Cannabis Related Disorders Flashcards
where are CB1 receptors found
primarily in brain and spinal cord but not around respiratory centers of CNS
where are CB2 receptors found
mostly in immune system, mast cells, macrophages
can THC cross the BBB or placenta
can cross both
why does THC have such a long half life (up to several days to a week)
highly lipophilic, can accumulate in fat
what is considered a “heavy” cannabis user
more than 3 joints per week
how long might it take a heavy cannabis user to clear THC from fatty tissues including the brain
can take months, up to a year
do more men or women have cannabis use disorder
2:1 men
what age group has the highest incidence of cannabis use disorder
18-29–> 4.4%
what is the heritability of cannabis use disorder
30-80%
*common genetic basis for teen substance use + conduct problems
list psychological + environmental RFs for cannabis use disorder
hx conduct disorder or ASPD
externalizing and internalizing disorders during childhood/adolescence
youth with high behavioural disinhibition scores
adverse childhood
tobacco smoking
cannabis use among family
family hx SUD
ease of availability
when does cannabis withdrawal start
1-3 days after cessation of cannabis
when does cannabis withdrawal peak
within first week
how long does cannabis withdrawal last
1-2 weeks
how long might sleep difficulty due to cannabis withdrawal last
can last up to a month or more
when is cannabis use disorder most common
teens/young adulthood
early onset (before age 14) of cannabis use disorder is a ROBUST predictor of what other disorders
development of CUD, SUD, AUD as young adult
likely related to externalizing problems
list physiological signs of cannabis intoxication
conjunctival injection
dry mouth
tachycardia–> can do 20-50bpm above baseline!!, this is amplified with alcohol use
increased appetite
sometimes orthostatic hypotension due to lower PVR
list subjective/psychological signs of cannabis intoxication
high feeling, then euphoria, inappropriate laughter, grandiosity
sedation, lethargy, impaired judgment
difficulty with complex mental processes, impaired motor performance
distorted sensory perceptions
sense of time passing slowly
can also get dysphoria, anxiety, social withdrawal
are cannabis withdrawal symptoms usually severe enough to require clinical attention
no
list symptoms of cannabis withdrarwal
initially decreased appetite, insomnia
fatigue, yawning, difficulty concentrating
can then have rebound hypersomnia, increased appetite
what is the prevalence of cannabis hyperemesis syndrome
up to 32%
list the major features of cannabis hyperemesis syndrome
severe cyclical N/V
resolution with cannabis cessation
relief of symptoms with HOT SHOWERS or baths
abdo pain
daily use of cannabis
how do you manage cannabis hyperemesis syndrome
complete abstinence from cannabis combined with supportive management
standard antiemetics to resolve N/V are NOT EFFECTIVE
limited evidence indicates some relief from LORAZEPAM and HALDOL as well as TOPICAL CAPSAICIN cream
what syndrome can accompany cannabis use disorder
amotivation syndrome–> can mimic PDD
those with a mental health disorder are how much more likely to have a cannabis use disorder than the general population
2-3x more likely
is cannabis a gateway drug?
it seems so–> cocaine, opioids
higher rates of AUD, TUD, likely other SUDs
in those seeking treatment for cannabis use disorder what % have another SUD
74%
–most common is alcohol, then cocaine, meth, opioids
what is the most commonly comorbid personality disorder with cannabis use disorder
ASPD (then OCPD, paranoid)
what is the most commonly comorbid psych disorder with cannabis use disorder
any anxiety disorder (24%)
MDD (11%)
bipolar (13%)
60% have an externalizing disorder like ADHD, conduct
are there any meds approved for treatment of cannabis use disorder
no
what meds may be helpful in treating cannabis use disorder
gabapentin–> possibly helpful, esp with withdrawal
NAC
naltrexone (equivocal results)
replacement theory is not great
list the 3 most helpful primary psychosocial interventions for cannabis use disorder
CBT
motivation enhancement therapy
contingency management
