Factores de adherencia al tratamiento en pacientes dependientes de cannabis

Introducción: En los últimos años se ha producido un aumento del consumo de cannabis en la población general, estando más extendido en los jóvenes entre 15 y 34 años, y en los hombres más que en las mujeres. Igualmente se ha producido una disminución en la edad de inicio del consumo. Por otro lado van detectándose aumento de las demandas de tratamiento por esta adicción en los centros especializados. Objetivo: valorar la adherencia al tratamiento de la población que consulta por problemas derivados del consumo de cannabis. La atención se realiza dentro de un Programa Específico para estos consumidores. Material y métodos: Se realiza una revisión de 74 pacientes que solicitan tratamiento en el centro, durante el periodo de tiempo de dos años. La adherencia al tratamiento se mide en términos de asistencia a visitas médicas/psicológicas posteriores. Se contabilizan visitas realizadas a dos semanas, un mes, tres meses y seis meses desde la primera demanada. Se tiene en cuenta la coexistencia de otro trastorno psiquiátrico, utilizando para esto la entrevista clínicadisgnóstica y las entrevistas semiestructuradas SCID-I y SCID-II. Resultados: De los 74 pacientes incluídos en el estudio, 22% son mujeres y el 78% son hombres. El 74% continúan tratamiento a los tres meses, y el 64% a los seis meses de haberlo iniciado. Hay que señalar que del total de la muestra, el 55% no son consumidores de otras sustancias de abuso, excepto nicotina, que en este caso correspondería al 100% de los pacientes admitidos a tratamiento. El 23% de estos pacientes presentan de forma comórbida a la dependencia de cannabis un diagnóstico de Trastorno Psicótico. Conclusiones: Dentro de las conclusiones de este estudio, podemos destacar que: existe elevada comorbilidad psiquiátrica en pacientes con diagnóstico de Trastorno por dependencia de cannabis; las mujeres abandonan el programa de tratamiento con mayor frecuencia que los varones; el hecho de no existir comorbilidad psiquiátrica es un factor de abandono temprano del tratamiento; los pacientes con diagnóstico comórbido de Trastorno psicótico mantienen la adherencia en su totalidad a los seis meses del inicio; los pacientes que solicitan tratamiento a menor edad tienden a abandonarlo antes; y la alta prevalencia de consumo de tabaco en las personas dependientes de cannabis.

From the vendor in the hemp shop to the dealer in the alleyway? A comparison of the sources of supply of cannabis in a time of 'de-normalising' cannabis use.

Objectives: After several years of increasing 'normalisation' of cannabis use in Switzerland at the beginning of the new millennium, a reversed tendency, marked among others by a more stringent law-enforcement, set in. The presentation examines the question of where adolescents and young adults obtained cannabis, within the context of this societal change. In addition, it compares the sources of supply for cannabis with those found in studies of other European countries. Methods: Analyses are based on data from the Swiss Cannabis Monitoring Study. As part of this longitudinal, representative population survey, more than 5000 adolescents and young adults were interviewed by telephone on the topic of cannabis. Within the total sample, 593 (2004) or 554 (2007) respectively, current cannabis users replied to the questions on sources of supply. Changes in law-enforcement and societal climate concerning cannabis are assessed based on relevant literature, media reports and parliamentary discussions. Results: Whereas 22% of cannabis users stated in 2004 that they bought their cannabis from vendors in hemp shops, this proportion drastically decreased to 6% three years later. At the same time, cannabis was obtained increasingly from friends, while the proportion of users who purchased cannabis from dealers in the alleyway, more than doubled from 6% (2004) to 13% (2007). It was male cannabis users, and in particular, young adult and frequent users, who have moved into the alleyways. Generally, users who buy cannabis in the alleyway show more cannabis-related problems than those who mainly name other sources of supply, even when adjusted for sex, age and frequency of cannabis use. Discussion: Possible consequences of these changes in cannabis supply, like the risk of merging a previously cannabis-only market with other 'harder' drugs markets, are discussed.

