Overview of presentation Update knowledge on cannabis

Overview of presentation § Update knowledge on cannabis, particularly within the Australian context § Cannabis – facts or fiction? § Introduce NCPIC § Show the DVD - Cannabis Facts: Clearing the Smoke

How much do you know about cannabis? § Complete the pre-test § If you don’t know the answer, please tick ‘don’t know’ rather than guess the answer § We’ll go through the correct answers at the end of the presentation

Patterns of cannabis use in Australia 2007 National Drug Strategy Household Survey (AIHW, 2008) Most commonly used illicit substance in Australia § 1 in 3 have ever used it § 1 in 10 have used it in the last year (‘recent use’) § 1 in 15 in the last month and 1 in 22 in the last week Much higher rates of use amongst Aboriginal and Torres Strait Islander peoples Average of initiation – 18. 7 years § in 1995, age of initiation was 19. 1 years Approximately 1 in 5 young Australians have ever used

Prevalence rates around the country Frequency order 1. Northern Territory 2. Tasmania 3. Western Australia 4. South Australia 5. Queensland 6. ACT 7. Victoria 8. New South Wales

Lifetime cannabis use, Australian secondary school students, 1996 -2008 ASSAD Surveys %

Principal drug of concern Number of treatment episodes Alcohol and other drug treatment services in Australia 2008 -09: Report on the National Minimum Data Set

So what are some of the major concerns about cannabis use in Australia?

Major concerns § Heavy use of cannabis by young people (particularly those under age of 16) § Use of cannabis by Aboriginal and Torres Strait Islander peoples § Long-term respiratory harms associated with cannabis use § Confusion about cannabis potency § Cannabis dependence and withdrawal § Cannabis and mental health

Problems associated with adolescent cannabis use Research shows using cannabis during adolescence increases the risk of: § experiencing mental health problems § up to 6 x the risk of developing schizophrenia § earlier on-set of psychosis by up to 2. 7 years § dropping out of school § becoming dependent on cannabis § having deviant peer affiliations and displaying antisocial behaviour § using other drugs § attempting suicide § participating in criminal behaviour § reduced life opportunities

Aboriginal and Torres Strait Islander peoples’ cannabis use National Aboriginal and Torres Strait Islander Health Survey (NATSIHS) 2004/5 § 19. 1% lifetime use § 9. 1% previous year 2004 survey rural community (Arnhem Land, NT) § 69% of the males, 26% of the females had ever used § 67% of the males, 22% of the females had used it in the last month (among 336 13 -36 -year-olds) 2007 National Drug Household Survey § almost one in four Indigenous Australians had used cannabis in last year

Aboriginal and Torres Strait Islander peoples’ cannabis use The limited available data suggests: § higher rates of use and dependence especially among rural communities § Indigenous secondary school children significantly more likely to use, more susceptible to initiating use, used more frequently § more harmful ways of using cannabis (e. g. , ‘bucket bongs’) § Indigenous communities have expressed concerns about; high proportion of income spent on cannabis, community violence related to supply, child neglect, sexual exploitation, declining participation in community life, reduced participation in education and training

Respiratory harms § Cannabis is primarily smoked – with cannabis smoke being similar to tobacco smoke with regard to respiratory harms § Almost two thirds of all Australian cannabis smokers mix tobacco with their cannabis (‘mull’) § Harms appear to be additive for those that use both tobacco and cannabis

Respiratory harms § Cannabis smoke contains 3 times more tar and 5 times more carbon monoxide than a standard cigarette (1 bong/joint equal to 3 -5 cigarettes in lung damage) § Cannabis smokers tend to inhale deeper and hold the smoke up to four times longer in their lungs § Cannabis has a higher combustion temperature and burns hotter on the throat and mouth

‘Bongs’ Many people use bongs as they believe: § it is a more economical way to use cannabis § it provides a bigger ‘hit’ § it provides a smoother inhalation Research shows that bongs do not reduce exposure to tar, carbon monoxide or provide deeper inhalation § using a plastic bong results in exposure to the by-products and petro chemicals caused by heating the implement Vapourisers also expose users to potentially neurotoxic amounts of ammonia

Cannabis potency Many believe that cannabis has become much stronger – mainly due to hydroponically grown cannabis becoming increasingly available It is now believed to be twice as strong as it once was, due to the following factors: § genetic (selected seed varieties and cultivation of female plants) § variation in cannabinoids and concentration of THC, CBN, etc § environmental (cultivation techniques, prevention of fertilisation and seed production) § freshness (the risk of storage degradation of THC is less likely today) Most importantly, we need to remember that users are now smoking the stronger part of the plant (heads/buds), more often

