CANNABIS USE

AND MISUSE
 OUTLINE
• INTRODUCTION
• HISTORY
• EPIDEMIOLOGY
• METHOD OF USE
• NEUROPHARMACOLOGY
• EFFECT OF CANNABINOIDS
• THERAPEUTIC USES OF CANNABINOIDS
• CANNABIS USE AND MISUSE
• DIFFERENTIALS
• MANAGEMENT
• CONCLUSION
 INTRODUCTION
• Cannabis is the most widely used illegal drug in the world.
• It is more commonly called marijuana and it is derived from the plant
Cannabis sativa. Cannabinoids are present in the stalks, leaves,
flowers and seeds of the plant and also in the resin secreted by the
female plant.
• It is used most commonly by teenagers and adolescents, and the
usage tends to decline as these groups age into adulthood due to
careers, marriage and parenthood.
• Cannabis is also referred to as; pot, dope, abana, igbo etc.
 HISTORY
• It is believed that cannabis arrived late to Nigeria, especially when compared
to the rest of the continent. Historians think that it was introduced in the 20th
century by soldiers and sailors returning from North Africa after World war II.
• The cultivation became widespread in the 1960s and was used by the soldiers
to suppress timidity.
• Between 1980 and 1990, the use of cannabis became popular among youths
of the country.
• Currently, cannabis is cultivated and produced in Nigeria for both domestic
consumption and export. According to 2018 Drug use survey, it is the most
commonly used drug with more than 10% or 10.6 million of adult population
reporting use.
 EPIDEMIOLOGY
• Cannabis is by far the most cultivated, trafficked and abused illicit
drug, covering practically every country of the world.
• About 147 million people, 2.5% of the world population, consume
cannabis (annual prevalence) compared with 0.2% consuming cocaine
and 0.2% consuming opiates and about 8% of teenagers report use in
US.
• The most rapid growth in cannabis abuse since the 1960s has been in
developed countries in North America, Western Europe and Australia,
with the abuse linked to young culture and younger age of initiation
when compared to other drugs.
 METHOD OF USE
• Inhalation
Cannabis is typically smoked as marijuana in hand rolled cigarettes or
joints, as pipes or in combination with tobacco.
• Oral
Cannabis can be consumed orally by baking in brownies or cookies.
• It is consumed either as the dried vegetable part or secretions of the
flowering shoot.
 NEUROPHARMACOLOGY
• The pharmacology of most of the cannabinoids is largely unknown
but the most potent psychoactive agent is delta-9-
tetrahydrocannabinol (THC). Others are; delta-8-
tetrahydrocannabinol, cannabinol and cannabidiol.
• These substances have additive, synergistic or antagonistic effects
with THC.
• About 50% of the THC in a joint of herbal cannabis is inhaled and
nearly all is absorbed in the lungs. It rapidly enters the blood stream
and reaches the brain within minutes.
 NEUROPHARMACOLOGY
• THC and other cannabinoids are extremely lipid soluble and can
therefore be rapidly distributed to tissues and stored in fat tissues for
continuous release back into the body system. Complete elimination
of a single dose may take up to 30 days.
• Cannabinoids are metabolised in the liver in to 11-hydroxy-THC which
is possibly more potent than THC itself and may be responsible for
some of its effects. The metabolites are excreted by the urine (25%)
and the gut(65%) where it is reabsorbed.
 NEUROPHARMACOLOGY
• Cannabinoids exert their effect by interaction with specific
endogenous cannabinoid receptor; CB1 and CB2 receptors which are
G-coupled receptors in the endocannabinoid system.
• CB1 is found primarily in the brain and mediate psychological and
behavioral effects.
• CB2 is associated with the immune system and modulate
inflammatory responses.
 EFFECT OF CANNABINOIDS
Effects of cannabinoids are seen in various areas such as;
1. Hippocampus- impairment of short term memory
2. Neocortex- impairment of judgment and sensation
3. Basal ganglia- altered reaction time and movement
4. Hypothalamus- increased appetite
5. Nucleus accumbens- euphoria
6. Amygdala- panic and paranoia
7. Cerebellum- ataxia
8. Brainstem- anti-emesis
9. Spinal cord- analgesia
10. Others are; dry mouth, tachycardia, hypotension, bradypnea.
THERAPEUTIC USES OF
CANNABINOIDS
• Studies have demonstrated the therapeutic effects of cannabinoids
for nausea and vomiting in the advanced stages of illnesses such as
cancer and AIDS.
• Dronabinol (tetrahydrocannabinol) has been available for over a
decade in the USA.
• Other uses noted in controlled studies include treatment of asthma
and glaucoma, antidepressant, appetite stimulant, anticonvulsant and
anti-spasmodic.
• Other examples are sativex, epidiolex.
 CANNABIS USE AND MISUSE
