Final exam Flashcards
History of Cannabis
Cannabis has been cultivated since the Stone Age and may be the earliest non-food-bearing plant grown by humans. Archaeologists have found pots made of hemp fibres dating back more than 10,000 years. The first known reference to cannabis’s medicinal use was in 2737 BCE, in the Pen Ts’ao Ching, the pharmacopeia of traditional Chinese medicine.
17th- to 19th-Century Canada and USA Cannabis history
First hemp crop planted in 1606 in Nova Scotia. By 1611, English settlers had planted cannabis in Jamestown. Even George Washington, the first president of the United States of America, grew cannabis. In 1801, hemp seeds were given to farmers in Upper Canada by the lieutenant-governor, on behalf of the king of England. By 1938, hemp production in Canada ended, with some growers licensed again starting in 1997. Throughout the 19th century, cannabis was legal and widely available, and used as an analgesic, appetite stimulant, and muscle relaxant. Anyone could walk into a pharmacy and purchase a wide range of cannabis preparations
Cannabis use n 20th Century and Beyond
In 1923 the Act to Prohibit the Improper Use of Opium and Other Drugs was passed into law, criminalizing the use of cannabis. The passing of the Act was associated with significant racist propaganda from Canadian judge Emily Murphy, who wrote that members of non-White races were using cannabis to bring about the downfall of the White race.
The La Guardia Report (1944)
Found that cannabis was not addictive and that it produced no permanent negative effects to the user or to society. In contrast to what Harry Anslinger had argued, the report did not find that cannabis led to physical, mental, or moral decay, insanity, sexual deviance, violence, or criminal misconduct. The committee recommended that cannabis’s medical uses be investigated. Anslinger rejected the findings; he called the authors “dangerous” and “strange” and instructed the FBN to investigate the commission members’ own drug use.
Le Dain Commission and Shafer Commission
In Canada, the Le Dain Commission (1969 through 1972) recognized that convictions under Canadian drug laws were more harmful than the effects of many drugs—especially cannabis—and recommended that cannabis specifically be removed from the Narcotics Control Act.
The Shafer Commission conducted the most comprehensive review of cannabis that had ever been produced. To the dismay of then US president Richard Nixon, the Shafer Commission found no evidence that cannabis causes physical or psychological harm, harsh withdrawal, birth defects, brain damage, a compulsion to use hard drugs, or death resulting solely from cannabis intoxication. They found the potential harm of getting arrested was much greater than any harm that might come from using the plant and recommended that laws be changed to remove criminal penalties for possession of cannabis for personal use.
Cannabis is the _____ most commonly used recreational drug in the world, surpassed only by ________________. Approximately ___ per cent of the world’s adult population, or 162 million people, use cannabis each year, and about _____ million people around the world use cannabis daily.
Fourth. Tobacco, caffeine, alcohol. 4%. 22.5.
What percentage of Canadian high school students reported that cannabis is “fairly easy” or “very easy” to obtain?
80-90
Cannabis sativa vs cannabis Indica plants differences
Cannabis sativa is a tall, slender plant with thin, light green leaves capable of reaching heights of 4.5 to 6 metres that grows in tropical or semitropical regions. The shorter (grows to a height of about 1 metre) and bushier Cannabis indica fares better than sativa in cooler climates and is cultivated in Afghanistan, Pakistan, and India. Indica has wider, darker, deeply serrated leaves and a compact and dense flower cluster. Cannabis indica has a higher cannabidiol (CBD) to THC (delta-9-tetrahydrocannabinol) ratio, which makes it less likely to induce anxiety and more likely to produce sedation and alleviate pain than Cannabis sativa.
Female vs male cannabis plants
Cannabis plants are either male or female. The female plants produce flower clusters (also called buds) with a sticky, psychoactive resin that protects the flowers from excessive heat and catches the pollen produced by the male plants. After fertilization, the flower no longer needs the protective (psychoactive) resin. But if it is not pollinated, the female plant continues to produce THC within the resin of the flowers. Growers separate the male plants from the female ones.
