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6 results

  • 12 - Cannabis Use Disorders

  • from Part IV - Use Disorders with Specific Drugs
  • Perry M. Duncan, Old Dominion University, Virginia
  • Book:
    Substance Use Disorders
    Published online:
    18 September 2020
    Print publication:
    17 September 2020, pp 436-483

  • Summary

    Endogenous cannabinoids assist in regulation of hunger, pain perception, inflammation, and stress responses. Tetrahydrocannabinol (THC), a component of cannabis, activates cannabinoid receptors, producing effects that are often emotionally pleasing and cognitively interesting. THC effects impair complex tasks, such as driving. Addiction develops in 8--10 percent of all cannabis users, and in about 25 percent of daily users. Regular adolescent users are especially vulnerable. Adverse outcomes of cannabis addiction include too much time spent intoxicated, important activities given up, worsening of psychological problems, and failed attempts to stop use. The withdrawal syndrome includes irritability, anxiety, depression, and sleep difficulties. Long-term heavy use of cannabis is associated with academic failure and subtle cognitive impairment. Medical uses of cannabis include relief of nausea, appetite improvement, and lessened neuropathic pain. Medical use may increase cannabis addiction, a risk somewhat similar to that of other, more traditional medications for pain, anxiety, and attention disorders. Because cannabis is now a commercial product, its potency has increased in recent years.

  • Medical Emergencies Related to Ethanol and Illicit Drugs at an Annual, Nocturnal, Indoor, Electronic Dance Music Event

  • Paul Calle, Nora Sundahl, Kristof Maudens, Sarah MR Wille, Diederik Van Sassenbroeck, Koen De Graeve, Stefan Gogaert, Peter De Paepe, Dieter Devriese, Geert Arno, Peter Blanckaert
  • Journal:
    Prehospital and Disaster Medicine / Volume 33 / Issue 1 / February 2018
    Published online by Cambridge University Press:
    29 December 2017, pp. 71-76
    Print publication:
    February 2018
  • Introduction

    Medical problems are frequently encountered during electronic dance music (EDM) events.

    Problem

    There are uncertainties about the frequencies and severity of intoxications with different types of recreational drugs: ethanol, “classical” illicit party drugs, and new psychoactive substances (NPS).

    Methods

    Statistical data on the medical problems encountered during two editions of an indoor electronic dance event with around 30,000 attendants were retrieved from the Belgian Red Cross (Mechelen, Belgium) database. Data on drug use were prospectively collected from the patient (or a bystander), the clinical presentation, and/or toxicological screening.

    Results

    In the on-site medical station, 487 patients were treated (265 in 2013 and 222 in 2014). The most frequent reasons were trauma (n=171), headache (n=36), gastro-intestinal problems (n=44), and intoxication (n=160). Sixty-nine patients were transferred to a hospital, including 53 with severe drug-related symptoms. Analysis of blood samples from 106 intoxicated patients detected ethanol in 91.5%, 3,4-methylenedioxymethamphetamine (MDMA) in 34.0%, cannabis in 30.2%, cocaine in 7.5%, amphetamine in 2.8%, and gamma-hydroxybutyric acid (GHB) in 0.9% of patients (alone or in combination). In only six of the MDMA-positive cases, MDMA was the sole substance found. In 2014, the neuroleptic drug clozapine was found in three cases and ketamine in one. Additional analyses for NPS were performed in 20 cases. Only in one agitated patient, the psychedelic phenethylamines 25B-NBOMe and 25C-NBOMe were found.

    Conclusions

    At this particular event, recreational drug abuse necessitated on-site medical treatment in one out of 350 attendants and a hospital transfer in one out of 1,000. Ethanol remains the most frequently abused (legal) drug, yet classical illicit recreational drugs are also frequently (co-) ingested. The most worrying observation was high-risk poly-drug use, especially among MDMA users. Regarding NPS, the number of cases was low and the clinical presentations were rather mild. It should be stressed that these observations only apply to this particular event and cannot be generalized to other EDM events.

    CalleP, SundahlN, MaudensK, WilleSMR, Van SassenbroeckD, De GraeveK, GogaertS, De PaepeP, DevrieseD, ArnoG, BlanckaertP. Medical Emergencies Related to Ethanol and Illicit Drugs at an Annual, Nocturnal, Indoor, Electronic Dance Music Event. Prehosp Disaster Med. 2018;33(1):71–76.

