Cannabis Information & Workbook

CANNABIS INFORMATION & WORKBOOK www.humlondon.org.uk Page 1

Contents:

Page

Introduction 3

Workers Information:

History 4

Types of cannabis 8

How cannabis works 11

Health effects 16

Harm reduction 20

Workbook: 25

Cannabis Diaries 26

Closing Doors 31

Patterns 33

The good, the bad and the ugly 41

Triggers 44

Cravings 47

High risk situations 51

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Introduction:

This pack was written by Aidan Gray and has hopefully been designed to give useful information to workers on cannabis and also to provide practical workbook sheets that can be used in key-working sessions or become part of care planning work.

The information section contains links to further reports and resources and also some ‘youtube’ videos that provide more information.

The workbook section provides a range of treatment tools that have been developed to incorporate different learning styles as a high percentage of clients are visual and kinaesthetic learners.

The tools have been put into a logical order, however we believe that the worker is the best judge of what tools to use and when so feel free to use the tools that you and your client feel comfortable with.

If you find this pack useful please feel free to distribute amongst colleagues as we believe that information should be shared to help improve good practice and treatment services.

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History

Timeline:

6000 BC Cannabis seeds are used as a food in China

4000 BC Clothes are being made out of the hemp (from cannabis plant)

2727 BC Earliest written record of cannabis being used for medicinal purposes in China

1200 BC Bhang (dried cannabis leaves, seeds and stems) is mentioned in the Hindu sacred text Atharva veda (Science of Charms) as “Sacred Grass”.

500 BC Hemp started to be grown in Northern Europe

70 AD Cannabis mentioned as a medicine in Roman literature

900 Hashish smoking starts to spread throughout the Middle East

1090 Legends of ‘Hashshasins’ (hashish smoking assassins) develop in Persia

1271 First reports in Europe (by Marco Polo) of cannabis being used as a psychoactive drug

1378 First attempt to make hashish illegal in the Ottoman Empire (modern Turkey)

1549 Cannabis is first introduced to South America via the slave trade

1500’s Some evidence to suggest hash smoking in Elizabethan England

1606 The British and French start to cultivate cannabis for hemp

1790’s George Washington cultivates hemp. There is also some evidence that he may have smoked it

1798 Napoleon prohibits the use of cannabis in Egypt, only to find that his own soldiers using it a bringing the habit back to France

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1840 Medicinal preparations (sold in pharmacies) are being made out of cannabis

1843 Le Club des Hachichins, or Hashish Eaters’ Club, is established in Paris

1856 The British tax the ‘ganja’ and ‘charas’ trade in India

1870’s Cannabis used as a medication for various ailments in UK: Queen Victoria was prescribed it for period pains

1890 Greece and Turkey prohibit the use of cannabis

1893 70,000 to 80,000 kg of hashish legally imported into India from Central Asia each year (remember, we were taxing it)

1915 Cannabis use starts to be prohibited in some US States

1920 Opium and cocaine are made illegal in the UK. Cannabis was not believed to be dangerous enough to add to the bill. The Indian Hemp Commission found that ‘the moderate use of hemp drugs is practically attended by no evil results at all’.

1928 Recreational use of cannabis is banned in Britain as a result of pressure from Egypt and Turkey, who primarily wanted to ban the substance under interpretations of Islamic Law. Claims by these countries that cannabis was dangerous and caused 30% - 60% of insanity in the countries were not investigated by the League of Nations. Legal imports to India are still allowed and taxed.

1936 The film ‘Reefer Madness’ is made to scare American youth away from smoking it. Others quickly follow

http://www.youtube.com/watch?v=M6MGVpl5ux8

1937 Cannabis made illegal in the USA. This was primarily due to paper manufacturing industries promoting ‘dope demon’ stories as paper made from hemp was taking business away.

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1945 Legal cannabis use continues in India

1952 First UK Cannabis bust at the Number 11 Club, Soho.

1961 The United Nations Single Convention on Narcotics Drugs implemented. It updated all previous drugs treaties, and set up classifications of drugs according to their supposed harmfulness. Cannabis went into the same list as opiates and cocaine, ‘having strong addictive properties’

1962 Hashish starts to be made in Morocco

1964 The first year when more white people than black were convicted of cannabis related offences in the UK. It was also the first year in which less than half of the people convicted were sentenced to prison. Also the first ‘head shop’ is opened by the Thelin brothers in the United States.

1965 Timothy Leary (of ‘Tune in, turn on, drop out’ fame) arrested in the USA for cannabis possession. Also a new crime was invented in the UK, that of allowing premises to be used for drug taking. Convictions for cannabis offences rose by 79% in the preceding year.

1967 The National Council for Civil Liberties published a pamphlet about the discriminatory ways the law worked regarding cannabis, the increase in unjustifiable searches, accusations of evidence planting, and the harshness of sentencing. Black people and people with long hair were particularly singled out.

Also in 1967 Keith Richards (Rolling Stones) was convicted for smoking cannabis, the first prosecutions occurred for allowing premises to be used for smoking and William Rees-Mogg’s subsequent editorial in the Times (‘Who Breaks a Butterfly on a Wheel?’) was influential in changing mainstream society’s attitudes to cannabis use

1968 John Lennon pleads guilty to cannabis possession (The Beatles were supposedly introduced to its use by Bob Dylan in 1964)

Early 1970’s Impact on UK of, first, Bob Marley and then other reggae artists awakening interest in Rastafarian ideology, which includes seeing cannabis use as a spiritual practice

1971 A permanent Advisory Council on the Misuse of Drugs [ACMD] was established to help formulate Government policy. Several governments have since ignored the ACMD’s advice about www.humlondon.org.uk Page 6

cannabis, which has generally been that it has ‘no significant harmful effects on man’. President Nixon declares drugs “America’s public enemy No. 1”.

