Welcome! []...Dab it Topical Enema or Suppositories Weed Suppositories May Be the Future of Medical Marijuana What is Dabbing? • The process involves vaporizing concentrates on a

Welcome!

Welcome!

• Thank you for joining us today

• Schedule for the evening

– 6:15-7:15 – presentations

– 7:15-7:35 – break • Be sure to submit your questions, visit booths,

have a snack…

– 7:35-7:50 – Fireside chat

– 7:50-8:30 – Question and Answer

Welcome!

• Why are we all here?

• The conversation doesn’t end here…

– www.stjoes.ca/WEEDtalk

• Updated resources

• Video to be produced

http://www.stjoes.ca/WEEDtalk

Who? What? Where? Why? And Huh?

Holly Raymond

Clinical Director, General Psychiatry and Addiction Service

St. Joseph’s Healthcare Hamilton

Not your grandmother’s weed

What is Marijuana Exactly?

• Marijuana produces some excitatory effects but it is not classified as a stimulant

• Marijuana produces sedative effects, but a person faces no risk of slipping into a coma or dying

• Marijuana produces mild analgesic effects, but it is not related pharmacologically to opiates like drugs

• Marijuana produces hallucinations at high doses, but its structure does not resemble LSD or any other drug formally categorized as hallucinogen

Basic Terminology

• Cannabis is the botanical term for the hemp plant cannabis sativa.

• Marijuana is a cultural term for the cannabis plant -- refers to the dried leaves, flowers, stems, and seeds

Cannabis History

• Long documented use of both medical and non-

medical use in many countries (best documented in

India)

• Was a basic part of Indian folk medicine

• Used for many symptoms: pain, fever, vomiting,

diarrhea, insomnia, cough, seizures, muscle spasms

• Non-medical use was related to religious

ceremonies within a family context

Cannabis

Origins & History of use

• 1,400 BC - in India used to treat anxiety

– Bhang (drink from leaves)

– Ganja (dried resin)

• Folk medicine in Europe • Germany - to treat seizures, aid in childbirth

• Poland - for toothache (seeds put on hot stones and vapors inhaled)

• Czechoslovakia - to treat fever

• Russia - to treat jaundice

• Serbia - as an aphrodisiac

Cannabis History in Canada • 1801: The Lieutenant Governor of Upper Canada distributed hemp seeds to farmers in an effort to

stimulate industry.

• 1822: The provincial parliament of Upper Canada allocated 300 pounds for machinery to process

hemp and incentivize domestic hemp producers

• 1923: Cannabis was deemed illegal in Canada in 1923, after the Narcotics Drug Act Amendment

Bill introduced the Act to Prohibit the Improper Use of Opium and Other Drugs, adding cannabis,

in addition to opium, cocaine and morphine

• 1962: Cannabis gained popularity and the number of cannabis convictions escalated from 25

convictions between 1930 and 1946, to 20 cases in 1962 alone.

• 1968: The number of cannabis convictions jumped up to 2,300 as marijuana use increased,

particularly among college students and the hippie psychedelic counterculture.

• 1969: The Canadian government formed the Royal Commission of Inquiry in the Non-Medical Use

of Drugs, known as the Le Dain Commission, to investigate the non-medical uses of cannabis.

• 1972: The Le Dain Commission released a report on cannabis, recommending that the federal

government remove criminal penalties for the use and possession of cannabis, although the report

did not recommend legalization outright. No steps were taken to decriminalize cannabis.

• 1996: Terrance Parker is arrested for cannabis possession, cultivation, and trafficking after he was

caught growing cannabis to control his epileptic seizures. He appealed to the Canadian Charter of

Rights and Freedoms.

https://sencanada.ca/content/sen/committee/371/ille/library/spicer-e.htm#Bhttp://www.cbc.ca/news/health/marijuana-was-criminalized-in-1923-but-why-1.2630436https://sencanada.ca/content/sen/committee/371/ille/library/spicer-e.htm#Bhttp://www.thecanadianencyclopedia.ca/en/article/royal-commission-on-the-non-medical-use-of-drugs/http://www.thecanadianencyclopedia.ca/en/article/royal-commission-on-the-non-medical-use-of-drugs/http://www.thecanadianencyclopedia.ca/en/article/royal-commission-on-the-non-medical-use-of-drugs/http://www.thecanadianencyclopedia.ca/en/article/royal-commission-on-the-non-medical-use-of-drugs/https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1947221/http://www.cbc.ca/archives/entry/canadas-marijuana-laws-declared-unconstitutional

