Film-based Classroom Resource Lets Teens Open Up About Cannabis, Choices and Consequences

“The film encourages students to come to their own conclusions about marijuana use through showing a variety of situations rather than just ‘telling them how to think.”—Teacher

….the video stimulates conversation because it is so powerful. So in all honesty the video did most of the work and I just kept the conversation going, changing its direction when needed and appropriate and prompting where I could.”—Substance use counselor

Teens need opportunities to talk openly and honestly about cannabis (marijuana). This is the thinking behind a new, award-winning classroom resource called CYCLES, developed by researchers at the UBC School of Nursing and based on studies involving youth in three BC communities.

The Cycles logo

Cycles is an educational resource to help engage young people in productive discussions around cannabis use.

The goal of CYCLES is to help engage young people in productive discussions involving decision-making and cannabis use. The resource features a locally produced short film (28 minutes) about two fictional high school students and their relationships with cannabis. There is also a facilitator’s guide containing lesson plans, teaching tips, student handouts, and quick facts about cannabis use. Together the classroom materials support self-reflection and dialogue about factors that can influence a teen’s choices to use—or not use—cannabis or any other drug.

Facilitators of the 50-minute module (or longer if a deeper discussion is desired) do not need to be drug experts. Their role is simply to guide a thoughtful class discussion, whether students are experienced with cannabis and its effects or not.

“Meaningful dialogue with young people about marijuana use can translate into informed decision-making,” say the resource’s creators. In other words, talking things out may make frequent users consider cutting down on how often they toke up, and it may delay or deter other students from trying cannabis in the first place.

A recent survey of BC students supports the call for open, non-judgmental conversations in schools about cannabis and other drugs. Teens who are able to discuss such issues with parents, teachers and other adults are more likely to make healthier decisions. Rates of substance use among students have been declining for a decade, says McCreary Centre Society’s 2013 Adolescent Health Survey. The vast majority of students in Grades 7 through 12 said they had never tried cannabis (74%), and many of those with experience reported waiting until they were at least 15 before first experimenting with the drug. Eight percent of students reported using cannabis on the weekend before the survey was taken, down from 12% in 2008.

“Judging young people for their choices regarding marijuana is not helpful,” reads a CYCLES footnote. “Rather, engaging in meaningful discussion contributes to healthy dialogue.”

For more information, check out the CYCLES resource on the CARBC website. While the CYCLES guide is currently published in English only, the video is available with French subtitles. Student worksheets will soon be available in French. A script of the video is also available.

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Author: Nicole Bodner, Centre for Addictions Research of BC

**Please note that the material presented here does not necessarily imply endorsement or agreement by individuals at the Centre for Addictions Research of BC.

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Driving under the influence of cannabis

Attitudes toward driving under the influence of cannabis vary greatly. Some individuals claim that driving under the influence is extremely dangerous; whereas others suggest that cannabis is a fairly innocuous substance that does not increase your risk of collisions.  Research indicates that the true answer is somewhere between these two extremes. Comparisons between studies of alcohol intoxication and collision risk versus studies of cannabis intoxication and collision risk show that alcohol has more detrimental effects on driving than cannabis has on driving. Conversely, some research has shown that drivers under the influence of high levels of cannabis attempt to compensate for their condition by driving slowly and cautiously. However, while compensation can help reduce the risks of collision, these risks are not fully eliminated.

A recent review of the evidence showed that cannabis doubled the likelihood of a collision, which would be similar to the likelihood of collision from having a blood alcohol content (BAC) of .05%, the legal alcohol limit in most Canadian provinces.  For comparison, heavy alcohol intoxication to a BAC of .20% alcohol is related to over an 80 fold increased likelihood of a collision. Cannabis affects your attention span making it harder to concentrate on driving and makes it difficult to shift attention to deal with changes in the environment. Evidence suggests cannabis may also impair tracking ability (i.e., harder to follow your lane), and sense of time and distance.  The duration of impairment from cannabis lasts on average about 90 minutes, but it is best not to drive within 4 hours after smoking cannabis.

