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Week 8 - Coggle Diagram

- - - - Ppts inhaled cannabis with controlled doses of THC (10mg) and CBD (0, 8, 30mg)
      - Results indicated no sig differences in psychotomimetic effects between THC only and THC plus CBD conditions
      - Conducted in 2022, testing effects of natural cannabis with varying CBD levels
      - Raises questions about effectiveness of natural CBD levels in mitigating THC effects compared to high dose CBD
    - - Results showed that those who received CBD had sig lower paranoia scores compared to placebo group
      - Highlights potential of CBD in reducing THC-induced paranoia, suggesting a clinical applications for safer cannabis products
      - Ppts received either a high dose of CBD or a placebo before IV THC administration
  - - - Confidentiality is a key principle, ensuring drug use does not lead to legal consequences
      - Ppts aged 16 and above can consent to research without parental involvement, facilitating adolescent studies
      - Ethical guidelines allow researchers to recruit ppts who are regular cannabis users without legal repercussions
    - - Use of IV THC requires careful monitoring due to stronger psychological effects compared to other methods
      - Ethical approval is essential for conducting studies involving controlled substances
      - Reserach involving cannabis must adhere to strict standards, including safety protocols for administration
  - - - Individual differences can influence severity of acute effects
      - Understanding these differences is essential for tailoring interventions and treatments for cannabis related issues
      - Can develop with regular use, affecting intensity of psychotomimetic effects
    - - Speculative approaches suggest that minimising acute effects may reduce long term risks of psychotic disorders
      - Research indicates that pre-administering CBD may attentuate paranoia induced by THC, suggesting protective effect
      - Future cannabis producgts could be designed to include higher CBD levels to mitigate adverse effects
    - - Non-regular users experience more pronounced effects compared to regular users - tolerance effect
      - Immediate psychotomimetic effects are crucial to understand potential long-term impklications
      - Higher doses of THC lead to increased psychotic-like effects in users
      - Relationship between THC and psychotic disorders is complex and requires further exploration of acute effects
  - - - Perception of cannabis as non-addictive can lead to underestimating tis potential for abuse and dependency
      - Awareness of symptoms and classifcartions of CUD is crucial for effective treatment and intervention
      - Characterised by a range of symptoms, with severity classified based on number of symptoms present
    - - Public health campaigns should address risks assoc with cannabis use, particularly vulnerable populations
      - Ongoing research is necessary to inform public policy and education regarding cannabis use and its effects
      - Cannabis is often viewed as safer than other recreational drugs but this perception can be misleading
  - - - Relationship between cannabis and mental health is complex; dosage, frequency & individual susceptibility play sig roles
      - Understanding neurobiological mechanisms is crucial for developing effective prevention and treatment strategies
      - Associated with an increased risk of developing psychotic disorders, particularly in individuals with a predisposition
    - - Endocannabinoid system's role in regulating mood, pain and cognition presents opportunities for novel treatments for various conditions
      - Public health policies regarding cannabis use must consider potential benefits & risks
      - Ongoing research needed to clarify pharmacological actions of cannabinoids, particularly CBD, and therapeutic potential
  - - - Factors influencing vulnerability include genetic predisposition, mental health issues & environmental influences
      - Age of first use is crucial; earlier initiation is assoc with higher risk of developing CUD
      - Young people are at a sig higher risk, with teenagers being 3.5x more likely to develop CUD than adults
    - - Using cannabis as a coping mechanism for emotional distress or neg life events increases vulnerability to addiction
      - These aren't unique to cannabis; they also apply to other SUDs
      - Socio-demographic factors such as gender (male) and prevalence of drug use in environment contribute to risk
      - Multifactorial model of CUD highlights interplay between genetic, environmental and psychological factors in addiction
      - Teenagers at higher risk 3.5x of developing CUD compared to adults due to developmental factors
      - Polygenic risk scores can predict susceptibility to CUD, emphasising role of genetics
    - - Among teenagees, cannabis is the most common substance leading to treatment, surpassing all other drugs
      - Study indicated that about 20% of individuals who have tried cannabis may develop a CUD, while about 9% may develop dependence
      - Approx 1% of UK population and 3% of US population are estimated to have cannabis addiction
