Considering Recreational Cannabis

Kate Kneisel, B.A. and Robert Kitcher, M.A., RP
This is the Extended Version of a Quinte Counselling Services Inc., Employee Assistance Program, Winter 2018 Newsletter article available in hard copy and on the Qxplore Group website at: www.qxplore.com/winter-2018. The Appendices can be accessed at www.qxplore.com/cannabis-appendices2
The previous article “Medical and Recreational Cannabis : Preparing for a New Era” in the Quinte Counselling Services Inc., Employee Assistance Program, Fall 2017 Newsletter article is available at www.qxplore.com/cannabis-extended and with Appendices at www.qxplore.com/cannabis-appendices

We follow up on our Fall 2017 EAP newsletter’s discussion of medical cannabis with some implications of the legalization of recreational use of cannabis.

First, we reiterate an important cautionary note – combining use of cannabis with other prescribed medications or recreational drugs can lead to unpredictable and potentially dangerous effects.

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This year Canada will see the legalization of recreational cannabis use. With 10% of adults and about 25% of teens admitting to using cannabis within the past year, Canadians have one of the highest rates of cannabis use in the world.¹

About 65% of Canadians support legalization of cannabis, and many consider physical/mental risks associated with its use to be no worse than those of tobacco and alcohol.² [See Appendix A on public health considerations]

Locally, reactions to the pending change in access range from excitement to concern to paranoia, observed one Quinte Counselling Services psychotherapist.

As cannabis becomes legally available and likely more widely used, it is important that we all be aware of its associated risks. Primary health concerns related to cannabis include its effect on brain development and functioning, including physical coordination, the possibility of increased motor vehicle / workplace accidents, and potential development of dependency or other mental health problems.¹

Precautions should also be taken to protect young children from accidental exposure, typically through edible forms of cannabis.³

Youth at greatest risk

In Ontario, the minimum legal age for buying cannabis has been set at 19, one year older than the mandatory federal minimum of 18.4 Cannabis use is most prevalent among Canadian youth 15-24 years of age, at a rate of about 2-3 times that of adults, according to recent surveys.2,3,5 [See Appendix B on public health implications]

Teens are also the most vulnerable to potential harms, especially of early, regular cannabis use, including negative and sometimes not fully reversible effects on brain development. It is worth noting that development of the prefrontal cortex of the brain, which is important to impulse control, working memory, planning, problem solving and emotional regulation, continues up to age 24.^5,6

Perhaps not surprisingly, teenage cannabis use has been linked with lower marks and higher drop-out rates in school, problem drinking and high-risk behaviors such as driving while under the influence of cannabis/alcohol, and cannabis use dependency.⁵

(Cannabis use disorder, a medical term that combines the terms substance abuse and substance dependence, is characterized as: regular cannabis use that is disrupting a person’s day-to-day functioning, causes cravings, requires increasing amounts to obtain the same effects, and causes withdrawal symptoms such as sleep problems sleeping, restlessness, nervousness, anger, or depression within a week of reducing heavy use.) ⁷

Teen cannabis use disorder appears to go hand-in-hand with social anxiety disorder, which respondents identified as either preceding (>80%) or following (15%) problematic cannabis use. The two disorders should be treated concurrently,8 as is recommended in most cases of dependence and a coexisting mental health disorder. [See Appendix C: “Legalization of Cannabis in Canada – A position paper of the Canadian Psychological Association”].⁶

Reflecting previous research, persistent psychotic experiences [i.e., loss of contact with reality, such as paranoia, delusions or hallucinations] were reported by 8% of adolescents in one Montreal based study, increasing to 15% with weekly or daily use.^{6, 9}

Limit your use

Persistent regular use (4 days/ week) among adolescents as well as adults has been linked with increased risks of developing anxiety, depression, fatigue and loss of motivation. ^{5, 10}

While cannabis use disorder can occur in any chronic or heavy user, dependence is most likely to first develop in teens 16-18 years of age.⁵

Substitutions – exploring therapeutic pot-ential

International studies suggest that where it is legalized, cannabis is increasingly used as a substitute for prescription drugs.6 A growing body of evidence supports use of cannabis (or medical marijuana) for a wide range of health conditions, from anxiety and depression to symptoms of multiple sclerosis and chronic pain.11 [See Appendix D on medical research evidence]

Emerging research suggests cannabidiol or Epidiolex may also help reduce cravings and/or withdrawal anxiety in people addicted to opioids or heroin, and a 3-month study of its use for cocaine withdrawal has just been launched in Montreal. ¹²

In two recent Canadian surveys, from 75% – 87% of medical cannabis users reported using cannabis as a substitute for various medications prescribed to treat anxiety, depression, pain, and sleep problems, among others, as well as using it to replace alcohol or illicit substances.⁶

It’s important to note that cannabis interacts with many commonly prescribed treatments including some antidepressant, anti-anxiety, antibiotic, and antifungal medications; its use may interfere with treatment effects and in some cases, increase blood concentrations of THC, the component of cannabis that provides the “high”.¹³

Do you know how cannabis affects the ability to drive?