Phytocannabinoids
phytocannabinoids bind to the body’s cannabinoid receptors. THC is the most psychoactive of the phytocannabinoids and is most abundant in the flowering heads
What is psychoactive THC or CBD and what do they stand for
THC psychoactive. CBD stands for cannabidiol, and THC stands for tetrahydrocannabinol
Synthetic Cannabinoids examples and what are they used for
Dronabinol (Marinol) is a synthetic THC pill approved to raise appetite and diminish nausea and vomiting in cancer and AIDS patients (dronabinol, although approved, is no longer marketed in Canada, as has been replaced by the synthetic THC analogue nabilone [Cesamet], and nabiximols [Sativex], which is a botanical extract of phytocannabinoids including THC.
Pros and cons to cannabis pills
Pros: avoids the respiratory damage
Cons: when cannabis is ingested rather than smoked, it may actually increase nausea. Second, a person taking oral THC to treat nausea may vomit up the pill before it has had a chance to work. Third, the dose, onset, and duration of action are harder to control in an orally administered pill than with smoking because of delayed absorption of the pill and the first-pass effect. Finally, while cannabis is made up of hundreds of natural compounds and scores of cannabinoids, each with a unique medicinal impact, which interact synergistically, dronabinol contains only THC.
Spice (K2)
Commercially available psychoactive product containing one or more synthetic cannabinoids, which is sprayed onto dried, shredded plant material and then smoked or eaten. Past-year use of Spice in grade 7–12 students is approximately 1.6 per cent. Spice’s popularity among some young people may be due to its easy access and affordability, a promise of a stronger high than with cannabis, the perception that it’s legal (it isn’t!), and the difficulty in detecting the drug in standard urine drug tests. Spice binds more fully to brain cannabinoid receptors than does THC and may produce more intense effects. It does not typically contain CBD, which in cannabis reduces many of THC’s negative effects.
CBD effects
Non-psychoactive, has antioxidant, anticonvulsant, anti-inflammatory, antianxiety, antipsychotic, and neuroprotective properties and can modify some of THC’s more negative effects.
Cannabis distribution in body
THC travels through the blood and is distributed to all areas of the body. Plasma levels decrease rapidly as THC leaves the blood and is deposited in fatty tissues and the brain. The maximum subjective effects are usually reported while THC plasma levels are falling, because THC levels in the brain continue to increase as the drug leaves the blood and enters the brain and other tissues. THC is gone from the brain within a few hours, but it accumulates in the lungs, liver, kidney, spleen, adipose, and testes. Because cannabinoids are so lipid-soluble, they can remain in the body fat for days.
Is ingested cannabis stronger
When cannabis is ingested, the liver metabolizes most of the absorbed THC into 11-hydroxy-THC, which is four times more potent than THC. This is known as the first-pass effect.
In 1992, Raphael Mechoulam and his colleagues discovered an ____ cannabinoid that mimics THC and binds to cannabinoid receptors. This substance is called ________
endogenous, Anandamide
Endocannabinoids synthesization (+retrograde signalling)
Endocannabinoids are too fat-soluble to be stored in vesicles—they would float right through the vesicle membrane; so, instead of being stored, they are rapidly synthesized as needed from components of the cell membrane, and released in areas that require that particular compound when certain biochemical processes occur. Undergo retrograde signalling, meaning they’re released from postsynaptic neuron and bind to Presynaptic terminal.
Endocannabinoids have significant roles in a variety of biological and neurobiological processes:
neuroplasticity and learning and memory, homeostasis, neurogenesis, the fine-tuning of neural connections during development, stress, emotional regulation, reward signalling, pain, appetite, and others. Researchers have also shown that cannabinoids may have anti-inflammatory and antioxidant effects, and thus may have neuroprotective value in cases of traumatic brain injury and stroke.
Cannabis: _______ receptors are found predominately in the central nervous system, whereas _______ receptors are found chiefly in the spleen, tonsils, and immune system.
CB1; CB2
Physiological Effects of Cannabis at Low and Moderate Doses
Brain: affect memories, coordination, reward, emotions, hunger, sex, sleep, perception and cognition.
Analgesia: reduce sensitivity to both short-term (acute) and long-term (chronic) painful stimuli, and their potency and efficacy are comparable to those of opioids.
Candidascular: increases heart rate.
