CMHA Youth Cannabis Presentation (ID 9609)...7klv fr pruelglw\ kdv d qhjdwlyh lpsdfw rq surjqrvlv...

$: CMHA Youth Cannabis Presentation (ID 9609)...7klv fr pruelglw\ kdv d qhjdwlyh lpsdfw rq surjqrvlv dqg frxuvh ri doo sv\fkldwulf glvrughuv hvshfldoo\ zkhq fdqqdelv xvh lv lqlwldwhg$
www.ccsa.ca • www.cclt.ca

Myth Busting: The effects of cannabis use on the developing brain

Amy Porath-Waller, Ph.D.Director, Research and Policy

Canadian Centre on Substance Abuse

September 29, 2016

Support

www.ccsa.ca • www.cclt.ca 2

CCSA activities and products are made possible through a financial contribution from Health Canada.

The views of CCSA do not necessarily represent the views of the Government of Canada.

About CCSA

www.ccsa.ca • www.cclt.ca3

• CCSA is Canada’s only agency with a legislated national mandate to reduce the harms of alcohol and other drugs on Canadians.

• Created by an Act of Parliament in 1988, CCSA has provided national leadership and expert advice, advanced knowledge, and prepared information and resources based on the latest evidence in order to inform policy, practice and programs that bring forward solutions.

• Together with our partners, we help mobilize individual and collective efforts to achieve collective impact on the major health and social issue of problematic substance use.

National Priorities and Areas of Action

Canada’s National

Framework for Action

Children & Youth

Problematic Substance use & Co-occurring

Issues

Canada’s Indigenous

People

Monitoring & Surveillance

Workforce Development

Treatment & Recovery

Impaired Driving

Alcohol

Prescription Drugs

Cannabis

4

National Framework for Action (2005): Collective action for collective impact


Why CCSA’s Work Matters


Health• Substance use disorder is a disease and should be treated like other

chronic diseases and health conditions• Contributes to the co-occurrence of mental health conditions, family

violence and suicide• Major contributor to 60+ diseases like cancer, heart disease, diabetes,

HIV/AIDS• Illicit drug dependence directly accounted for 20 million disability adjusted

life yearsPublic Safety• Significant factor in the commission of crime; as many as 80% of federal

offenders have a history of problematic substance use issues• Impaired driving accounted for 9,000 deaths in Canada from 2000–2010 Economics• Substance abuse costs over $40 billion per year in Canada

Substance Abuse in Canada Series


Purpose of the SAIC Report


Youth Perceptions: Use


Everyone is using weed

“If every single one of your friends is doing it and you know maybe two people who aren’t doing it. You think everybody’s doing it and they’re fine. Why wouldn’t I do it? I just want to try it.”

“If you haven’t tried weed, most people will say, oh well that’s very weird of you. Everyone else has.”

Prevalence

0%

5%

10%

15%

20%

25%

30%

15-19 20-24 25+

Past-Year Cannabis Use in Canada


Source: Statistics Canada (2015). Canadian Tobacco, Alcohol and Drugs Survey: Summary of Results from 2013.

Prevalence

0%

10%

20%

30%

40%

50%

Alcohol Marijuana Ecstasy PharmaceuticalMisuse

Past-Year Substance Use in Canada


Source: Health Canada (2014). Youth Smoking Survey 2012-2013.

Motivations for Use


Positive Negative

External Social (e.g., “because it helps me enjoy a party”)

Conformity (e.g., “so I won’t feel left out”)

Internal Enhancement(e.g., “because it is exciting”)

Coping (e.g., “to forget about my problems”)

?????? Expansion (e.g., “to understand things differently)

Routine(e.g., “out of boredom”)

Valence

Source

Sources: Cooper, 1994; Simons et al., 1998; Benschop et al., 2015

Perceived Risk and Use


Source: Volkow, Baler, Compton, & Weiss, 2014; reproduced with permission, Massachusetts Medical Society

Complexity of Substance Use

• Development of substance use disorders are multifactorial (related to genetics, trauma, mental illness, peer and parental modeling, etc.)

• Education alone does not lead to behaviour change

• Knowledge of risks is an important component of prevention and treatment



Youth Perceptions: Harms

Weed is natural and so it’s harmless

“You don’t hear about people dying from using marijuana.”

“For me, I’m thinking about my health. I smoke two packs of cigarettes a day. A cigarette gives you cancer, but the weed will clean it up.”

“Also it’s been proven that it actually helps slow down the development of cancer.”


How Does Cannabis Affect Youth?

• The endocannabinoid system aids the pruning and myelination that takes place throughout youth

• Consumed cannabis binds to the receptors in the endocannabinoid system and prevents it from working efficiently


Youth Perceptions: Thinking

“There’s been people that could completely function on marijuana. They could do everything on marijuana.”

Weed helps you focus

Cannabis Effects on the Brain and Behaviour

• Emerging evidence that early and frequent cannabis use can alter the structure of the developing brain

• Particularly areas responsible for memory, decision making and executive functioning

• Consistent evidence that regular cannabis users have lower educational attainment than their non-using peers– Poor academic performance– Increased risk of dropping out of school– Some evidence suggesting reduced IQ



Youth Perceptions: Driving

Weed makes you a better driver

“It started to make me more cautious and I started to pay more attention to the roads, signs and everything that’s going on around me.”

“If you get drunk and drive a car you might crash into a baby or something… if you get stoned, you forget the keys and walk home and raid your fridge.”

Cannabis Impairs Driving Ability


Image reproduced with permission from Arrive Alive.

