Is Cannabis Addictive?
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Clearing the Smoke on Cannabis: Regular Use and Cognitive Functioning
6 Clearing the Smoke on Cannabis Regular Use and Cognitive Functioning Robert Gabrys, Ph.D., Research and Policy Analyst, CCSA Amy Porath, Ph.D., Director, Research, CCSA Key Points • Regular use refers to weekly or more frequent cannabis use over a period of months to years. Regular cannabis use is associated with mild cognitive difficulties, which are typically not apparent following about one month of abstinence. Heavy (daily) and long-term cannabis use is related to more This is the first in a series of reports noticeable cognitive impairment. that reviews the effects of cannabis • Cannabis use beginning prior to the age of 16 or 17 is one of the strongest use on various aspects of human predictors of cognitive impairment. However, it is unclear which comes functioning and development. This first — whether cognitive impairment leads to early onset cannabis use or report on the effects of chronic whether beginning cannabis use early in life causes a progressive decline in cannabis use on cognitive functioning cognitive abilities. provides an update of a previous report • Regular cannabis use is associated with altered brain structure and function. with new research findings that validate Once again, it is currently unclear whether chronic cannabis exposure and extend our current understanding directly leads to brain changes or whether differences in brain structure of this issue. Other reports in this precede the onset of chronic cannabis use. series address the link between chronic • Individuals with reduced executive function and maladaptive (risky and cannabis use and mental health, the impulsive) decision making are more likely to develop problematic cannabis use and cannabis use disorder. -
Cannabinoid Hyperemesis Syndrome: a Case Report in Mexico
CASE REPORT Cannabinoid hyperemesis syndrome: a case report in Mexico Luis Fernando García-Frade Ruiz,1 Rodrigo Marín-Navarrete,3 Emmanuel Solís Ayala,1 Ana de la Fuente-Martín2 1 Medicina Interna, Hospital Ánge- ABSTRACT les Pedregal. 2 Escuela de Medicina, Universi- Background. The first case report on the Cannabinoid hyperemesis syndrome (CHS) was registered in 2004. dad la Salle. Years later, other research groups complemented the description of CHS, adding that it was associated with 3 Unidad de Ensayos Clínicos, Instituto Nacional de Psiquiatría such behaviors as chronic cannabis abuse, acute episodes of nausea, intractable vomiting, abdominal pain Ramón de la Fuente Muñiz. and compulsive hot baths, which ceased when cannabis use was stopped. Objective. To provide a brief re- view of CHS and report the first documented case of CHS in Mexico. Method. Through a systematic search Correspondence: Luis Fernando García-Frade Ruiz. in PUBMED from 2004 to 2016, a brief review of CHS was integrated. For the second objective, CARE clinical Medicina Interna, Hospital Ángeles case reporting guidelines were used to register and manage a patient with CHS at a high specialty general del Pedregal. hospital. Results. Until December 2016, a total of 89 cases had been reported worldwide, although none from Av. Periférico Sur 7700, Int. 681, Latin American countries. Discussion and conclusion. Despite the cases reported in the scientific literature, Col. Héroes de Padierna, Del. Magdalena Contreras, C.P. 10700 experts have yet to achieve a comprehensive consensus on CHS etiology, diagnosis and treatment. The lack Ciudad de México. of a comprehensive, standardized CHS algorithm increases the likelihood of malpractice, in addition to con- Phone: +52 (55) 2098-5988. -
DIAGNOSIS REFERENCE GUIDE A. Diagnostic Criteria for Substance
ALCOHOL & OTHER DRUG SERVICES DIAGNOSIS REFERENCE GUIDE A. Diagnostic Criteria for Substance Use Disorder See DSM-5 for criteria specific to the drugs identified as primary, secondary or tertiary. P S T (P=Primary, S=Secondary, T=Tertiary) 1. Substance is often taken in larger amounts and/or over a longer period than the patient intended. 2. Persistent attempts or one or more unsuccessful efforts made to cut down or control substance use. 3. A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from effects. 4. Craving or strong desire or urge to use the substance 5. Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home. 6. Continued substance use despite having persistent or recurrent social or interpersonal problem caused or exacerbated by the effects of the substance. 