Talking to Patients About Recreational Cannabis

With the upcoming legalization of recreational cannabis, you may find that more patients want to talk to you about its use. This can be approached similar to conversations about other controlled substances, like alcohol and tobacco. This resource provides information about some health risks associated with recreational cannabis use and considerations to guide a conversation with patients about recreational cannabis. Ontario’s doctors believe that recreational cannabis is an inherently harmful substance and the health risks caused by recreational cannabis can best be avoided by abstaining from use. There is strong evidence that demonstrates that recreational cannabis impacts brain development through early adulthood. For that reason, Ontario’s doctors advocate that those under 25 years of age abstain from recreational cannabis. More research on cannabis is required to inform broader clinical evidence. It is important to keep in mind that this resource is intended for discussions about recreational cannabis. This document is not intended to inform discussions about medicinal cannabis used for therapeutic purposes. Further, health impacts from recreational cannabis use can vary depending on a number of factors including, but not limited to: age of user, THC levels, consumption method and frequency of use.

What is cannabis?

Cannabis is a product derived from the Cannabis sativa plant. Cannabis contains hundreds of chemical substances known as cannabinoids. Cannabinoid receptors and the endocannabinoid system process cannabinoids. Terpenes give cannabis its distinct smell.

What is the endocannabinoid system?

The endocannabinoid system is a lipid signaling system found in all vertebrates. This system has important regulatory functions throughout the body and has been linked with the following physiological and pathophysiological processes: neural development, immune function, inflammation, appetite, metabolism and energy homeostasis, cardiovascular function, digestion, bone development and bone density, synaptic plasticity and learning, pain, reproduction, psychiatric disease, psychomotor behaviour, memory, wake/sleep cycles, and the regulation of stress and emotions.

What is THC?

Delta-9-tetrahydrocannabinol (THC) is the cannabinoid responsible for how the body reacts to cannabis, including intoxication. The concentration of THC is usually shown as a percentage of THC by weight of the cannabis product or by volume if dealing with a cannabis oil. If a cannabis product has less than 0.3% of THC in its flowers or leaves it is considered as hemp.

What is CBD?

Cannabidiol (CBD) is a cannabinoid that does not intoxicate users or produce a high, but it does affect ion channels, receptors and enzymes. There is some evidence that CBD can block or decrease the effects of THC. Common effects of CBD use include: anti-inflammatory, analgesic, anti-nausea, anti-emetic, anti-psychotic, anti-ischemic, anxiolytic, and anti-epileptiform.

Other names for cannabis

Commonly used terms include ‘recreational cannabis’ and ‘adult use cannabis’ for cannabis that is used outside of a therapeutic setting. There are several other terms for cannabis. Language and terminology may vary depending on social groups, age, culture and communities. The Government of Canada lists the following as additional names for cannabis:

• Marijuana • Skunk • Honeycomb • Mary Jane (MJ) • Pot • Shatter • Trees • Purp • Bud • Budder • Gangster • Dank or dank krippy • Dope • Errl • Keef • Weed • Wax • Rosin • Boom • Herb • Ganja

Health Effects of Recreational Cannabis

Addiction and Problematic Use

Recreational cannabis can be addictive. The addiction risk is 1 in 6 for those who start using as a teen.

• Cannabis use disorder:
  • The DSM-5 defines as “a problematic pattern of cannabis use leading to clinically significant impairment or distress”.
  • Symptoms include tolerance and withdrawl.
  • Cannabis withdrawal includes: irritability, anger or aggression, anxiety, depressed mood, restlessness, difficulty sleeping, decreased appetite, and weight loss.
  • Adolescence is the most common time for onset.

Cannabis smoke & second-hand smoke

• Exposure to cannabis smoke can trigger acute and chronic health issues that include: cardiovascular events, asthma, cancers, chronic obstructive pulmonary disease, and a range of respiratory and circulatory conditions.
• Cannabis smokers tend to inhale more deeply and hold their breath for longer, this can push cancercausing agents to travel further into the lungs.
• Exposure to second hand cannabis smoke contains many of the same toxins found in cannabis smoke that is directly inhaled, including carcinogens.

