Marijuana Marijuana consists of the dried and crushed

Marijuana

Marijuana consists of the dried and crushed leaves, flowers, stems, and seeds of the Cannabis sativa plant. THC (delta-9 tetrahydrocannabinal) is the primary mind-altering ingredient in marijuana.

Derivatives of the cannabis plant Hashish Ave. concentration of THC is 2% to 8% Ganja Consists of the dried tops of female plants Sinsemilla Ave. concentration of THC is 7. 5% Bhang Ave. concentration of THC is 1% to 2%

Drug Effects on Neurotransmission: LSD Serotonin receptor Stimulates some receptors (agonist) Blocks other receptors (antagonist)

? Questions and Answers ? Q. Today marijuana is how many times more potent than the marijuana on the street in the 1960 s and 1970 s? A. 20 times more potent Q. How many Americans are current marijuana users? A. 20 million Americans

Drug Effects on Neurotransmission: THC Binds receptors in nucleus accumbens (and other sites in the brain such as the hippocampus– memory) and increases dopamine release

THC Receptor Sites in the Brain

Behavioral effects Low to moderate doses produce euphoria and a pleasant state of relaxation Common effects: dry mouth, elevated heartbeat, some loss of coordination and balance, slower reaction times, reddening of the eyes, elevated blood pressure A typical high last from 2 to 3 hours, and user experiences altered perception of pace and time, impaired memory

Behavioral effects An acute dose of cannabis can produce adverse reactions: mild anxiety to panic and paranoia A few rare cases exhibit psychoses, delusional and bizarre behavior, and hallucinations. These reactions occur most frequently in individuals who are under stress, anxious, depressed or borderline schizophrenic

Behavioral effects A subjective euphoric effect associated with marijuana use is the “ongoing social and psychological experiences incurred while intoxicated with marijuana. It includes both the user’s altered state of consciousness and his or her perceptions while intoxicated. ” - “connoisseurs” - differential reinforcement

Driving performance The ability to perform complex tasks, such as driving, is strongly imparted while under the influence of marijuana In limited surveys, from 60% to 80% of marijuana user indicate that they sometimes drive while high. In a study conducted in the Boston area, marijuana smokers were overrepresented in fatal highway accidents

Critical thinking skills Marijuana has been found to have a negative impact on critical thinking skills Impairment can affect: attention, memory, learning The unresolved question is whether these impairments are short-term or long-term

Amotivational syndrome characterizes regular users of marijuana who experience a lack of motivation and reduced productivity. Specifically, users show apathy, a poor short-term memory, difficulty in concentration, and a lingering disinterest in pursuing goals. Does marijuana or other factors create this syndrome?

Physiological effects Central nervous system Respiratory system Cardiovascular system Sexual performance and reproduction

Therapeutic uses Marinol - indicated for treatment of nausea and vomiting in cancer patients Anorexia in AIDS patients Glaucoma Antiasthmatic drug Muscle relaxation Antidepressant Analgesic

Cannabinoid Receptors Are Located in Many Areas Throughout the Brain and Play An Important Role In Regulating: . . . . Cannabino. . . Receptors. . . . . . . . . . . . . . . . . . . . . . . . . • Brain Development • Memory and Cognition • Motivational Systems • & Reward • Appetite • Immunological Function • Reproduction • Movement & Coordination • Pain Regulation • & Analgesia . . .

Basic Research Selective CB 2 Cannabinoid Receptor Agonist (AM 1241) Dose-Dependently Inhibits Sensory Hypersensitivity in Rats Source: Ibrahim, M. M. et al. , PNAS, 100(18), pp. 10529 -10533, September 2, 2003.

Treatment Research Cannabinoid Antagonists Have Been Shown to Block Major Triggers of Drug Relapse Cocaine-Seeking Responses (per 120 min) Cannabinoid Antagonist Blocks Cocaine. Seeking in Response to Cocaine-Related Cues in a Dose. Dependent Manner Impact of SR 141716 on Response to Cocaine-Related Cues 90 80 70 60 50 40 30 20 10 0 0 0. 3 1. 0 3. 0 mg/kg SR 141716 Dose Source: De Vries, T. J. , & Shaham, Y. et al. , Nature Medicine, 7(10), 2

Marijuana Use Disorders in the United States: 1991 -1992 and 2001 -2002 Wilson M. Compton, M. D. , M. P. E. Director, Division of Epidemiology, Services and Prevention Research National Institute on Drug Abuse Department of Health and Human Services May 5, 2004 American Psychiatric Association Annual Meeting

Background A great deal of information about trends in use of drugs is available, but no data provides reliable and valid measures of drug disorders over the past decade.

Background With data from two large household surveys of the U. S. adult population, this study seeks to answer the following questions: 1. What are the rates of marijuana abuse and dependence in 19911992 compared to 2001 -2002? 2. Have the relationships of age, race/ethnicity or gender to marijuana abuse and dependence changed during this period?

