understanding the impact of marijuana on today’s youth · 2020. 5. 14. · understanding the...
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Understanding the Impact of Marijuana on
Today’s Youth:
Andrea G. Barthwell, MD, FASAMCEO of EMGloval, Founder and Director of Two Dreams
TOI Annual Educational ConferenceNovember 10th, 2014
Compassionate Care Act
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Disclosures No conflict of interest with this content Potential perception of conflict:
Collaborator: Caron Foundation Consultant: Alvee Laboratories, Braeburn Pharmaceuticals,
Millennium Laboratories Founder: The Parents Academy (supported, in part, by Caron
Foundation) Managing Partner: Treatment Partners LLC (Two Dreams Outer
Banks) Medical Director: Encounter Medical Group, P.C. Partner: EMGlobal LLC Former Consultant: GW Pharmaceuticals
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Outline
Debunking the myths Prevention works
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My Opinions Extensive review of scientific literature Personal communications with scientists in the area
Physician in addiction medicine Former member of FDA advisory board Former policy advisor to President Bush
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The Marijuana Problem
Bigger Than Previously Recognized
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The Marijuana Problem Most widely used illicit drug in America Of 5.6 million suffering, 62% are using marijuana
Young people represent 23% of the suffering population
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Problem, Continued Average age of initiation decreasing Marijuana’s potency is increasing With increasing potency and earlier use, marijuana poses significant threat
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Problem, Continued Of all teens in drug treatment, 62% had primary marijuana diagnosis
More young people in treatment than for alcohol
Almost equal numbers from criminal justice and other sources
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Treatment Admissions (Ages 12 ‐ 17)Primary Diagnosis
18%
60%3%
2% 2%
8%
8%
Alcohol only
Alcohol w/drug
Opiates
Cocaine
Marijuana
Stimulants
Other/NoneSOURCE: SAMHSA, Treatment Episode Data Set, 1999
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Debunking the Myths
Marijuana is harmless Marijuana is not addictive Youth experimentation is inevitable The criminalization of marijuana use is what leads to crime, not the drug itself
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Myth 1: Marijuana Is Harmless Health consequences Social consequences Economic consequences
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Health Consequences Defined Acute Effects
while intoxicated
Post acute withdrawal abstinent state in the regular, dependent user
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Health Consequences Defined Persistent and Chronic Effects
impairments developed as a result prolonged use, endure beyond the period of intoxication
impairments due to use, structural and functional changes to major organs
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Acute Effects Time sense alterations
Short term memory loss
Attention skills General difficulty expressing simple thoughts in words
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Acute Effects Motor skills Increase in hunger Nausea Dizziness
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Acute Effects Alter mood Euphoria State of relaxation
Panic
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Acute Effects Trait and state anxiety
Tension and anger Confusion Depersonalization and other behavioral effects
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Areas of Harm Need for acute care
Central Nervous System
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Need for Acute Care Relationship to acute need for medical assistance
Rising faster than heroin caused need for medical assistance
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0
30,000
60,000
90,000
120,000
150,000
1988
1990
1992
1994
1996
1998
2000
2002
DAW
N M
ENTI
ON
S
0
1
2
3
4
5
6
7
8
9
10
% D
ELTA
-9 T
HC
DAWN mentions
Marijuana potency
Sources: Drug Abuse Warning Network, SAMHSA, August 2003Univ of Miss Marijuana Potency Report #82, Aug 2003
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0
50,000
100,000
150,00019
90
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
Heroin Marijuana
Source: SAMHSA, Drug Abuse Warning Network
*NOTE: Data prior to 1994 may not be comparable to 1994 through 2001
DATA BREAK*
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Central Nervous System Sites of action Memory Psychological vulnerability
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Mechanisms of Action Produces anticipated and unanticipated effects binding with receptors
High‐affinity sites specific for Cannabinoids Two receptors CB1 And CB2
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Human Memory Most profound effect on recent memory Long term memories not affected Incapable of functioning on the basis of knowledge regarding his personal life
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More on Memory
Hippocampus has receptors for endogenous “marijuana” (anandamide)
Hippocampal damage is associated with failure to make new memories
If stimulate receptor, hippocampus activity decreases
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With repeated use, tolerance to loss of memory develops
With repeated use, tolerance to drug develops and user uses more drug
You do the math
More on Memory
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Post Acute Effects Human aggressive responding Conditions
Provoke subjects coming off drug Provide opportunity to retaliate Measure amount of retaliation
Acute Marijuana, Ss with ASPD Increased aggressive responding
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Persistent and Chronic Effects Physical Psychological
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Physical Respiratory
Carcinogenic components Air obstruction Decreased exercise tolerance
Chronic cough Bronchitis Decreased pulmonary function
Cancer
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Physical Cardiovascular
Increases in heart rate Can aggravate existing cardiac conditions or hypertension
Reversed with abstinence
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Physical Reproductive