Immune system: immunomodulators, which means they increase some immune responses and decrease others
Cannabis effects on Respiratory System
Smoking cannabis on a regular basis is associated with an increased risk of chronic cough and bronchitis. Cannabis smoke contains as much or more tar, carbon monoxide, hydrocarbons, acetaldehyde, acetone, benzene, toluene, benzopyrene, and hydrogen cyanide as tobacco smoke does.
Cannabis drug interactions
Cannabis can enhance the sleep-inducing effects of barbiturates, benzodiazepines, alcohol, and other sedatives, and also may increase the hypertension and tachycardia that occur with cocaine and amphetamines. Drinking alcohol when using cannabis increases the concentration of THC in the blood, which in part explains the increased impairment seen when cannabis and alcohol are combined.
Amotivational syndrome
Amotivational syndrome describes the decreased productivity, lack of interest, and inability to implement long-term plans in adolescent cannabis users. Evidence for amotivational syndrome is mostly from people’s observations and personal stories.
Therapeutic effects of cannabis
Substantial evidence exists that cannabis is effective for treating chronic pain, reducing seizures, reducing nausea and vomiting, stimulating hunger, and alleviating the stiffness and muscle spasms experienced by patients with multiple sclerosis. There is considerable evidence that cannabis can effectively treat chronic pain in adults.
Cannabis smoke has been found to contain carcinogenic hydrocarbons; however, epidemiological data has failed to find an association between cannabis use and an increased incidence with most types of cancers. What have researchers concluded about these contradictory findings?
Methodological concerns with some studies, as well as a lack of longitudinal research, mean that the relationship between cannabis and cancer remains unclear.
Difference between anabolic and androgenic steroids
AAS have similar effects to those of testosterone. Anabolic substances encourage muscle growth, while androgenic ones promote male physiological characteristics.
tetrahydrogestrinone (THG, or “the clear”)
Developed and manufactured by the Bay Area Laboratory Co-Operative (BALCO). This synthetic performance-enhancing steroid was designed to escape detection during drug analysis. The lab was raided, and many steroids were found, along with a list of customers.
Prevalence of Performance-Enhancing Drug Use
Globally, 6.4 per cent of men and 1.6 per cent of women have reported ever using AAS.
Adult steroid users characteristics
Users were significantly less confident about their body appearance before weight training and steroid use; body image disorders may be both a risk factor for steroid use and a consequence of it. Some who abuse steroid had physical or sexual abuse in childhood and use steroids to increase muscle size.
Forms of Performance-Enhancing Drugs
These drugs include AAS, central nervous system (CNS) stimulants, pain relievers, beta2-agonists, beta-blockers, human growth hormone (HGH), and creatine, as well as the process of blood doping.
Blood doping
The use of illicit products and methods to increase oxygen transport in the body is known as blood doping. Erythropoietin (EPO) is a hormone that controls red blood cell production. Because red blood cells carry oxygen through the body, increasing their production can improve an athlete’s aerobic capacity and endurance. Another method of blood doping is athletes receiving a blood transfusion one to seven days before a high-endurance event. Can be dangerous as can cause myocardial infarction.
Beta2-Agonists and Beta-Blockers as steroids
Drugs that affect norepinephrine can influence athletic performance. Norepinephrine binds to both alpha and beta receptors. When inhaled, beta2-agonists such as albuterol increase lung capacity by dilating the bronchi leading to the lungs. When taken orally or injected, beta2-agonists may build muscle. Beta-blockers, on the other hand, slow heart rate, lower blood pressure, and reduce anxiety and trembling, actions that are desired in archery and shooting events.
Steroids Routes of Administration
AAS can be administered orally, by IM injection, or topically as creams or gels either worn as skin patches or rubbed on the skin. Oral administration is the most convenient, but orally administered AAS undergo rapid first-pass metabolism by the liver, making the drugs less effective. Oral administration of steroids is especially toxic to the liver.
Dosage and Pattern of Use of steroids
Cycling: Cycles of use are typically 4–16 weeks in duration followed by a period of abstinence that allows adverse side effects to subside, allows tolerance to decline, and reduces the chance of detection of banned substances.
Pyramiding: start with low doses and build up, no proven benefits.
Stack: simultaneously take two or more types of steroids at the same time to increase the effects on muscle size, no proof it works
Steroids and testosterone regulation
Testosterone self-regulates its own release, but when a person continually takes high doses of AAS, the hypothalamus and pituitary gland will remain inhibited, ultimately leading to infertility, impotence, and shrinkage of the testes.
