Legal Marijuana is Coming to Canada – Know the Facts

Marijuana for BT, part 2

Dr. Zach, 2018

 

Marijuana will become legal in Canada on October 17/18  (edibles later)

 

Topics:

 

  1. What do we see in ER

including Inhaled vs ingested

 

  1. What can we expect based on places where it was legalized

 

  1. Marijuana and driving and testing for marijuana in the body

 

  1. Marijuana and mental illness

 

Extra – can 2nd hand smoke make you high, the legalities of cannabis use

 

There are 10 main constituents of cannabis (marijuana).  Of these active components, THC (tetrahydrocannabinol) and CBD (cannabidiol) are found in the greatest quantities.

 

THC is responsible for the neuropsychiatric and addictive properties of the cannabis plant.  It causes the high.

 

CBD has no psychoactive effect.  It’s processed into oils tinctures and caplets and is used for medicinal purposes.

 

  1. Patients present to ER because of cannabis “poisoning” (bad trip) or cannabis hyperemesis syndrome.

 

Cannabis poisoning (aka a “bad trip”) — anxiety, paranoia, numbness, dizziness, hallucinations, confusion, psychosis, hallucinations, slurred speech

High heart rate and BP (or orthostatic hypotension), red eyes, dry mouth

Can cause asthma exacerbation.  Rarely angina or heart attack (risk is increased)

No deaths have been reported

 

Peak concentration levels by route of administration:

Inhalation — 3-10 minutes (smoke vs vape, no smoke with vape)

Oral — 1-5 hours — patients with oral ingestion may take more because they won’t feel intoxicated immediately

 

Treatment.  Largely symptomatic.  Fluids, relaxants if needed, antivomiting medications

 

Cannabinoid Hyperemesis Syndrome:

Most commonly reported cluster of symptoms that brings regular cannabis users to the ER is cannabinoid hyperemesis syndrome.   (even though cannabis decreases nausea in cancer patients)

It consists of intractable nausea, vomiting, and abdominal pain.

Recurrent relapsing disorder.

Vomiting may last 24-48 hours and may lead to dehydration and weight loss.

Symptoms may respond to showering in very hot water.

 

Treatment: supportive therapy, cannabis cessation.  IV hydration. Metoclopramide, ondasetron. Haloperidol, capsaicin cream to the abdomen chest or back.

 

Termination of heavy habitual cannabis use may lead to withdrawal symptoms within 48 hours — irritability, anxiety, nervousness, restlessness, sleep difficulty, seizures, and aggression.

 

  1. Legalization results elsewhere:

 

In colorado ER visits spiked for 6-12 months after legalization but then leveled off.

 

Experience in places where pot is legalized — In Washington and Colorado:

 

Rising rates of pot use by minors

Increasing arrest rates of minors, especially

black and Hispanic children

Higher rates of traffic deaths from driving

while high

More marijuana-related poisonings and

hospitalizations

A persistent black market

 

The public health impact of decriminalization or legalization of recreational cannabis use include:

 

  • Both decriminalization and legalized recreational use have been associated with increased unintentional pediatric ingestions. As an example, after legalization of recreational marijuana use in Colorado, annual calls to the regional poison control center for pediatric marijuana exposure increased 34 percent on average to 6 cases per 100,000 population, which was almost twice the rate for the rest of the United States.  Exposure to recreational marijuana accounted for about half of cases. Rates of hospital visits at a large regional children’s hospital system also increased significantly during the period of the study, although the total number of presenting patients (81) was small.

 

  • In regions with medical marijuana availability, diversion of drug from registered users may also encourage adolescent abuse.

 

  1. Driving:

 

In QC you’ll get a 90 day license suspension if police find any THC in your system.

Not clear how much time before it’s safe but probably at least 4 hours for inhaled and longer for edibles.

Driving stoned is not safe.  One focuses too much on one thing and is too slow to respond to sudden changes.

No clear level that is safe.

Canadian law Bill C-46 states that if you drive with 2-5 nanograms of THC per ml of blood, you’ll face a maximum fine of $1000.  More than 5 nanograms, or having a mix of booze and THC, gets a minimum $1000 fine. Repeat offenders can face up to 10 years in prison.  QC’s law is zero tolerance.

 

Drivers using cannabis are two to seven times more likely to be responsible for accidents compared to drivers not using any drugs or alcohol. Furthermore, the probability of causing an accident increases with plasma levels of delta-9-tetrahydrocannabinol.

Cannabis use increases reaction time and impairs attention, concentration, short term memory, and risk assessment.  Lasts 12-24 hours

 

Federally approved roadside police tool is Drager DrugTest 5000 — takes a saliva sample but apparently there are false positives and negatives and there are concerns about keeping swabs at the right temperature in Canada.  Other ones are being tested.

Many police forces have not ordered the devices yet.

In the meantime police will rely on a field sobriety test, which can involve standing on one leg or tracking an object with your eye, to screen for impairment.

