jhanson 2019 reefer madness

JHanson 2019 Reefer Madness 1936 American propaganda film - PowerPoint PPT Presentation

JHanson 2019 Reefer Madness 1936 American propaganda film Extolling risks of marijuana use in high school students Suicide, hallucinations, attempted rape, manslaughter Film rediscovered in early 1970s and gained new life

  1. JHanson 2019

  2. Reefer Madness  1936 American propaganda film  Extolling risks of marijuana use in high school students  Suicide, hallucinations, attempted rape, manslaughter  Film “rediscovered” in early 1970s and gained new life as an unintentional satire among advocates of cannabis reform.  “Turn on, tune out, don’t worry be happy.”

  3. Marijuana in Pregnancy  Mother  Fetus  Neonate  Infant

  4. Maternal Comments  “It must be safe, it is legal.”  “It is natural, not a drug.”  “The internet says it is safe and can improve developmental outcomes.”  “Pot shops say it is safe and effective for treating morning sickness.”  “Better than methamphetamines, cocaine, or heroin.”  “I will take the chance.”

  5. Marijuana, the New Panacea  Morning sickness  Intractable childhood seizure disorders  Autism spectrum disorders.  “Good for what ails you, modern day equivalent of epsom salts.”  Pure mineral compound: magnesium and sulfate.  “A wonder drug in search of a disease!” JHanson

  6. THC and Autism Spectrum Disorder  Pediatrics, Vol 143, No 2, Feb 2019  Broad Diagnostic Category  Complementary Health Approaches (CHA)  An array of modalities developed outside of or parallel to mainstream medicine  Specific vitamins, herbal supplements, mind/body practices (yoga), chelation therapy.  THC is newest CHA

  7. THC, Autism, Questions  Define exactly what child is receiving.  How much THC or CBD in current product?  May be efficacious in a few selected cases of refractory seizures  What is the safety profile of THC and CBD?  Recommendation for use of benzodiazepine (valium, ativan) before THC. (behavioral health/psychiatry)  Is the state legislature now determining who has autism and appropriate treatment modalities based on a few testimonials?

  8. Full Disclosure  Never had prescriptive authority for medical marijuana.  Do not own a pot shot or grow house.  Discussion not a comment on general use of marijuana.

  9. Main Concern  What is the effect on the developing brain?  Fetus  Neonate  Infant

  10. Thinking About Cannabis  Joseph P Cannavo, MD  Regional Service Chief, Addiction Treatment Services  Divisional Value Advisor, Specialty Psychiatry  Colorado Permanente Medical Group.

  11. Marijuana  Source: dried leaves/flowers of hemp plant: Cannabis sativa.  Active agreement: Tetrahydrocannabinol: THC  Medical marijuana same as street marijuana.  Back in the day  Pot, Hash, Hash Oil  Getting up to date  Edibles, Waxes, Tinctures  Increased potency

  12. Mechanism of Action  Interacts with all parts of the brain, a vast modulatory network.  Endocannabinoid System:  CNS, PNS, other physiological processes.  Memory, Mood, Appetite and Energy, Balance, Pain Sensation, Vision, Stress Responses, Reproduction, Sleep, Thermoregulation, Inflammatory/Immune Response.

  13. Hazardous Cannabis Use  Miracle Plant of Evil Weed?  Polarized debate.  Unlike alcohol: Use thresholds not well-defined.  Problematic pharmacokinetics

  14. Is Cannabis Addictive?  Chemical Reward>Pathology of drive/reward>Addiction.  9% cannabis users become addicted.  16% when use begins in teens.  50% with daily use.

  15. Cognition  Divergent literature.  Acute: Impaired learning, memory, attention and executive function.  Pharmacokinetics: Cannabinoids accumulate with regular use.  Heavy users: Impairment for days to weeks after cessation.

  16. Cognition: Children/Adolescents  Not neurotoxic like alcohol.  Dunedin Cohort: 1037 New Zealanders: Birth to 38 yrs.  Adolescents with heavy use: decrease 8 IQ points @ 38 yr.  Hazard: Irreversible cognitive loss.  Insidious life trajectory effect.  Role of genetics, environment?

  17. Withdrawal  Severity: Think nicotine  Common: Irritability, dysphoria, sleep difficulty, decreased appetite, restlessness.  Dysphoria: anxiety, depression, restlessness  Less Common: physical symptoms: GI, tremors, sweating, fever, chills, headache.  Hazard: Sustained daily use: likely withdrawal.

