la consommation de cannabis : État des connaissances · 2019-11-19 · • for the treatment for...
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LACONSOMMATIONDECANNABIS:ÉTATDESCONNAISSANCESLaurenceD’Arcy,D.Ps.Institutuniversitairesurlesdépendances24maiet14juin2018
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Plandelaprésentation• Leproduit
• Agentsactifs• Modesd’administration(nouvellestechnologies)• Internet
• Leseffets• Effetsd’intoxication• Effetsd’uneconsommationchronique• Effetssurlasantémentale
• Intervention• Sevrage
• Détectiond’uneconsommationproblématique• « Nouveautés »
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LEPRODUIT
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Dangerositédesproduits:alcoolvscannabis
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Dangerositédesproduitssuite
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Marchénoiretqualitéducannabis
• Concentrationd’agentsactifsinconnue
• Testsenlaboratoire• Bactéries(ex:bacillepyocyanique)• Moisissures,sporeschampignons• Pesticidestoxiques(ex:myclobutanil,pyréthrines)
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Documentderéférence1. Startlow,goslow2. Consider appropriate timeand
place3. Choose less risky cannabis
products4. Choose safer methods of
cannabisconsomption5. Utilize safer smokingpratices6. Reduce theamount ofcannabis
used,andhowfrequently it isused
7. Avoid synthetic cannabisaltogether
8. Avoid mixing cannabiswithtobacco andalcohol
9. Don’t drivehigh– haveplanfortransportationbefore usingcannabis
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Cannabis:différents« looks »
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Modedeconsommationinhalé
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Modedeconsommationingéré
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Indica etsativa
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Cannabis
• THC(Δ9-tetrahydrocannabinol)§ Euphorisant§ Affectelessens§ Symptômespsychotiquesetparanoïa
• CBD(cannabidiol)§ Anxiolytique§ Antipsychotique
• Principauxcannabinoïdes impliquésdanslecannabisrécréatif
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Scores on the Oxford Liverpool Inventory of Life Experiences factors categorised by cannabis group.
Celia J. A. Morgan, and H. Valerie Curran BJP 2008;192:306-307
©2008 by The Royal College of Psychiatrists
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Izzo,Borrelli,Capasso,DiMarzo&Mechoulam (2009)
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Leafly TV
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DispensairedecannabisVancouver
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Ventedecannabisetdérivéssurinternet
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LESEFFETS
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Effetsrecherchésdelaconsommationrécréative?
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Rapport2017duNationalAcademies ofSciences,Engineering,andMedecine
In the report The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research, an expert, ad hoc committee of the National Academies of Sciences, Engineering, and Medicine presents nearly 100 conclusions related to the health effects of cannabis and cannabinoid use.
The committee developed standard language to categorize the weight of the evidence regarding whether cannabis or cannabinoids used for therapeutic purposes are an effective or ineffective treatment for certain prioritized health conditions, or whether cannabis or cannabinoids used primarily for recreational purposes are statistically associated with certain prioritized health conditions. The box on the next page describes these categories and the gen-eral parameters for the types of evidence supporting each category.
The numbers in parentheses after each conclusion correspond to chapter conclusion numbers. Each blue header below links to the corresponding chapter in the report, providing much more detail regarding the committee’s findings and conclusions. To read the full report, please visit nationalacademies.org/CannabisHealthEffects.
