Cannabis: Edibles Cannabinoids and the Adolescent Brain • Cookies, brownies, candies… • Measure in times used and mg of THC • Standard “serving size” in Colorado is 10 mg Susan F. Tapert, Ph.D. University of California, San Diego Hash & Concentrates Overview • Concentrated marijuana with high THC content • Rates of marijuana use and disorders • Hash: purified cannabis resin • ¼ ounce (7 grams) flowers=1 gram hash or oil. • Typically sell in 1 gram units for around $35-70. • Does cannabis use affect the adolescent brain • Wax/Dabs: ~40mg; 1 gram has 25 40mg doses • Kief: dry concentrate • Water hash: bubble hash, solventless wax, ice wax • Education, prevention, and treatment • C02 Oil: BHO (solvent extracted): wax, shatter, crumble, oil, honeycomb Bubble hash Wax Budder Honeycomb Shatter Synthetic Cannabinoids Cannabis: Smoking Joints, Bowls, Pipes • Fake weed, synthetics, herbal incense, Spice, K2 Blunts (+/- • Measure in grams per occasion tobacco) • 1 joint= .5 grams • 1 blunt= 1-2 grams. • 1 bowl=.25-.5 grams. 1 Gram K2 Bong Joints Bowl 1
Past Month Use of Intoxicants Quick Brain Review! 100% 8th grade 90% 12th grade 80% 70% College Students 60% 50% 40% 30% 20% 10% 0% 10 Monitoring the Future, 2017 Cannabis: Prevalence Gray & White Matter • 34% of young adults (18-28) used in past year – 28% of 10 th graders – 13% of 8 th graders – Little change in recent years for youth • Dependence in ~9% of users • 2 nd highest reason for SUD treatment (1=alcohol) • 12% users drove high in past 2 weeks Top view Side view SAMHSA, National Surveys on Drug Use and Health, 2013 and 2014. Johnston et al., 2017. Monitoring the Future. Perceived Risk of Harm Adolescent Brain Development Trajectories of cortical volume Age of asymptote for connectivity adjusting for total brain volume (Dosenbach et al., 2010) and structural Percentage Saying Great Risk (schematized from data in Ostby (Tamnes et al., 2010) development. 100 et al., 2009). 80 % say 60 regular MJ use 40 is a 2016: 31% “great 20 risk” 0 1975 1982 1991 2002 2012 2016 Somerville, 2016, Neuron Monitoring the Future, 2017 2
Participants (N=108) Overview Light Heavy MJ+Alc • Rates of marijuana use and disorders Drinkers Drinkers Users Age (15-19) 17.2 16.8 17.7 • Does cannabis use affect the adolescent brain Female 35% 37% 29% No FH of alcoholism 46% 42% 45% • Education, prevention, and treatment IQ 111 113 109 Cigarettes/day <1 2 2 Drinks/month 4 42* 44* Lifetime MJ use 1 11 541* * p <.05 Cognition in Abstinent Users Design of 3-Year Study (Age ~17) 1.0 Controls (n=34) Baseline Year 1.5 Year 3 MJ+Alc Users (n=31) 0.5 z-score MRI SCAN #3 MRI SCAN #2 MRI SCAN #2 MRI SCAN #1 0.0 (age ~20) (age ~19) (age ~17) Substance Use Substance Use Substance Use Mental Heath Mental Heath Mental Heath -0.5 NP Assessment NP Assessment NP Assessment NP Assessment NP Assessment NP Assessment -1.0 1. Groups defined by substance use patterns 2. All participants followed for 3 years 17 R01 DA021182 (PI: Tapert) Medina, Hanson, Schweinsburg, Cohen-Zion, Nagel, & Tapert, 2007 Inclusion Criteria Neurocognitive Performance over 3 Years CON MJ • Age 15-18 Digit Span Logical Memory Logical Memory I • Right-handed Recognition Backwards 14 * 10 30 * * * • Lifetime marijuana use: * 12 * * 8 28 * – > 200 for “MJ Users” Scaled Score 10 Raw Score Scaled Score 6 26 8 – < 5 for “Controls” 6 4 24 • < 150 lifetime drinks 4 22 2 • < 10 cigs/day 2 0 20 0 • < 30 lifetime other drugs * p <.05 Jacobus et al., 2015, Neuropsychology 3
