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Psychology & Neuroscience of Addiction > Focus on Cannabis policy > Flashcards

Focus on Cannabis policy Flashcards

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1
Q

What is the principle ingredient of cannabis that was identified in 1964?

A

THC

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2
Q

Why is there controversy on the optimal policy approach for cannabis?

A

Health effects of cannabis are less known, compared to alcohol and tobacco

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3
Q

Why do we currently know less about cannabis than alcohol or tobacco?

A

> Illegal status of cannabis has tampered research on potential medical benefits

> Cannabis is less harmful than other illicit drugs such as cocaine and heroin

> Most people stop using cannabis on their own when entering adulthood

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4
Q

How have cohort trends in cannabis use evolved?

A

> 1940-44: 2% of cohorts used cannabis at age 21

> 1975-79:v 60% of cohorts used cannabis at age 21
- AND younger cohorts reporting cannabis use

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5
Q

What are the cannabis use disorders in the ICD and DSM?

A
  • Cannabis misuse
  • Cannabis dependence

Criteria similar to other diagnoses

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6
Q

What is the prevalence of cannabis use disorders in most countries?

A

Most prevalent illicit drug use disorder in most countries

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7
Q

What are the peak age periods for cannabis use disorders?

A
  • Adolescence

- Young adulthood

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8
Q

Is there a cannabis withdrawal syndrome in the nosographies?

A

Withdrawal syndrome in cannabis use disorders recently added in DSM

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9
Q

What is the prevalence of withdrawal symptoms?

A

One of the most frequently reported symptoms of dependence: 30%

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10
Q

What is the association between cannabis and schizophrenia?

A

> Reasonable evidence cannabis use exacerbates schizophrenia

> Consistent evidence cannabis use can precipitate schizophrenia

  • consistent risk ratio of 2 (2-fold increase)
  • attributable risk to schizophrenia cases: 13%
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11
Q

What is the evidence of biological plausibility of the cannabis-schizophrenia association?

A
  • Cannabinoid-dopamine interaction

- Provocation studies induce transient psychotic symptoms

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12
Q

What does Denise Kandel’s Stage theory on cannabis use (1992) propose?

A

Invariant sequence of drug use:
- cannabis precedes use of other drugs

BUT it does not mean causation

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13
Q

What is the current evidence on the causality between early cannabis use and subsequent use of other drugs?

A

Several studies have not been able to invalidate the possibility that early onset cannabis use may increase risk for subsequent use of other illicit drugs

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14
Q

Which pharmacological mechanisms could explain the potential association between early onset cannabis use and subsequent use of other illicit drugs?

A

> Cannabis and heroin have similar effects on dopamine neurotransmission

> Chronic treatment with THC induces cross-tolerance to amphetamine and opioids in rats

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15
Q

Which evidence invalidates the pharmacological explanation for association between early onset cannabis use and subsequent use of other illicit drugs?

A

Amount of THC inhaled by humans is significantly lower than dosage administered to rodents in experiments

  • between 5000 and 25000-fold lower
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16
Q

What could explain the association between early onset cannabis use and subsequent use of other illicit drugs?

A

> Initial experiences with cannabis rated as pleasurable

> Early experiences with cannabis perceived as safe

> Access to cannabis may provide access to other drugs

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17
Q

Which argument led the Netherlands to decriminalise cannabis in the 1970s?

A

Access to cannabis may provide access to other illicit drugs

18
Q

Is cannabis the only drug with which early onset use is associated to subsequent use of other illicit drugs?

A

Similar associations for alcohol and tobacco

  • early use associated to subsequent use of cannabis and other illicit drugs
19
Q

What is the state of evidence on the association between cannabis use and motor vehicle accidents?

A

> Only 9 studies could be included in recent meta-analysis

> Very little empirical evidence about effects of cannabis use on motor vehicle accidents

20
Q

What does the recent analysis of Asbridge and colleagues (2012) show about the association between cannabis use and motor vehicle accidents?

A

Driving under influence of cannabis increase by 2-fold the risk of having a motor vehicle accident

  • 2.5% of traffic deaths in France
21
Q

What is the rank of cannabis use as actual cause of death in the United States in 1990 and 2000, compared to tobacco and alcohol?