CONCLUSIONS FOR: THERAPEUTIC EFFECTS
There is conclusive or substantial evidence that cannabis or cannabinoids are effective:• For the treatment for chronic pain in adults (cannabis) (4-1)• Antiemetics in the treatment of chemotherapy-induced nausea and vomiting (oral cannabinoids) (4-3)• For improving patient-reported multiple sclerosis spasticity symptoms (oral cannabinoids) (4-7a)
There is moderate evidence that cannabis or cannabinoids are effective for:• Improving short-term sleep outcomes in individuals with sleep disturbance associated with obstructive sleep apnea
syndrome, fibromyalgia, chronic pain, and multiple sclerosis (cannabinoids, primarily nabiximols) (4-19)
There is limited evidence that cannabis or cannabinoids are effective for:• Increasing appetite and decreasing weight loss associated with HIV/AIDS (cannabis and oral cannabinoids) (4-4a)• Improving clinician-measured multiple sclerosis spasticity symptoms (oral cannabinoids) (4-7a)• Improving symptoms of Tourette syndrome (THC capsules) (4-8)• Improving anxiety symptoms, as assessed by a public speaking test, in individuals with social anxiety disorders (cannabidiol)
(4-17)• Improving symptoms of posttraumatic stress disorder (nabilone; one single, small fair-quality trial) (4-20)
There is limited evidence of a statistical association between cannabinoids and:• Better outcomes (i.e., mortality, disability) after a traumatic brain injury or intracranial hemorrhage (4-15)
There is limited evidence that cannabis or cannabinoids are ineffective for:• Improving symptoms associated with dementia (cannabinoids) (4-13)• Improving intraocular pressure associated with glaucoma (cannabinoids) (4-14)• Reducing depressive symptoms in individuals with chronic pain or multiple sclerosis (nabiximols, dronabinol, and nabilone)
(4-18)
THE HEALTH EFFECTS OF CANNABIS AND CANNABINOIDSJanuary 2017
THE CURRENT STATE OF EVIDENCE AND RECOMMENDATIONS FOR RESEARCH
The Health Eff ects of Cannabis and Cannabinoids
REPORT
COMMITTEE’S CONCLUSIONS
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Cannabinoïdes thérapeutiques
• Évidencessubstantielles• Douleurchronique• Spasticitédelascléroseenplaques• Améliorationdelanausée/vomissementslorsdela
chimiothérapie• Évidencesmodérées
• Troubledusommeil(courtterme)• Évidenceslimitées
• AmélioreappétitetgaindepoidsVIH• SyndromedeGillesdelaTourette• Phobiesociale
• Manquesd’évidences• Côlonirritable• Épilepsie• Maladiesneuromusculaires(Huntington,Dystonie,Parkinson)• Etc.
(NationalAcademies ofSciences,Engineering,andMedicine,2017)
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Thérapeutiqueoupathologique?
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Effets« secondaires »del’intoxication
• Déficitssurleplancognitif• Concentrationetattention(attentionpartagéeaffaiblie)• Mémoire
§ Detravail:Traitementetutilisationdel’information§ Épisodique:Déficitd’encodagedenouveauxsouvenirsetdoncderécupération(voirCraneetal.,2013)
• Déficitssurleplanpsychomoteur• Capacitésmotrices(coordination)• Équilibre• Poursuitevisuelle• Tempsderéaction
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Risquerelatifd’accidentsimpliquantalcoolvsTHC
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Effetsetrisquesàlaconsommationdecannabis
• 5rapports« Dissiperlafuméeentourantlecannabis »• Santémentaleetfonctionscognitives• Grossesse• Conduiteautomobile• Fonctionsrespiratoires• Usageàdesfinsmédicales
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Effetsd’uneconsommationchroniquesurlesfonctionscognitives(quotidienneetàlongterme)
• Attention• Mémoiredetravail• Planification,organisation,prisesdedécision(fonctionsexécutives)• Apprentissageverbal
àAugmentationdurisqued’échecsscolaires,abandon
Semblentréversibles siconsommationaprès18ans…moinsclairchezlesadolescents
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Consommationdecannabis,diminutionduQIetatrophieducerveau???
