A tragédia da maconha: causas, consequência e prevenção / The tragedy of marijuana: causes, consequence and prevention

O principal objetivo deste livro é oferecer, aos médicos, profissionais de saúde, educadores, legisladores, gestores e à população em geral, informações sobre a maconha baseadas por evidências científicas que auxiliem em sua prática diária e contribuam para maior conscientização dos jovens, pais e a sociedade como um todo, sobre os riscos e efeitos nocivos que o uso da Cannabis acarreta para a saúde, além de apresentar os benefícios de seu uso medicinal. Atualmente, a Cannabis é a droga ilícita mais produzida e consumida no mundo, com um número global de usuários chegando a 182,5 milhões (3,8% da população mundial). Da mesma forma, é a substância ilícita mais usada entre a população de 15 a 64 anos na América do Norte, com prevalência anual estimada de 11,6%. Um estudo longitudinal recente mostrou que 12,4% dos usuários de tabaco relataram fumar maconha antes do início do tabaco. Além disso, também foi observado maior uso entre jovens negros em comparação com brancos e, entre aqueles expostos a traumas violentos. Segundo o Levantamento Nacional de Álcool e Drogas (Lenad, 2012), a substância ilícita com maior prevalência de uso na população brasileira é a maconha. Do total da população adulta, 7% declarou ter experimentado a maconha alguma vez na vida, o que corresponde a 8 milhões de pessoas. No grupo dos adolescentes, estimado na época em 14 milhões, cerca de 4,3% (597 mil) já haviam experimentado a droga. Considerando o consumo de maconha nos últimos 12 meses, 2,5% dos brasileiros adultos declararam tê-la 8 usado, assim como 3,4% dos adolescentes, ou seja, mais de 3 milhões de adultos e 478 mil adolescentes em todo o país. Há evidências de que o uso precoce de Cannabis pode estar relacionado com maior probabilidade de uso crônico, uso abusivo e dependência, além de efeitos sistêmicos, portanto não se trata de uma droga inofensiva, como tem sido divulgado. O uso da maconha é generalizado na população de adolescentes e jovens adultos: dados da pesquisa anual (Monitoring the Future) sobre uso de drogas por estudantes nos Estados Unidos (EUA) revelam que as taxas de uso no último ano variaram de 9% (ensino fundamental) a 35% (ensino médio). Nos EUA, a Cannabis é uma agenda prioritária do setor de saúde, e tem alto potencial de abuso. O uso medicinal da substância vem se intensificando e remonta a muitos séculos. Paralelamente ao aumento generalizado do uso recreativo da droga em todo o mundo, especialmente entre os jovens adultos, houve movimentos para a descriminalização do uso de Cannabis em várias partes do mundo e, em alguns países, a prescrição de Cannabis é agora permitida para outras condições clínicas do que era para a dor tradicional do câncer e a neuropatia. Recentemente, vários países aprovaram seu uso clínico para diversas condições clínicas, enquanto outros legislaram sobre a descriminalização do porte da droga. Nos EUA, em 2016, um total de 25 estados, o Distrito de Columbia e Guam já permitiam programas abrangentes de maconha medicinal e Cannabis.

Alcohol-related blackouts among college students: impact of low level of response to alcohol, ethnicity, sex, and environmental characteristics

Objective: To explore how a genetically-influenced characteristic (the level of response to alcohol [LR]), ethnicity, and sex relate to environmental and attitudinal characteristics (peer drinking [PEER], drinking to cope [COPE], and alcohol expectancies [EXPECT]) regarding future alcohol-related blackouts (ARBs). Methods: Structural equation models (SEMs) were used to evaluate how baseline variables related to ARB patterns in 462 college students over 55 weeks. Data were extracted from a longitudinal study of heavy drinking and its consequences at a U.S. university. Results: In the SEM analysis, female sex and Asian ethnicity directly predicted future ARBs (beta weights 0.10 and -0.11, respectively), while all other variables had indirect impacts on ARBs through alcohol quantities (beta weights ~ 0.23 for European American ethnicity and low LR, 0.21 for cannabis use and COPE, and 0.44 for PEER). Alcohol quantities then related to ARBs with beta = 0.44. The SEM explained 23% of the variance. Conclusion: These data may be useful in identifying college students who are more likely to experience future ARBs over a 1-year period. They enhance our understanding of whether the relationships of predictors to ARBs are direct or mediated through baseline drinking patterns, information that may be useful in prevention strategies for ARBs.