7. Important social, occupational or recreational activities given up or reduced because of substance use. 8. Recurrent substance use in situations in which it is physically hazardous. 9. Substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance. 10. Tolerance, as defined by either of the following: a. Markedly increased amounts of the substance in order to achieve intoxication or desired effect; Which:__________________________________________ b. Markedly diminished effect with continued use of the same amount; Which:___________________________________________ 11. Withdrawal, as manifested by either of the following: a. The characteristic withdrawal syndrome for the substance; Which:___________________________________________ b. -
Clearing the Smoke on Cannabis: Regular Use and Mental Health
1 Clearing the Smoke on Cannabis Regular Use and Mental Health Sarah Konefal, Ph.D., Research and Policy Analyst, CCSA Robert Gabrys, Ph.D., Research and Policy Analyst, CCSA Amy Porath, Ph.D., Director, Research, CCSA Key Points • Regular cannabis use refers to weekly or more frequent cannabis use over a period of months to years. • Regular cannabis use is at least twice as common among individuals with This is the first in a series of reports mental disorders, including schizophrenia, bipolar disorders, depressive and that reviews the effects of cannabis anxiety disorders, and post-traumatic stress disorder (PTSD). use on various aspects of human • There is strong evidence linking chronic cannabis use to increased risk of developing psychosis and schizophrenia among individuals with a family functioning and development. This history of these conditions. report on the effects of regular • Although smaller, there is still a risk of developing psychosis and cannabis use on mental health provides schizophrenia with regular cannabis use among individuals without a family an update of a previous report with history of these disorders. Other factors contributing to increased risk of new research findings that validate and developing psychosis and schizophrenia are early initiation of use, heavy or extend our current understanding of daily use and the use of products high in THC content. this issue. Other reports in this series • The risk of developing a first depressive episode among individuals who use address the link between regular cannabis regularly is small after accounting for the use of other substances cannabis use and cognitive functioning, and common sociodemographic factors. -
Can Tobacco Dependence Provide Insights Into Other Drug Addictions? Joseph R
DiFranza BMC Psychiatry (2016) 16:365 DOI 10.1186/s12888-016-1074-4 DEBATE Open Access Can tobacco dependence provide insights into other drug addictions? Joseph R. DiFranza Abstract Within the field of addiction research, individuals tend to operate within silos of knowledge focused on specific drug classes. The discovery that tobacco dependence develops in a progression of stages and that the latency to the onset of withdrawal symptoms after the last use of tobacco changes over time have provided insights into how tobacco dependence develops that might be applied to the study of other drugs. As physical dependence on tobacco develops, it progresses through previously unrecognized clinical stages of wanting, craving and needing. The latency to withdrawal is a measure of the asymptomatic phase of withdrawal, extending from the last use of tobacco to the emergence of withdrawal symptoms. Symptomatic withdrawal is characterized by a wanting phase, a craving phase, and a needing phase. The intensity of the desire to smoke that is triggered by withdrawal correlates with brain activity in addiction circuits. With repeated tobacco use, the latency to withdrawal shrinks from as long as several weeks to as short as several minutes. The shortening of the asymptomatic phase of withdrawal drives an escalation of smoking, first in terms of the number of smoking days/ month until daily smoking commences, then in terms of cigarettes smoked/day. The discoveries of the stages of physical dependence and the latency to withdrawal raises the question, does physical dependence develop in stages with other drugs? Is the latency to withdrawal for other substances measured in weeks at the onset of dependence? Does it shorten over time? The research methods that uncovered how tobacco dependence emerges might be fruitfully applied to the investigation of other addictions. -
