THC Supervisor Impairment Knowledge

As Canada enters its new era of THC in 2017/18, worker and employer training on what things are you covering

with your teams in your worksite policies and drug education!

Origin in China or central Asia in Neolithic times (10,000 years ago)

First “used” as food

First “high” could have occurred around 6,500 B.C.

As a medicine (Chinese emperor Shen Nung – c. 2700 B.C.)

Social “hospitality” 200 A.D. (Galen)

Source of ropes and sails – 3rd century Rome

Utilized in Africa 6 centuries ago for religious, social rituals, medicinal purposes

George Washington and the colonies

Cannabis sativa:- most common- high concentration of fiber and still used for hemp- typical plant produces 1-5 lbs of buds and smokable leaves pending the new federal regulated size limit in Canada

Cannabis indica:- shorter and bushier- stronger/smellier (“skunk weed”)- usually the base plant for “sinsemilla” (without seeds)

MARIJUANA CONCENTRATIONS

- ordinary; average of 3 percent THC- sinsemilla; average of 7.5 percent THC, can be 24 percent- hashish; averages 2 to 8 percent THC, can be 20 percent- hash oil; averages 15 to 50 percent THC, but be 70

percent - "joint“ contains between 0.5 and 1.0 grams of plant matter; THC content between 5 and 150 milligrams

A simple Fact

Marijuana affects the part of the brain that controls body movement, balance and coordination. THC is also known to impair judgment and memory. Drivers with blood concentrations of 13.1 ug/L THC, the psychoactive ingredient in cannabis, showed increase weaving that was similar to those with a .08 breath alcohol concentration, the legal limit in most states and ALL CANADIAN PROVINCES.

Well Documented in both Law Enforcement and Industry!

Cannabis and alcohol acutely impair several driving-related skills in a dose-related fashion, but the effects of cannabis vary more between individuals than they do with alcohol because of tolerance, differences in smoking technique, and different absorptions of tetrahydrocannabinol (THC), the active ingredient in marijuana. Detrimental effects of cannabis use vary in a dose-related fashion, and are more pronounced with highly automatic driving functions than with more complex tasks that require conscious control, whereas with alcohol produces an opposite pattern of impairment. But it’s important to note that THC remains in the blood even after its effects have worn off. In addition, people will often metabolize THC at different rates, which means some may feel the effects for up to five hours later. In fact, people who only smoke weed occasionally can have traces of THC in their blood for up to seven days.

False Positive in your ProgramJust to name a small few over the counter drugs that have THC in them• Dronabinol consists of the chemical delta-9-tetrahydrocannabinol, the active ingredient found

in marijuana. Therefore, this medication produces a positive result when testing for THC. Doctors prescribe dronabinol to stimulate the appetite in patients with AIDS anorexia as well as to treat nausea and vomiting triggered by chemotherapy treatments.

• Ibuprofen, classified as a nonsteroidal anti-inflammatory medication, effectively relieves pain and reduces swelling and stiffness. Both prescription and nonprescription medications contain ibuprofen, which often occurs in combinations with other drug such as in some cough and cold medications.

• Ketoprofen, similar to ibuprofen, relieves pain, swelling and stiffness. Often prescribed to treat rheumatoid arthritis--swelling of the joints--the chemical structure of ketoprofen resembles that of ibuprofen. This means the metabolites look similar and can cause the same interference with drug tests for THC.

• Naproxen, also classified as a nonsteroidal anti-inflammatory drug, treats inflammation, swelling, stiffness and pain in joints. Available in prescription and nonprescription strength, naproxen can trigger a false-positive result on a drug test

• Promethazine, a prescription medication, blocks the effects of histamine, a substance produced and released in the body during an immune response. Doctors prescribe promethazine for many types of conditions. It relieves the symptoms of allergies, including runny nose, watery eyes and skin reactions.

Note to my supervisor to know

•Blood THCCOOH level >40 μg/l suggests regular cannabis use and long-term * impairment.(The half-life of the psychoactive ingredient of cannabis, THC, is 7 days. The substance is fat soluble and traces can be found in the body up to 12 weeks after use. Pilots tested in flight simulators were unable to land planes accurately up to 50 hours after smoking just one 3 mg. joint). Cannabis stays in the body for many weeks, much longer than alcohol (which is cleared at the rate of 1 unit per hour).

Known Medical DataDon’t bank on always feeling good, relaxed and happy. You could instead get confused, forgetful or depressed. You may even panic or hallucinate.

Babies born to cannabis-smoking mothers are 10 times more likely to develop a form of leukaemia. They are also smaller, hyperactive, have learning deficits, and suffer low attention span, anger and disruptiveness. Look at the behaviour problems in primary schools today – is there a link?

Fewer white blood cells (the body’s immune system) are made, and many are abnormal. You will catch more infections – sometimes mild like tonsilitis or athletes foot but sometimes more serious, and you will stay sicker for a longer period of time. HIV positive people should avoid cannabis.

What is the HARM in a Puff

Why does cannabis cause so much damage?• THC (Tetrahydrocannabinol) is fat-soluble and

accumulates in the fatty membranes of cells, slowly being released over weeks. It interferes with the production of new cells by preventing the DNA in the chromosomes in the nuclei from replicating properly, and kills cells by blocking the channels carrying energy-supplying substances inwards and toxins outwards.

