1 The More You Know: Marijuana Then and NowBrooke Mann, Faith Burdine, Jenna DeLeon, Gabriela Hernandez

2 Overview Marijuana History Problematic Usage Current Status Treatment

3 History of Marijuana

4 What is marijuana? Dried leaves, flowers, stems, and seeds from the hemp plant Contains the mind altering chemical delta-9-tetrahydrocannabinol (THC) and other related compounds

5 The Origins The first evidence of usage of cannabis was found in China in 4,000B.C. The Chinese also used cannabis fruits as food Pen-ts’ao ching (oldest pharmacopoeia) Ma-fen

6 Moving forward 16th Century 19th Century O’Shaughnessy“The narcotic effects of Hemp are popularly known in the south of Africa, South America, Turkey, Egypt, Middle East Asia, India, and the adjacent territories of the Malays, Burmese, and Siamese. In all these countries, Hemp is used in various forms, by the dissipated and depraved, as the ready agent of a pleasing intoxication. In the popular medicine of these nations, we find it extensively employed for a multitude of affections. But in Western Europe, its use either as a stimulant or as a remedy is equally unknown.” During this time, various sources were citing the effects of cannabis (medicinal and recreational

7 20th Century Medicinal use decreased at this time Factors includeReplicability Vaccines Analgesics Hypodermic syringes Legal restraints

8 20th Century Congress passed the Marijuana Tax Act in 1937, effectively banning cannabis by making it expensive and difficult to obtain It was consequently removed from the American pharmacopoeia in and continuously marginalized

9 20th Century Since the 1960’s, the recreational use of cannabis rapidly spread among the younger ranges of the population throughout the Western world In 1964, the chemical structure of D-THC was identified by Gaoni and Mechoulam, which contributed to a proliferation of studies about the active constituents of cannabis Significant increased in scientific interest for cannabis, as of 1965 Controlled Substance Act in 1970

10 21st Century The “zero tolerance” climate of the Reagan and Bush administrations Still considered gateway drug Most commonly used illicit drug in the United States

11 Problematic Cannabis Usage

12 Cannabis-Related DisordersCannabis Use Disorder Cannabis Intoxication Cannabis Withdrawal Other Cannabis- Induced Disorders Unspecified Cannabis-Related Disorder

13 Cannabis Use Disorder Pattern of cannabis useSignificant impairment or distress Tolerance Withdrawal Failed attempts to cut back or quit

14 Cannabis Use Disorder Specifiers Severity Remission typeControlled environment Severity Based on symptoms present Mild Moderate Severe

15 Cannabis IntoxicationRecent use Problematic behavioral or psychological changes during or after cannabis usage Symptoms within 2 hours of use Specify with Perceptual disturbances

16 Cannabis Withdrawal Cessation of heavy/prolonged usageSymptoms within 1 week after termination Significant impairment

17 Other Cannabis- Induced DisordersCannabis-induced psychotic disorder Cannabis-induced anxiety disorder Cannabis-induced sleep disorder Unspecified cannabis-related disorder

18 Current Trends in Marijuana Usage

19 Three Main Strands Cannabis sativa Cannabis indicaCannabis ruderalis (a rarer form) Hybrids

20 Simplified PsychopharmacologyDelta-9 Tetrahydrocannabinol (THC): most psychoactive of its many cannabinoid constituents Cannabidiol (CBD): this cannabinoid appears to counteract the psychedelic effect of THC

21 CBD to THC Ratio 0:1- Strong “high” psychotropic effect. Euphoria, uplifting mood, confused thought, uncontrolled laughs. 1:2- Remarkable “high” effect. Euphoria, laugh and thoughts more calm. 1:1- Relaxation with very light “high” effects. Little euphoria, calmness and tranquility. 2:1- Little sedation and heaviness. Few to no “high” effects. No euphoria, sedation, lightheadedness, dizziness. 1:0- No “high” effect, at all. Ease up general mood.

22 Effects of Tetrahydrocannabinol (THC) on the BrainBrain Structure Function THC Effect Hypothalamus Appetite, hormones Increased appetite Basal ganglia Motor control Reduced reaction time Amygdala Emotions, fear, and anxiety Panic, anxiety Neocortex Higher cognitive functions Altered judgment Hippocampus Memory, learning Impaired memory Cerebellum Motor control, coordination Impaired coordination Brainstem and spinal cord Vomiting reflex, pain Antiemetic, analgesic

23 Form of the Drug Smoking Food (Edibles) Marijuana Extracts (Dabbing)Hand-rolled cigarettes (Joints) Pipes or Water Pipes (Bongs) Food (Edibles) Desserts Candies Teas Marijuana Extracts (Dabbing) Hash oil or honey oil Wax or budder Shatter

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25 Negative Effects Breathing Problems Increased Heart RateLung Irritation Impaired Judgment Impaired Motor Coordination Temporary Psychological Reactions Increased Heart Attack Due to increase sympathetic and decreased parasympathetic activity

26 Marijuana as Treatment

27 Medical Marijuana Dronabinol and Nabilone Medical marijuana28 states- CA being the first in and AR, FL, ND, OH, and PA being the most recent in 2016 A small number of studies have been conducted on natural and synthetic cannabinoid derivatives, particularly THC and nabilone.