Patient-Focused Drug Development Meeting on Opioid Use Disorder
Patient-Focused Drug Development Meeting on Opioid Use Disorder April 17, 2018 FDA will be streaming a live audio recording of the meeting with the presentation slides, which is open to the public at: https://collaboration.fda.gov/pfdd041718/. The audio recording and presentation slides, along with a meeting transcript and summary report, will also be made publicly available after the meeting. Because of the sensitive nature of the meeting topic, and the importance of gathering candid, meaningful input from individuals who have come forward to speak about living with opioid use disorder, no other audio recording, video recording, and/or photography will be allowed at this Patient-Focused Drug Development meeting. FDA is asking for your cooperation and strongly requests that you respect the privacy of all attendees. #PFDD Wi-Fi Network: FDA-Public Password: publicaccess Welcome Sara Eggers, PhD Office of Strategic Programs Center for Drug Evaluation and Research April 17, 2018 U.S. Food and Drug Administration Agenda • Opening Remarks • Setting the context – Overview of Opioid Use Disorder – Road from PFDD Meetings to Clinical Trial Endpoints – Overview of Discussion Format • Discussion Topic 1 • Lunch • Discussion Topic 2 (with a short break) • Open Public Comment • Closing Remarks 3 3 No Recording or Photography • FDA is streaming a live audio recording of the meeting with the presentation slides, which is open to the public – Access the live stream: https://collaboration.fda.gov/pfdd041718/. – The audio recording and presentation slides, along with a meeting transcript and summary report, will also be made publicly available after the meeting. • Because of the sensitive nature of the meeting topic, and the importance of gathering candid, meaningful input from individuals who have come forward to speak about living with opioid use disorder, no other audio recording, video recording, and/or photography will be allowed at this Patient-Focused Drug Development meeting. -
Long-Term Outcomes of Chronic, Recreational Marijuana Use
The Corinthian Volume 20 Article 16 November 2020 Long-Term Outcomes of Chronic, Recreational Marijuana Use Celia G. Imhoff Georgia College and State University Follow this and additional works at: https://kb.gcsu.edu/thecorinthian Part of the Medicine and Health Sciences Commons, and the Psychology Commons Recommended Citation Imhoff, Celia G. (2020) "Long-Term Outcomes of Chronic, Recreational Marijuana Use," The Corinthian: Vol. 20 , Article 16. Available at: https://kb.gcsu.edu/thecorinthian/vol20/iss1/16 This Article is brought to you for free and open access by the Undergraduate Research at Knowledge Box. It has been accepted for inclusion in The Corinthian by an authorized editor of Knowledge Box. LONG-TERM OUTCOMES OF CHRONIC, RECREATIONAL MARIJUANA USE Amidst insistent, nationwide demand for the acceptance of recreational marijuana, many Americans champion the supposedly non-addictive, inconsequential, and creativity-inducing nature of this “casual” substance. However, these personal beliefs lack scientific evidence. In fact, research finds that chronic adolescent and young adult marijuana use predicts a wide range of adverse occupational, educational, social, and health outcomes. Cannabis use disorder is now recognized as a legitimate condition in the Diagnostic and Statistical Manual of Mental Disorders and cannabis dependence is gaining respect as an authentic drug disorder. Some research indicates that medical marijuana can be somewhat effective in treating assorted medical conditions such as appetite in HIV/AIDS patients, neuropathic pain, spasticity and multiple sclerosis, nausea, and seizures, and thus its value to medicine continues to evolve (Atkinson, 2016). However, many studies on medical marijuana produce mixed results, casting doubt on our understanding of marijuana's medicinal properties (Atkinson, 2016; Keehbauch, 2015). -
Cannabis Hyperemesis Syndrome: an Update on the Pathophysiology and Management
