Alcohol and Drugs_5Q
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AlcoholandDrugs_5Q.pdf
Alcohol and other Drugs Class (Marijuana Questions - AOD Study)
Required Text:
Hanson, G., Venturelli, P., Fleckenstein, A. (2011 or 2014) Drugs and Society, Eleventh, Twelfth or Thirteenth Edition. Jones and Bartlett Publisher.
Please answer all questions in the last page.
Professor gave us PowerPoint I have transferred it to PDF in the same file after this page and also these links:
https://medicalmarijuana.procon.org/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1336774/
http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=24625&utm_s ource=NAP+Newsletter&utm_campaign=629c834b80- EMAIL_CAMPAIGN_2017_02_06&utm_medium=email&utm_term=0_96101de015- 629c834b80-102127153&goal=0_96101de015-629c834b80- 102127153&mc_cid=629c834b80&mc_eid=ad95803851
https://www.drugabuse.gov/publications/drugfacts/prescription-over-counter- medications
https://moodle.wou.edu/pluginfile.php/247024/mod_resource/content/1/DEAmarijuana_ position_2011.pdf
Marijuana
Chapter 13
What Is Marijuana? • Marijuana is a hemp plant
whose biological name is cannabis sativa. It consists of green, brown, or a grey mixture of dried, shredded leaves, stems, seeds, and flowers.
• THC (delta-9-tetrahydrocannabinol) is the primary mind-altering ingredient in marijuana.
Brief History and Trends • Marijuana has historically been a valued crop. The
woody fibers of the stem yield a fiber that can be made into cloth and rope.
• Early records of marijuana use: - China 2737 BC and India (religious ceremonies) - Assyrians, dating back to 650 BC used it for making
rope, cloth, and consumed it to experience euphoria - Ancient Greeks also knew about marijuana - In North America, in Jamestown (1611), marijuana
was used to make rope and clothing - Currently, marijuana grows wild in many U.S. states
Early History
• Earliest mention: Chinese pharmacy book (2737 BC)
• Social use of the plant had spread to the Muslim world and North Africa by AD 1000 - “Hashishiyya” religious cult carried out
political murders - Story of cult spread in works by Marco Polo
(1299) and Boccaccio (1350s) • Possible origin of the term assassin
- Hashish use mentioned frequently in The Arabian Nights
History: Europe
• Napolean’s soldiers brought use of hashish back from campaign in Egypt (1790s)
• Popular account of hashish use appeared in Dumas’ The Count of Monte Cristo (1844)
• French Romantic writers (1840s to 1860s) wrote about effects of hashish
U.S. History: “Marijuana, Assassin of Youth”
• Early 1900s: Little public interest or use • 1926: Series of newspaper articles linked marijuana
and crime - Other reports by police and in popular literature followed
• 1936: All states had laws regulating the use, sale, and/or possession of marijuana
• Federal Bureau of Narcotics- Harry Anslinger - “cause for greatest national concern” - Testimonnies linking marijuana use with crime or violence
U.S. History: “Marijuana, Assassin of Youth”
• Contributing factors to “pyramid of prejudice” against marijuana - Marijuana use associated with lower-class groups and
recent immigrants - Regular references made in popular literature to the
murdering cult of assassins as suggestive of the characteristics of the drug
- Testimonies to US Congress by Bureau’s agents told outrageous stories of murder and sexual perversion
Marijuana Tax Act of 1937
• Act followed the regulation-by-taxation theme of the 1914 Harrison Act - Grower, distributor, seller, and buyer were taxed - Administratively almost impossible to deal in Cannabis
• Bureau of Narcotics uniform law specifically named Cannabis sativa
• State laws made possession and use of Cannabis illegal per se
• 1969: U.S. Supreme Court declared the Marijuana Tax Act unconstitutional
• 1970: marijuana was listed as Schedule I
After the Marijuana Tax Act
• 1950s and 60s - Little scientific research done on Cannabis - Use of Cannabis continued to increase
• A common symbol of youthful rejection of authority • Identification with a new era of personal freedom
• Usage peaked around 1980, declined until the early 1990s, and then rose again
• Cost of marijuana increased significantly (black market) • Reports continued to be published that marijuana use had
less serious effects than commonly believed BUT - Substantial disagreement over the interpretation of research findings
© 2008 McGraw-Hill Higher Education. All rights reserved.