1972 The Nixon-appointed Shafer Commission recommend that cannabis be re-legalised in the USA

1979 The Advisory Council proposed moving cannabis to class C under the Misuse of Drugs Act, and changing penalties for possession. Nothing was done about this proposal.

1990 The discovery of THC receptors in the human brain is reported in Nature. This started the crossbreeding of plants to produce higher THC content (‘skunk’).

1991 42,209 people are convicted of cannabis offences in the UK. 19,583 escape with cautions.

1994 Home Secretary Michael Howard increases maximum fines for possession from £500 to £2,500.

1997 The newspaper The Independent on Sunday launches a “Decriminalise cannabis” campaign.

2001 ‘Softly, softly’ approach to cannabis trialled in Brixton.

2004 Cannabis reclassified as a class ’C’ drug in the UK

2007 Gordon Brown announces his intention to move cannabis to class B again. This is in reaction to media reports concerning the link between cannabis and schizophrenia.

2009 Cannabis again reclassified as a class ‘B’ drug in the UK. The chair of the advisory body the ACMD, resigns for criticising the government’s decision to move cannabis back to class B.

The important lesson to learn from history is to understand the facts and reality. Hype and scaremongering only weaken the truth…

“I now have absolute proof that smoking even one marijuana cigarette is equal in brain damage to being on Bikini Island during an H-bomb blast.”

President Ronald Reagan

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Types of cannabis:

Some of the names for cannabis include… Marijuana; Marihuana; Pot; Dope; Weed; Grass; Bud; Ganja; Mary Jane; Doobie; Hashish; Hash; Bhang; Punk; Food; Cheese; Green…

There are three distinct species or varieties of cannabis: Cannabis sativa, Cannabis indica, and Cannabis ruderalis. Most recreationally used cannabis is the result of crossbreeding between these three types. The term 'hemp' is generally used to describe low THC varieties of cannabis which are grown for industrial uses to make paper, cloth, rope etc.

Once processed for recreational use there are basically 3 types of cannabis, but only 2 of them are commonly available on the streets of the UK.

Cannabis (plant)

This is primarily made from the buds of the plant as this is where the highest concentration of psychoactive ingredients is. There are many different types and strengths of cannabis but basically these can be split into 2 groups.

o Outdoor grown cannabis (grown outside with strength varying according to country of origin and type of plant)

o Indoor grown cannabis (plants grown using hydroponic water feed systems and high wattage lights. Again these will vary in strength according to type of plant and if the plant has been flowered with no interruptions to the 12 hour dark light cycle. This group includes ‘skunk’)

Politicians and the media often talk about skunk being 3, 4 or even 10 times stronger than other cannabis forms. This is not true. Cannabis varies in strength just like alcohol, for instance British ‘home grown’ ranges from 0.3% to 3.5% THC but British Columbian buds grown in Canada (and not sold in UK) can have 27% - 35% THC. The ‘Skunk’ sold in the UK has an average THC content of about 16%, but can be as strong as 40%. Strength depends upon the type of plant and there are stronger varieties than ‘skunk’. As noted above cannabis is like alcohol and comes in different strengths but the market in the UK predominately sells ‘skunk’ (or similar hydroponically grown cannabis), kind of like having an off licence only selling strong cider and little else.

The issues that can sometimes arise from smoking ‘skunk’ (and other hydroponically grown varieties), such as paranoia and anxiety, are not so much to do with the THC level but are more to do with balance between a molecule called tetrahydrocannabinol (THC) and another active ingredient called cannabidiol (CBD). If there isn’t enough CBD in the plant then the balance of the ‘hit’ is affected.

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The average CBD% in resin is currently about 3.5%, whereas the average for ‘skunk’ type cannabis is 0.1%. So you can see that they have managed to breed all the CBD content out, which causes the problems.

Traditionally most cannabis varieties have had a balance of THC and CBD. Cannabis types such as ‘skunk’ have been selectively bred to produce higher THC %, however they didn’t increase the CBD % to match, resulting in increased negative effects such as paranoia, hallucinations and anxiety.

Another problem is the availability of different types of cannabis. The below table demonstrates the cannabis market from 2002 to 2008, and that in 6 years ‘skunk has managed to dominate UK markets, giving you very little choice in what you smoke.

Year % Skunk % Herbal % Resin 2002 15% 15% 70% 2004 55% 9% 36% 2008 81% 3% 16%

As these figures are 2 years old at the time of writing, the market has probably become even more dominated by ‘skunk’. This means that most of the cannabis available will be very low in CBD and won’t give a balanced high.

Hashish (resin)

Hashish or cannabis resin is generally made in either North Africa (light hash) or the Indian Sub-continent (dark hash). Both are produced from the cannabis plant but by different methods. North African hash is made from powdered cannabis tops called kif or kief. This is then heated to allow the resins naturally present in the plant to melt and bind the mixture together. This is then compressed and imported for sale in the UK. This type of resin is usually light yellow-brown and can be quite hard. The UK tends to get the poorest quality hash (repressed with plastic in it, smelling of diesel) compared to Europe as it has further to travel to get to us and we are an island with tough customs on all the borders.

