Download Chapter 14 Marijuana

Marijuana
Marijuana
Marijuana consists of the dried
and crushed leaves, flowers,
stems, and seeds of the
Cannabis sativa plant.
THC (delta-9tetrahydrocannabinal) is the
primary mind-altering
ingredient in marijuana.
Derivatives of the cannabis plant
Hashish
Ave. concentration of THC is 2% to 8%
Ganja
Consists of the dried tops of female
plants
Sinsemilla
Ave. concentration of THC is 7.5%
Bhang
Ave. concentration of THC is 1% to 2%
Drug Effects on Neurotransmission:
LSD
Serotonin receptor
Stimulates some
receptors (agonist)
Blocks other receptors
(antagonist)
?
Questions and Answers
?
Q. Today marijuana is how many times
more potent than the marijuana on the
street in the 1960s and 1970s?
A. 20 times more potent
Q. How many Americans are current
marijuana users?
A. 20 million Americans
Drug Effects on Neurotransmission:
THC
Binds
receptors in
nucleus
accumbens
(and other
sites in the
brain such as
the
hippocampus–
memory) and
increases
dopamine
release
THC Receptor Sites
in the Brain
Behavioral effects
Low to moderate doses produce euphoria
and a pleasant state of relaxation
Common effects: dry mouth, elevated
heartbeat, some loss of coordination and
balance, slower reaction times, reddening
of the eyes, elevated blood pressure
A typical high last from 2 to 3 hours, and
user experiences altered perception of
pace and time, impaired memory
Behavioral effects
An acute dose of cannabis can
produce adverse reactions: mild
anxiety to panic and paranoia
A few rare cases exhibit psychoses,
delusional and bizarre behavior, and
hallucinations. These reactions occur
most frequently in individuals who are
under stress, anxious, depressed or
borderline schizophrenic
Behavioral effects
A subjective euphoric effect
associated with marijuana use is the
“ongoing social and psychological
experiences incurred while
intoxicated with marijuana. It
includes both the user’s altered state
of consciousness and his or her
perceptions while intoxicated.”
- “connoisseurs”
- differential reinforcement
Driving performance
The ability to perform complex
tasks, such as driving, is strongly
imparted while under the influence of
marijuana
In limited surveys, from 60% to 80%
of marijuana user indicate that they
sometimes drive while high.
In a study conducted in the Boston
area, marijuana smokers were
overrepresented in fatal highway
accidents
Critical thinking skills
Marijuana has been found to have a
negative impact on critical thinking
skills
Impairment can affect:
attention, memory, learning
The unresolved question is whether
these impairments are short-term
or long-term
Amotivational syndrome
Amotivational syndrome characterizes
regular users of marijuana who
experience a lack of motivation and
reduced productivity.
Specifically, users show apathy, a poor
short-term memory, difficulty in
concentration, and a lingering
disinterest in pursuing goals.
Does marijuana or other factors
create this syndrome?
Physiological effects
Central
nervous system
Respiratory
system
Cardiovascular
system
Sexual performance
and reproduction
Therapeutic uses
Marinol - indicated for treatment of
nausea and vomiting in cancer
patients
Anorexia in AIDS patients
Glaucoma
Antiasthmatic drug
Muscle relaxation
Antidepressant
Analgesic
Cannabinoid Receptors Are Located in Many
Areas Throughout the Brain and Play An
Important Role In Regulating:
•Brain Development
•Memory and
Cognition
•Motivational Systems
• & Reward
•Appetite
•Immunological
Function
•Reproduction
•Movement &
Coordination
•Pain Regulation
• & Analgesia
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Cannabino
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Basic Research
Selective CB2 Cannabinoid Receptor Agonist
(AM1241) Dose-Dependently Inhibits
Sensory Hypersensitivity in Rats
Source: Ibrahim, M.M. et al., PNAS, 100(18), pp. 10529-10533, September 2, 2003.
Treatment Research
Cannabinoid Antagonists Have Been
Shown to Block Major Triggers of Drug
Relapse
Cocaine-Seeking Responses
(per 120 min)
Cannabinoid
Antagonist
Blocks CocaineSeeking
in Response to
Cocaine-Related
Cues in a DoseDependent
Manner
Impact of SR141716 on Response to
Cocaine-Related Cues
90
80
70
60
50
40
30
20
10
0
0
0.3
1.0
3.0
mg/kg mg/kg mg/kg
SR141716 Dose
Source: De Vries, T.J., & Shaham, Y. et al., Nature Medicine,7(10), 2
Marijuana Use Disorders
in the United States:
1991-1992 and 2001-2002
Wilson M. Compton, M.D., M.P.E.
Director, Division of Epidemiology, Services and Prevention
Research
National Institute on Drug Abuse
Department of Health and Human Services
May 5, 2004
American Psychiatric Association Annual Meeting
Background
A great deal of information
about trends in use of drugs is
available, but no data provides
reliable and valid measures of
drug disorders over the past
decade.
