Transcript Marijuana: How is it Used?

PASAP Conference 2016
Understanding the Impact on Adolescent Students
of Combined Nicotine and Marijuana Use
Selena Morresi, MPH, CTTS, CHES
Mallory Henry, BS
Objectives
1. After completing this workshop, the learner
will be able to understand the impact of
students who use both marijuana and
nicotine together.
2. After completing this workshop, the learner
should understand the prevalence of
students who use marijuana and nicotine
together.
Objectives
3. After completing this workshop, the learner
will be able to understand the current trends
in nicotine and marijuana.
4. After completing this workshop, the learner
will be able to recognize potential risks faced
by students who combine nicotine and
marijuana.
Current Trends in Nicotine and
Marijuana Use
Nicotine
Nicotine Delivery
Products
• Cigarettes:
• Cigars & cigarillos:
• Smokeless
tobacco &
snus:
• Vaping devices:
• Hookahs:
• Dissolvables:
Cigar Types
Cigars/Little Cigars/
Cigarillos
• Unlike cigarettes, cigars
can be marketed with
candy, fruit and chocolate
flavors
• Cigars are also taxed less
and can be sold as singles,
unlike cigarettes that must
be sold in packs of 20
• Cigars are marketed more
heavily in black
neighborhoods than in
others
• Used for smoking blunts
Vaping Devices:
Electronic Cigarettes
• What is it called? “e-cig”, “an e-cigarette”, “a personal
vaporizer”, a “PV”, a “nicotine vaporizer” , etc.
• How does it work? A rechargeable battery powers a heating
element called an atomizer which touches a cartridge holding eliquid. The atomizer heats (steams) the liquid turning it into a
vapor which is inhaled and delivers nicotine to the bloodstream
• What does the e-liquid (e-juice) consist of? Varying amounts of
nicotine (also available without nicotine), flavoring (also
available without flavoring) and propylene glycol and/or
vegetable glycerin
Other Vaping Devices
• Called by various names:
“hookah pens”, “hookah
sticks, “e-hookahs”, “vape
pipes”, “vape pens”
• Similar in construction to an
e-cigarette
• They’re all about the flavor
• Some are disposable; some
are rechargeable/refillable
• Some are nicotine-free; many
have nicotine
What are the dangers
of vaping?
• No medical studies have been conducted on
the long-term effects of inhaling glycerin,
propylene glycol, or any kind of flavoring
• Not regulated; no consistency in what is
added
• Certain e-cigarette devices may also release
metals as well as other impurities known to
be toxic and/or carcinogenic
Substances Vaporized
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Hookah
• Hookah is a water pipe used by
indirectly heating the tobacco,
usually with burning embers or
charcoal
• Hookah smoke can be served in
a variety of flavors like
strawberry, mint, and chocolate
• The device has been used for
centuries in the Middle East and
Asia to smoke tobacco
• 19.8% of 12th graders smoked
hookah at least once in the past
year (MTF, 2015)
Comparison of Hookah
& Cigarette Smoke
A 45-60 minute session of hookah smoking
could be the same as chain smoking 15
cigarettes, meaning:
• 5 xs more cancer causing
agents than cigarettes
• 100 xs more tar
• 11 xs more carbon
monoxide
Marijuana
Marijuana:
How is it Used?
Dabbing
• New concentrated form
• Made with most potent
part of plant and butane
• Ear wax, canna wax,
honey oil, dabs
• 80% THC reported
• Overdose potential
Types of Dabs
• Butane honey oil
• Earwax
• Shatter
• Honeycomb
Combined Nicotine and Marijuana
Use
How are they used together?
• Little Cigar/cigarillo wraps
“blunts”
• Vaporizers/vape pens
• Hookah
• “Chaser”
• Spliffs
Blunts
• Cigars or cigarillos are emptied of their tobacco
products and filled with marijuana.
Spliffs
• Rolled in similar paper to joints, filled with a
combination of loose tobacco and marijuana.
• Often include a paper filter.
How Many Students are Using?
