Marijuana: What Future Do You See?

Transcription

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2 Marijuana: What Future Do You See?

3 Marijuana and Children s Mental Health - Why it Matters

4 Speaker: Christian C. Thurstone, MD Activity Medical Director Celia Woods, MD Cheryl Lambing, MD, FAAFP, CME Director Victoria Yuschenkoff, PhD, CME Coordinator

5 The individuals involved in the planning and/or presentation of this Ventura County Medical Center CME activity lack any relevant financial relationships with a commercial interest to disclose. This presentation will include photos, images and websites of products related to the consumption or promotion of marijuana. These slides have been deemed as information essential to the audience for recognizing marketing strategies designed to influence adolescents and should not be construed as commercial endorsements. This presentation has been peer reviewed.

6 The Ventura County Medical Center is accredited by the Institute for Medical Quality/California Medical Association (IMQ/CMA) to provide continuing medical education for physicians. The Ventura County Medical Center designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits(s) TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity. This credit may also be applied to the CMA Certification in Continuing Medical Education.

7 Marijuana Updates Christian Thurstone, M.D. Associate Professor University of Colorado

8 CME Objectives Discuss new research regarding the impact of marijuana exposure on the developing adolescent brain. Analyze current trends in adolescent marijuana use to enhance accurate assessment and apply intervention strategies with patients engaged in marijuana use. Summarize the latest research-based prevention, treatments and policies regarding marijuana.

9 1. Marijuana use across development 2. Trends in use 3. Prevention, treatment

10 1. Marijuana use across development

11 Pregnancy Latency Adolescence Adulthood In utero MJ exposure: - IQ by 5 points at age 6 years Goldschmidt et al. (2008), J Am Acad Child Adolesc Psychiatry 47: depression at age 10 (35% v 17%, p<0.01) Gray et al. (2005), Neurotoxicol Teratol 27: hyperactivity, impulsivity, inattention at age 10 Goldschmidt et al. (2000), Neurotoxicol Teratol 22: odds of MJ use by age 14 and heavier MJ use Day et al. (2006), Addiction 101: achievement at age 14 (Composite WIAT 83.9 v 89.9, p=0.003) Goldschmidt et al. (2012), Neurotoxicol Teratol 34:

12 Pregnancy Latency Adolescence Adulthood - 1 in 6 develop addiction - Heavy marijuana exposure starting in adolescence predicts and 8-point drop in IQ from age 13 to 38 years ( SES was not relate to adolescent to adult IQ, p=0.86) -2-fold increased risk of psychosis in adulthood Sources: Hall and Degenhardt (2009), Lancet 374: ; Degenhardt et al. (2012), Addiction 108: ; Meier et al., (2012), Proc Natl Acad Sci USA 109:E2657-E2664

13 Pregnancy Latency Adolescence Adulthood Animal Data No MJ in adolescence MJ in adolescence Rubino et al. (2009), Hippocampus 19:

14 Pregnancy Latency Adolescence Adulthood MJ Control Gilman et al. (2014), J Neurosci 34:

15 Pregnancy Latency Adolescence Adulthood 1,253 young adults interviewed annually for 8 years 1st year MJ use skip class GPA graduation time controlled for psychological functioning, demographics Arria et al., 2015, Psychology of Addictive Behaviors 29:

16 % of traffic fatalities in CO testing + for THC 13 % NHTSA, 2015, FARS Data Set

17 Pregnancy Latency Adolescence Adulthood - 1 in 9 develop addiction - Chronic marijuana use causes cognitive impairment for up to 1 month - Chronic marijuana use causes psychomotor impairment for up to 3 weeks Sources: Hall and Degenhardt (2009), Lancet 374: Pope et al., (2002), J Clin Pharmacol 42:41S-47S Bosker et al. (2013), PLoS One 8:e53127

18 Pregnancy Latency Adolescence Adulthood - 4X risk of MI after using marijuana - Cannabis dependence doubles risk of bronchitis, wheezing, chronic cough - May increase risk of head/neck, lung, testicular cancer Sources: Hall and Degenhardt (2013), Drug Testing and Analysis epub ahead of print; Lacson et al. (2012), Cancer 118: ; Mittleman et al. (2001), Circulation 103:

19 2. Trends in use

20 Green crack Ear wax Budder Butane hash oil Hash oil capsules Shatter

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22 Disclaimer The following slides include photos, images and websites of products related to the consumption or promotion of marijuana. These slides have been deemed as information essential to the audience for recognizing marketing strategies designed to influence adolescents and should not be construed as commercial endorsements.