Physiological effects of steroids
AAS increase skeletal muscle growth, increase muscle mass by boosting the production of proteins and by blocking muscle breakdown, decrease fat, thicker skin, stimulate oil and pore size, irreversible male-pattern baldness and a deeper voice. In males, AAS lead to reduced sperm production, testicular atrophy, enlarged prostate, and temporary infertility. In women, AAS lead to reversible menstrual irregularities and loss of breast tissue, as well as permanent enlargement of the clitoris and excessive growth of body and facial hair. Increase blooding clotting and hypertension, very had on liver, Herron death, reduce immune cells.
Psychological Effects of steroids
AAS users initially report feelings of euphoria, well-being, increased energy, confidence, and sex drive. Eventually, some may experience severe mood swings, anxiety, heightened aggression, distractibility, forgetfulness, confusion, decreased sex drive, and even mania and delusions.
Medical and Therapeutic Uses of Anabolic-Androgenic Steroids
They are used to replace male hormones in men who have androgen deficiency; to stimulate the bone marrow in the treatment of leukemia, kidney failure, and certain forms of aplastic anemia; to treat breast cancer and osteoporosis; and to treat severe muscle loss, such as after major trauma or HIV/AIDS. Drugs with higher androgenic and lower anabolic effects are given to treat hypogonadism (absence of hormones) in males, while steroids higher in anabolic effects are used for anemia and osteoporosis, as well as to reverse protein loss.
Succeed clean
Program providing information about performance-enhancing substances to coaches, educators, parents, and children and youth in sport. In this university-led program, local elite Ontario Hockey League players made presentations to middle and high school students.
Athletes Training and Learning to Avoid Steroids (ATLAS) and ATHENA
Interactive, peer-led program designed to reduce the use of steroids among male high school athletes. The program includes information on both the positive and negative effects of steroids, healthy sports nutrition, drug-refusal role play, and demonstrations of strength training exercises as alternatives to the use of PEDs. Students were less likely to use. The ATHENA program (Athletes Targeting Healthy Exercise and Nutrition Alternatives) is aimed at adolescent girls on sports teams.
_______ is a naturally occurring metabolic precursor of testosterone and is currently a Schedule IV drug in Canada.
Androstenedione
Synthesis of new proteins is a(n) _______ effect of steroids, inhibiting the breakdown of complex molecules to release energy is a(n) _______ effect, and _______ effects are also known as masculinizing.
anabolic; anti-catabolic; androgenic
Prevalence of ADHD
The prevalence of ADHD has been estimated to be between 5 and 9 per cent for children and adolescents, and to be approximately 3–5 per cent for adults. Around 7.2% globally. Males are diagnosed at about two to three times the rate of females.
Why ADHD prevalence increasing?
Medicalization of problems, direct to consumer ads, electronic devices, changes in schooling
Causes of ADHD
Heritable. People with ADHD have significantly reduced brain volume in the frontal lobe, hippocampus, basal ganglia, amygdala, and cerebellar areas that are involved with attention. Environmental factors also influence the development of ADHD. Exposure to domestic violence, chaotic living situations, and second-hand smoke, and a lack of social support from friends or relatives may increase ADHD behaviours. Birthdates, age gap between classmates.
Pharmacological Treatments for ADHD
Stimulant drugs. Use increased 20x. Use highest in North America (with the United States alone consuming about 85–90 per cent of the world’s ADHD drugs). The most common ADHD drugs are methylphenidate and amphetamine. Ritalin, Concerta, and Focalin are the most common brands of methylphenidate. Adderall, Dexedrine, and Vyvanse are commonly administered amphetamines.
Mechanism of Action of ADHD Drugs
Both methylphenidate and amphetamine increase dopamine and norepinephrine levels in the nucleus accumbens, striatum, and other areas. Methylphenidate works mostly by blocking reuptake of dopamine, norepinephrine, and serotonin, and amphetamines block reuptake of these neurotransmitters but also increase release of dopamine. Works in locus coeruleus, which helps focus attention and filter out extraneous stimuli.