Background
With data from two large household
surveys of the U.S. adult population,
this study seeks to answer the
following questions:
1. What are the rates of marijuana
abuse and dependence in 19911992 compared to 2001-2002?
2. Have the relationships of age,
race/ethnicity or gender to
marijuana abuse and dependence
changed during this period?
Methods
Studies:
Large studies of the U.S. noninstitutionalized household adult (18+)
population conducted by the Census
Bureau.
NLAES: National Longitudinal Alcohol
Epidemiologic Study (N = 42,862)
NESARC: National Epidemiologic
Study of Alcohol and Related
Conditions (N = 43,093)
Methods
Interview:
AUDADIS: Alcohol Use Disorder
and Related Disabilities Interview
Schedule - DSM-IV Version
Specific measures of each criterion
of abuse and dependence on
marijuana
Reliability and validity wellestablished
Methods
Outcomes
Marijuana use, abuse and dependence
in overall population and by age,
race/ethnicity and sex
Marijuana abuse and dependence
among marijuana users by age,
race/ethnicity and sex
Results: Total Population
40
35
30
%
25
20
15
10
5
0
35.6
30.2
4.0
4.1
Use
= p < .05
1.2
1.5
Abuse/Dependence Abuse/Dependence
in Users
NLAES 1991-1992
NESARC 2001-2002
Results: Total Population
Comparing 1991-1992 to 2001-2002:
• Marijuana use rates were virtually the
same: 4.0% versus 4.1%
• Marijuana abuse or dependence
increased from 1.2% to 1.5% (p = .014)
• Marijuana abuse or dependence among
users increased from 30.2% to 35.6% (p
< .01)
How consistent are these results across age groups,
race/ethnic groups and sexes?
Results: Marijuana Use by Sex and Race/Ethnicity
6
5
4
%
3
2
1
0
= p < .05
Black
White Hispanic
NLAES 1991-1992
Male
Female
NESARC 2001-2002
Results: Marijuana Use In Age Groups
12
10
8
%
6
4
2
0
= p < .05
Total
18-29
NLAES 1991-1992
30-44
45-64
NESARC 2001-2002
Results: Marijuana Use in Whites
12
10
8
%
6
4
2
0
= p < .05
Total
18-29
NLAES 1991-1992
30-44
45-64
NESARC 2001-2002
Results: Marijuana Use in Blacks
12
10
8
%
6
4
2
0
= p < .05
Total
18-29
NLAES 1991-1992
30-44
45-64
NESARC 2001-2002
Results: Marijuana Use in Hispanics
8
7
6
%
5
4
3
2
1
0
Total
18-29
30-44
= p < .05
NLAES 1991-1992
NESARC 2001-2002
Results: Marijuana Use in Men
14
12
10
%
8
6
4
2
0
= p < .05
Total
18-29
30-44
NLAES
NESARC
45-64
Results: Marijuana Use in Women
8
7
6
%
5
4
3
2
1
0
= p < .05
Total
18-29
30-44
NLAES
NESARC
45-64
Results: Marijuana Use in Detailed Age-SexRace/Ethnicity Categories
Use increased significantly
for:
White males 45-64 years old
Black females overall and
Black females 18-29 and 4664 years old
Hispanic females 18-29 years
old
Results: Summary of Marijuana Use
Rates did not change significantly
overall
Rates increased significantly for:
18-29 and 45-64 year olds
Black and Hispanic 18-29 year olds
White and Black 45-64 years olds
Women 18-29 years old and both men
and women 45-64 years old
Selected age-sex-race/ethnicity
categories
Results: Marijuana Abuse or Dependence in Overall
Population
%
4.5
4.0
3.5
3.0
2.5
2.0
1.5
1.0
0.5
0.0
= p < .05
Total
18-29
NLAES 1991-1992
30-44
45-64
NESARC 2001-2002
Results: Marijuana Abuse or Dependence by Sex and
Race/Ethnicity
2.5
2.0
%
1.5
1.0
0.5
0.0
= p < .05
Black
White Hispanic
NLAES 1991-1992
Male
Female
NESARC 2001-2002
Results: Marijuana Abuse or Dependence in Whites
5.0
4.0
%
3.0
2.0
1.0
0.0
= p < .05
Total
18-29
NLAES 1991-1992
30-44
NESARC 2001-2002
Results: Marijuana Abuse or Dependence in Blacks
5.0
4.0
%
3.0
2.0
1.0
0.0
= p < .05
Total
18-29
NLAES 1991-1992
30-44
NESARC 2001-2002
Results: Marijuana Abuse or Dependence in Hispanics
3.0
2.5
2.0
%
1.5
1.0
0.5
0.0
= p < .05
Total
18-29
NLAES 1991-1992
30-44
NESARC 2001-2002
Results: Marijuana Abuse or Dependence in Men
7
6
5
%
4
3
2
1
0
= p < .05
Total
18-29
NLAES 1991-1992
30-44
45-64
NESARC 2001-2002
Results: Marijuana Abuse or Dependence in Women