It is a criminal offense to drive under the influence of cannabis, however, nearly half a million Canadians admitted to driving within two hours of using marijuana or hashish in 2006 and youth report driving after cannabis more than after alcohol (40% vs. 20%). If a police officer suspects that you are driving while under the influence of cannabis, you can be sent to the police station for examination of impairment by a drug recognition expert, and possibly be asked to provide a biological specimen, such as urine or blood for analysis. This process is time consuming and cumbersome for the police. Some countries have dealt with the issue by implementing roadside saliva testing – a test that can detect the use of cannabis over the past few days. For example, Australia has a zero tolerance policy for driving under the influence of cannabis and uses roadside saliva tests to assess for the presence of THC. However, saliva and urine tests are not as effective at detecting impairment compared with the Breathalyzer test used for alcohol, where increased blood alcohol concentration corresponds closely with safety risk. That is, a person who tests positive for cannabis on a saliva or urine test may not be under the influence at the time of the test and therefore their driving may not be impaired. Another more accurate option for detecting cannabis impairment is the use of blood tests, currently being used in Germany, however these tests are also more intrusive and difficult to implement at roadside.

Driving under the influence of cannabis is a serious public health concern and with the recent legalization of cannabis in Washington State and Colorado and the continued movement towards decriminalization of cannabis in BC, cannabis related driving policies will be an important component of any regulatory system. 

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Authors: Scott MacDonald, Assistant Director, CARBC, and Chantele Joordens, Research Associate, CARBC

 

Lowering the Risks of Cannabis Use

As we move toward greater acceptance of cannabis use, and possibly decriminalization or legalization down the road, it is important to recognize cannabis is not a benign drug. While it has benefits, like any other drug, there are also risks involved. Whenever we choose to use cannabis, it is helpful to know what steps we can take to ensure that our use is the least harmful possible. Here are some things to think about to help reduce the risk of harms and bad experiences.

Some of the risks around cannabis are related to its production. Since cannabis is illegal and unregulated, it is often produced in conditions where products are not tested for quality and potency. One way consumers can lessen the risk of experiencing harms is to purchase cannabis from someone who knows about the drugs they sell. Another precaution is to carefully inspect the cannabis for visible contaminants such as molds and mildew. And, since levels of THC (the main psychoactive ingredient in cannabis) can vary, starting with a small amount helps adjust the dosage to achieve the desired effect. Using as little as is necessary also helps prevent inhaling unnecessary smoke and toxins.

The method used to consume cannabis also influences the risk of harmful consequences. Using a vaporizer is safer than smoking, since cannabis smoke contains tar and toxins. But, if smoking cannabis, research suggests joints are safer than bongs or pipes. Bongs filter out more THC than tars since water tends to absorb THC. This requires puffing harder, increasing the amount of tar that is inhaled. If using a bong or a pipe, consumers should avoid those made of materials (such as plastic) that may be toxic when heated. (Bennett, 2008; Gieringer, 1996, Rev. 2000).

Other ways to lessen risks include taking shallow puffs rather than deep inhalations, and if sharing joints or other devices, avoiding touching the lips (this helps decrease the risk of spreading germs and viruses). When eating or drinking cannabis, consuming a small amount and waiting at least one hour to feel the effects before using more helps avoid getting higher than intended.

Making informed decisions about where, and with whom, cannabis is used is another way to reduce adverse consequences. For instance, staying in the company of trusted friends in a safe place helps manage potential uncomfortable effects such as feeling too high or anxious. If going out, it is important to avoid driving. Cannabis can impair motor coordination, judgment and other skills related to safe driving (Mann, et al., 2008; Ramaekers, et al., 2004).

People sometimes mix cannabis with other drugs to experience different effects. But the effects of cannabis are intensified and may last longer than expected or wanted if combined with alcohol or other drugs at the same time. Cannabis in combination with even small doses of alcohol impairs driving ability more than either drug used alone.  And, tobacco contains many cancer-causing toxins, so it’s safer to use cannabis by itself.

All of the above practices are important to keep in mind when choosing to use cannabis. While all drug use involves risk, being clear on safer ways to use the drug helps to minimize harms, both acute and over time.

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Author: Bette Reimer, Research Associate at the Centre for Addictions Research of BC

Helping Youth Make Sense of Cannabis

We have all heard a variety of claims about cannabis. Some are scary, like, “cannabis causes psychosis” or “cannabis leads to brain damage and dropping out of school.” Others tell a different story, “cannabis is a miraculous herb that alleviates the symptoms of everything from hiccups to Multiple Sclerosis.”

Making sense of these competing claims can be confusing . While there is at least some truth in almost all of them, accurate and balanced information about cannabis is more complex than simple statements. It is particularly important for young people to realize that there are no simple answers. People are complex beings. Cannabis use can affect  us all differently, but it has potential to impact our minds, bodies, relationships and future prospects.