Even when cannabis is legal, driving while under its influence will continue to be illegal. While experts have not agreed on how cannabis affects driving, and many point to the combined use of cannabis and alcohol as a greater concern, no one should drive within several hours of using cannabis. It interferes with the ability to concentrate, to pay attention, and to judge distances. It also slows your reaction time – effects that last for up to five hours after you use cannabis, possibly longer if you are taking it in edible form.⁵

Know your addiction risks

Risk for developing cannabis dependence is about 9%, increasing to 17% when is first used in adolescence. Mental health vulnerabilities and various preexisting psychiatric conditions increase your risk of harm from cannabis use.¹⁴

CAMH’s Dr. Fischer notes, “It makes an enormous difference in acute and chronic health outcomes whether someone uses cannabis once or twice a week or daily.”¹

If you are using cannabis to help you deal with or avoid other issues in your life, you may find medical / psychological support helpful. Decision making, healthy coping, and substance use resistance skills can be learned, and can help those who are struggling.¹⁴

College age? Check out RainyDaze, an online game that can help you learn more about harm reduction and how it might help you deal with potential risks associated with alcohol, cannabis and MDMA. The app was developed as part of Algonquin College’s Umbrella Project.14 [See Appendix E on harm reduction initiatives]
http://plato.algonquincollege.com/umbrellaproject/rainydaze/#/home

If you are experiencing harmful consequences and/ or loss of control, your cannabis use may be risky. Assess your usage risks online, confidentially: Adults, visit https://www.rehabs.com/assessments/marijuana-addiction-quiz/ or for Youth, visit Electronic THC Online Knowledge Experience (e-TOKE).

If you’re concerned about your own or someone else’s risks, gain insight from “Getting Help with Addiction and Substance Abuse” by Paula Buskard in Quinte Counselling Services Spring 2017 newsletter http://www.qxplore.com/spring-2017/, and consider opening the conversation with your EAP therapist.

Want to have a good talk about cannabis with your teen? Get the Cannabis Talk Kit at https://www.drugfreekidscanada.org/.

[See Appendix F]

In Ontario, the Drug & Alcohol Helpline provides free, confidential and anonymous information about alcohol and other treatment services, 24 hours a day. Call 1 800 565-8603. CAMH Kids Help Phone at 1 800 668-6868

[See Appendix G for CAMH help and treatment resources]

Accessing Cannabis for Medical Reasons

Not all doctors are familiar with medical cannabis or the evidence supporting its role as part of a treatment plan for some conditions – so they may not feel comfortable prescribing it.

As with any other newer treatment, you may need to inform your physician about why you feel it can help you manage your symptoms. It may help to have a friend or family member at the appointment to support you when you open the discussion.

• Explain how your condition affects you.
• List all the treatments you have tried for your symptoms, along with what worked, what didn’t, and how they failed.
• Identify and describe the symptoms you feel cannabis has helped you manage.
• Explain what form of cannabis you would use (vaporization, smoking, edibles, etc.)¹⁵

Health care professionals who are interested in upgrading their knowledge about Medical cannabis might be interested in a course geared to Canadian health care providers and consumers. This course was developed by a “cross-professional” committee of Canadian medical professionals. The company offering it, Advancing Practice, is an established provider of accredited medical education. http://www.advancingpractice.com/p-98-medical-cannabis-iq-the-fundamentals.aspx

Medical cannabis suppliers also offer a good resource for clients with questions about cannabis strains for specific problems.

[See Appendix H for primary care provider’s information on treating addiction.]

[See Appendix I for National Institute for Cannabis Health and Education / NICHE Canada Resources]

Kate Kneisel, B.A. is an award-winning content producer – she has written hundreds of articles on health and medical topics, and also writes on topics of interest in the community. Kate graduated from Trent University with a BA in English. She recently moved back into Belleville from a farm in Prince Edward County. To find out what Kate has been writing over the last 25 years, visit www.yourmedicalcopywriter.com

Bob Kitcher M.A., RP is the Managing Director of the Qxplore Group of companies which includes Quinte Counselling Services, Quinte Assessment and Treatment Group, and Qxplore Inc.