Types, methods and rationales of use. Balance between THC and CBD..poor knowledge

Transcription

1 Cheryl Irvine

2 Who are we? We are a 3 rd sector organisation set up in 1985, working in the areas of tobacco, alcohol and drugs. Providing evidenced based education, prevention and training and services to reduce harm and support recovery and abstinence. We have excellent local knowledge and are integrated into many of the strategic planning and service delivery groups. COSCA registered Open 8-6 and Saturday mornings Self referrals, drop ins & clinics throughout West Lothian (most referrals now are self referrals) Daily visit to both Custody suite and A&E

3 Why Cannabis? A substance which polarises opinions politically and socially Societal and historical attitudes Divergence in terms of the law and treatment services Physical, social, legal and emotional effects Across social spectrumnot just adolescents

4 Types, methods and rationales of use. Balance between THC and CBD..poor knowledge

5 Policy and research. Neglected drug in public health.. Disparity of drug and alcohol providers, has limited the amount of support available.. Perception from cannabis users that their needs will not be effectively met. Limited resources available - some are lacking in levels of quality and accessibility. Report published February 2017

6 Cannabis & mental health- reality Paranoia, anxiety and depression juxstaposition of acceptance and poor mental health Gender differences (Whitmore et al 1997, Paxton 2002) Poor engagement minimise use (Stephens et al, 2007; Diamond et al, 2006) ADHD coping strategy Anger management, dependency Psychiatric ward full of cannabis users Clients attending Drop in service regularly cannabis users struggling to cope

7 Legislative changes.. UK Durham, Cambridgeshire, Derbyshire and Dorset Police Commissioners move away from criminalising cannabis users Police Scotland 2016 fixed penalty warnings Illegal 11 Decriminalised 4 Legal 7 Medical - 31 Medical Australia & Germany Legal Uruguay & Mexico Decriminalised Holland, Argentina, Canada, Portugal, Brazil, Spain, Italy

8 Other developments Under 18 s service no longer funded More clients reporting less tobacco in joints, or no additional cigarettes, YP buying a gram on a Friday not smokers Average age of clients 31 High levels of clients reporting depression or/ and anxiety using HADS to evidence changes Current caseload ALL clients on prescribed medication for mental health Retail CBD sales discontinued & under investigation by MHRA Sold by weight anecdotal reports of being stored in fridge; sticks/leaves to bulk up, fibreglass

9 SCRA s (Synthetic Cannabinoid Receptor Agonists) Onset within minutes of smoking Intoxication 1-6 hours depending on product Recovery within 24 hrs, minor residual effects day after use THC-like effects include alterations in mood, sleep, perception/wakefulness, body temperature, and cardiovascular function Partial THC-like effects include palpitations, tachycardia, and (often unspecific) electrocardiogram changes Tolerance Withdrawal symptoms similar to cannabis withdrawal sleep disturbance, disturbances, anxiety, craving, and nausea (Fattore, 2016) No ceiling on high; no counter balance (Global Drugs Survey 2016)

10 Cannabis.. The evidence base.. Johnson Large lung bullae in marijuana smokers Dunedin (NZ) study with 1037 individuals - findings suggest that 10% of adolescents developed schizophrenic from disorder by 26yrs (Poulton et al, 2005) Unpleasant - 1 in 10 cannabis users experience confusion, hallucinations, anxiety and paranoia (Royal College of Psychiatrists 2006) Reid et al Cannabis use, respiratory symptoms and lung function, in a North Edinburgh primary care population. South London Study 600 participants- cannabis and psychosis potent strains (Di Forti et al, 2015) Cannabis & tobacco study 30,000 users asking if using both substances psychological problems and addiction more likely (Hindocha & Freeman, 2017)

11 Working with cannabis users WHY.. Are you using cannabis, what do you want to do, method, quantity, types??? Holistic approach education and cessation - toolkit of options Look at whole picture social, financial, legal, physical and mental health effects Recovery capital the fundamental basics Client advocacy EFT & relaxation techniques Client centred goal orientated, CBT focus reduction plans CO and Lunglife monitors Reasons for attending may be very different (SCS)

12 Case study I (male age 27). Referred to service by criminal justice assault & BOP; poor history of engagement with services. Sofa surfing, significant history of childhood trauma. Multidisciplinary working - psychology, psychiatry, housing, criminal justice & community rehab regular communication between disciplines. Venture Trust 10 day excursion in February.. Cannabis free throughout engaged well with programme returned home to stress bought a gram of grass Rx Quetiapine and Duloxetine

13 Case study D (male age 36) Paranoid Schizophrenic - diagnosed at 19 in Army in Poland. Daily alcohol and cannabis use- doesn t see cannabis as an issue wants to reduce alcohol. Had many attempts at cessation of substances. Several charges of assault, BOP aggression. Regular contact with Psychiatry. Uses cannabis in buckets with tobacco, recently changed this to joints- describes tobacco in joints as sedating and feels cannabis alone makes you fresh and funky. Rx Clopixol, Temazepam, Diazepam & Mirtazapine

14 Case study I (male age 26) Bereavement loss of his mum in December, used cannabis to block out emotions 20 Joints daily ( 100 daily) Homeless temporarily placed in hotel, drug debts in fear of his life. Suicidal ideation, extremely anxious & paranoid I just don t know what to do.. presented at A& E after sister found him with a rope prescribed Chlorpromazine not registered with a GP therefore no medication at present.

15 Case study M (female age 16). Sexual assault at 14, worked with CAHMS and Open Secretdisengaged - What's the effing point of counselling. Historical reports of auditory hallucinations, poor concentration. Substance assessment Cannabis, Drone, Cocaine, Base, MDMA & Alcohol. Cannabis isn t even a real drug. ESA not in further education or training (GP drug dependency) Referred to addictions psychiatry for mental health assessment. Diagnosis ADHD, BPD, Dissociative Disorder. Rx Olanzapine & Concerta XL

16 Normalised attitudes - The physical effects are often ignored... its better than a fag.. The emotional effects are often undermined - its just a joint.. And. Its easier to access than a bar of chocolate (Andrew, 18)