Drug use in Ireland and Northern Ireland 2010/11 Drug Prevalence Survey: Cannabis Results Bulletin 3

This bulletin presents findings regarding the use of cannabis in Ireland from the third drug prevalence survey of households in Ireland and Northern Ireland. A representative sample of adults aged between 15 and 64 years was sampled during late 2010 and early 2011. Click here to download PDF 894kb

Monitoring de la problématique du cannabis en Suisse: étude sentinelle 2004-2009

Le monitoring de la problématique du cannabis en Suisse constitue un ensemble de travaux qui permettent le suivi de la situation au niveau national et qui sont mis en oeuvre par un consortium d'institutions de recherche. Ce monitoring comprend l'étude présentée dans ce rapport, l'étude sentinelle. Celle-ci s'intéresse à l'évolution de la situation en matière de cannabis ainsi qu'à la gestion de cette situation au niveau local. Il s'agit de répondre aux questions suivantes : - quelle est la situation en matière de consommation de cannabis et de marché et quelle est son évolution ? - quels sont les principaux problèmes rencontrés sur le terrain ? - quelles sont les mesures et interventions qui ont été développées dans ce domaine ? Pour y répondre, on a choisi de suivre la situation dans quatre cantons suisses dits "sentinelle" (St-Gall, Tessin, Vaud, Zurich). Les critères de choix de ces cantons font appel à leur taille, au rapport ville/campagne et à la présence de frontière avec des états voisins, à la langue, au type de politique drogue pratiqué. Dans chaque canton on a constitué des panels d'experts formés par des profes-sionnels de terrain dans trois domaines différents (santé et social, école, police et justice). Leurs observations ainsi que les données cantonales disponibles sont récoltées et discutées lors d'un workshop et analysées sur plusieurs années. Le présent rapport fait état des résultats des quatre workshops de suivi (2005, 2006, 2008, 2009). [Résumé, p. 5]

A Cannabis Reader: Global Issues and Local Experiences

The EMCDDA’s cannabis monograph addresses one basic question. How can I find quality information on cannabis, amid all the bias and opinion? The monograph is divided into two volumes. The first volume centres on political, legislative, commercial and social developments relating to cannabis. Its core audience thus comprises policymakers, sociologists, historians, journalists and those involved in enforcement. The second volume is targeted at drugs professionals working in the fields of treatment, prevention and healthcare.This resource was contributed by The National Documentation Centre on Drug Use.

Routes of administration of cannabis used for nonmedical purposes and associations with patterns of drug use.

PURPOSE: Little is known regarding cannabis administration routes for nonmedical use-that is, its delivery methods (e.g., joints, water pipe, food). Therefore, we examined the prevalence rates of different cannabis delivery methods and assessed the relationship of the distinct administration routes with problematic drug use. Subgroups of cannabis users were also investigated (i.e., "pure" cannabis users, previously described as employing a harmless route of administration, and water pipe users, previously described as using a harmful route of administration). METHODS: As part of the Cohort Study on Substance Use Risk Factors, 1,763 cannabis users answered questions concerning their drug use (i.e., routes of administration, problematic cannabis use, other illicit drug use). Descriptive statistics, latent class analysis, correlations and t-tests were assessed. RESULTS: The main administration route was "joints with tobacco"; other routes of administration had prevalence rates from 23.99% to 38.23%. In addition, increasing the number of administration routes was associated with more problematic cannabis use, as well as heavier illicit drug use. Water pipes without tobacco were especially linked to heavy drug use patterns, whereas "pure" cannabis use seemed less harmful. CONCLUSIONS: Our findings highlighted that diversification in routes of administration can be associated with heavier illicit drug use. This was especially true for water pipe users, whereas "pure" cannabis users, who did not mix cannabis with tobacco, were an exception. Indeed, these results may be useful for future preventive programs, which may need to focus on those who have diversified routes of administration for cannabis.

