Marijuana

Marijuana

Marijuana consists of the dried and crushed leaves, flowers, stems, and seeds of the Cannabis sativa plant.

THC (delta-9-tetrahydrocannabinal) is the primary mind-altering ingredient in marijuana.

Derivatives of the cannabis plant

Hashish Ave. concentration of THC is 2% to 8%

Ganja Consists of the dried tops of female plants

SinsemillaAve. concentration of THC is 7.5%

Bhang Ave. concentration of THC is 1% to 2%

Drug Effects on Neurotransmission: LSD

Serotonin receptorStimulates some receptors (agonist)Blocks other receptors (antagonist)

? Questions and Answers ?

Q. Today marijuana is how many times more potent than the marijuana on the street in the 1960s and 1970s?

A. 20 times more potentQ. How many Americans are current

marijuana users?A. 20 million Americans

Drug Effects on Neurotransmission: THC

Binds receptors in nucleus accumbens (and other sites in the brain such as the hippocampus– memory) and increases dopamine release

THC Receptor Sites in the Brain

Behavioral effects

Low to moderate doses produce euphoria and a pleasant state of relaxationCommon effects: dry mouth, elevated heartbeat, some loss of coordination and balance, slower reaction times, reddening of the eyes, elevated blood pressure A typical high last from 2 to 3 hours, and user experiences altered perception of pace and time, impaired memory

Behavioral effects

An acute dose of cannabis can produce adverse reactions: mild anxiety to panic and paranoia A few rare cases exhibit psychoses, delusional and bizarre behavior, and hallucinations. These reactions occur most frequently in individuals who are under stress, anxious, depressed or borderline schizophrenic

Behavioral effects

A subjective euphoric effect associated with marijuana use is the “ongoing social and psychological experiences incurred while intoxicated with marijuana. It includes both the user’s altered state of consciousness and his or her perceptions while intoxicated.”

- “connoisseurs” - differential reinforcement

Driving performance

The ability to perform complex tasks, such as driving, is strongly imparted while under the influence of marijuana In limited surveys, from 60% to 80% of marijuana user indicate that they sometimes drive while high. In a study conducted in the Boston area, marijuana smokers were overrepresented in fatal highway accidents

Critical thinking skills

Marijuana has been found to have a negative impact on critical thinking skills Impairment can affect:

attention, memory, learning

The unresolved question is whether these impairments are short-term or long-term

Amotivational syndrome

Amotivational syndrome characterizes regular users of marijuana who experience a lack of motivation and reduced productivity. Specifically, users show apathy, a poor short-term memory, difficulty in concentration, and a lingering disinterest in pursuing goals. Does marijuana or other factors create this syndrome?

Physiological effects

Cardiovascularsystem

Sexual performanceand reproduction

Respiratorysystem

Centralnervous system

Therapeutic uses

Marinol - indicated for treatment of nausea and vomiting in cancer patients Anorexia in AIDS patients Glaucoma Antiasthmatic drug Muscle relaxation Antidepressant Analgesic

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..CannabinoidReceptors

Cannabinoid Receptors Are Located in Many Areas Throughout the Brain and Play An Important Role In Regulating:

Cannabinoid Receptors Are Located in Many Areas Throughout the Brain and Play An Important Role In Regulating:•Brain Development•Memory and Cognition•Motivational Systems • & Reward•Appetite•Immunological Function•Reproduction•Movement & Coordination•Pain Regulation • & Analgesia

•Brain Development•Memory and Cognition•Motivational Systems • & Reward•Appetite•Immunological Function•Reproduction•Movement & Coordination•Pain Regulation • & Analgesia

Source: Ibrahim, M.M. et al., PNAS, 100(18), pp. 10529-10533, September 2, 2003.Source: Ibrahim, M.M. et al., PNAS, 100(18), pp. 10529-10533, September 2, 2003.

Selective CB2 Cannabinoid Receptor Agonist (AM1241) Dose-Dependently Inhibits

Sensory Hypersensitivity in Rats

Selective CB2 Cannabinoid Receptor Agonist (AM1241) Dose-Dependently Inhibits

Sensory Hypersensitivity in Rats

Basic ResearchBasic Research

Cannabinoid Antagonists Have Been Shown to Block Major Triggers of Drug Relapse

Cannabinoid Antagonists Have Been Shown to Block Major Triggers of Drug Relapse

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10

20

30

40

50

60

70

80

90

Coc

aine

-See

king

Res

pon

ses

(per

120

min

)

Impact of SR141716 on Response to Cocaine-Related Cues

Impact of SR141716 on Response to Cocaine-Related Cues

Treatment ResearchTreatment Research

Cannabinoid Antagonist

Blocks Cocaine-Seeking

in Response to Cocaine-

Related Cues in a Dose-

Dependent Manner

Cannabinoid Antagonist

Blocks Cocaine-Seeking

in Response to Cocaine-

Related Cues in a Dose-

Dependent Manner

Source: De Vries, T.J., & Shaham, Y. et al., Nature Medicine,7(10), 2002.Source: De Vries, T.J., & Shaham, Y. et al., Nature Medicine,7(10), 2002.