Indian Sub-continent hash uses a different method that involves rubbing the resinous tops of the plants with the hands. The resin sticks to the skin and is scraped off and either rolled into balls or sausage shapes that are called ‘strings’. This hash is usually dark brown / black on the surface (can be lighter on the inside) and is soft and malleable. A better quality cannabis in today’s market as it generally has a balanced CBD % and none of the additives as with North African hash.

Just like with cannabis, the strengths of hash will vary with THC % ranging from 1% to 26%. If hash is made from hybrid plants that have high THC % and low CBD % there can be the same negative side effects associated with ‘skunk’.

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Oil (hash, honey)

Oil is a solution of tetrahydrocannabinol and is very strong due to its high THC %, which generally varies between 15% and 20%, but can reach 60% to 70% in some cases. The different names (hash and honey) relate to different solvents used in the processes of manufacture. Honey oil is derived from a process using butane and ethyl alcohol as the solvents, which produce a light honey coloured oil.

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How Cannabis Works

Cannabis, like other drugs, works by interacting with and affecting the normal processes of the brain. So to start with we need to understand a little more about how the brain works so that the effects can be better understood.

The brain is full of neurons that process and transmit information by electrical and chemical signalling. Different neurons do different jobs, such as controlling balance, reward or memory etc. Within neurons there are neurotransmitters that cross over a small gap (synaptic gap) between each neuron passing the signal on to its neighbour (neuro-pathways).

Neurons also have receptors that enable them to receive signals so that they can both send and receive signals. Just think of a daisy as being a neuron and the pathway being a daisy chain.

Different drugs affect different types of neurons and in different ways, producing the range of effects experienced by stimulants, downers and hallucinogenics etc.

In the brain, there are groups of cannabinoid (CB) receptors concentrated in several different areas. The highest concentration of CB receptors are in the hippocampus (memory), cerebellum (directs movement and balance), cerebral cortex (thinking) and the basal ganglia (movement) regions of the brain.

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These cannabinoid / THC receptors have an effect on several mental and physical activities, including: o Short-term memory o Movement and balance o Learning o Problem solving o Stress o Appetite

CB receptors are normally activated by a neurotransmitter called anandamide (a cannabinoid chemical naturally occurring in the body). THC and cannabidiol are also CB chemicals and once it reaches the brain it mimics the actions of anandamide by binding onto the CB receptors and activating neurons. Cannabis fools the brain into thinking it’s anandamide so it gets a back door entrance to parts of the brain that influence perception, movement and memory etc.

Cannabis has an effect upon Dopamine (a pleasure-giving neurotransmitter), although scientists are not entirely sure about the precise mechanisms of this. When you use cannabis more of these neurotransmitters are released, giving you the pleasurable experiences felt.

Below is a link to an excerpt from the BBC Horizon programme explaining how the mechanisms of cannabis developed in the brain: http://www.youtube.com/watch?v=hpV6licCOMw

Cannabis also increases a brain protein called Brain Development Neurotrophic Factor (BDNF). BDNF acts on certain neurons of the central nervous system and the peripheral nervous system, helping to support the survival of existing neurons, and encourage the growth and differentiation of new neurons and synapses. In the brain, it is active in the hippocampus, cortex, and basal forebrain—areas vital to learning, memory, and higher thinking. BDNF itself is important for long-term memory. Currently researchers are looking at the possible connection between cannabis, BDNF and psychotic disorders as BDNF seems to play a significant role in schizophrenia. However the vast majority of drugs increase BDNF so care needs to be taken when drawing conclusions.

Cannabis can have positive, neutral and negative effects, depending upon the type of cannabis used, how much is used and tolerance.

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Positive:

o Mood lift, euphoria o Laughter o Relaxation, stress reduction o Creativity, philosophical / abstract thinking, ideas o Increased awareness of music o Increased awareness of senses (eating, drinking, smell) o Change in experience of muscle fatigue; pleasant feeling in the body; increase in body / mind connection o Pain relief (headaches, cramps) o Reduced nausea, increased appetite (used medically for this) o Boring tasks can become more interesting or funny

Neutral:

o General change in consciousness o Increased appetite, munchies o Slowness (slow driving, talking) o Change in vision, such as sharpened colours or lights o Tiredness, sleepiness, lethargy o Blood-shot eyes o Mouth dryness, sticky-mouth o Interruption of linear memory; difficulty following a train of thought o Time sense altered (slow, slow, slow)

Negative:

o Nausea, especially in combination with alcohol o Coughing o Difficulty with short-term memory o Racing heart, agitation, feeling tense o Mild to severe anxiety (panic attacks) o Depression o Sweating o Headaches o Dizziness, light-headedness o Paranoia, confusion o Difficulty in sleeping o Possible psychological dependence o Clumsiness, loss of co-ordination o Psychosis o Can make existing mental disorders worse o Weight loss o Whitey’s (see page 21)

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The Munchies:

One of the strange feelings associated with marijuana use is the increased hunger people feel, often called the "munchies." Essentially there are molecules in the brain called endocannabinoids that bind with receptors in the hypothalamus area of the brain. These activate cannabinoid receptors in that area that are partly responsible for regulating food intake. They switch the ‘I’m hungry’ button on and strange combinations of food can become the best tasting thing in the world. This can lessen when your body gets used to it and some people report weight loss after smoking heavily for a few years.