Mental health and growing up factsheet. Cannabis and mental health: information for young people.

About this leaflet This is one in a series of leaflets for parents, teachers and young people entitled Mental Health and Growing Up. These leaflets aim to provide practical, up-to-date information about mental health problems (emotional, behavioural and psychiatric disorders) that can affect children and young people. This leaflet gives you some basic facts about cannabis and also how it might affect your mental health. Introduction Lots of young people want to know about drugs. Often, people around you are taking them, and you may wonder how it will make you feel. You may even feel under pressure to use drugs in order to fit in, or be â?~coolâ?T. You may have heard that cannabis is no worse than cigarettes, or that it is harmless. What is cannabis? The cannabis plant is a member of the nettle family that has grown wild throughout the world for centuries. People have used it for lots of reasons, other than the popular relaxing effect. It comes in two main forms: ï,§ resin, which is a brown black lump also known as bhang, ganja or hashish ï,§ herbal cannabis, which is made up of the dried leaves and flowering tops, and is known as grass, marijuana, spliff, weed, etc. Skunk cannabis is made from a cannabis plant that has more active chemicals in it (THC), and the effect on your brain is stronger. Because â?~streetâ?T cannabis varies so much in strength, you will not be able to tell exactly how it will make you feel at any particular time. What does it do to you? When you smoke cannabis, the active compounds reach your brain quickly through your bloodstream. It then binds/sticks to a special receptor in your brain. This causes your nerve cells to release different chemicals, and causes the effects that you feel. These effects can be enjoyable or unpleasant. Often the bad effects take longer to appear than the pleasant ones. ï,§ Good/pleasant effects: You may feel relaxed and talkative, and colours or music may seem more intense. ï,§ Unpleasant effects: Feeling sick/panicky, feeling paranoid or hearing voices, feeling depressed and unmotivated. Unfortunately, some people can find cannabis addictive and so have trouble stopping use even when they are not enjoying it. The effects on your mental health Using cannabis triggers mental health problems in people who seemed to be well before, or it can worsen any mental health problems you already have. Research has shown that people who are already at risk of developing mental health problems are more likely to start showing symptoms of mental illness if they use cannabis regularly. For example if someone in your family has depression or schizophrenia, you are at higher risk of getting these illness when you use cannabis. The younger you are when you start using it, the more you may be at risk. This is because your brain is still developing and can be more easily damaged by the active chemicals in cannabis. If you stop using cannabis once you have started to show symptoms of mental illness, such as depression, paranoia or hearing voices, these symptoms may go away. However, not everyone will get better just by stopping smoking. If you go on using cannabis, the symptoms can get worse. It can also make any treatment that your doctor might prescribe for you, work less well. Your illness may come back more quickly, and more often if you continue to use cannabis once you get well again. Some people with mental health problems find that using cannabis makes them feel a bit better for a while. Unfortunately this does not last, and it does nothing to treat the illness. In fact, it may delay you from getting help you need and the illness may get worse in the longer term. [For the full factsheet, click on the link above]This resource was contributed by The National Documentation Centre on Drug Use.

Sativa seeds against Schistosoma mansoni different stages

The schistosomicidal properties of Nigella sativaseeds were tested in vitro against Schistosoma mansoni miracidia, cercariae, and adult worms. Results indicate its strong biocidal effects against all stages of the parasite and also showed an inhibitory effect on egg-laying of adult female worms. In the present work we also studied the effects of crushed seeds on some antioxidant enzymes; which have a role in protection of adult worms against host oxidant killing; as well as some enzymes of glucose metabolism; which have a crucial role in the survival of adult worms inside their hosts. The data revealed that the used drug induce an oxidative stress against adult worms which indicated by a decrease in the activities of both antioxidant enzymes, superoxide dismutase, glutathione peroxidase, and glutathione reductase and enzymes of glucose metabolism, hexokinase and glucose-6-phosphate dehydrogenase. Disturbing of such enzymes of adult worms using N. sativa seeds could in turn render the parasite vulnerable to damage by the host and may play a role in the antischistosomal potency of the used drug.