Physiological and Psychological Effects of ADHD Drugs
Similar to those of amphetamine and cocaine. Users experience increased focus, alertness, arousal, and elevations in heart rate and blood pressure. Some common side effects include headache, dizziness, stomach ache, nausea, loss of appetite, and insomnia.
Effectiveness of ADHD Drugs
Many studies have documented that ADHD medications have significant short-term impact on quiz scores, classwork productivity, and other objective measures of academic functioning. But it is less clear if long-term medication improves behavioural problems, relationships with peers, or grades. Other studies show that these drugs have no long-term benefits. May make things worse.
Non-pharmaceutical Treatments for ADHD
CBT, changing diet, exercising
About _______% of those with a current ADHD diagnosis receive prescriptions for medications for stimulants or non-stimulants, including drugs such as Ritalin and Adderall.
70
The vast majority of drugs to treat ADHD belong to the _______ family and they are often formulated as either _______ release pills which should be taken _______.
stimulant; immediate, sustained, or extended; orally
ADHD drugs: _______ work(s) by blocking reuptake of dopamine, norepinephrine, and serotonin, and _______ work(s) by blocking reuptake of these neurotransmitters while also increasing dopamine release
Methylphenidate; amphetamines
The Canadian Drugs and Substances Strategy has these priorities:
• Prevention: Provide resources to Canadians, and in particular, youth, about the risks associated with drugs and other substance use
• Treatment: Provide support for improving treatment and rehabilitation for Canadians who suffer substance use disorders
• Enforcement: Stop illegal production and trafficking of drugs, as well as stop the diversion of drugs away from legitimate uses
• Harm reduction: Implement strategies that decrease the negative effects of drugs and other substances on individuals and their communities, including decreasing stigma
• Evidence: The strategy and associated programs and policies should be evidence based to be effective
• Funding: The strategy commits to funding programs within the above pillars of the Canadian Drugs and Substances Strategy
Primary Prevention + example
Primary prevention is directed at those who have had little to no personal experience with drugs; the goal is to prevent drug use and abuse from starting. Primary prevention programs, such as the school-based program LifeSkills Training, are typically used in elementary and middle schools. Common approaches include providing information about drugs and building drug-resistance skills.
Secondary Prevention
Secondary prevention aims to minimize the damage in a population that already has had some experience with drugs. The goals are to limit the extent of abuse, prevent drug use from spreading to substances beyond those that already are being used, alter attitudes and behaviours about drugs, and stress healthy and responsible lifestyles. These programs are more typically offered in high schools or college and university environments.
Tertiary Prevention
Tertiary prevention is geared to those who are already heavy drug users. The goals are to assess and diagnose, refer into treatment, terminate use of the substance, and prevent relapse.
Universal Prevention
Universal prevention programs are designed to preclude the development of drug use and abuse and are delivered to the general population. A national media campaign to discourage tobacco use is one example of a universal prevention program.
Selective Prevention
Selective prevention programs are targeted to individuals of the general population who are thought to be at a higher risk of developing AOD dependence, due to biological, psychological, social, or environmental factors.
Indicated Prevention
Indicated prevention programs are for individuals who show early danger signs of abuse but have not yet been diagnosed with drug addiction. These programs might focus on children who begin alcohol or tobacco use at a young age or on an adult who has received his first impaired driving arrest.
Family drug prevention methods
Training programs that focus on parenting skills. Provide adequate support for future parents who have psych disorders or socio economically disadvantaged.
School drug prevention methods
Keep kids in schools, adequate classroom management, address personal vulnerabilities, School policies and culture that discourage drug use. Effective prevention programs.
Community drug prevention methods
Stricter drug policies by increasing cost and minimum ages requirements for alcohol end tobacco. Media campaigns against drugs, less exposure of youth to drugs, workplace prevention
Why Cognitive Approaches and Scare Tactics do not work
• The mere exposure effect suggests that the more we’re exposed to something, the more we like it.
• Demonstrating the drugs aroused the students’ curiosity, and taught them of the existence of some substances that they might not have known of otherwise.
• Many students who had previous pleasant experiences with drugs learned to distrust everything in the officers’ message and to disbelieve the reality of AODs’ harmful effects.
• Adolescents often want to take risks and rebel, so trying to scare them actually may have increased drug use.