    - - Evidence of cog decline, including reduced IQ and educational attainment especially in adolescents with heavy use
      - Socio-economic consequences can be profound, affecting employment, relationships and overall quality of life
      - Long-term heavy use is assoc with increased risks of psychotic disorders, depression & anxiety
      - Relationship between cannabis use and psychotic disorders has been established through epidemiological studies, showing a clear correlation between frequency & potency and risk of Sz
      - Can lead to sig changes in brain function, including reductions in CB1 receptor expression, which is crucial for cannabinoid signaling
      - Absolute risk of developing psychotic disorders remains low, but relative risk increases sig with ehavy use, especially in teens
    - - Severity is categorised based on number of criteria met; 2-3 symptoms indicate mild, 4-5 moderate & 6 or more severe
      - Criteria includes tolerance, withdrawal symptoms and continued use despite problems
      - Characterised by a problematic pattern of cannabis use leading to sig impairment or distress, as defined by the DSM-5
  - - - Common pos effects include laughter, content and increased appetite while neg effects can include paranoia & altered memory
      - High doses of THC can lead to psychotomimetic effects, such as delusions and hallcuinations, particularly in infrequent users
      - Can vary among users, influenced by mood and anxiety levels prior to consumption
    - - Doses of THC can impair verbal memory and learning, with effect being dose-dependent
      - Val Currant (2002) demonstrated that doses of 7.5 and 15mg of oral THC resultsed in cog impairments, which resolve after 14hrs
      - DeSouza's research using IV THC highlighted increased psychotic-like effects at higher doses, particularly in non-regular
    - - Prevalence of cannabis use has decreased since late 90s, when nearly a third of young adults used it
      - Other illegal drugs have much lower usage rates, around 1-2%
      - Most commonly used illegal drug in UK, with approx 13% of young adults reporting use in past year
  - - - Psychosocial treatments, such as motivational interveing & CBT have shown effectiveness in reduction & quitting
      - Contingency management, incentivises abstinence through rewards, is less commonly used despite potential effectiveness
      - Many manage to recover on their own, with about 50% achieving recovery after 6yrs without formal treatment
      - Role of self-help strategies, such as avoiding environments that promote cannabis use & developing alternative coping mechanisms is crucial in recovery
      - Sig number of individuals with CUD do not seek professional help; only about 6%
      - Pharmacoogical treatments for CUD are still in development with some promising options like high dose oral CBD & THC substitution therapy
    - - Motivational interviewing can help individuals recognise negative consequences of cannabis use, increasing likelihood of quitting
      - CBT focuses on developign strategies to change thought patterns & behaviours assoc with drug use
      - Placebo effects plays sig role with many individuals achieving abstinence even without active treatment
      - Importance of social support and community resources in recovery cannot be overstated, provide essential encouragement & accountability
      - Absoltue effective size of pharm treatmetns are small, indicating that many individuals still benefit from non-pharm approaches
      - Long-term follow-up studies suggest that many individuals who quit do so successfully without treatment
  - - - CBD doesn't directly activate the CB1 receptor but may act as a negative allosteric modulator, altering the receptor's shape & function
      - CBD had a complex pharmacological profile, affeting receptors like serotonin 1A, dopamine D2 & TRPV receptors, may contribute to therapeutic effects
      - THC acts as partial agonist at the CB1 receptor, mimicking the effects of anandamide and 2AG but with less efficacy
    - - CBD may influence metabolism of endocannabinoids by interacting with enzyme FAAH, which breaks them down
      - Interaction of CBD with the CB1 receptor can lead to changes in how THC binds, potentially reducing its psychoactive effects
      - THC suppresses the release of neurotransmitters, leading to altered synaptic activity and potential psychoactive effects
    - - Key endocannabinoids include anadamide and 2-AG, which help regulate neurotransmitter release, particularly glutamate and GABA
      - CB1 receptor is the primary receptor for endocannabinoids, influencing synaptic transmission & maintaing homeostasis
      - Operates in a retrograde manner, where endocannabinoids are relased from the postsynpatic neuron an travel back to bind to receptors on presynaptic neuron
  - - - Risk of psychotic disorders is particularly pronounced in teenagers, who face an 11x greatr risk comapred to adults
      - Majority of cannabis users don't develop psychotic disorders, reflecting complexity of relationship