Methods Studies: Large studies of the U. S. noninstitutionalized household adult (18+) population conducted by the Census Bureau. NLAES: National Longitudinal Alcohol Epidemiologic Study (N = 42, 862) NESARC: National Epidemiologic Study of Alcohol and Related Conditions (N = 43, 093)

Methods Interview: AUDADIS: Alcohol Use Disorder and Related Disabilities Interview Schedule - DSM-IV Version Specific measures of each criterion of abuse and dependence on marijuana Reliability and validity wellestablished

Methods Outcomes Marijuana use, abuse and dependence in overall population and by age, race/ethnicity and sex Marijuana abuse and dependence among marijuana users by age, race/ethnicity and sex

Results: Total Population % = p <. 05

Results: Total Population Comparing 1991 -1992 to 2001 -2002: • Marijuana use rates were virtually the same: 4. 0% versus 4. 1% • Marijuana abuse or dependence increased from 1. 2% to 1. 5% (p =. 014) • Marijuana abuse or dependence among users increased from 30. 2% to 35. 6% (p <. 01) How consistent are these results across age groups, race/ethnic groups and sexes?

Results: Marijuana Use by Sex and Race/Ethnicity % = p <. 05

Results: Marijuana Use In Age Groups % = p <. 05

Results: Marijuana Use in Whites % = p <. 05

Results: Marijuana Use in Blacks % = p <. 05

Results: Marijuana Use in Hispanics % = p <. 05

Results: Marijuana Use in Men % = p <. 05

Results: Marijuana Use in Women % = p <. 05

Results: Marijuana Use in Detailed Age-Sex. Race/Ethnicity Categories Use increased significantly for: White males 45 -64 years old Black females overall and Black females 18 -29 and 4664 years old Hispanic females 18 -29 years old

Results: Summary of Marijuana Use Rates did not change significantly overall Rates increased significantly for: 18 -29 and 45 -64 year olds Black and Hispanic 18 -29 year olds White and Black 45 -64 years olds Women 18 -29 years old and both men and women 45 -64 years old Selected age-sex-race/ethnicity categories

Results: Marijuana Abuse or Dependence in Overall Population % = p <. 05

Results: Marijuana Abuse or Dependence by Sex and Race/Ethnicity % = p <. 05

Results: Marijuana Abuse or Dependence in Whites % = p <. 05

Results: Marijuana Abuse or Dependence in Blacks % = p <. 05

Results: Marijuana Abuse or Dependence in Hispanics % = p <. 05

Results: Marijuana Abuse or Dependence in Men % = p <. 05

Results: Marijuana Abuse or Dependence in Women % = p <. 05

Results: Summary of Marijuana Abuse or Dependence Rates increased significantly overall Increases in rates were significant for: 18 -29 and 45 -64 year olds overall Blacks and Hispanics overall and 18 -29 years old Women overall and 18 -29 years old Men 45 -64 years old Black and Hispanic men overall and 18 -29 years old Black women overall and 18 -29 years old

Results: Marijuana Abuse or Dependence Among Users in Overall Population % = p <. 05

Results: Marijuana Abuse or Dependence among Users, by Sex and Race/Ethnicity % = p <. 05

Results: Marijuana Abuse or Dependence Among Black Users % = p <. 05

Results: Marijuana Abuse or Dependence Among White Users % = p <. 05

Results: Marijuana Abuse or Dependence Among Hispanic Users % = p <. 05

Results: Marijuana Abuse or Dependence Among Male Users % = p <. 05

Results: Marijuana Abuse or Dependence Among Female Users % = p <. 05

Results: Summary of Marijuana Abuse or Dependence Among Users Rates increased significantly overall Increases in rates were significant for: 18 -29 and 30 -44 year olds overall Blacks overall and 30 -44 and 18 -29 years old Hispanics overall and 18 -29 years old Women and men overall and 18 -29 years old Black and Hispanic men overall and 18 -29 years old Black women overall and 18 -29 years old

Estimated Population Increases in Marijuana Abuse or Dependence White Total Black Hispanic Other Male Female

Why have rates increased? • Changes in quantity/frequency of marijuana use? • Changes in potency of marijuana? • Psychosocial factors?

Why have rates increased? Changes in quantity/frequency of marijuana use? Not likely…

Changes in Frequency of MJ Use? %

Changes in Quantity of MJ Smoked? %

Why have rates increased? Changes in potency of marijuana? Possibly…

Changes in Potency of Marijuana Source: Research Institute of Pharmaceutical Sciences, School of Pharmacy, University of Mississippi; 2003

Why have rates increased? Psychosocial factors? Possibly…

Plausible Psychosocial Factors • Acculturation? • Lifestyle factors and attitudinal factors? • Sociodemographic or socioeconomic factors? • Economic factors such as price, tax and policy changes affecting other substances that may inadvertently affect marijuana? • Historical and cultural factors?

Summary • Rates of Marijuana use were nearly the same in the total population in 1991 -1992 as in 2001 -2002, but increases were seen in certain subgroups: – younger male and female blacks, – younger Hispanic males – white and black 45 -64 year olds.

Summary • Marijuana-related disorders (abuse and dependence) increased from 1991 -1992 to 2001 -2002, especially for younger male and female blacks and younger hispanic males. • Increased potency of marijuana may play a role

Marijuana Use Disorders in the United States: 1991 -1992 and 2001 -2002 Wilson M. Compton, M. D. , M. P. E. - NIDA Bridget F. Grant, Ph. D. - NIAAA James D. Colliver, Ph. D. - NIDA Meyer D. Glantz, Ph. D. - NIDA Frederick S. Stinson, Ph. D. - NIAAA