Inhibitory effects on pituitary leutenizing hormone, prolactin, and growth hormone
Decreases plasma testosterone, sperm count and motility
Marijuana is antiandrogenic with decreased libido or impaired fertility
Disrupts female reproductive system Impacts pregnancy in adverse ways
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Physical Immune impairment
Contradictory in human studies Animal models show impairment Decreases signals to T helper cells Interferes with macrophage antigen processing May increase the risk of cancer (cancer surveillance system)
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Psychological Psychiatric illness‐ no specific syndromes, however, may precipitate an illness
Visual distortions Decrease in color discrimination Decrease in ocular tracking Decreased detection, recognition and analysis of peripheral visual field
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Social Consequences Marijuana changes the way sensory information is processed
Poor performance in school Increased delinquency
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Psychological‐ Cognitive Impairment in ability to learn Listening and repetition learning compromised
Heavy use associated with deficits in mathematical skill and verbal expression
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Economic Consequences: Lost employee productivity
Public health care costs Accidents and crashes Americans spent $10.6 billion on marijuana purchases in 1999
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MYTH 2: Marijuana Is Not Addictive Science of dependence and addiction Syndrome described
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Laboratory Evidence Marijuana is much more powerful today than it was 30 years ago
Marijuana addicts experience withdrawal There is an animal model for dependence
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Absorption and Metabolism Self administration is by smoking and inhalation
Can be taken orally
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Absorption and Metabolism Smoke contains more than 150 compounds
Many of the Cannabinoids have psychoactive properties
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Pharmacology Is Complex Volatilized THC Deep inhalation Rapid absorption from the lungs THC and major metabolites traced throughout body and brain
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Physical Dependence Producing Properties
Long half life Low clearance Cumulative drug load
High intrinsic pharmacological activity
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Reinforcing Properties Rapid absorption High intrinsic pharmacological activity Rapid entry into specific regions of brain
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Tolerance Extreme tolerance develops quickly and continues for a long time after stopping
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Addiction Liability Reproducible tolerance Acute physical dependence Physical dependence
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Syndrome Described Insomnia Abstinence Nausea Anorexia
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Syndrome Described Agitation Restlessness Irritability Depression Tremor
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Syndrome Described After 21 days of heavy use
Onset 10 hours of cessation Peaks within 48 hours Terminates by fifth day of abstinence
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Clinical Observations Antisocial problems associated with progression
One in ten who try develop dependence
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MYTH 3: Youth Experimentation With Marijuana Is Inevitable
Peer to peer spread has been misunderstood The majority of young people do not use Recent decreases belie the belief that “nothing works”
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MYTH 4: Criminalization Leads to Crime, Not the Drug
Research links Why non‐dependent use is harmful When controls are lifted, harms are increased
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Research Links Marijuana use and violence
Availability increases use
The Dutch experience Prison data
Numbers of those serving time
Percent dealers
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Responsible Public Policy Stopping Initiation Brief and Early Interventions Treatment Improvement
Denial Gap Motivation Gap Treatment Gap Recovery Gap
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When Controls Are Lifted Drug Culture Messages Drugs can’t hurt you Drugs are fun You can use responsibly
1970s experience
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During the 1970s 11 states decriminalized marijuana 30,000 head shops “Responsible‐use” messages Drinking age of 18 Sale of cigarettes, alcohol to teens
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By 1979: 35 percent of adolescents 65 percent of high school seniors
70 percent of young adults had tried an illicit drug
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Prevention Messages Drugs can hurt you Drugs cause addiction and death Drugs are not healthy Breaking the law is not responsible
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Parent Movement Formed 3,000 parent groups Stopped decriminalization Banned head shops
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Parent Movement “No‐use” messages Drinking age of 21 Worked to stop sale of cigarettes, alcohol to adolescents
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Results From 1979 to 1992… Drug use drops by 2/3 among adolescents, young adults
Daily marijuana use drops 500 percent
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Fact: We Can Make A Difference When communities come together, the drug problem recedes
Proven techniques can halt marijuana use: Student drug testing Parent involvement Respect for community norms and laws Science‐based drug prevention
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02468
101214161820
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
All Grades
Source: University of Michigan, Monitoring the Future Study, 2003
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ParentingIdentifying Risky Behaviors
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Objectives Describe path to use, abuse, and dependence Explain developmental tasks of adolescence Explore parenting for development Understand variables to use