Cannabis History in Canada • 2000: The Ontario Court of Appeal ruled that the prohibition of cannabis use infringed

on Terrance Parker’s right to life, liberty and security of the person, therefore

rendering cannabis prohibition unconstitutional

• 2001: The Canadian government enacted the first rendition of the country’s medical

marijuana law, the Marihuana for Medical Access Regulations (MMAR), allowing

licensed patients to grow their own cannabis or access it from licensed growers

• 2003: The Liberal government of Jean Chrétien introduced the first federal marijuana

decriminalization measure, reducing the possession of up to 15 grams of cannabis to

a civil fine. The bill died, mostly due to pressure from the U.S. Drug Enforcement

Administration

• 2016: Neil Allard challenged the MMPR for suspending personal production licenses

from patients, requiring patients to access cannabis solely through licensed

producers. The Federal Court of Canada ruled in Allard’s favor, and revised the law

yet again with the Access to Cannabis for Medical Purposes Regulations (ACMPR)

• 2017: The Government of Canada proposed the Cannabis Act, which would legalize

the possession, use, cultivation, and purchase of limited amounts of cannabis by

adults 18 years of age and older.

• 2018: The Cannabis Act goes into effect, legalizing cannabis for adult use nationwide

http://www.cbc.ca/archives/entry/canadas-marijuana-laws-declared-unconstitutionalhttp://www.cbc.ca/archives/entry/canadas-marijuana-laws-declared-unconstitutionalhttp://lois-laws.justice.gc.ca/eng/regulations/sor-2001-227/page-1.htmlhttp://www.parl.ca/DocumentViewer/en/37-2/bill/C-38/second-readinghttp://www.parl.ca/DocumentViewer/en/37-2/bill/C-38/second-readinghttps://www.leafly.com/news/canada/judge-declares-home-medical-grows-legal-in-canadahttp://laws-lois.justice.gc.ca/eng/regulations/SOR-2016-230/index.htmlhttps://www.canada.ca/en/services/health/campaigns/introduction-cannabis-act-questions-answers.html

Cannabis

– Source of: • Strong fiber for rope and

paper

• Nutritious fruit

• Industrial oil

• Medicine

– Cannabis Sativa is a fiber plant

– Cannabis Indica is a resin plant

– Cannabis Ruderalis (lesser known)

Cannabinoids

• Plant Cannabinoids

• Synthetic Cannabinoids created in

laboratories

• Endocannabinoids which are

neurotransmitters produced naturally

by humans and many other species

Compounds and Cannabinoids

• 400 compounds and 60 cannabinoids • Main psychoactive compound is THC

(Tetrahydrocannabinol) • Cannabinoids found in Cannabis Sativa • Delta-9-THC is principal psychoactive

component • Brain binding sites discovered in late

1980’s • 1990 – Receptor CB1 first cloned and

sequenced

Components

THC (tetrahydrocannabinol): This component is responsible for the euphoric and psychoactive effects of the plant and as such, is the most sought-after component for recreational users. THC has a wide array of applications as a medicine.

CBD (Cannabidiol): Non-psychoactive, has shown promise for protective factors for substance induced psychosis, an anti-inflammatory, and an experimental treatment for cancer

https://pubchem.ncbi.nlm.nih.gov/compound/2977https://pubchem.ncbi.nlm.nih.gov/compound/644019

Increase in THC

Biol Psychiatry. 2016

Administration

Eat it (Cookies, brownies)

Smoke it (Joints, bongs, hash oil)

Drink it (Tea)

Vap it

Pill form

Dab it

Topical

Enema or Suppositories

Weed Suppositories May Be the

Future of Medical Marijuana

What is Dabbing?

• The process involves vaporizing

concentrates on a hot surface (the “nail,”

generally made of titanium, quartz or

ceramic) and then inhaling them though an

“oil rig,” which is a specialized pipe meant

for this use

• Increases intensity of high and risks

Most Common Forms

Dried Bud

Hashish

Hash Oil

• Use

–Smoked

–Eaten

Shatter

Extracts from the

cannabis plant that

concentrate chemical

compounds

(cannabinoids) like

THC and CBD. These

extracts can yield over

80% THC content

Concentrates

Smoke or Eat?

