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In an era that is often characterized as one of a growing convergence of the laws governing criminal activities in different countries, the issue-area of cannabis policy undergoes processes of fragmentation and polarization. Some countries continue to criminalize all forms of medical and recreational uses of cannabis. Others have sought to “separate the market” for cannabis from that of other drugs by decriminalizing the possession of small amounts of marijuana, authorizing its use for medical purposes, and establishing administrative measures for taxing and regulating the commercial sale of the drug. This chapter explores the causes and consequences of the decline of the transnational legal order of cannabis prohibition. It shows how the erosion of the regulatory capacities of this transnational legal order reflects deep-seated political conflicts over the legitimacy of prohibition norms in this field. It analyzes the ways in which conflicting regulatory approaches become institutionalized as a consequence of the structural mismatch between the actors framing the meaning of cannabis prohibition norms at the international level and the actors implementing these norms in national and local contexts. Finally, the chapter shows how this transnational legal order has created path-dependent trajectories of legal change that continue to shape domestic drug policies in various countries.
Non-medical cannabis recently became legal for adults in Canada. Legalization provides opportunity to investigate the public health effects of national cannabis legalization on presentations to emergency departments (EDs). Our study aimed to explore association between cannabis-related ED presentations, poison control and telemedicine calls, and cannabis legalization.
Data were collected from the National Ambulatory Care Reporting System from October 1, 2013, to July 31, 2019, for 14 urban Alberta EDs, from Alberta poison control, and from HealthLink, a public telehealth service covering all of Alberta. Visitation data were obtained to compare pre- and post-legalization periods. An interrupted time-series analysis accounting for existing trends was completed, in addition to the incidence rate ratio (IRR) and relative risk calculation (to evaluate changes in co-diagnoses).
Although only 3 of every 1,000 ED visits within the time period were attributed to cannabis, the number of cannabis-related ED presentations increased post-legalization by 3.1 (range -11.5 to 12.6) visits per ED per month (IRR 1.45, 95% confidence interval [CI]; 1.39, 1.51; absolute level change: 43.5 visits per month, 95% CI; 26.5, 60.4). Cannabis-related calls to poison control also increased (IRR 1.87, 95% CI; 1.55, 2.37; absolute level change: 4.0 calls per month, 95% CI; 0.1, 7.9). Lastly, we observed increases in cannabis-related hyperemesis, unintentional ingestion, and individuals leaving the ED pre-treatment. We also observed a decrease in co-ingestant use.
Overall, Canadian cannabis legalization was associated with small increases in urban Alberta cannabis-related ED visits and calls to a poison control centre.
Posttraumatic stress disorder (PTSD) is the most highly co-occurring psychiatric disorder among veterans with cannabis use disorder (CUD). Despite some evidence that cannabis use prospectively exacerbates the course of PTSD, which in turn increases the risk for CUD, the causal nature of the relationship between cannabis and psychiatric comorbidity is debated. The longitudinal relationship between PTSD diagnosis and traumatic intrusion symptoms with cannabis use and CUD was examined using cross-lagged panel model (CLPM) analysis.
Prospective data from a longitudinal observational study of 361 veterans deployed post-9/11/2001 included PTSD and CUD diagnoses, cannabis use, and PTSD-related traumatic intrusion symptoms from the Inventory of Depression and Anxiety Symptoms.
A random intercept CLPM analysis that leveraged three waves (baseline, 6 months and 12 months) of cannabis use and PTSD-related intrusion symptoms to account for between-person differences found that baseline cannabis use was significantly positively associated with 6-month intrusion symptoms; the converse association was significant but reduced in magnitude (baseline use to 6-month intrusions: β = 0.46, 95% CI 0.155–0.765; baseline intrusions to 6-month use: β = 0.22, 95% CI −0.003 to 0.444). Results from the two-wave CLPM reveal a significant effect from baseline PTSD to 12-month CUD (β = 0.15, 95% CI 0.028–0.272) but not from baseline CUD to 12-month PTSD (β = 0.12, 95% CI −0.022 to 0.262).