      - Epidemiological studies show that individuals who use high-potency daily have a fivefold increased risk of developing psychotic disorders compared to infrequent users
      - Meta-analyses confirm a dose-response relationship where increased frequency and potency of cannabis use correlate with higher risks of mental health issues
      - Understanding neurobiological mechanisms is crucial for developing effective prevention and intervention
    - - In UK, medical cannabis was legaled in 2018, primarily for specific medical conditions while recreational use remains illegal
      - Comparative analysis reveals diverse approaches, from strict prohibition in some countries to regulated markets in others
      - Recent rends show a shift towards decriminalisation and legalisation
      - Impact of legalisation on usage rates and social outcomes is complex, with evidence suggesting that legalisation does not necessarily lead to increased use among the general population
      - Vary widely across the globe, with historical context dating back to the 1961 UN Convention on Narcotic Drugs, which established drug control laws
      - Evaluating the effectiveness of cannabis policies requires consideration of various factors, including youth usage rates, public health outcomes and social harms assoc with prohibition
  - - - Higher potency may increase risk of developing menal health disorders especially in vulnerable populations
      - Understanding relationship between cannabis use and metnal healht is crucial for effective treatment and prevention
      - Long term cannabis use has been assoc with various mental health issues incl anxiety, depression and psychosis
    - - Effective regulation could reduce harms assoc with cannabis use while promoting its medicinal properties
      - Ongoing research is needed to inform policy decisions and public health initiatives related to cannabis use
      - Cannabis policy varies across jurisdictions, impacting availability, regulation and public healht outcomes
    - - Symptoms may include cravings, tolerance, withdrawal and continued used despite negative consequenecs
      - Prevalence of CUD has increased alongisde rise in potency and availability
      - CUD is characteised by problematic cannabis use leading to sig impairment or distress
  - - - Risk of developing dependence increases over time but at a slower rate compared to cocaine
      - Large scale study involving tens of thousands of ppts
      - Cumulative risk of dependence of about 7% after 10yrs of ue, lower than alcohol (10%), cocaine (15%) and nicotine (15%)
    - - Physical effects are generally less severe than those assoc with alcohol or cocaine but can still impact MH and cog function
      - Long-term heavy use can lead to respiratory issues, cog impairments and increased risk of MH disorders
      - Often perceived as less harmful than substance slike alcohol and tobacco but it can still lead to sig healht issues, with heavy use
  - - - Interaction of THC with endocannabinoid system provides neurobiological basis for effects of cannabis on cog and behav
      - Anandamide and 2-AG are endogenous cannabinoids that module neurotransmitter release, acting as homeostatic regulators
      - THC interacts with CB1 receptors, leading to 'stoned' effects, including impaired memory and altered emotions
    - - Endocannabinoids like anandamide and 2-AG travel retrograde across synapses, binding to pre-synaptic receptors and modulating neurotransmitter release
      - Retrograde signalling helps maintain balance in neurotransmitter activity, preventing excessive stimulation
      - Typical synaptic transmission involves neurotransmitters like glutamata and GABA, which influence neuronal firing
    - - CB1 receptors are densely located in brain regions such as the hippocampus, amygdala and PFC, influencing memory, emotion and DM
      - CB2 receptors are mainly found in peripheral tissues and do not sig contribute to psychoactive effects of cannabis
      - Consists of CB1 and CB2 receptors, with CB1 receptors primarily involved in psychoactive effects of cannabis
  - - - Peak of withdrawal usually occurs between 2-6 days after cessation, similar to nicotine but less severe than opioid or alcohol
      - Pharmacologically specific; administering THC can alleviate these symptoms, indicating a physiological dependence
      - Can occur in individuals who use it daily; symptoms include insomnia, irritability and nausea, lasting 7-14 days
    - - Degree of receport reduction correaltes with severity of withdrawal, suggesting neuroadaptive response to prolonged cannabis exposure
      - Understanding mechanisms is crucial to address misconceptions about cannabis addiction & potential for withdrawal
      - PET scans show that individuals in withdrawal have reduced availability of CB1 receports, affected by chronic cannabis use
  - - - Skunk is derived from female plants that are not pollinated, maximising THC production
      - Lower strenght cannabis may contain seeds and is often a mix of male and female plants, leading to lower THC
      - Commonly found in 3 forms; high potency cannabis (skunk), lower strength herbal cannabis and resin (hash)
    - - Rise in potency raises concerns about potential MH consequences associated with higher THC levels
