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Smokers of cannabis the challenge…s

Smokers of cannabis the challenge…s. Dr Louise Restrick Respiratory Physician, Whittington Health and NHS Islington NHS London Respiratory Team Co-Lead. BLF cannabis report 2002. Cannabis smoking r espiratory experience in London. Tobacco and cannabis smoking common

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Smokers of cannabis the challenge…s

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  1. Smokers of cannabis the challenge…s Dr Louise Restrick Respiratory Physician, Whittington Health and NHS Islington NHS London Respiratory Team Co-Lead

  2. BLF cannabis report 2002

  3. Cannabis smokingrespiratory experience in London • Tobacco and cannabis smoking common • Younger people with severe COPD • Bullous emphysema on CT scans • Young people with pneumothorax

  4. Cannabis smokingInner London experience 50 year old man 20 pack year smoker Cannabis for 30 years

  5. Cannabis smoking and respiratory health • Is it common? • Does it matter for respiratory health? • How do we help cannabis smokers stop smoking?

  6. UK Prevalence of Cannabis Smoking • 8% of 11-15 year olds smoke cannabis • Smoking, Drinking and Drug Use Among Young People in England in 2010, NHS Information Centre for Health and Social Care • Social Survey of 7,296 secondary school pupils aged 11-15 in 246 shcools • 1 in 5 young adults say they have recently used drugs, mostly cannabis Healthy Lives, Healthy People White Paper 2010 • HOSB. Drug Misuse Declared. 2009/2010 British Crime Survey, England & Wales • 1 in 3 tobacco smokers in an inner London hospital population also smoke cannabis* • all groups in society • have to ask not volunteered *Restrick et al ERJ 2011; 776S

  7. Cannabis smoking and respiratory health • Symptoms • COPD • Pneumothorax &pneumomediastinum • Bullous emphysema • Lung cancer

  8. Challenges of studying cannabis smoking & respiratory health • Variations in smoking method and content • Resin - Scotland • Marijuana/‘grass’ - America, London? • Without tobacco – New Zealand • Water pipe - Australasia • Skunk - ‘sensemilla’ • Lack of data • Not volunteered • Health professionals uncomfortable asking

  9. Comparisons of cannabis and tobacco smoking 1 joint cf 1 cigarette same weight 3 x carbon monoxide levels 5 x tar deposition No filter, shorter butt length, higher temperature Deeper inspiration, breath-hold, Valsalva at maximum breath-hold 0.4 g cannabis cf 1g tobacco per cigarette Joint-year - ‘one joint/day for 1 year’

  10. Cannabis & respiratory symptoms in Scotland N= 238 Age (range) years N= 142 38 (20-63) N= 96 37 (22-58) • Resin - 77% (grass 16%; both 7%) • Mixed with tobacco - 93% Reid et al, ERJ 2011; 778S

  11. Cannabis & respiratory symptoms in Scotland Reid et al, ERJ 2011; 778S

  12. Cannabis and COPD • US studies • California – no effect on airway obstruction • Arizona – airway obstruction • New Zealand* Adlington et al Thorax 2007;62:1058-1063 • Dose response with FEV1/FVC ratio & hyperinflation • 1 joint equivalent to 2.5-5 cigarettes • Additive to tobacco • Canada Tan et al CMAJ 2009:180;814-20 • Increased risk of COPD after 50 ‘joints’ with tobacco • Synergistic with tobacco

  13. Cannabis and COPD • Random sample • 878 people >40 years in Vancouver • 43% men, mean (SD) age 56 (12) years • Only 12/878 (1.4%) refused to complete questionnaire! • Prevalence history of • marijuana use 46% • tobacco use 53% • Current smoking (past 12 months) • marijuana 14% • tobacco 14% • COPD Prevalence 19% GOLD 1-4, 8% GOLD 2-4 Tan et al, Vancouver BOLD Research Group CMAJ 2009;180:814-20

  14. Cannabis and COPD Tan et al, Vancouver BOLD Research Group CMAJ 2009;180:814-20

  15. Cannabis and pneumothorax Emphysema & secondary pneumothorax in young adults smoking cannabis 17 patients: pneumothoraces with bullous emphysema Mean (range) age 27 (19-43) years; 16 M; Switzerland All smoked marijuana; 8.8 years; tobacco 11.8 years Asymptomatic CT: multiple bullae or bullous emphysema at apices Histology (VATS): emphysema, inflammation & heavily pigmented macrophages ‘1 joint/day equivalent to 1 pack cigarettes/day’ Beshay et al, European Journal of Cardiothoracic Surgery 2007:32;834-838

  16. Cannabis and lung cancer • Tunisia, Morocco & Algeria* • OR 2.4 for history of cannabis use • New Zealand** Case-control study • 79 cases lung cancer in <55 years • Lung cancer risk increased: • 8% for each joint-year cannabis smoking • 7% for each pack-year cigarette smoking • 5.7 Relative risk if >10.5 joint-years cannabis • ‘5% of lung cancer in those aged <55 years may be attributable to cannabis smoking.’ *Berthiller et al J Thoracic Oncology 2008 **Aldington et al ERJ 2008:31;280-286

  17. Cannabis and respiratory health Increasing evidence smoking cannabis causes respiratory symptoms, apical bullae & emphysema, COPD, pneumothoraces and lung cancer. So what now…

  18. Cannabis & lung health challenges • Raising awareness of respiratory risks • Cannabis smokers • Health professionals NB Mental health • Silos • DH responsible for tobacco • Home Office (National Treatment Agency) responsible for drugs • ‘NTA is not interested in tobacco & drug action teams • do not have tobacco strategies’. • Evidence gaps in cannabis cessation strategies

  19. Cannabis and Respiratory Health ‘Anti-smoking campaigns should include a reduction in marijuana use amongst their goals, aiming especially at those who regularly use both marijuana and tobacco.’ Tan et al, CMAJ 2009 Coming in 2012… ‘A smoking gun II’ What else should and can we do as respiratory clinicians/BTS Quit Smoking Champions?

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