Center for Applied Behavioral Health Policy
Darien Allen, M.A., Harrison Stratton, Ph.D. Candidate, & Michael S. Shafer, Ph.D., Arizona State University Center for Applied Behavioral Health Policy As a result of attending this session, you can expect to:
1. Gain knowledge about the basic physiology and pharmacology of the Endogenous Cannabinoid System.
2. Acquire a better understanding of the health risks and benefits associated with cannabis use.
3. Examine the research involving the association between cannabis use and the onset of mental illness and addiction.
4. Describe the evidence for cannabis use in the treatment of mental illness and drug addiction.
5. Explore strategies for integrating client medical marijuana use with other treatment programming. Schedule 1 Schedule 2 Schedule 3 Heroin 6,2352013 Methamphetamine Ketamine LSD Cocaine 4,9442013 Anabolic Steroids Ecstasy Opiates 16,2352013 Buprenorphine Peyote Nabilone* Dronabinol*
Deaths related to alcohol: 29,0012013 Deaths related to marijuana: 02013
Distribution of Top 5 Qualifying Conditions
Muscle Spasms 0.96
Hepatitis C 1.1
Cancer 2.7
2+ Conditions 18.5
Chronic Pain 72.2
0 10 20 30 40 50 60 70 80 PTSD was added in January 2015 and is the designated qualifying condition for 0.52% of the Arizona MMJ population. Gender Distribution among Age Groups in the Arizona MC Population (N=70,189) Mean: 43.9 81+ (SD 15.4) 71-80 61-70 51-60 41-50 31-40 18-30 <18
0% 10% 20% 30% 40% 50% 60% 70% 80% Female (N=23306) Male (N=46883) * *
CBD-only Medical Cannabis Marijuana Decriminalization Decriminalization & Medical Medical & Recreational *Medical Cannabis laws in 1+ city Top 10 Conditions Covered by State Medical Cannabis Programs + PTSD (%) Muscle Spasms MS Hepatitis C HIV/AIDS Seizures Nausea Cachexia Glaucoma PTSD Cancer Pain 0 20 40 60 80 100 Terpenes Flavonoids Cannabinoids * *
Marijuana is notTHC Some cannabinoids are non-psychoactive, such as CBD and CBG Emotion Neuro- & Stress development
Immune Appetite & Function Metabolism & Pain
Zalesky, Solowij, Yucel, Lubman, Takagi, Harding & Seal, 2012
Seeking Behavior
Relapse
SA Treatment Reduced opioid mortality in states w/ medical marijuana
States w/ Medical Cannabis
States w/out Medical Cannabis
Bachhuber, Saloner, Cunningham & Barry, 2014 Consensus
No Consensus
Crowe, Nass, Gabella & Kinsey, 2014 Effects on Symptoms
Improved No Consensus
Sleep Disturbance Re-experience Numbing, Negative Affect Anxiety following Hyperarousal cessation Anxiety Decreased AEA, 2-AG Elevated AEA, 2-AG
Decreased CB2R CB2R overexpression Anxiety
CB1 activation (H) CB1 activation (L) Anxiety
CB1 blockade CB2 activation Reduced stress axis activation/ Increase in anxiety hippocampal Neurogenesis serotonin activity
Prevention of Anti- Reduction of over- depressant inflammation excitation Effect Global Functioning, Cannabinoids share Depressive many characteristics of Symptoms drugs used to treat BAD.
Patients poorly managed Elevated on current treatments Mood, Mania report benefits Symptoms Cannabis during Schizophrenia or adolescence and/or Schizoaffective
adulthood Disorder Symptoms THC/ CBD Psychotic High THC Increased AEA
strains
Psychotic Symptoms Top 3 Qualifying Conditions among Dispensary Sample & Greater Arizona MC Population 0.9% Nausea 17.5%
Muscle 1.2% Spasms 30.8%
Chronic 89.8% Pain 83.3%
0% 20% 40% 60% 80% 100% State of Arizona Dispensary Sample Qualifying Conditions among Dispensary Sample & Greater Arizona MC Population Cachexia Crohn's Disease MS Glaucoma Seizures HIV/AIDS Hepatitis C Cancer
0.0% 0.5% 1.0% 1.5% 2.0% 2.5% 3.0% 3.5% 4.0% Arizona MC Population Dispensary Sample Mental Health (MH) Diagnoses among Dispensary Sample
None
Other
Schizophrenia/Schizoaffective…
Personality Disroders
Bipolar or Affective Disorder
Major Depressive Disorder
Anxiety Disorders & PTSD
0% 10% 20% 30% 40% 50% 60% 70% 80% 1+MI Sample Dispensary Sample Psychiatric Medication Use
Anti-psychotic
Anti-anxiety & Anti- depressant
Anti-anxiety 1+ MI Sample Dispensary Sample Anti-depressant
Psychiatric Medication
0% 10% 20% 30% 40% 50% Significant Improvement upon Cannabis Ingestion (%)
Major Depression 80.2 Muscle Tension 95.4 Feeling Irritable 91.1 Restless/On Edge 90.1 Excessive Worry/Anxiety 89.0 Agitated/Listless 90.6 Sleeping Difficulties 98.2 Lack of Interest in Most Activities 87.4 Depressed Mood 96.0
0 50 100 Majority of Recommendations Human studies not permitted human based solely on representative of studies funded by human studies whole plant use NIDA/NIH Adjunct therapy for SA Cannabis as therapy for treatment & pain MH symptoms management
ECS Dysfunction in MH illness
Not for everyone: abuse Potentially harmful prior to potential adulthood Renewal: $150 w/in 30 days of Application: expiration $150; $75 SNAP Assessment: cost varies w/ insurance *
Do you know what the qualifying conditions are in Arizona? Have you tried marijuana in the past? What do you know about methods of consuming cannabis? In what way do you think it will help you?
PTSD is the only qualifying psychiatric condition in 2015 Similar to counseling patients on any new medication with abuse potential*.
*dosing guidelines inconsistent Practitioners & patients can submit petitions to ADHS to add debilitating conditions several times throughout the year.
Upcoming: July 27-31, 2015 “We need to recognize that the issue must bypass our philosophical bias as to whether marijuana is good or bad, and focus our attention on efficacy, safety, and risk versus benefit.”
Gerold Aronoff, MD Past President of The American Academy of Pain Medicine