• Using DSM-5, the classification of cannabis use is understood as the
acute and chronic effects.
• The acute phase includes intoxication and withdrawal states along
with secondary complications such as; delirium, psychosis, anxiety
and insomnia.
• Chronic regular use can be characterized by behavioral disorder.
 CANNABIS INTOXICATION
• Recent use of cannabis
• Clinically significant problematic behavioral or psychological changes
(e.g. impaired motor coordination, euphoria, anxiety, impaired
judgment) that developed during or shortly after cannabis use
• At least 2 of the following signs developing within 2 hours of cannabis
use; conjuctival injection, increased appetite, dry mouth, tachycardia.
• Symptoms not due to a general medical condition and are not better
accounted for by another mental disorder
• Specify if perceptual disturbances such as hallucinations, or illusions
are present.
 CANNABIS WITHDRAWAL
• Evidence suggests that withdrawal is seen only in a subset of patients
and symptoms begin within first 24 hours, peaks by day 3 and can last
for up to 2 weeks.
• Criteria for diagnosis includes;
1. It accompanies cessation of cannabis use that has been heavy and
prolonged (I.e. usually daily or almost daily use over a period of at
least a few months) with three or more of the following signs and
symptoms developing within approximately 1 week after cessation;
irritability, anger or aggression, nervousness or anxiety, sleep
difficulty, decreased appetite or weight loss, restlessness, depressed
mood.
2. At least one of the following physical symptoms causing significant
discomfort; abdominal pain, shakiness/tremors, sweating, fever,
chills, or headache.
3. The signs or symptoms cause clinically significant distress or
impairment in social, occupational or other important areas of
functioning.
4. The signs and symptoms are not attributable to another medical
condition and are not better explained by another mental disorder,
including intoxication or withdrawal from another substance.
 CANNABIS USE DISORDER
• Cannabis use disorder (CUD) combines abuse and dependence into a
single entity capturing the behavioral disorder that can occur with
chronic cannabis use.
• It is defined as a problematic pattern of cannabis use leading to
clinically significant impairment or distress, as manifested by at least 2
of the following occurring within a 12-month period;
1. Cannabis is often taken in larger amounts or over a longer period
than was intended.
2. Persistent desire or unsuccessful efforts to cut down or control
cannabis use.
3. A great deal of time is spent in activities necessary to obtain
cannabis , use cannabis or recover from its effects.
4. Craving or strong desire or urge to use cannabis.
5. Recurrent cannabis use that results in failure to fulfill role
obligations at work, school or home.
6. Continued cannabis use despite having persistent or recurrent social
or interpersonal problems caused or exacerbated by the effects of
cannabis.
7. Reduction in important social, occupational or recreational activities
due to cannabis use.
8. Recurrent use in situations which it is physically hazardous.
9. Use of cannabis despite knowledge of having persistent or recurrent
physical or psychological problem that is likely to have been caused
or exacerbated by cannabis.
10. Tolerance, as defined as either a need for markedly increased
cannabis to achieve intoxication or the desired effect or a markedly
diminished effect with continued use of the same amount of
substance.
11. Withdrawal, as manifested by either the characteristic withdrawal
syndrome for cannabis or cannabis is taken to relieve or avoid
withdrawal symptoms.
• Severity of CUD is graded as either mild(2 or 3), moderate(4 or 5) or
severe (>6) depending on the number of criteria present.

• Laboratory testing of urine, blood, saliva, or hair can be done to

detect the active metabolite of cannabis.
 DIFFERENTIALS
• Intoxication from other substances of abuse e.g. cocaine,
amphetamine
• Anxiety disorder
• Schizophrenia
 MANAGEMENT
• Assessment; history, physical examination and investigations
• Detoxification
• Rehabilitation
 COMPLICATIONS
• Decreased sense of life satisfaction and achievement
• Altered brain development
• Cognitive impairment
• Poor educational outcome
• Psychomotor impairment
• Chronic bronchitis
• Lung cancer
 CONCLUSION
• Cannabis is a widely used illicit drug which has the capacity to cause
various mental and/or behavioral disorders.
• It is important to advocate for the education of the public on these
adverse effects in order to curb the rapid spreading use of cannabis all
over the world.