Marijuana use among persons age 12-25 Source: National Survey on Drug Use and Health
Several Questions and Answers • Today marijuana is how many times more
potent than the marijuana on the street in the 1960s and 1970s? - Approximately 20 times more potent as result
of more efficient agriculture largely due to new methods of harvesting, new varieties, and special processing marijuana of plants
- http://www.drugabuse.gov/drugs- abuse/marijuana
• How many Americans are current marijuana users? - Aged 12 or older in 2011: Out of 18.1 million
illicit drug users, approximately 64.3% reported current use of only marijuana and another 16.2% used marijuana with another illicit drug. (This means that a staggering 80.5% [64.3% + 16.2%] either used marijuana alone or used marijuana with another drug.) The remaining 19.5% of drug users used an illicit drug but not marijuana.
Several Questions and Answers (continued)
Noteworthy Findings Regarding Marijuana Users
• It is the most highly abused illicit type of illicit drug. • The highest rate of use was found among young
adults (ages 18–25) with 18.9% reporting current use (past month) and among youth (ages 12–17) with 7.6% reporting current use.
• The average age of first use was 17.5 years. • There were 2.6 million new marijuana users in 2011,
which averages 7,200 initiates per day.
Major Factors Affecting Marijuana Use
• Structural factors: Age, gender, family background, lack of any religious beliefs
• Social and interactional factors: Type of interpersonal relationships, friendship cliques, drug use within the peer group setting
• Setting: Type of community and neighborhood (physical location of drug use)
• Attitudinal factors: Personal attitudes toward the use of drugs, self esteem, maturation level
Major Factors Affecting Marijuana Use (continued)
• Participation in after-school activities is associated with higher levels of academic achievement and self-esteem, as well as lower levels of substance use
• Religious involvement affects illicit drug use and this clearly includes marijuana use
• http://www.drugabuse.gov/publications/rese arch-reports/marijuana/there-link-between- marijuana-use-mental-illness
Cannabis Use Disorder Defined by DSM-V*
• Cannabis is often taken in larger amounts than was intended
• There are persistent desires or unsuccessful efforts to cut down or control cannabis use
• Much time is spent securing the drug, using the drug and/or recovering from its effects
• Craving the euphoric effects of the drug • Failure to fulfill major role obligations at work,
school, or home • Continued use of cannabis despite persistent or
recurrent social and interpersonal problems cased by the effect of cannabis
Cannabis Use Disorder Defined by DSM-V* (continued)
• Important social, occupational or recreational activities are given up or reduced because of cannabis use
• Recurrent cannabis usage in situations in which it is physically hazardous
• Cannabis use is continued despite persistent or recurrent physical or psychological problems stemming from usage
• Tolerance develops to offset the diminishing effects of cannabis resulting in more use of cannabis
• Withdrawal symptoms lead to increased use of cannabis _________________ *These two slides, (slides 9 and 10), are Heavily paraphrased from American Psychiatric Association
(APA). "Substance-Related and Addictive Disorders." In Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 5th ed., 509–510. Arlington, VA: American Psychiatric Association, 2013.
Marijuana • Gateway drugs are drugs that often lead to the
use of more addictive types of drugs (gateway to the use and abuse of other more potent drugs). - Alcohol, tobacco, and marijuana are the drugs
most commonly believed to be gateway drugs. - Other common gateway drugs include
inhalants and anabolic steroids. More recently, the abuse of prescription drugs (mainly painkillers) are also included.