Strong prospective associations capturing within-person changes suggest that cannabis use is linked with greater severity of trauma-related intrusion symptoms over time. A strong person-level directional association between PTSD and CUD was evident. Findings have significant clinical implications for the long-term effects of cannabis use among individuals with PTSD.
It is not clear to what extent associations between schizophrenia, cannabis use and cigarette use are due to a shared genetic etiology. We, therefore, examined whether schizophrenia genetic risk associates with longitudinal patterns of cigarette and cannabis use in adolescence and mediating pathways for any association to inform potential reduction strategies.
Associations between schizophrenia polygenic scores and longitudinal latent classes of cigarette and cannabis use from ages 14 to 19 years were investigated in up to 3925 individuals in the Avon Longitudinal Study of Parents and Children. Mediation models were estimated to assess the potential mediating effects of a range of cognitive, emotional, and behavioral phenotypes.
The schizophrenia polygenic score, based on single nucleotide polymorphisms meeting a training-set p threshold of 0.05, was associated with late-onset cannabis use (OR = 1.23; 95% CI = 1.08,1.41), but not with cigarette or early-onset cannabis use classes. This association was not mediated through lower IQ, victimization, emotional difficulties, antisocial behavior, impulsivity, or poorer social relationships during childhood. Sensitivity analyses adjusting for genetic liability to cannabis or cigarette use, using polygenic scores excluding the CHRNA5-A3-B4 gene cluster, or basing scores on a 0.5 training-set p threshold, provided results consistent with our main analyses.
Our study provides evidence that genetic risk for schizophrenia is associated with patterns of cannabis use during adolescence. Investigation of pathways other than the cognitive, emotional, and behavioral phenotypes examined here is required to identify modifiable targets to reduce the public health burden of cannabis use in the population.
Introduction: Inhaled toxins from tobacco smoking, cannabis leaf smoking as well as vaping/e-cigarette products use are known causes of cardio-respiratory injury. While tobacco smoking has decreased among Canadian adults, there are now several other forms of legal inhalant products. While legal, the evidence of benefit and safety of vaping is limited. Of concern, cases of e-cigarette or vaping products use associated lung injury (EVALI) have been accumulating in the U.S. and now in Canada. Despite this, very little is known about the inhalation exposure of emergency department (ED) patients; this study was designed to explore lung health in the ED. Methods: We investigated the prevalence of exposure to vaping, tobacco and cannabis among patients presenting to a Canadian ED from July to November 2019. Ambulatory (CTAS 2 to 5), stable, adult (≥ 17 years) patients were prospectively identified and invited to complete a survey addressing factors related to lung health (previous diagnosis of respiratory conditions and respiratory symptoms at the ED presentation) and information on current exposure to vaping, tobacco and cannabis smoking. Categorical variables are reported as frequencies and percentages; continuous variables are reported as medians with interquartile range (IQR). The study was approved by the Health Research Ethics Board. Results: Overall, 1024 (71%) of 1433 eligible patients completed the survey. The median age was 43.5 (IQR: 29, 60), and 51% were female. A total of 351 (31%) participants reported having been previously diagnosed with ≥1 respiratory conditions, and 177 (17%) were visiting the ED as a result of ≥1 respiratory symptoms (e.g., cough, shortness of breath, wheezing). Daily tobacco smoking was reported by 190 (19%), and 83 (8%) reported using vaping/e-cigarette products. Cannabis use within 30 days was described by 80 (15%) respondents. Exposure to tobacco and vaping products was reported by 39 (4%) participants, 63 (6%) reported using tobacco in combination with cannabis smoking, and 3% reported combining vaping and cannabis use. Conclusion: Patients seeking care in the ED are exposed to a large quantity of inhaled toxins. Vaping products, considered the cause of the most recent epidemic of severe lung injury, are used in isolation and in combination with other smoking products in Canada. These exposures should be documented and may increase the risk of lung health injuries and exacerbations of chronic respiratory conditions.
