ALTERED STATES: MARIJUANA, THE BRAIN & LEGALIZATION. May 15, :30 1:30 p.m. Presented by: Karen Wolownik-Albert and Dr.

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1 ALTERED STATES: MARIJUANA, THE BRAIN & LEGALIZATION May 15, :30 1:30 p.m. Presented by: Karen Wolownik-Albert and Dr. John Larson

2 Overview Marijuana Today Consumption Facts Marijuana and the Brain Medical Uses Side Effects Synthetic Marijuana Co-Occurring Disorders Treatment Issues Marijuana and Relapse Illinois Marijuana Laws

3 Marijuana... AKA... Cannabis THC Weed Pot Mary Jane Chronic Grass Bud Herb Blunt Joint Reefer Hydro Kush Ganja Bhudda Hemp Green Indo Wacky Tabacky

4 How Marijuana Looks

5 Marijuana Today Marijuana is the most commonly used illicit drug in America with 17.4 million past month users and used by 76.8% of current illicit drug users. New growing and harvesting techniques produce marijuana that is about 275% more potent than in was 10 years ago. And its cool to smoke weed....

6 Marijuana in Pop Culture

7 Changing Attitudes in America 1992: I did not inhale. 2008: I inhaled frequently. That was the point.

8 Audience Poll: Is marijuana addictive? A) Yes, it is. B) No, it is not. C) I m not sure.

9 Consumption Facts SHORT-TERM EFFECTS Difficulty in thinking and problem solving. Problems with memory and learning. Loss of coordination. Decreased reaction time. Distorted perception. Anxiety/panic. After an initial up user may feel depressed, emotional. Increased heartbeat (and risk of heart attack).

10 Consumption Facts LONGER TERM EFFECTS Fertility implications. Animal studies suggest that heavy users may experience disruptions in ovulation or produce less sperm. So it s possible people who use a lot of marijuana might have difficulty having children as they get older. Studies also show that babies born to women who use marijuana when they are pregnant may be more likely to have developmental and behavioral problems. Respiratory problems. People who smoke marijuana have more respiratory problems such as having more mucus, a chronic cough and bronchitis (irritated breathing passages).

11 Consumption Facts LONGER TERM EFFECTS Changes in blood pressure. Over time, continued use of marijuana can lead to decreased blood pressure, which may cause dizziness. It also seems to impair the body's ability to fight off infections and some other diseases. Emotional problems. Heavy users are more likely to report symptoms of depression than nonusers. They can also feel more anxiety, have more personality disturbances, and could exacerbate symptoms of schizophrenia or psychotic disorders. Suppression of immune system. Regular users are more likely to contract infections and other health problems. Impaired learning, memory, concentration and lower IQ for adolescents, as well as Changes in the brain. Marijuana can affect the areas of the brain that play a part in response to stress, motivation and reward.

12 Marijuana and The Brain What s in cannabis sativa? Cannabinoid receptors. Does the brain make a natural cannabinoid and what does it do? Acute effects of THC. Chronic physical effects of marijuana use. THC s chronic effects on brain function. Medical uses of marijuana. Is it addicting?

13 Cannabis Sativa Used for over 4000 years. Contains over 400 compounds, 60 are psychoactive. Most active component is THC (delta-6- tetrahydrocannabinol).

14 All drugs of abuse mimic neurotransmitters that exist naturally in the brain.

15 Cannabinoid Receptors Located throughout the brain and immune system. Two have been identified: CB1 in the brain and CB2 on T-cells in the immune system. Endogenous cannabinoid discovered in late 1990s: Anandamide. Synthetic THC subsequently developed.

16 Role of endogenous cannabinoids Work against the current. Act as a dimmer switch. Play important role in pain control (runner s high) and appetite regulation. Modulate dopamine activity. Modulate the immune response. High level of individual variability.

17

18 Dopamine Plays major role in motivation/reward. Food (sugar, fat, salt, chocolate), sex, nurturing. Final common pathway for most drugs of abuse.

19 Medical Uses FDA approved synthetic THC: Marinol. Combat weight loss in AIDS. Reduce nausea in chemotherapy. Multiple sclerosis. Glaucoma. Weaken the immune system following transplant? Treatment of chronic pain. Sedation.

20 Side Effects Smoking linked to same risks as tobacco: Emphysema. COPD. Interaction with anesthesia, CNS depressants, Prozac. Use during pregnancy linked to childhood leukemia.

21 Effect on Brain Function Special concern with adolescent brain development. Psychological side effects: Panic. Depression and amotivational syndrome. Psychosis (dose-related or toxic effect). Effect on pre-existing mental illness. Withdrawal and dependency.

22 Is It Addicting? Originally thought to be nonaddicting. Mounting evidence over the last 40 years. Tolerance. Withdrawal. Compulsive use and inability to stop, despite consequences. 17% of those who have used more than 5 times are at risk for dependence.

23 Synthetic Marijuana According to Gateway research, those in treatment for abusing K2 report the following: K2 can induce a limitless high. Significant agitation and aggression. Overdose victims experience blacking out, seizures, vomiting. Hallucinations, paranoia, seizures, anxiety and overactivation of the central nervous system are common (no CBD).