Marijuana use and teens
• Concern for pot use under age 21 • http://www.drugabuse.gov/news-
events/news-releases/2012/12/regular- marijuana-use-by-teens-continues-to-be- concern
Two Major Types of Marijuana • Cannabis Sativa:
- Originates from Colombia, Mexico, Jamaica, South Africa, Thailand, and Southeast Asia
- Causes uplifting and energetic feelings, appetite stimulant, and provides pain relief
• Cannabis Indica: - Originates from hash producing with very warm climates in
such countries Afghanistan, Pakistan, India, Turkey, Morocco, and Tibet
- Causes body relaxation, stress relief, and calmness and serenity and has lower THC content than Sativa
Varieties of Marijuana from the Cannabis Sativa Plant
• Hashish: Average concentration of THC is 12.1% for domestic, 7.03% for non-domestic, and 20.76 for samples seized by law enforcement officials
• Ganja: Consists of the dried tops of female plants. The term is also used as a slang term for marijuana (pot, weed, reefer)
• Sinsemilla (without seeds), “hydro” (grown in water), kind bud, dro, 30s, AK-47, and blueberry (more recent names of popular types of marijuana). The average concentration of THC is 7.5% and higher
• Bhang: Average concentration of THC is 1% to 2%
Pharmacology: Cannabinoid Chemicals
• Chemistry of Cannabis is complex and unique - Active agent contains no nitrogen and thus is not an
alkaloid like other psychoactive plant materials • Cannabinoids are 66 chemicals unique to the
Cannabis plant - Delta-9-tetrahydrocannabinol (THC)
• Isolated and synthesized in 1964 • The most pharmacologically active cannabinoid
- There may be several other active agents in Cannabis
Pharmacology: Cannabinoid Chemicals
© 2008 McGraw-Hill Higher Education. All rights reserved.
Delta-9 THC, the most active substance found in Cannabis (left), and anandamide, isolated from brain tissues (right)
Pharmacology
• Smoked marijuana - THC is absorbed rapidly by the blood and travels to the
brain and then the rest of the body • Within 30 minutes, most THC is gone from the brain
- Peak psychological and cardiovascular effects occur together within 5 to 10 minutes
• Oral THC - THC is absorbed more slowly and the liver transforms
it into 11-hydroxy-delta-9-THC • Less THC reaches the brain
- Peak effects occur about 90 minutes following ingestion
Pharmacology • Metabolites have different half-lives
- After one week, 25 to 30 percent of the THC and its metabolites might remain in the body
- Two or three weeks may be required to completely eliminate a large dose of THC and its metabolites
• High lipid solubility of THC and its metabolites - Selectively taken up and stored in fatty tissue, to be released
slowly - No easy way to monitor THC and metabolite levels and relate
them to effects - Long-lasting low concentrations of THC and metabolites may have
effects on the brain and other organs
Laws regarding Cannabis
• State and federal action - Federal government announced plans to prevent
medical marijuana use • Closure of Cannabis clubs • Revocation of the DEA registration of any physician who
advised a patient to use marijuana • Prosecution of physicians and patients
- 2005: U.S. Supreme Court ruled that patients could be prosecuted for possessing marijuana even if their physicians recommended its use for a serious illness
Medical research of Cannabis
• Findings from Institute of Medicine report - Marijuana is a relatively safe and effective medicine for
patients suffering from certain chronic conditions - More research is needed on marijuana and synthetic
cannabinoids - An effective inhaler should be developed to solve the
problem of poor oral absorption of THC - Compassionate use of smoked marijuana cigarettes
should be allowed for no more than six months in certain patients with debilitating, intractable pain or vomiting
Abuse and Dependence
• Tolerance to many marijuana effects develops after regular use of high levels - Tolerance may not develop uniformly to
all effects • Marijuana has abuse potential • A significant minority (9%) of
current marijuana users may be abusing or dependent on the drug
• DAWN: Nearly 80,000 marijuana- related ER visits per year