Introduction: The legalization of cannabis for recreational use in 2018 remains a controversial topic. There are multiple perceived benefits of cannabis including pain relief, treatment of epilepsy syndromes, and improving body weight of cancer patients. However, there are also many potential risks. The short-term health consequences include cannabinoid hyperemesis syndrome and cannabis induced psychosis. These conditions directly impact the influx of patients presenting to Emergency Departments (ED). There is currently limited research in the area of cannabis legalization burden. However, the studies performed have shown a significant impact in those states which cannabis is legal. A study completed in Colorado found that hospitalization rates with marijuana related billing codes increased from 274 to 593 per 100 000 hospitalizations after the state legalization of recreational cannabis. This study aims to examine if Canada's hospitals are experiencing the same burden as other jurisdictions. Methods: A descriptive study was preformed via a retrospective chart review of cannabis related visits in tertiary EDs in St. John's, NL, from six months prior to the date of legalization of cannabis for recreational use, to six months after. Hospital ED visit records from both the Health Science Centre and St. Clare's Mercy Hospital were searched using keywords to identify patients who presented with symptoms related to cannabis use. We manually reviewed all visit records that included one or more of these terms to distinguish true positives from false positive cases, unrelated to cannabis use. Results: A total of 287 charts were included in the study; 123 visits were related to cannabis use six months prior to legalization, and 164 six months after legalization. A significant increase in ED visits following the legalization of recreational cannabis was seen (p < .001). There was no significant difference in the age of users between the two groups. Additionally, the number one presenting complaint due to cannabis use was vomiting (47.7%), followed by anxiety (12.2%). Conclusion: Following the implementation of the Cannabis Act in Canada, EDs in St. John's, NL had a statistically significant increase in the number of visits related to cannabis use. It is important to determine such consequences to ensure hospitals and public health agencies are prepared to treat the influx of visits and are better equipped to manage the associated symptoms.
Introduction: Non-medical cannabis recently became legal on October 18th, 2018 to Canadian adults. The impact of legalization on Emergency Departments (EDs) has been identified as a major concern. The study objective was to identify changes in cannabis-related ED visits and changes in co-existing diagnoses associated with cannabis-related ED visits pre- and post-legalization for the entire urban population of Alberta. Urban Alberta was defined as Calgary and Edmonton, inclusive of Sherwood Park and St. Albert given the proximity of some Edmontonians to their EDs) encompassing 12 adult EDs and 2 pediatric EDs. Methods: Retrospective data was collected from the National Ambulatory Care Reporting System, and from the HealthLink and the Alberta Poison and Drug Information Service (PADIS) public telehealth call databases. An interrupted time-series analysis was completed via segmented regression calculation in addition to incident rate and relative risk ratio calculation for the pre- and post-legalization periods to identify both differences among the entire urban Alberta population and differences among individuals presenting to the ED. Data was collected from October 1st, 2013 up to July 31st, 2019 for ED visits and was adjusted for natural population increase using quarterly reports from the Government of Alberta. Results: The sample included 11 770 pre-legalization cannabis-related visits, and 2962 post-legalization visits. Volumes of ED visits for cannabis-related harms were found to increase post-legalization within urban EDs (IRR 1.45, 95% CI 1.39, 1.51; absolute level change: 43.48 visits per month in urban Alberta, 95% CI 26.52, 60.43), and for PADIS calls (IRR 1.87, 95% CI 1.55, 2.37; absolute level change: 4.02 calls per month in Alberta, 95% CI 0.11, 7.94). The increase in visits to EDs equates to an increase of 2.72 visits per month, per ED. Lastly, increases were observed for cannabinoid hyperemesis (RR 1.23, 95% CI 1.10, 1.36), unintentional ingestion (RR 1.48, 95% CI 1.34, 1.62), and in individuals leaving the ED pre-treatment (RR 1.28, 95% CI 1.08, 1.49). Decreases were observed for coingestant use (RR 0.77, 95% CI 0.73, 0.81) and hospital admissions (RR 0.88, 95% CI 0.80, 0.96). Conclusion: Overall, national legalization of cannabis appears to be correlated with a small increase in cannabis-related ED visits and poison control calls. Post-legalization, fewer patients are being admitted, though cannabinoid hyperemesis appears to be on the rise.