A
  • First is tobacco
  • Illicit drug use is 9th
  • > not even cannabis use specifically
22
Q

What is the evidence on the adverse effects of cannabis use?

A

Insufficient evidence

23
Q

Why is there insufficient evidence on the adverse effects of cannabis use?

A
  • Low number of studies assessing whether all cause mortality rate is elevated among heavy cannabis users in general population
24
Q

What is the prevalence of dependence in tobacco and alcohol use compared to cannabis use in the general population?

A

Dependence is more prevalent in alcohol and tobacco use compared to cannabis use

25
Q

Is alcohol more associated to motor vehicle accidents than cannabis?

A

Yes

> Cannabis:

  • 2 to 3-fold increase in risk of MVA
  • 2.5% traffic deaths in France

> Alcohol:

  • 6 to 15-fold increase in risk of MVA
  • 29% traffic deaths in France
26
Q

What is the contribution of cannabis, alcohol and tobacco to the burden of disease, in terms of DALYs?

A
  • Cannabis: 0.2% of DALYs
  • Alcohol: 2.3% of DALYs
    (10x higher than cannabis)
  • Tobacco: 7.8% of DALYs
27
Q

What limits the conclusions on population level harm from cannabis?

A

Current patterns of cannabis use:
- cannabis used by fewer people and less frequently than tobacco and alcohol

-> Sparse body of research

28
Q

What is the dominant policy approach to cannabis use?

A

Possession and supply of cannabis is ciminalised

29
Q

What are the key criticisms against the illegality of cannabis possession and supply?

A

> Social justice

> Costs of justice system

> Illegal status may create barriers for those seeking treatment

> Illegal status may add attractiveness of cannabis amongst youth

30
Q

What are the current policy alternatives on cannabis?

A

> Cannabis caution notices

> Commercial provision of cannabis (Colorado)

> Medical marijuana

> Legalisation

31
Q

What led the state of Colorado to legalise cannabis?

A

Referendum

-> supplying and using cannabis for recreational purposes is legal

32
Q

What were the advantages of the legalisation of cannabis in Colorado?

A
  • Reduction of legal problems for users
  • Reduction in costs of criminal justice system
  • Cannabis and other illicit drug trades separated
  • > eliminating ‘gateway effect’ of cannabis (engages subsequent use of other drugs)
  • Reduction in stigma to facilitate help-seeking
33
Q

What is the gateway effect of a drug?

A

When use of a drug initiates the subsequent use of other drugs

34
Q

How can the price of legalised cannabis be managed?

A

Taxation as benefit to state finances

35
Q

What limits the taxation of legalised cannabis?

A

Need to undercut the illegal market:

- set inferior price

36
Q

How can legalised cannabis be innovated?

A

Product diversification:

  • edibles
  • cannabinoid infused liquids
  • increasing potency
37
Q

What are the advantages to innovated legal cannabis products?

A

> Development of non-smoking routes of administration

> Increased use of vaporisers in ‘medical marijuana’ states

> Consistent quality and known THC concentrations

38
Q

How can clear labelling of legalised cannabis products combat the adverse effects of cannabis use on mental health?

A

> Recent research: Cannabidiol (CBD) may protect against adverse effects of cannabis

  • particularly related to psychosis
  • risk of psychosis associated with ‘skunk’ (high THCm low CBD)

> Brands with high levels of CBD would reduce risk of psychosis

=> health benefits of legal cannabis market

39
Q

What are the epidemiological consequences of legalised cannabis?

A

> Expected increase in cannabis use

> Expected increase in frequency among established users

> Problems may increase with higher frequency of use

> Problems may decline if these problems are related to illegal status of cannabis

> Reduction in barriers to treatment-seeking

40
Q

If cannabis is legalised, what would happen whether it is a complement or a substitute for alcohol?

A

Cannabis legalisation

  • if it’s a complement -> encourage alcohol use
  • if it’s a substitute -> decrease alcohol use
41
Q

What would be the components of an optimal policy to regulate a legal cannabis market?

A

> Heavily taxed

> Limit on sales

> Advertising ban

> Undercut potential black market

> Product control

  • on potency
  • content ratio between THC and CBD

Psychology & Neuroscience of Addiction (14 decks)

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