constantly • Increases in cannabis use but no clear trends in schizophrenia or cannabis psychosis (?)

  19. Zammit, S, et. al. (2002) • Swedish conscript study (n=50,000) • Users of cannabis 2.2 times more likely to develop schizophrenia • Areseneault, L, et. al. (2004 • Review article • Frequent use of cannabis leads to increase in psychosis later. Suggest 8% reduction in schizophrenia if cannabis use were eradicated

  20. Smit, Boiler and Cuijpers (2004) • Assessed recent evidence • Testing 5 hypotheses • Self-medication (schizophrenia causes drug use) • Other drugs (effects of opiates and stimulants) • Confounding (Shared risk factors) • Interaction (predisposition to schizophrenia) • Aetiological (cannabis causes later psychosis)

  21. Smit, Boiler and Cuijpers (2004) • Hypotheses 1 and 2 dismissed • 3 open to debate • Converging evidence for 4 and 5 • “There is an intrinsic message here for public health, but how that message is to be translated into action is not immediately clear”

  22. Macleod et. al. (2004) • Other confounding variables – childhood adversity, reporting, dose, measurement biases (general population studies) • Tobacco and alcohol show similar psychosocial outcomes • Smoking and criminality far bigger problems

  23. Dr Mike Farrell National Addiction Centre X2 risk of developing schizophrenia But uncommon disorder so increase may not be picked up in general incidence studies Whatever outcomes worse if you have schizophrenia Dr John McLeod University of Birmingham Early symptoms of psychosis may predispose to cannabis use Under or over reporting may be shared Non causal link – like coffee and lung cancer The Experts

  24. Treatment • Drugs • Nabilone – synthetic cannabinoid • Oral maintenance cannabis did not effect self-administration of cannabis in a laboratory study.Oral THC did decrease cannabis craving and withdrawal compared with a placebo • CB1 selective cannabinoid receptor antagonist SR141716 (Rimonabant): Blocks acute psychological and physiological effects of cannabis. Maybe useful with highly motivated clients but not yet trialled for this use NB Rimonabant is an anti-obesity drug

  25. Other: • Buproprion (Zyban): exacerbates withdrawal but may reduce craving. NB Zyban is a treatment for nicotine addiction • Nefazadone: ameliorates anxiety and muscle pain during withdrawal • Lithium Carbonate: Animal study demonstrated abolition of withdrawal syndrome

  26. Treatment • Motivational Interviewing • CBT • Relapse prevention • With co-occurring MI delivered alongside PSIs and relapse prevention (see Mueser et. al., 2002)

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