Introduction of Substance Use

Question 1

What are the canadian studies that looked into safe supply/opioid agonist therapies?

Answer 1

North American Opiate Medication Initiative (NAOMI)

Study to Assess Long-Term Opioid Medication Effectiveness (SALOME)

Question 2

How does the harm reduction field differ in terms of evidence based practice?

Answer 2

Interventions often precede the evidence, as there is limited data in intervention efficacy as well as on harm and how to mitigate them.

Question 3

What are 5 recommendations to improve care for substance users?

Answer 3

1. Expand access to pharmacy based harm reduction programs
2. Expand undergrad and professional education opportunities for substance use
3. Address stigma and other structural barriers
4. Instill a proactive leadership approach
5. Encourage research focused on pharmacist involvement

Question 4

What does the 2018 Cannabis Act dictate?

Answer 4

Legal requirements to recreational cannabis. Each province has their own regulations to the sale and use of cannabis– ex. in Ontariom, we have the Cannabis Statute Law Amendment Act.

Question 5

How much cannabis can an adult posses? In Ontario, how many plants can a household have?

Answer 5

30g of dried cannabis

4 plants

Question 6

Did legalization change cannabis use?

Answer 6

15->17% use in Canadians 15+
33% use rate in 18-24
50% of Canadians reported obtaining cannabis through legal sources

Question 7

Define phytocannabinoid

Answer 7

Plant-derived cannabinoids (vs. synthetic ones)

Question 8

Describe cannabinoid receptors

Answer 8

GPCRs
CB1 receptors are mainly in the brain, but also in other tissues
CB2 receptors are mainly in the immune system and in blood cells
Both are G-alphai coupled

Question 9

What is the psychoactive cannabinoid?

Answer 9

∆9-THC
A partial agonist at both CB1 and CB2 receptors
Causes dopamine release in the brain

Question 10

What is the non-psychoactive cannabinoid?

Answer 10

Aka the medical cannabinoid, but both names are inaccurate
Exerts CNS effects, including modulating the psychoactive effects of THC
A poor ligand at cannabinoid receptors
Binds (as an agonist or antagonist) to serotonin and dopamine receptors as well as ion channels

Question 11

What are 4 examples of pharmaceutical cannabinoids?

Answer 11

Nabilone
Nabiximols
Dronabinol
Epidolex

Question 12

What is nabilone?

Answer 12

synthetic THC-like cannabinoid for chemotherapy induced nausea- and vomiting

Question 13

What is nabiximols?

Answer 13

Combo product of ∆9-THC and cannabidiol

spasticity and neuropathic pain associated with MS and cancer pain

Question 14

What is dronabinol?

Answer 14

Synthetic ∆9-THC

Increases appetite in patients with HIV/AIDS and treats chemotherapy-induced nausea and vomiting

Question 15

What is epidolex?

Answer 15

indicated for lennox-gastaut and dravet’s epilepsy syndromes in those >2y/o

Question 16

What are common AEs associated with cannabis use?

Answer 16

blurred vision
dizziness
dry mouth and eyes
urinary retention
muscle twitchin
tachycardia
hypotension/hypertension
somnolence
memory loss, time distortion, hallucinations, anxiety, paranoia and psychosis

Question 17

What is the link between smoking cannabis and lung cancer?

Answer 17

No definitive link between the two

Question 18

What are the effects of ∆9-THC on the CV system?

Answer 18

Can cause tachycardia commonly and bradycardia at high doses.
Risk of myocardial infarction in angina patients due to increase in cardiac output caused by ∆9-THC