Exploring the Perceptions of Psychiatric Patients Regarding Marijuana Use

There is limited understanding on marijuana use by psychiatric patients; specifically with regard as to why they continue to smoke marijuana despite the negative consequences; such as readmittance to psychiatric hospitals following marijuana-induced psychosis. It is; therefore; important to understand why psychiatric patients continue to use marijuana; despite experiencing its negative effects. The purpose of this study was to explore and describe the perceptions of psychiatric patients with regard to marijuana use in Potchefstroom; North West Province; as well as to formulate recommendations for nursing education; nursing research and nursing practice; with the aim of reducing the readmission of psychiatric patients following marijuana-induced psychosis. A qualitative; exploratory; descriptive and contextual research design was followed in order to give 'voice' to the perceptions of psychiatric patients about marijuana use. Purposive sampling was utilised to identify participants who complied with selection criteria. The sample size was determined by data saturation; which was reached after 10 individual interviews with psychiatric patients. Unstructured individual interviews were utilised to gather data after written approval from the Ethics committee of the North-West University (Potchefstroom Campus); North West Provincial Department of Health; the clinical manager of the psychiatric hospital where data were collected; as well as from the psychiatric patients. The co-coder and the researcher analysed the data independently. The findings of this study include perceptions of psychiatric patients on the use of marijuana; the negative effects of marijuana use; marijuana use and mental illness; and quitting marijuana. Recommendations were formulated for nursing education; nursing research as well as for nursing practice

Manifestações do uso de maconha e opiáceos durante a gravidez / Outcomes of marijuana and opioids use during pregnancy

Visando a analisar o uso de maconha e opiáceos durante a gestação e suas consequências, tanto na formação como no futuro desenvolvimento da criança, realizou-se uma revisão crítica da literatura, com foco nos efeitos deletérios dessas drogas no recém-nato. Muitas dúvidas ainda não foram sanadas referentes à ação das drogas e o reflexo no concepto. Foram observadas coincidências entre o uso de maconha e o mau desenvolvimento do tubo neural do recém-nato, além de possíveis anencefalias. Em relação à ação dos opiáceos durante a gestação, foi observado um maior número de partos prematuros, bebês nascidos com baixo peso, com menor circunferência craniana e menor estatura

Aiming at analyzing the marijuana and opioids use during pregnancy and their consequences both in formation and in the future development of the child, a critic review of the literature was carried out focusing on the deleterious effects of these drugs in the recent born. Many questions have not been answered referring to the action of the drug and its reflection on the concept. It had been observed a relationship between use of marijuana and the poor development of the neural tube of the newly born and possible anencephalies. In relation to the opioids outcomes during pregnancy, an increase of premature births, babies born with low-birth weight, small cephalic circumference, and lower height were observed

Falacias, controversias y realidades acerca del consumo de marihuana: [revisión] / Cannabis consumption: falacies, controversies and reality: [review]

La marihuana es la droga ilegal más ampliamente consumida a nivel mundial, tan sólo por detrás de las legales alcohol y tabaco. A pesar de que las encuestas entre usuarios señalan un buen conocimiento de los efectos que produce, la impresión de los profesionales que atienden a los consumidores es que tal información es claramente escasa, parcial, cuando no directamente incorrecta. Lamentablemente, esta misma desinformación se advierte en algunos profesionales que atienden a los pacientes, o entre educadores y padres de jóvenes consumidores. En el presente artículo se abordan de manera científica una serie de controversias respecto del consumo de marihuana y sus consecuencias, con el objetivo de clarificar la información y ayudar a la prevención y tratamiento del consumo de dicha sustancia. Se persigue, igualmente, llamar la atención sobre la gravedad de su consumo, no sólo en cuanto a prevalencia sino también en cuanto a sus consecuencias.

