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<10grams• criminalmisdemeanor

• punishablebyfineonly• Cultivationremainsillegal.

• MedicalCBDoilfortreatingpersistentseizuresispermitted

6/2/2015 3

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

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

• 30stateshaveadoptedlegalizedmarijuana• studentrecruitmentcrossesthesestatelines

• Decreasesstudentperformancemeasuresandretentionrates

• Effectshort-termmemoryimpairment,detachment,decreasedalertness,anddepression

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

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

CampusPerceptionsofMarijuanaareAlreadyStrongInMissouri,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

PreventionandPracticeAlignswithSubstanceAbusePrimarypreventiononcampusisvaried;participantsreportedusingeducationalbrochures,webinars,andsocialnorming.

Campusactivityrelatedtomarijuanahaveincludedactivitiessuchapublicburns(toeducatethecampus)anddrugdoguse(forlawenforcement).

Assessmentofstudentmarijuanauseisoftenpartofothersubstanceabuseassessments.

Motivationalinterviewingisrecommendasanavailabletreatmentinestablishedsubstanceabuseprograms.

2015AIHce6/2/2015 27

SpecificProfessionalDevelopmentNeedsRelatedtoMarijuanaProfessionaldevelopmentneedsformarijuanaaregenerallybeingmetasitisincludedinsubstanceabusetopics.

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?