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Objectives, continued Minimize enabling feelings, beliefs and behaviors
Encourage growth and responsibility Outline potential consequences of potential insults
Create recovery plan
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Major Forms of Drug Use Alcohol Use Cocaine Use Hallucinogen Use Heroin Use Inhalant Use Marijuana Use Methamphetamine Use Sedative‐Hypnotics and Anxiolytics Use
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The Lure and the Trap Start to use drugs Pleasure experienced
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Path to Addiction Innocent beginning
Minor effects Pleasurable effects Cannot “unlearn”
Continued social use Unpleasant effects diminish
Economic costs minimal No interference with activities
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Path to Addiction Line crossed
Consequences increase Use to feel normal Hard to connect experience to drugs
Majority of students, no observable major consequences
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Why Use a Developmental Model? To assess To encourage and promote growth To understand
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Seven Areas of Development
moral
cognitive
social
physical
emotional
psychosexual
temperamentalAreas of
Development
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Four Tasks of Adolescence Seven areas translate into four major areas where major developmental tasks are defined as:
Future
Friends
Fertility
Family
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Goals of Development are Balanced by Preoccupations of Adolescence
Sexual identity — Body image (fertility)
Self identity — Friends
Separation — Independence (family)
Vocational selection — Value clarification (future)
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Early Adolescence First efforts at separation
Recognition of non‐perfect parent and rebellion against them
Strong identification with peers
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Early, continued Abstract thinking Verbalization of values
Mood swings Difficulty with impulse control
Insecurity about body changes
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Middle Adolescence Peak of rebellion Transition from parental to peer direction
Increased sexual interest
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Middle, continued Difficulty with postponement of gratification
Increased cognitive abilities
Values clarification
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Late Adolescence Firmer identity Increased ability to express emotions
Increased ability to postpone gratification
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Late, continued Resolution of relationship with authority figure
Increased emotional stability
Increased self reliance
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Why Use a Developmental Model? To assess To encourage and promote growth To understand
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Parenting Description Security v. Freedom Limits
Clear Age Appropriate Earned Growth Oriented
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Good Consequences Related Reasonable Timely Basic Escalate Consistently applied Calmly applied
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Bad Consequences Revengeful Self‐punishing Empty Shaming Primary
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Why Kids Use: Contrasting Views Parents School Parents Peers Pushers Media Police Role Models
Adolescents Feelings Fun Risk Taking Thrill Seeking Autonomy Experimentation New Identity
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Variables to Experimentation Availability Access Perceived Risk
Prior Use Peer Use Respect Norms
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Enabling: Feelings Protective instinct Self‐doubt Fear Performance anxiety
Anger
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Enabling: Beliefs Pressures are too great
I am not relevant All kids do it I love, therefore, I trust
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Enabling: Behaviors Keeping secrets Avoiding conflict Shielding from consequences Doing their work
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Adolescents’ Responsibilities Feelings Behaviors Performance Social life Outside life Future
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Teaching Adolescents Modeling Reinforcement Consistency Encouraging Patience Allowing mistakes
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Consequences Early Ambivalence about separation
Persistent anger Self harming behaviors
Rebellious peers/subculture
Doubts
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Early, continued Frustration and isolation
Inability to deal with the abstract
Confusion Inability to learn from experiences
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Consequences, Middle Struggles with parents Self involvement Peer approval seeking Active sexual fantasy life
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Middle, continued Inability to postpone gratification
Unable to abstract Poorly defined moral values
Inability to use wisdom and to evaluate situations according to appropriate values
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Consequences, Late Minor adult disturbances
Unresolved relationship and identity issues
Expression stunted Unable to postpone
gratification Persistent emotional
instability Personal responsibility lags Ability to make choices
confused
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Late, continued Mood swings Difficulty in defining
vocational goals Deficits in formulation of
moral, religious, and sexual values
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Model Treatment Programs Bio‐behavioral assessment Detoxification considerations
Counseling Medical treatment Psychiatric care Referral to wrap around services
Long term follow‐up
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Resources ASAM website for PPC
(http://www.asam.org/publications/patient‐placement‐criteria/ppc‐2r)
NIDA (http://drugabuse.gov/) Two Dreams (http://www.twodreams.com) Dr. AGB (https://twitter.com/dragb) Dr. AGB Goes to Back Rehab
(http://drbarthwell.wordpress.com/) The Challenge in Higher Education: Confronting and Reducing
Substance Abuse on Campus (https://www.ncjrs.gov/ondcppubs/publications/pdf/challenge_higher_ed.pdf/)
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Thank You!Questions?