  • 21 - Addressing cannabis use in people with psychosis

  • Edited by David Castle, University of Melbourne, Robin M. Murray, Deepak Cyril D'Souza, Yale University, Connecticut
  • Book:
    Marijuana and Madness
    Published online:
    05 November 2011
    Print publication:
    27 October 2011, pp 225-233

  • Summary

    Studies that provide mechanistic evidence delineating how the enhancement of the risk of psychosis by cannabis may be mediated at the neural level in humans are important. The modulatory effects of tetrahydrocannabinol (THC) on medial temporal, anterior cingulate/medial prefrontal and striatal activation during verbal learning were observed in the absence of differential task performance between the drug conditions. This chapter summarizes the evidence from studies that have examined the acute neural effects of cannabis and its main psychoactive ingredients during cognitive tasks, as well as on resting state activity of the brain. The acute effects of cannabis on neural activity during cognitive processing paradigms apart from learning have been examined by few other studies. Studies are underway that aim to provide mechanistic insights into the genetic modulation of the acute symptomatic, cognitive and neural effects of cannabis in humans.

  • 8 - Cannabis and cognition: short- and long-term effects

  • Edited by David Castle, University of Melbourne, Robin M. Murray, Deepak Cyril D'Souza, Yale University, Connecticut
  • Book:
    Marijuana and Madness
    Published online:
    05 November 2011
    Print publication:
    27 October 2011, pp 91-102

  • Summary

    This chapter reviews what is known about the interactions of cannabis with the cannabinoid system in the brain, and how the drug affects psychomotor, cognitive, perceptual and appetitive functions. In both animals and humans the cerebral cortex, particularly the frontal regions, contains high densities of CB1 receptors. The presynaptic localization of CB1 receptors suggests a role for cannabinoids in modulating the release of neurotransmitters from axon terminals. CB1 receptors are expressed at particularly high densities in the basal ganglia and cerebellum so it is not surprising that cannabinoids have complex effects on psychomotor function. Controlled clinical trials showed that tetrahydrocannabinol (THC) had significant beneficial effects in counteracting the loss of appetite and reduction in body weight in patients suffering from AIDS-related wasting syndrome. The interaction of the cannabinoid and opioid systems in CNS remains to be demonstrated convincingly in humans.

  • 11 - Cannabis, cannabinoids and bipolar disorder

  • Edited by David Castle, University of Melbourne, Robin M. Murray, Deepak Cyril D'Souza, Yale University, Connecticut
  • Book:
    Marijuana and Madness
    Published online:
    05 November 2011
    Print publication:
    27 October 2011, pp 129-136

  • Summary

    The psychoactive ingredients of cannabis are the terpenophenolic cannabinoids. The main psychoactive cannabinoid is tetrahydrocannabinol (THC). In Canada, seized cannabis products are submitted for THC analysis for court purposes. Data on cannabis potency is generally obtained from the analysis of law enforcement seizures. In the Netherlands, data have been derived from cannabis products purchased in coffee shops since 1999. A study on the THC content of fresh illicit cannabis products seized on entry into the United Kingdom was conducted by the Laboratory of the Government Chemist (LGC). Cannabidiol, the main non-psychotropic constituent of cannabis, does not bind to the cannabinoid receptors, probably exerting its effects through novel cannabinoid receptors mediating non-CB1/CB2 receptor effects. In conclusion, it is clear that high-potency cannabis products are freely available on the international drug markets, and that cannabis products have at least a two-fold increased THC content compared with pre-2000 products.

  • 5 - The Adverse Health and Psychological Consequences of Cannabis Dependence

  • from Part I - The Nature of Cannabis Dependence
  • Edited by Roger Roffman, University of Washington, Robert S. Stephens, Virginia College of Technology
  • Foreword by G. Alan Marlatt, University of Washington
  • Book:
    Cannabis Dependence
    Published online:
    29 October 2009
    Print publication:
    23 February 2006, pp 106-128

  • Summary

    This chapter summarizes the most probable adverse health effects that cannabis-dependent persons are at increased risk of experiencing. A major difficulty in appraising the adverse health effects of chronic cannabis use is a dearth of good epidemiological evidence on the long-term health consequences of cannabis use. Cannabis exerts its most prominent effects on the central nervous system where it acts on an endogenous cannabinoid system that is involved in regulating mood, emotion, memory, attention, and other cognitive functions. The findings from both human and animal research suggest that prolonged use of cannabis alters the functioning of the brain's cannabinoid system but that this does not translate to serious impairment. The most consistent physiological effect of cannabis in humans and animals is to increase heart rate. This change parallels the experienced "high" and is related to amount of tetrahydrocannabinol (THC) in the blood.