Introduction: One of the most common adverse effects of habitual cannabis use is hyperemesis—recurrent bouts of protracted vomiting, retching and abdominal pain superimposed on a baseline of daily nausea and anorexia. Largely anecdotal evidence supports the use of haloperidol, benzodiazepines or topical capsaicin over traditional antiemetics, yet little is known about the cause or optimal treatment of this newly recognized disorder. We report the results of one of the first clinical trials on so-called cannabis hyperemesis syndrome (NCT03056482). Methods: We approached adults with a working diagnosis of hyperemesis due to cannabis, provided they had ongoing emesis for >2 hours, a cyclic pattern of 3+ episodes in the last 2 years, and near daily use of cannabis by inhalation. We excluded those who were pregnant, deemed unreliable, or using opioids. Subjects provided written consent to be randomized during the index or any subsequent visit to either haloperidol (with a nested randomization to either 0.05 mg/kg or 0.1 mg/kg) or ondansetron 8 mg intravenously in a quadruple-blind fashion, and to be followed for 7 days. The primary outcome was the average reduction from baseline in abdominal pain and nausea (each measured on a 10-cm VAS) at 2 hours. While the original trial design allowed for crossover, the primary analysis used only the first treatment period since fewer than the prespecified threshold of 20% of subjects crossed over. Results: We enrolled 33 subjects, of whom 30 (16 men, 29+/-11 years old, using 1.5+/-0.9 g/day since age 19+/-2 years) were treated at least once (haloperidol 13, ondansetron 17). Haloperidol at either dose was superior to ondansetron (difference 2.3 cm [95%CI 0.6, 4.0]; p = 0.01), with similar improvements in both pain and nausea, as well as less rescue antiemetics (27% vs 61%; p = 0.04), and shorter time to ED departure (3.1+/-1.7 vs 5.6+/-4.5 hours; p = 0.03 Wilcoxon rank sum). There were two (haloperidol) vs six (ondansetron) return visits for ongoing nausea/vomiting, as well as two return visits for acute dystonia, both in the higher dose haloperidol group. Conclusion: Haloperidol is superior to ondansetron for the acute symptomatic treatment of patients with ongoing hyperemesis attributed to habitual cannabis use. The efficacy of this agent over ondansetron provides insight into the mechanism of this new disorder, now almost a daily diagnosis in many Canadian emergency departments.
Introduction: Acute psychosis is a disruptive change in mental state that requires the mobilization of significant resources for its immediate treatment and ongoing management in the emergency department (ED). Cannabis-induced psychotic disorder (CIP) is one potential cause; however, the diagnosis may be overlooked due to limited understanding of the etiology of CIP. Methods: This study employed a retrospective cohort analysis of all CIP cases admitted from a tertiary care ED in Edmonton, Alberta between 10/2016 and 10/2018 – the month cannabis was legalized in Canada. Charts were identified based on a most responsible diagnosis of CIP, as defined by ICD-10 code F12.5. Two reviewers abstracted data using a standardized form, which was entered into a database; 10% of charts were analyzed by both reviewers to examine inter-rater reliability. Patients were excluded if there was any documentation of methamphetamine use within the week prior to presentation. Outcomes included management, symptom profile, and length of stay. Results: In total there were 44 cases of CIP identified in 40 unique patients during the two-year period. The largest age group of patients (n = 14, 35%) were between 15-20 years old and the median length of admission was 6 days. A minority of patients (n = 13, 32.5%) had a previous psychiatric diagnosis. A distinct clinical picture evolved during the summation of patient symptoms in the ED with 65% of patients (n = 26) exhibiting persecutory delusions and 52.5% endorsing auditory hallucinations (n = 21). Only four patients were found to have visual hallucinations, three of which also had auditory hallucinations. Most patients (n = 34, 85%) were treated with an antipsychotic medication in the ED and during their time as inpatients, but only 70% of patients were prescribed an antipsychotic medication at the time of discharge (n = 28). Conclusion: This study is the first of its kind describing a cohort of patients with CIP in a Canadian ED setting. The patients presenting to the ED who would later be diagnosed CIP were more likely to be 15-20 years old, experiencing persecutory delusions, and unlikely to be experiencing isolated visual hallucinations. With the recent legalization of cannabis in Canada, further prospective research is required to determine any changes in the characteristics, incidence, and prevalence of CIP, as well as data from other centers to look for any regional differences in the presentation and management of CIP.
