adolescent cannabis use disorder - fmf...substance metrics •caffeine –cups per day •nicotine...
TRANSCRIPT
LearningObjectives
• Prevalence• Uses/Risks• Diagnosis• Co-morbidity• AssessmentofFunction• Treatment• Monitoring
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PresenterDisclosures
Dr.AntonioOcana
Speaker– AdvisoryBoard• Janssen• Purdue• Shire• Pfizer• Otsuka• Lundbeck
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DisclosureofCommercialSupport
• Nofinancial/inkindsupport
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MitigatingPotentialBias
Allnamedproductsareusedtherapeuticallybasedontheir:
• Efficacy• Tolerability• Cost
Notbasedonanyconsultingfees/speakerhonoraria
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Off-LabelPrescribingnotapprovedbyFDAorHPB
• BupropionXR• Lamotrigine• Topiramate• Valproate• Vortioxetine• Aripiprazole
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Prevalence
8
5%
6%
38%
DailyCigarettes
DailyCannabis
RecreationalCannabis
Grade12
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Overview
• DailyCannabisusers- 6%• Strength– 10%• Fat-soluble/longhalf-life• Remainsillegalexceptfor“medicinal”use• Dispensariesareunlicensed/unregulated• CannabisActcomingsoon
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SativaIndica
• Dailycannabisusersareself-medicating• Specificstrainforspecificsymptoms• Specificamounttocontroldosage• Specifictimingtocontroleffect
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NametheStrain
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Uses/Benefits
Indica • Anxiety/Agitation• Insomnia• ChronicPain• Anorexia• Seizures• MoodStabilizer
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Sativa u Increase Energyu Improve cognitionu Executive function
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Risks
Indica• Drop-out– EarnLess• 4xSTD– 10xTeenPregnancy• Depression
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Sativa u Agitationu Anxietyu Psychosis
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Chemistry
Sativa• Tetrahydrocannabinol(THC)• CBpartialagonist• Dopamine• Cognition/Execution
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Indicau Cannabidiol (CBD)u CB antagonist u Serotoninu Pain/ Anxiety/
Insomnia/ Digestion
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Management
• Book3x30min• Diagnosis• Co-morbidity• BaselineFunction• Treatment• Follow-upin4-8wks
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Diagnosis
• Lifetimeuse• Currentuse- Strain• Incidence• Severity• WorstConsequence• ValidatedAssessmentTool
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CannabisAbuseScreeningTest(CAST)Legleye S,Karila L,Beck F,Reynaud Min JSubst Use 2007,12(4),233– 242.
Continueduseofcannabisdespite:• Otherstoldyoutoreduceyourcannabisuse• Memory• Productivity• ConflictwithFamily/Relationship/Social• Health• Mood• Legal
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SubstanceMetrics
• Caffeine– cupsperday• Nicotine– cigarettesperday• Alcohol– days/wkxdrinks/day• Club-drugs– everuseMDMA/Methamphetamine/GHB• Cocaine– lastuse;use/month;$/use• Benzos– everuse/evermisuse/everdaily• Opiates– everwithoutanRx
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Co-morbidity1
• Depression• Anxiety• PTSD• ChronicPain• Bipolar• Suicide
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Co-morbidity2
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§ Impulsive Aggression§ Self Harm§ Eating Disorder§ Substance Use§ Compulsive Disorders
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Co-morbidity3
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§ ADHD
§ Personality Disorder
§ Hallucinations
§ Psychosis
§ Autism
§ Head Injury
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BaselineFunction
• ADLs• Work• Cognition• Productivity
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Interpersonal
• Family• Relationship• Parenting• Social
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Psychological
• SelfCare• StressManagement• Mood• QOL• SupportSystem
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HealthyLife
• Diet• Fitness• Sleep
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ReadinessforChange
• Pre-contemplative• Contemplative• Committed• AssemblingResources• Changing• SustainingChange
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MoodDysregulation
• Distress• MoodRegulation• Agitation• Aggression• Addiction• Complusivity
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Treatment
• SelfManagement• TalkTherapy• Mind/Body• Medical• Advocacy
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SmartGoals
• Specific• Measurable• Accountable• Realistic• Time-line
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SelfManagement
• Family/Relationship/Parenting/Social• SelfCare/Grooming/Mindfulness• Diet• Fitness• Sleep• StressManagement
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TalkTherapy
• Individual– Motivational/Cognitive-Behavioural• Coaching• Group– Peer/Professional• Psycho-Ed– Disease/Treatment/Medication
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Medication
• Antidepressants• MoodStabilizers• AtypicalAP• Stimulants• Sedatives
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Antidepressants
• SSRI• SNRI• NDRI• Multimodal– Vortioxetine– pro-cognitive
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MoodStabilizers
• Lamotrigine Glutamateblocker• Topiramate GABAagonist/glutamateblocker• Valproate GABAagonist• Acamprosate
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AtypicalAntipsychotics
Aripiprazole• Pro-cognitive• Antidepressant• Moodstabilizer
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StimulantsMethyl-phenidate• OROSMPH• MPH
Amphetamine• D- amphetamineSR• D- amphetamineXR• Lys-Dexamfetamine
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Sedatives
• OTC• Melatonin• Quetiapine• Zopiclone
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Advocacy
• School• Employer• Government• Insurance• CriminalJustice
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