Thursday, September 26, 2013

Marijuana and Youth

Marijuana and Youth
-Dr Shimi Kang

This was a lecture at the Canadian Society of Addiction Medicine Conference in Vancouver Sept. 26, 2013.  Dr. Shimi Kang is on staff at UBC Women’s Hospital and with the Department of Addiction Psychiatry UBC.  She is a truly brilliant speaker, and astute clinician whose presentation was one of the best I ‘ve ever head on a subject I’m very familiar with.  I have copied my rough notes here though would strongly recommend for anyone who ever has the opportunity to hear her, to take advantage of this, as she is one of the very best speakers for combining scientific and academic information with clinical experience.  I apologize for the notes that really don't do justice to this splendid presentation. However I believe that by uploading these notes it will perhaps help someone find the right direction to look.  Dr. Kang has a book coming out as well and it certainly will be worth looking for and reading.  

Learning objectives
  • incidence in youth
  • risk factors

Are you a tiger, dolphin or jellyfish?

When we look at therapists we see
  • distinct results 
  • engagement
  • success

Average doctor patient 
-70% doctor
Listening more is good
Non judgemental
I give information to adolescents all the time but in the end I always tell them it’s your 

Empathy is the biggest thing for success
Standing in their shoes and walking in their shoes

Saying “i can tell marijuana serves in your life but....”

3 qualities
genuineness --I don’t say anything I don’t believe in with adolescence -

Tiger therapist - I am the authority, I’ve recommendations
Jellyfish therapist - going with flow, very kind and empathic and rapport but they don’t use this for any goal - we all know these - patients say I saw this counsellor three yeas and she was very nice - but when I ask her did your substance change - and she says no
We don’t want to be tiger or jellyfish
We want to be a dolphin - highly intelligent, collaborative - working with young people, collaborative - playful, going side by side - creative - great communicators - adaptable - not a tiger pushing and not a jellyfish - 

Favourite teacher
Attributes and Affect
Challenge patient
Even if they’re forced to come to us - we allign them to move forward - everyone wants to move forward in their life

  • life magazine -1950 on cover

  • time magazine - 2013 - still on cover
50 years later same questions being asked, big topic

15 -24 -3x risk
average age 15
in BC its lower age of starting 

Michael Phelps - “What a Dope?”  I always use him as comorbidity - 13 times Olympic goald medal winner with cannabis pipe

When I started psychiatry years ago and we asked do you drugs - now I ask specifically - marijuana use - if you ask drugs -they don’t answer - it’s pervasive

THC content and potency
-it’s increased over 30 years
NIDA  Marijuana Abuse (2010)
Saw father of adolescent and he said he didn’t think his son’s smoking marijuana is a problem because he used marijuana every day through law school - however his son was 16 and the potency was greater than a man at 23.  As we’re seeing younger and younger we’re seeing greater problems  - we shouldn’t call it the same drug - we don’t call heroin - poppy - even though marijuana is very different drug we call it the same drug - what you son is using is a very differrent drug than what it was in the 60’s.  

the more potent for THC the less neuroprotective drug in the cannabinoid.

Also I said that the life style was different - different situations from the 60’s - the son wasn’t sleeping and had had head injuries from hockey and 

Brain impact from marijuana
  • Marijuana Effects 
  • CBR - Cannabinoid receptors - naturally in the brain - high densities are found in areas that influence pleasure, memory, thinking, concentration, movement, coordination and sensory and time
  • NIDA Marijuana ABuse 2010

THC stimulates CBR - overstimulation - disruption of natural or endogenous cannabinoids - ‘marijuana - ‘high’

They say I’m not depressed and not anxious - but I tell them they are ‘high’ and that they wouldn’t be anxious or depressed with being drunk but they’d recognise that they were ‘drunk’.

High - heightened perception, altered perception of time and increased appetite
disrupts co ordination 
-psychosis - 
effects on general health - heart rate speeds up
when they say they feel anxious without pot - I ask how long since they were off marijuana for 2 weeks - there is a withdrawal phase - so I explain the withdrawal and cycle and explain that we really don’t know until we have a period of time to see

Medical marijuana - scientists confirmed cannabis plants contain active ingredients with therapeutic potential for relieving pain, controlling nausea, stimulating appetite and decreasing ocular pressure
NIDA 2010

Heath Canada grants accept to marijuana for medical use to those who are suffering from grave and debilitating illnesses
-documentary WEED 
-young people saw this and come with the argument and there was real disconnect in this documentary, what it was saying and who it was saying about

Csnnabis and Schizophrenia
  • Longitudinal studes in 5 countries strong evidence of causal link
  • researchers established drug abuse lead to double rate in adolescents in hospitalization for sx
  • metal analysis McLaren et al 2010 causal link
--temporal link can not be connected
Prodromal patients
  • genetic marker - at risk
  • Haroun t al 2006
  • Kristensen & 2006

Pre-existing vulnerability
  • family history of psychosis
  • have you had hallucinations using pot - risk - not everyone who experiences psychosis when they use coke or pot - then ask how long after you used did the psychosis - if longer days or weeks - then it sounds like your brain is having trouble recovering from the hit you gave it
  • head injury - I use analogy of head injury - mohammed alli - boxer dementia - his condition didn’t come from a single knockout - culmination of multiple hits - everytime we experience psychosis when high - this works
  • Stefanis et al 2004 
  • Downside of High-CBC Documentary
I tell young people to look at this documentary on You Tube
Marijuana, Memory, Amotivation
-amotivational syndrome is real - we see it all the time - 28 year old guy playing video games in parents basement
associations with marijuana use and depression, anxiety, suicidal thoughts, among adolescences and personality disturbances
  • told parents to be hypocrites- be parent not the friend - don’t get caught in that - don’t tell them you smoked pot - 

Cannabis and MVA
  • clear evidence that cannabis like alcohohl impairs psychomotor skills required for safe driving
  • moderate doses cannabise impaires automated tasks but leave complex function
  • drives at increased risk of crashin
  • lower reaction

Should marijuana be legalized? 

WHO _ Biggest public health disaster of all time was the legalization of tobacco - director general
When alcohol prohibition was in the states - all health indicators improved though in a different system - crime went up but from health basis - much improved

Cons to Legalization
  • cannabis use is harmful to adolescents especially with early or frequent use

  • Implications
  • marijuania more prevalent among patients with psychaitric disorders

increase schizophrenia and chronic psychosis

One tool - cycle of drug use - 1 abstience - experimentation - recreation use - habitual use - abuse - dependence 
I show this to adolescents 
When I ask adolescents where they are they are usually not that far off telling me where they are in the cycle - then I ask ‘wouldn’t it be great if you could go back ‘ then show them how especially to the very resistant

In psychiatry we say you shouldn’t self disclose but I find that self disclosure helps and I saw myself doing this when I was a mother that I was self disclosing so I developped a different view .  But if I’m working with a person and I’m not using a ‘recovery’ model I can say that I’m not talking about  but rather I’m talking about coping methods so I don’t only have to speak from experience and be helpful

Asked re harm reduction and marijuana - don’t see any benefit for ‘smoked’ marijuana - 

Discussion of other agents - sativex, cesamet and newer pharmaceuticals that are superior to ‘medical marijuana’ and recommendation that doctors specify that there is no ‘medical’ benefit to ‘smoked’ so indicated only for use as ‘tea’.

No comments: