Final

- THC
- CBD
- Terpenes

THC

the main draws to cannabis are the cannabinoids that create physical and mental effects, the primary two being THC and CBD

psychoactive
euphoric, reinforcing, rewarding
anxiety-inducing
psychosis-inducing

non-psychoactive
anxiolytic (reduces anxiety)
anti-psychotic
anti-inflammatory
neuroprotective
anti-epileptic

increased effectiveness of one chemical when accompanied by other chemicals

synergy among compounds to enhance effects of THC/CBD

1.) recent use of cannabis

2.) clinically significant problematic behavioral or psychological changes (e.g., impaired motor coordination, euphoria, anxiety, a sensation of slowed time, impaired judgment, social withdrawal) that developed during, or shortly after, cannabis use


3.) at least two of the following signs, developing within 2 hours of cannabis use: conjunctival injection (red eyes), increased appetite, dry mouth, tachycardia (increased heart rate)

4.) symptoms due to a general medical condition and not better accounted for by another mental disorder

5.) specify if perceptual disturbances are present: hallucinations with intact reality testing or auditory, visual, or tactile illusions occur in the absence of delirium

true

studies show that both adults and adolescents increasingly view cannabis as a drug that "some" can use without harm

however, there are still significant risks associated with cannabis use
- increase in the use
- the adverse consequence of use

Addiction is a loaded construct with a complex history
it involves two components:
- biological component
- behavioural component

physiological dependence

- tolerance/ withdrawal
- changes in brain-reward circuitry
- cravings

- loss of control
- compulsive use
- negative consequences
- 'habit forming'
- functional impairment

Cannabis Use Disorder describes patterns of cannabis use that lead to some form of life impairment or hindrance, such as health problems, persistent/increasing use, failure to meet daily responsibilities; these hindrances are generally brought on by one or more of the withdrawal symptoms
Cannabis Use Disorder- Patterns of Use

while patterns of cannabis use vary widely across individuals, most cannabis users who develop cannabis use disorder do so after several years of use and with at least weekly use


- increased frequency of cannabis use
- use of more potent cannabis products

^ are associated with a greater risk of cannabis use disorder

A Problematic pattern of cannabis use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period

1.) taken in larger amounts/over longer periods than intended

2.) persistent desirensuccessful efforts to cut down/ control use

3.) a great deal of time spent in activities necessary to obtain, use, or recover from its effects

4.) craving, or a strong desire or urge to use

5.) recurrent use resulting in failure to fulfill major role obligations at work, school, or home

6.) continued use despite having persistentecurrent social interpersonal problems caused/ exacerbated by the effects

7.) important social/occupationalecreational activities given upeduced because of use

8.) recurrent use in situations in which it is physically hazardous

9.) continued use despite persistent/ recurrent physical/psychological problems likely to have been caused/exacerbated by cannabis

10.) tolerance (i.e. need for increased amounts to achieve intoxication/desired effects or markedly diminished effect with continued use of the same amount of cannabis

11.) withdrawal (i.e. defined by the characteristic withdrawal syndrome or cannabis/closely related substance is taken to relieve/avoid withdrawal symptoms)

nearly 4% of the global population was using cannabis in 2015

Hasin et al (2017) estimate that 20-30% of cannabis users qualify for CUD

"studies done over 25 years ago indicated that cannabis users rarely become dependent, leading to a present-day common misconception that the risk of developing CUD among cannabis users is low"

- however, recent national data indicate that approximately one out of five-lifetime cannabis users meet the criteria for DSM-V CUD, and 23% are considered symptomatically severe

Cannabis use is an obvious precursor for CUD, but there is much more that goes into determining who is more likely to develop disordered use

- genetic predisposition to have disordered use

- environmental predisposition:
availability
desirability
social factors

The last symptom outlined by the DSM-5 is cannabis withdrawal

however, cannabis is often referred to as a drug that does not have physical withdrawals like those of opioids or amphetamines

is cannabis withdrawal a real thing?

there are four conditions required to qualify as cannabis withdrawal according to the DSM-5
A: cessation of use that has been heavy/prolonged (i.e., near-daily over a period of a few months)

B: 3 (or more) signs/symptoms develop within approx. a week of Criterion A
- irritability, anger, or aggression
- nervousness or anxiety
- sleep difficulty (e.g., insomnia, disturbing dreams)
- decreased appetite or weight loss
- restlessness
- depressed mood
- at least one of these physical symptoms causing significant discomfort: abdominal pain, shakiness/ tremors, sweating, fever, chills, or headache

C: the signs/symptoms in Criterion B caused significant distress impairment in social/occupational/other important areas of functioning

D: the signs/symptoms are not attributable to another medical condition and not better explained by another mental disorder, including intoxication or withdrawal from another substance

studies found that withdrawal symptoms when the most intense the week after cessation, and could continue for as long as a month

users that experience withdrawal will have a hard time quitting with worsened treatment outcomes

it is mildly heritable, with genetic and environmental factors affecting the experience and intensity

among cannabis users in the general population: ⅓

among heavy users: 50 to 95%

approximately half of patients in treatment for cannabis use disorder experience a withdrawal syndrome an Abrupt reduction or cessation of heavy or prolonged cannabis use
- negative reinforcement to begin cannabis use again

major depression genetic studies find an underline comorbidity between depression and CUD


psychosis: strongly associated with CUD end cannabis use in general. Research isn't sure if it is causal or a predictor

psychological problems are a symptom of CUD and withdrawal, indicating cannabis users should be wary of inducing/exacerbating mental health issues through cannabis

the treatment for cannabis use disorder is typically either:
- sustained abstinence from cannabis
- harm reduction Coalition reduce use that ameliorates cannabis-associated problems


reducing frequency of use is associated with greater Improvement than reducing the quantity of use

treatment for cannabis use disorder is rare

current DSM-5 cannabis use disorder diagnosis: 7.2%
lifetime DSM cannabis use disorder diagnosis: 13.7%


despite the overall increase in cannabis use, the proportion of adults who have received treatment for cannabis use has not changed since 2003


treatment for cannabis use disorder typically occurs on an outpatient basis for many occur in an inpatient setting if a patient is acutely psychotic, suicidal, or requires hospitalization to treat a concurrent substance use or psychiatric disorder.


evidence indicates that psychosocial interventions for cannabis use disorder are most effective, while trials of medication treatments have inconsistent or weak results

the best results come from:
increasing awareness of cannabis' negative effects
Enhancing motivation to decrease the use
managing painful feelings
improving social skills
improving social support
improving interpersonal functioning


either cognitive-behavioural treatment (CBT), motivational enhancement Theory (MET), or a mixture of the two has been proven effective

helps individuals identify and cope with the overwhelming emotions that encourage substance abuse. CBT encourages replacing negative thoughts with healthier alternatives.
research shows that even one session of CBT can help those with cannabis use disorder abstain

CBT has the most robust evidence of efficacy for this disorder

helps to motivate individuals to abstain by providing personalized and pathetic, educational support alongside motivational interviewing (MI).
the patient is encouraged to explicitly identify the pros and cons of their cannabis use and balance them

MET lessens cannabis use and cannabis use disorder severity

the combination of MET and CBT is more helpful than either alone

MI: a directive, patient-centered Psychotherapy approach that helps individuals resolve ambivalence and increase motivation to reduce substance use through an empathic, supportive counseling Style

treating cannabis addiction with Pharmaceuticals is very different from treating other substance addictions. The medications used to help opioid or nicotine addicts have not been found to be effective.


N-acetylcysteine and gabapentin are two drugs that have shown promising results, but no medications are approved by the US FDA

adoption of stable roles at school or work is associated with a reduction in or cessation of cannabis use

spending more time with friends and family, exploring passions, curating your hobbies, focussing on work or school, etc. are all great ways to reduce the use

the transitional stage from childhood to adulthood that occurs between ages 13 and 19

starts in puberty and ends in when individuals become independent

the brain during adolescence undergoes neuromaturation- a period of "fine-tuning"
particularly in areas of the brain involving cognition, emotional regulation, and decision-making

white matter volume increases

grey matter volume Peaks late childhood then decreases
- "pruning"
- numbers of dendritic trees
- number of synapses
- mesolimbic circuit
- prefrontal cortex

age restrictions

Restricting promotion and enticement

Possession

no person may sell or provide cannabis to any person under the age of 18. There are two criminal offenses related to providing cannabis to youth, with maximum penalties of 14 years in jail:

- giving or selling cannabis to youth
- using a youth to commit a cannabis-related offence


underage by Province
Alberta: under 18
Quebec under 21
all other provinces and territories: under 19

the Cannabis Act helps discourage youth cannabis use by prohibiting:
- products that are appealing to youth
- packaging or labeling cannabis in a way that makes it appealing to youth
- selling cannabis through self-service displays or vending machines
- promoting cannabis, except in narrow circumstances where young people could not see the promotion


penalties for violating these prohibitions include a fine of up to \$5 million or 3 years in jail

Individuals under the age of 18 years would not face criminal prosecution for possessing or sharing a very small amount of cannabis (up to 5 grams)

provinces and territories have the flexibility to prohibit the possession of any amount of cannabis by youth, thereby permitting police to seize any cannabis that a youth may possess. All provinces and territories will be including such prohibitions in their cannabis legislation

possession over 5 grams is subject to criminal code

despite the laws, we know that both young adults and underage minors use cannabis in Canada. In what proportions are they using cannabis?

In 2010, Canadian youth reported the highest cannabis use out of 43 countries across Europe and North America

Past year use of cannabis is highest among young people ages 15 to 19 (19%) end ages 20 to 24 (33%)

2.3% of users aged 12 to 17 have a cannabis use disorder, while 7.5% of users aged 18 to 29 have a cannabis use disorder

first use occurs on average at age 15 to 16

2018 to 2019 use increase: the corresponding rates for 15 to 24-year-olds (27.6%-26.4%) and females (12.3-13.4%) remained constant. whereas you 15 to 17-year-olds declined (19.8-10.4%)

the decline may in fact be due to legalization, just a continuation of the steady decrease that has been happening since the 2010s

In Canada? 19% of 15 to 19-year-olds report past-year use, with first use occurring at the average age of 15/16

why do young people use cannabis recreationally?
Generally,
- to relieve boredom
- to satisfy curiosity
- to experiment
- to feel goodetter
- to fit in

it is thought that generally, males are more likely to use key substances for the positive reward, or the high experience, whereas females use substances to avoid a negative feeling, to cope, or self-medicate

Overall, young people seem to be misinformed about cannabis. In many studies the express perceptions that:

- cannabis is not harmful, especially when compared to other drugs, because it is a natural plant

- cannabis improves driving because it heightens Focus

- cannabis is not addictive and does not cause withdrawal

- the effects of cannabis depend more on the person than on the substance

- that all youth use cannabis, with their estimated rates ranging from 30 - 98.8%

CUD in Fathers is correlated with earlier age of use in daughters (14.6 vs 17.2 years) but not sons

conduct problems predict peer cannabis use, which predicts increasing levels of youth cannabis use, which ultimately predicts CUD

other important factors that increase use include availability, mental disorders, trauma, parental absence, or divorce

positive parental relationships and peer relationships that avoid cannabis are associated with at least two times lower prevalence of past-month cannabis use among adolescents

a higher frequency of use is associated with the male gender, lower economic status, maternal effective problems, and openness towards/consumption of other drugs

Many youths reports using cannabis to "feel better", and not for the high

self-medicated users (ages 16-24) have been found to have lower mental health, higher psychopathology, more psychosocial distress, and more stressful life events than non-cannabis-using youth

reasons behind use ranged from childhood trauma, ADHD, depression, insomnia, to stress

while self-medicated users did have measured doses, they lacked a lot of knowledge about medical cannabis, despite presenting themselves as sophisticated cannabis users

the use of cannabis on a developing brain is not recommended, as shown by the laws protecting minors in the Cannabis act.

Most people think cannabis use is harmless, however, there are specific risks for people under age 25

our brains are not fully developed until around the age of 25

- early and frequent cannabis use can hurt the brain's prefrontal cortex which can impair memory, decision-making, and problem-solving

- we cannot predict if these effects are permanent and who they can affect

- Cannabis can lower motivation in young people and can lead to lower grades and school attendance

- Links to mental illness

- Potential for addiction

- motor vehicle safety

Cannabis use before the age of 16 is associated with the use of other drugs later in life

Regular cannabis use may be linked to depression and anxiety
associated with psychosis, especially for youth who have a parent or sibling who has been affected by schizophrenia

1 in 6 teens who use cannabis during their teen years will experience problematic use, physical dependence, and symptoms of withdrawal

in young people, problems with cannabis can develop more quickly than with tobacco or alcohol

In Canada, teens between the ages of 15-19 are most likely to drive after using cannabis

cannabis can increase the risk of car accidents by impairing the driver's reaction time, coordination, and concentration

The brain is still maturing, driven by changes in brain grey matter (GM) due to synaptic pruning, until the mid-20s

cannabinoid receptors modulating neurotransmitters that have significant effects on the brain. As such, they are susceptible to THC

the frontal cortex is going through Rapid change and more susceptible to THC

"structural changes on MRI have also been documented in youth who use cannabis regularly. They show lower brain volumes, different folding patterns and thinning of the cortex, less neural connectivity, and lower white matter integrity, all of which indicate damage by THC"

Regular cannabis use in Youth and Young adults can affect aspects of cognition, including attention, memory, processing speed, visual-spatial functioning, and overall intelligence

cannabis use in teenage years is associated with a disruption to the brain's reward system, impaired memory and cognition, and the potential for structural brain changes

cannabis is suggested to negatively affect IQ, although this is difficult to prove because the earlier onset of use is associated with lower baseline IQ

Earlier and higher frequency of use increases the risk of developing mental health disorders in vulnerable individuals

high THC content is strongest related to mental disorders

the onset of many mental disorders occur before the brain is done developing

anxiety, depression, bipolar disorder, psychosis/schizophrenia

using cannabis could increase the risk for predisposed illnesses

Abstinence following regular used May improve some, but not all, of cognitive consequences

a study reported that having greater days of abstinence from alcohol and drugs was associated with improved executive functioning

continued absence is expected to improve attention, verbal memory, and neuronal processing speed

the most important thing is prevention, with the key detrimental factors being high-frequency, high THC content, and young age of onset

heavy marijuana use in adolescence or early adulthood has been associated with a dismal set of Life outcomes including poor school performance, higher dropout rates, increased welfare-dependent, greater unemployment, and lower life satisfaction

this seems extremely condemning, HOWEVER:
research acknowledges that those predisposed to try and enjoy cannabis in the first place may be predisposed to a variety of vulnerability factors

- correlation does not equal causation

one reason that parents or programs advise use against cannabis use is that it is supposedly a "gateway drug" and that it can lead to more intense and dangerous experimentation

- the gateway drug hypothesis is a general causal model.

- The correlation between cannabis use and later substance use is significant, but we cannot be sure that it is cannabis use that causes other drug use

a habit-forming drug that, while not itself addictive, mainly to the use of other addictive drugs

most of the research in the last 10-15 years suggests unlikely that cannabis is a gateway drug
but there has been a research study recently, that raises some concern

= those who use recreational marijuana, showed an increased risk of using other drugs at least a few years later includind opioids

= but there other factors needed to be considered

There's been some interesting epidemiological studies looking at death certificates over the course of 10 years after the legalization of medical marijuana,Which found that there were very dramatic reductions in opioid-related deaths

- Might be that medical cannabis reduces the effects of withdrawal due to opioids which makes it a lot easier to get off opioids and less opioid-related deaths

- There has been some studies that show that CBD can actually reduce the effects of withdrawal in cannabis users

the desire to use cannabis may have a pre-existing (potentially genetic) trait that would predispose them to use other drugs as well as cannabis


that using cannabis makes the individual more likely to be with peers and in settings that "provide more opportunities to use other illicit drugs at an early age"


that "socialization into an illicit drug subculture" could promote favorable attitudes towards the use of other drugs

while the danger of driving while high on cannabis is not isolated to adolescence, as discussed, teenagers have many misconceptions about the activity. It is an issue that affects every age group, especially as it is often touted as safer than drinking drunk.

in reality, driving while under the influence of any substance is incredibly irresponsible and endangered the lives of the driver, the passenger, and strangers

- 50% of cannabis users don't think that it affects their driving much, while 1 in 5 don't think it has any negative effect at all

- 2 in 5- 39% of those who have used cannabis in the past year have driven within 2 hours of consuming cannabis

- 3489- numbers of DID violations reported in Canada in 2017

- 149- number of fatally injured Canadian drivers who tested positive for cannabis in 2014

- 2 in 5- approximate number of people who were a passenger in a vehicle driven by someone who had recently used cannabis

balance and coordination
motor skills
judgment
reaction time
attention
decision-making skills

every 3 hours- how often drug-impaired driver incident is recorded in Canada

\$1000+ a one-year driving prohibition- minimum penalty if you're caught driving impaired

increase the likelihood- Recent research shows a 1.3 to 3.0 fold increase in the risk of motor vehicle collisions after cannabis use


- among those who have used cannabis, 28% reported they have operated a vehicle while under the influence

- one in three Canadians (33%) report that they have ridden in a vehicle operated by a driver who was under the effects of cannabis

cannabis can impair each person differently

the impairment on individuals can depend on:

- the method of consumption, for example, how cannabis was consumed (smoked, inhaled, ingested)

- the quantity of cannabis consumed
the variety of cannabis and its THC levels, including cannabis prescribed for medical use


- cannabis use in any amount can:
- affect motor skills
- slow reaction time
- impair short-term memory and concentration
- cars drivers to very speed and to wander
- reduce the ability to make decisions quickly or handle unexpected events


evidence suggests resuming smoking and/or blood THC concentrations 2-5 ng/mL are associated with substantial driving impairment, particularly in occasional smokers

drunk drivers are involved in 25% of Motor Vehicle fatalities
- many drivers from alcohol-related accidents also test positive for cannabis

- cannabis and alcohol acutely impair several driving-related skills in a dose-related fashion


the effects of cannabis vary more between individuals than they do with alcohol due to:
- tolerance
- differences in smoking techniques
- different absorption of THC

testing at the side of the road for impairment is not a simple of cannabis as it is with alcohol

- when ingesting cannabis, THC is distributed to body tissue, where it is absorbed and still detectable even after impairment has resolved

- due to the accumulation of THC in body tissue, drivers (especially frequent cannabis users) will test positive for cannabis even if they are not impaired at the time of driving, and for example, had smoked the day before driving

- the law requires less than two nanograms of THC per milliliter of blood within 2 hours of driving
for reference, blood THC levels peak around 50 ng/mL after smoking (10 mins)

- frequent users will often have 2 ng/mL lingering in their system

wait several hours before driving
avoid combining alcohol and cannabis
risk of using both higher than either alone
risk of using one or the other or higher than none

with proper research and regulations, there are benefits to underage medical cannabis use

the majority of the research regarding pediatric medical cannabis use highlight its impacts on epilepsy

While there are plenty of anecdotal claims that medical cannabis can help the suffering of children, the research is not yet developed about the long-term dangers and effects

most of the research about underage medical cannabis use has revolved around epilepsy
more specifically, Dravet Syndrome

- the famous case of young Charlotte Figi who used high-CBD low-THC cannabis to find relief from 300 seizures a week

- with CBD, she was down to once a week seizures

- Charlotte was a Pioneer, and now many epileptic children are treated with CBD

- Growers named a strain after her, called Charlotte's Web. It is 13% CBD and 1% THC

cancer treatment (high THC)
autism
ADHD

however, there has not been enough research to substantiate these anecdotal claims that medical cannabis is purely beneficial and safe for children

true but this depends on age of onset, frequency, dose of cannabis use, impact cognitive performance
before age 16 (early onset), after age 16 (late onset)

- those at greater risk for the detrimental effects of cannabis
- do statistically more likely to use and abuse cannabis

these vulnerable populations include pregnant women, babies, couples trying to conceive, and those with certain physical and mental health complications

in Western societies, pregnant women consume cannabis more frequently than any other illicit drug (at 2-6%)

- An estimated 4.0% of women use cannabis in the first trimester, 3.5% in the second, and 2.7% in the third

- cannabis is mostly used during pregnancy to treat morning sickness, despite lack of research

- Pregnant women using cannabis are also more likely to use other substances, which can create a synergistic effect

- cannabis decreases blood sugar, which may cause dizziness or fainting, potentially resulting in an injury to mother or fetus
- may cause anxiety, paranoia, confusion or forgetfulness

- increases odds of anemia
- may increase odds of precipitous labour and manual placenta removal
- Long term use of cannabis during pregnancy can increase the odds of the labour lasting more than 3 hours

THC is lipophilic, resulting in an estimated one-third of THC in the plasma crossing the fetal placental barrier

A study found that the placentas of cannabis users were heavier, suggesting more grams of placentalram fetal tissue or needed to support development

Cannabis use negatively affects birth weight, neonatal length, head circumference at birth and size for gestational age

- cannabis use increases the odds of fetal low birth weight (LBW), preterm birth (PTB), and placement in ICU/NICU

- at least weekly cannabis use during pregnancy resulted in a lighter birth weight of an average of 84.2 G when compared to offspring of women who did not use cannabis

- newborns demonstrated withdrawal like symptoms
- however, studies are often confounded by polysubstance use

research shows that 0.8 to 2.5% of the mothers THC dose enters the breast milk

- in chronic heavy users the milk to plasma ratio can be as high as 8:1 and metabolic rates of cannabis are found in infant feces and urine, suggesting that it may have been absorbed and metabolized by the infant

- THC exposure in babies may result and drowsiness and poor cycling, impeding breastfeeding and nutrient intake

- THC may impede lactation by stopping prolactin secretion

- The pump-and-dump method does not seem to be helpful with cannabis because the pharmacokinetics of THC / CBD do not suggest a practical way to eliminate the cannabinoids from breast milk

Secondhand cannabis exposure is an independent risk factor for sudden infant death syndrome
- a positive test for THC in a child's system may have negative legal implications, especially in certain States
- additionally, babies may be indirectly affected by THC if their caregiver is impaired and unable to properly care for them

- worst mental scores and developmental test at nine months, although difference disappeared by 18 months
- increase aggression
- decreased attention in females

- Decrease verbal and perceptual skills
- decrease verbal and visual reasoning
- decrease short-term memory
- increase hyperactivity, attention deficits, and impulsivity
- unaffected intelligence scores

- short term memory deficits
- increase hyperactivity and impulsivity
- impaired vigilance
- unaffected intelligence scores

- reduced cortical grey matter and parenchymal volume
- deficits in executive functioning, reading, spelling, abstract and visual reasoning
- increase hyperactivity, depressive and anxious symptoms, inattention and impulsivity

- Deficits in executive functions, visual memory, visual cognitive functioning, academic achievement, information processing speed, and visual motor coordination
- increased delinquency and inattention

- Deficit in certain executive functioning, response inhibition, and visual spatial working memory
- increased rates of smoking, substance use, and early initiation of substance use

True

sperm concentration (28% lower), count (28% lower), motility, and percentage of morphologically normal forms were all decreased in men who reported smoking more than once per week

- CB1 receptors have been identified in the testis, vas deferens, and human sperm cells

- however, men who smoke more cannabis tend to lead less healthy lifestyles

cannabis may disrupt menstrual cycles or decrease egg implantation

smoking at least 90 times over a lifetime resulted in 27% fewer oocytes retrieved and one fewer embryo transferred

- smoking one year before IVF resulted in 25% fewer oocyte retrieved and 28% fewer oocytes fertilized

- smoking cannabis reduces IVF success chances by 25%

individuals with the following conditions are statistically more likely to have adverse effects when using cannabis:

1.) have respiratory diseases such as asthma or chronic obstructive pulmonary disease (COPD)

2.) individuals should avoid cannabis if they have severe cardiopulmonary disease with:

3.) individuals should avoid cannabis if they have severe liver or renal disease, including chronic hepatitis C

4.) People taking other medications

Bramnes & Soest (2019) found that cannabis is a risk factor for bronchial asthma or use of asthma medication

the association between smoking cannabis and cancer, specifically lung cancer, remains unclear

- occasional hypertension (low blood pressure)
- possible hypertension (high blood pressure)
- syncope (loss of consciousness) or
- tachycardia (rapid heart rate)
- risk factors for cardiovascular disease heart disease and stroke show that it does not mix well with cannabis

cannabis has been found to worsen conditions for patients with chronic hepatitis C virus (HCV)

use should be carefully monitored for those with chronic kidney disease (CKD) and smoking should be avoided
- cannabis use medal a kidney transplant candidate listing or contribute to inelligbility

cannabis can have potential reaction with many prescription drugs, non-prescription drugs, and herbal products

individuals should be especially careful if they are taking any of the following:
- sleeping pills
- high doses of opioids
- tranquilizers (specifically benzodiazepines)
- some pain medications
- some allergy or cold medications
- anti-seizure medications

other products that may interact with cannabis include antiretroviral drugs used to treat HIV / AIDS, certain antidepressants, stomach acid Inhibitors, certain antibiotic and anti-fungal medications, certain heart medications, and Saint John's Wort

research has found that individuals with certain mental health afflictions are more likely to consume cannabis

potential reasons for increased use may be that they are self-medicating, that the drug and disorder have a positive feedback loop, or that the individual was predisposed to it

- bipolar disorder
- depression
- anxiety
- schizophrenia
- ADHD
- OCD
- ASPD

cross-sectional Studies have found that the Comorbidity rate of bipolar disorder and lifetime cannabis use is 70%, with the rate of bipolar disorder and CUD as 30%

- cannabis use is associated with higher levels of mood symptoms
- Studies have found that cannabis use has a three-fold increase risk for a new onset of manic symptoms
- current cannabis users had a lower remission, recovery, higher recurrence and greater impairment from a manic episode

in comparison to light / non-users,Heavy cannabis users had an odds ratio of 1.62 for developing clinically diagnosed major depression or depressive symptoms

- however, cannabis use does not seem to be a causal factor in depression

- a twin study found concluded that they comorbidity was most likely due to genetic and environmental factors that predispose individuals comorbidity
- found concluded that the comorbidity was most likely due to genetic and environmental factors that predispose individuals to both smoking and depression
- A different study found no correlation between depression and cannabis use

- a meta-analysis with 112000 individuals found the odds ratio of anxiety and Cannabis used to be 1.24 and the odds ratio of anxiety and cannabis use disorder to be 1.68

- individuals with a lifetime of anxiety disorders were two to three times more likely to have lifetime cannabis use, and more likely to develop cannabis use disorder after initial use than those without any psychiatric disorder

- however, an additional study found that cannabis users are at no further risk for developing anxiety disorder, suggesting anxiety may cause cannabis use instead of cannabis use causing anxiety

42.2% of schizophrenic patients reported lifetime use, with 27.1% reporting lifetime cannabis use disorder

23.1% reporting using within the past six months, with 16.0% reporting current cannabis use disorder
there is considerable comorbidity between schizophrenia and cannabis use
- many experts believe cannabis use may cause schizophrenia

cross-sectional studies reveal a 22 3 * increase of developing schizophrenia in cannabis users when compared to non users
- increased chances are correlated with early-onset, regular use and high THC content

however, causality tests reveal that schizophrenia most likely has a causal effect on cannabis use, meaning current/developing schizophrenia increases the individuals odds of trying cannabis

a cross-sectional Australian study found that 19.9% of individuals with cannabis use disorder had obsessive compulsive disorder, that 4.6% of cannabis users have OCD and that only 2.4% of non-users had OCD
- however, the odds ratios for having OCD did not change depending on cannabis use

a sibling study found that OCD patients experienced higher Cravings than their siblings
- this may suggest that individuals with OCD may crave cannabis more due to their symptoms
- cannabis may offer relief for OCD symptoms, as the endocannabinoid system may have a role in OCD

studies suggest that there is a comorbidity rate of 20 to 30% between ADHD and cannabis use disorder
- prevalence of cannabis use among ADHD patients depends on the ADHD subtype (inattentive, hyperactive-impulsive or combined)

- a US study found a 30% lifetime cannabis use among ADHD patients, as opposed to 5% for those without ADHD

The effects of cannabis on ADHD are currently unknown. Some suggest that it may be used to combat the anxiety and insomnia of ADHD medication, although the combination of the drugs together has not been studied

However, a study found that 25% of ADHD related online discussion posts discussed its benefits, with only 8% and 2% of posts discussing negative outcomes and no/neutral outcomes respectively. The public opinion seems to think cannabis is therapeutic.

a study found that respondents with lifetime cannabis use disorder where 10 times more likely to have lifetime antisocial personality disorder than those without cannabis use disorder

- a twin study found that genetics explain 32 to 60% of the difference in cannabis use/ cannabis use disorder for personality disorders (APD and BPD)

- antisocial personality disorder has been found to be one of the most common psychiatric disorders among substance abusers

false.

- The most common substance abused is alcohol, followed by cannabis

- under 25 years old
- personal or family history of strong psychosis
- past or current cannabis use disorder (dependency), or other substance use disorder
- cardiovascular or respiratory disease
- pregnant (or planning to) or breastfeeding

true. many individuals with turned mental illnesses are more likely to consume cannabis but this is more of a chicken or egg effect.

- the caveat is that there are many factors contributing to a health condition including genetic, environmental influences, diet etcetera; cannabis is only one influence

using cannabis and cannabinoids to treat symptoms of illnesses and other conditions

- the recent trend is to equate evidence-based medicine with only the large and expensive randomized, double-blind, placebo-controlled trials... the history of medicine shows that it's major advances come from Individual practitioner is pushing the boundaries of the status quo to discover such a life-changing treatments is Anastasia, new surgical techniques, antibiotics, and epidemic control

cannabis is classified as a schedule 1 drug under the Controlled Substances Act
high potential for abuse and no medical use

however, cannabis for medicinal purposes is legal in many states

California was the first in 1996

- the use of cannabis for medicinal purposes is legal in 36 States, four out of five permanently inhabited US territories, and the District of Columbia as of May 2021

- as cannabis is not legal federally, the research on the health effects of cannabis and cannabinoids is limited in the United States

2001:marijuana medical access regulations (MMAR)

2014 calling the new marijuana for medical purposes regulations (MMPR)

permitted cannabis for severe illnesses

enable medical practitioners to prescribe medical cannabis

cannabis is not only use for the "fun" psychoactive effects - it is also gaining traction as a drug that can treat a variety of ailments, including some of the following symptoms, conditions and diseases, and neurological conditions

- appetite loss
- nausea and vomiting
- pain management

Cannabis is an appetite stimulant- you'll have heard of the common side effect called the munchies we're getting high results in craving food

- using cannabis can be helpful for individuals with certain eating disorders

- dronabinol is medication with cannabinoids that is approved for AIDS-related anorexia treatment

Some studies suggest that endocannabinoids may interfere with normal leptin signalling

- leptin is the appetite-suppressing hormone

Considerable evidence demonstrates that manipulation of the endocannabinoid system regulates nausea and vomiting in humans and other animals

certain synthetic cannabinoid medications have been approved to help with nausea

nausea is a common side effect of many illnesses and treatment plans, including cancer and HIV / AIDS

- pain is the most common reason for Canadians using the healthcare system and it is estimated that one in five adults experience chronic pain

- large percentage of adults looking to use medical cannabis site pain relief as their reasoning

Endocannabinoid such as anandamide and 2-arachidonoyl-sn-glycerol (2-AG) are produced in injured tissues, and activate the cannabinoid receptors ( CB1 and CB2) and suppress neural pain signal conduction

Several studies show that Medium low doses of THC helped to reduce pain, while high doses actually increased pain

nociceptive and neuropathic

pain from tissue damage

inflammatory and immune cells are recruited to the area to help the repairing process

this inflammatory process activates nerves in the spinal cord and brain causing the sensation of pain

1.) one is at the site of the injury by blocking the signalling of the inflammatory process
- cannabinoids actually have anti-inflammatory properties when they interact with the CB2 receptors at the tissue here can reduce the inflammatory process

2.) by directly interfering with the pain signalling in the spinal cord and the Brain
- THC is able to do this because we know there are CB1 receptors in the spinal cord and brain so it can there directly interfere with the CB1 receptors and reduce the effects of signalling as it travels to the spinal cord and brain

pain from damage to neurons of either the peripheral or central nervous system

damage to the body's nervous system so this could be a pinch the nerves or ailments like multiple sclerosis or Parkinson's

THC helps to mitigate the Pain by interacting with a CB1 receptors and interfering with the pain signalling in the spinal cord and brain but you may remember that CB1 receptors do build up a tolerance overtime so the analgesic properties of THC will be lessen over time the so a balance of THC and CBD as opposed to own

glaucoma

Cancer

HIV / AIDS

1975 case study: American man arrested for growing marijuana for medicating his glaucoma, charges were dropped, physician confirmed his patient had to smoke 5 joints per day to avoid blindness, and joints were eventually supplied by government; again one of the first compassionate use/expanded access programs

a disorder of the eye that is a leading cause of blindness worldwide. Cells in the retina and the optic nerve are destroyed, progressively constricting the field of view

age, race, and heightened intraocular pressure increases the risk of glaucoma

several studies have found that cannabis reduces intraocular pressure (IOP) by lowering production of the aqueous humour

smoked or eating marijuana, THC and synthetic cannabinoids in pill form, and intravenous injections of several Natural cannabinoids have all been shown to reduce IOP significantly and glaucoma patients and healthy adults with normal IOP
- Effects lasted on average 3 to 4 hours

THC as a licensed dronabinol is prescribed to help with the nausea and vomiting associated with chemotherapy

there are suggestions that cannabis could do more good than just easing nausea, including anti-tumor activity, although the findings are only preliminary

prevalence: a study found that 43% of cancer patient respondents had lifetime cannabis use
- 46% of respondents reported using for cancer-related pain, with 34% reporting use for nausea

- 31% and 56% reported use for other cancer symptoms and non-cancer related reasons respectively

in addition to appetite stimulation, marijuana-based medicines may I prove helpful in treating a variety of painful symptoms associated with AIDS

- an estimated 62% of people living with HIV report lifetime cannabis use, indicating their cannabis is very prevalent among this population

- however, cannabis is frequently used among people living with HIV due to the symptoms from both HIV itself and the medication

- a study found 27% of respondents had used cannabis to treat symptoms include nausea, loss of appetite, pain, weight loss, anxiety and depression

a condition that affects the brain, spinal cord, or nervous system

several neurological conditions have been improved through the use of cannabis for medicinal purposes- multiple sclerosis, Alzheimer's, epilepsy, headaches

- multiple sclerosis
- epilepsy
- post traumatic stress disorder

an inflammatory, autoimmune, degenerative disease of the brain and spinal cord


prevalence: a study found
- 47% of respondents with MS report considering using cannabis
- 26% have used cannabis
- 16% are currently using cannabis to treat symptoms

cannabinoids are suggested to help with muscle stiffness (significant), spacity, Tremors, pain, relaxation, sleep and anxiety

- cannabis is being studied for its beneficial properties regarding multiple sclerosis, due to its and anti-inflammatory properties that may suppress disease activity and potentially even promote re-myelination

- However, certain studies show that cannabis may increase cognitive impairment in individuals with multiple sclerosis

here are plenty of accounts of how cannabis helps individuals with epileptic disorders

- Endocannabinoids ( cannabinoid synthesize normally within the central nervous system) have a role in decreasing the release of excitatory neurotransmitter in the CNS hence preventing from seizures

the US FDA has approved medical cannabis (Epidiolex) are two forms of epilepsy:
- Dravet Syndrome
- lennox-gastaut syndrome

definitive research is still lacking, but the amount of individual success story seems promising

cannabis was associated with a 75% reduction in three areas of PTSD symptoms compared to cannabis abstinent participants
- re-experiencing
- avoidance
- arousal

Nabilone, a synthetic cannabinoid, has been shown to be effective in reducing PTSD symptoms including nightmares and insomnia

synthetic cannabinoid products, including
- Rimonabant
- Epidiolex
- Nabilone (Cesamet)
- Dronabinol (Marinol)
- Nabiximols (Sativex)

a drug that blocks cannabinoid CB1 receptors

This is a direct CB1 receptor antagonist which means it blocks cannabinoid endocannabinoids activity

it was once approved in the European Union and other countries excluding the US as an anti-obesity drug

it was never approved by the Food and Drug Administration (FDA) in the USA due to the concerns of psychological side effects ( anxiety / depression)

It was removed from the global market in 2009 because of depressive and suicidal side effects

This is a CBD-based liquid oral medication approved by the FDA in 2018

it was approved for the treatment of childhood epilepsy conditions: Dravet Syndrome and lennox-gastaut syndrome

it is the first drug that is purified substance derived from cannabis and contains nearly pure CBD (>98%)

evidence shows that for Dravet Syndrome and lennox-gastaut syndrome 20 mg per kg is effective

this is a synthetic THC analog drug, approved by the FDA 1985 but marketed since 2006

it is approved as an anti-nausea / anti-emetic drug for chemotherapy patients who fail to respond to other antiemetic medication

nabilone is currently approved for use in Canada

it is also marketed as an appetite stimulant for AIDS patients, and is also helpful for sleep, arthritis, and pain

this is a synthetic THC derivative drug, approved in 1985. It is taken orally

it is similar to nabilone; approved for an anti nausea during chemotherapy, and for appetite stimulation in AIDS patients

As well as it shows similar signs as an agonist substitute for patients dealing with cannabis withdrawal symptoms

In Canada, the drug is approved but has been discontinued by the manufacturer since 2012 for non safety-related reasons

Mouth spray that contains equal parts THC and CBD

it was approved in the United Kingdom, Canada, and parts of Europe, but not in the USA

used in the treatment of muscle control issues in multiple sclerosis patients

it may also be used as a supplement to opioids as an analgesic in patients with Advanced cancer

increase heart rate
increased appetite
decrease blood pressure
dizziness
sleepiness
paranoia/ anxiety/ hallucinations
impaired attention/ memory/ psychomotor ability

* this indicates concern for those with pre-existing conditions such as diseases involving heart rate/ blood pressure, depression/ anxiety, all risks of psychosis

- If people have pre-existing conditions there are some potential risks to their health

in immunocompromised patients, there is a significant risk in using cannabis prepared and non sterile environments

many regions that offer medical marijuana program is required lab testing of medical cannabis in other quality assurance measures to ensure there is no contamination

chronic cannabis use puts patients at risk for psychosis development

some individuals were prescribed medical cannabis may not know what to expect
first-time users can experience reactions that differ from the normal high such as Panic, anxiety, and psychosis

Some preparations are routes of administration that can result in unexpected and/ or delayed effects that the patient does not realize; this can lead to serious dangers concerning Falls/ physical injury, motor vehicle accidents, etc.