• RésultatsmixtesconcernantleQI• Cheetham etcoll,2012vsMeieretcoll.2012)
• Neurotoxicité etcannabis:analysedesdonnéesdeneuro-imageriestructurelle• Lesmêmesconstatsquepourlesadultespeuventêtrefaitspourlesadolescents:lesétudesdisponiblesnemontrentaucunedifférencedevolumestotaux,etlesdifférencesrégionales trouvéesdanscertainesétudessontsoitnonrépliquées, soitcontreditesparplusieursautresétudes.(Zullinoetcoll.,2017)
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« Complications »delaconsommation
Syndromeamotivationnel Psychose toxique
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Cannabisetschizophrénie
• Relationcomplexe
• Augmentationdurisquedepsychose• Chezlespersonnesdéjàprédisposées• ProduitsàforteconcentrationenTHC• Chezlesconsommateurs« lourds »
(consommationquotidienneetengrandequantité)
• Consommationdecannabissemblediminuerl’efficacitédesanti-psychotiques
• SelonLargeetcoll.(2011)laconsommationdecannabisentraîneraitundébutdelamaladiede2,7ansplustôt
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Cannabisetdépendance
• Dépendanceaucannabischezlespersonnesquienontconsomméaucoursdeleurvie
=9%
• Dépendanceaucannabischezlespersonnesquienontconsommédurantl’adolescence
=16%
(Lopez-Quintero etcoll.2011)(Antony,2006)
?
?
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Sevrage
• Symptômes:é anxiété• Difficultédesommeil,cauchemars,colère/irritabilité,dysphorie,nausée
• Affecteenviron50%desusagersréguliers• Début1à2jouraprèsarrêt• Pic:2à6jours• S’arrêteaprès1à2semaines
• ATTENTION:tabac?
• Traitementpharmacologique?Pasd’évidencesclairesàcejour.
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CannabisAbsuse ScreeningTest(CAST)
• )
�
3�
�
To�calculate�a�score,�the�responses�are�coded�on�a�scale�of�0�to�4.�The�total�score�obtained�(which�
can�range�from�0�to�24)�indicates�whether�or�not�the�questioned�users�are�at�risk.�A�score�of�less�than�
3�indicates�no�addiction�risk.�A�score�of�3�or�less�than�7�indicates�low�addiction�risk,�and�a�score�of�7�
or�above�indicates�high�addiction�risk.�The�score�is�calculated�for�those�respondents�who�completed�
the�test�in�its�entirety�and�who�had�used�cannabis�in�the�year�preceding�the�test�(N=7,668�in�2011,�or�
28%�of�the�sample�questioned).�
N.B.�The�CAST�results�presented� in�the�2011�European�ESPAD�survey�report�were�established�using�
thresholds� that� referred� to� initial� validations� and� employed� a� slightly� different� score� calculation�
method�[11].��
�
Description�of�the�validation�protocol�
The�validation�process�concerned� first� the�general�population.�This� involved�using�a� reference� test�
such�as�the�MͲCIDI�to�establish�the�best�way�to�use�CAST�for�diagnostic�purposes.��
This� initial� validation� relied� on� a� quantitative� survey� conducted� in� late� 2008� on� an� adolescent�
population�based�on� the�ESCAPAD� survey�model.�This� initial� validation�was� funded� in�part�by� the�
ConsommationproblématiquedecannabisScoreauquestionnaire<3=risquenégligeable3à7=risque faible7et+=risqueimportant
(Spilka, Janssen&Legleye,2013)
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Stopcannabis:applicationetsiteinternet• https://www.stop-cannabis.ch
BrochuresréaliséesparAddictionSuisse
• Cannabis,enparleraveclesados• Lecannabisenquestion• Focussurlecannabis• Guided'aideàl'arrêtducannabis• Cannabis,lesrisquesexpliquésauxparents• Guided’aideàl’arrêtducannabis• Repérageprécocedel’usagenocifdecannabis,
repèrespourvotrepratique(INPES:documentréservéauxprofessionnelsdelasanté.Étatdesconnaissancesjuillet2006)
• RondPoint:leflyer:RondPointbrochurepourparentsetprofessionnels
• BrochureréaliséeparRupturessurlecannabis(2004)• Lesjeunesetlecannabis
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Cannachoix àvenir!
• Versiond’Alcochoix+adaptéaucannabis
• Pourlesadultesquidésirediminuerleurconsommationdecannabisetquisontfonctionnels
• Vaêtreoffertenpremièreligne
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Sitedugouvernement
• https://encadrementcannabis.gouv.qc.ca/
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MERCI!