Hasheeesh

الحشيشالحشيشسرحان وليد

CANNABIS FAMILYCANNABIS FAMILY

Cannabaceae contains two genera Cannabis Humulus (hop plant)

Resin used as a preservative and as a natural flavor in beer

3

CANNABISCANNABIS

Known as cannabis, hashish, hemp and marijuana

Marijuana – Cannabis sativaMarijuana – Cannabis sativa

Source of:Strong fiber for rope and paperNutritious fruitIndustrial oilMedicine

Cannabis Sativa is a fiber plantCannabis Indica is a resin plant

CANNABISCANNABIS

Male and female plants Female plants are better resin producers If female plant is not allowed to be

fertilized, it flowers but does not produce seeds – sinsemilla (spanish for “without seeds”)

Greatest resin producers

CANNABISCANNABIS

Resin contains Hallucinogenic compounds called

cannabinoids Delta-1 Tetrahydrocannabinol, also

known as Delta-1-THC THC

Major active compound in the cannabis plant

CANNABISCANNABIS How is it used?

Leaves and flowering tips are dried Smoked Consumed as tea Mixed into food

Resin from flowering heads Smoked Mixed with tobacco Alcohol extract (cannabis oil) is mixed

with tobacco and smoked

CANNABIS HISTORYCANNABIS HISTORY

4,000 BC - used as a medicine Rheumatism – loss of yin (female energy)

2,700 BC - Chinese emperor said “liberator of sin - good for female weakness, gout, rheumatism, malaria, beri beri, constipation and absent-mindedness”


1,400 BC - in India used to treat anxiety Bhang (drink from leaves) Ganja (dried resin)

1,200 BC - found in a Chinese burial site, also used for bow strings and paper (mixed with mulberry bark)


Folk medicine in Europe

• Germany - to treat seizures, aid in childbirth

• Poland - for toothache (seeds put on hot stones and vapors inhaled)

• Czechoslovakia - to treat fever

• Russia - to treat jaundice

• Serbia - as an aphrodisiac


1843 U.S. Medical

text, treatment

for

• Gout• Tetanus• Hysteria• Depression• Insanity• Dysentery

Al-Hasan ibn al-Sabbah Al-Hasan ibn al-Sabbah

By 1090 had established fortress on trade routes to China and India – ruled army of thieves whom he supplied with hashish and women in return for their loyalty

04/11/2023 12sarhan

Introduction to EuropeIntroduction to Europe

Europeans were introduced to Cannabis as a psychoactive plant by Napoleon’s soldiers after the conquest of Egypt in 1800. They began by consuming resin of Cannabis flowers and leaves (hashish).

Marijuana and cannabinoidsMarijuana and cannabinoids

Cannabis sativa, hempOne of earliest non-food plants cultivated fiber for rope, seeds for oil and birdseed

8000 BC 2700 BC 2000 BC 1000 AD 1850s 1996

1st archaeological evidenceof hemp use

Medical usein China

Ritual usein India

Hashish use inArab world

Westerm world find bioactiv.

Use semi-legal in CA/AZ

from Childers & Breivogel (1998)

CANNABINOIDSCANNABINOIDS

60 cannabinoids have been isolated from the hemp plant and there are

naturally occurring cannabinoids in most species called endocannabinoids,

in a similar fashion as endorphins (opiates) have been found.

CANNABINOIDSCANNABINOIDS There are two main receptors for

cannabinoids in humans CB1(in brain) if stimulated produces

Euphoria Impaired short term memory and sense

of time CB2 (in spleen, peripheral sites) if

stimulated produces Immunosuppressant activity Not psychoactive


Receptors have also been found in the

Cerebellum – body movement and coordination

Cortex – higher cognitive functions Nucleus accumbens – reward Basal ganglia – movement control Hypothalamus – body temperature,

salt and water balance, reproductive functions

Amygdala – emotional responses, fear

18

PREPARATION OF CANNABISPREPARATION OF CANNABIS

Marijuana Not a single drug

but a complex mixture of over 400 chemicals

Dried flowering tops and leaves of the plant

THC concentration 0.5% - 5% in the past, now up to 20 – 25%

Dried cannabis buds

19

PREPARATION OF CANNABISPREPARATION OF CANNABIS

Hashish – dried cannabis resin and flowers THC

concentration, 2 - 8% or higher

Pieces of Hash

Cannabis names

Bhang, black, blast, blow, blunts. Bob Hope, bush, dope, draw, ganja, grass, hash, hashish, hemp, herb, marijuana, pot, puff, Northern Lights, resin, sensi, sensemilla, shit, skunk, smoke, soap, spliff, wacky backy, weed, zero. pot, herb, grass, weed, boom, Mary Jane, gangster,

الحشاشين بين الحشاشين أسماء بين أسماء

صاروخحشيشماريواناماريجواناجوزه ملغومه سيجاره

Modern Water Pipe and HashishModern Water Pipe and Hashish

How is it Used? How is it Used?

Usually smoked as a cigarette rolled, hand-made (called a joint or a nail), in pipe or a bong. Has recently appeared in cigars called blunts and spliffs.

04/11/2023 23sarhan

Bob Marley and the Wailers Album Cover - 1973Bob Marley and the Wailers Album Cover - 1973

Cannabis smoker – Southeast AsiaCannabis smoker – Southeast Asia

Forms and preparationsForms and preparations

Marijuana mixture of leaves, stems, tops 1960’s: 1-3% THC; 1990’s: up to 8-10%

“Bubble Gum” “Big Bud” “Dutch Northern Lights”

Forms and preparationsForms and preparations

Hashish dried resin from top of female plant THC usually 2-5%, but up to 15%

Hash Oil organic extraction

from hashish THC usually ~ 10-20%

up to 70%

Concentration of THC variesConcentration of THC varies

Marijuana crushed dried leaves 5.2 %

Hashish dried cakes of resin 5-10 times concentration

Hash oil 80 %

Concentration of THCConcentration of THC

Sinsemilla -flowering part of unfertilized female plant 13.4%

Marijuana typically smoked as joints, blunts or water pipes

http://images.google.ca/imgres?imgurl=http://egyptian-hand-blown-glass-hookah-water-pipes.com/images/large/Egyptian-Hand-Blown-Glass-Hookah-Water-Pipe-3131_20_2_5_1_4_11_002.JPG&imgrefurl=http://egyptian-hand-blown-glass-hookah-water-pipes.com/&h=1632&w=1224&sz=179&hl=en&start=4&tbnid=nClV1d1S67f-GM:&tbnh=150&tbnw=113&prev=/images?q=water+pipe&gbv=2&svnum=10&hl=en

32

CANNABISCANNABIS

Routes of marijuana administration Joints

Average is 500 mg of marijuana

inside of rolling papers 20% - 50% of the THC makes it

into the bloodstream Blunts (marijuana in hollowed out

cigar) 6 times the amount of marijuana 20% of the THC makes it into the

bloodstream

CANNABISCANNABIS

Routes of marijuana administration Pipes

Stone, ceramic or glass 50% of the THC makes it into the

bloodstream Water pipes

Bongs – most efficient 90% of the THC makes it into the

bloodstream

CANNABIS KINETICSCANNABIS KINETICS

THC mechanism

of action

• Peripheral and central effect

• Low dose :Mixture of depression and stimulation

• High dose :CNS depression


Typical joint

• 0.5 - 1 gram cannabis• THC concentration 5 -

150mg• 20 to 70% of THC is

delivered in the smoke• Lipid soluble so

deposited into fat tissue


80 probable biologically inactive metabolites of THC

11-hydroxy - THC is the primary active

metabolite

THC is eliminated in the feces and 33% in

the urine


SMOKING three cannabis joints will cause you to inhale the same amount of toxic chemicals as a whole packet of cigarettes.


Oral use Psychoactive effects slowed to about one

hour Absorption is erratic High is less intense, but lasts longer than

if smoked IV use

Water insoluble so cannot be injected

Metabolism and clearanceMetabolism and clearance

rapid initial drop due to redistribution to fats slower metabolism in liver metabolites may persist for a week

1. Primary metabolic product of 9-THC (11-OH-9-THC) is more potent than 9-THC 2. Delay between peak plasma levels and “high”

Major biologically active compound may be metabolite


Desired effects of the user

• Sense of well being• Relaxation• Euphoria• Modified level of

consciousness• Altered perceptions• Intensified sensory

experiences• Altered time sense• Sexual disinhibition

41

PHARMACOLOGIC ACTIONSPHARMACOLOGIC ACTIONS

Psychomotor effects Object distance

distortion Object outlines

distorted Inability to make

rapid judgment Slowed reaction time Impaired tracking

behavior Slowed time

perception

All are dose-related

PHARMACOLOGIC ACTIONSPHARMACOLOGIC ACTIONS “Amotivational Syndrome”

Tolerance to marijuana was supposed to be a manifestation of desensitization of brain cells, was supposed to create an amotivational syndrome characterized by apathy and inactivity.

.

Cannabis and Motor Function: fMRI Changes Following 28 Days of Discontinuation

Cannabis and Motor Function: fMRI Changes Following 28 Days of Discontinuation

The results suggest that residual diminished brain activation is still observed 28 days after discontinuing cannabis use in motor cortical circuits.

Source: Experimental and Clinical Psychopharmacology Volume 16, Issue, Feb. 2008, Pages 22-32.