MTF 2015
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MTF 2015 percentages
Cigarette Usage
8th Grade
10th Grade
12th Grade
Lifetime
13.3%
19.9%
31.1%
Past 30Days
3.6%
6.3%
11.4%
Daily
1.3%
3.0%
5.5%
½ pack or
more daily
0.4%
1.0%
2.1%
How Prevalent is
Adolescent Marijuana Use?
Lifetime Use
Past Year Use
Past 30 Day Use
Daily Use
8th Grade
10th Grade
12th Grade
15.5%
31.1%
44.7%
8th Grade
10th Grade
12th Grade
11.8%
25.4%
34.9%
8th Grade
10th grade
12th Grade
6.5%
14.8%
21.3%
8th Grade
10th grade
12th Grade
1.1%
3.0%
6.0%
Source: 2015 Monitoring the Future Study
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MTF 2015
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Our Data: Nationally
• 2,530 students across 8 states
• Identified for Nicotine Cessation Support Group
• Tobacco Products Used:
–
–
–
–
–
Cigarettes: 27.9%
Cigars and Little Cigars: 51.9%
Hookah: 34.3%
Chewing Tobacco: 6.7%
Electronic Cigarettes/Vape Pens: 20.4%
Project Connect 2014
Our Data: Pennsylvania
Percentage
Percentage
Roll own cigarettes
16.5
Hookahs
32.5
Regular cigarettes
40.5
Snus
9.0
Light cigarettes
13.5
Cigars or little cigars
28.5
Menthol cigarettes
45.5
Chewing tobacco/Dip
20.5
Flavored
cigarettes/Cloves
6.5
Electronic cigarettes
31.0
Dissolvable tobacco
products
1.5
Project Connect 2015
Prevalence of Marijuana Use
among Adolescents Who Use Both
Tobacco and Marijuana
Past 30-Day Marijuana
Use (Alone)
Males: 19%
Females: 16%
Percentage of Days Using
Tobacco or Marijuana in
which Both Substances
Were Used
Males: 49%
Females: 42%
Cycle of Addiction and
The Impact of Co Use on the Brain
Activity
The Spiral into
Addiction
Use
Misuse
Abuse
Addiction/Chemical Dependency
NICOTINE
EFFECT
(Use of tobacco product)
(Release of Chemical)
WITHDRAWAL
CYCLE OF
NICOTINE
ADDICTION
Craving and Withdraw
Symptoms
TOLERANCE
(Nicotine needed to
function normally)
INCREASED
DOSE
(imbalance of chemicals in the brain causes
person to use more)
Health Effects of Nicotine and
Marijuana Use
The Blunt Truth
• Cardiovascular
problems associated
with cigarettes are
caused by nicotine
• Increases respiratory
symptoms and
aggravates COPD
Health Effects
• According to the American Lung Association, smoke
from marijuana combustion has been shown to
contain many of the same toxins, irritants and
carcinogens as tobacco smoke.
• Typically marijuana users inhale more deeply and
hold their breath longer than cigarette smokers,
which leads to a greater exposure per breath to tar.
Health Effects
• Weakened immune system
• Marijuana affects brain development
• Marijuana use that begins in their teens and
continues into adulthood can cause IQ to lower by 8
points.
Impact on Adolescents Who Use
Both Marijuana and Nicotine
Together
Cigarillos as a Marijuana
Delivery System
• The percentage of adolescents who smoked
tobacco in the past 30 days increased by more
than half when cigarillos - small cigars or little
cigars - are included with regular cigarettes as
a form of tobacco use (MTF 2015).
• A contributing factor to this percentage is due
to many users emptying the cigarillos of
tobacco and replacing it with marijuana.
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Chasing the High
• “Chasing” is when an individual follows up
smoking marijuana with tobacco use.
• Claims to “boost the high.”
• However, this combination can lead to
unexpected outcomes.
Impact of Combined Use
• Frequent marijuana use can lead to greater nicotine
addiction in adolescent smokers.