Acute cannabis administration can produce transient psychotic-like effects in healthy individuals. However, the mechanisms through which this occurs and which factors predict vulnerability remain unclear. We investigate whether cannabis inhalation leads to psychotic-like symptoms and speech illusion; and whether cannabidiol (CBD) blunts such effects (study 1) and adolescence heightens such effects (study 2).
Two double-blind placebo-controlled studies, assessing speech illusion in a white noise task, and psychotic-like symptoms on the Psychotomimetic States Inventory (PSI). Study 1 compared effects of Cann-CBD (cannabis containing Δ-9-tetrahydrocannabinol (THC) and negligible levels of CBD) with Cann+CBD (cannabis containing THC and CBD) in 17 adults. Study 2 compared effects of Cann-CBD in 20 adolescents and 20 adults. All participants were healthy individuals who currently used cannabis.
In study 1, relative to placebo, both Cann-CBD and Cann+CBD increased PSI scores but not speech illusion. No differences between Cann-CBD and Cann+CBD emerged. In study 2, relative to placebo, Cann-CBD increased PSI scores and incidence of speech illusion, with the odds of experiencing speech illusion 3.1 (95% CIs 1.3–7.2) times higher after Cann-CBD. No age group differences were found for speech illusion, but adults showed heightened effects on the PSI.
Inhalation of cannabis reliably increases psychotic-like symptoms in healthy cannabis users and may increase the incidence of speech illusion. CBD did not influence psychotic-like effects of cannabis. Adolescents may be less vulnerable to acute psychotic-like effects of cannabis than adults.
Previous research suggests recovery from cannabis-related deficits in verbal learning and memory functioning after periods of cannabis abstinence in adolescents. Here, we examine how cannabis cessation affects cognitive performance over 2 weeks of monitored abstinence compared to controls in adolescents and young adults.
Seventy-four participants (35 cannabis users) aged 16–26 ceased all cannabis, alcohol, and other illicit substance consumption for a 2-week period; abstinence was monitored via weekly urinalysis, breath, and sweat patch testing. Starting at baseline, participants completed weekly abbreviated neuropsychological batteries. Measures included tests of attention, inhibition, verbal working memory, and learning. Repeated measures assessed within and between subject effects for time and group status, while controlling for past year alcohol and nicotine use.
Cannabis users showed increased performance compared to controls on sustained attention tasks after 2 weeks of cannabis use.
Deficits in attention, but not verbal learning and memory, recovered after 2 weeks of monitored abstinence. This differs from previous literature, suggesting that other cognitive domains may show signs of recovery after periods of cannabis cessation in adolescents and young adults.
Certaines études ont retrouvé que la consommation précoce de cannabis était associée à une fréquence plus élevée de troubles cognitifs ou psychiatriques, mais l’âge exact reste indéterminé, entre 13 et 18 ans selon les études [1–4].
Comparer certaines caractéristiques cliniques des sujets dépendants au cannabis ayant commencé leur consommation à l’âge de 13 ans ou moins et celles de ceux qui ont commencé après.
Cent soixante-douze patients, consultant consécutivement dans le service d’Addictologie du CH Sainte-Anne pour dépendance au cannabis (critères DSM-IV), entre juin 2007 et juin 2013, ont été inclus dans l’étude. Les patients présentant des troubles psychotiques, bipolaires type 1, des dépendances opiacées ou à la cocaïne étaient exclus de l’étude. Ils ont été évalués à l’aide du Diagnostic Interview for Genetic Studies (DIGS).
