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  • Trends, Tactics and Toxicity: Marijuana Movement on Missouri College Campuses

    Janice Putnam PhD, RN Amy Kiger MS, ABD

    Kelly Skinner DNP, FNP-C

    1

  • Marijuana/Cannabis

    • Marijuana use is growing in popularity

    • Consumption: – Joints, blunts, vaporizers – Drinks – Derivatives - wax, dabs, oils and shatter

    – Capsules – Tinctures and spray (under tongue)

    – Edibles

  • 2015 AIHce

    Current Laws in Missouri


    • Marijuana possession

  • College and Marijuana • Most prevalent users 18 to 25 y.o. • 20% using in the past month (NIH, 2016)

    • ER visits by 13-21-year-olds doubled from 1.7 to 4 per 1,000 between 2009 and 2015 (U. of CO)

    • 30 states have adopted legalized marijuana • student recruitment crosses these state lines

    • Decreases student performance measures and retention rates

    • Effect short-term memory impairment, detachment, decreased alertness, and depression

    http://health.usnews.com/health-care/articles/2017-05-05/pot-a-factor-in-more-er-admissions-for-colorado-teens-after-legalization

  • Missouri College MACH B Survey Racial Demographics

    Other

    Asian/ Pacific Islander

    Hispanic

    Black (non-Hispanic)

    White (non-Hispanic)

    2015 2016 2017

  • Use In Car—Missouri

    0%

    2%

    4%

    6%

    8%

    2015 2016 2017

    3% 3%

    5%5%

    6%

    7%

    1% 1% 1%

    Parked on campus Parked off campus Being driven

  • Not everyone who uses marijuana experiences the feeling of relaxation and calm. In some users, it can cause fear, distrust, anxiety and even a feeling of panic. This is more likely to occur in someone who takes too much or too high of a concentration. These reactions are serious, but temporary, and may resemble symptoms of schizophrenia with only short lasting psychotic symptoms

    The Correlation Between Ultra-Potent Pot and Psychosis - video

    https://www.youtube.com/watch?v=4zZXVjxBK4g https://www.youtube.com/watch?v=4zZXVjxBK4g

  • Problematic Usage and Intervention 


    • Marijuana toxicity • fainting, passing out, extreme paranoia, excitement, the body frozen in time, and loss of reality

    • Marijuana addiction • used marijuana at least once, risk is 9% • starting to use in adolescence, risk is 17% • use daily, risk is 25-50%. • Chronic marijuana use is linked to psychosis, schizophrenia, anxiety, depression

  • Diagnosing Cannabis Use Disorder • Cannabis take in larger amounts or over longer periods of time than desired • Desire to decrease or control of cannabis use • More time than desired working to obtain, use or recover from the effects of

    cannabis • Strong craving to use cannabis • Use results in failure to fulfill role obligations such as work, school or home • Continued use despite interference with social or interpersonal relationships • Continued use with the knowledge that it causes or exacerbates current physical

    or psychological problems • Withdrawal symptoms develop when not used

    • Mood disorder • Behavioral disorder • Nausea

    Tolerance: • Need for more cannabis to achieve the high • Diminished effect with the continued use of the same amount

  • Withdrawal Syndrome:

    • Impaired motor coordination • Euphoria • Anxiety • Impaired judgement • Slow time sensation • Social withdrawal • Difficulty sleeping • Irritability • Conjunctival injection • Increased appetite • Dry mouth • Tachycardia

    Perceptual disturbances: • Hallucinations, Auditory disruption, Visual disruption • Tactile Illusions (e.g. feeling a soft object but not being able to describe it)

  • Acute intoxication:

    ER treatment

    1. Close monitoring

    2. Quiet Environment

    • Dimly lit room • Assign one caretaker • Calm and limited conversation

    3. Benzodiazepines if severe agitation or anxiety develops

  • Marijuana Cessation Techniques

    • Cognitive behavioral therapy

    • Contingency management

    • Motivational enhancement therapy

    (National Institute on Drug Abuse, 2018)

  • Medical Use – MARINOL/SYNDROS (dronabinol)

    A cannabinoid indicated in adults for: • Anorexia • Nausea and vomiting

    Adverse Effects: • Dizziness • Drowsiness • Confusion or feeling “high” • Exaggerated sense of well-being • Nausea and vomiting • Stomach/abdominal pain

  • 2015 AIHce

    • Given PIPs track record with alcohol and substance abuse , college healthcare providers and staff are in a strong position to anticipate the needs of college students who are likely to struggle with problematic marijuana use or addiction

    6/2/2015 19

  • What We Wanted To Find Out 


    What is the environment of health assessment skills, student resources, and professional development for marijuana use by college students in the state of Missouri?

  • How We Answered the Question

    • 3 PIP Focus Groups • 15 schools • N=42 • Questions covered – Assessment – Resources – Professional development

  • Voluntary Participation 


    • IRB • Audio recordings • Any information which identified individual schools or staff was coded

    • Thematic analysis by three researchers • Debriefed findings with PIP prior to dissemination

  • 2015 AIHce6/2/2015 23

  • 2015 AIHce6/2/2015 24

    Campus Perceptions of Marijuana are Already Strong 
 In Missouri, campus-wide marijuana perceptions are already strongly influenced by marketing and low-risk health messages encountered through the media and social interactions.

    Campus-wide perceptions of marijuana as “just pot” and “harmless” is shared by many including students, staff, and faculty.

    As an issue, marijuana use is seen across campus as a secondary priority to many issues of higher prevalence - specifically alcohol.

    Talking to students about marijuana has been reported as volatile in group settings, but not in individual discussions.

    There is usually little faculty and parental involvement when college staff work on issues of marijuana use by students.

  • 2015 AIHce6/2/2015 25

    Tone of Message is Disciplinary

    Students are not voluntarily using college services for “problems” with marijuana use.

    Students are using prevention services only if required by disciplinary actions.

    An awareness of a desire to use less has been heard, although rarely.

  • 2015 AIHce6/2/2015 26

    Prevention and Practice Aligns with Substance Abuse 
 Primary prevention on campus is varied; participants reported using educational brochures, webinars, and social norming.

    Campus activity related to marijuana have included activities such a public burns (to educate the campus) and drug dog use (for law enforcement).

    Assessment of student marijuana use is often part of other substance abuse assessments.

    Motivational interviewing is recommend as an available treatment in established substance abuse programs.

  • 2015 AIHce6/2/2015 27

    Specific Professional Development Needs Related to Marijuana 
 Professional development needs for marijuana are generally being met as it is included in substance abuse topics.

    Professional development needs specific to marijuana not being met include variability in marijuana forms, routes, and dosages, language and advocating statements for decreased marijuana use, hooks for discussion, and safe levels of use.

  • 2015 AIHce

    Discussion

    • The results are valuable to Missouri colleges - they provide insight into the current attitudes, environment, skills, and practices related to marijuana use by college students

    • The results may provide a foundation for further studies related to channels of communication, tone for messages, influential social models, practice models, and professional development

    • Programs may find the results helpful for future decision making, strategic planning, and program improvement

    6/2/2015 28

  • 2015 AIHce

    Limitations

    • Small sample size may make the conclusions non-transferable

    • Focus groups tend to be less depthful than individual interviews

    • Focus group member contributions may have been influenced by other members of the group or the researchers leading the discussions

    6/2/2015 29

  • 2015 AIHce6/2/2015 30

    • Questions?

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