 

Testing for cannabis in the body:

 

Urine drug screens are less helpful in adolescents and adults for the diagnosis of acute intoxication. Although testing is usually positive several hours after acute exposure it can also be positive well after symptoms have resolved. As an example, positive results for delta-9 tetrahydrocannabinol metabolites (urine test) have been reported up to 10 days after weekly use and up to 25 days for after daily use

 

Saliva swab test positive for 6-12 hrs after use

Blood test shows level, positive for 36 hrs after use

Urine test positive for up to 10+ days

 

Blood samples, which are legally binding, can only be taken if you fail the roadside test, and only at a police station.

 

  1. Cannabis seems to unmask predisposition to certain mental illness, especially if used in youth

 

Public health agency of Canada: “One of the things that the research clearly demonstrates is that early access to cannabis can have detrimental effects for brain development and the brain develops up to age 25.”

 

Several studies have linked marijuana use to increased risk for psychiatric disorders, including psychosis (schizophrenia), depression, anxiety, and substance use disorders. The amount of drug used, the age at first use, and genetic vulnerability have all been shown to influence this relationship. The strongest evidence to date concerns links between marijuana use and substance use disorders and between marijuana use and psychiatric disorders in those with a preexisting genetic or other vulnerability

 

Teenagers: Prolonged cannabis consumption below age 17 is linked to memory and attention issues later.  Alcohol is not better.  Young people struggling with anxiety, depression, or learning problems are more at risk of dependency.

 

Mental health: people at risk of mental health issues are more likely to suffer adverse effects from cannabis use

 

Can one get high from second hand marijuana smoke?  No.  Exhaled smoke contains so little THC that you’d have to sit in a room with 16 joints being smoked per hour to show any signs of being high.

 

Plans for cannabis laws in Canada once legalized:

https://www.canada.ca/en/services/health/campaigns/legalizing-strictly-regulating-cannabis-facts.html

Controlled access

When the Cannabis Act becomes law in October 2018, adults who are 18 years or older would be able to legally:

  • possess up to 30 grams of legal dried cannabis or equivalent in non-dried form
  • share up to 30 grams of legal cannabis with other adults
  • purchase dried or fresh cannabis and cannabis oil from a provincially-licensed retailer
    • In those provinces that have not yet or choose not to put in place a regulated retail framework, individuals would be able to purchase cannabis online from a federally-licensed producer.
  • grow up to 4 cannabis plants per residence for personal use from licensed seed or seedlings
  • make cannabis products, such as food and drinks, at home provided that  organic solvents are not used

The sale of cannabis edible products and concentrates would be authorized no later than 12 months following the coming into force of the proposed legislation.

 

Strict Regulation

 

QC law:

 

Under the new plan, the legal age to buy, possess and consume marijuana in Quebec will be 18 — the same as the drinking age.

Other key points include:

  • No one will be allowed to grow cannabis for personal use. It will also be banned to grow it for commercial use, unless following the laws set out by the government.  (this is different from federal law; you can grow up to 4 cannabis
  • It must be smoked in the same places as tobacco. Smoking will also be prohibited on university and CEGEP grounds.
  • There will be zero tolerance for drivers — police officers will be able to ask for a saliva sample if they suspect someone is driving while high and will be able to suspend a driver’s licence for 90 days if a sample comes back positive for ANY cannabis.

While saliva testing has yet to be federally regulated, the province says that police officers are being trained to detect signs of marijuana-impaired driving.

 

The Quebec law would set the legal age at 18 and allow individuals to transport up to 30 grams at a time and hold 150 grams at home

 

A government agency, the Société québécoise du cannabis, will have exclusive legal control of recreational use, selling the product through a limited number of storefronts and online. The province will have 15 stores ready by July 1 and up to 150 in two years.

 

Laws re driving high Canada:

Drivers caught with more than five nanograms of THC in their blood would be guilty of impaired driving, while drivers with both alcohol and THC in their system would be considered impaired if they have more than 50 miligrams of alcohol (per 100 mililitres of blood) and greater than 2.5 nanograms of THC in their blood.

The government said the other two proposed offences would be similar to the offences for drunk driving. Drivers with more than five nanograms of THC in their blood would be punished with a mandatory fine of $1,000 for a first offence, 30 days imprisonment for a second offence and 120 days for a third offence.

 

Laws re driving high Canada:

Drivers caught with more than five nanograms of THC in their blood would be guilty of impaired driving, while drivers with both alcohol and THC in their system would be considered impaired if they have more than 50 miligrams of alcohol (per 100 mililitres of blood) and greater than 2.5 nanograms of THC in their blood.

The government said the other two proposed offences would be similar to the offences for drunk driving. Drivers with more than five nanograms of THC in their blood would be punished with a mandatory fine of $1,000 for a first offence, 30 days imprisonment for a second offence and 120 days for a third offence.

 

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