CAPC/CPNP Coalition Face to Face Meeting October 18, 2018

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1 CAPC/CPNP Coalition Face to Face Meeting October 18, 2018

2 Topics What is cannabis and how is it used? What does the evidence say about health effects? What about effects during pregnancy and breastfeeding? Harm reduction messages Having the conversation about cannabis Alberta s approach to legalization Resources available

3 What do you see?

4 What do you see?

5 Cannabis 101: The Basics

6

7 What is cannabis?

8

9 Cannabis Sativa/ Indica/ Hybrids Part 2 of Legalization Marijuana Concentrates (oils and resins) Edibles Dried Flowers Leaves Solvent Non-Solvent

10 Synthetic Cannabis Medical Grade (capsule) Underground Market Nabilone Dronabinol Marinol K2 Spice Joker, Mamba, Kush, Kronic +100 s more

11 THC Psychoactive; gives the feeling of being high. Some may feel anxious or paranoid. CBD Non-psychoactive; may reduce feelings of anxiety. Being studied for medical purposes.

12 How is THC broken down in the body? Mostly broken down in the liver Elimination occurs via feces and urine Accumulates in fatty tissues and is slow to release into the bloodstream Detected in body anywhere from several days to several weeks following last use Health Canada (2013)

13 Potency Potency is primarily measured by THC content Potency of cannabis is much greater today than it was 20+ years ago According to Caulkins (2016), daily THC consumption in Washington has increased by 60x, when compared to 20 years ago Products containing THC levels higher than 30% (30g THC per ml of oil) will not be available in the legally regulated market THC = Effect Caulkins (2016)

14 How is cannabis used? Inhalation Oral or Ingestion Topical

15 How is cannabis used? Inhalation Handheld pipe Rolling papers Handheld vaporizer Water pipe (bong) Hookah Vaporizer Images courtesy of CPHA Community Consultations (2018)

16 Oral or Ingestion Soda Candies Oil Chocolate Hard Candy Tincture Images courtesy of CPHA Community Consultations (2018)

17 Topical Body cream Bath soak Pleasure oil Night cream Salve Shampoo Images courtesy of CPHA Community Consultations (2018)

18 How does cannabis make you feel? Euphoria Relaxation Cognitive impairment Time-distortion Appetite and heart rate Decreased inhibition Intensification of ordinary experiences Followed by depressant period May experience anxiety or paranoia

19 Can you overdose on cannabis? If you are concerned that you or someone you re with is showing signs of cannabis poisoning or excessive consumption, call: Poison & Drug Information Service (PADIS) (toll-free ) Health Link (call 811 or for internet phone users), or 911. Consuming too much cannabis can cause toxic effects. Combining cannabis with other drugs can increase this risk. Signs of cannabis poisoning/ toxicity include: Changes in heart rate Extreme nausea/vomiting Anxiety Panic attacks or paranoia Extreme confusion Seizures

20 Cannabis Hyperemesis Syndrome (CHS) Severe and sudden nausea and vomiting Can lead to dehydration and kidney failure Associated with frequent, long term use Most effective treatment is to stop cannabis use

21 Does cannabis use cause dependence? No Use Use Misuse Abuse Dependence Physical Dependence Psychological Dependence

22 Who is using cannabis? 44.5% Lifetime cannabis consumption of Canadians 15+ years 12% Past-year consumption of Canadians 15+ years 33% Past-year reporting daily or almost daily consumption 24% Past-year reporting consumption for medical purposes CTADS (2015)

23 Who is using cannabis? 21% Past-year cannabis use years 30% Past-year cannabis use years CTADS (2015)

24 Evidence-Based Health Effects of Cannabis

25 More evidence is needed to understand the association between cannabis consumption and health risks and harms

26 But that does not mean cannabis is harmless.

27 Lung Health Brain Health Mental Health Dependency Pregnancy/ Breastfeeding Driving Impairment

28 Does cannabis use increase the risk of developing psychosis or schizophrenia? According to Health Canada (2018) The risk of developing psychosis or schizophrenia may increase when cannabis is used more frequently (daily and near-daily use). High-potency products have been linked to an increased risk of psychosis. The risk of psychosis may increase when cannabis use is initiated before the age of 16. Persons with a family history of psychosis or schizophrenia who use cannabis are at greater risk of developing these conditions.