      - Skunk currently dominates the market, reflecting shift to higher potency products
      - Over 40yrs, potency of cannabis has sig increased, with average THC in UK rising from 5-10% to 15-20%
    - - Contains various cannabioids, with THC being the primary intoxicating compound
      - Cannabidiol (CBD) is another sig cannbinoid, known for tis non-intoxicting properties and potential medical benefits
      - Plant that grows naturally in warmer climates, such as northern India and Nepal
- - - - Vaping poses a small fraction of the risks assoc with smoking
      - Vaping is not ris-free especially for non-smokers
      - McNeil & Nicotine Research Group reviewed over 400 studies on vaping health risks
    - - Levels of NNAL, a metabolite of a group 1 carcinogen, were found to be 96% lower in vapers compared to smokers
      - Exposure to tobacco-specific nitrosamines is highest in sokers, then vapers then non-users
      - Taylor system review analysed tobacco-specific toxicants in vapers, smokers and non-users
    - - E-cigs contain varying levels of nicotine
      - Technology behind e-cigs is rapidly evolving
      - Inhaling vapour instead of smoke, using e-cigs
  - - - 40% of adults hold these perceptions, which have been increasing over time
      - Misunderstandings about nicotine's role in health risks are prevalent; most harms from smoking come from tobacco
      - Many adults in GB inaccurately perceive vaping as equally or more harmful than smoking
    - - Only 14% of smokers who vape in GB understand that nicotine is not primarily responsible for smoking-related health harms
      - Critical gap in public knowledge regarding risks assoc with nicotine vs other tobacco components
  - - - Current evidence that e-cigs pose a fraction of health risks assoc with trad smoking, particularly in short to medium term
      - Most health harms arise from combustion of tobacco rather than nicotine itself
    - - Research on long-term effects is still developing and caution is advised as more data becomes available
      - Ongoing studies are necessary to fully understand implications of e-cig use on public health
    - - Russell emphasises that while nicotine is the addictive component, the harmful effects are primarily due to tar & combustion products
      - E-cigs are positioned on a continuum of risk, with combustible cigs being the most harmful & NRTs being least harmful
  - - - Regulations include max nicotine conc of 2% and a max e-liquid bottle size of 10ml
      - E-cigs must carry warning labels indicating nicotine's addictive nature and are subject to marketing restrictions
      - E-cigs in England are regulated by the MHRA, with specific guideliens on nicotine concentration and product safety
    - - Recent review provided recommendatiosn to promote vaping as an effective smoking cessation tool while acknowledging risks
      - Emphasises that while vaping is not a silver bullet, it is sig less harmful than smoking
      - E-cigs are key component of England's strategy to achieve a smoke-free status by 2030
  - - - In 2022, the overall prevalence of e-cig use among adults in GB was 8.3%
      - Approx 70% of current smokers have tried vaping, indicating sig overlap between smoking and vaping populations
    - - Vaping among youth aged 11-15 remained low and stable from 2013-2020 but saw a dramatic increase in 2022
      - Currently, 18% of 18yo in GB are reported to use e-cigs, with disposable devices being a major driver
  - - - E-cigs can be disposable or reusable, with options for refilling cartridges or tanks with nicotine fluids, known as e-juice
      - Nicotine content in e-liquids vary; some have no nicotine
      - Involves inhaling vapour produced by e-cigs instead of smoke from trad cigs
    - - Disposable e-cigs are popular for their convenience and ease of use
      - A typical disposable e-cig contains a lithium battery, e-liquid, a coil for heating and a sponge that absorbs the e-liquid
      - E-cigs come in various forms, incl cig-alikes, pod systems and tank models, each designed for different user preferences
- - - - Prospective cohort study tracked smoking behaviours over decades, correlation between smoking & mortality rates
      - Quitting smoking at various ages sig impacts life expectancy with quitting at 30 assoc with an average gain of 10 yrs of life
      - Doll et al (1951) focused on British male doctors' smoking habits, providing crucial insights into smoking-related health risks
    - - Extensive list of health consequences underscores vast impact of smoking on public health, necessitating ongoing awareness
      - Average smoker dies approx 10yrs earlier than non-smokers, highlighting severe long-term effects of tobacco use
      - Causally linked to numerous health issues including various cancers and chronic diseases
  - - - UK has seen a decline in rates over the past 40-50yrs, currently at just under 15% among adults
      - Decline in smoking in UK shows a gradual decrease since 2007
      - Varies sig across countries, with Russia & China reporting rates of over 40-50%
