Cannabis and my Mental Health. Association des médecins psychiatres du Québec

Transcription

1 Cannabis and my Mental Health Association des médecins psychiatres du Québec

2 2 Objectives of the presentation What are psychiatry and mental health? What are the most frequent mental disorders? What are the different cannabis products, and how are they used? What chemicals are contained in cannabis and what are their effects? What increases the risks of cannabis use? How to detect a dangerous use of cannabis? How to talk about it with teenagers. Is the legalization of cannabis a good thing?

3 3 Why I m here today? I worry because of what I see in my practice. Frequent use among my patients Prognosis is worse with use I expect it ll get worse It ll be legal, so it s not dangerous! I worry as a parent or adult in charge of young people. Legalization allows for education.

4 What do I do in life? 6

5 A psychiatrist is a physician: The psychiatrist can treat severe and less severe mental disorders. The psychiatrist can evaluate, establish a treatment plan, and treat the patient, or delegate part of the treatment. The psychiatrist often works together with The brain is an organ, which is influenced by the health of the body. Psychologists, pediatricians, family doctors, social workers Emotions have chemical equivalents but that doesn t mean that all problems come from a chemical imbalance. Psychiatrist or psychologist?

6 What is mental health? The World Health Organization (WHO) says: State of well-being, in which every individual realises his/her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his/her community. WORK, LOVE and PLAY Psychiatrists treat mental disorders, but their objective is always to help patients return to a «normal» life. 9

7 Mental illnesses 10

8 Psychosis Loss of contact with reality (3% of the population during life) Hallucinations (experiences in the absence of sensory stimulus) auditive, visual, somatic, etc. Delusions (false beliefs) Hearing voices, noises, music, etc See people, shadows, ghosts, demons, etc Feel bizarre sensations such as tingling or being touched Feeling followed, spied on, victim of a plot Feeling that the TV and radio talk about us Having magical powers Disorganized thoughts and behaviour Walking outside naked, hitting strangers, being confused Incoherent speech 11

9 Psychotic illnesses Psychosis can happen in the context of several illnesses such as: Toxic psychosis Drug induced Schizophrenia Psychoses and loss of functionning Bipolar disorder Depressions and manic episodes 12

10 Toxic psychosis Drug-induced amphetamines (speed, peanut) MDMA (ecstasy, X) cocaine (coke, snow, blow, powder ) and crack cannabis In acute intoxication (in first-time user) Or chronic use (regular user) Main treatment: eliminate drug from body and don t use again May need help from antipsychotic drug Hospitalization sometimes necessary 50% will develop other psychoses* 13

11 Presence of positive symptoms Delusions and hallucinations Presence of negative symptoms Schizophrenia (1% of population) Social withdrawal Loss of emotions Attention difficulties/concentration/memory Loss of autonomy and functionning Long-term antipsychotic medication necessary Genetic risks are present Prognosis worsened by consumption 14

12 The «Two-Hit» theory (genetics, development, stressors which include the drug) Schizophrenia (1% of population) The risk increases if there is psychosis in the family, specifically if there is schizophrenia If a parent has schizophrenia, 13% risk of developing the disease If a brother/sister has schizophrenia, 9% risk to develop the disease 15

13 Major depression Big episode of sadness, which doesn t go away. Main symptoms: Sadness and loss of pleasure Loss of hope, loss of self-esteem Sleep and appetite disorders Loss of memory/concentration Fatigue May lead to thoughts of suicide Treatment : psychotherapy, lifestyle changes, and antidepressants 16

14 Bipolar disorder (Manic-depression) Manic episodes Followed by depressive periods Medication to stabilize mood Requires a stable lifestyle Prognosis worsened by consumption Euphoria, grandiosity Too much energy, loss of sleep Fast speech, full of projects Risk taking 17

