Addiction

Cannabis Legalization in Canada will Minimally Impact Emergency Departments

May 8, 2020 Addiction, Canada, Cannabis, Mental Health

Planning capacity for mental health and addiction services in the emergency department- a discrete-event simulation approach

In summary

A study published in June of 2019 has revealed the forecast for emergency department visits based on the current opioid crisis in Canada and the legalization of cannabis. Researchers observed an increase in the number of emergency department visits at hospitals in Canada, specifically for mental health addiction complaints. It was determined that the opioid crisis will continue to cause issues for emergency departments but that the legalization of cannabis will cause a minimal amount of issues due to the low-risk of addiction. While forecasting the effects of addiction-related emergencies researchers determined that there would be increased waiting times and the length of stay will deteriorate. It is recommended that Psychiatric Emergency Service Units increase their number of beds and that programs aimed at preventing alcohol and opioid addiction will be especially helpful for managing the future influx of patients.

The opioid crisis is ravaging more than just the emergency rooms in Canada, extending all over North America. Opioids are incredibly dangerous considering their high risk of addiction, often leading to people illegally obtaining opioids or other illicit drugs like heroin. Opioids most commonly act on µ-opioid receptors which affect the reward pathway in the central nervous system, preventing pain and convincing the body that opioids are a great substance. Some doctors are all too willing to overprescribe opioids for chronic pain or during recovery periods leading many to begin their lifelong addiction. Considering the economic cost of dealing with addicts, the emotional cost to families and caretakers, and the promise of cannabis as an anti-nociceptive, the federal government should seriously consider rescheduling cannabis so that it can be more seriously considered as an adjunct or replacement therapy for pain.

The study is available for review or download here

Planning-Capacity-for-Mental-Health-and-Addiction-Services-in-the-Emergency-Department-A-Discrete-Event-Simulation-Approach-1 Download

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Addictive Disorders are Associated with Neuroticism, Low Agreeableness, and Low Conscientiousness

April 23, 2020 Addiction, Alcohol, Cannabis, Cannabis Use Disorder (CUD), Nicotine

Big Five personality traits and alcohol, nicotine, cannabis, and gambling disorder comorbidity

In summary

In a recent study published by the American Psychological Association researchers determined that addictive disorders, like cannabis use disorder, are associated with neuroticism, low agreeableness, and low conscientiousness. Neuroticism, agreeableness, and conscientiousness are some of the Big Five personality traits, which was the taxonomy chosen by the researchers to examine possible personality underpinnings of addictive behavior and comorbidity. As all three of the traits were equally associated with substance use disorders they may explain the co-occurrence of addictive behaviors but these traits also may more broadly associate the propensity to develop any psychiatric disorder. Further research is needed to fully elucidate the relationship between neuroticism, agreeableness, and conscientiousness for substance use disorders as the research may lead to the development of better prevention programs.

The idea of cannabis use disorder is interesting as the endocannabinoid system does not act upon the reward system, making the threat of addiction almost nil. Cannabis is often pedestilized by advocates for its safety profile, especially when compared to other pain medications like opioids, yet there are still some concerns for dependency. The endocannabinoid system is ever changing, especially as we learn more about it. Very little research has been done that assesses cannabis dependency although it is known that, like with most substances, frequent users gain a tolerance to cannabis. Tolerance to cannabis can be reset with abstinence, supposedly for a 48 hour period, but again more research is needed. Tolerance, addiction, and dependence all need to be properly defined and standardized across the medical community, not just the advocates, because addiction and dependence can be frightening words that should not be thrown about.

The study is available for review or download here: https://drive.google.com/file/d/1xQqAEU3sr5niKtarRR_nUutUwDE6E4um/view?usp=sharing

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Interventions by Nursing Staff Aids in the Recovery of Addicts

February 3, 2020 Addiction, Intervention, Nurses

The effectiveness of a brief motivational nursing intervention to reduce psychoactive substance consumption in entertainment-sector workers- transversal, observation, and semi-experimental study

In Summary

In this observational study followed by a small experiment, it was revealed that addicts attempting to recover from substance abuse were benefited by an intervention from nursing staff. Addiction continues to claim the lives of many members of society, which could be heard as a calling for the development of effective treatment plans to help addicts recover. This work aims to test the effectiveness of outside motivation during recovery. Addicts in support groups found benefit from intervention during their recovery as the presenters facilitated an increase in self-motivation.

This study highlights the prevalence of abuse among entertainment workers. Certain areas of work maintain a celebratory culture that is almost synonymous with drug culture in today’s society. There are members of the greater community who are at higher risk of substance abuse than others, yet few outreach and education programs designate dedicated focus to support these groups. As substance abuse continues, federal health programs will need to be implemented to help prevent members of society from engaging in dangerous behavior. Motivating them to disengage from dangerous activity is one such intervention!