Effects on behaviorEffects on behavior

Low - moderate

doses

• disinhibition, relaxation, drowsiness

• feeling of well being, exhileration, euphoria

• sensory - perceptual changes

• recent memory impairment

• balance/stability impaired

• decreased muscle strength, small tremor

• poor on complex motor tasks (e.g., driving)

Effects on behaviorEffects on behavior

High doses

• pseudohallucination• impaired judgment,

reaction time• pronounced motor

impairment• increasingly

disorganized thoughts, confusion, paranoia, agitation

46


Increased focus on taste

Increased appetite (street slang - ”munchies”)

Dry mouth


Cognitive effects may be

due to a reduction in blood flow to

the brain - seen even 30 days

after last use in heavy

smokers.

• Impaired short-term memory• Especially

verbal IQ• Impaired

attention• Impaired

integration of complex information


Psychomotor effects

Behavioral effects

Cognitive effects

Effects of Exposure During PregnancyEffects of Exposure During Pregnancy

Babies display altered responses to visual stimuli, increased tremulousness, and a high-pitched cry.

During the preschool years, marijuana-exposed children have been observed to perform tasks involving sustained attention and memory more poorly . In the school years, these children likely to exhibit deficits in problem-solving skills, memory, and the ability to remain attentive.

Fried PA, Makin JE. Neonatal behavioral correlates of prenatal exposure to marihuana, cigarettes and alcohol in a low risk population. Neurotoxicology and Teratology 9(1):1–7, 1987.

Lester BM, Dreher M. Effects of marijuana use during pregnancy on newborn crying. Child Development 60(23/24):764–771, 1989.Fried PA. The Ottawa prenatal prospective study (OPPS): Methodological issues and findings. It’s easy to throw the baby out with

the bath water. Life Sciences 56(23–24):2159–2168, 1995.Fried PA, Smith AM. A literature review of the consequences of prenatal marihuana exposure: An emerging theme of a deficiency in

aspects of executive function. Neurotoxicology and Teratology 23(1):1–11, 2001.

Cannabis and SchizophreniaCannabis and Schizophrenia

Cannabis use can precipitate schizophrenia

Cannabis can exacerbate schizophrenia

But were these people susceptible and likely to develop this illness in time anyway?

ADDICTION LIABILITYADDICTION LIABILITY

9% of those who ever used become dependent

Dependence associated with gradual increase in use

ADDICTION LIABILITYWithdrawal difficult to demonstrate

ADDICTION LIABILITYWithdrawal difficult to demonstrate

10 hour onset and 5 day duration Anxiety Mental clouding Insomnia Anorexia Irritability Tremor Depression Headache Craving

ADDICTION LIABILITYADDICTION LIABILITY

71% of marijuana users relapse to marijuana use within 6 months after achieving initial 2 weeks of abstinence

Cannabis Use and Later Life OutcomesCannabis Use and Later Life Outcomes

The increasing cannabis use in late adolescence and early adulthood is associated with High levels of cannabis use are related to poorer educational outcomes, lower income, greater welfare dependence and unemployment and lower relationship and life satisfaction.

Source: Fergusson, David M.; Boden, Joseph M.; Addiction Volume 103, Number 6, June 2008 , pp. 969-976(8).

TOXICITY AND ADVERSE EFFECTSTOXICITY AND ADVERSE EFFECTS

Mental health issues have been seen to co-occur in users. Transient panic and anxiety Depersonalization Bizarre behavior Delusions Hallucinations Acute mania Acute paranoia Depression Psychosis Aggression


MENTAL HEALTH ISSUES

• Depression• -Psychosis• -Panic

disorder• Amotivational

syndrome

TOXICITY AND ADVERSE EFFECTSIMMUNE SYSTEM

TOXICITY AND ADVERSE EFFECTSIMMUNE SYSTEM

CB2 receptors

on immune system cells =

immune modulation

• Decrease macrophage function

• Decrease killer cell function

• Increase in HIV - 1 host infections


CARDIOVASCULAR SYSTEM

• Increase heart rate

• Decrease blood pressure

• Increase myocardial infarction risk


PULMONARY

• Tracheitis (inflammation of the trachea)

• 3 cannabis cigarettes = 20 tobacco cigarettes with significantly more carcinogens


REPRODUCTIVE / ENDOCRINE

SYSTEM

• Alters pituitary hormones

• Decreases prolactin • Decreases growth

hormone• Decreases

luteinizing hormone• Galacctorhea • Decrease

testosterone in males

• Decrease sperm production

• Decrease sperm motility


Increase drowsiness if used with tricyclic antidepressants

Heavy sedation if used with benzodiazepines

Alcohol toxicity causes vomiting due to an increase in acetaldehyde. Marijuana anti-emetic effect can

suppress the chemo-trigger point and lead to severe alcohol toxicity

Multiple cavities in youth?

Potential medical

uses

• Glaucoma • Antiemetic• Anticonvulsant• Enhance

appetite (e.g., AIDS patients)

• Analgesic

• THC versus marijuana controversy?