• We also observe that smoking tobacco along with
marijuana can increase dependence of cannabis.
• Using tobacco with marijuana – smoking blunts and
“chasing” marijuana with tobacco – contributes to
cannabis dependence symptoms. Treatment for cannabis
dependence may be more effective if it addresses the
issue of concurrent tobacco use. (Ream, Geoffrey L. et al.
2008)
Neurotransmitters
New desires
cravings
Receptors
Activates
Genes
New
Proteins
New memories
Learning
Sets off new chemical
reactions
Survival Brain (Limbic Area)
Rewards/Instincts
• Food/Water
• Fight or Flight
• Social
• Sex
Limbic
• Drugs
emotions
Drugs of abuse trigger
reward area
Alcohol
Marijuana
Opioids
Benzodiazepines
Barbiturates
Cocaine
Amphetamines
Nicotine
Anabolic steroids
Ketamine
“Bath salts”
Impact of Combined Use
• Marijuana also reduces nicotine withdrawal
symptoms.
• This can lead to lower success rates in tobacco
cessation.
Balerio et al., 2004; Cohen et al.,2005a,b
Impact of Combined Use
• Daily cigarette smoking in adolescence is
associated with marijuana and other
substance use in young adulthood (Patton et
al., 2006).
Exposure to drugs of abuse during adolescence could
have profound effects on Brain Development
Earlier use increases risk
• Individuals who begin drinking
before age 15 are 4 times more
likely to develop alcohol
dependence during their lifetimes
than those who begin drinking at
age 21.
(Grant & Dawson 1997; Journal of Substance Abuse 9:103-110)
• Same applies for combined use of
marijuana and nicotine.
The Blunt Truth
What are some common comments you get in defense
of using nicotine or smoking marijuana?
Myth: “It Helps Me Relax”
• This is one of the most common defenses for
using nicotine or smoking marijuana.
• Nicotine actually increases your stress level!
• Nicotine keeps you trapped in a cycle of
addiction because of the withdrawal.
Myth: “It Helps Me Relax”
• U.S. researchers found the brains of users
were less able to react to dopamine - the feelgood chemical.
• This can lead to an increase in anxiety and
depression in marijuana users.
So …
What do we do about it?
What can we do
about it?
•
•
•
•
Nicotine Cessation Programs
Marijuana Awareness/Intervention Groups
Programs that address co-use
Education on the risks of co-use
Resources
Resources
• http://legacy.nreppadmin.net/ViewInterventio
n.aspx?id=340
• http://nrepp.samhsa.gov/ProgramProfile.aspx
?id=10
References
•
•
•
•
•
Johnston, L. D., O’Malley, P. M., Miech, R. A., Bachman, J. G., & Schulenberg, J. E. (2015).
Monitoring the Future national survey results on drug use: 1975-2014: Overview, key
findings on adolescent drug use. Ann Arbor: Institute for Social Research, The University of
Michigan.
Ream, G. L., Benoit, E., Johnson, B. D., & Dunlap, E. (2008). Smoking tobacco along with
marijuana increases symptoms of cannabis dependence. Drug and Alcohol Dependence,
95(3), 199–208. http://doi.org/10.1016/j.drugalcdep.2008.01.011
Rubinstein. Mark L., Rait, Michelle A, Prochaska, Judith J. (2014). Frequent marijuana use is
associated with greater nicotine addiction in adolescent smokers. Drug and Alcohol
Dependence, 114, 159–162.
Meiera,Caspia,Amblere,Harringtonb, Houts, Keefed, McDonaldf,Wardf, Poultonf,and
Mof!tta.(2012). Persistent cannabis users show neuropsychological decline from childhood to
midlife. www.pnas.org/cgi/doi/10.1073/pnas.1206820109.
Ramo, D. Prochaska, J. (2012). Prevalence and co-use of marijuana among young adult
cigarette smokers: an anonymous online national survey. Addiction Science & Clinical
Practice. 7:5 http://www.ascpjournal.org/content/7/1/5
Thank you!