So where do we begin? We need to acknowledge that all drugs can be both good and bad. Even medications recommended by a doctor can cause harm. Since all drug use carries some risk, it is important to learn how to weigh the potential benefits against the potential risk. Fortunately, human beings have been doing this for a long time. And the wisdom of the ages might be summed up as, “not too much, not too often, and only in safe contexts.” Using more of a drug (or a higher strength preparation) or using daily as opposed to once in a while is more dangerous. But risk is also linked to a wide range of contextual factors. Age – the younger a person is when they start using cannabis regularly, the more likely they are to experience harms in the short term or later in life. But other factors, like where and with whom one uses, also impact risk. Smoking cannabis on school property or driving under the influence are examples of particularly high-risk contexts for quite different reasons.

The reasons why we might use cannabis are also important, and they influence the balance of risk and benefit. If our use is motivated only by curiosity, for example, our use will likely be only occasional or experimental. On the other hand, if our use is about fitting in with a particular group or a way to cope with anxiety or some other mental health problem, we are more likely to develop a more regular and riskier pattern of use. Yet again, if we are consciously choosing to use cannabis to address troubling symptoms related to various health challenges, we may find it relatively easy to manage our use in a way that minimizes risk.

While it may be helpful to know the various potential risks and benefits associated with cannabis use, the more important issue is to become consciously aware of our own pattern of use and our reasons for using or not using. As human beings, we tend to “outsource” control of our behaviour to the environment. For example, when we are with our friends, we may talk a certain way. But when we are talking with our parents, our teachers, our boss – without thinking about it – we slip into a different way of talking. Drug use is more dangerous when we allow it to become a pattern that we don’t think about.

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Author: Dan Reist, Assistant Director (Knowledge Exchange) at the Centre for Addictions Research of BC

Cannabis and psychosis: Is there evidence of causal association?

It has been well known since historic times that cannabis may cause a variety of psychiatric symptoms. In fact, the desire to take cannabis or marijuana is primarily to obtain mental effects, and the line may be thin even in an occasional user between experiencing a pleasant and exciting psychoactive effect and a real psychotic episode. “Cannabis psychosis” is a term widely used for psychotic episodes resulting from cannabis use. These occur during or shortly after intake and may last days or weeks, but subside after discontinuation of the drug. They may require hospitalization and medication. Comprehensive summaries of mental health effects of cannabis have been published by Murray and Hall & Degenhardt.

It has often been debated whether use of cannabis can cause long-term psychotic states, and in particular schizophrenia and other chronic psychoses. Seeing patients with a combination of heavy cannabis use and schizophrenia, I was intrigued to assess the causal direction of the association. It was in the 1980s when I found out there was a survey on drug use in a national cohort of 50,000 Swedish 18-19 year old male conscripts (one year of military service was compulsory in Sweden until 2010) that we could link to data on occurrence of schizophrenia later in life. We found that those who reported use of cannabis in adolescence had a doubled risk of schizophrenia compared to those who did not use cannabis. With data on social background, psychological characteristics, and psychiatric condition assessed at conscription, we could control for such factors that might influence the association.

We have continued to follow this cohort and the men are now over 50 years old. The contribution of cannabis to new cases of schizophrenia has declined in occasional users but those who reported heavy use of cannabis in adolescence still have a twofold increased risk of schizophrenia, even at older ages. We do not know whether this is due to continued use of cannabis, or whether heavy early use could indeed have had very long lasting effects.

In recent years, several other studies have also found an association between cannabis use and later onset of chronic psychosis. A review was published in 2007 concluding that there is now “sufficient evidence to warn young people that using cannabis could increase the risk of developing a psychotic illness later in life.” The paper was accompanied by an editorial in which the prestigious journal the Lancet admitted that they had previously underestimated the risk of harmful effects of cannabis.

We recently studied the pattern of care of the patients with schizophrenia in our cohort of male conscripts, and it turns out that those patients with a history of cannabis use had double the number of total days in hospital and around double the number of hospitalizations that were twice as long in duration of those who did not have a history of cannabis use.

Thus, there is now evidence that cannabis is indeed a contributory cause of chronic psychoses, including schizophrenia. Certainly, cannabis is not the only cause of chronic psychosis. There generally needs to be other factors, such as genetic factors, personality characteristics, etc. to cause schizophrenia or other long-standing psychoses. It has been shown that the risk of psychosis in cannabis users is especially strong in psychologically vulnerable persons. Thus young people, and especially persons with mental health illness, should be warned about the risk of chronic psychotic disorders as an effect of cannabis use. Not only because of the risk of chronic psychosis, but also a number of other negative physical and mental side effects.