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34 3. Prevention and treatment

35 Attitudes Social norms Availability NIDA (1997), Preventing Drug Use among Children and Adolescents

36 Prevention Works National Registry of Evidence-Based Programs and Practices

37 Secondary prevention 5% Access care Do not access care 95% Drop out of school Juvenile justice Access care National Survey on Drug Use and Health

38 Variable Baseline End of treatment p-value Mean proportion of days used substances (n=47) Mean depression score on the PHQ9A (n=16) (clinical cutoff score is 10) Mean PTSD score on the CPSS (n=15) (clinical cutoff score is 15) Mean anxiety score on the SCARED (n=15) (clinical cutoff score is 25) Mean ADHD score on the ADHD checklist (n=7) (clinical cutoff score is 22) Proportion of participants with a month of confirmed abstinence by the end of treatment (n=56) 56% 29% * * * * NA 32% (18) NA

39 Commercialization hypothesis lifetime prevalence mj use for yr olds coffee shops % coffee shops Macon and Reuter, 1997, Science 278:47-52

40 Commercialization hypothesis past month use for year olds 12 % coffee shops 700 coffee shops Macon and Reuter, 1997, Science 278:47-52

41 Tobacco industry prevention programs at best do no harm Landman et al., 2002, Am J Pub Health 92: The MJ Industry cannot help create prevention messaging

42 Summary - MJ has unique effect across development - MJ products changing - Prevention works ( - special opportunities with pregnant women, - driving, early intervention

43 Questions, comments

44 Pregnancy Latency Adolescence Adulthood 410 patients compared to 370 controls risk of psychosis = 5.4 with daily use of high potency MJ compared to no marijuana use Di Forti et al., 2015, Lancet Psychiatry 2: boys followed from 1st grade to age 17. each year of marijuana use predicted increase in number of psychotic symptoms by 22% Bechtold et al., 2016, AJP

45 Pregnancy Latency Adolescence Adulthood youth assessed at age 8, 15, 16 - mj use >=50 times in IQ by 2.9 points (p<0.001) - educational testing at 16 was 11 percentage points lower for those w >=50 times of mj use, compared to non-users (p<0.001) - ever cigarette use in IQ by 6.2 points (p<0.001) and in testing by 7.8 points (p<0.001). Mokrysz et al., 2016, J of Psychopharm epub

46 Pregnancy Latency Adolescence Adulthood Cognition year olds followed for 25 years - marijuana exposure measured by years (1 year of mj use = 365 days of mj use) - for each 5 years of marijuana exposure, verbal memory decreased by 0.13 units (remembering 1 out of 15 words fewer on average) compared to no use Auer et al., 2016, JAMA Intern Med pub

47 Pregnancy Latency Adolescence Adulthood MJ and Aggression Low dose THC (0.1 mg/kg) aggression (Taylor et al., 1976) High dose THC ( mg/kg) aggression (Salzman et al., 1976) Marijuana withdrawal aggression on days 3, 7 but baseline on day 28 (Kouri et al., 1999)

48 Pregnancy Latency Adolescence Adulthood - followed boys from divided groups into low/nonusing (n=186), adolescent limited (n=38), late increasing (n=76), early onset chronic (n=86) - no difference in prevalence of asthma, allergies, headaches, hypertension, physical limitations, injuries, concussions, anxiety disorder, mood disorder, psychotic disorder between groups Bechtold et al., 2015, Psychology of Addictive Behaviors