Slides - Portico Network

Thursday October 1st, 2015
11:00 a.m. – 12:00 p.m. (EDT)
The Effects of Cannabis Use during Adolescence
Sheena Gereghty, Ph.D., Knowledge Broker, Canadian Centre on Substance Abuse
Dr. Sharon Cirone, MD., Chair, Addiction Medicine Program Committee, College of Family
Physicians of Canada (CFPC), Chair, Education Committee, Canadian Society Of
Addiction Medicine (CSAM)
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please turn up your computer speakers. Please note this event will be
recorded.
Webinar Outline
• Introductions
• Cannabis use among Ontario students: OSDUHS
highlights
• Overview of CCSA’s 2015 report The Effects of
Cannabis Use During Adolescence
Please type in the chat pod!
• Reflections from the field: Dr. Sharon Cirone,
Family Physician and Addictions Consultant to
the Child and Adolescent Mental Health team
at St. Joseph’s Health Centre in Toronto
• Q&A
Percentage Reporting Cannabis Use at Least Once in the Past
Year by Sex, Grade, and Region, 2013 OSDUHS
50
40
39.2
33.5
%
30
25.3
24.5
23
21.8
20.6
20
25.1
22.9 23.1
14.6
10
7
1.7
0
Total
M
F
G7 G8 G9 G10 G11 G12
TO
N
W
E
Notes: (1) vertical 'whiskers' represent 95% confidence intervals; (2) horizontal band represents 95% CI for total estimate; (3) significant
difference by sex and by grade (p<.05), no significant difference by region
Frequency of Drug Use in the Past Year Among
Users, 2013 OSDUHS (Grades 9-12 only)
1-2 Times
Cannabis
3-9 Times
26
Waterpipe ('Hookah')
26
36
47
28
Cocaine
52
Smokeless Tobacco
Opioid Pain Relievers (NM)
10+ Times
14
42
30
32
50
ADHD Drugs (NM)
35
28
45
Tranquillizers/Sedatives (NM)
36
32
54
Synthetic Cannabis ('Spice')
23
18
29
17
63
LSD
22
66
OxyContin/OxyNEO (NM)
20
62
Ecstasy
48
Salvia Divinorum
0
68
20
12
25
51
Mushrooms/Mescaline
13
32
64
OTC Cough/Cold Medication
14
25
56
Inhalants (Glue, Solvents)
15
11
40
10
43
8
26
40
60
80
%
Notes: NM=nonmedical use, without a doctor's prescription; frequencies displayed only for drugs with 50 or more users
6
100
Grade First Tried Cannabis Among All 7th Graders, 1981-2013
10
1981
8
1989
Fewer 7th
graders today
tried cannabis
at an early age.
1993
1997
6
2001
2003
2005
4
2007
2009
2011
2
2013
0
Grade 4
Grade 5
Grade 6
Grade at First Cannabis Use
Grade 7
For example, in
2013 about 2%
reported trying
cannabis for the
first time before
the end of grade 7,
compared with 9%
in 1981
Long-Term Trend:
Percentage Reporting Past Year Use, 1977-2013
40
Cannabis
%
30
20
10
0
77 79 81 83 85 87 89 91 93 95 97 99 01 03 05 07 09 11 13
www.ccsa.ca • www.cclt.ca
The Effects of Cannabis Use During Adolescence
Substance Abuse in Canada 2015
Registered Nurses Association of Ontario
Sheena Gereghty PhD
October 1, 2015
Substance Abuse in Canada Series
www.ccsa.ca • www.cclt.ca
8
Scientific Advisory Council
• Provides advice to CCSA regarding emerging areas of clinical and
neuroscience research
• Ensures that biomedical and neuroscience’s role in substance
use and abuse is considered in CCSA’s work
• Membership
•
•
•
•
•
•
•
•
Dr. Franco Vaccarino (Chair), University of Guelph
Dr. Tony P. George, Centre for Addiction and Mental Health
Dr. Rachel Tyndale, Centre for Addiction and Mental Health
Dr. Sherry H. Stewart, Dalhousie University
Dr. Zul Merali, University of Ottawa
Dr. Michael Krausz, University of British Columbia
Dr. Marco Leyton, McGill University
Rita Notarandrea, CCSA
www.ccsa.ca • www.cclt.ca
9
Knowledge Mobilization
www.ccsa.ca • www.cclt.ca
Image retrieved from EducatorsWeb2-0. https://educatorsweb2-0.wikispaces.com/3+Collaboration.
Date accessed: April 17, 2015.