• This approach assumes that drug use is a conscious, rational decision, and that it can be stopped or prevented based on information alone.
Affective Programs
These programs identified low self-esteem, negative self-awareness, and poor communication and interpersonal skills as risk factors for drug use. They then taught the students to recognize their feelings and express them, and to analyze and clarify their values. Although sometimes helpful in boosting self-esteem, these programs did not prevent drug use.
The DARE program
Drug Abuse Resistance Education—was created in 1981 by Daryl Gates of the Los Angeles Police Department. Over a 17-week program, police officers would go to elementary school classrooms and teach students about drugs and personal safety. Students would write essays critical of drug use and publicly pledge their opposition to drug use. Unfortunately, the program did not work. Some students who went through the DARE program showed higher drug use compared with students who never went through the program.
Effective School-Based Methods of Drug Abuse Prevention/social influence model
• They are structured, interactive sessions given once a week over the course of a school term, with booster sessions presented over subsequent years.
• They are delivered by trained facilitators and peer counsellors.
• They provide opportunities to learn and practise personal and social skills, such as decision-making, coping strategically , and avoiding peer pressure.
• They dispel misconceptions about the prevalence of drug use and present the realities of its effects.
• They include many shareholders—students, teachers, facilitators, administrators, parents, and community members.
Media Literacy Campaigns
Media literacy is the ability to understand, analyze, and critically evaluate messages from ads, television shows, or movies, in order to be less influenced by these messages. Media literacy helps viewers to recognize that the authors of these ads, shows, and films:
• often have political or financial motives
• target their message to specific audiences, such as minorities or adolescents
• try to link the use of the product to romance, love, good looks, and power
• make the product look as attractive as possible, while leaving out important (negative) information
One study found that media literacy campaigns actually increased a participant’s expectations of future smoking.
The LifeSkills Training program (LST)
evidence-based substance abuse prevention program that has been shown to be effective in preventing drug use. The program typically is delivered in 15 class sessions (each session is 40–45 minutes long) in the grade 7, with 10 booster classes in grade 8 and 5 in grade 9. Many studies have shown that LST reduces the use of alcohol, tobacco, and cannabis, even in long-range follow-up surveys over a six-year period.
Other school-based programs that have proven successful include
Project alert, project toward no drug use, project success.
Anti-drug Ads, examples and are they effective
Canadian: drugs not 4 me
US: National Youth Anti-Drug Media campaign These ads increased likelihood of teen drug use.
Above the influence: example Pete’s couch, more effective
Canada’s Tobacco Strategy
Goal of fewer than 5% of Canadians being daily tobacco smokers by 2035. For 2018–2023, the government has committed approximately $330 million to achieve this goal by supporting Canadians trying to quit tobacco, taking a harm reduction approach, deterring non-users from initiating tobacco use, and recognizing the unique challenges of tobacco use in Indigenous people, where tobacco both is a leading cause of preventable death and has a sacred and ceremonial role. Canada does not, however, currently have an active national anti-tobacco ad campaign.
TRUTH anti-smoking campaign (USA)
This was the first national anti-smoking campaign to discourage tobacco use among youth, with annual funding of $100 million from 2000 to 2002. The campaign used graphic images, highlighted health consequences, deglamorized the social appeal, countered perceptions that smoking is widespread among youth, and exposed the tobacco industry’s marketing practices and denial of tobacco’s addictive and deleterious health effects. From 1999 to 2002, smoking among students in grades 8, 10, 12 in the US declined from 25.3 to 18%. The TRUTH campaign accounted for an estimated 22% of this
Drug-Free Workplace Act 1988 (USA)
Required all federal grantees and some federal contractors to establish drug-free workplaces, including programs for drug education, awareness, and testing. Today, almost all federal agencies and major corporations in the United States have drug-monitoring programs in place, and drug testing is required for many people seeking employment, welfare, or adoption of a baby. Can lose benefits if they refuse. Federal employees, law enforcement agents, transportation workers, and those in the military are subject to random drug testing.
When Do Drug Tests Typically Occur?
- Pre-employment. After one has applied for a job, a job offer may be conditional upon passing a drug screen.
- Reasonable cause. A drug test may be required if someone is suspected of using a prohibited drug, either due to direct observation of drug use, physical symptoms of drug use, abnormal or erratic behaviour, absenteeism, or deterioration of one’s productivity at work.