large doses and/or high THC concentrations can lead to unexpected effects as well
- hyperemesis: vomiting
- High THC can include paranoia and hallucination and potential for hypersensitivity or allergic reactions, depending on the preparation, composition, or contamination of the medical product

asthma
bronchitis
and emphysema or other pulmonary diseases (for these, smoking is the primary concern)
heart disease
alcohol or other drug dependence

Ko, Bober, Mindra and Moreau (2016) identified hash as the common concerns patients have before trying medical cannabis
H- the "high feeling"
A- acquisition costs
S- stigma
H- How to

in a study conducted by Isle-Belle and Walsh (2014) before federal legalization,

- many reported that their physicians recommended cannabis, but refused to endorse applications for the patient to be federally authorized to possess it

- as well many physicians had charged patients for the service of application (anywhere from \$10 to \$800)

- Median amount spent per month was \$200 and greater than half of survey respondents reported they only sometimes, or never, were able to afford sufficient cannabis quantities for their needs

- financial status will remain a barrier to access. In one survey, more than half of the respondents in the low income groups reported choosing between medical cannabis and other necessities

many physicians are reluctant to prescribe medical cannabis
- there is currently a lack of a good body of research and clinical evidence for its benefits

- in poorer health, or
- if other treatment options have already failed

in places that don't physicians properly educated on the full scope of cannabis, there can exist a 'bottleneck' where the few truly qualified physicians are over capacity and cannot serve the full patient cases

- Inadequate scientific knowledge about the dosage,

- Administration, medical indications, drug-drug interactions, and overall effectiveness;

- Lack of a standard for education and training for medical staff and dispensaries

- Lack of communication and coordination for patient care

- Amount of options for dosing, as well as their complexity and inconsistencies in their availability

Not only that, there are barriers involving travel with cannabis medication, should they need to.

There is a lack of educationnderstanding, since many patients have limited experience with cannabis.

Methods of growing or otherwise obtaining cannabis can be complex, as well as the multiple products, strains and methods of administration available.

the individual is in a physical, mental, and emotional state which enables the employee to perform the essential tasks of their work assignment in a manner that does not threaten the safety or health of oneself, co-workers, property, or the public at Large

an individual has a physical disability or sickness which renders them unable to have gainful employment

if possible an independent assessment (medical, psychologist, their party vendor)

When cannabis became legal, employees finally had the right to use it at work - this is actually false

Cannabis use, especially in safety-sensitive positions, mainly to end intention, injuries or even workplace fatalities

Due to cannabis' properties and effects, the occupational and environmental medicine Association of Canada recommends a wait time of at least 24 hours before engaging in safety-sensitive work

legalized recreational Cannabis may result in more workers consuming cannabis, as well as confusion over the laws in the workplace

a pre-hire drug test will only be justified in one of these two contexts:

1.) the work place our position has important safety concerns

2.) the employer has reasonable grounds to believe that the employee may have a drug problem, or if the employee has admitted to having one

1.) the employer has reasonable grounds to believe that an employee is impaired
the employee was involved in a major incident, near miss, or work-related accident

2.) the employee resumes work after having been absent due to problems related to consumption or for purposes of following a treatment aimed at curing them of the substance


testing is almost always frowned upon, however, so employers will need to have reasonable grounds in order to test

each province has its own legislation regarding testing- Alberta has been notoriously known for not protecting workers rights to privacy when it comes to testing and this is because of our oil and gas sector (safety-sensitive work)

each province has its own legislation in the area of testing

in Alberta, the courts have been less protective of individual privacy rights and have allowed drug testing in the oil and gas sector

BC and Ontario do not do drug testing as freely as Alberta

An employee can agree to drug testing as part of the accommodation or a return-to-work plan following addiction

an employer in a safety-sensitive position must establish that there is a very serious problem with drug use to drug test (rare)

- urine
- blood
- saliva
- hair
- breath

detects THC a few days to several weeks after use, low-cost, 2- 8 hours must Elapse before the test will turn positive. Most frequently used in pre-employment

detects THC up to several weeks following usage. Results are more dependant on the frequency of use versus the level of impairment, it is expensive, invasive, and requires trained Personnel to administer

samples can be taken at the site, the window for testing is 48 Hours, variable results, false positives

won't test positive for 5 to 7 days after use and then we'll stay positive for 90 days following use

is the newest form of testing. It will test positive immediately and the windows only 2 to 3 hours. however, breath testing is relatively expensive and still needs more testing.

at this time there's not a universal valid test. The current tests indicate the person has THC in their body but that does not necessarily mean they are presently under the influence

The blood level of THC does not correspond to the level of impairment

Long-time users have a different profile; someone who used a week ago but it's showing impairment - this might be due to another drug in cannabis

employers must outline the requirements of the positions, including the safety sensitivity and related cannabis regulations. Their policies should be clear


employers have the 'duty to inquire' if they suspect an employee to be impaired or addicted


employers must accommodate employees who are addicted to cannabis, as this is seen as a disability. Failure to help would be considered discrimination

- In their duty to accommodate, employers must make arrangements that allow the dependant employee to continue working within the company

there has to be a balance between the employers need to maintain a safety workplace while respecting the employee's right to privacy. Information requests should be limited to essential duties and accommodation needs

- the employer is not entitled to receive the diagnosis, nor are they entitled to the details of the treatment plan. If a request for an independent medical evaluation is necessary, the employer should receive legal advice as this request may infringe on an employer's privacy rights (Canadian Human Rights Commission, 2017)

- under the Freedom of Information and protection of Privacy Act (FOIP Act ),You may ask for access to any record, including your own personal information, in the custody or under the control of a public body

there is no duty to accommodate recreational cannabis

there is a duty to accommodate substance use disorders to the point of hardship for the employer

the duty to accommodate must be balanced against the duty to protect the worker and other workers

an employer can impose restrictions on the use of cannabis even if it is used for medical purposes

If employers must accommodate medical plans, there are some recommended guidelines for reducing disturbances for other employees including:
- establishing a separate smoking area for cannabis away from Windows and vents
- working with employees to see if non-smoking treatment plan would be effective or not
- updating smoking and scent policies to include cannabis

employers have the right to control the consumption, trafficking, and possession of cannabis in their workplace

employers have the right to prohibit cannabis use (so long as it does not infringe on the duty to accommodate)

employers have the right to set time boundaries
- for example, the RCMP and Toronto police are prohibited from consuming cannabis within 28 days of Duty

employers have the right to set their own limits free cannabis metabolite testing, so long as it is not arbitrarily low

some of the weight falls onto the employee to ensure they can be treated fairly in the workplace