Physical Effects:

If people smoke cannabis they can be susceptible to some of the same health problems that are associated with smoking tobacco such as bronchitis, emphysema and bronchial asthma. Other physical effects include:

o Increased heartbeat o Drop of the pressure in your eyeball o Change of blood pressure o Sense of cold or hot hands and feet o Discoloration of the white of the eye to somewhat pink because of dilation of the vessels in the conjunctiva of the eye o Relaxation of the muscles o A dry mouth o Low sperm count / infertility

Although cannabis is known to have negative physical health effects, it is also used as a medicine, so also has positive physical benefits. Cannabis is used by people with illnesses such as cancer (pain relief), HIV* (to suppress nausea and stimulate appetite), glaucoma (to alleviate eye pressure), epilepsy (to stop convulsions) multiple sclerosis (to decrease muscle spasms) and ME / Parkinson’s disease (to reduce some of the symptoms and increase BDNF).

*It must be noted that there is some research that suggests certain chemicals in cannabis might suppress the immune system.

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Routes of use: Cannabis is usually taken in one of two ways:

o Smoking o Rolled in a spliff (zoot) with tobacco o Rolled in a spliff with no tobacco (Ital) o Vapourisers (heating cannabis to a point that releases THC but doesn’t burn it) o Pipes o Bongs o Buckets o Glasses o Hot-Knives o Lungs o Spotting (small pieces of hash on the end of a cigarette)

o Ingesting o Eating raw o Teas o Cooking (cakes, biscuits, stews, yoghurts etc) o Tinctures

Different ways of taking cannabis change the experience, intensity and duration of the effects.

So for example processes such as ‘buckets’ and ‘hot knives’ can deliver high concentrations of cannabis to the brain very quickly. This is partly due to higher levels of smoke inhaled and also because smoking delivers the drug to the brain quicker than any other route; whereas eating cannabis takes a lot longer for the ‘hit’ to come on, but the effects last longer. But this also make it harder to gauge the amount you are taking so you can end up much more out of it than you intended as it’s not a gradual process like smoking. The following clips demonstrate the methods used for:

Buckets: http://www.youtube.com/watch?v=Ld1tg0bkkFA

Hot Knives: http://www.youtube.com/watch?v=PRa8YIk5mtY

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Health effects of cannabis use:

Generally there are not the same amount of physical health problems associated with cannabis use as there are with a lot of other illegal drugs. According to a 2006 government report (Drug classification: making a hash of it?), using cannabis is less dangerous than tobacco, prescription drugs, and alcohol in social harms, physical harm, and addictive properties. However there are some risks to both physical and mental health. http://www.official-documents.gov.uk/document/cm69/6941/6941.pdf

Physical health:

One of the main risks to physical health associated with cannabis use is the use of tobacco in joints, although it has to be said that cannabis also contains many of the carcinogens that are in tobacco so may in the long term cause lung cancer (more research is needed on this). Other risks include:

o Lung problems such as bronchitis (with heavy use) o Reduced resistance to infections, especially coughs, colds and flu’s. o Blood pressure changes (especially if there is an existing condition) o Low sperm count / infertility o Increased heart rate

THC has a very low toxicity level, so much so that it is thought virtually impossible to die from cannabis use due to the very high amounts that would be theoretically needed to cause an overdose. There have been no officially recorded fatalities associated with cannabis overdose.

Other physical health issues may be caused by the consequences of some of the effects, such as loss of co-ordination or slow reaction times when driving a car (crash) or by chemicals used in the production of the plant / bad cuts.

Smoking cannabis and/or tobacco has been linked to the following conditions (although we are not talking big numbers here it is best that you are at least aware of them):

o Chronic bronchitis – coughing, excessive sputum production, wheezing o Exacerbation and/or onset of asthmatic conditions o Lung cancer o Throat cancer o Tongue cancer www.humlondon.org.uk Page 16

o Cervical cancer o Stomach cancer o Bladder cancer o Kidney cancer o Cardiovascular disease o Emphysema o Pulmonary infections o Disabling shortness of breath o Dementia o Alzheimer’s disease o Macular degeneration (blindness) o Pneumococcal disease o Lung bullae o Thyroid disease o Myocardial infarction (heart attack)

It is also worth noting that nearly all of the above were associated with smoking and not eating cannabis (see harm reduction).

Heart problems:

Although most people say that cannabis relaxes them, it also increases your heart rate by up to 40 beats per minute, so if you have an existing heart condition you are increasing the risks of cardiac problems.

Pregnancy:

Cannabis has the ability to pass through the placental barrier and is also detectable in the breast milk of mothers who smoke. There is a lack of substantial research into this subject but some potential identified risks include low birth weight and an increased risk of infant leukaemia.

Mental Health:

Cannabis can produce the following short-term psychological effects:

o Confusion o Anxiety o Paranoia o Agitation www.humlondon.org.uk Page 17

o Distorted reality o Tiredness (mental & physical) o Loss of motor control o Memory impairment

There is also developing evidence to suggest that people with serious mental health problems (psychosis, schizophrenia) are more likely to use cannabis. However this does not mean that they cause the above conditions as the question essentially is does the cannabis cause schizophrenia or do people with these problems use it as a form of self medication?