Efectos del consumo de marihuana en funciones cognitivas en jóvenes adolescentes / Effects of consumption of marihuana on cognitive functions in young students

El presente estudio explora el efecto de la marihuana en una población de jóvenes adolescentes escolares, que sólo consumen esta droga ilícita y no otra, y que jamás han consultado a un especialista por problemas de adicción. Los resultados muestran el efecto del consumo habitual de marihuana en funciones cognitivas involucradas en el aprendizaje. Una vez identificados los sujetos, se realizan evaluaciones individuales de estudiantes consumidores y no consumidores de educación media de establecimientos de dependencia municipal, particular subvencionada y particular pagada del Area Metropolitana (Santiago de Chile). Se evidencian efectos nocivos sobre la memoria inmediata, atención-concentración y estrategias de ejecución en los consumidores, con diferencias estadísticamente significativas respecto al grupo control. Se constata mayor consumo relativo en colegios pertenecientes a sectores marginales y escasa o inexistente percepción de daño asociado al consumo de la droga, especialmente entre los consumidores habituales. Las niñas tienden a igualar los niveles de consumo de los varones.

This study evaluates the effects of marihuana in a population of 14 to 17 year old secondary school students, who consume exclusively this illegal drug, and who have never consulted a specialist for addiction problems. The results show the effects of habitual consumption of marihuana on cognitive functions involved in the learning process. Once the subjects have been identified, individual evaluations are performed on students who consume and who do not consume marihuana in public, subsidized public, and private schools of Santiago, Chile. Harmful effects are detected on immediate memory, attention-concentration and execution strategies in consumers, with statistically significant differences in comparison to the control group. Higher consumption is found in schools in poorer districts. There is impaired perception of harm associated with the consumption of the drug especially among habitual consumers. Girls tend to consume the same amount as boys.

Revisão: funcionamento executivo e uso de maconha / Review: executive functioning and cannabis use

OBJETIVO: A maconha é a droga ilícita mais consumida no mundo, porém ainda existem poucos estudos examinando eventuais prejuízos cognitivos relacionados ao seu uso. As manifestações clínicas associadas a esses déficits incluem síndrome amotivacional, prejuízo na flexibilidade cognitiva, desatenção, dificuldade de raciocínio abstrato e formação de conceitos, aspectos intimamente ligados às funções executivas, as quais potencialmente exercem um papel central na dependência de substâncias. O objetivo do estudo foi fazer uma revisão a respeito das implicações do uso da maconha no funcionamento executivo. MÉTODO: Esta revisão foi conduzida utilizando-se bases de dados eletrônicas (MedLine, Pubmed, SciELO and Lilacs). DISCUSSÃO: Em estudos de efeito agudo, doses maiores de tetrahidrocanabinol encontram-se associadas a maior prejuízo no desempenho de usuários leves em tarefas de controle inibitório e planejamento; porém, este efeito dose-resposta não ocorre em usuários crônicos. Embora haja controvérsias no que se refere a efeitos residuais da maconha, déficits persistentes parecem estar presentes após 28 dias de abstinência, ao menos em um subgrupo de usuários crônicos. CONCLUSÕES: Os estudos encontrados não tiveram como objetivo principal a avaliação das funções executivas. A seleção de testes padronizados, desenhos de estudos mais apropriados e o uso concomitante com técnicas de neuroimagem estrutural e funcional podem auxiliar na melhor compreensão das conseqüências deletérias do uso crônico da maconha no funcionamento executivo.

