TALK Early! TALK Often! – Preventing Marijuana Use by Teens Sharyn Turner MA,RN TUPE County Coordinator Nevada County Tobacco Use Prevention Program Nevada County Superintendent of Schools

Cannabis in the 21st Century It’s a Whole New Product

What do youth believe about marijuana? Ask parents what youth think about marijuana: It’s natural No big deal: 8 out of 10 teens do not believe monthly cannabis use is risky. Legal Medical

Youth and Cannabis 46% of teens will have tried marijuana by high school graduation. 23% of high school seniors use marijuana regularly. The perceived harm of marijuana use is on the decline. (Directly effects the increase in use.) 8 out of 10 California teens believe monthly use poses no health risks. Legalization is adding to the harmless perception of cannabis.

THC Levels were between 2-5% THC: Tetrahydrocannobinol Psychoactive Ingredient From the 1960’s-1990’s THC Levels were between 2-5%

In the early 2000’s THC Levels were between 8-10% Tetrahydrocannabinol In the early 2000’s THC Levels were between 8-10%

In the last decade THC levels in marijuana plants have grown up to 30% Tetrahydrocannabinol In the last decade THC levels in marijuana plants have grown up to 30%

Psychoactive Ingredient THC-Tetrahydrocannobinol (psychoactive ingredient) CBD-Cannabinol is a cannabis compound that has significant medical benefits, but does not make people feel “stoned” and can actually counteract the psychoactivity of THC THC levels have drastically increased while CBD levels have stayed the same THC: Psychoactive Ingredient

EVERYONE REACTS DIFFERENTLY Metabolism - Your Body Family History Genetics Environment 3

POT FACTS! Marijuana's average potency has more than tripled in the last two decades. Marijuana smoke contains 50% to 70% more carcinogenic hydrocarbons than tobacco smoke Heavy marijuana use is associated with higher rates of skipping class, lower GPAs, and failure to complete college. 5

POT FACTS! (self defense for the plant) THC was used as a defense mechanism to keep animals from consuming the plant in the wild. Individuals may build up a tolerance to weed, the same amount that used to get you “high” may no longer be enough. THC can stay in your system and be detected in a drug test longer than most other drugs. 5

Now listed in the DSM 4 as an addiction

CHRONIC USE Teens who use between 10 – 20 times a day. They will openly admit they need it. They will use when nervous, anxious or can’t sleep. Their use has interfered with school, work, family and relationships. Marijuana is overwhelmingly the drug of choice for teens admitted into treatment. 4

No longer do we just smoke or eat marijuana

Evolving Products CONCENTRATES - WAX, BUTANE HASH OIL, EDIBLES (BUD CONTAINING – 26% THC, CONCENTRATES MAY CONTAIN 30 - 99%)

Cannabis Concentrates: THC Levels: 80-90% Butane Hash Oil (BHO) BHO is also known as... Dabs Budder Shatter Wax Used by heating up the concentrate and smoking the “vape” “Green Crack” wax “Ear Wax” “Budder” “Shatter” Hash Oil Capsules

DABBING & PARAPHERNALIA Wax can be dabbed using paper clips, dental tools, small screw drivers and pens. Grinders and blunts, bongs. 8

“Secret” Vaporizers JUUL Vaporizer Teens are good at hiding their devices. JUUL Vaporizer

Nevada County Tobacco Use Prevention Program Youth: “Age Related Risk” Nevada County Tobacco Use Prevention Program Nevada County Superintendent of Schools

CRITICAL GROWTH PHASES CRITICAL GROWTH PHASES OF THE BRAIN CRITICAL GROWTH PHASES OF THE BRAIN Critical growth phases take place at the following times in our life: In Utero 0-5 years Adolescence (12-25)- The pre frontal Cortex is established. 15

WHAT IS THE PREFRONTAL CORTEX? Executive function describes the activity of a system that manages other cognitive systems: Reason Logic Problem Solving Planning Memory The prefrontal cortex plays a significant part in directing attention, developing and pursuing goals, and inhibiting counterproductive impulses.

CANNABINOID RECEPTORS The body’s own cannabinoid system is responsible for connections being made to developing parts of the brain. Endocannabinoids-Produced by body Phytocannabinoids- Produced from Marijuana. (THC,CBD) Introducing foreign cannabinoids causes the body to limit the production of endocannabinoids. Limits the pathways and connections from forming properly.