REVIEW ARTICLE Annals of Gastroenterology (2020) 33, 571-578 Cannabis hyperemesis syndrome: an update on the pathophysiology and management Abhilash Perisettia, Mahesh Gajendranb, Chandra Shekhar Dasaric, Pardeep Bansald, Muhammad Azize, Sumant Inamdarf, Benjamin Tharianf, Hemant Goyalg University of Arkansas for Medical Sciences, Little Rock, AR; Texas Tech University Health Sciences Center El Paso; Kansas City VA Medical Center; Moses Taylor Hospital and Reginal Hospital of Scranton, Scranton, PA; University of Toledo, HO; The Wright Center for Graduate Medical Education, Scranton, PA, USA Abstract Cannabis hyperemesis syndrome (CHS) is a form of functional gut-brain axis disorder characterized by bouts of episodic nausea and vomiting worsened by cannabis intake. It is considered as a variant of cyclical vomiting syndrome seen in cannabis users especially characterized by compulsive hot bathing/showers to relieve the symptoms. CHS was reported for the first time in 2004, and since then, an increasing number of cases have been reported. With cannabis use increasing throughout the world as the threshold for legalization becomes lower, its user numbers are expected to rise over time. Despite this trend, a strict criterion for the diagnosis of CHS is lacking. Early recognition of CHS is essential to prevent complications related to severe volume depletion. The recent body of research recognizes that patients with CHS impose a burden on the healthcare systems. Understanding the pathophysiology of the endocannabinoid system (ECS) remains central in explaining the clinical features and potential drug targets for the treatment of CHS. The frequency and prevalence of CHS change in accordance with the doses of tetrahydrocannabinol and other cannabinoids in various formulations of cannabis. -
HHS Guide for Clinicians on the Appropriate Dosage Reduction Or
This HHS Guide for Clinicians on the Appropriate Dosage HHS Guide for Clinicians on the Reduction or Discontinuation of Long-Term Opioid Analgesics provides advice to clinicians who are contemplating or initiating a reduction in opioid dosage or discontinuation Appropriate Dosage Reduction of long-term opioid therapy for chronic pain. In each case the clinician should review the risks and benefits of the or Discontinuation of current therapy with the patient, and decide if tapering is appropriate based on individual circumstances. Long-Term Opioid Analgesics After increasing every year for more than a decade, annual needs.2,3,4 Coordination across the health care team is critical. opioid prescriptions in the United States peaked at 255 million in Clinicians have a responsibility to provide or arrange for 2012 and then decreased to 191 million in 2017.i More judicious coordinated management of patients’ pain and opioid-related opioid analgesic prescribing can benefit individual patients as problems, and they should never abandon patients.2 More well as public health when opioid analgesic use is limited to specific guidance follows, compiled from published guidelines situations where benefits of opioids are likely to outweigh risks. (the CDC Guideline for Prescribing Opioids for Chronic Pain2 At the same time opioid analgesic prescribing changes, such and the VA/DoD Clinical Practice Guideline for Opioid Therapy as dose escalation, dose reduction or discontinuation of long- for Chronic Pain3) and from practices endorsed in the peer- term opioid analgesics, have potential to harm or put patients at reviewed literature. risk if not made in a thoughtful, deliberative, collaborative, and measured manner. -
Treatment of Benzodiazepine Dependence
The new england journal of medicine Review Article Dan L. Longo, M.D., Editor Treatment of Benzodiazepine Dependence Michael Soyka, M.D. raditionally, various terms have been used to define substance From the Department of Psychiatry and use–related disorders. These include “addiction,” “misuse” (in the Diagnostic Psychotherapy, Ludwig Maximilian Univer 1 sity, Munich, and Medical Park Chiemsee and Statistical Manual of Mental Disorders, fourth edition [DSM-IV] ), “harmful use” blick, Bernau — both in Germany; and T 2 3 Privatklinik Meiringen, Meiringen, Switzer (in the International Classification of Diseases, 10th Revision [ICD-10] ), and “dependence.” Long-term intake of a drug can induce tolerance of the drug’s effects (i.e., increased land. Address reprint requests to Dr. Soyka at Medical Park Chiemseeblick, Rasthaus amounts are needed to achieve intoxication, or the person experiences diminished strasse 25, 83233 Bernau, Germany, or at effects with continued use4) and physical dependence. Addiction is defined by com- m . soyka@ medicalpark . de. pulsive drug-seeking behavior or an intense desire to take a drug despite severe N Engl J Med 2017;376:1147-57. medical or social consequences. The DSM-IV and ICD-10 define misuse and harm- DOI: 10.1056/NEJMra1611832 ful use, respectively, on the basis of various somatic or psychological consequences Copyright © 2017 Massachusetts Medical Society. of substance use and define dependence on the basis of a cluster of somatic, psychological, and behavioral symptoms. According to the ICD-10, dependence is diagnosed if 3 or more of the following criteria were met in the previous year: a strong desire or compulsion to take the drug, difficulties in controlling drug use, withdrawal symptoms, evidence of tolerance, neglect of alternative pleasures or interests, and persistent drug use despite harmful consequences. -