Cannabis and mental health

• Recreational cannabis use can trigger or heighten symptoms of anxiety and or depression.
• Recreational cannabis use in teenage years is linked to the development of mood and anxiety disorders and an increased likelihood of developing psychiatric disorders later in life.
• Cannabis use and schizophrenia:
  • Increases the risk of developing schizophrenia in youth o Increases the risk of triggering an early onset of schizophrenia for an individual that has a genetic predisposition (for example, family history)
  • Continued cannabis use for an individual with schizophrenia can heighten psychotic symptoms

Cognitive effects

The immediate effects normally lessen within about six hours of use, although cognitive impacts have been seen for up to 3 weeks after cessation. More evidence-based research on the cognitive impacts of cannabis is required. Below is a list of known acute and long-term effects that can be caused by cannabis use. While these effects are general, the severity may be impacted by THC levels, age of the person using, and frequency of use

Acute cognitive effects: • Inattentiveness • Impaired judgement • Impaired decision making • Challenges in processing and retaining information • Impaired motor coordination and reaction time

Long-term cognitive effects for regular users: Challenges with problem solving and learning • Challenges with inattentiveness • Challenges with memory • Challenges with processing complex information

Considerations to Guide a Conversation

Provide health information

Let the patient know that part of your role is to convey health information, including the side effects of recreational cannabis and how it can impact his or her health.

Encourage honesty

The patient may feel embarrassed to share information. Encourage the patient to be accurate with the information he or she provide about their cannabis use.

There are no stereotypes

Recreational cannabis crosses all ages, cultures, genders, and socioeconomic groups.

Be aware of other medications

Recreational cannabis could interact with other medications. The most significant interactions are between cannabis and other central nervous system drugs (sedative-hypnotics or alcohol).

Talk about health impacts

Recreational cannabis can have negative health impacts that include: harmful effects on mental health and addiction, cognitive effects, respiratory and circulatory diseases and impairment.

Ask the patient about their cannabis use

This can be a discussion on its own or part of a conversation about substance use when talking alcohol and tobacco. Quickly screening to see if the patient plans on using recreational cannabis or how often a patient is using recreational cannabis can help to determine whether a more in depth conversation is appropriate.

Be supportive

If your patient lets you know he or she is using cannabis, try to understand why. Some common reasons might include stress management, peer pressure, or self-medication. Be prepared to help your patient with additional supports if appropriate.

Additional Considerations for Talking to Underage Patient

Unique health risks for youth

The health risks of using recreational cannabis are higher for those who start using in their teens. These health risks include addiction, increased risk for developing mental illness, and impacts on cognitive development. There is strong evidence that demonstrates that recreational cannabis impacts brain development through early adulthood. Ontario’s doctors continue to recommend that individuals under 25 should abstain from recreational cannabis.

Reasons for using

A young person’s desire to use or try recreational cannabis may be similar or different from adults’. Youth have described a number of factors that motivate trying and using recreational cannabis, including: peer pressure; to experiment; to party or socialize; to cope with stress; to alter their perspective. Consider having a conversation with teens that is similar to the conversation you have about alcohol.

Commonly Asked Questions About Recreational Cannabis

Talk about health impacts

Recreational cannabis can have negative health impacts that include: harmful effects on mental health and addiction, cognitive effects, respiratory and circulatory diseases and impairment.

How does recreational cannabis make you feel?

Recreational cannabis can affect users in very different ways. Some users feel relaxed and happy, others feel drowsy, panicked, confused, or forgetful. Some users have delusions and altered perceptions.

Is one consumption method safer than the rest?

Recreational cannabis is an inherently harmful substance and the health risks caused by recreational cannabis use can best be avoided by abstaining from use. Cannabis smoke can trigger acute and chronic health issues, including a range of respiratory conditions, cardiovascular events, asthma, cancers, and chronic obstructive pulmonary disease.

Is it safe to use recreational cannabis safe to use when trying to get pregnant?

Individuals trying to get pregnant should refrain from consuming cannabis and exposure to second-hand cannabis smoke.

Is it safe to use recreational cannabis when pregnant?

Women who are pregnant should refrain from consuming recreational cannabis and exposure to second-hand smoke. Cannabis use during pregnancy may increase the risk of: preterm birth, low birth weight and and small for gestational age.

Is it safe to use recreational cannabis when breastfeeding?

Women who are breastfeeding should refrain from consuming recreational cannabis and exposure to second-hand cannabis smoke.

Is it safe to use recreational cannabis and drive?

It is not safe to drive when impaired by the use of recreational cannabis, as it negatively affects reaction times and concentration.

How long should a patient wait to drive after consuming recreational cannabis?

The recently published Lower-Risk Cannabis Use Guidelines, instruct individuals who consume cannabis to wait before driving for at least six hours. This wait time may need to be longer, depending on the user and the product consumed.

Is it safe to use recreational cannabis before surgery?

It is not safe to use recreational cannabis prior to surgical procedures as cannabis can interact with other medications, including anesthetics.

Source: https://www.oma.org/wp-content/uploads/Cannabis-Conversation-Guide.pdf