24 Effects of K2 According to Gateway individuals in treatment for abusing K2 report the following: Although K2 is known as synthetic marijuana, in reality, it is nothing like marijuana (signs and symptoms of use are not similar either). Many adults report getting some peer education prior to using, so they realize they should not use very much (quantity). Teens however seem to smoke K2 in the same manners and quantities as marijuana creating significant problems.

25 Long-Term Effects of K2 Research on the safety of synthetic K2 is only now becoming available. Initial studies are focused on the role of synthetic cannabis and psychosis. Studies suggest that synthetic marijuana intoxication is associated with acute psychosis, worsening of previously stable psychotic disorders, and also may have the ability to trigger a chronic psychotic disorder among vulnerable individuals, such as those with a family history of mental illness.

26 Honey Hash Oil Increasing THC Potency Process for extracting concentrated THC using butane or other chemicals Hash oil can then be smoked or used in edibles Increases overdose risk, risk of negative side effects

27 Marijuana and Co-occurring Disorders Many clients with co-occurring disorders use marijuana and believe it helps their symptoms. Research to the contrary. Persons with mental illness are more likely to experience negative effects when using marijuana: anxiety, depression and paranoia while high. Persons with schizophrenia and other psychotic illness who use marijuana experience more frequent hospitalizations and increased symptoms. Source: NAMI (

28 Failure to Launch Recent information from NIH Many studies have shown that daily marijuana users are functioning at a reduced intellectual level most or all of the time.

29 Failure to Launch One meta study compared daily marijuana users with persons who have used marijuana more than once but less than 50 times in their lifetime. Subjects had similar education and income backgrounds. Study found significant differences in educational attainment, fewer daily users completed college, and more daily users had an annual household income of less than $30,000.

30 Failure to Launch When heavy marijuana users were asked how use affected cognitive abilities, career achievements, social lives and physical and mental health, the majority of respondents reported negative effects on all of these measures.

31 Opening Doors to Other Drug Use Support in literature for and against gateway theories. Of adults ages 26 and older who used marijuana before age 15, 62% went on to use cocaine, 9% used heroin, and 54% reported non medical use of mind altering prescription drugs.

32 Opening Doors to Other Drug Use Yale University School of Medicine study found men and women ages who were marijuana users were 2.5 more likely than non users to later abuse prescription drugs.* Peer group and peer pressure issues. Decreased inhibitions when under the influence of marijuana, impaired judgment. *Fiellin et al., 2013, Journal of Adolescent Health.

33

34 Marijuana Abuse Treatment Abusers should be professionally evaluated for treatment need and level of care. Just Weed Syndrome. Many users of heroin, cocaine or prescription drugs are unconcerned with marijuana and may intend to continue using post-discharge.

35

36 Marijuana and Relapse Currently no medication assisted treatment specific to marijuana cravings. Relapse rates for marijuana dependent clients in outpatient treatment are similar to those clients dependent on alcohol, opiates and tobacco. One study showed a relapse rate of 71% within six months. In poly-substance dependent clients, relapsing on (or continued use of) marijuana in early recovery is likely to lead clients back to other drugs of choice.

37 Consequences of Illegal Use In 2005, 242, 200 emergency room visits in the U.S. involved marijuana use. After alcohol, marijuana is the second most frequent substance found in the bodies of drivers involved in fatal vehicle accidents. Marijuana remains in body for approximately days. Businesses drug test job applicants and employees to promote drug-free workplace. In Illinois, drivers testing positive for THC can be charged with DUI and subject to $25,000 fine and jail time.

38 Audience Poll: Should Marijuana be legal for medical use? A) Yes, it should. B) No, it should not. C) I m not sure.

39

40 Medical Marijuana Legalization in Illinois Four-year pilot project in Illinois as of January 1, Qualified patients must be ages 18 or older, residents of Illinois, certified by a doctor and have a qualified diagnosis: Cancer, Glaucoma, HIV, AIDS, Hepatitis C, ALS, Crohn s Disease, Alzheimer s, Muscular Dystrophy, Fibromyalgia, Rheumatoid Arthritis, Traumatic Brain Injury Patients may take home 2.5 ounces of marijuana with valid ID. Qualifying caregivers can cultivate up to six pot plants.

41 Unintended Effects of Legalization Increases access and supply for non qualified patients including adolescents. Manipulations of systems, doctor shopping; similar to what we see with prescription drug abuse. Increased need for monitoring, not sure how that can or will be met. May increase number of impaired drivers on the road, number of accidents, etc.

42 Audience Poll: Should marijuana be legal for recreational use in Illinois? A) Yes, it should. B) No, it should not. C) I m not sure.

43 Legal Recreational Marijuana in Illinois? Recreational use is legal in Colorado. Already seeing boom in tourism. After recent overdoses and death investigations, Colorado revising guidelines, particularly for edible products.

44 Opinion Poll: Young Men s Program Sample: 22 male residential (inpatient) clients, aged Primary drug of choice: Heroin/Opiates 36% Marijuana 23% Alcohol 18% Cocaine 13% Other (Amphetamines, Hallucinogens, Benzos) 10%. Clients who identified marijuana as the first drug they tried: 55% (Alcohol was second at 32%) Clients who believe marijuana is a gateway drug: 45% Clients who believe marijuana should be legal for RECREATIONAL USE: 100%

45 Client Stories

46 Sources US DEA data reported on Moore & Budney, 2003, Journal of Substance Abuse Treatment Source: drugfreeworld.com

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