Regular and intensive use of cannabis and related problems: Some results from

literature and from the 2002 REITOX reports

(CT.2003.103.P1)

Roland Simon

Lisbon, TDI Annual Expert Meeting, 22.-24. September 2004

Contents

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Problematic use of cannabis is defined in different studies through:

Concept “Frequent or regular use”

Some results from recent research: framework

Results from NFP Reports 2002: Prevalence, Treatment

Conclusions

Antecedent factors of PCU

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Area Specific aspect Evidence for negative effects

Demographic factors Gender Education

+ male + low level

Psychotropic substances Alcohol Nicotine addiction

+ regular use before the age of 14 + getting drunk for the first time before the age of 14 +

Mental disorders Conduct disorders Early psychological disorders

+ +

Family situation Incomplete family situation Drug use mother Alcohol problems mother Sexual assault Experience of violence Interrupted education

+ + + + + +

Social situation Drug using peers Drug supply through friends Special settings (clubs, prisons)

+ + +

Chronic effects of PCU

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Area Specific field Evidence for negative effects

Somatic Genetic harm Immune system Reproduction Bronchitis Cancer Lung Bronchi Oesophagus Head/neck Prostate

- - - + + + + - -

Mental

Perception Cognition Memory Development Dependence syndrome Tolerance Withdrawal Harmful use of other substances Psychotic disorders Anxiety Disorders „Cannabis psychosis“ „Amotivational syndrome“

- + up to 3 weeks after use + + + + + + + + = toxic psychosis = continued intoxication

Secondary effects of PCU

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Area Specific field Evidence for negative effects

Unborn children Reduced birth weight Cognitive impairment

+ + (only at the age of 4)

Performance and social adaptation

Social adaptation Problem in school and workplace Reduced school and work performance

+ + +

Traffic accidents Traffic accidents + (small effect) Crime Maladaptation

Violent acts + -

Prevalence

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Country Comments Prevalence

Austria regular use, age group 15+, use once per week, age group 12-25

4,6% Male: 14,7%

Female: 7,1%

Denmark constant users suffering from physical, social, mental damage N=6.000

Finland use during last 30 days 1% N=40.000

France (almost) daily use within last 2 weeks, age group 17-75 3%

Germany Cannabis dependence (DSM-IV), age group 14-24, lifetime prevalence

dependence, age group 18-59, last year prevalence

abuse, age group 14-24, lifetime prevalence

0,9%

0,2%

4%

Greece used when alone

problems through cannabis use (self-report)

9%

~ 1%

Ireland 17% cannabis abusers in clinical group with primary schizophrenic disorder --

Netherlands Cannabis dependence (DSM-IIIR) age group 18-64 years, last years prevalence 0,3-0,8%

Netherlands Problem youth in Rotterdam, age 14-17, cannabis use during 11+/30 last days and related problems

20%

Norway used cannabis more than 10 times in the last 6 months 3%

Portugal Daily use among prison population 6%

Slovenia Used cannabis more than 40 times in lifetime, age-group_ 15-16 (ESPAD), used cannabis during the last 12 months

2%

Spain daily use during last 12 months

weekly use during the last 12 months

2%

4%

UK cannabis dependence only, age group 16-74 3%

Clients characteristics I

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Country Characteristics

Austria Gender: primary males Socio-economic state: socially integrated Problems: often psychotic disorders

Belgium --

Czech Republic Gender: 74% male Age: 62% between 15 and 20 years, Drug use: 51% use cannabis not more than 2 years Problems: 39% parents; 30% discipline, 23% school

Denmark Gender: 81% male Age: males: 26 years, females: 28 years Socio-economic state: 54% receive cash benefits, 10% daily benefits Problems: handling daily activities, average marks and absence from school

Finland Gender. 79% male Age: 20,2 years Education: 70% primary level Socio-economic state : 29% unemployed Drug use: 40% 2nd problem substance alcohol, duration of C. use: 5 years Problems: depression, school attainment, psychoses

France Gender: 82% male Age: 25,5 years Drug use: 40% have a 2nd problem substance, in most cases alcohol Problems: social achievements (school, work)

Germany Gender: 82% male Age: main age group 18-25 years Drug use: 22% have alcohol as a 2nd problem substance, 20% ecstasy Problems: social achievements (school, work)

Greece Gender: 88% male Age: mean 23 years Socio-economic state : 81% live with their family, 33% unemployed Problems: Psychiatric comorbidity

Clients characteristics II

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Country Characteristics

Ireland Gender: 85% male Age: Start of drug use at 15, begin treatment at 20 (outside Greater Dublin)