0 0.3mg/kg

1.0mg/kg

3.0mg/kg

SR141716 Dose

Marijuana Use Disorders in the United States: 1991-1992 and 2001-2002

Wilson M. Compton, M.D., M.P.E.Director, Division of Epidemiology, Services and

Prevention ResearchNational Institute on Drug Abuse

Department of Health and Human ServicesMay 5, 2004

American Psychiatric Association Annual Meeting

Background

A great deal of information about trends in use of drugs is available, but no data provides reliable and valid measures of drug disorders over the past decade.

BackgroundWith data from two large household surveys of the U.S. adult population, this study seeks to answer the following questions:

1. What are the rates of marijuana abuse and dependence in 1991-1992 compared to 2001-2002?

2. Have the relationships of age, race/ethnicity or gender to marijuana abuse and dependence changed during this period?

Methods

Studies:

Large studies of the U.S. non-institutionalized household adult (18+) population conducted by the Census Bureau.

NLAES: National Longitudinal Alcohol Epidemiologic Study (N = 42,862)

NESARC: National Epidemiologic Study of Alcohol and Related Conditions (N = 43,093)

Methods

Interview:

AUDADIS: Alcohol Use Disorder and Related Disabilities Interview Schedule - DSM-IV Version

Specific measures of each criterion of abuse and dependence on marijuana

Reliability and validity well-established

Methods

Outcomes

Marijuana use, abuse and dependence in overall population and by age, race/ethnicity and sex

Marijuana abuse and dependence among marijuana users by age, race/ethnicity and sex

Results: Total Population

4.01.2

30.2

4.11.5

35.6

05

10152025303540

Use Abuse/Dependence Abuse/Dependencein Users

NLAES 1991-1992 NESARC 2001-2002

= p < .05

%

Results: Total Population

Comparing 1991-1992 to 2001-2002:

• Marijuana use rates were virtually the same: 4.0% versus 4.1%

• Marijuana abuse or dependence increased from 1.2% to 1.5% (p = .014)

• Marijuana abuse or dependence among users increased from 30.2% to 35.6% (p < .01)

How consistent are these results across age groups, race/ethnic groups and sexes?

Results: Marijuana Use by Sex and Race/Ethnicity

0

1

2

3

4

5

6

Black White Hispanic Male Female

NLAES 1991-1992 NESARC 2001-2002= p < .05

%

Results: Marijuana Use In Age Groups

0

2

4

6

8

10

12

Total 18-29 30-44 45-64

NLAES 1991-1992 NESARC 2001-2002= p < .05

%

Results: Marijuana Use in Whites

0

2

4

6

8

10

12

Total 18-29 30-44 45-64

NLAES 1991-1992 NESARC 2001-2002

= p < .05

%

Results: Marijuana Use in Blacks

0

2

4

6

8

10

12

Total 18-29 30-44 45-64

NLAES 1991-1992 NESARC 2001-2002

= p < .05

%

Results: Marijuana Use in Hispanics

0

1

2

3

4

5

6

7

8

Total 18-29 30-44

NLAES 1991-1992 NESARC 2001-2002= p < .05

%

Results: Marijuana Use in Men

0

2

4

6

8

10

12

14

Total 18-29 30-44 45-64

NLAES NESARC

= p < .05

%

Results: Marijuana Use in Women

0

1

2

3

4

5

6

7

8

Total 18-29 30-44 45-64

NLAES NESARC

= p < .05

%

Use increased significantly for:

White males 45-64 years old Black females overall and Black females 18-29 and 46-64 years oldHispanic females 18-29 years old

Results: Marijuana Use in Detailed Age-Sex-Race/Ethnicity Categories

Rates did not change significantly overall

Rates increased significantly for:

18-29 and 45-64 year olds

Black and Hispanic 18-29 year olds

White and Black 45-64 years olds

Women 18-29 years old and both men and women 45-64 years old

Selected age-sex-race/ethnicity categories

Results: Summary of Marijuana Use

Results: Marijuana Abuse or Dependence in Overall Population

0.00.51.01.52.02.53.03.54.04.5

Total 18-29 30-44 45-64

NLAES 1991-1992 NESARC 2001-2002= p < .05

%

Results: Marijuana Abuse or Dependence by Sex and Race/Ethnicity

0.0

0.5

1.0

1.5

2.0

2.5


NLAES 1991-1992 NESARC 2001-2002= p < .05

%

Results: Marijuana Abuse or Dependence in Whites

0.0

1.0

2.0

3.0

4.0

5.0

Total 18-29 30-44

NLAES 1991-1992 NESARC 2001-2002

= p < .05

%

Results: Marijuana Abuse or Dependence in Blacks

0.0

1.0

2.0

3.0

4.0

5.0

Total 18-29 30-44

NLAES 1991-1992 NESARC 2001-2002

= p < .05

%

Results: Marijuana Abuse or Dependence in Hispanics

0.0

0.5

1.0

1.5

2.0

2.5

3.0

Total 18-29 30-44

NLAES 1991-1992 NESARC 2001-2002

= p < .05

%

Results: Marijuana Abuse or Dependence in Men

0

1

2

3

4

5

6

7

Total 18-29 30-44 45-64

NLAES 1991-1992 NESARC 2001-2002

= p < .05

%

Results: Marijuana Abuse or Dependence in Women

0.0

0.5

1.0

1.5

2.0

2.5

Total 18-29 30-44

NLAES 1991-1992 NESARC 2001-2002

= p < .05

%

Rates increased significantly overallIncreases in rates were significant for:

18-29 and 45-64 year olds overallBlacks and Hispanics overall and 18-29 years oldWomen overall and 18-29 years oldMen 45-64 years oldBlack and Hispanic men overall and 18-29 years oldBlack women overall and 18-29 years old

Results: Summary of Marijuana Abuse or Dependence

Results: Marijuana Abuse or Dependence Among Users in Overall Population

05

1015202530354045

Total 18-29 30-44 45-64

NLAES 1991-1992 NESARC 2001-2002= p < .05

%

Results: Marijuana Abuse or Dependence among Users, by Sex and Race/Ethnicity

0

5

10

15

20

25

30

35

40


NLAES 1991-1992 NESARC 2001-2002

= p < .05

%

Results: Marijuana Abuse or Dependence Among Black Users

05

1015202530354045

Total 18-29 30-44

NLAES 1991-1992 NESARC 2001-2002= p < .05

%

Results: Marijuana Abuse or Dependence Among White Users

05

1015202530354045

Total 18-29 30-44

NLAES 1991-1992 NESARC 2001-2002= p < .05

%

Results: Marijuana Abuse or Dependence Among Hispanic Users

05

1015202530354045

Total 18-29 30-44

NLAES 1991-1992 NESARC 2001-2002= p < .05

%

Results: Marijuana Abuse or Dependence Among Male Users

0

10

20

30

40

50

Total 18-29 30-44 45-64

NLAES 1991-1992 NESARC 2001-2002= p < .05

%

Results: Marijuana Abuse or Dependence Among Female Users

0

5

10

15

20

25

30

35

Total 18-29 30-44

NLAES 1991-1992 NESARC 2001-2002= p < .05

%

Rates increased significantly overall

Increases in rates were significant for:

18-29 and 30-44 year olds overall

Blacks overall and 30-44 and 18-29 years old

Hispanics overall and 18-29 years old

Women and men overall and 18-29 years old

Black and Hispanic men overall and 18-29 years old

Black women overall and 18-29 years old

Results: Summary of Marijuana Abuse or Dependence Among Users

Estimated Population Increases in Marijuana Abuse or Dependence

10%

26%

35%

29%38%

38%

10%

14%Male Female

20%

26%

24%

30%

White

Black

Hispanic

Other

Total

Why have rates increased?

• Changes in quantity/frequency of marijuana use?

• Changes in potency of marijuana?

• Psychosocial factors?


Changes in quantity/frequency of marijuana use? Not likely…

Changes in Frequency of MJ Use?

0

5

10

15

20

25

30

35

40

<1 dy/mo 1-3 dys/mo 1-4 dys/wk 5-7dys/wk

1991-1992 2001-2002

%

Changes in Quantity of MJ Smoked?

0

10

20

30

40

50

60

70

1 Joint 2-3 Joints 4-6 Joints 7+ Joints

1991-1992 2001-2002

%


Changes in potency of marijuana?

Possibly…

Changes in Potency of Marijuana

0%

1%

2%

3%

4%

5%

6%

7%

Δ9-THC

Source: Research Institute of Pharmaceutical Sciences, School of Pharmacy, University of Mississippi; 2003


Psychosocial factors?

Possibly…

Plausible Psychosocial Factors

• Acculturation?

• Lifestyle factors and attitudinal factors?

• Sociodemographic or socioeconomic factors?

• Economic factors such as price, tax and policy changes affecting other substances that may inadvertently affect marijuana?

• Historical and cultural factors?

Summary

• Rates of Marijuana use were nearly the same in the total population in 1991-1992 as in 2001-2002, but increases were seen in certain subgroups:

– younger male and female blacks,

– younger Hispanic males– white and black 45-64 year

olds.

• Marijuana-related disorders (abuse and dependence) increased from 1991-1992 to 2001-2002, especially for younger male and female blacks and younger hispanic males.

• Increased potency of marijuana may play a role

Summary

Marijuana Use Disorders in the United States: 1991-1992 and 2001-2002

Wilson M. Compton, M.D., M.P.E. - NIDABridget F. Grant, Ph.D., Ph.D. - NIAAAJames D. Colliver, Ph.D. - NIDAMeyer D. Glantz, Ph.D. - NIDAFrederick S. Stinson, Ph.D. - NIAAA

Marijuana

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