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  • Trends,TacticsandToxicity:MarijuanaMovementonMissouriCollegeCampuses

    JanicePutnamPhD,RNAmyKigerMS,ABD

    KellySkinnerDNP,FNP-C

    1

  • Marijuana/Cannabis

    • Marijuanauseisgrowinginpopularity

    • Consumption:– Joints,blunts,vaporizers– Drinks– Derivatives-wax,dabs,oilsandshatter

    – Capsules– Tincturesandspray(undertongue)

    – Edibles

  • 2015AIHce

    CurrentLawsinMissouri


    • Marijuanapossession

  • CollegeandMarijuana• Mostprevalentusers18to25y.o.• 20%usinginthepastmonth(NIH,2016)

    • ERvisitsby13-21-year-oldsdoubledfrom1.7to4per1,000between2009and2015(U.ofCO)

    • 30stateshaveadoptedlegalizedmarijuana• studentrecruitmentcrossesthesestatelines

    • Decreasesstudentperformancemeasuresandretentionrates

    • Effectshort-termmemoryimpairment,detachment,decreasedalertness,anddepression

    http://health.usnews.com/health-care/articles/2017-05-05/pot-a-factor-in-more-er-admissions-for-colorado-teens-after-legalization

  • MissouriCollegeMACHBSurveyRacialDemographics

    Other

    Asian/PacificIslander

    Hispanic

    Black(non-Hispanic)

    White(non-Hispanic)

    201520162017

  • UseInCar—Missouri

    0%

    2%

    4%

    6%

    8%

    2015 2016 2017

    3% 3%

    5%5%

    6%

    7%

    1% 1% 1%

    Parkedoncampus ParkedoffcampusBeingdriven

  • Noteveryonewhousesmarijuanaexperiencesthefeelingofrelaxationandcalm.Insomeusers,itcancausefear,distrust,anxietyandevenafeelingofpanic.Thisismorelikelytooccurinsomeonewhotakestoomuchortoohighofaconcentration.Thesereactionsareserious,buttemporary,andmayresemblesymptomsofschizophreniawithonlyshortlastingpsychoticsymptoms

    TheCorrelationBetweenUltra-PotentPotandPsychosis-video

    https://www.youtube.com/watch?v=4zZXVjxBK4ghttps://www.youtube.com/watch?v=4zZXVjxBK4g

  • ProblematicUsageandIntervention 


    • Marijuanatoxicity• fainting,passingout,extremeparanoia,excitement,thebodyfrozenintime,andlossofreality

    • Marijuanaaddiction• usedmarijuanaatleastonce,riskis9%• startingtouseinadolescence,riskis17%• usedaily,riskis25-50%.• Chronicmarijuanauseislinkedtopsychosis,schizophrenia,anxiety,depression

  • DiagnosingCannabisUseDisorder• Cannabistakeinlargeramountsoroverlongerperiodsoftimethandesired• Desiretodecreaseorcontrolofcannabisuse• Moretimethandesiredworkingtoobtain,useorrecoverfromtheeffectsof

    cannabis• Strongcravingtousecannabis• Useresultsinfailuretofulfillroleobligationssuchaswork,schoolorhome• Continuedusedespiteinterferencewithsocialorinterpersonalrelationships• Continuedusewiththeknowledgethatitcausesorexacerbatescurrentphysical

    orpsychologicalproblems• Withdrawalsymptomsdevelopwhennotused

    • Mooddisorder• Behavioraldisorder• Nausea

    Tolerance:• Needformorecannabistoachievethehigh• Diminishedeffectwiththecontinueduseofthesameamount

  • WithdrawalSyndrome:

    • Impairedmotorcoordination• Euphoria• Anxiety• Impairedjudgement• Slowtimesensation• Socialwithdrawal• Difficultysleeping• Irritability• Conjunctivalinjection• Increasedappetite• Drymouth• Tachycardia

    Perceptualdisturbances:• Hallucinations,Auditorydisruption,Visualdisruption• TactileIllusions(e.g.feelingasoftobjectbutnotbeingabletodescribeit)

  • Acuteintoxication:

    ERtreatment

    1. Closemonitoring

    2. QuietEnvironment

    • Dimlylitroom• Assignonecaretaker• Calmandlimitedconversation

    3.Benzodiazepinesifsevereagitationoranxietydevelops

  • MarijuanaCessationTechniques

    • Cognitivebehavioraltherapy

    • Contingencymanagement

    • Motivationalenhancementtherapy

    (NationalInstituteonDrugAbuse,2018)