Benzodiazepine Abuse and Dependence: Misconceptions and Facts
CLINICAL REVIEW Benzodiazepine Abuse and Dependence: Misconceptions and Facts Michael G. Farnsworth, MD St Paul, Minnesota Benzodiazepines can be prescribed for a number of medical conditions. Many physi cians are reluctant to prescribe benzodiazepines out of fear of producing depen dence in patients and incurring the disapproval of their peers. Studies of psychotropic drug use and abuse demonstrate that individuals using benzodiazepines for treat ment of a medical illness rarely demonstrate tolerance to the therapeutic action of the medication or escalate the dose. Eighty percent of benzodiazepines are pre scribed for 6 months or less, and elderly women are the most common long-term users of low-dose benzodiazepines. In contrast, recreational use of benzodiazepines is associated with polysubstance abuse, lack of medical supervision, rapid tolerance to the euphoric or sedating side effect, and escalation of dose. Most recreational us ers of benzodiazepines are young men. Documentation of indication for use, collec tion of drug-abuse history, close monitoring, and drug holidays can improve the man agement of this class of medication. J Fam Pract 1990; 31:393-400. enzodiazepines, as a class of psychotherapeutic med barbiturates and meprobamate, introduced in 1955, re B ications, have enjoyed widespread use since their US mained as dominant anxiolytic drugs. Physicians, how introduction in the early 1960s. These medications are ever, were concerned with the propensity of barbiturates used to treat some of the most prevalent emotional and to induce tolerance, physical dependence, drug interac physical disorders seen in medical practice, which include tions, and potential for a lethal withdrawal syndrome. anxiety, insomnia, seizure disorders, muscle spasms, and Accordingly, chlordiazepoxide was synthesized and mar alcohol withdrawal. -
Phenomenology Epidemiology
Phenomenology DEFINITIONS Intoxication: reversible, substance-specific physiological and behavioral changes due to recent exposure to a psychoactive substance. Addiction: compulsion to use a drug, usually for its psychic, rather than therapeutic, effects Tolerance: the decline in potency of an opioid experienced with continued use, so that higher doses are needed to achieve the same effect. This is a receptor mediated effect, typical of many psychoactive drugs. Physical Dependence: refers to the development of withdrawal symptoms once a drug is stopped. Withdrawal: a physiological state that follows cessation or reduction in the amount of a drug used. Generally these effects are the opposite of the drugs normal effects. Substance Dependence (DSM version): A maladaptive pattern of substance use with adverse clinical consequences. Substance Abuse (DSM version): A maladaptive pattern of use that causes clinically significant impairment. Alcoholism: A repetitive, but inconsistent and sometimes unpredictable loss of control of drinking which produces symptoms of serious dysfunction or disability. Clearly there is a wide range of findings possible on the mental status exam, however any exam should look for typical signs of regular substance use. Epidemiology Use of psychoactive substances is common in society, and is often socially acceptable or at least tolerated. Historically, psychoactive substance has served a variety of purposes, including medicinal, social, recreational and religious. In the U.S., 90% people report some alcohol use, 80% report some caffeine use, 25% report use of tobacco products, and 37% report having used illicit substances (at least once in life). Dependence and Abuse are also very common (13.6% in ECA). Over 10 million Americans are alcoholics, over 8 million are "Problem drinkers." Only 3% of alcoholics are on skid row.