ADOLESCENT BRAIN Heavy Marijuana use appears to have a significant effect on adolescents’ brain structure and development. Increased use may interfere with sleep patterns, increase anxiety/paranoia and depression. Source: Jacobus e t a l . ( 2 0 0 9 ) . Functional consequences o f marijuana use i n adolescents. Pharmacology, Biochemistry and Behavior. 18

PLENTY OF RESEARCH Tapert et al. (2007). Functional MRI of inhibitory processing in abstinent adolescent marijuana users. Psychopharmacology. Medina et al. (2010). Abnormal cerebellar morphometry in abstinent adolescent marijuana users. Psychiatry Research: Neuroimaging. Bava et al (2009). Altered white matter microstructure in adolescent substance users. Psychiatry Research: Neuroimaging Medina et al. (2007). Neuropsychological functioning in adolescent marijuana users: Subtle deficits detectable after a month of abstinence. Journal of the International Neuropsychological Society. Schweinsberg et al. (2010). The Influence of Recency of Use on fMRI Response During Spatial Working Memory in Adolescent Marijuana Users. Journal of Psychoactive Drugs. Jacobus et al. (2009). Functional consequences of marijuana use in adolescents. Pharmacology, Biochemistry and Behavior. 19

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HASH OR HONEY OIL Sprayed onto generic candies Vaped in vape pens Oil can be whipped into a budder and cooked into products like brownies, cookies, etc. Sprayed onto generic candies Vaped in vape pens Made into drops known as tinctures 28

EDIBLE EFFECTS May not feel anything for 30 to 60 minutes (on a full stomach may take nearly two hours to feel full effects). The high can last 4 to 8 hours while the effects from smoking can wear off in an hour or less. 29

DOSAGE  A cookie or candy may be meant for multiple doses. 30

Edible doses are processed by the liver before WHY EDIBLES ARE POTENT! Edible doses are processed by the liver before entering the bloodstream, THC consumed as edibles produce high levels of 11-OH-THC (active metabolite), while smoked cannabis, goes directly from the lungs to the brain via the bloodstream and does not enter the liver produces lower levels. This is why the effects of smoked or vaporized cannabis come on faster and diminish quickly.

CDC - PSYCHOTIC EPISODE RISK CDC - PSYCHOTIC EPISODE RISK College Student ate an entire marijuana cookie purchased from a legal pot shop in Colorado. Soon after he began to exhibit what witnesses described as erratic behavior, and reportedly jumped out of bed from his hotel room, and jumped over the balcony railing. Marijuana intoxication was a contributing factor

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Withdraw is REAL” Marijuana withdrawal symptoms: anxiety, nausea, sweating, body aches, psychosis

AMERICAN PSYCHIATRIC ASSOCIATION There is no current Scientific evidence that marijuana is in any way beneficial for the treatment of any psychiatric disorder. In contrast, current evidence supports, at minimum, a strong Association of cannabis use with the onset of psychiatric disorders.

Psychosis or Psychotic Episode: MRI scans of young adult males who smoked marijuana daily (and started at an average age of 15). The corpus callosum, the bundle of fibers that allow the two hemispheres to communicate and work in a coordinated way, showed significant impairment. This impairment is similar to that of a brain affected by Schizophrenia.

CANNABIS USE DISORDER DSM-5. Diagnostic and Statistical Manual of Mental Disorders (DSM) is the standard classification of mental disorders used in the U.S. by mental health professionals. Marijuana users build up a tolerance to the drug, they either have to increase the amount or switch to harder dugs.

Prop 64: What does it mean for our youth? It is illegal for anyone under 21 to smoke, consume, buy or possess cannabis.  Teens caught in possession of cannabis will be required to complete drug education or counseling and community service. Driving under the influence of cannabis is against the law. Advertising will create a greater challenge for prevention efforts.

The Best Treatment is Prevention The best treatment is still prevention. Normalizing sobriety is key. Educating youth in a way that will resonate with their culture. Educating parents is a key component.

Nevada County Tobacco Use Prevention Program Nevada County Superintendent of Schools