The study is available for review or download here

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An Analysis of Sudden Cardiac Death Exposes the Danger of Tobacco and Cocaine

December 21, 2019 Abuse, Addiction, Adolescents, Adult, Adverse Effects, Cannabis, Cannabis Education, Cannabis Science, Cardiovascular Effects, Future Medicine, Impairment, Products, THC

Sudden cardiac death associated to substances of abuse and psychotropic drugs consumed by young people- A population study based on forensic autopsies

In Summary:

A recent study out of Spain has revealed alarming trends among cases of sudden cardiac death associated with substances of abuse consumed by young people. Half of the 15-36-year-olds who suffered sudden cardiac death were found with illicit substances in their bodies, primarily cannabis, tobacco, and cocaine. Researchers found that although cannabis was the most common substance found in the deceased systems, cocaine and tobacco are known to have a stronger impact on the cardiovascular system and lead to ischemic heart disease, which is often the more acute causes of sudden death. It was also mentioned here that the duration of cannabis is far longer in the body than that of either tobacco or cocaine, and this duration may easily confuse people to associate it as a trigger for sudden death.

However, on the other hand, there are several tragic cases of young, otherwise heart-healthy individuals who have died with cannabis as the only substance discovered. Fortunately, these cases are extraordinarily rare, but unfortunately, no reproducible association has been established, so the mysterious concerns are not easily relieved or forgotten.

Dr. Caplan and the #MDTake:

While the return of medical cannabis to modern medical care seems to bring with it a return of appreciation for more naturalistic care, it is critical for us all to recognize that we still have much to learn. The tools and high standards of scientific evaluation have only recently been applied to cannabis, and there are reasonable arguments that the usual tools may not actually apply (for example, some are suggesting that the placebo effect, a cornerstone of randomized control trials may be a facet of effects related to the endocannabinoid system.)

For these, and a great many other unknowns, it is important for the discerning consumer to consult with trusted resources, including friends, family, scientists, and where possible, doctors, to ensure the appropriateness of use on an individual basis.

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Sudden cardiac death associated to substances of abuse and psychotropic drugs consumed by young people- A population study based on forensic autopsies Download

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Reducing Cannabis Use Equally Effective as Abstinence in Treating Cannabis Use Disorder

September 5, 2019 Addiction, Adverse Effects, Behavior change, Cannabis, Cannabis Dependence, Cannabis Science, Cannabis Use Disorder (CUD), Dosing, Future Medicine

Reduction in Cannabis Use and Functional Status in Physical Health, Mental Health, and Cognition

In a survey of 111 cannabis use disorder (CUD) patients with abstinent, low use, or heavy use of cannabis, similar benefits were experienced by patients who reduced their use to zero or low use. Both groups exhibited significantly better outcomes than the heavy use group with respect to overall health, appetite, and depression. According to the study, CUD patients “who used cannabis at a low level did not differ from the abstinent individuals in any of the functional outcome measures.” With a relatively small subject population, it is challenging to know if this is applicable to broader audiences, but regardless, It is likely to open up some new treatment option for CUD patients.

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Reduction in Cannabis Use and Functional Status in Physical Health, Mental Health, and Cognition Download

This paper is also stored here: http://bit.ly/2MTBOAm inside the CED Foundation Archive

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Cannabinoid Receptors Regulating the Function of Opioid Receptors

August 26, 2019 Abuse, Addiction, Behavior change, Cannabinoids, Cannabis, Cannabis Science, CB1, Future Medicine, Illicit Drug Use, Opiates, Overdose

Constitutive Activity of the Cannabinoid CB1 Receptor Regulates the Function of Co-expressed Mu Opioid Receptors

Summary info:

Cannabinoid receptors have been found to regulate the function of co-expressed mu-opioid receptors. Researchers have found data that indicates the constitutive activity within the cannabinoid system reduced the capacity of expressed mu-opioid receptor functions. This research brings to light the possible benefits of modulating opioid consumption with cannabis-based medicines.

Dr Caplan Discussion Points:

One of the interesting discussion points in this paper is a close look at the effects of the CB1 receptor and its capacity to reduce the function of some mu-opioid receptors, through a mechanism different than naloxone. This suggests some appropriate optimism for cannabinoid-based tools in the battle against the worldwide opioid epidemic.