Depression:

Various studies into depression and cannabis use seem to suggest that regular use (daily) of cannabis may be a cause of depression. However there may also be other factors that are causing depression (such as life problems) or other substance use such as alcohol.

Schizophrenia:

There have been a lot of reports in the newspapers regarding cannabis use causing schizophrenia. However the evidence for this is still not clear. What we do know is that using cannabis before the age of 15 seems to increase your chances of developing a psychotic disorder. This might be because the brain is still developing (re-wiring itself to work more effectively) and use below this age messes this process up, causing some form of permanent damage. As previously mentioned researchers are looking into possible connections between cannabis and BDNF as a possible link between early age cannabis use and schizophrenia.

Cannabis psychosis:

Research suggests that short-lived psychotic episodes can be caused by the use of cannabis. However this seems to be quite rare. For instance in the whole of Denmark they found around 100 new cases a year, but half of these cases were later found to be symptoms of longer lasting disorders such as schizophrenia, brining the number of definite cases of psychosis down to about 50 a year.

Is cannabis addictive?

Cannabis has addictive qualities such as having to smoke more spliffs to get the same effect (tolerance) and also some symptoms of withdrawal such as:

o Cravings o Decreased appetite o Difficulty in sleeping / restlessness / strange dreams o Anger, aggressive behaviour, irritability www.humlondon.org.uk Page 18

However this needs to be put into perspective as these symptoms are on the same level as giving up cigarettes. Cannabis is much more psychologically addictive than physically but for some people this can mean that it is very hard to give up. So if the first thing you do everyday when you wake up in the morning is light up a spliff so that you can face the day, it is likely that you have developed a psychological dependence to cannabis.

Further resources and reports:

UKDPC ACMD Cannabis Submission http://www.ukdpc.org.uk/resources/ACMD_Cannabis_Submission_Jan_2008.pdf

ACMD Cannabis Report: http://www.drugsandalcohol.ie/13914/1/Home_office_acmd-cannabis-report- 2008.pdf

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Harm Reduction:

Although cannabis may not have a lot of harmful effects (see health section), there are some and these can be reduced. The below information will enable people to use in a safer way if they are choosing to continue it’s use.

Cannabis Types:

As mentioned previously, the CBD content of hydroponically grown varieties like ‘skunk’ is extremely low. This causes more of the negative effects such as paranoia and anxiety. To avoid this use outdoor grown herbal or resin where the CBD content is higher and the negative effects are less pronounced. Outdoor grown cannabis or hash is harder to get hold of in the UK, but this vary from area to area.

Dosage:

As strengths of cannabis can vary greatly from variety to variety and sometimes people never really know what they are buying. If they are unsure about the strength, they should build there spliff as usual and take a couple of tokes. Wait about 5 – 10 minutes to see how it affects them. They should then be able to judge its strength and smoke accordingly.

Eating cannabis is a completely different ball game as it takes much longer for the effects to come, so if people do this the best way to work out dose is to make the ‘brownies’ themselves. The common mistake people make when eating cannabis is that they think it hasn’t worked or that they haven’t had enough. More is then eaten to compensate for this. The trouble is it is now in your system and you have absolutely no control over dosage or when you have had enough (this can make you feel very sick, see whitey / spin).

Mixing:

Some people combine drugs together to either increase effects or take the edge off some of the negative side effects of a particular drug. For instance crack and cannabis can be combined in the same joint so that the cannabis takes the edge off the ‘come down’, however this combination can also increase feelings of paranoia and anxiety when ‘skunk’ is used.

Most common mixes are with tobacco. If people smoke cannabis with tobacco remind them that they are subject to all the risks associated with tobacco. It doesn’t get reduced because it’s in a spliff, in fact you have to inhale more (because you have reduced the amount of cannabis in each hit) to get the desired effect and at the same time you are taking in more tobacco.

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Smoking:

Smoking anything is harmful. But how people smoke their cannabis can have a large influence on how much harm it does. Cannabis contains tars and carcinogens just like tobacco.

Joints:

Neat cannabis in joints (Ital) is probably one of the least harmful ways to smoke the drug (vapourisers and eating are safer alternatives). Do not use cigarette filters in joints as they eliminate up to 60% of the THC in the smoke, leaving you with a much higher proportion of tar and other toxic substances in the smoke and again leading you to use more to get the same high. Smoke unfiltered joints or use ‘roaches’ in the end of the joint.

Bongs:

Some people prefer smoking cannabis in bongs as the water cools the smoke and doesn’t feel so harsh on the lungs. However this form of smoking may be one of the most harmful as the water in the bong absorbs large amounts of THC but not tar. As you have to smoke more to get the desired effect this increases the amount of tar being inhaled. There is also a risk of water vapour inhalation and dioxins being released from plastic if this type of bottle is used.

Pipes:

If people use a pipe, it is best to choose one made of glass, stainless steel or brass, as wooden or plastic pipes can give off noxious fumes when you burn cannabis in them.

Holding your breath?

A lot of people hold the smoke in their lungs for a long time as they think it increases the hit. This is not true as about 95% of the THC is absorbed into the blood stream within the first few seconds. Holding smoke in your lungs only allows more tar and potentially other chemicals to build up.

Contaminated cannabis:

Cannabis can be contaminated in different ways and at different stages of its production or sale before it gets to you. Don’t think that because it’s a plant you are smoking a natural organic substance!

