CDHA 2016 Fall Symposium. Speaker Handout Files. For registered attendees only

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1 CDHA 2016 Fall Symposium Speaker Handout Files For registered attendees only

2 Providing Care in a Marijuana Legal World Heather Rogers, BSDH Objectives We will discuss some of the history of marijuana. This course will describe marijuana and how it is used. The class will discuss physical implications of medical and recreational marijuana use. This class will also discuss myths and truths of medical and recreational marijuana use. This class will list and discuss the effects of marijuana use on the dentition and oral tissue. The course will discuss contraindications in providing dentistry to patients using marijuana in a medical or recreational manor. The class will explore possible health care provider liabilities in regards to treating patients using marijuana for clinical or recreational purposes. Marijuana comes in many strains and varietals. Each strain fits into two marijuana families, indica and sativa. Mixed strains are known as hybrids. Marijuana overactivates the endocannabinoid system, causing the high and other effects that users experience. These effects include altered perceptions and mood, impaired coordination, difficulty with thinking and problem solving, and disrupted learning and memory. Marijuana smoking by people with cardiovascular disease poses health risks because of the consequences of the resulting increased cardiac work, and postural hypotension. There is clear evidence that regular use of marijuana increases the risk of heart, lung and mental health problems. Frequent marijuana smokers can have many of the same problems that tobacco smokers have, such as a daily cough, mucus, more chest colds and a higher risk of lung infections. There is no clear evidence to prove cannabis smoking causes lung cancer. Eliminating smoking marijuana may produce more positive results in health benefits as studies continue. Rising Potency The amount of THC in marijuana samples confiscated by police has been increasing steadily over the past few decades. In the 1980s, THC concentrations in marijuana averaged 4 percent. In 2012, THC concentrations in marijuana averaged close to 15 percent. There have been reports of marijuana being contaminated by mold, bacteria and pesticides. Some contamination issues have led to disease outbreaks and other health problems. The chemical process used to create marijuana products such as wax and hash oil is another area of concern. It can be used to treat... Multiple Sclerosis Parkinson s Nausea from cancer chemotherapy Poor appetite and weight loss caused by chronic illness, such as HIV, or nerve pain Seizure disorders Crohn's disease Tourette's Asthma Children with Treatment Resistant Epilepsy Sixteen (84%) of the 19 parents reported a reduction in their child's seizure frequency Two (11%) reported complete seizure freedom, Eight (42%) reported a greater than 80% reduction Six (32%) reported a 25 60% seizure reduction Other beneficial effects included increased alertness, better mood, and improved sleep. Side effects included drowsiness and fatigue.

3 Conclusion The authors conclude that safety and tolerability data for cannabidiol enriched cannabis use among children are not available and objective measurements of a standardized preparation of pure cannabidiol is needed to determine whether it is safe, well tolerated, and efficacious at controlling seizures in this pediatric population with difficult to treat seizures. It can be... Smoked Vaporized (heated until active ingredients are released, but no smoke is formed) Eaten (usually in the form of cookies or candy) Taken as a liquid extract Side Effects Dizziness Drowsiness Short term memory loss Euphoria More serious side effects include severe anxiety and psychosis. Concerns for patients Medical marijuana is not monitored like FDA approved medicines. Only people who have a card from a doctor should use medical marijuana. Doctors will not prescribe medical marijuana to anyone under 18. Others who should not use it: People with heart disease Pregnant women People with a history of psychosis Concerns for practitioners We may not know the patient is currently medicated We won t know the dosage or long term effect while we are treating the patient We may have a medical emergency with this patient The patient should not use Marijuana for one week prior to treatment Oral Effects Cannabis intoxicated patients may experience acute anxiety and dysphoria during dental treatment. Local anesthetic containing epinephrine may prolong tachycardia following an acute dose of cannabis. Chronic smokers of cannabis have an increased risk of developing oral leukoplakia, oral candidiasis and xerostomia. A rare disorder called cannabinoid hyperemesis can cause severe vomiting and may cause enamel erosion. Health History Patients don t always associate substance use as Marijuana. Medical and recreational marijuana use should be added to the health history. You may have to ask directly. It s important to develop a trust in order to get them to open up. Complications Studies show that THC can raise anxiety and cause paranoia, while cannabidiol (CBD) may reduce them. Components of the whole plant can have nearly opposite effects in the human brain, so that one compound can change the effects of another. Complications of Chronic Use Addiction Withdrawal Symptoms Overdose Impaired Function

4 Psychotic Episodes Extreme Anxiety Impaired Memory Infertility Hemp A commonly used term for high growing varieties of the Cannabis plant and its products, which include fiber, oil, and seed. Hemp is refined into products such as hemp seed foods, hemp oil, wax, resin, rope, cloth, pulp, paper, and fuel. Hemp has very low THC. Cooking Class Medical Marijuana Flour Marijuana can be cooked into any favorite recipe. However most people do not care for the taste so it's important to choose recipes that will mask the flavor. Chocolate and tomato sauce are often used for that reason. Increased ER visits due to Marijuana Edibles The majority of patients reporting marijuana related emergencies at the Telluride Medical Center have the same symptoms: severe nausea and vomiting, anxiety, elevated heart, respiratory and blood pressure rates. The reaction resembles someone who is having a severe anxiety attack and often patients are worried they're having a stroke or a heart attack. Some fear they are going to die. Treatment with anti anxiety and anti nausea medications can be very helpful. Children ingesting Marijuana Edibles A recent study published by the journal JAMA Pediatrics reported a spike in the number of young children treated at Children's Hospital Colorado for accidentally eating marijuana treats. The study found that in the two years after marijuana laws were liberalized in 2009, 14 kids were treated for accidental ingestion. In the four years before the change, the study found no children had been hospitalized for accidental ingestion. Drugged Driving we can test only for the presence of marijuana metabolites, not for inebriation. Metabolites can linger in the body for days after the drug s effects wear off sometimes even for weeks. Because we all metabolize drugs differently (and at different times and under different conditions), all that a positive test tells us is that the driver has smoked pot at some point in the past few days or weeks. Radley Balko The Washington Post August 5, 2014 Clarification on Testing A blood test taken at a hospitals can measure for THC, the psychoactive ingredient in marijuana. Regular users can have still have remnant THC in their blood well after the effects have worn off. Regular users can also have levels above the legal limit and still drive perfectly well. Time Will Tell The long term effects of cannabis have been the subject of ongoing debate. Because cannabis is illegal in most countries, research presents a challenge; as such, there remains much to be concluded.