15 Suicidal thoughts and self-harm The expression of pain: sadness, anger and or shame Always a delicate topic to discuss Remember: The use of substances is not an efficient way to decrease death wishes or hurting self It s a risk factor in terms of acting out (loss of touch with reality, disinhibition, etc.) Need to address the underlying problem and consult a professional Risk of developing another problem, such as a substance abuse disorder 18

16 + 19 The many faces of cannabis POT WEED MARY-J MARI Grass, ganga, wacky-tobacky Herb, skunk, bud, dank, bhang Joint Leaves: week, herb, MJ Oil: hash oil, dab, wax, butane, honey oil Resin: hash Shatter Edibles

17 Cannot be used to predict effects. The vast majority of cannabis is, today, hybrid.

18 The endocannabinoid system Cannabinoids affect the endocannabinoid system, a neurotransmission system in the brain. The best known cannabinoid receptors are CB1 et CB2 They re everywhere in the body and mostly in the brain. Anandamide is a product, which naturally attaches to the CB1 and CB2 receptors.

19 Cannabis contains several cannabinoids, which affect CB1 and CB2 Active ingredients: cannabinoids THC : Tetrahydrocannabinol Hallucinogenic effect Concentration has increased tremendously 4% in 1995, 12% in 2014, Up to 30% in legal markets CBD: cannabidiol Calming effect, antipsychotic, About 60 other cannabinoids with yet unknown effects

20 Smoking (the flower) Smoke absorbed by the lungs, transferred to the blood, directly to the brain. Initial effect in a few minutes, peak in 30 minutes, total duration 2 4 hours about 25% of quantity is absorbed. Vape Consumption According to temperature, various products are released. Effects in a few minutes, peak in 30 minutes, total duration 2 4 hours About 33% of quantity is absorbed. Eating Product absorbed by the intestines, through the liver, then to the brain requires 2.5 times more product than in smoking for the same effect Initial effect in 2 hours, total duration 6 8 hours. Danger of overdose

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22 How to detect a dangerous use of cannabis? NO CONSUMPTION IS 100% WITHOUT RISKS SO What is it that increases or lowers the risks?

23 The risk of a toxic psychosis for any specific individual is unknown: it s impossible to predict who is more vulnerable. Toxic psychosis and cannabis In the case of use of at least once in a lifetime, the risk of psychosis is increased by 40%. In the case of regular use of cannabis, the increase in the risk of psychosis is 390%. The disorder appears, on the average, 2.7 years earlier among cannabis users. 50% of toxic psychoses will develop into a primary psychotic disorder in the 10 following years. Increase in the risk of disease with an early start of use, regular use and use of large quantities. 26

24 The use of a substance which alters functionaning or causes distress Escalation of doses A lot of time invested in the substance Substance use disorder Cravings Incapacity to perform duties Social and family problems Abandonment of other activities Use of the substance despite consequences, even in dangerous situations Tolerance/Withdrawal symptoms 27

25 Fatigue The use of cannabis can mimic symptoms of depression. Loss of motivation and pleasure Increased appetite Increase in the need for sleep Decrease in attention/concentration Social isolation Loss of functionality More or less the same as alcohol 28

26 In general, cannabis hinders the treatment of anxiety. Cannabis and anxiety Consumption could have an appeasing effect, but anxiety returns quickly. Cannabis can induce some types of anxiety disorders. 29

27 The brain develops until the age of 25. Cannabis and learning The use of cannabis lowers It is one of the reasons why cannabis impairs driving. Cannabis does not cause ADHD but the regular user might mimic some symptoms of ADHD. It can distort the therapeutic effect of the treatment of ADHD. attention memory the processing speed of information intelligence Cannabis may hinder school progress, more so among heavy users. 30

28 Other key points Cannabis can have an impact on physical health, specifically on lungs. In the long term, smoking cannabis can be a risk for lung cancer. Cannabis has medicinal uses, such as a treatment of pain and nausea. Other than the development of a chronic mental disorder, there is no irreversible damage caused to the brain by cannabis. 31