OBJECTIVE: Cannabis is the most used illicit drug worldwide, however only a few studies have examined cognitive deficits related to its use. Clinical manifestations associated with those deficits include amotivational syndrome, impairment in cognitive flexibility, inattention, deficits in abstract reasoning and concept formation, aspects intimately related to the executive functions, which potentially exert a central role in substance dependence. The objective was to make a review about consequences of cannabis use in executive functioning. METHOD: This review was carried out on reports drawn from MedLine, SciELO, and Lilacs. DISCUSSION: In studies investigating acute use effects, higher doses of tetrahydrocannabinol are associated to impairments in performance of nonsevere users in planning and control impulse tasks. However, chronic cannabis users do not show those impairments. Although demonstration of residual effects of cannabis in the executive functioning is controversial, persistent deficits seem to be present at least in a subgroup of chronic users after 28 days of abstinence. CONCLUSIONS: The neuropsychological studies found did not have as a main aim the evaluation of executive functioning. A criterial selection of standardized neuropsychological tests, more appropriate study designs as well as concomitant investigations with structural and functional neuroimaging techniques may improve the understanding of eventual neurotoxicity associated with cannabis use.

Marijuana Smoking among Secondary School Students in Zaria; Nigeria: Factors Responsible and Effects on Academic Performance

Background: The use of Marijuana is on the increase worldwide especially among adolescents and youths. Marijuana smoking has gained a foothold in our environment because of peer group influence; accessibility and availability. Its medico-social effects could ruin the life and future of our youths. This study was undertaken to determine the prevalence and the factors that influence secondary school students in Zaria LGA to smoke and the effects on academic performance. Methods: A cross-sectional descriptive study was employed to generate data among secondary school students. A multi-stage sampling technique was used. Data was collected with the use of a structured; pre tested self-administered questionnaire. c2 test was used to test for significance of association between categorical variables. Results: Of the 350 respondents; 262 (74.9) were males; while 88 (25.1) were females. The study shows that 33 of the students smoke marijuana giving a prevalence of 9.4. There were more smokers in the age group 15-19 years (54.6). Other factors that influence marijuana smoking include family background; peer pressure and attendance of social functions. There was better academic performance (51.1) among non smokers as compared to smokers (27.2); and this was found to be statistically significant (x2 = 11.73;df = 5;P .05) There was also statistically significant association between age and marijuana smoking (x2 ) were males; while 88 (25.1) were females. The study shows that 33 of the students smoke marijuana giving a prevalence of 9.4. There were more smokers in the age group 15-19 years (54.6). Other factors that influence marijuana smoking include family background; peer pressure and attendance of social functions. There was better academic performance (51.1) among non smokers as compared to smokers (27.2); and this was found to be statistically significant (x2 = 11.73;df = 5;P .05) There was also statistically significant association between age and marijuana smoking (x2

Profesor Armando Roa y su aporte al estudio clínico de la marihuana en la perspectiva actual / Professor Armando Roa and his contribution to the clinical study of the marijuana in the present perspective

Se revisan los aspectos fundamentales del uso de la marihuana, a la luz del conocimiento actual, junto a los aspectos clínicos descritos por el Profesor Armando Roa sistematizados en su libro La Marihuana; se comenta sobre la importancia de su aporte a la clínica de este fenómeno

Cardiopatía isquémica por cocaína / Ischemic cardiopathy due to cocaine

Se presenta el caso de un paciente masculino de 28 años de edad, adicto a marihuana y cocaína durante seis años, quien desarrolló cardiomiopatía isquémica manifestada por angina de pecho, infarto agudo del miocardio, arritmias ventriculares, insuficiencia cardiaca, choque cardiogénico y muerte. Se presentan los hallazgos de autopsia y se hace hincapié en las complicaciones cardiacas provocadas por cocaína

Complicaçöes respiratórias do uso da maconha / Respiratory complications of use of cannabis

Realiza-se uma revisäo quanto às complicaçöes respiratórias do uso da maconha. Descreve-se os achados sintomáticos, as alteraçöes da funçäo pulmonar, a sua associaçäo com infecçöes e reaçöes alérgicas; a possibilidade da maconha ser uma gente carcinogênico. Conclui-se que o uso da maconha deve ser investigado em casos de pacientes com queixas respiratórias, especialmente se estes forem adultos jovens

Consumo de substancias que producen dependencia en Colombia / Consumption of dependency-producing substances in Colombia