Duties
- if an addicted employees seeking accommodation, they have the duty to disclose to their employer that they are substance dependant
- employees must only provide enough information to enable accommodation. They are not obliged to offer additional details

employees are prompted to speak to their union if they're concerned about the medical information requested by their employer

employees should speak to their unions if their employees thinking of drug testing, as there are very complex regulations for the privacy and rights of the employees

employees are prompted to contact the union if their employer is infringing on their privacy and life outside of the workplace

true

there is no definition for this phrase but the Human Rights Commission describes it as work that:

"if not performed in a safe manner, can cause direct and significant damage to property and/or injury to the worker, others around them, the public and/or the immediate environment"

This means the worker must be alert, physically coordinated and exercise good judgment such that the impairment won't affect the health, safety or security of the worker, other persons, property or the environment

a serious health and safety concern that can lead to workers putting themselves and others at risk for injury

- impairment is not just caused by drugs and alcohol

- a worker may be impaired by effects of many external influences in which their productivity or their physical or mental abilities are reduced

employees need a clear statement of what constitutes employment. The employer needs to follow proper protocols for suspected impairment: incident reports, Progressive discipline, and appropriate corrective actions

behaviour, speech, unusual actions and balance

nervous, insulting, sleepy, exaggerated politeness, confused, combative, excited, quarrelsome, fatigued, uncooperative, poor memory, overly talkative, other

sweating, slow reactions, crying, quick moving, Tremors, fighting, other

slurred, slow, confused, thick, rambling, pressured, other

falling, staggering or unsteady gait, unsure, need support, stumbling, normal, other

a controlled study involving airline pilots demonstrated impairments and aircraft Landings 24 hours after smoking a joint. The pilots reported no awareness of their impairment.


in the Canadian cannabis survey, in the previous 12 months, 39% reported driving within 2 hours of consumption with 29% having done it 10 or more times in the past 12 months. 18% reported using cannabis before or after work
laws and impairment due to medical condition

under the Canadian Human Rights Act. The commission protects the human rights of all individuals lawfully present in Canada. It promotes a vision for Canada we're all individuals have equal opportunity and are able to live their lives free from discrimination


occupation health and safety act
- responsible for enforcing OHS laws to do inspections, investigations, and prosecutions
establishes minimum standards for safe and healthy practices in Alberta workplaces
Canada Labour Code

code requires employers to develop a hazard prevention program. This would include policies related to impairment.

the Cannabis act includes amendments to the non-smokers' Health act which prohibits smoking and vaping cannabis in workplaces
- The purpose is to protect non-smokers from secondhand smoke in federally regulated workplaces or Transport

Employees must report to the employer if there is a hazard to their health or safety
- they need to follow the internal complaint resolution process under the code
- it goes to their supervisor, then to the Workplace Health and Safety Committee to investigate and is still unresolved, and can go to the labor program and a health and safety officer will investigate

true

- apply to staff, students staff, postdoctoral fellows, volunteers, contractors

- is the person fit for work?

- safety-sensitive positions must be considered

- if a student is not an employee or volunteer, they will be disciplined under the code of student Behavior

- there's assistance for people who have addictions
University of Alberta policies

There are five sites between three of the campuses

The student will be charged under the code of student Behavior or the provincial gaming liquor and cannabis act if found by a vent, doorway or window

They would fall under the respective rules within their Collective agreements, Although they may also be charged under the GLCA

they should develop a harm reduction strategy through the office of the dean of students and the University Health Center

enforce bans on smoke or restrict smoking to specific areas to reduce secondhand smoke exposure

they can work with the dean of students in Human Resource Services to establish a protocol for their treatment

people who reported they were currently attending a school, college, cegep, or university reported cannabis use during the past 12 months (40%) at a higher proportion compared to those who are not currently students (22%)

those who reported having less in high school or a high school diploma as their highest level of Education had the highest proportion reporting cannabis use in the past 12 months (31% each), almost twice that of those with postgraduate degrees/diplomas (17%)

while 79% of the U of A students reported believing that their friends had used cannabis in the last 30 days, only 10% reported actually having done so

Current students use cannabis more often than those who are not currently students

69.7% reported no cannabis use in the past 6 months
17.3% use cannabis monthly or less
5.8% used for 2-4 times a month
3.5% Used 2 to 3 times a week
3.7% used 4 or more times a week

Recreational and medical

- the study found that 74.1% of Lifetime cannabis users reported recreational use, with 21.1% reporting Cannabis used for medical/medicinal purposes

- of the medicinal users, 78.2% endorsed use for at least one mental health condition

- about two-thirds of the medicinal users were not authorized by Health Care Providers. Nearly 40% of the users had replaced a different medication with cannabis.

Why do high school students deem cannabis as readily available, University students go even further to say it is very easy or easy to obtain Through The Social Network

this in turn affects the perceived danger of the drug, as it permeates through Social Circles

anxiety: 49.2%
sleep problems: 26%
depression: 25%
pain: 24%

many Studies have found that cannabis is associated with a reduced likelihood of entering a post-secondary education, especially with frequent use


- Homer et. al (2014 )- On trajectories of cannabis use from ages 15 to 25 found that, relative to non-users, occasional cannabis users were more likely to delay enrolment in or drop out of post-secondary education, and frequent users were significantly less likely to enroll


- Hunt, Eisenberg, and Kilbourne (2010) otherwise National epidemiologic data and observed the individuals with cannabis use disorder more likely to drop out of college


*** furthermore, heavy cannabis users who do enrol in college are more likely to experience gaps in enrolment even when controlling for a number of potentially confounding variables

one European study found that the combined use of cannabis and tobacco, regardless of the type of use (concurrent or simultaneous), is moderately related to poor academic achievement amongst University students

- using cannabis with alcohol can increase the risk of over intoxication and impaired driving ability

- smoking cannabis with tobacco increase its exposure to chemicals that can further your risk of developing lung and heart disease. Using cannabis with tobacco can increase the risk of dependents on these substances more than smoking either one alone.

- Using cannabis with other drugs can lead to interactions that can be dangerous to your health

cannabis users are also more likely to be heavy Drinkers, and to use other drugs, meaning there may be a concurrent use

- in the US, Recreational Cannabis legalization is associated with a decrease in binge drinking in students aged 21 and older

- the truth is, students are replacing drinking with smoking, they're doing both

- There is a worry of University students mixing many substances

- University students use cannabis, even without legalization it is available to them through their Networks

- three-quarters of them use it for recreational purposes (we know that the students at University are overall healthy so would not be surprised at the low medical cannabis use)

- there is a split between Arts and Science orange is students and students are co-using alcohol and cannabis

- there's a lot more that we do not know