  18. Safety and Side Effects of THC in Children  Pediatrics, Vol 143, N02, Feb 2019  Short Term  Decrease in working memory, IQ, executive function, sustained attention, motor coordination.  Long Term  Altered brain development, addiction, poor educational outcomes, diminished life achievement, increased risk for chronic psychosis disorder.

  19. How Marijuana Harms a Developing Baby’s Brain  Dana Smith; Scientific American: Nov 7, 2018  Previous research: infants exposed to cannabis inutero 50% likely to be low birth weight and premature.  Society for Neuroscience: Nov 2018, 3 new studies suggest prenatal cannabis exposure: serious consequences for fetal brain development.

  20. Washington State University Study  Newborn rat pups exposed to THC, similar to 2 joints/day took longer to learn new rule (pushing a lever for food).  Finally press correct lever x 2 then press wrong lever.

  21. Auburn University  THC exposed rat pups impaired on several different memory tasks involving mazes.

  22. University of Maryland School of Medicine  Finding of impairments of memory and changes of glutamate in brains of rats exposed to THC.  Increased levels of kynurenic acid, decreased glutamate levels with THC exposure.  Kynurenic acid regulates glutamate and other important neurochemicals.  Glutamate: important neurochemical for brain growth and neuronal electrical transmission.

  23. Medicinal Effects?  Clear “medicinal beneficial effects”, great potential for cannabinoid therapeutics.  Chronic pain, nausea, wasting syndromes, spasticity, seizures, cancers, psychiatric.

  24. Money Talks

  25. By The Numbers: DP: Jan 2019 Steamboat Marijuana tax CO Marijuana Sales revenue  2014: $618 million  2015: $366,456  2015: $995 million  2016: $431,112  2016: $1.3 billion  2017: $489,885  2017: $1.5 billion  2018: $534,753  2018: $1.4 billion  Total: $1,822,206  Total: $6 billion  Total: $1 billion in marijuana tax, licensing, and fee revenue

  26. Magnitude of Problem  Bob Troyer; former US Attorney Colorado: Denver Post Commentary, 10/2018.  CO youth use marijuana 85% higher than national av.  Marijuana-related traffic fatalities: up 151%.  Increased alcohol consumption, not decreased.  Denver Health Study  70% of 400 licensed pot shops surveyed recommend pregnant women use marijuana to treat morning sickness, 35% state safe for baby.

  27. Pediatrics: S.Ryan, 9/2018  Marijuana: most common recreational drug used by pregnant and lactating women.  Up to 36% of women report having used marijuana at some point in pregnancy.  18% report using it while breastfeeding.  Level of THC metabolites in breast milk was 8 times higher than in mother’s plasma level.

  28. Colorado Birth Statistics 2015  Total Births: 66,566  Potential neonates exposed to THC  36%: 23,963 (~24,000)  Mothers that smoked during pregnancy:  6.4%: 4,217  6 times as many babies exposed to THC than nicotine.

  29. THC  Highly lipophilic  Accumulates in fat-rich organs: brain.  Accumulation of THC in brain tissue when growth is greatest: 1 st 2 yrs of life.  Brain grows for 1 st 20 years of life.  THC can disrupt normal axonal growth and development in growing human brain.

  30. Most Important Question  What are the short term and long term effects of marijuana exposure in the developing fetus, newborn, and infant?  Note: there are no associated physical findings.

  31. Questions asked in NICU  Will my baby survive?  How long will my baby be in the hospital?  Will my baby be normal?  “What is normal?” JHanson

  32. Factors that determine outcome  Genes  Environment

  33. Developmental Outcome  Motor  Verbal  Cognition

  34. THC use during pregnancy and while breastfeeding.  Safety:  No known safe level of use.  Increased risk of premature birth, low birth weight  Increased risk of behavioral and learning complications.  Neonates exposed to THC: may manifest:  Tremors in arms, legs,  Poor eating coordination.  Difficulty with weight gain.  Delays in motor growth.  Visual complications.

  35. Is Marijuana safe while breastfeeding.  No known safe level of use during breastfeeding.  Benefits of breastfeeding  Maternal infant bonding  Less obesity  Decreased incidence of reactive airway disease (asthma)  Improved developmental outcomes.  Value judgment:  Breastfeeding with or without THC  “Just say no.

  36. Studied Outcomes  No long term prospective studies regarding outcomes.  Confounding variables.  Simultaneous exposure to other drugs:  Methamphetamines  Cocaine  Opioids  Cigarettes  Ethanol  Dose effects

  37. THC and morning sickness  Morning sickness  Occurs: week 4-16 weeks  Peak incidence 8-12 weeks  Critical time for brain development.  Question  Once morning sickness abates, does THC use persist?

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