MEDICAL USESMEDICAL USES

Overall problems

of use

• Mode of administration

• No standard dose of smoked marijuana

• Smoke is hazardous in and of itself

• Smoking may impair immune system response

• Difficulty concentrating on complex tasks

• Slowed reaction times• Tolerance develops

quickly• Effect is 4 - 6 hrs

MEDICAL USESMEDICAL USES

Overall problems

of use

• Chronic bronchitis can develop

• Pharyngitis can develop

• Large airway obstruction can be seen

• Acute panic reactions can develop

• Acute paranoia can develop

• Heart rate increases 20 - 100% for 2 - 3 hrs

• Decreased blood pressure seen with use

Warning Signs Parents Should Look For…Warning Signs Parents Should Look For…

Increasing agitation and irritability

Loss of motivation and interest in previously enjoyed activities

Decreased attention span and increased distracted behavior

Red or glassy eyes, extreme fatigue, and poor health

A loss of motivation and interest in previously enjoyed activities

Assessment of cannabis useAssessment of cannabis use

Quantity and frequency of use

Presence of dependence

Predisposing factors, e.g. psychiatric illness, other

substance misuse

Complications : physical, psychological and social

Clinical features of dependenceClinical features of dependence

Withdrawal syndrome: common in users seeking help

Compulsive use: common in problem users

-Tolerance

Large amounts of day spent using (salience)

Continued use despite clear evidence of harm:

May continue use despite self reported paranoia, or past exacerbation of schizophrenia; despite social conflict arising from use, wheeze; all known to be

associated with use

Prevalence of dependencePrevalence of dependence

2-4% of the general population

9% of lifetime users

33-50% of daily users become dependent

WithdrawalWithdrawal

Symptoms (rarely life-

threatening):

• irritability, anger• restlessness,

anxiety• sleep difficulties,

including strange dreams

• craving, weight/appetite change, depressed mood, physical discomfort

Drug testsDrug tests

Cannabis and its active ingredient THC is tested for in most drug tests. After one-off or occasional use its break-down products or metabolites can be detected between 3-5 days after use


However, THC can be detected in a chronic user up to 12 weeks after use , although the average is 25 -27 days


Cannabis is highly detectable a long time after use because THC lingers in the fatty tissues of the body and leaks steadily into the blood and then the urine over weeks


passive inhalation should be seriously considered as a possible explanation for a positive urine test for marijuana, although he noted that passive inhalation does not have a major effect outside the laboratory

Salivary testsSalivary tests

After smoking a single cigarette containing 11mg THC, salivary THC levels substantially exceeded 100ng/ml for the first hour after smoking, with levels over 10ng/ml persisting for up to 4 hours

Blood TestingBlood Testing

Cannabis is detectable in the blood for approximately 2-3 days after use in an infrequent user. Frequent use can be detected in the blood for approximately 2 weeks.


Most urine tests only detect an inactive metabolite - THC carboxylic acid. The results for cannabinoid metabolites in urine are of no significance whatsoever in determining intoxication or performance impairment

Hair TestingHair Testing

Cannabis use is detectable with hair tests and is generally included in the standard hair test. That provides a detection period of approximately 90 days.

Substances or Conditions which can cause false positivesSubstances or Conditions which can cause false positives

-Ibuprofen-Naproxen

-Ketoprofen -Promethazine -Pantoprazole

-Riboflavin - Kidney infection

Adverse consequences of dependenceAdverse consequences of dependence

Withdrawal

Physical complications: e.g. respiratory symptoms

Impaired memory

Poor work performance

Criminal involvement

Social disapproval

Demand for treatmentDemand for treatment

Fewer than 10% seek any treatment Why so few?

high rates of remission? fewer short term consequences? existing treatment services unattractive?

Treatment optionsTreatment options

Self-help

Mutual support

Brief interventions

Psychotherapy

Pharmacotherapy

Goals of psychotherapyGoals of psychotherapy

Reviewing benefits of cutting down/stopping

Reviewing harms of continued use

Identifying likely risk times for using

Discussing means of avoiding risk situations

Setting realistic goals

Societal Effects Societal Effects

Society sends kids mixed messages about alcohol, tobacco, and other drugs

Kids see and hear messages intended for adults – misinterpret them as being for kids

As far as Media is Concerned…As far as Media is Concerned…

Carefully planned mass media campaigns can reduce substance

abuse

Also by influencing personal beliefs that motivate drug use

Having media programs work in conjunction with other

community drug programs

What parents could do to help…What parents could do to help…

Be good role models.

Stay involved with your children

Educating children about drugs.

The proposal for JORDANThe proposal for JORDAN

The national forum for drug addiction

Thank youThank you

www.walidsarhan.net

Hasheeesh

Education

Transcript of Hasheeesh