- Post-incident. If an accident or injury occurs at work, drug testing can help to determine whether drugs or alcohol were a factor.
- Periodic. Periodic testing is usually scheduled in advance and uniformly administered.
- Random. Some organizations give random drug tests. In a truly random test, there is an equal probability that any employee from the group of workers subject to testing will be selected without warning.
- Return-to-work testing. When someone who has previously tested positive is returning to work after completing the required treatment, they may be asked to complete a one-time, announced drug test.
Immunoassay
First screening of drug test sample. Quick and inexpensive, immunoassay measures the metabolites of drugs. Immunoassays are not very accurate and might not distinguish between drug metabolites and closely similar structures.
Gas chromatography/Mass spectrometry (GC/MS)
After a positive first test, a second drug test is then ordered, and gas chromatography/mass spectrometry (GC/MS) is used as the confirmation test. GC/MS is more time-consuming and expensive, but it is also more precise and specific. The levels of the drug or its metabolite that constitute a positive test differ for each drug. Generally, if a drug is detected, the follow-up GC/MS confirmation test requires a lower level of drug to trigger a positive test.
How long can drugs be detected in system?
In general, detection times are longest with a hair test (up to 90 days), followed by urine (couple of weeks), saliva (3 days), and, finally, blood tests (>1-3 days).
Urine drug test
Urine is the most common test, because it is the least expensive of the test methods and it is easy to collect the sample. Urine tests typically detect drug use within the past week but do not detect drug use immediately; it usually takes six to eight hours after consumption for a drug to be metabolized and excreted.
Saliva drug test
Saliva tests are convenient, easy, safe, and less invasive than other forms of drug testing. This method is also less prone to a user’s efforts to beat the drug test. A little more expensive than urine testing, saliva testing is still less expensive than testing hair or blood. Some drugs, like MDMA, inhibit salivary secretions, which may make collection difficult. Salivary tests typically only measure drugs used in the past 24 hours, so they are more commonly being used to measure recent drug use, such as with motor vehicle or workplace accidents.
Hair drug test
Hair tests can be used to evaluate long-term patterns of drug use. Drugs are incorporated into the hair shaft from the bloodstream. About 10 days after use, the affected hair grows from the follicle to emerge above the scalp. Some drugs, like cocaine, migrate along the shaft and will show use at an undetermined time in the testing period. For other drugs, like opioids, it’s sometimes possible to pinpoint exactly when drug use occurred and whether it has been discontinued.
Hair tests are more expensive than urine or saliva tests and may be less accurate. Environmental factors, such as exposure to cannabis smoke, shampoo, hair treatments, and air pollution may influence the results.
Sweat drug test
Sweat tests are not very common. Drugs and their metabolites can collect in sweat, which is captured in a waterproof adhesive pad about the size of a playing card. The patch is worn for about a week or two, then removed and sent for analysis. Sweat patches are more expensive than urine tests and are considered more intrusive, because they must be worn for an extended period of time. Security features keep them from being removed and reapplied.
Blood drug test
Blood tests are the most expensive and intrusive, but also the most accurate. They are the least common form of drug test, due to their cost, invasiveness, and ability to only test recent drug use. Blood drug tests are usually done for clinical and diagnostic purposes, or in hospital emergency rooms (ERs) with a drug overdose. Blood tests can be performed on those who can’t willingly submit a urine sample, such as those who are severely intoxicated, comatose, or dead.
Why organizations perform drug tests and is it effective
Workplace Safety-Drug users can be a safety hazard to themselves, their co-workers, and the public. In Canada, workers who engage in safety-sensitive work can be drug tested by their employers.
Workplace Productivity-Small association with substance abuse and work related injuries. Alcohol and drugs may reduce workplace productivity, but there is no evidence that drug testing increases it.
Prevention of Drug Use-Results mixed.
In terms of the types of drug tests that occur in the workplace, _______ produced the lowest rate of positive tests and _______ testing produced the highest rate.
pre-employment testing; reasonable suspicion
Prevalence of addiction in Canadians
Millions of Canadians—more than 20 per cent over their lifetime—suffer from addiction.