*Please note that the material presented here does not necessarily imply endorsement or agreement by individuals at the Centre for Addictions Research of BC

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Peter Allebeck, Professor of Social Medicine, Karolinska Institute, Stockholm, Sweden

 

 

Marijuana, a Friend to Crohn’s Patients Everywhere

I am 33 years old, married, a university graduate, and a business professional. I also have Crohn’s Disease, and I have used marijuana to treat ongoing symptoms such as pain, nausea, lack of appetite, and low energy. I do not use “medical” marijuana, but rather the dispensaries that currently fall under a grey area of legality in BC. I take no other pharmaceuticals for my Crohn’s Disease, and am able to control it with diet and a healthy lifestyle. I have chosen to write this blog as anonymous because unfortunately, there is still a fair amount of stigma, stereotypes and misinformation surrounding the “typical” marijuana user (and I think my parents would kill me).

I started using marijuana as part of my treatment when I was 26. My doctor informed me I was underweight and needed to gain about 15 lbs. The problem was, I couldn’t eat. My stomach would turn at the thought of eating, and I would often throw up after meals. I started smoking a very minuscule amount of weed before dinner so that I could not only eat, but enjoy eating again.  It worked like a charm.

However, I struggled to find a reliable source of marijuana. I did not like the idea of going to a dealer. It was shady and illegal and I was never quite comfortable with it (though it was never very difficult to come by). My GP at the time was not open to prescribing medical marijuana to me, and I felt extremely judged! She was very closed minded about the medical benefits of marijuana despite the living proof standing right in front of her, 15 lbs heavier and healthier than before.  

In 2011, a friend took me to a medical marijuana dispensary in downtown Victoria. She was a member there due to ongoing and severe debilitating back pain, which would put her on the floor for days at a time. To become a member at the dispensary, I simply needed proof of my condition and photo ID. Crohn’s is classified as Category 2 symptom on the Health Canada info page on medical marijuana. I brought in proof of my condition, sat through a 45-minute orientation and happily became a full-fledged member of the Victoria Cannabis Buyers Club. The role of the dispensary is to serve those who have legitimate conditions that can be treated by marijuana, but whose doctors will not prescribe it. They offer an incredible selection of products, including dried smokeables, edibles, oils, creams, compresses, and capsules. I tend to favour their Cannoil, which is made specifically to treat upper gastrointestinal disorders, and has provided me relief from not only nausea, but also severe cramping and bouts of diarrhea. The staff is friendly and knowledgeable on recommending the different strains to best suit your specific needs. As for the clientele, you’d perhaps be surprised to know that more often than not, it’s other “normal” people, business professionals, moms and grandparents seeking relief from what ails them.

Will I seek eligibility for medical marijuana? Perhaps one day, though I feel less inclined to now. I am a light user, and I like the convenience and selection of products that are on offer at the dispensary. I will probably also start growing my own, when I have suitable space to do so, so that I may control exactly what is in my medicine.

Though currently not using, marijuana will always be a part of my wider treatment plan. It’s enabled me to avoid harsh pharmaceuticals that are, in my opinion, far worse for me than something that has been grown naturally from the earth.

Further information on Crohn’s and Marijuana can be found here:

Treatment of Crohn’s Disease with Cannabis: An Observational Study

Cannabis Alleviates Symptoms of Crohn’s Disease

Medical Marijuana for Crohn’s Disease

Medical Marijuan & Crohn’s Disease—Getting your Doctor to Sign Health Canada’s Paperwork

*Please note that the material presented here does not necessarily imply endorsement or agreement by individuals at the Centre for Addictions Research of BC

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Author: Anony Mous 

 

Nuts and Bolts of Cannabis Regulation in Canada

At the Canadian Drug Policy Coalition (CDPC) one of things we’ve noticed is that any blog we publish on cannabis regulation attracts more attention than any other topic. This is because there’s widespread interest in discussion of changes to the laws that govern cannabis. Unfortunately when it comes to the nuts and bolts of cannabis regulation – in other words – the how of regulation, interest tends to drop off. This is because regulation is actually rather tedious. This is borne out by the length of the proposed regulations for legal recreational cannabis markets in the U.S. states of Washington (43 pages) and Colorado (72 pages). That’s why I’m making a special plea to you our dear readers to stay with me as I say a few words about what regulation might actually entail.