–Smoked

• Quick effect

• Peaks at 20 min. Lasts 1-2 hours

–Eaten

• Onset 1-2 hours

• Effects last for 3-4 hours

Caution

First death in Colorado after

legalized recreational marijuana

• 19 year-old Levy Thamba-Pongi, college student visiting on Spring Break

• Died March 11, 2014

• Jumped out 4th floor hotel window after eating cookie with 65 mg of THC

Considerations with Legalization

• Impact on traffic accidents

• Some research shows an increase in youth rates with legalization

• No reduction in black market in legal states

• Decriminalization vs Legalization

• Risk of OD with edibles

• Impact on physical health and mental health

• Significant risk on brain development

Bibliography

Biol Psychiatry. 2016 Apr 1; 79(7): 613–619.

Published online 2016 Jan 19.

Marijuana as Medicine: Separating Fact from Fiction

James MacKillop, PhD

Peter Boris Chair in Addictions Research

Director, Peter Boris Centre for Addictions Research

Director, Michael G. DeGroote Centre for Medicinal Cannabis Research

Professor, Department of Psychiatry and Behavioural Neurosciences

What is Medicinal Cannabis?

Medical Marihuana

Access Regulations

(MMAR)

Marihuana for Medical

Purposes Regulations

(MMPR)

Access to Cannabis for

Medical Purposes

Regulations (ACMPR)

Geneva International

Convention on Narcotics

Control Federal

Legalization

1925 2018 2014 2017 2001

+2900%

What is Medicinal Cannabis?

• Is it the same as prescription medicine?

No.

– Authorized, not prescribed

– No drug identification number (DIN)

– Less standardized product

– Imprecise dosing

What is Cannabis?

What is Cannabis? D-9-Tetrahydrocannabinol (THC)

Cannabidiol (CBD)

What is Cannabis? D-9-Tetrahydrocannabinol (THC)

Cannabidiol (CBD)

Cannabinol (CBN)

Cannabigerol (CBG)

Cannabichromene (CBC)

Camphene

Terpineol

D-3-carene

Limonene

Eucalyptol

Humulene

Trans-neroliol

Myrcene

Linalool

a Bisalol

Borneol

Caryophyllene

a Pinene

b Pinene

Does it work?

Ware et al. 2010, CMAJ

Does it work?

Of 79 trials, only

4 judged to have

low risk of bias

Increased risk of

short-term side

effects

Low quality evidence

in general

Moderate quality

evidence for pain

and spasticity in MS

Whiting et al. 2015,

JAMA

Does it work?

Supportive Evidence

• Reducing chemotherapy-

induced nausea and vomiting

• Reducing chronic pain

• Reducing spasticity in MS

Side Effects

• Motor impairment

• Cognitive difficulties

• Anxiety

• Paranoia

• Cannabis use disorder

• Overdose

Residual Effects on Memory

Participants (N=1042): 54.3%

female, M age = 28.8

THC+ Status and N-Back Performance

(covariate-adjusted β = -.08, t = 2.58, p = .01)

cMFG

vmPFC

cMFG

CB

AG

rMFG

vmPFC

Age-related Considerations

But isn’t that why it’s being

legalized?

• Cannabis is not being legalized because it has been shown to be an effective medicine or because it is generally safe

• Bill C-45 - The Cannabis Act

– Prevent underage access

– Ensure product quality

– Improve law enforcement

Want to learn more?

Vision An evidence-based understanding of medicinal cannabis, encompassing both its potential therapeutic effects and

associated risks.

Want to learn more?

Evidence Briefs

Consolidated overviews of the state of medicinal cannabis across various

clinical and research areas.

Research Summaries

Synopses of high impact research publications from clinical and research

experts studying cannabis.

Evidence Syntheses

‘Deep dive' explorations of topics related to medicinal cannabis via the

McMaster Health Forum

https://cannabisresearch.mcmaster.ca/

Take Home Messages

• Medical uses of cannabis have increased dramatically, but the evidence only supports a small number of applications

• All medicines have benefit-cost ratios and cannabis is no different

• Just because its legal, doesn’t mean its safe

Let’s Be Blunt: Marijuana Can Induce Psychosis in

Vulnerable Youth

Dr. Suzanne Archie, MD, FRCPC

Clinical Director – Cleghorn Early Intervention Clinic

Associate Professor – Department of Psychiatry and Behavioural Neurosciences, McMaster University

Chair of Research – Early Psychosis Intervention Ontario Network

Marijuana : Harm Reduction, Addiction and Where to Get

Help

Penny Burley

Executive Director – Alternatives for Youth

Why talk about Harm Reduction &

Addiction?

