A Conversation: Marijuana and Youth Kevin P. Hill, M.D., M.H.S. North Shore Community College, 9/28/17 Division of Addiction Psychiatry, Beth Israel Deaconess Medical Center khill1@ bidmc.harvard.edu, DrKevinHill.com, @DrKevinHill
Disclosures Grants from NIDA, Brain and Behavior Research Foundation, American Lung Association, Greater Boston Council on Alcoholism, Peter G. Dodge Foundation. Book- Hazelden Publishing.
Three Areas of Focus Clinical work: Director of Addiction Psychiatry, private practice, pro sports teams and leagues. Clinical research: cannabis clinical trials. Educational outreach: Science vs. public perception, schools, policymakers.
Why Cannabis? Addiction treatment: 40% alcohol, 40% opioids, 20% everything else. Around 60%: time when smoked cannabis daily for years. How many of these folks would you see down the road if an effective cannabis intervention existed?
Theme 1
What is Today s Marijuana? 100+ pharmacologicallyactive cannabinoids. THC: euphoria, antiinflammatory, psychosis. CBD: non-psychoactive, anti-anxiety, antipsychotic?
Potency Rising 60s, 70s, 80s: avg THC content 3-4%. Now: avg THC content 12% (ElSohly 2016). BUT you can get cannabis (plant not oil) in the 20s and low 30s.
Implications on Youth Health Not Harmful Not Addictive No Withdrawal
HARMFUL: DOSE MATTERS Early onset poor cognitive function, IQ decline (Pope 2003, Gruber 2011, Meier 2012) Anxiety (Crippa 2009) Depression (Degenhardt 2003) Risk of psychosis (Kuepper 2011, Large 2011, Di Forti 2015) Review of Cannabis and Psychiatric Disorders: Halah et al. Curr Addict Rep 2016
Source: Recovery.org
IT IS ADDICTIVE! % of Basal Release % of Basal Release 1100 1000 900 800 700 600 500 400 300 200 100 0 150 125 AMPHETAMINE 0 1 2 3 4 5 hr MARIJUANA 100 0 20 40 60 80 Drugs of abuse increase DA in the Nucleus Accumbens.triggers the neuroadaptions that result in addiction? % of Basal Release 200 150 100 50 0 Tanda, et al, Science 1997. FOOD Empty Box Feeding 0 60 120 180 Time (min) Di Chiara et al.
Trends of Youth Use
National Statistics: Not Going Away About 22 million Americans used cannabis in the past year, use doubled in past 10 years (Hasin et al. 2015). Powerful messages medical marijuana, legalization, celebrities. Most messages off the mark, contribute to gap between science and public perception.
Current Trends in Cannabis Use Compton, Lancet Psychiatry (2016)
12 th Graders Past Year Cannabis Use vs. Perceived Risk of Occasional Cannabis Use SOURCE:The Monitoring the Future study, the University of Michigan.
Theme 2
What is Recreational Marijuana?
Why Is Marijuana Controversial? Can t paint with a broad brush- political agendas. Many misguided by their own experiences. Math can be tricky.
What to do if a loved one has a problem
Case Kristin is a 15 year-old high school student who comes to me after getting suspended for selling marijuana at school. Previous treatment for anxiety, cutting. I rather be (messed) up.
What to Look for Social problems caused by or worsened by drugs or alcohol. Gives up important activities. Use in dangerous situations. Use despite obvious physical, psychological problems.
Preparation. Conversation. Evaluation. Referral. How to have the Conversation
Step 1: Preparation Previous relationship. Idea of what you want to say. Plan: yes/no.
Step 2: Conversation Preservation of tangible things. I am concerned and I think an evaluation is necessary.
Step 3: Evaluation Never worry alone. Someone who knows addiction. Thorough assessment (MI, history, alliance, recommendations).
Thorough Evaluation Motivational interviewing. Careful history. Alliance. Recommendations.
Step 4: Referral Residential. Structured outpatient programs. Outpatient therapy. Groups.
Treatment
What does treatment look like? Medical detox may not be necessary. 30 days of rehab is unlikely. Get prospective patient to talk to somebody. Readiness/alliance work.
Why Use? Enhance recreational activity. Relax/escape. Anxiety. Insomnia.
Case Kristin started weekly talk therapy with to establish at least a limited period of abstinence. She addressed her coping mechanisms and the difficulty in giving up an activity she had come to rely upon. She had an uneventful last 2 years of high school and went on to college.
Critical Period Lots of misinformation so it is critical to be informed and thoughtful on this topic. If treatment is necessary, it can work.
Matt Palastro Acknowledgments
Questions? DrKevinHill.com @DrKevinHill