I think it’s fair to suggest that both the CDPC and the Centre for Addictions Research of BC favour a model of regulation that draws on the best evidence from public health regulation of alcohol and tobacco. But when it comes to cannabis regulation the devil really is in the details. There’s no magic bullet that will make all the current problems with cannabis prohibition disappear. But thanks to the Health Officer’s Council of BC, some of the heavy lifting when it comes to creating models for drug regulation has been done. If you’re curious, check out their 2011 report. As you can see from the diagram drawn from that report, regulations for cannabis should not be so loose that they create a free and unregulated market for cannabis; nor should regulations be so overly restrictive that we end up reproducing the negative aspects of the current underground economy (control by organized crime, etc.). 

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At the same time we need to be clear about the goals we hope to achieve with a legal regulated market for cannabis. Ideally our regulations will help protect and improve public health, reduce drug related crime, protect the young and vulnerable, protect human rights and provide good value for money. So what are some of the things we’ll need to consider? How about we start with the basics.

Presumably legalization would entail the removal of cannabis from Schedule 2 of the federal Controlled Drugs and Substances Act, followed by its inclusion in the Food and Drug Act. It seems like the next logical thing to do would be to turn over the regulation of cannabis to the provinces, in the same way that alcohol is currently regulated. We would want to ensure that there is at least some consistency across the provinces so that means somebody at the federal level will have to oversee the regulations as they emerge. That’s the easy part because legalization would ALSO entail consideration of at least the following issues: production, product, packaging, vendor and outlet controls, marketing controls, creation of a system of regulators and inspectors as well as on-going research and monitoring.

For this blog post, I want to focus on production and product controls. Future blog posts may consider the other items on the long list noted above. My comments meant to stimulate discussion of regulation rather than to propose firm rules for how a legal recreational cannabis market might operate.

In Canada, marijuana is currently produced in one of two ways – under existing legal medical marijuana guidelines or in illegal circumstances. Growing marijuana takes places in a vast array of situations ranging from a few plants grown for personal use all the way to large-scale industrial size operations with 100’s of plants.

Thus regulating the growth of marijuana for a legal recreational market will not be simple. Many people are very attached to their small-scale gardens, and it would be difficult to impossible (as well as undesirable) to eliminate growing marijuana for personal use. And it’s important not to turn the whole thing over to heavily capitalized large scale commercial producers who main motivation is profit, especially since the range of available strains of marijuana has been the result of innovation by many small-scale growers. Thus, we need to ensure that the best practices in indoor, outdoor, personal, commercial production are preserved while ensuring that cannabis is produced in safe and clean facilities.  We will also need to decide who is the appropriate authority for regulating growing operations: municipalities or provinces or some combination of both. Neither seems overly keen on this role so they will require some convincing.

Okay if your head doesn’t hurt yet lets turn our attention to product controls. Product controls include issues like price, age limits, potency, permissible preparations (edibles, tinctures, etc.), quality control, and labeling and packaging requirements. Price is a key issue when it comes to meeting public health goals. Price can help shape sales and thus use of cannabis, so we want to ensure that pricing reflects what we’ve learned from alcohol – namely that alcohol consumption is sensitive to price and that price must in some way be related to potency. Related to price is taxation – at what point in the chain from seed to sale will cannabis be taxed and at what rate? And what preparations will cannabis regulations allow? Plant materials, tinctures and oils, edibles? Right now Canada’s medical marijuana access program only allows for the distribution of plant material. Clearly this is a very limited approach given that the medical cannabis dispensaries have created a range of edible and other products that eliminate the necessity of smoking cannabis. We will also need to decide where we stand on potency: in other words will we put limits on how potent products can be, and given that there are over 100 cannabinoids, how will we decide which ones we want to measure and regulate? 

Okay so I haven’t covered other essential issues like vendor controls, marketing and evaluation and monitoring but I think you get the picture. Regulation is by no means a simple matter, but it can be done. In fact, experience from legal recreational markets in Washington and Colorado will provide valuable insights that can inform Canada’s approach. And regulation has the potential to create conditions where cannabis production and use is a whole lot safer than the current prohibition approach.

 

*Please note that the material presented here does not necessarily imply endorsement or agreement by individuals at the Centre for Addictions Research of BC

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Connie Carter, Senior Policy Analyst, Canadian Drug Policy Coalition