Neurocognition & Age of Onset Design of 4-Week Study TMT Number Sequencing Day 28 TMT Letter Sequencing Day 1 18 18 16 16 r = .33-.44 Scaled Scores 14 Scaled Scores 14 12 12 2x Weekly Urine Toxicology 10 10 8 8 6 6 SCAN #1 SCAN #1 4 SCAN #2 SCAN #2 4 (age ~17) (age ~17) 8 10 12 14 16 18 20 (age ~17) (age ~17) 8 10 12 14 16 18 20 MJ Age of Onset MJ Age of Onset Substance Use Substance Use Substance Use Substance Use WAIS-III Digit Symbol Coding TMT Switching Mental Heath Mental Heath 18 Mental Heath Mental Heath 18 16 16 Scaled Scores Scaled Scores NP Assessment NP Assessment 14 14 NP Assessment NP Assessment 12 12 10 10 1. Groups defined by substance use patterns 8 8 6 6 2. All were asked to stop all substance use 4 4 8 10 12 14 16 18 20 8 10 12 14 16 18 20 MJ Age of Onset MJ Age of Onset P20 DA024194; Center PI: Mason, Jacobus et al., 2015, Neuropsychology Subcontract PI: Tapert Arterial Spin Labeling MRI 85 Brain blood flow after 28 days * • Safe 80 Mean CBF (ml/100g/min) of monitored abstinence 75 – Non-invasive 70 Marijuana 65 – No radioactivity Left Insula Users 60 55 Controls 50 * • Issues 80 * *p <.01 – Motion ~Age 17 70 N =46 – Artifact 60 Medial Frontal Gyrus 50 Baseline 28 Days Jacobus, Goldenberg, Wierenga, Tolentino, Liu, & Tapert, 2012, Psychopharm White Matter, Marijuana, & Alcohol Recovery with Abstinence (~Age 20) R Sup. Longitudinal Fasciculus 19 users 21 non-users 0.6 * CON 0.6 * Verbal Memory Working Memory Attention BG ALC 0.5 Fractional Anisotropy 0.47 0.5 BGMJ MJ+ALC * p <.01 0.4 0.4 0.3 Age 20 0.3 17yrs 19yrs 20 yrs 0.6 R Superior Corona Radiata 0.6 * 0.5 * 0.5 0.4 0.4 0.3 24 Age 20 0.3 17yrs 19yrs 20 yrs Jacobus et al., 2013, Psychiatry Research Hanson et al., 2010, Addict Behav 4
Mood Beck Depression Inventory-II 10 Controls 8 MJ Users 6 4 2 0 Day 1 Day 7 Day 14 Day 21 Day 28 Jacobus et al., in preparation THANK YOU! Overview Tapert lab: Joanna Jacobus, PhD, Asst Prof • Rates of marijuana use and disorders Sonja Eberson, MA, Lab Manager MJ Meloy, PhD, Lead MR Techologist Norma Castro, MA, Project Coordinator Silvia Escobar, Project Coordinator • Does cannabis use affect the adolescent brain Sarah Dowling, Project Coordinator Kara Bagot, MD, Asst Prof Postdoctoral fellows: Drs. Ty Brumback, Kelly Courtney, Alejandra Infante. • Education, prevention, and treatment Resident : Alejandro Meruelo, MD PhD Grad students : Tam Nguyen-Louie MA, April May, MS. RAs : Alyssa Lopez, Nadia Dorosti, Claudia Cota, Irene Li, Caroline Barnet, Evan Winiger, Funding Support: NIDA & NIAAA Vanessa Diaz. • Youth at Risk: R01 AA013419 (Tapert) Lab alumni and collaborators: • NCANDA: Alecia Dager, PhD, Yale • U01 AA021692 (Tapert) Krista Lisdahl, PhD, UWM U01 AA021695 (Brown/Tapert) • Bonnie Nagel, PhD, OHSU • ABCD: Lindsay Squeglia, PhD, MUSC • U01 DA041089 (Tapert/Paulus) Key UCSD collaborators: • U24 DA041147 (Jernigan/Brown) Sandra Brown PhD, Anders Dale PhD Terry Jernigan PhD, Martin Paulus MD Marc Schuckit MD, Alan Simmons PhD Treatment • Motivational Enhancement Therapy (MET) with Cognitive Behavioral Therapy (CBT) – Kaminer, Sampl, Kadden – https://store.samhsa.gov • 5 45-75-minute sessions: 1. Motivation building 2. Goal setting 3. Marijuana refusal skills 4. Enhancing social support and pleasant activities 5. Planning for emergencies and coping 5
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