Contamination during cultivation:

Chemicals are sprayed on the plant or added to the soil to enhance growth and for pest / disease control just like other crops. However there are laws concerning what www.humlondon.org.uk Page 21

you can use in food cultivation: cannabis is grown illegally and banned chemicals / pesticides are sometimes used.

Contamination during storage:

When cannabis is being stored certain types of moulds and fungi can grow on the plant. These moulds have been identified to usually be Aspergillus flava, Streptococcus or Penicillium. Although we know that this sometimes occurs, there is no current research as to what the potential health consequences may be. However, for people with compromised immune systems (such as those with HIV/AIDS or cancer) it could be a more serious.

Contamination from dealers:

Substances can be added to cannabis to increase weight, improve appearance or increase effect.

Negative mental effects:

Sometimes people take too much and can experience some bad negative symptoms such as

o Confusion o Anxiety or panic attacks o Paranoia o Agitation

If people are experiencing some of these effects they should stop smoking as it won’t help. Advise them to make sure that they are with people they trust and that the environment also feels safe. If not change it. Some people report that eating (food not dope) helps to calm them and bring down some of the negative feelings.

Negative physical effects:

Smoking cannabis has definite physical effects (these can be more pronounced if you eat it) such as:

o Slowness (reaction time is slow like with alcohol) o Time sense altered (slow, slow, slow) o Clumsiness, loss of co-ordination

These can increase chances of having an accident. Advise people to smoke in a safe place and don’t be tempted to think it would be great to smoke a big joint at the top of a very tall tree! If people have used cannabis, advise them not to drive. They may think that they are safer because they drive slower, but they’re reaction times are a lot slower and co-ordination can sometimes be all over the place. www.humlondon.org.uk Page 22

Having a ‘whitey’ or ‘spin’:

Whitey’s or spins are a result of blood pressure being lowered causing people to look very pale (hence the name). People can feel faint and in some cases can faint. There sometimes may also be other factors involved such as not eating much, tiredness, lack of fluids and hot environments. Having a whitey can also include nausea, vomiting and shaking. Another form of a whitey is a spin. Symptoms include; sweaty palms, nausea / being sick, hot flushes, blurred vision and an overwhelming feeling of paranoia

Whitey’s can last for minutes or sometimes hours and are not very pleasant. Once in one there is not much that people can do. Make sure that they are in a quiet comfortable environment and with people they trust and who can look after them if they’re feeling. Take regular sips of water to keep fluids up and move to a cooler environment.

Burns:

Burns most often occur with o Heating hash to soften it (burns to fingers and thumbs) o Hot knives (especially if you’re stoned) o Burns to clothes, furniture, bed and body (if naked!)

Make sure burns are kept clean so they don’t become infected and get more serious burns treated properly, especially if they become infected.

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Cannabis Harm Reduction Tips:

1. Don’t share any using equipment or joints.

2. Smoke outdoor-grown herbal or Resin as there is a better balance between THC and CBD percentages (less paranoia) especially with resin.

3. Take a toke and wait 5 – 10 minutes to gauge the strength of the cannabis.

4. If eating cannabis, don’t be tempted to eat more as you think it hasn’t worked - it takes a lot longer for the high to come on.

5. Don’t mix your drugs.

6. Bongs can increase the risk of water vapour inhalation and also releasing dioxins (when heated) if made of plastic.

7. If using a pipe, make sure it’s glass or metal as these won’t give off fumes when burnt.

8. Don’t hold your breath - remember 95% of it is absorbed by the lungs in the first few seconds.

9. Remember that cannabis is now rarely ‘organic’ and can contain pesticides / growing chemicals, moulds and fungi and also nastier things like ground glass or crack.

10. If you are experiencing any negative mental or physical effects… o Stop smoking o Find a more comfortable environment o Make sure you are with people you trust who can look after you

11. Keep any wounds caused by burns clean and free from infection

12. Don’t drive if you have used cannabis as your reactions are much slower and you could cause an accident.

13. Don’t do things that require good co-ordination such as climbing trees or buildings, operating machinery etc, as this and judgement are impaired.

14. If you are uncomfortable about using cannabis or it doesn’t feel right (you feel down, depressed, anxious etc) don’t smoke, take a break.

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Cannabis Workbook

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Cannabis Diary: Week Number …………

Day of the Time of Time of Place/s People you Number of Money Did you achieve things How did you feel before you started week first use last use were with? hits or spent that you planned? smoking and how did you feel joints afterwards? Any unpleasant effects? Monday

Date: / / Tuesday

Date: / / Wednesday

Date: / / Thursday

Date: / / Friday

Date: / / Saturday

Date: / / Sunday

Date: / / Weekly notes or comments about your patterns:

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Week Number …………

Date: / / Tuesday

Date: / / Wednesday

Date: / / Thursday

Date: / / Friday

Date: / / Saturday

Date: / / Sunday

Date: / / Weekly notes or comments about your patterns:

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Week Number …………

Date: / / Tuesday

Date: / / Wednesday

Date: / / Thursday

Date: / / Friday

Date: / / Saturday

Date: / / Sunday

Date: / / Weekly notes or comments about your patterns:

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Week Number …………

Date: / / Tuesday

Date: / / Wednesday

Date: / / Thursday

Date: / / Friday

Date: / / Saturday

Date: / / Sunday

Date: / / Weekly notes or comments about your pattern s:

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Cannabis Diary Review: Date………….

Review Area Patterns noticed Actions Signed Times of first use

Times of last use

Place/s used in

People you were with?