29 Key Research The Health Effects of Cannabis and Cannabinoids: The National Academies of Sciences, Engineering, Medicine Cannabis Evidence Series: The Health Technology Assessment Unit, University of Calgary

30 The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research (2017) Insufficient Limited Moderate Substantial Conclusive Substantial (not conclusive) Development of schizophrenia & other psychoses in those with genetic or biological liability Increased risk of motor vehicle crashes Low birth weight of offspring Respiratory symptoms with long term use Problematic use patterns and cannabis use disorder with early onset and/or heavy use Increased likelihood of use in males and those who use tobacco McCormick et al. 2017

31 Health Effects No evidence of harm Overall health effects: arteritis Cancer: lung, head, and neck cancers Inconclusive Overall health effects: all cause mortality, atrial fibrillation, bone loss Mental health: psychosis in high-risk individuals, worse psychotic symptoms, suicide, depression, anxiety Cancer: bladder, prostate, penile, cervical, childhood cancers Brain changes: white matter, blood flow changes Evidence of harm Overall: driving, stroke, pulmonary function, cross-interaction with drugs, vision Mental health: psychosis, mania, neurological soft signs, relapse, dependency Cancer: testicular cancer Social effects: impaired driving Brain changes: decreased glutamate, changes in dopamine, poorer global functioning Neurocognitive changes: reduced memory, decreased efficiency Harms associated with use during pregnancy Source: University of Calgary, The Cannabis Evidence Series

32 Medical Use of Cannabis Evidence of Benefit Inconclusive Evidence of Harm Nausea and vomiting due to chemotherapy Chronic pain Spasticity due to Multiple Sclerosis or paraplegia Sleep Disorders Tourette Syndrome Loss of appetite in HIV/Aids patients Anxiety disorders Glaucoma Depression-- due to high doses of THC University of Calgary (2017)

33 For Pregnant and Breastfeeding Women

34 Cannabis Use During Pregnancy Between 2012 and 2016: 2.5 % of women in Alberta self-reported using cannabis during pregnancy Alberta Birth Registry - Alberta Trends, March 2018

35 There is substantial evidence of a statistical association between maternal cannabis smoking and: o Lower birth weight of the offspring There is limited evidence of a statistical association between maternal cannabis smoking and: o Pregnancy complications for the mother o Admission of the infant to the neonatal intensive care unit There is insufficient evidence to support or refute a statistical association between maternal cannabis smoking and: o Later outcomes in the offspring (e.g., sudden infant death syndrome, cognition/academic achievement, and later substance use) McCormick, et. al (2017)

36 Health Canada- Key Messages Just like with tobacco and alcohol, a pregnant woman or new mother's use of cannabis can affect her fetus or newborn child Frequent cannabis use during pregnancy can lead to lower birth weight of the baby Toxins in cannabis can pass through the placenta to the fetus during pregnancy and into breastmilk to a breastfed baby

37 Health Canada- Key Messages Associated with longer-term developmental effects in children and adolescents, such as: decreases in: memory function, the ability to pay attention, reasoning & problem-solving skills hyperactive behaviour increased risk for future substance use

38 For Healthcare Providers The Society of Obstetricians and Gynaecologists of Canada recommends that: Pregnant women and women of child-bearing age should be periodically asked about substance use Women who are pregnant or contemplating pregnancy should be encouraged to discontinue cannabis use Women should be encouraged to abstain from cannabis use during lactation and breastfeeding Use of cannabis for medicinal purposes should be strongly discouraged during pregnancy, in favor of alternative therapies proven to be safe Government of Canada (2018)

39 Can cannabis use affect my ability to become pregnant or conceive a baby? FOR MALES Cannabis use can have a negative impact on your reproductive health as it may reduce testosterone production, sperm count, and semen quality FOR FEMALES Some research suggests that cannabis use can affect ovulation and the length of your menstrual cycle

40 Nausea and Vomiting The use of cannabis for nausea and vomiting during pregnancy is not well studied However, we do know that cannabis will pass to a baby through the placenta There are several nausea treatments that have been well studied and are recommended for use during pregnancy Talk with your healthcare provider about which treatment would be the right choice for you