Les sujets ayant commencé leur consommation de cannabis à l’âge de 13 ans (n = 37) ou moins présentaient plus fréquemment un diagnostic de trouble de personnalité antisociale (respectivement 58,8 % vs 22,1 % ; Chi2 = 16,6 p = 0,0001, OR : 4,9) et rapportaient plus fréquemment des troubles subjectifs de l’attention que les sujets ayant commencé leur consommation plus tard (n = 135) (respectivement 86,5 % vs 66,7 %, Chi2 = 5,53, p = 0,03, OR : 3,02). En revanche, il n’y avait pas de différences significatives entre les deux groupes concernant la fréquence des troubles dépressifs, des phobies sociales, des troubles anxieux, des conduites suicidaires, des traitements anxiolytiques ou antidépresseurs antérieurs, ni de différence au niveau des symptômes de sevrage et des effets subjectifs induits par le cannabis.
Les sujets dépendants au cannabis qui commencent leur consommation avant l’âge de 13 ans ont un risque de présenter un trouble de la personnalité antisociale cinq fois plus élevé et des troubles subjectifs de l’attention trois fois plus élevés, par rapport aux sujets qui commencent le cannabis après l’âge de 13 ans.
Cannabis is one of the most prevalent drugs used in industrialized countries. Regular cannabis use is associated with impairments in highly integrative cognitive functions such as memory, attention and executive functions. However, the neural impact of cannabis use remains poorly understood. Elucidating the cerebral mechanisms underlying these deficits represents now a crucial step in addictive disorders. The retina is a part of the central nervous system due to its embryonic origin thereby reflecting the neurochemistry of the brain. Furthermore its measure is well standardized allowing good reproducibility. Considering the anatomical and functional distribution of endocannabinoids in the retina , we evaluated the retinal function in regular cannabis users and healthy control subjects. Recordings of flash electroretinogram (fERG) were performed in regular cannabis users and healthy controls using guidelines of international society for clinical electrophysiology of vision (ISCEV) . Both amplitude and implicit time of a-wave and b-wave were assessed in scotopic and photopic conditions. Measurements of fERG showed increased implicit time of a-wave and b-wave in both photopic and scotopic conditions in regular cannabis users compared to healthy controls. These findings suggest that retinal processing may be altered at the level of photoreceptor and bipolar cells in regular cannabis users. These results are consistent with previous reports in animal species, which show the involvement of the cannabinoid system in the regulation of the retinal metabolism thus leading to alterations of fERG measurements. Since alterations in the central neurotransmission may affect the ERG measurements, the retina might constitute a possible biomarker of brain disorders in addictive diseases .
A cross-sectional home survey on the epidemiology of drug use in Greece, with a nationwide general population sample of 4,291 respondents aged 12 to 64, was carried out. The weighted life prevalence of reported illicit drug use in the total sample was found to be 9% among males and 2.5% among females, with a ratio of 3.6: 1. Six and a half percent of males of all ages had used, at some time, licit psychotropic drugs without a doctor's order, while females presented much higher prevalence rates (14.9%). Young adults reported higher rates of both illicit and licit lifetime and past-year use, compared to the other age groups. Illicit drug use was less common, in females of all ages. Cannabis was the most common illicit drug used. Current as well as lifetime use of pain relievers without a doctor's prescription was found to be highest among all other licit substances. This holds true for all age groups and for both sexes. Tranquillizers were predominantly used by females of all ages. Certain sociodemographic variables, such as sex, educational level, marital status, place of residence and occupational status were found to be related to drug use in Greece.
Cannabis has been reported to produce acute psychiatric reactions, among these panic anxiety and derealization, which are self-limited. We report on three patients who experienced an initial panic attack during cannabis intake. Anxiety attacks reoccurred after the cessation of intake. Two of these patients had a current depressive disorder, one of them had a single Grand Mal seizure before the onset. We suggest that cannabis may trigger the emergence of recurrent panic attacks and uncover latent panic disorders in vulnerable persons.
To test the relationship between schizotypal symptoms and cannabis use in a non-clinical population, cannabis users and non-users were asked to complete the Schizotypal Personality Questionnaire. Significant differences in scores between the groups were observed. There may be a developmental process in the relationship between cannabis use and schizotypal symptoms.