• Consistent evidence that cannabis impairs driving ability and doubles the risk of collisions

- Impaired tracking, reaction time, visual function, divided attention, decision making

• Risk increases even further when cannabis is mixed with even small amounts of alcohol


Youth Perceptions: Mental Health

Weed is natural and so it’s harmless

“A man like me, with ADHD and bipolar, that stuff keeps my mind at ease and I could just think normally. I can go on with my day. Usually, when I don’t smoke weed, I can’t do anything. Too much of my brain is flustered.”

Link Between Cannabis and Mental Illness

• Consistent evidence of high rates of cannabis use disorders in those with mental illness

• This co-morbidity has a negative impact on prognosis and course of all psychiatric disorders, especially when cannabis use is initiated in adolescence

• Consistent evidence of a strong relationship between adolescent cannabis use and psychosis

• Role of adolescent cannabis use in the onset of depression, anxiety, eating disorders and childhood behavioural disorders is less understood



Youth Perceptions: Addiction

Weed is not addictive

“Psychological addiction, that’s it, it’s not physical if you quit weed”

Cannabis Can Be Addictive

• 1 in 6 who use cannabis during adolescence will develop a cannabis use disorder

• 1/20 Canadian youth met the criteria for cannabis abuse during 2012

• Cannabis use disorder develops faster than alcohol or tobacco

• Withdrawal can occur with the individual experiencing irritability, anxiety, restlessness and sleep disturbances



Cannabis Dependence

Risk Factors

• Initiation of use by age 15

• Low socioeconomic status

• Personal or peer use of tobacco and other drugs

• Regular cannabis use

• Anti-social behaviour

• Living alone

• Using cannabis as a coping mechanism

• Recent life events/trauma history

• Availability

• Lack of knowledge of risk

• Norm misperceptions

• Concurrent mental health disorders

• Poor parental monitoring and supervision

• Low family bonding, high family conflict

• Academic failure

• Lack of school engagement

• Lack of involvement in community/ religious organizations

• Gender

24


Youth Perceptions: Problematic Use

“…and you know how else I knew I was addicted? You got ten dollars in your pocket and you spend half of it on weed. And the other half on food.”

“I realized I have a problem… when I wake up in the morning and I say I need some weed in my system”

Prevention of Cannabis Use

• Comprehensive, school-based prevention programs have a 27.9% success rate at reducing adolescent cannabis use (Porath-Waller et al., 2010)

• Incorporation of elements from multiple prevention models

• Longer program duration

• Facilitation by non-teachers

• Targeting high school students

• Interventions in non-school settings less studied



Screening and Brief Interventions

27

• Emerging evidence for screening tools in primary care

• CRAFFT

• Brief Screener for Tobacco, Alcohol and Other Drugs

• Project Chat

• Adolescent Cannabis Check Up

What Interventions Are Available?

• Consistent evidence of efficacy of several types of psychosocial therapies

• Cognitive behavioural therapy (CBT)

• Motivational enhancement therapy (MET)

• Multidimensional family therapy (MDFT)

• Contingency management (CM)


What Interventions Are Available? (cont’d)

• Emerging evidence on efficacy of medications– As of yet, no approved medications for treating either withdrawal or

dependence

• Emerging evidence on efficacy of alternative delivery methods (e.g., technology-based)– Expand treatment accessibility and acceptance in adolescents

– Private

– Immediate


Core Principles of Adolescent Treatment

• Early identification is crucial

• A complex understanding of the risk and protective factors is essential

• Integrated treatment is necessary if a concurrent mental health disorder is present

• Family involvement leads to better outcomes


Key Messages

Talk to youth about myths and evidence

• Delay initiation of use to protect the brain

• Reduce use to reduce harms

• Cannabis use can influence driving, cognition and mental health

• Cannabis can be addictive

Screen youth for problematic use

More research needed on

• Effects of occasional use and differing THC concentrations

• Youth perceptions

• Effective prevention


Cannabis Research Products

• Clearing the Smoke on Cannabis Series (updates)• Chronic Use and Cognitive Functioning and Mental

Health (Coming in September)

• Maternal Cannabis Use During Pregnancy (2015)

• Cannabis Use and Driving (2015)

• Respiratory Effects of Cannabis Smoking (2016)

• Medical Use of Cannabis and Cannabinoids (Coming in Fall 2016)

• Cannabis: Canadian Drug Summary (2016)

Available at www.ccsa.cawww.ccsa.ca • www.cclt.ca32

Mobilization of Knowledge, Tools and Resources


• Series of live panels across Canada to mobilize knowledge about the effects of cannabis use during adolescence

• Online learning module

• Toolkit for hosting live learning events related to cannabis and youth

• Drug-Impaired driving toolkit for educators

• Toolkit for parents to speak with their kids about cannabis (Coming in Winter 2017)

Issues of Substance 2017


SAVE THE DATEIssues of Substance (IOS) Conference 2017

Addiction MattersNovember 13-15, 2017

Calgary, Alberta

Call for Abstracts Opens December 2016www.ccsa.ca

Questions, Comments, Ideas


Contact Information


Amy Porath-Waller, PhDDirector, Research and Policy613-235-4048 ext. [email protected]

Canadian Centre on Substance Abuse75 Albert Street, Suite 500Ottawa, ON K1P 5E7

36

@CCSAcanada • @CCLTcanada

CMHA Youth Cannabis Presentation (ID 9609)...7klv fr pruelglw\ kdv d qhjdwlyh lpsdfw rq surjqrvlv...

Documents

Transcript of CMHA Youth Cannabis Presentation (ID 9609)...7klv fr pruelglw\ kdv d qhjdwlyh lpsdfw rq surjqrvlv...