10
Purpose of the SAIC Report
Report
available
on CCSA
website.
www.ccsa.ca • www.cclt.ca
11
Motivations for Use
•
•
•
•
•
•
Enhancement “it’s exciting”
Social “it helps me enjoy a party”
Coping “it helps me forget about my problems”
Expansion “it helps me understand things differently”
Conformity “so I won’t feel left out”
Routine “I use it out of boredom”
www.ccsa.ca • www.cclt.ca
12
Expectancies of Use
• Positive: relaxation/tension reduction, social/sexual
facilitation, perceptual/cognitive enhancement
• Negative: cognitive/behavioural impairments,
global/negative effects, craving/physical effects
www.ccsa.ca • www.cclt.ca
13
Perceived Risk and Use
Source: Volkow, Baler, Compton, & Weiss, 2014; reproduced with permission, Massachusetts Medical Society
www.ccsa.ca • www.cclt.ca
14
Youth Perceptions
Report
available
on CCSA
website.
www.ccsa.ca • www.cclt.ca
15
Youth Perceptions-Use
Everyone is using weed
“If like every single one of your friends is
doing it and say you know maybe two
people who aren’t doing it. You’re like
well everybody’s doing it and they’re
fine. Like why wouldn’t you do it? Like I
just want to try it.”
“Like if you haven’t tried weed, like most
people will say, oh well that’s very weird
of you. Like everyone else has.”
www.ccsa.ca • www.cclt.ca
16
Youth Perceptions-Harms
Weed is natural and so it’s
harmless
“You don’t hear about people
dying from grass.”
“Also it’s been proven that it
actually help, um not fight
cancer, but slow down the
actual development of the
cancer.”
www.ccsa.ca • www.cclt.ca
“For me, I’m thinking about for
my health. I take care of my
health. Because I smoke two
pack of cigarettes a day. A
cigarette gives you cancer, but
the weed cover it. It going to
clean it up.”
17
How does cannabis affect youth?
• The endocannabinoid
system aids the pruning
and myelination that takes
place throughout youth
www.ccsa.ca • www.cclt.ca
18
Youth Perceptions-Driving
Weed makes you a better driver.
“It started to make me
more cautious and I
started to pay more
attention to the roads,
signs and everything
that’s going on around
me.”
www.ccsa.ca • www.cclt.ca
“Yeah you get drunk and drive a
car and crash into a baby or
something… you get stoned and
you forget the keys and walk
home and raid your fridge.”
19
Cannabis Impairs Driving Abilities
www.ccsa.ca • www.cclt.ca
Image reproduced with permission from Arrive Alive.
20
Effective ID Prevention Programs
• Include parents, peers, schools and community
• Dialogue promotes critical thinking about attitudes and life choices
• Examples of injury and trauma make the risks real
• Youth-centric, youth-created, culturally sensitive, factual messaging
ensures comprehension
• Enforcing detection and penalties makes the consequences real
www.ccsa.ca • www.cclt.ca
21
Youth Perceptions-Mental Health
Weed is natural and so it’s harmless.
“A man like me, with ADHD and bipolar, that
stuff keeps my mind at an ease and I could
just think normally. I can go on with my day.
Usually, when I don’t smoke weed, I can’t do
nothing. Too much of my brain is flustered.”
www.ccsa.ca • www.cclt.ca
22
Cannabis and Psychosis
Cannabis use
• Leads to earlier onset of psychotic
symptoms
• Major risk factor for developing
schizophrenia
• Worsens the symptoms of those
predisposed to developing schizophrenia
• Causation still debated
• Risk is increased in a dose-dependent
manner
www.ccsa.ca • www.cclt.ca
Caspi et al., 2005; adapted with
permission from Elsevier
23
Cannabis and Mood Disorders
Cannabis use
• Increases risk of depression in parallel to earlier initiation
and frequency of use
• Increases risk of suicidal thoughts and attempts, especially
among females
• May be better explained by confounding factors
• Related to greater length of affective, and number of manic
episodes, more rapid cycling, increased overall disability
and more sever prognosis for individuals living with bipolar
disorder
www.ccsa.ca • www.cclt.ca
24
Cannabis and Anxiety Disorders
• Cannabis use
anxiety
• Social anxiety & PTSD
• Cannabis
www.ccsa.ca • www.cclt.ca
HPA axis
cannabis use
reactions to stress
25
Youth Perceptions - Thinking
Weed helps you focus.
“There’s been people that could
completely function on marijuana.
They could do everything on
marijuana. Sometimes better than
what they do, you know.”
www.ccsa.ca • www.cclt.ca
26
Cognitive and Behavioural Effects
Early and regular cannabis use can
result in
• Poor academic performance
• Structural imaging reveals
difference in the size,
connectivity, and quality of brain
structures
• Functional imaging reveals
greater activity while completing
tasks
• Apathy may be related to
reduction in brain volume
www.ccsa.ca • www.cclt.ca
27
Youth Perceptions - Addiction
Weed is not addictive.
