Winter 2018

“Factual, science-based information can provide guidance to cannabis users to make choices that reduce both immediate and long-term risks to their health.” ¹

Dr. Benedikt Fischer, Senior Scientist, Centre for Addiction and Mental Health (CAMH), Lead developer of Canada’s Lower-Risk Cannabis Use Guidelines (LRCUG) An extended version of this article is available at: www.qxplore.com/cannabis-extended2 References and Appendices for this article are atwww.qxplore.com/cannabis-appendices2 We follow up on our Fall 2017 EAP newsletter’s discussion of medical cannabis www.qxplore.com/cannabis-extended with some implications of the legalization of recreational use of cannabis in Canada. First, we reiterate an important cautionary note – combining use of cannabis with other prescribed medications or recreational drugs can lead to unpredictable and potentially dangerous effects. At the local level, Quinte Counselling Services and Quinte Assessment and Treatment Group provide Employee Assistance Program services, psychological assessment and psychotherapy services including assistance with use, abuse and addiction. This year Canada will see the legalization of recreational cannabis use.

Teen cannabis use disorder appears to go hand-in-hand with social anxiety disorder, which respondents identified as either preceding (>80%) or following (15%) problematic cannabis use. The two disorders should be treated concurrently,⁸ as is recommended in most cases of dependence and a coexisting mental health disorder. Reflecting previous research, persistent psychotic experiences [i.e., loss of contact with reality, such as paranoia, delusions or hallucinations] were reported by 8% of adolescents in one Montreal based study, increasing to 15% with weekly or daily use.^{6, 9}

Limit your use

Persistent regular use (4 days/ week) among adolescents as well as adults has been linked with increased risks of developing anxiety, depression, fatigue and loss of motivation. ^{5, 10} While cannabis use disorder can occur in any chronic or heavy user, dependence is most likely to first develop in teens 16-18 years of age.⁵

Substitutions – exploring therapeutic pot-ential

International studies suggest that where it is legalized, cannabis is increasingly used as a substitute for prescription drugs.6 A growing body of evidence supports use of cannabis (or medical marijuana) for a wide range of health conditions, from anxiety and depression to symptoms of multiple sclerosis and chronic pain.¹¹ Emerging research suggests cannabidiol or Epidiolex may also help reduce cravings and/or withdrawal anxiety in people addicted to opioids or heroin, and a 3-month study of its use for cocaine withdrawal has just been launched in Montreal. ¹² In two recent Canadian surveys, from 75% – 87% of medical cannabis users reported using cannabis as a substitute for various medications prescribed to treat anxiety, depression, pain, and sleep problems, among others, as well as using it to replace alcohol or illicit substances.⁶ It’s important to note that cannabis interacts and may interfere with many commonly prescribed treatments including some antidepressant, anti-anxiety, antibiotic, and antifungal medications.¹³

Do you know how cannabis affects the ability to drive?

Even when cannabis is legal, driving while under its influence will continue to be illegal. While experts have not agreed on how cannabis affects driving, and many point to the combined use of cannabis and alcohol as a greater concern, no one should drive within several hours of using cannabis. It interferes with the ability to concentrate, to pay attention, and to judge distances. It also slows your reaction time – effects that last for up to five hours after you use cannabis, possibly longer if you are taking it in edible form.⁵

Know your addiction risks

Risk for developing cannabis dependence is about 9%, increasing to 17% when it is first used in adolescence. Mental health vulnerabilities and various preexisting psychiatric conditions increase your risk of harm from cannabis use.¹⁴

“Life is inherently risky. There is only one big risk you should avoid at all costs, and that is the risk of doing nothing.” — Denis Waitley

Something to ponder: Life’s challenges have many different faces. Let’s take a moment to empathize with someone who may be going through serious struggles in life – job loss, relationship breakdown, addiction, loss and grief, physical or mental illness. Let’s replace judging with understanding. Ask ourselves the question, how can we help? What are the things we can do to make things a little bit better for ourselves and for others? One hectic Wednesday, during rush hour, I sat down next to a busy street in downtown, Toronto. I was curious. I observed. I wondered. I acted. I was curious as to what’s happening in these people’s lives, rushing around the busy streets of downtown. I wondered, what could be the things that made them laugh? What are their own personal challenges and how do they manage? What are the thoughts, emotions and struggles that may be hiding behind their daily masks in life? I started to observe and saw many people walking so fast, minding their own business, trying to survive the fast demands of life. Some looked happy, some looked stressed, tired, upset, anxious and one looked lost. I wondered if they felt supported or felt lonely. I wondered if they felt important or neglected. I wondered if they felt understood or judged. I paused and wondered how I would react if I personally felt alone, neglected or judged. I wondered what I could do to manage these potentially negative thoughts that could have a harmful effect on my mental and emotional health? My curiosity inspired me to take a moment and process the many ways we can directly or indirectly connect to people in need of support. I realized, by looking at them, that I can only try to guess what they may be going on in their personal lives. I can only speculate what’s happening within them that may be triggering positive or negative behaviours.