Number of hits or joints

Money spent

Did you achieve t hings that you planned?

How did you feel before and how did you feel afterwards? Any unpleasant effects? Any other things noticed or you have become aware of?

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Closing Doors This form will help you to identify the doors that you may have left open to scoring cannabis or other drugs you might be using. Once identified you need to look at developing action plans that will help you close these doors.

What doors are open that might lead me to score? Door closed or action to close the door Initial

1. Is money still available to you?

2. How are you getting the money that might enable you to score?

3. Do you still mix with people that use cannabis or other drugs?

4. Do you still go into areas / places that you can score from?

5. Have you still got dealers ’ numbers in your phone?

6. Have you told people that you don’t want to use anymore?

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Closing Other Doors…

Other doors that might lead me to score or use cannabis? Door closed or action to close the door Initial 7.

10.

11.

12.

PS Remember to link this work into the following sections of Patterns, Triggers and Cravings… www.humlondon.org.uk Page 32

Patterns of use ‘A’

How do you feel before you use cannabis?

Paranoid Confused Excited Anxious Alone

Angry Bored Sad Worried Happy

Sick Hungry Lazy Confident Depressed

How do you feel when you use cannabis?

Paranoid Confused Excited Anxious Alone

Angry Bored Sad Worried Happy

Sick Hungry Lazy Confident Depressed

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How do you feel after you use cannabis?

Paranoid Confused Excited Anxious Alone

Angry Bored Sad Worried Happy

Sick Hungry Lazy Confident Depressed

How do you want to feel most of the time?

Paranoid Confused Excited Anxious Alone

Angry Bored Sad Worried Happy

Sick Hungry Lazy Confident Depressed

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Q: Are there any differences between the first three smiley charts and the last one? Discuss these with your key worker about any thoughts or feelings you might have and write down possible solutions.

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Patterns of use ’B’ 1. Do you use alone or with friends, partner?

Alone: With friends:

Partner or close friend: Mixture:

2. Are these real friends or just people you smoke with?

Answer:

3. What days of the week do you use?

Monday Yes £ No £

Tuesday Yes £ No £

Wednesday Yes £ No £

Thursday Yes £ No £

Friday Yes £ No £

Saturday Yes £ No £

Sunday Yes £ No £ www.humlondon.org.uk Page 36

4. What times of the day do you smoke? (Also mark down the time that you usually have your first joint)

Morning Late Early Early Late (just woken up) Morning Afternoon Evening at night

Yes £ No £ Yes £ No £ Yes £ No £ Yes £ No £ Yes £ No £

5. Where do you mainly smoke?

At Home At Friends Street Park Other

6. What equipment do you use?

Papers Lighters Pipes Bong Other

7. How do you get the money to support your smoking?

Work Benefits Crime Borrow Other

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Patterns Actions

Now that you have identified some of your patterns, use the information from the previous exercise and from your cannabis diaries to explore what you can do about the patterns that you are not happy with.

a. Feelings and thoughts…

Issues identified: What can I do?

b. People I smoke with…

Issues identified: What can I do?

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c. Days of the week and times of the day…

Issues identified: What can I do?

d. Where I smoke…

Issues identified: What can I do?

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e. Equipment that I use…

Issues identified: What can I do?

f. How I get the money to smoke…

Issues identified: What can I do?

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The Good, the Bad and the Ugly…

This section looks at pro’s and con’s of your cannabis use and how it might have impacted on your life. As well as identifying the bad bits it is important to look at the good bits that you might have got from using so you can look at how you can replace these. Please circle and of the areas that you feel relate to you, write notes if you want and then complete the action plan afterwards.

The bad and the ugly bits… No Energy Crime Relationships Poor Health No Job

Notes: Notes: Notes: Notes: Notes:

Poor diet Debt Mental Health Family Problems Loss of Friends

Notes: Notes: Notes: Notes: Notes:

Other bad and ugly bits…

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The Good bits… Please circle and of the areas that you feel relate to you, write notes if you want and then complete the action plan afterwards. Good areas might be things like the high, network of friends, kills boredom etc. Music The ‘High’ Friendship Sex Thinking

Notes: Notes: Notes: Notes: Notes:

Fun Other good bits?

Notes: Notes:

Now spend a bit of time looking at both the good and the bad of your cannabis use. If it helps discuss this with your key worker… Then look at the actions you might need to take…

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Actions for the bad and the ugly…

Issues identified: What can I do?

Ï 1.1.1.

2.2.2. Ï

3.3.3. Ï

4.4.4. Ï

Actions for the good bits…

Issues identified: What can I do?

Ï 1.1.1.

2.2.2. Ï

3.3.3. Ï

4.4.4. Ï 5.5.5.

REMEMBER: There are good bits to using cannabis sometimes and it can be difficult to lose these. So look at ways that you could replace them by doing other things (you don’t have to lose the what you get, just how you get it!).

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Triggers

Triggers are things that either lead you to smoke or make you feel like smoking. Triggers can vary between Physical, emotional and time or activity based . You probably have a range of triggers (they can work also in conjunction with each other) so use the worksheet below to help you identify them and look at what you can do to avoid or cope with them.

a. Physical Triggers…

Trigger Action to avoid or cope with it… Equipment: What can I do if using equipment sparks me off?

Places: How can I avoid or cope with places that spark me off?

People: How can I avoid or cope with people that spark me off?