  • MedicalUse–MARINOL/SYNDROS(dronabinol)

    Acannabinoidindicatedinadultsfor:• Anorexia• Nauseaandvomiting

    AdverseEffects:• Dizziness• Drowsiness• Confusionorfeeling“high”• Exaggeratedsenseofwell-being• Nauseaandvomiting• Stomach/abdominalpain

  • 2015AIHce

    • GivenPIPstrackrecordwithalcoholandsubstanceabuse,collegehealthcareprovidersandstaffareinastrongpositiontoanticipatetheneedsofcollegestudentswhoarelikelytostrugglewithproblematicmarijuanauseoraddiction

    6/2/2015 19

  • WhatWeWantedToFindOut


    Whatistheenvironmentofhealthassessmentskills,studentresources,andprofessionaldevelopmentformarijuanausebycollegestudentsinthestateofMissouri?

  • HowWeAnsweredtheQuestion

    • 3PIPFocusGroups• 15schools• N=42• Questionscovered– Assessment– Resources– Professionaldevelopment

  • VoluntaryParticipation 


    • IRB• Audiorecordings• Anyinformationwhichidentifiedindividualschoolsorstaffwascoded

    • Thematicanalysisbythreeresearchers• DebriefedfindingswithPIPpriortodissemination

  • 2015AIHce6/2/2015 23

  • 2015AIHce6/2/2015 24

    CampusPerceptionsofMarijuanaareAlreadyStrong
InMissouri,campus-widemarijuanaperceptionsarealreadystronglyinfluencedbymarketingandlow-riskhealthmessagesencounteredthroughthemediaandsocialinteractions.

    Campus-wideperceptionsofmarijuanaas“justpot”and“harmless”issharedbymanyincludingstudents,staff,andfaculty.

    Asanissue,marijuanauseisseenacrosscampusasasecondaryprioritytomanyissuesofhigherprevalence-specificallyalcohol.

    Talkingtostudentsaboutmarijuanahasbeenreportedasvolatileingroupsettings,butnotinindividualdiscussions.

    Thereisusuallylittlefacultyandparentalinvolvementwhencollegestaffworkonissuesofmarijuanausebystudents.

  • 2015AIHce6/2/2015 25

    ToneofMessageisDisciplinary

    Studentsarenotvoluntarilyusingcollegeservicesfor“problems”withmarijuanause.

    Studentsareusingpreventionservicesonlyifrequiredbydisciplinaryactions.

    Anawarenessofadesiretouselesshasbeenheard,althoughrarely.

  • 2015AIHce6/2/2015 26

    PreventionandPracticeAlignswithSubstanceAbuse
Primarypreventiononcampusisvaried;participantsreportedusingeducationalbrochures,webinars,andsocialnorming.

    Campusactivityrelatedtomarijuanahaveincludedactivitiessuchapublicburns(toeducatethecampus)anddrugdoguse(forlawenforcement).

    Assessmentofstudentmarijuanauseisoftenpartofothersubstanceabuseassessments.

    Motivationalinterviewingisrecommendasanavailabletreatmentinestablishedsubstanceabuseprograms.

  • 2015AIHce6/2/2015 27

    SpecificProfessionalDevelopmentNeedsRelatedtoMarijuana
Professionaldevelopmentneedsformarijuanaaregenerallybeingmetasitisincludedinsubstanceabusetopics.

    Professionaldevelopmentneedsspecifictomarijuananotbeingmetincludevariabilityinmarijuanaforms,routes,anddosages,languageandadvocatingstatementsfordecreasedmarijuanause,hooksfordiscussion,andsafelevelsofuse.

  • 2015AIHce

    Discussion

    • TheresultsarevaluabletoMissouricolleges-theyprovideinsightintothecurrentattitudes,environment,skills,andpracticesrelatedtomarijuanausebycollegestudents

    • Theresultsmayprovideafoundationforfurtherstudiesrelatedtochannelsofcommunication,toneformessages,influentialsocialmodels,practicemodels,andprofessionaldevelopment

    • Programsmayfindtheresultshelpfulforfuturedecisionmaking,strategicplanning,andprogramimprovement

    6/2/2015 28

  • 2015AIHce

    Limitations

    • Smallsamplesizemaymaketheconclusionsnon-transferable

    • Focusgroupstendtobelessdepthfulthanindividualinterviews

    • Focusgroupmembercontributionsmayhavebeeninfluencedbyothermembersofthegrouportheresearchersleadingthediscussions

    6/2/2015 29

  • 2015AIHce6/2/2015 30

    • Questions?