“psychological addiction, that’s it, it’s
not physical if you quit weed”
www.ccsa.ca • www.cclt.ca
28
Cannabis Can Be Addictive
• 1/6 who use cannabis during adolescence will develop a
cannabis use disorder
• 1/20 Canadian youth met the criteria for cannabis abuse
during 2012
• CUD develop faster than alcohol or tobacco
• Withdrawal can occur with individual experiencing
irritability, anxiety, restlessness and sleep disturbances
www.ccsa.ca • www.cclt.ca
29
Which youth are at risk?
Genes
Shared
Environment
Unshared
Environment
Males
Females
Genes
Shared
Environment
Unshared
Environment
www.ccsa.ca • www.cclt.ca
30
Cannabis Dependence
Risk Factors
Protective Factors
• Religiosity
• Initiation of use by age 15
• Low socioeconomic status
• Use of other drugs
• Regular cannabis use
• Anti-social behaviour
• Persistent tobacco use
• Living alone
• Using cannabis as a coping mechanism
• Number and type of recent life events
www.ccsa.ca • www.cclt.ca
31
Youth Perceptions – Problematic Use
“I realized I have a
problem… when I
woke up in the
morning and I say yo I
need some herb in my
system, you know
what I’m saying?”
“…and you know what else I knew I was
addicted? You got ten dollars in your pocket
and you spend half of it on weed. And the
other half on food.”
www.ccsa.ca • www.cclt.ca
32
Prevention of cannabis use
Comprehensive school-based prevention programs have a
27.9% success rate at reducing adolescent cannabis use
• Incorporation of elements from multiple prevention
models
• Longer program duration
• Facilitation by non-teachers
• Targeting high school students
www.ccsa.ca • www.cclt.ca
33
Screening and Brief Interventions
• CRAFFT
• Brief Screener for Tobacco,
Alcohol and Other Drugs
• Project Chat
• Adolescent Cannabis Check Up
www.ccsa.ca • www.cclt.ca
34
Behavioral Interventions
Treatments mainly involve therapies focusing on
psychological well-being
• Cognitive behavioral therapy (CBT)
• Motivational enhancement therapy (MET)
• Multidimensional family therapy (MDFT)
• Contingency management (CM)
www.ccsa.ca • www.cclt.ca
35
Pharmacological Interventions
• Potential targets
• Cannabis withdrawal symptoms
• Abstinence initiation
• Relapse prevention
• Treatment of co-occurring disorders
• Medication can
• Diminish withdrawal symptoms
• Reduce cravings
• No improved clinical outcomes
• Adolescents not the primary target group
www.ccsa.ca • www.cclt.ca
36
Emerging Approaches to Treatment
Web/Computer-based interventions
• Accessible
• Private
• Immediate
www.ccsa.ca • www.cclt.ca
37
Key Messages
• Talk to youth about myths and evidence
• Delay initiation of use to protect the brain
• Regular cannabis use can influence driving, cognition
and mental health
• Cannabis can be addictive
• Screen youth for problematic use
• Know the appropriate brief intervention and treatment
referral options
www.ccsa.ca • www.cclt.ca
38
RNAO Best Practice Guideline:
Engaging Clients Who Use Substances
• This guideline addresses the
question of how to assess and
provide care to individuals who use
substances
• Provides evidence-based
recommendations and tools for all
nurses and the interprofessional
team
• Available at:
www.rnao.ca/substanceuse
www.ccsa.ca • www.cclt.ca
39
RNAO Mental Health and Addictions
Initiative: E-learning Modules
1. Addictions E- learning Series (MTT Focused)
(http://rnao.ca/bpg/courses/addictions-elearning-series)
2. Engaging Clients with Substance Use Disorders Adults
(http://rnao.ca/bpg/courses/engaging-clients-substance-use-disorders)
3. Engaging Youth who Use Substances
(http://rnao.ca/bpg/courses/engaging-youth-who-use-substances)
4. Tobacco Use Cessation in Clients with Mental Illness and Concurrent
Addictions (http://rnao.ca/bpg/courses/nurses-and-other-healthprofessionals-supporting-tobacco-use-cessation-clients-mental-il)
www.ccsa.ca • www.cclt.ca
40
Contact Information
Sheena Gereghty, PhD
613-235-4048 ext. 229
[email protected]
Canadian Centre on Substance Abuse
75 Albert Street, Suite 500
Ottawa, ON K1P 5E7
@CCSAcanada • @CCLTcanada
www.ccsa.ca • www.cclt.ca
41
Reflections from the Field
Dr. Sharon Cirone, MD.
Chair, Addiction Medicine Program Committee, College of Family Physicians
of Canada (CFPC), Chair, Education Committee, Canadian Society
Of Addiction Medicine (CSAM)
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