Taxonomy of cannabis Cannabis sativa Cannabis indica Cannabis ruderalis

THC and other cannabinoids Cannabis sativa contains around 500 compounds § approximately 80 are cannabinoids, some of which provide the psychoactive effect THC – delta-9 tetrahydrocannabinol has the strongest psychoactive effect § THC content commonly used as measure of potency § effect of cannabis may depend not only on THC content but on the presence of other cannabinoids such as: § cannabidinol (CBD) not psychoactive but has anti-anxiety properties § cannabinol (CBN) mildly psychoactive § cannabinodial (CBDL) mildly psychoactive

Cannabis dependence § People can become both psychologically and physically dependent on cannabis § Prevalence rates amongst those who ever try cannabis are around 9 -15% (about one in ten) § Risk increases the more often cannabis is smoked § Early initiation is linked with progression to heavy use and dependence

Withdrawal symptoms Generally last 1 -7 days § § § anger, aggression, irritability anxiety/nervousness decreased appetite restlessness sleep difficulties including strange dreams Less common symptoms § § § chills depressed mood stomach pain/physical discomfort shakiness night sweats

Cannabis and mental health There continues to be considerable debate in the literature about the links between cannabis and mental health Some people experience very unpleasant psychological effects when they use cannabis such as: § severe anxiety or panic attacks § or with higher doses – confusion, delusions and hallucinations Symptoms more likely to be felt by people who aren’t used to the effects or have smoked more then they are used to § they usually do not last and many of these people try once or twice and never use again due to this effect

Cannabis-induced psychosis A short-lived psychotic disorder that: § can last up to a few days § is often characterised by hallucinations, delusions, memory loss and confusion § usually results from prolonged or heavy cannabis use § responds well to treatment The association between cannabis use and psychosis is stronger for those who start using early and use heavily § peak age range during which males are more vulnerable to developing a psychosis is 18 -30 years of age

Cannabis and schizophrenia Schizophrenia is characterized by the person having difficulty distinguishing what is real from what is not real. They may also experience: § hallucinations or delusions § muddled thinking and speech Cannabis may trigger schizophrenia in those who have a family history Early and heavy use of cannabis are factors associated with up to six times the risk of developing schizophrenia

Cannabis and depression The link between cannabis and depression is not clear cut but people who use cannabis - particularly early, regular and heavy users – are more likely to develop depression § young women appear to be more likely affected The relationship between cannabis use and suicide among adolescents is mixed § although an elevated risk factor appears to be heavy use under the age of 15

Cannabis and anxiety Anxiety and panic attacks are among the most common negative reactions to cannabis reported by users There is concern that cannabis may exacerbate longer lasting forms of anxiety disorders such as panic disorder Many longer term users report that they continue to use cannabis because it relieves unpleasant feeling states such as anxiety and depression

Cannabis and mental health: summary Cannabis use may not be directly associated with the more prevalent mental health problems – an indirect association is possible and there needs to be more research to be certain A younger age of initiation to cannabis use is likely to increase the risks of mental-health problems substantially Chronic heavy cannabis use can lead to psychotic symptoms in vulnerable individuals, symptoms usually recede after stopping Cannabis may precipitate schizophrenia in vulnerable individuals and continued use worsens prognosis

NCPIC website The NCPIC website contains upto-date cannabis-related information in the form of fact sheets, as well as PDFs of all print resources Future web-based interventions will also be delivered from the site: www. ncpic. org. au

NCPIC website: Young people The NCPIC website has also developed a young people’s section – providing information from a prevention perspective. Some of the topics covered include psychosis, dependence, sniffer dogs, cannabis and driving, joints vs bongs, etc 9 young people and their experiences with cannabis – real-life stories and a series of questions that relate

Cannabis and driving One of NCPIC’s major education projects has been targeting cannabis and driving § § § young people are less likely to drink and drive than their parents they know the risks involved and are aware of the legal consequences the result is a change in behaviour research suggests that ‘smoking and driving’ is becoming more prevalent poster and support materials launched in August 2009

Cannabis and sport Linking in with the AGDHA’s ‘Drugs and Sport’ Campaign – a poster was designed highlighting the negative effect of cannabis on sporting performance – once again, a message widely supported NCPIC partnered with five of the seven sports that signed up to the AGDHA’s Club Champions Program for their endorsement and assistance with rolling out the poster and supporting materials q AFL, FFA, RUPA, ACA and the NRL

Aboriginal and Torres Strait Islander peoples Cannabis: it’s not our culture www. notourculture. org. au

Cannabis Facts: Clearing the Smoke

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Thanks for listening Any questions? Remember: Cannabis Help Line 1800 30 40 50 Presentation prepared by Annie Bleeker, NCPIC