L’usage de substances licites et illicites pendant la grossesse peut avoir de graves conséquences à court et long terme chez l’enfant  et constitue une préoccupation majeure de santé publique . L’objectif de notre étude est d’établir la prévalence de la consommation d’alcool et de substances psychoactives chez la femme enceinte en couplant les données déclaratives de la mère avec les dosages toxicologiques réalisés dans le méconium du nouveau-né. C’est la première étude de ce type en France.
Etude épidémiologique transversale réalisée dans l’ensemble des maternités de Rouen (Seine-Maritime). Elle a été proposée à toutes les femmes ayant accouché au cours des mois d’août 2010 et 2011.
Sept cent vingt-quatre dyades mère/enfant ont été incluses sur les 993 accouchements. Quatre-vingt-quatorze pour cent des femmes interrogées ont accepté de participer. L’âge moyen des femmes est de 30 ans. Les consommations rapportées sont les suivantes : consommation d’alcool 15 %, consommation du tabac 21 %, consommation de cannabis 1 %. Les analyses toxicologiques sont en cours (éthyl glucuronide pour alcool, cotinine pour le tabac et THC-COOH pour le cannabis ).
La prévalence de consommation d’alcool et de tabac est élevée dans notre population, ce qui doit encourager à poursuivre les campagnes d’information et de prévention chez les femmes enceintes.
The recurrence of flashbacks without acute or chronic hallucinogen consumption has been recognized in the DSM IV criteria as the hallucinogen persisting perception disorder (HPPD). Perceptual disturbances may last for 5 years or more and represent a real psychosocial distress. We reported here a case of a 18-year-old young man presenting HPPD after a mixed intoxication with psylocibin and cannabis. This report shows symptomatic recurrences persisting more than 8 months. Various differential diagnoses were evoked and our therapeutic strategies were described.
We have studied the occurrence of dual diagnoses (psychoses as well as abuse of either amphetamine, cannabis or opiates) during a 15-year period, among patients treated at Huddinge Hospital, Stockholm, Sweden. The purpose of the study is to evaluate if the different drugs were coupled to different rates of psychiatric co-morbidity. During the period in question, 461, 425 and 371 different patients respectively had been admitted at least once due to dependency on amphetamine, cannabis and opiates. Approximately 30% of the patients with a pure abuse of amphetamine or cannabis and less than 6% of the opiate abusers had been diagnosed at least once with any of the psychoses studied. Comparing the frequency of psychoses among mixed and pure abusers of illegal drugs, with and without a concomitant abuse of alcohol, we found that the co-morbidity rate for mixed opiate abusers increased significantly from 7.2 to 20.2% when alcohol abuse was also present. For abusers of amphetamine and cannabis (both pure and mixed), no differences in co-morbidity rates were seen when an abuse of alcohol was added to that of the drugs. It is difficult to find an explanation for the significant difference between the co-morbidity of pure abuse of amphetamine or cannabis on the one hand and opiates on the other. In conclusion, our findings show that the distribution of psychotic illness is high among abusers of amphetamine and cannabis, in contrast to the generally lower co-morbidity among abusers of opiates. Although these findings are consistent with earlier studies that have shown a propensity for developing psychoses among abusers of amphetamine and cannabis, one should bear in mind that this study is based on inpatients, and is not necessarily representative for all abusers of the drugs in question.
To test the hypothesis that recent onset psychotic patients who use cannabis will have psychotic symptoms that are more severe and more persistent than those who do not use cannabis.
Subjects and methods
We carried out a 4-year follow-up study of a cohort of 119 patients with recent onset of psychosis. The patients were divided into four groups according to duration of cannabis use, taking index admission and follow-up as reference points.
Those subjects who persisted in the use of cannabis had more positive (but not negative) symptoms and a more continuous illness at follow-up.
The main limitations of the study were: the relatively small sample size, and that the excess of male subjects and the presence of cannabis induced psychosis could have a confusing impact on the interpretation of the results.
It is possible that psychotic patients who use cannabis are at a greater risk of a more continuous illness with more positive symptoms than those who do not.