2.5
2.0
%
1.5
1.0
0.5
0.0
= p < .05
Total
18-29
NLAES 1991-1992
30-44
NESARC 2001-2002
Results: Summary of Marijuana
Abuse or Dependence
Rates increased significantly overall
Increases in rates were significant for:
18-29 and 45-64 year olds overall
Blacks and Hispanics overall and 18-29
years old
Women overall and 18-29 years old
Men 45-64 years old
Black and Hispanic men overall and 18-29
years old
Black women overall and 18-29 years old
Results: Marijuana Abuse or Dependence Among Users in
Overall Population
%
45
40
35
30
25
20
15
10
5
0
Total
= p < .05
18-29
NLAES 1991-1992
30-44
45-64
NESARC 2001-2002
Results: Marijuana Abuse or Dependence among Users, by
Sex and Race/Ethnicity
40
35
30
%
25
20
15
10
5
0
= p < .05 Black
White Hispanic
NLAES 1991-1992
Male
Female
NESARC 2001-2002
Results: Marijuana Abuse or Dependence Among
Black Users
%
45
40
35
30
25
20
15
10
5
0
Total
= p < .05
18-29
NLAES 1991-1992
30-44
NESARC 2001-2002
Results: Marijuana Abuse or Dependence Among
White Users
%
45
40
35
30
25
20
15
10
5
0
Total
= p < .05
18-29
NLAES 1991-1992
30-44
NESARC 2001-2002
Results: Marijuana Abuse or Dependence Among
Hispanic Users
%
45
40
35
30
25
20
15
10
5
0
Total
= p < .05
18-29
NLAES 1991-1992
30-44
NESARC 2001-2002
Results: Marijuana Abuse or Dependence Among
Male Users
50
40
%
30
20
10
0
Total
= p < .05
18-29
NLAES 1991-1992
30-44
45-64
NESARC 2001-2002
Results: Marijuana Abuse or Dependence Among
Female Users
35
30
25
%
20
15
10
5
0
Total
= p < .05
18-29
NLAES 1991-1992
30-44
NESARC 2001-2002
Results: Summary of Marijuana
Abuse or Dependence Among Users
Rates increased significantly overall
Increases in rates were significant for:
18-29 and 30-44 year olds overall
Blacks overall and 30-44 and 18-29 years old
Hispanics overall and 18-29 years old
Women and men overall and 18-29 years old
Black and Hispanic men overall and 18-29 years old
Black women overall and 18-29 years old
Estimated Population Increases in Marijuana
Abuse or Dependence
24%
20%
White
Total
Hispanic
Other
30%
26%
Male
Black
10%
14%
Female
29%
38%
10%
26%
35%
38%
Why have rates increased?
Changes in quantity/frequency of
marijuana use?
Changes in potency of marijuana?
Psychosocial factors?
Why have rates increased?
Changes in quantity/frequency
of marijuana use?
Not likely…
Changes in Frequency of MJ Use?
40
35
30
%
25
20
15
10
5
0
<1 dy/mo 1-3 dys/mo 1-4 dys/wk 5-7dys/wk
1991-1992
2001-2002
Changes in Quantity of MJ Smoked?
70
60
50
% 40
30
20
10
0
1 Joint
2-3 Joints 4-6 Joints
1991-1992
2001-2002
7+ Joints
Why have rates increased?
Changes in potency of
marijuana?
Possibly…
Changes in Potency of Marijuana
7%
6%
5%
4%
Δ9-THC
3%
2%
1%
01
20
99
19
97
19
95
19
93
19
19
91
0%
Source: Research Institute of Pharmaceutical Sciences, School of Pharmacy, University of Mississippi; 2003
Why have rates increased?
Psychosocial factors?
Possibly…
Plausible Psychosocial Factors
Acculturation?
Lifestyle factors and attitudinal factors?
Sociodemographic or socioeconomic
factors?
Economic factors such as price, tax and
policy changes affecting other substances
that may inadvertently affect marijuana?
Historical and cultural factors?
Summary
Rates of Marijuana use were nearly
the same in the total population in
1991-1992 as in 2001-2002, but
increases were seen in certain
subgroups:
younger male and female blacks,
younger Hispanic males
white and black 45-64 year olds.
Summary
Marijuana-related disorders
(abuse and dependence) increased
from 1991-1992 to 2001-2002,
especially for younger male and
female blacks and younger hispanic
males.
Increased potency of marijuana
may play a role
Marijuana Use Disorders in the United States:
1991-1992 and 2001-2002
Wilson M. Compton, M.D., M.P.E. - NIDA
Bridget F. Grant, Ph.D., Ph.D. - NIAAA
James D. Colliver, Ph.D. - NIDA
Meyer D. Glantz, Ph.D. - NIDA
Frederick S. Stinson, Ph.D. - NIAAA