adolescent cannabis use disorder - fmf...substance metrics •caffeine –cups per day •nicotine...

AdolescentCannabisUseDisorder

Dr.AntonioOcañaMSC,MD,CCFP,ABAM

info@northshoreADHD.com

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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