Cannabis use in a Swiss male prison: qualitative study exploring detainees' and staffs' perspectives.

BACKGROUND: Several studies suggest a high prevalence of cannabis use before and during imprisonment, but subjective perspectives of detainees and staff towards its use in prison are lacking. This issue was explored in the framework of an observational study addressing tobacco use in three Swiss prisons in 2009 and 2010 that involved multiple strands (quantitative and qualitative components). This article presents qualitative data on cannabis use collected in one of the settings. METHODS: We used in-depth semi-structured interviews with both detainees and staff to explore their attitudes towards cannabis in one post-trial male Swiss prison. We performed specific coding and thematic analysis for cannabis with the support of ATLAS.ti, compared detainees' and staff's opinions, and considered the results with regard to drug policy in prison in general. RESULTS: 58 participants (31 male offenders, mean age 35 years, and 27 prison staff, mean age 46 years, 33% female) were interviewed. Detainees estimated the current use of cannabis use to be as high as 80%, and staff 50%. Participants showed similar opinions on effects of cannabis use that were described both at individual and institutional levels: analgesic, calming, self-help to go through the prison experience, relieve stress, facilitate sleep, prevent violence, and social pacifier. They also mentioned negative consequences of cannabis use (sleepiness, decreased perception of danger and social isolation), and dissatisfaction regarding the ongoing ambiguous situation where cannabis is forbidden but detection in the urine was not sanctioned. However, the introduction of a more restrictive regulation induced fear of violence, increased trafficking and a shift to other drug use. CONCLUSION: Although illegal, cannabis use is clearly involved in daily life in prison. A clearer and comprehensive policy addressing cannabis is needed, including appropriate measures tailored to individual users. To sustain a calm and safe environment in prison, means other than substance or medication use are required.

Etude d'administration contrôlée de cannabis et profils cinétiques des cannabinoïdes dans les fluides biologiques

Le cannabis est l'une des drogues illégales les plus consommées au monde. Le delta-9- tétrahydrocannabinol (THC) est le composé psychoactif majeur du cannabis et est fréquemment détecté dans le sang de conducteurs impliqués dans un accident de la route, alors qu'il est actuellement interdit de conduire sous l'influence du THC en Suisse comme dans de nombreux pays européens. La détection de ce composé dans le sang est suivie d'une série de mesures pénales et administratives à l'encontre du conducteur impliqué. Cette thèse intitulée « Etude d'administration contrôlée de cannabis et profils cinétiques dans les fluides biologiques » s'inscrit dans une étude toxicologique menée au Centre Hospitalier Universitaire Vaudois (CHUV). Le but de cette étude est d'évaluer les effets du cannabis sur le fonctionnement du cerveau lorsque le consommateur accompli une tâche fondamentale de la conduite automobile. Pour cela, l'imagerie médicale par résonnance magnétique fonctionnelle (IRMf) est combinée à un test informatisé simulant une tâche psychomotrice requise pour une conduite automobile sûre. Il s'agit d'un test de double tâche de poursuite d'une cible au moyen d'un curseur dirigé par un joystick, combiné à une tâche secondaire de détection de signaux routiers. Parallèlement, les profils cinétiques sanguins et salivaires des volontaires ont été déterminés grâce à des prélèvements effectués tout au long de la journée d'étude. Les objectifs principaux de ce travail de thèse sont les suivants : après une revue de la littérature existante sur les techniques d'analyse des cannabinoïdes dans les fluides biologiques, une méthode a été développée et validée pour ces composés dans la salive puis appliquée aux échantillons de l'étude. En parallèle, les échantillons sanguins et urinaires ont été analysés, en partie avec une méthode adaptée de celle développée pour la salive. Pour montrer la versatilité de cette méthode, celle-ci a été employée pour analyser des échantillons de bile qui a l'avantage de contenir des concentrations élevées de métabolites conjugués. Dans un deuxième temps, les dosages effectués sur le sang et la salive ont permis d'établir les profils cinétiques des cannabinoïdes, de déterminer leurs paramètres pharmacocinétiques et de les comparer. Les données obtenues ont montré que la concentration sanguine en acide 11-nor-9- carboxy-delta-9-tétrahydrocannabinol (THCCOOH) pouvait servir à distinguer les fumeurs occasionnels des fumeurs réguliers de cannabis, car elle est significativement plus élevée chez les consommateurs réguliers. De plus, d'autres cannabinoïdes présents dans la salive pourraient servir de marqueurs de consommation récente dans ce fluide biologique. Enfin, que ce soit dans le sang, la salive ou l'urine, des phytocannabinoïdes peuvent être utilisés comme marqueur de consommation de cannabis illégal car ils sont absents des médicaments à base de cannabis utilisant des préparations synthétiques ou purifiées du THC.