Abuse and Dependence: Withdrawal
• DSM-IV: No listing of cannabis withdrawal BUT • Research suggests an abstinence syndrome does exist
- Not life threatening but unpleasant - Symptoms
• Negative mood states–anxiety, irritability • Disrupted sleep • Decreased food intake • Aggressive behavior (in some cases)
- Begins about 1 day after the last dose - Lasts 4 to 12 days
Toxicity Potential
• Acute physiological effects - Increased heart rate, possibly risky for someone with
preexisting cardiovascular disease - No human overdose deaths have been reported
• Panic reactions - Characterized by fear of loss of control and fear that
things won’t return to normal - More common among less-experienced users
Toxicity Potential
• Driving ability: Research findings mixed - Laboratory studies of computer-
controlled driving simulations • Marijuana produces significant impairment
- Epidemiological studies • Little evidence that drivers who use
marijuana alone are more likely to be involved in an accident
- Effects may be more severe in infrequent users
• Watch Colorado and Washington statistics
Driving Performance
• The ability to perform complex tasks, such as driving, is often impaired while under the influence of marijuana.
• In limited surveys, from 70% to 80% of marijuana users indicate that they sometimes drive while being high.
• Research reveals that approximately 600,000 high school seniors drive after smoking marijuana (DEA, 2006) and 41% of teens were not concerned about driving after taking drugs.
• Habitual cannabis users were 9.5 times more likely to be involved in crashes.
Mechanism of Action
• Anandamide - Endogenous substance isolated from brain tissue with
marijuana-like effects - From ananda, Sanskrit for “bliss”
• THC and other cannabinoids bind to two receptors - CB1 receptor - CB2 receptor
Mechanism of Action • CB1 receptor found primarily in the brain but also
unusually widespread throughout the body - Potential actions of cannabinoids are widespread - High density of CB1 receptors in specific brain regions
• Basal ganglia (movement coordination) • Cerebellum (fine body movement coordination) • Hippocampus (memory storage) • Cerebral cortex (higher cognitive functions) • Nucleus accumbens (reward)
• CB2 receptor found mainly outside the brain in immune cells - Potential role of cannabinoids in the modulation of the immune
system
Mechanism of Action
• Rimonabant, a selective CB1 receptor antagonist, is being tested
- Shows promise in reducing food intake and helping people quit smoking
- Concerns raised over use of the drug due to lack of understanding of the normal function of anandamide’s action on CB1 receptors
- Obesity drug withdrawn from market: - http://www.netdoctor.co.uk/diet-and-
nutrition/medicines/acomplia.html
Behavioral Effects • Low to moderate doses produce euphoria and a
pleasant state of relaxation. • Common effects: dry mouth, elevated heartbeat,
some loss of coordination and balance, slower reaction times, reddening of the eyes, elevated blood pressure, some mental confusion (short- term memory loss).
• A typical high lasts from 2 to 3 hours (length of effect depends on amount of THC), and the user experiences altered perception of space and time as well as impaired memory.
Behavioral Effects (continued)
• An acute dose of cannabis can produce adverse reactions: mild anxiety to panic and paranoia.
• In a minority of cases users can exhibit psychosis, delusional and bizarre behavior, and hallucinations. These reactions occur most frequently in individuals who are under stress, anxious, depressed, or borderline schizophrenic, and are using the more potent types of marijuana.
Behavioral Effects (continued) • Subjective euphoric effects: The ongoing social
and psychological experiences incurred while intoxicated with marijuana. These include both the user’s altered state of consciousness and his/her perceptions while intoxicated.
• Attachment to the use of Marijuana: Users exhibit a strong attachment to their passsionate feelings about using marijuana.
• Differential association: Behavioral satisfaction derived from friends who use marijuana (“fun- times when high with friends”).