Demographics of people getting drug addiction treatment in Canada
In 2016–2018 approximately 1 in every 200 adult Canadians was being treated for substance use—slightly more than 100,000 Canadians per year. Most prevalence order: alcohol, cocaine, cannabis, opioids, amphetamine-type stimulants, other substances. About two-thirds of individuals in treatment reported the use of at least two problem substances, suggesting widespread polysubstance use. The median age of those in treatment is mid-thirties, 62 per cent of those in treatment are male, and 38 per cent are female—a ratio that is similar for those in treatment both for alcohol use and for illicit drug use.
Stages of addiction recovery
Pre-contemplation (may believe they don’t have a problem), contemplation (not yet made a commitment to change but debating it), preparation (developing strategy), action, maintenance (being drug free and trying to reduce relapse), relapse or termination
Medical detoxification
A user goes through physical withdrawal from the drug and the body and brain readapt to its absence. First step in treatment
Pharmacological Treatments for Addiction for opioids, tobacco and alcohol
Opioids: methadone agonist, clonidine (Catapres), buprenorphine (Suboxone)
Opioids and alcohol: naltrexone (ReVia) block opioids euphoric effects, decrease alcohols intoxicating effects
Alcohol: LSD, ondansetron (Zofran) seratonin antagonist, disulfiram (Antabuse) makes alcohol unpleasant, oxytocin, acamprosate (Campral) restores the balance between excitatory (glutamate) and inhibitory (GABA) neurotransmission
Nicotine and alcohol: varenicline (Champix)
Nicotine: antidepressant bupropion (Zyban)
Difference between antagonist and agonist
An agonist is a molecule capable of binding to and functionally activating a target. The target is typically a metabotropic and/or ionotropic receptor. An antagonist is a molecule that binds to a target and prevents other molecules (e.g., agonists) from binding. Antagonists have no effect on receptor activity.
Immunopharmacotherapy
A drug “vaccine” would entail stimulating the production of drug-specific antibodies. If a person used that drug of abuse, the antibodies would bind to the drug in the blood and prevent it from crossing the blood brain barrier into the central nervous system, thus suppressing its addictive qualities. Progress has been made in creating vaccines for cocaine, nicotine, methamphetamine, PCP, and heroin.
The chemists working on developing a heroin vaccine had to create a multitarget vaccine “cocktail” with three components:
a large protein that carries drug-like molecules into the body, a molecule designed to make the body’s immune system respond to heroin as well as to its psychoactive metabolites, and an agent that stimulates the body’s immune cells to destroy invaders.
Inpatient Programs
Inpatient treatment centres include hospitals, clinics, and chemical dependence centres. Medical professionals assist the detox process, and individual and group therapy sessions address underlying psychosocial issues.
Outpatient Programs
Those who either do not need the intensity of an inpatient program, can’t afford the time or expense, or are employed or have extensive family or community support may consider outpatient options. These include intensive outpatient programs and individual, group, and family counselling.
In an intensive outpatient program, patients spend considerable time in comprehensive therapy sessions during the day—perhaps two to four hours a day for three days a week—but reside in their own homes at night
Self-Help Groups
Self-help groups are non-professional organizations that are peer-operated by people who share the same addictive disorder. Attendance is free, and members can attend indefinitely if they wish. Alcoholics Anonymous (AA) is one of the most popular self-help programs.
12 steps in AA
Step 1: Honesty about addiction
Step 2: Faith in a higher power
Step 3: Surrender to the higher power
Step 4: Take a personal inventory/soul searching
Step 5: Honestly admit your wrongdoings
Step 6: Acceptance and trust in your higher power
Step 7: Humility, asking higher power for help
Step 8: Make a list of people you’ve harmed
Step 9: Make amends
Step 10: Take responsibility
Step 11: Spiritual improvement
Step 12: Service to others
Characteristics of Effective Addiction Treatments
Must be accessible, last for an adequate time. address issues other than drug use, continually assess, mix of therapy and drugs, comorbid conditions addressed, treat/assess any infectious diseases, relapses must be monitored
Rates of relapse
Range from 40 to 80 per cent
Factors that increase a person’s risk of relapse
having less education, a lower likelihood of employment, fewer positive life events, less family and social support, more frequent and heavier AOD consumption, and more drug-related psychological and social problems