28 Medical Marijuana The American Academy of Neurology (AAN)Multiple sclerosis Neurological disorders sufferers are suggested to use nabiximols Spray containing both THC and cannabidiol Some conditions might respond to cannabinoids not yet available in the US. Under these circumstances, it is reasonable to treat with marijuana itself. A variety of cannabinoids are being developed, so with new FDA indications, these should reach the market in the future.

29 Approved Conditions Cancer HIV/AIDS Amyotrophic Lateral SclerosisParkinson Disease Alzheimer’s Disease Multiple Sclerosis Spasticity Inflammatory Bowel Disease Neurophathies Huntington Disease Glaucoma Cachexia Fibromyalgia Severe Pain/Nausea Epilepsy/Seizures Muscle Spasms Hepatitis C Crohn Disease Anorexia PTSD Arthritis Pancreatitis Traumatic brain injury Tourette Syndrome

30 Positive Effects PTSD Anxiety Hyperarousal Self-harmEmotional distress Intrusive thoughts Nightmares Anxiety Self-harm Sleep Fear extinction type Therapy

31 Positive Effects Dementia Anxiety Weight gain Disturbed behaviorNocturnal motor activity Anxiety Anxiety due to public speaking Cognitive impairment Discomfort Reduces anxiety behaviors in GAD, PD, OCD, and SAD

32 Future Directions for ResearchControlled research Adequately powered outcome studies Potentially different outcomes of marijuana use in adolescence vs adulthood

33 Problems with Future ResearchLegal restrictions and funding Rigorous review process Research in this area mostly involves THC and THC analogs, rather than the whole plant More acceptance of marijuana

34 Until clear evidence becomes available on therapeutic effects, known risks may outweigh unknown benefits. However, the most clearly defensible statement to be made at this time is that rigorous research on the effects of marijuana and cannabinoids is very overdue (Steenkamp, M., Blessing, E., Galatzer-Levy, I., Hollahan, L., & Anderson, W., 2017).

35 Questions?

36 Resources Abuse, N. I. (n.d.). Marijuana. Retrieved April 18, 2017, from https://www.drugabuse.gov/publications/drugfacts/marijuana American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Washington, D.C.:American Psychiatric Association. Belendiuk, K. A., Baldini, L. L., & Bonn-Miller, M. O. (2015). Narrative review of the safety and efficacy of marijuana for the treatment of commonly state- approved medical and psychiatric disorders. Addiction Science and Clinical Practice, 10(10). doi: /s Blessing, E. M., Steenkamp, M. M., Manzanares, J., & Marmar, C. R. (2015). Cannabidiol as a potential treatment for anxiety disorders. Neurotherapeutics, 12(4), doi: /s Clifford, T. (2016). Marijuana. Journal of PeriAnesthesia Nursing,31(6), doi:doi.org/ /j.jopan Hill, K. P. (2015). Medical marijuana for treatment of chronic pain and other medical and psychiatric problems: A clinical review. Clinical Crossroads: Clinical Review and Education , 313(24), Hillig, K. W., & Mahlberg, P. G. (2004). A chemotaxonomic analysis of cannabinoid variation in Cannabis (Cannabaceae). American Journal of Botany,91(6), doi: /ajb How to interpret the CBD & THC ratio results? (n.d.). Retrieved April 18, 2017, from Nutt, D. J., King, L. A., & Nichols, D. E. (2013). Effects of schedule I drug laws on neuroscience research and treatment innovation. Nature Reviews Neuroscience, 14(8), doi: /nrn3530 Steenkamp, M. M., Blessing, E. M., Galatzer-Levy, I. R., Hollahan, L. C., & Anderson, W. T. (2017). Marijuana and other cannabinoids as a treatment for posttraumatic stress disorder: A literature review. Depression and Anxiety, 34(3), doi: /da.22596

37 Presenter InformationBrooke Mann Faith Burdine Jenna DeLeon Gabriela Hernandez