29 Don t consume: completely safe use does not exist: Specifically if there s a personal or family history of psychosis or addiction Specifically if there are school problems, ADHD Specifically if there is depression and anxiety Wait before you start to use Ideally until 25 years of age, but even 20 is better than 18, which is better than 16, and so on. Limit frequency of use and quantity Make it into a recreational and occasional activity How to limit the risks

30 Stick Stick to the legal market, once it s been legalized Fewer risks of contaminants (pesticides, bacteria, fungus, other drugs) Choose Choose products with more CBD and less THC. Use in Use in a secure place with trustworthy persons. Don t drive or do Don t drive or do sports. Stop If you develop symptoms of a mental disorder, stop using and consult an expert. How to limit risks

31 Talk about it with your teen

32 Why some teens use Teens use cannabis for different reasons, which may include: To relax To have fun To alter their perspective To fit in To experiment To try something new Some teens see it as natural and easy to get maybe even easier than alcohol.

33 To start conversation Have an open mind Put yourself in your teen s shoes Try to stay calm, no matter what No speeches Identify the objectives of the conversation Start a continuing conversation on consumption Learn about the pressures your teen has to deal with Express concern Express support Evaluate the teen s position with respect to cannabis.

34 Active listening

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36 Legalization of cannabis Positive or negative? 39

37 Why legalize cannabis? Prohibition does not work. In Canada, cannabis has been illegal since A significant proportion of the population is already smoking: In Québec, 15.2% of the population has smoked cannabis during the last year, according to statistics. Among the age group, this proportion increases to 38.4%. We have to stop criminalizing this large group of people. Where does the cannabis which is consumed come from? 40

38 Why legalize cannabis? Goals of the federal government (C-45) Release the penal system from crimes linked to cannabis. Stop the black market and crime Limit access to cannabis for young persons Give access to a controlled product Increase education and prevention 41

39 Canada: Bill C-45 An Act respecting cannabis and to amend the Controlled Drugs and Substances Act, the Criminal Code and other Acts Legal age for use: 18 May carry up to 30 gr of cannabis Can grow four plants at home Strengthening of penalties against the sale of illicit drugs No edibles for now The provinces are in charge of the application of the law and the method of distribution. 42

40 Québec: Bill 157 An Act to constitute the Société québécoise du cannabis, to enact the Cannabis Regulation Act and to amend various highway safety-related provisions Legal age to use: 18 No home growing Distributed by the Société québécoise de cannabis (branch or online) No promotion or publicity to encourage consumption Profits reinvested in prevention. 43

41 Québec: Bill 157 An Act to constitute the Société québécoise du cannabis, to enact the Cannabis Regulation Act and to amend various highway safety-related provisions Consumption areas regulated: no use in schools or playgrounds No edibles such as muffins Automobile driving regulated for cannabis 44

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43 October 2018: New majority government promises to Up legal age to 21 to send a message Prohibit smoking in public spaces to avoid normalization of use

44 GRANDE OPENING October 17 th stores and on line shopping

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46 Conclusions Cannabis is legalized so as to better control its use and not because there are no risks. Take care of your mental health. Don t hesitate to consult. Evaluate your risk factors before you start to consume. If you do consume, be wise. 49

47 Conclusions Cannabis remains forbidden for minors Cannabis remains forbidden in school. If a minor gets caught with cannabis, there will likely be fines and possibly community work or mandatory drug education. 50

48 What to do if I am not feeling well? Speak about it with family, friends or relatives. Consult a counsellor at school or affiliated to your work environement. Speak to your family doctor. In case of an emergency, dial 811. Tel-jeunes ( ) or text ( ). Centre for Suicide Prevention 51

49 References Section on mental disorders Section on legalization of cannabis Section on how to have access to mental care org Information on drugs Suggestions on how to speak with your teen 52