41 Cannabis and Breastfeeding Babies who have been exposed to cannabis through breast milk could: Have slower motor development (affects baby s movements and responses) Become drowsy and have a hard time latching properly to the breast Centre of Excellence for Women s Health, Women and Cannabis (2017)

42 Cannabis and Childcare Using cannabis can affect mood, judgment and how a person supervises and cares for their baby It can also affect the ability to breastfeed and respond to the baby s feeding cues Avoid using cannabis if you are breastfeeding

43 Cannabis & Safety Do not smoke cannabis in the home or around children. Keep cannabis and all drugs (alcohol, tobacco and tobacco-like products) locked up, out of sight, out of reach and in their original containers. If a child is exposed to cannabis and shows signs of distress, contact: Poison & Drug Information Service (PADIS) (toll free ) Health Link (call 811 or for internet phone users)

44 Cannabis & Harm Reduction

45 Reducing Health Risks Related to Cannabis Use

46 Lower-Risk Cannabis Use Guidelines Delay using cannabis until later in life. If you choose to use cannabis, choose lower-risk products such as low THC and avoid smoking it. Limit and reduce your use of cannabis.

47 Lower-Risk Cannabis Use Guidelines Avoid mixing cannabis with alcohol, tobacco or other drugs (street & prescription). Don t use if you are breastfeeding or pregnant (or think you might be).

48 Lower-Risk Cannabis Use Guidelines Don t use and drive. Don t use synthetic cannabinoids (e.g. K2, Spice). It can be more toxic and potent and create a greater risk for poisoning/toxicity.

49 Lower-Risk Cannabis Use Guidelines Don t use if you have your own or a family history of psychosis, substance use disorders or other mental health problems. Be aware of bad reactions: Symptoms of too much cannabis include: paranoia, panic, increased heart rate, confusion, nausea and vomiting.

50 Having a conversation with clients about their cannabis use How to approach it? Where to start? What are the tools? Rottach, et al., 2009 as cited in CPHA Community Consultations

51 Making Choices About Cannabis: Pathways Research

52 Alberta s Approach to Non-Medical Cannabis

53 The possession of non-medical cannabis is legal in Uruguay Washington State Washington D.C. Colorado Oregon Alaska California Maine Massachusetts Nevada It has been decriminalized in 31 countries and 18 states. Government of Alberta (2016)

54 Cannabis Legalization Milestones Apr 2017 Oct 2017 Federal Government proposes legislation to legalize cannabis by July 1, 2018 Draft of Alberta Cannabis Framework released (public consult) Feb 2018 Provincial regulations released Oct 2018 Federal cannabis legalization date Jun 2017 Alberta launches 2- month public consultation Nov 2017 Alberta Bill 26 introduced and passed third reading Jun 2018 Federal Cannabis Act and Regulations passed

55 Why legalize cannabis? Restrict youth access Displace the illegal market Protect public health

56 Activity Responsibilities Federal Provincial Municipal Possession limits ** Trafficking Advertisement & packaging ** Impaired driving Medical cannabis Send-to-sale tracking system Production (cultivation and processing) Age limit (federal minimum)** Public health Education Home cultivation (growing plants at home) ** Workplace safety Distribution and wholesaling Retail model Retail location rules Regulatory compliance Public consumption Land use/zoning

57 Bill 26 This legislation gives the Alberta Gaming, Liquor (and now Cannabis) Commission (AGLC) authority for oversight, compliance and retail licensing, enables online sales, and creates restrictions.

58 Alberta s Approach to Cannabis Legalization

59 Questions to Consider When Travelling Within Canada What is the minimum age of consumption? How/where is cannabis sold? It is your responsibility to inform yourself about the rules around cannabis when travelling. How much cannabis can a person possess at one time? Where can cannabis be consumed? Government of Canada (2018)

60 Travelling Outside of Canada Taking cannabis or cannabis products across international borders will remain illegal and can result in serious criminal penalties. Transporting cannabis used for medical purposes will also remain illegal. Previous use of cannabis, or any other substance prohibited by local law, could result in a traveler being denied entry to their destination country. Government of Canada (2018)

61 Cannabis Resources

62 Cannabis and the Developing Brain Cannabis Information and Support (2014)

63 Thank you

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