• 25% of high school students reported past year use

(OSDUHS)

• 2% of high school students reported symptoms of

dependence (OSDUHS)

• 14% of Canadians 15+ reported use in past 3

months (Statistics Canada)

• 56% of them reported daily or weekly use (Statistics

Canada)

What is Addiction?

• Addiction - repeated use of a psychoactive substance or

substances, to the extent that the user is periodically or

chronically intoxicated, shows a compulsion to take the

preferred substance(s), has great difficulty in voluntarily

ceasing or modifying substance use, and exhibits

determination to obtain psychoactive substances (WHO)

• Substance abuse - a maladaptive pattern of use

indicated by continued use despite knowledge of having a

persistent or recurrent social, occupational, psychological

or physical problem that is caused or exacerbated by the

use [or by] recurrent use in situations in which it is

physically hazardous

What is Harm Reduction?

• evidence based, client centred approach - policies or programmes that focus directly on reducing the health and social harms associated with substance use

• core principal is that it is beneficial to prevent and reduce the harm that is associated with risky behavior

• has been embraced as a fundamental principal for Canada’s Drug Strategy

• values people’s right to make choices for themselves, to be fully informed of risks, provided the means to make safer choices

What harms do we want to reduce?

• problems with thinking, memory or physical co-

ordination

• impaired perceptions or hallucinations

• injuries, accidents due to impairment

• mental health problems and dependence

• chronic respiratory or lung problems

Canada’s Lower-Risk Cannabis Use

Guidelines (CRISM)

Marijuana use has health risks best avoided by

abstaining

Delay marijuana use until later in life

• using marijuana at a young age, particularly

before age 16, increases likelihood of developing

health, educational and social problems

• generally, the later in life you begin to use

marijuana, the lower the risk of problems


Guidelines

Identify and choose lower-risk cannabis products

• high potency products, with high

tetrahydrocannabinol (THC) content are more

likely to result in harms

• choose products with lower THC content


Guidelines

Choose safer ways of using

• smoking marijuana, especially when combined with tobacco, can harm your lungs and respiratory system

• choose other methods, such as vaporizers or edibles instead – but, recognize that they also come with risks (e.g. edibles are safer for your lungs, but you may consume larger doses and experience more severe impairment because effects are delayed)


Guidelines

Avoid Harmful Smoking Practices

• avoid deep inhalation or breath-holding

• these practices are meant to increase

effects/experiences but they increase the amount

of toxic material absorbed by your lungs and into

your body


Guidelines

Limit and reduce how often you use

• frequent use (daily or almost daily) is strongly

linked to a higher risk of health and social

problems

• limit yourself to occasional use, such as

weekends or one day per week

Don’t use and drive

• driving while impaired by marijuana increases

your risks of being involved in a motor-vehicle

accident

• wait at least 6 hours after using marijuana before

driving

• combining marijuana and alcohol further

increases impairment


Guidelines

Avoid marijuana use altogether if you are at risk of

mental health problems or are pregnant

• if you, or a family member, has a history of

psychosis or substance use disorder, your risk of

marijuana related mental health problems

increases

• pregnant women should not use marijuana

because it could harm the fetus or newborn


Guidelines

Avoid combining the previously identified risks

• the more risky behaviours engaged in when using

marijuana, the higher the risk of harms

• e.g. starting to use at a young age combined with

high potency daily use increases risk of immediate and long term problems


Guidelines

Where to get Help

Alternatives for Youth – ay.on.ca

905-527-4469

Cleghorn Early Intervention Clinic

905-522-1155, ext. 36586

Concurrent Disorders Program

905-522-1155, ext. 36425

http://www.ay.on.ca/

Break

We will start up again in 20 minutes.

Fireside Chat:

A Conversation of Lived Experience

James, Julie and Suzanne

Question and Answers

Answering Your Questions

Documents

Welcome! []...Dab it Topical Enema or Suppositories Weed Suppositories May Be the Future of Medical Marijuana What is Dabbing? • The process involves vaporizing concentrates on a