In 1987 a study was made of the consumption of dependency-producing substances in the urban population of Colombia. For this purpose the prevalence survey method was applied to a representative sample of 2,800 individuals between the ages of 12 and 64. The descriptive analysis was supplemented by the exploration of causal associations and measurement of the strength of such associations by means of the prevalence ratio coupled with calculation of the degree of statistical significance. The study included three substances whose consumption is socially accepted - alcohol, tobacco, and tranquilizers - and another three considered to be illicit - basuco (coca-paste), cacaine, and marijuana. Alcohol and tobacco were the two drugs most used by both sexes (560 and 297 per 1,000 subjects studied, respectively.) Tranquilizers, the only one of the drugs in the study that was used more by women, ranked third (60 per 1,000). Reported in much smaller proportions were marijuana (11 per 1,000), basuco (6 per 1,000), and cocaine (3 per 1,000). It may be noted that the consumption of basuco has recently reached a level double that of cocaine. Analysis of the use and abuse of these substances by age, marital status, socioeconomic situation, and other variables indicates that the prevalence of consumption is higher in the medium age groups

Niveles sanguineos de plomo en neonatos hijos de madres consumidoras de "basuco": estudio comparativo / Lead blood levels in newborns of \"basuco\" consumer mothers: comparative study

La obtencion del clorhidrato de cocaina a partir de la hoja de coca requiere el uso de gasolina; residuos de esta pueden permanecer en la pasta base(basuca); al fumar esta, mezclada con cigarrillo o marihuana (basuco) el consumidor puede captar residuos de plomo e incrementar sus concentraciones sanguineas del mismo; quisimos saber si el uso del basuco durante el embarazo podria tener tal efecto en los recien nacidos de madres consumidoras. Se midieron las concentraciones de plomo serico en 19 recien nacidos hijos de gestantes consumidoras de basuco y en 18 de sus madres, asi como en 20 parturientas no consumidoras y en 19 de sus hijos. Se utilizo un espectrofotometro de absorcion atomica Perkin-Elmer modelo 2380. Las madres se dividieron en 4 grupos segun el grado de consumo, asi: leve, moderado, intenso y ninguno. Las cifras promedio y las DE encontradas fueron respectivamente: en los hijos:13.5 mas o menos 9.4; 15.8 mas o menos 6.5; 16.6 mas o menos 7.8; 6.9 mas o menos 5.0 ug/dl, y en las madres, 13.3 mas o menos 4.6; 13.5 mas o menos 6.9; 16.2 mas o menos 4.9; 8.4 mas o menos 4.6 ug/dl. Las pruebas estadisticas demostraron diferencias altamente significativas entre las madres e hijos expuestos al basuco y la cohorte no expuesta; no existio diferencia entre las concentraciones segun el grado de consumo. Los altos niveles de plomo detectados ameritan seguimiento de los recien nacidos y estudios adicionales, con el fin de evaluar su repercusion a largo plazo

Obtention of cocaine clorhydrate from coca leaves requires the use of gasoline; therefore residues such as lead may remain in the base paste (basuca); the latter is smoked, under the name basuco, mixed with tobacco or marijuana; It is conceivable that the smoker takes up lead residues that Increase lead blood levels; we wanted to determine whether the use of basuco during pregnancy could produce such effect In the newborninfant. Serum lead concentrations were measured In 19 newborn children and In 18 of their mothers. The latter were basuco consumers. They were compared to those of 20 non consuming delivering women along with 19 of their newborn Infants. Measurements were performed on a Perkin-Palmer model 2380 atomic absorptionspectrophotometer. Women were divided in four groups according to the degree of consumption, as follows: mild, moderate, Intense or non existent. Mean levels and SDs in the children were respectively: 13.5 ± 9.4; 15.8 ± 6.5; 16.6 ± 7.8; 6.9 ± 5.0 ug/dl; and In their mothers: 13.3 ± 4.6; 13.5 ± 6.9; 16.2 ± 4.9; 8.4 ± 4.6 ug/dl Statistic analysis revealed highly significant differences between mothers and children exposed to basuco and those that were not exposed. No difference was observed ac. cording to the degree of consumption. In conclusion: newborn from basuco consuming mothers have Increased lead blood levels; the long term effects of such alteration should be the subject of further studies