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Cannabis-Related Disorders

Cannabis-Related Disorders. Patty Ghazvini, PharmD. CGP. Cannabis. World-wide, most commonly used illicit substance In the United States, 42% of persons over age 12 have used cannabis at least once in their lifetime

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Cannabis-Related Disorders

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  1. Cannabis-Related Disorders Patty Ghazvini, PharmD. CGP.

  2. Cannabis • World-wide, most commonly used illicit substance • In 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.

  3. Cannabis • Primary psychoactive component – ????? • Potency – percentage of THC in the dry weight of the sample • Substantial increases in the potency of street samples over the last few decades

  4. Physiologic Effects of Marijuana • Stimulation of the sympathetic nervous system????????? • It has been shown to increase cardiac output by????????????????????????????????????? • HR increases start? • Causes an increase in carboxyhemoglobin levels – ??????????

  5. Somatic Consequences • Physiologic effects – • Immediate pulmonary effects – • Heavy use – • Metabolites cross the placenta and are found in human milk – babies weigh less, shorter

  6. Behavioral and Cognitive Consequences • Acute effects – ???? • Regular use – • More likely to use “harder” drugs such as cocaine

  7. Cannabis Withdrawal • Dysphoric mood – ????? • Disturbed sleep • GI symptoms • Decreased appetite • Most symptoms begin during the first week of abstinence and resolve after a few weeks

  8. Treatment for Withdrawal • No medications are approved • Cross-tolerant – ? • Lithium – In clinical studies, 600-600mg/day for 6 days reduced withdrawal symptoms • Depakote

  9. CNN NEWS – Synthetic Marijuana • Teen narrowly escapes death after smoking synthetic marijuana

  10. 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.

  11. Amphetamine and Related CompoundsCrystal – Powder(inhaled, injected)Crank – Tablet, Capsules Ice and Glass - Smokeable

  12. Meth Videos • http://www.youtube.com/watch?v=CfI5lCoA3b8&list=PL7307BDF42924AC44 • http://www.youtube.com/watch?v=v5KL_mc1nx4

  13. Drug and Alcohol Data Information System: 2009

  14. Medical Complications

  15. Treatment • Amphetamines can be withdrawn abruptly • If 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

  16. Lysergic Acid Diethylamide Magic Mushrooms

  17. LSD video • http://www.youtube.com/watch?v=qxmqx7Ifu8s

  18. Lysergic Acid Diethylamide (LSD) • Prototype of the hallucinogen class • “Psychedelic” • Street names:???????????????? • Stimulates both dopamine and serotonin receptors • Early drugs effects??????????????????? • No physical or psychological addiction; however, chronic use – psychosis and hallucinogenic persistent perception disorder – “flash backs”

  19. Intoxication • Somatic symptoms: • Psychomimetic symptoms: • Treatment: Supportive care and BZDs for agitation

  20. 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.

  21. Magic Mushrooms • From 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.

  22. Clinical Symptoms of Intoxications • Alterations 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.

  23. Treatment • Activated charcoal – Most useful if administered within 2 hours of ingestion • Benzodiazepines

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