Swiss adolescents' and adults' perceptions of cannabis use: a qualitative study.

Few studies have attempted to investigate the nature of adolescents' and adults' conceptions and perceptions of cannabis use. Our objectives were to explore adolescent and adult perception of use and misuse of cannabis, and their opinions and beliefs about the current legal context and preventive strategies. We used focus group discussions with four categories of stakeholders: younger (12-15 year old) adolescents, older (16-19 year old) adolescents, parents of teenagers and professionals working with young people. In some areas (legal framework, role of the media, importance of early preventive interventions), we found consensual attitudes and beliefs across the four groups of participants. In all four groups, participants did not have any consensual vision of the risks of cannabis use or the definition of misuse. In the area of the prevention of cannabis use/misuse, while parents focused on the potential role of professionals and the media, thus minimizing their own educational and preventive role, professionals stressed the importance of parental control and education. Within the Swiss context, we conclude there exists an urgent need for information and clarification of the issues linked with cannabis use and misuse directed at parents and professionals.

Neural Correlates of the Severity of Cocaine, Heroin, Alcohol, MDMA and Cannabis Use in Polysubstance Abusers: A Resting-PET Brain Metabolism Study

INTRODUCTION Functional imaging studies of addiction following protracted abstinence have not been systematically conducted to look at the associations between severity of use of different drugs and brain dysfunction. Findings from such studies may be relevant to implement specific interventions for treatment. The aim of this study was to examine the association between resting-state regional brain metabolism (measured with 18F-fluorodeoxyglucose Positron Emission Tomography (FDG-PET) and the severity of use of cocaine, heroin, alcohol, MDMA and cannabis in a sample of polysubstance users with prolonged abstinence from all drugs used. METHODS Our sample consisted of 49 polysubstance users enrolled in residential treatment. We conducted correlation analyses between estimates of use of cocaine, heroin, alcohol, MDMA and cannabis and brain metabolism (BM) (using Statistical Parametric Mapping voxel-based (VB) whole-brain analyses). In all correlation analyses conducted for each of the drugs we controlled for the co-abuse of the other drugs used. RESULTS The analysis showed significant negative correlations between severity of heroin, alcohol, MDMA and cannabis use and BM in the dorsolateral prefrontal cortex (DLPFC) and temporal cortex. Alcohol use was further associated with lower metabolism in frontal premotor cortex and putamen, and stimulants use with parietal cortex. CONCLUSIONS Duration of use of different drugs negatively correlated with overlapping regions in the DLPFC, whereas severity of cocaine, heroin and alcohol use selectively impact parietal, temporal, and frontal-premotor/basal ganglia regions respectively. The knowledge of these associations could be useful in the clinical practice since different brain alterations have been associated with different patterns of execution that may affect the rehabilitation of these patients.