    - - Smoking prevalence among females is lower than that of males, althought patterns of decline are similar across genders
      - Understanding these differences is crucial for tailoring public health interventions & support programs
  - - - Prescription meds such as varenicline & bupropion can assist in reducing cravings and withdrawl, enhancing chances of cessation
      - Behavioural support, incl counselling & support groups, helps individuals develop coping strats & maintain motivation to quit
      - NRT options include patches, gum, lozenges & inhalers, which help reduce withdrawal & cravings by providing a controlled dose
      - Public health campaigns & educational programs are esential in raising awareness about dangers of smoking
      - Various methods exist for quitting smoking, including nicotine replacement therpaies, prescription meds and behavioural support
      - Combining phrarmacologicl and behavioural approaches has been shown to be the most effective strategy long term
    - - Tobacco control policies - tax on tobacco products, advert restrictions & smoke free laws to reduce secondhand smoke
      - Education and awareness campaigns target current smokers & non-smokers to inform them about risks assoc with tobacco use
      - Public health initiatives aim to reduce smoking prevalence through policies, regulations & community programs
      - Global efforts, such as Framework Convention on Tobacco Control, seek to unite countries in combating tobacco epidemic
      - Monitoring and surveillance of tobacco use trends to help inform policy decisions and public health strategies
      - Collab between governments, health organisations & communities is vital for effective tobacco control & prevention
  - - - NICE recommends a combo of behavioural interventions and medicinal products to aid smoking cessation
      - Non-nicotine meds like bupropion and varenicline are also suggested for those seeking to quit
      - Telephone quit lines provide additional support for individuals looking to stop smoking
    - - Difficulty in quitting is reflected in only 3% of smokers successfully quit for a year or more after attempting to do so
      - Average smoker makes about 40 quit attempts by age 40
      - Nicotine is primary addictive substance, with its rapid delivery to the brain reinforcing addictive behaviours
  - - - Severity of TUD can be quantified by counting number of criteria met, with 11 indicating the most severe form of the disorder
      - First cigarette of the dat has a strong pharmacologic effect, reinforcing cycle of addiction & tolerance development
      - Key criteria include withdrawal, tolerance & continued use despite recurrent problems, which can help assess severity of disorder
      - Concept of neutral zone illustrates the balance smokers maintain betwene pleasure derived from nicotine & onset of withdrawal
      - TUD characterised by problematic tobacco use that leads to sig impairment or distress, requiring at least 2 of specified critiera in 12 month period
      - Resensitisation occurs during periods of abstinence, such as overnight, allowing the body to regain sensitivity to effects
    - - In the UK, smoking prevalence & its assoc health harms are sig public health concerns
      - Global stats reveal widespread nature of tobacco use and its devastating healht impacts
      - Total number of deaths in 21st century is projected to reach 1 billion, with increasing mortality rates over the years
      - Harmful effects extend beyond the individual smoker, impacting public health systems and increasing healthcare costs
      - Only consumer product that when used as intended will kill half of its users
      - Effective interventions for smoking cessation include behavioural therapies, pharamcotherapy & public health campaigns
    - - Rapid absorption into bloodstrum occurs within 10-20s after inhalation
      - Tolerance develops as receptors become desensitised, requiring higher doses to achieve the same effects
      - Binds to nicotinic acetylcholine receptors, particularly in the ventral tegmental areas, leads to release of neurotransmitters, such as dopamine, which is crucial for pleasure & reward system
      - Russell highlights distinction between nicotine and harmuful tar in tobacco smoke 'people smoke for the nicotine but die from the tar'
      - Nicotine is a naturally occurring alkaloid found in tobacco leaves, acting as the primary psychoactive component that drives tobacco addiction
      - Withdrawal symptoms such as irritability, anxiety & cravings typically peak within the first week of cessation & can last ofr many weeks
  - - - Despite decrease in smoking prevalence, approx 15% of adults in England still smoke
      - Effective quitting strategies include behavioural support & medicinal aids
      - Smoking is highly addictive & poses sig health risks, with nicotine being the main addictive component but not primary cause of health harm
    - - Ongoing research is needed to develop more effective cessation strategies and to understand long term impacts of smoking and vaping
      - Public health campaigns should continue to address the risks of smoking and promote available resources for quitting