Driving Performance • The ability to perform complex tasks, such as
driving, is often impaired while under the influence of marijuana.
• In limited surveys, from 70% to 80% of marijuana users indicate that they sometimes drive while being high.
• Research reveals that approximately 600,000 high school seniors drive after smoking marijuana (DEA, 2006) and 41% of teens were not concerned about driving after taking drugs. (Driving while under the influence of a drug termed drugged driving.)
• Habitual cannabis users were 9.5 times more likely to be involved in crashes.
Drugged Driving
NIDA • http://www.drugabuse.gov/publications/dru
gfacts/drugged-driving • Criminal Justice Dept Facts • https://www.ncjrs.gov/impaireddriving/gene
ral.html
Critical Thinking Skills • Marijuana has been found to have a
negative impact on critical thinking skills. • Specifically, heavy marijuana use impairs
attention, memory and learning. • Marijuana alters brain activity because
residues of this drug persist in the brain. • http://www.drugabuse.gov/about-
nida/directors-page/messages- director/2012/09/marijuanas-lasting-effects- brain
Amotivational Syndrome or Anti-motivational Syndrome
• Amotivational syndrome refers to a belief that heavy use of marijuana causes a lack of motivation or impaired desire and reduced productivity.
• Specifically, users show an increase in: - Apathy - Poor short-term memory - Difficulty with concentration - A lingering lack of interest in pursuing goals
Therapeutic Uses of Marijuana
• Medical marijuana use: Involves using the THC derived from smoking marijuana or using Marinol as a drug to calm or relieve symptoms of an illness.
• 1985: Oral TCH (dronabinol; brand name Marinol) licensed for sale to cancer patients experiencing nausea from chemotherapy
• Marinol
Medical Uses
• Some research shows that THC can be used for treating: - Glaucoma: potentially blinding eye
disease causing continual and increasing intraocular pressure
- Analgesic effect: In patients experiencing frequent migraines and chronic headaches or inflammation
Therapeutic Uses of Marijuana (continued)
• Appetite stimulant: Patients experiencing anorexia, AIDS, chemotherapy and radiation therapy
• Antiseizure: Aids in the prevention of seizures (epilepsy)
• Antiasthmatic effect: Short-term smoking of marijuana improves breathing for asthma patients
• Antidepressant effect: Used in Great Britain as a euphoriant for treating depression
• Muscle relaxation: Aids in reducing muscle spasms
Arguments Against Marijuana Use • It contains 421 chemicals. • It is stronger than it was 20 years ago. • Smoking this drug is worse for the lungs than
tobacco. • Impairs short-term memory and may cause “amotivational syndrome.”
• U.S. federal law continues to legally prohibit the possession, the sale, and use of marijuana. (The federal government believes marijuana has no medically proven use.)
Physiological Effects • The brain: THC activates the reward system in the brain
by stimulating brain cells to release the chemical dopamine
• Central nervous system: Alters mood, coordination, memory, and self-perception
• Respiratory system: Damage to the lungs • Cardiovascular system: Marijuana products limit the
amount of oxygen that can be carried to the heart • Sexual performance and reproduction: Affects the
sympathetic nervous system, increasing vasodilation in the genital and delaying ejaculation; high doses can decrease sexual desire
Effects of Marijuana on the Central Nervous System
• Altered perceptions - Changes in the interpretation of stimuli
resulting from marijuana use • “Munchies”
- Hunger experienced while under the effects of marijuana
• Anandamide - Possible neurotransmitter acting at the
marijuana (cannabinoid) receptor site
Effects on Other Systems
• Alveolar Macrophages (respiratory system) - Special white blood cells that play a role in
cleaning lung tissue are less able to remove debris when exposed to smoke
• Vasodilation (cardiovascular system) - Enlarged blood vessels
• Aphrodisiac (sexual performance and reproduction) - In lower doses of marijuana, THC is believed
to cause sexual arousal
Marijuana
Marijuana
u Hallucinogen? Sedative hypnotic? Stimulant? Narcotic?
