Cannabis-Related Disorders

Cannabis-Related Disorders

Patty Ghazvini, PharmD. CGP.

CannabisWorld-wide, most commonly used illicit

substanceIn the United States, 42% of persons over

age 12 have used cannabis at least once in their lifetime

Between 2007 and 2010, past month use among youth aged 12 to 17 increased from 6.7 to 7.4%, corresponding with a decrease in perception of risk over that same period.

CannabisPrimary psychoactive component – ?????Potency – percentage of THC in the dry

weight of the sampleSubstantial increases in the potency of street

samples over the last few decades

Physiologic Effects of MarijuanaStimulation of the sympathetic nervous

system?????????It has been shown to increase cardiac output

by?????????????????????????????????????

HR increases start?

Causes an increase in carboxyhemoglobin levels – ??????????

Somatic ConsequencesPhysiologic effects –

Immediate pulmonary effects –

Heavy use –

Metabolites cross the placenta and are found in human milk – babies weigh less, shorter

Behavioral and Cognitive ConsequencesAcute effects – ????

Regular use –

More likely to use “harder” drugs such as cocaine

Cannabis WithdrawalDysphoric mood – ?????

Disturbed sleepGI symptomsDecreased appetiteMost symptoms begin during the first week

of abstinence and resolve after a few weeks

Treatment for WithdrawalNo medications are approvedCross-tolerant – ?

Lithium – In clinical studies, 600-600mg/day for 6 days reduced withdrawal symptoms

Depakote

CNN NEWS – Synthetic MarijuanaTeen narrowly escapes death after

smoking synthetic marijuana

One month after the life-changing night, Emily is blind. Each day since has been a fight -- a fight to move a finger, a fight to whisper something to her family, a fight for life, according to her big sister.

Amphetamine and Related Compounds

Crystal – Powder(inhaled, injected)

Crank – Tablet, Capsules

Ice and Glass - Smokeable

Meth Videoshttp://

www.youtube.com/watch?v=CfI5lCoA3b8&list=PL7307BDF42924AC44

http://www.youtube.com/watch?v=v5KL_mc1nx4

Drug and Alcohol Data Information System: 2009

Medical ComplicationsOrgan System Acute Complications Chronic Complications

CNS

Cardiovascular

Pulmonary

GI

LiverHead and Neck

Sexual Function

Reproductive System

TreatmentAmphetamines can be withdrawn abruptlyIf sedation is necessary – ???????(avoid phenothiazines, can worsen dysphoria and highten agitation)Severe hypertension –?????? for

vasodilation(avoid beta or beta-alpha blockers – worsen stimulant-induced cardiotoxicity)Most signs of intoxication clear in 2-4 days

Hallucinogen-Related

Disorders

Lysergic Acid Diethylamide

Magic Mushrooms

LSD videohttp://

www.youtube.com/watch?v=qxmqx7Ifu8s

Lysergic Acid Diethylamide (LSD)Prototype of the hallucinogen class“Psychedelic”Street names:????????????????

Stimulates both dopamine and serotonin receptorsEarly drugs effects???????????????????

No physical or psychological addiction; however, chronic use – psychosis and hallucinogenic persistent perception disorder – “flash backs”

IntoxicationSomatic symptoms:

Psychomimetic symptoms:

Treatment: Supportive care and BZDs for agitation

Psilocybin (Magic Mushrooms)Structural analogues of serotonin

In one study of 174 adolescents with a history of substance abuse, 45 (26%) reported having used hallucinogenic mushrooms at some point in their life, often combined with alcohol or marijuana.

Carter OL, Pettigrew JD, Burr DC, et al. Psilocybin impairs high-level but not low-level motion perception. Neuroreport. Aug 26 2004;15(12):1947-51.

Magic MushroomsFrom data collected from September 2008 to

December 2009, the Youth Risk Behavior Surveillance System reported that 8% of students had used an hallucinogenic drug, including LSD, PCP, angel dust, mescaline, or mushrooms, at least once in their life.

Use was more common among males and Caucasians than among females and African Americans and Hispanics.

Eaton DK, Kann L, Kinchen S, et al. Youth risk behavior surveillance - United States, 2009. MMWR Surveill Summ. Jun 4 2010;59(5):1-142.

Clinical Symptoms of IntoxicationsAlterations in perception begin within 30

minutes and subside after 6 hours.

CNS manifestations: euphoria, visual and religious hallucinations, and feeling closer to nature have been reported.

Visual hallucinations may include perceived motion of stationary objects or surfaces.

TreatmentActivated charcoal – Most useful if

administered within 2 hours of ingestionBenzodiazepines