Italy --

Lithuania Problems: depression, mood disorders

Luxembourg Problems: 33% had previous demands for psychiatric treatments

Netherlands Gender: 80% male Age: 85% older than 20 Drug use: most have problems also with other substances, biggest increase for single users and users with cannabis plus alcohol problems Problems: Increased 12 months prevalence of cannabis use for people with mood disorders (7,1%), mixed mood/anxiety disorders (8,8%) compared to people without such disorders (3,2%)

Norway Problems: younger ones “dropping out” of family, school and social context, older clients show more often mental problems: anxiety/ depression/ general antisocial behaviour, Increased problems at school and workplace

Portugal Problems: Amotivational syndrome and psychoses are frequent

Overview: Situation Prevalence:

- Dependence: 0,2-3%

- Misuse 3%

- Frequent Use 1-6%

- Regular Use 4-10%

Characteristics

- Msle

- 28-24 years old

- problems with school and social achievements

- psychiatric comorbidity: anxiety, depression, psychosis

- multiple drug use

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Treatment demands

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Country Prevalence Treatment Demands 2002/2001/2000 Type Trend 10y

Austria 20-25% cannabis OR hallucinogens Out ?

Austria 18 dependence, 45 abuse (ICD9) In

Belgium -- ?

Czech Republic 751 cases main drug cannabis All ?

Denmark 21% All

Finland 18% -

France 23% All

Germany 27% Out

Greece 7% Out

Ireland 15% All

Italy 8% All

Lithuania 6% Out ?

Luxembourg 11% All

Netherlands 24% Out

Norway 9% (females), 16% (males) All

Portugal extremely small number All ?

Slovenia 8% All

Spain 7% All

Sweden 50% below 20y, 27% above 20 years of age All

UK England: 9%, Scotland: 7% only cannabis All

Treatment needs and referrals

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Country Treatment needs Referral

Justice Self Family

Austria Many do not need medical treatment or psychosocial care for cannabis use

Austria 75%

Austria Mixing users with opiate addicts and poly drug users very problematic

Czech Republic 40% 30%

Denmark Different from traditional treatment institutions and heroin addicts, additional problems besides drugs

Finland 19% 26%

France 24%

Germany 20-25%

Greece 19% 57%

Ireland 22% 44%

Lithuania mainly police

Luxembourg most

Netherlands most problem cannabis users avoid the specialised drug treatment centre for unknown reasons

9/14% 35/42% 3/19%

Sweden 5% 43% 18/90%

United Kingdom 7-9% 26-29% 4-9%

Special treatments offered

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Country Treatment provision

Austria Short term counselling programme (max. 5 contacts) Information and increased risk competence through peer education

Denmark Combined social services and interventions Municipal dedicated peer teams for very young cannabis users

Finland Acupuncture for cannabis users with depression disorder

France No special institutions, but specific programmes. Multi partnership project outside the field of drug treatment

Germany Peer education for driving licence groups

Greece Counselling unit for adolescent drug users (KETHEA) integerating counselling, community intervention, social support and family support

Luxembourg MSF youth solidarity project: intervention team in collaboration with youth magistrate and law enforcement

Netherlands Ongoing review of existing treatment programmes Self-help internet programme

Norway 6-weeks course: Smoking cessation for cannabis users to “free young people’s resources”

Portugal under discussion

Spain no specific interventions

Sweden Manual based cognitive behavioural therapy for cannabis users

United Kingdom Use of general health care: 25% of 20 GPs in Inner London researched in 2001 treated cannabis problems within the last 4 weeks

smoking cessation programmes used: 24% of clients in a smoking cessation clinic hat used cannabis during the last 4 weeks

Overview Treatment Referrals:

- Justice plays a big role: 20-25%

- Majority is self-referred, partly motivated by the family

- Frequent Use 1-6%

- Regular Use 4-10%

Trends

- Up to 50% ( most countries: 10-20%) of out-patiente clients come mainly for cannabis

- Increase in most of the Member States over the last years

Treatment needs

- No mix with opiate addicts

- Little specific treatment programmes, additional elements very important

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Conclusions

In relation to the topic cannabis in treatment

- there seem to be a relevant and increasing number of clients asking for help

- while cannabis is the main substance in these cases, often other drugs are used as well

- additional aspects (school achievements, psychiatric problems ..) play a import role in treating this group

- treatment offered in most countries looks less developed and sophisticated than for heroin addicts

In relation to TDI and “Problematic drug use”

- common definitions needed for this client group

- possible basis: frequency of use, consequences of use

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