u Cannabis sativa, sinsemilla, ganja, bhang, hashish, Marinol,
u THC - delta 9 tetra hydro cannabinol u cannabinoids and 360 chemical
compounds
Short term psychological
u Reaches brain in seconds, peak effect at about 30 minutes
u giddiness, decreased judgement, relaxation, decreased concentration,
u short term memory loss, time distortion, dream like state, exaggerated mood
u hallucinations, paranoia, anxiety, depersonification
Short term physical
u Impaired eye tracking u dry mouth, increased appetite,
increased heart rate, bronchodilator u bloodshot eyes, reduces pressure
(glaucoma) u sleepiness
Why the munchies? u “These findings indicate that
endocannabinoids in the hypothalamus may tonically activate CB1 receptors to maintain food intake and form part of the neural circuitry regulated by leptin,
u “The endocannabinoid receptors such as CB1 are very widespread in the central nervous system,Cannabinoids have effects on memory, cognition, coordination, mood, pain sensation, sleep and appetite
u Jo et al.: "Integration Of Endocannabinoid and Leptin Signaling in an Appetite-Related Neural Circuit." Publishing in Neuron, Vol. 48, 1055-1066, December 22, 2005, DOI 10.1016/j.neuron.2005.10.021
Long term physical
u Increased tolerance - decreased tolerance
u lung damage - bronchitis, emphysema, decreased immune function
u Fat soluble - 4 day half life - easiest to test for in UA’s
u disruption of testosterone in males, estrogen/menstrual cycle in females
u Brain damage?
Long term psychological
u Apathy, amotivational syndrome u short term memory deficit u difficulty in long term planning u post hallucinogen drug perceptual
disorder u http://drugabuse.gov/infofacts/marij
uana.html
Overdose
u Anxiety attacks, paranoia, panic attacks, hallucination/elation
u Withdrawal: mild but long lasting (6 to 12 months) irritability, sleep disturbances, headache, cravings, cravings, cravings, cravings
Drug interactions
u People mix marijuana with everything: alcohol, barbiturates, tranquillizers, LSD, cocaine, amphetamines, tobacco
u Medical uses:glaucoma, asthma, nausea and vomiting, pain in MS, withdrawal from sedative hypnotics or stimulants, increase appetite for chemo or AIDS
Treatment u Oregon Drug Rehab Programs - Statistics (2004) u Oregon Population (2004): 3,589,168
Source: The Office of Applied Studies, Substance Abuse Treatment and Mental Health Services Administration, Treatment Episode Data Set. A total of 45,073 admissions to Oregon alcohol rehabilitation programs and Oregon drug rehabs took place in 2004 according to data collected by TEDS. 31.7% these admissions were for alcohol rehabilitation only. 6.4% for heroin addiction treatment, marijuana 15.3% and cocaine addiction treatment 2.3%.
u http://drugabuse.gov/DrugPages/Marijuan a.html
The Oregon Medical Marijuana Program The Gold Standard of Government Programs
Full Presentation and Data Links at http://ornorml.org/data
Oregon NORML – Madeline Martinez – Executive Director
1. Using information from the text and class power point, write out the pharmacology of marijuana using the pharmacology format taught in this class. Include, short term physical and psychological effects, long term physical and psychological effects, overdose, withdrawal.
2. Briefly explain conclusions from research for marijuana use and driving.(what kind of impairment from marijuana use might make driving dangerous, what do research reports from the DEA show)
3. Define amotivational syndrome and briefly explain conclusions from research for marijuana use and amotivational syndrome.
4. List 6 recognized medicinal uses for marijuana.
5. Is marijuana addictive? Explain the NIDA data that answers this question. http://www.drugabuse.gov/publications/research- reports/marijuana/marijuana-addictive Make sure to use the DSM IV or V criteria to describe marijuana dependence.