Learn more at http://bit.ly/2wRsbbt

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Constitutive Activity of the Cannabinoid CB1 Receptor Regulates the Function of Co-expressed Mu Opioid Receptors Download

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Video: 5 Myths about Cannabis – DEBUNKED

August 10, 2019 Addiction, Adult, Adverse Effects, Anxiety, Behavior change, Cannabinoids, Cannabis, Cannabis Education, Cognition, Future Medicine, History, Impairment, Mental Health, Stigma, THC, Video

Video: Controversial Questions in Cannabis Today

August 2, 2019 Abuse, Addiction, Adult, Adverse Effects, Anxiety, Behavior change, Cannabis, Cannabis Education, CBD, CED Clinic, CED Foundation, CED In The News, Cognition, DIY, Dr Caplan, Edibles, Future Medicine, History, Impairment, Jobs, Law, Legislation, New York, Products, Reaction Time, Regulation, Testing, THC, Video

As cannabis finds its place back into modern human culture quickly, there is much still to be learned. As the science grows and adapts to modern need and expectations, the “can we” may be out-pacing the “should we.” On the other hand, there are circumstances where modern culture really “should be” and is handicapped by years of misinformed stigma.

Here, a few controversial questions about cannabis:

Should teachers be allowed to use cannabis around children?

Should spiritual leaders be allowed to use cannabis, as they have for millennia?

Should taxi drivers be allowed to use cannabis on the job?

Should pilots be allowed to use cannabis?

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The Effect of Chronic Cannabis Use on Volumetric Alterations in Brain Regions

August 1, 2019 Addiction, Adult, Adverse Effects, Cannabinoids, Cannabis, Cannabis Dependence, Cannabis Science, Case Study, CB1, CB2, Cognition, Dementia, Heavy Use, Impairment, Memory, Mental Health, Testing, THC

Title: Neuroanatomical alterations in people with high and low cannabis dependence

A recent article has been published revealing some volumetric alterations in specific brain regions in people who report dependence on cannabis. Magnetic resonance imaging revealed that the volume of certain regions, including the hippocampus, the cerebellum, and the caudate, in cannabis dependent users, were all reduced in size, relative to recreational cannabis users who did not use cannabis chronically. Future research will likely focus on the effects of the structural alterations on patients’ reward, stress, and addiction-relevant circuitry to examine the possible relevance of cannabis dependance on those circuits.

There are certainly possibilities that suggest this volume difference could be of concern, but there are also a great number of explanations (more than likely) whereby this is related to another variable that we have not yet fully appreciated.

Currently, cannabis use is thought to have a little-to-no risk of addiction (beyond any “normal” product of medical value, such as coffee or eyeglasses), because it does not act directly on the reward circuit. Opioids have a high risk of addiction, and therefore a concerning safety profile, in part because of the direct effect of the opioid system on the reward pathway of the central and peripheral nervous systems. While the endocannabinoid system has been observed to act directly up the reward circuit, it does so in subtle, soft ways, making it an ideal adjunct therapy for opioids to help with pain management. Current research provides inconsistent results and appropriately emphasizes a need for more testing to validate the possibility of cannabis as a recommended pain medication.

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Neuroanatomical alterations in people with high and low cannabis dependenceDownload

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Author’s Response to Discrepancies in Medical Cannabis Use

August 1, 2019 Abuse, Addiction, Adult, Business of Cannabis, Cannabis Education, Cannabis News, CED Clinic, Dispensaries, Financial Projections, Future Medicine, History, Massachusetts, Politics, Products, Social Equity, Social Justice, THC

Medical Cannabis Use: The Authors Reply

In yesterday’s blog post, the discrepancies in the number of medical cannabis users were discussed and the suggestion arose that perhaps medical cannabis use may need stricter regulations. The author of the piece that inspired the letter featured in the post responded, highlighting the possibility that recreational cannabis is being used for medical purposes rather than users obtaining cannabis from more nefarious sources. The author points out that renewing medical licenses can be a hassle and in states where recreational cannabis has been legalized patients may just be obtaining their cannabis, used for medical purposes, from recreational dispensaries. Surveys that delve into this issue are needed to confirm the author’s hypothesis.

Describing the medical process of obtaining a cannabis license as a hassle is, unfortunately, reported by many consumers. State governments are forced to run the regulatory processes, in the absence of federal support, and conservative politicians and opposition groups often create difficulty around opening dispensaries in their districts. On top of the expenses of renewing or obtaining a medical license, it may seem almost less confrontational for people who reside in a state or have access to recreational marijuana (from a state-regulated dispensary) simply to purchase recreational cannabis, rather than take the time to obtain a license.

Of note, Massachusetts is one of the few states that has anticipated this circumstance and has codified protections and advantages of the medical program, into law. In Massachusetts, medical patients are incentivized through robust discounts (totaling greater than $2000 in discounts, and 20% cost reduction because of the absence of state taxation for medical patients.) Further, there are legal protections available only to medical patients, and the opportunity for delivery, which are not available to recreational consumers.