Money: How can I cope with money if it sparks me off?

Other:

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b. Emotional Triggers…

Trigger Action to avoid or cope with it… Anger / stress : How can I prevent anger or stress sparking me off?

Anxiety : How can I prevent anxiety sparking me off?

Sad / depressed: Ho w can I prevent sadness or depression sparking me off?

Good feelings: How can I prevent good feelings sparking me off?

Other:

c. Time or activity Based Triggers… www.humlondon.org.uk Page 45

Trigger Action to avoid or cope with it… Day or days: There may be some days that you associate with smoking (weekends?) Mon, Tues, Wed, Thurs, Fri, Sat, Sun

Time: You might find that you automatically think of smoking at certain times?

Payday : Having money might start thoughts of buying weed…

Crime : Committing crime might give you money and thoughts of smoking

Other:

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Cravings

Cannabis doesn’t develop a physical addiction, it’s a psychological addiction. This usually means that the cravings for the drug need triggers like you have identified in the previous session.

If you get a craving you need to know how to deal with it and the first thing to say is that they don’t last and you get through them. If fact you have probably done this lots of times such as when you didn’t have money or couldn’t get hold of any.

Symptoms of craving:

Withdrawal from using cannabis can cause feelings of anxiety, restlessness, physical feelings of sweating, loss of appetite, and also you can have weird vivid dreams (sometimes involving use).

The symptoms of craving can be exactly the same and you feel as if you need cannabis or that cannabis will get rid of the feelings.

Pavlov’s dog, triggers and craving:

Pavlov was a psychologist who had a dog. Every time he fed the dog he used to ring a bell. Eventually the dog associated the bell with being fed. In the end Pavlov could ring the bell and the dog would start to salivate even if food was not there. Essentially the bell became the trigger that then led the dog to feel hungry and expect food.

Your triggers do the same with cannabis. Your pattern might have been to start smoking cannabis in the early evening. After a period of time you get used to doing this. Now that you are stopping or have stopped you might find that at this time of the day you feel anxious, restless or uncomfortable and start thinking that you need a joint.

Coping with cravings:

As mentioned previously cravings don’t last forever, they do stop. So one of the ways of coping with them is simply to ride through them…To help make this easier there are a few tips below:

Ways of coping What I can do

Cravings at a certain time of day?

Do something different at that time (retrain your dog not to expect a joint!)

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Ways of coping What I can do

Craving linked with emotions?

Learn how to cope with stress, anxiety etc

Do something different if feeling good makes you want to smoke

Distract yourself…

Breathing technique:

Breath in for 1… 2… 3… 4…. (sec)

Breath out 1… 2… 3… 4… 5… 6… (sec

Repeat for 10 to 15 minutes

Be with people you trust (who don’t smoke!)

Other ideas?

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Urge surfing…

Another way to get through cannabis cravings is to ride through or ‘surf the urge’. Cravings are totally normal and you can get through them, in fact you probably already have on a number of occasions when you couldn’t get any cannabis or didn’t have the money to but any. Nothing bad happened to you, you got through it and can do again…

Remember cravings and urges to use always need a ‘trigger’ so you can lessen cravings by avoiding some of your triggers. However the reality is that you will probably experience cravings during the process of stopping cannabis use. When or if they do happen remember the following:

1. You don’t have to give into the feelings, you can control them

2. They only last a few minutes

3. You have ridden through them before

The peak of the Surf through the ‘craving’ wave only urge to use and lasts for a few ride the craving

minutes, so… CRAVING WAVE

Triggers Once through think (Something that about what might have sparked you caused the craving? off?) What could you do about this?

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While you are riding through the craving try doing the 4 Minute plan… They help you to pass through the time and also remind you of why you want to stop smoking…

Try filling this sheet out so that you can get used to the idea. At the back of this pack you will find extra 4 minute sheets for you to use to help you get through a craving…

Minute 1: Minute 2:

What goals do you want to achieve? Will Visualise a forked path in front of you. One smoking get in the way of you reaching path is you smoking cannabis, the other is these goals? not. Which path do you want to take?

Minute 4: Minute 3:

Use the time to phone a friend that will be Write down or draw pictures of some of the supportive to you. Don’t phone someone negative things that have happened to you that might want to smoke with you! because of cannabis…

Important: You may want to photocopy this form to make sure that you have a few of these handy when you need it. www.humlondon.org.uk Page 50

High Risk situations

It is important that you can anticipate high risk situations as much as possible and develop plans to cope with them if they do arise. In anticipating these situations you need to have an awareness of situations, emotions, people and places that may have lead to a using event (refer to your previous worksheets to help you with this).

Suggested plans Personal plans

1. Anticipate high risk Situations that lead me to crave: situations

2. Leave or change the Safe places I can go: situation

3. Distract yourself with things Good distracters: you like to do

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4. Have a list of emergency People I can call in an emergency: numbers

5. Remind yourself of your My main achievements / what I want to achieve: achievements or what you want to achieve 1.

6. Change the thoughts of Positive thoughts I could use: using to positive thoughts

7. I will put off the decision to Techniques I can use to relax / bring me down me during use for 15, 30, 60 minutes those 15, 30, 60 minutes:

Source: Adapted from All Purpose Coping Plan, Kathleen M. Carroll Ph.D, 1998

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A final few words…

Good Luck with everything

Remember you have choice as to where your life goes and how you live it

And also remember you can always come and see us for support when if you need it.