Brain regions in which cannabinoid receptors are abundant

Brain Region Functions Associated with RegionCerebellum Body movement coordinationHippocampus Learning and memoryCerebral cortex, especially cingulate, Higher cognitive functions frontal, and parietal regionsNucleus accumbens RewardBasal ganglia Movement control

Brain regions in which cannabinoid receptors are moderately concentrated

Brain Region Functions Associated with RegionHypothalamus Body “housekeeping”

(temperature regulation, salt/water balance)Amygdala Emotional response, fearSpinal cord Peripheral sensation, painBrain stem Sleep and arousal, temperature, motor controlCentral gray AnalgesiaNucleus of the solitary tract Visceral sensation,

nausea/vomiting

SHORT-TERM EFFECTS Physical:

- relaxation to sedation - bloodshot eyes - coughing/lung irritation

- some pain control - increase in appetite, - loss in muscular coordination

- decreased blood pressure - decrease in pressure behind the eyes - increased heart rate - increased blood flow through the mucous membranes of the eye - decreased nausea

- impaired tracking ability - marijuana can act as a stimulant or depressant,

- temporary disruption of the secretion of testosterone

SHORT TERM EFFECTS Mental Mild to moderate dose:

- confused and separated from the environment - feeling of deja vu - drowsiness

- feelings of detachment and being aloof - difficulty in concentrating

- disrupts short-term memory

Strong dose: - stimulation, giddiness, distortions of color/time/sound

Very strong dose: - feelings of movement, visual hallucinations and hallucinations

Mental effects dependent on set, setting, and experience - can exaggerate mood, personality, empathy or suggestibility

Classifying Marijuana

• Marijuana produces some excitatory effects but it is not generally regarded as a stimulant.

• Marijuana produces sedative effects, but a person faces no risk of slipping into a coma or dying.

• Marijuana produces mild analgesic effects, but it is not related pharmacologically to opiates like drugs.

• Marijuana produces hallucinations at high doses, but its structure does not resemble LSD or any other drug formally categorized as hallucinogen.

- 65% of heavy drinkers also smoke marijuana

- marijuana appears in urine and blood 3 - 5 times more frequently in fatal driving accidents than in the general population. - marijuana, drive slower; alcohol, drive faster; - low dose marijuana + low dose alcohol (.04 BAC) = .09 BAC - moderate marijuana + low dose alcohol = > .12 BAC - high marijuana + low dose alcohol = inability to stand- impairment lasted 3 hours

Institute of Human Psychopharmacology/The Netherlands .

So

marijuana is clearly a hybrid drug in a league of its own.

Basic Terminology

• Marijuana is frequently a synonym for cannabis but technically the two terms are separate.

• Cannabis is the botanical term for the hemp plant cannabis sativa.

Definitions

• Cannabinoids: Any of the several dozen active substances in marijuana and other cannabis products.

• Delta-9-tetrahydrocannainol (THC): The active psychoactive ingredient in marijuana and hashish.

• Marijuana: The most commonly available psychoactive drug originated from the cannabis plant. The THC concentration ranges from approximately 1 to 4 percent.

Definitions

• Sinsemilla: A form of marijuana obtained from the un-pollinated or seedless portion of the cannabis plant, it has a higher THC concentration than regular marijuana, as high as 6 percent.

• Hashish: A drug containing the resin of cannabis flowers, the THC concentration ranges from approximately 8 to 14 percent.

Definitions

• Hashish Oil: A drug produced by boiling hashish, leaving the potent psychoactive residue, the THC concentration ranges from approximately 15 to 60 percent.

• Hashish oil crystals: Solid form of hashish oil.

• Bhang: A liquid form of marijuana, popular in India.

• Pot• Ganja• Herb• Weed• Mary Jane• Grass• Chronic

• And more than 200 others• Different strains of

marijuana have their own “brand” names

Marijuana Slang/Street Names

• Marijuana is usually smoked – As a cigarette (joint) – In a pipe or water pipe (bong)– In “blunts,” which are cigars that are hollowed out

and refilled with a mixture of marijuana and tobacco

• Marijuana can be mixed in food or brewed as a tea - medibles

• Marijuana can be combined with other drugs such as PCP

How is it Abused?

What it looks like

New Trends - Dabbing

• Hash oil• Budder• Honey Oil• Wax or Ear Wax• Smoked in oil rig• 1 dab = 5 joints*

• THC effects specific parts of the brain called cannabinoid receptors

• The parts of the brain that have the most cannabinoid receptors influence:– Pleasure– Memory, thinking and concentration– Sensory and time perception– Coordinated movement

Marijuana effects the brain

• Marijuana intoxication can cause:– Reduced inhibition– Distorted perceptions– Impaired coordination– Difficulty with thinking and problem solving– Interferes with learning and memory– Can make driving dangerous– Causes increased heart rate

Short-term Effects

Marijuana Effects – After the Euphoria

• Sleepy• Depressed• Occasionally marijuana use may produce– Anxiety– Fear– Distrust– Panic

• Effects on body/health after long-term use:– Ability to do complex tasks could be compromised– Negative impact on pursuit of life goals– Can contribute to lung damage

Long Term Effects and Addiction

Adverse Reactions

• Anxiety provoking with mild intoxication. • Panic attacks – acute anxiety reactions to

Marijuana may include restlessness, depersonalization, sense of loss of control, fear of panic and paranoia.

Cannabis induced psychotic reaction – Acute toxic confusion

• Toxic psychosis can follow ingestion of cannabis.

• Acute toxic psychosis is more common to occur with higher doses of Delta-9-THC.

• Typically symptoms are apprehension suspiciousness, confusion, memory impairment, depersonalization, de- realization, and hallucination.

Acute psychotic reaction in clear consciousness

• An acute psychotic reaction may follow cannabis use, clinical picture is characterized by rapid onset and mixture of affective and schizophrenic like symptoms.

Mood Disturbances • Self-limiting, dysphoric reactions are well recognized

consequences of cannabis use. • Serious mood disturbances can occur with

prolonged marijuana use, however this has not been supported by controlled studies.

• The increased risk of suicide found in one large study needs further consideration.

• Clinical reports have suggested that cannabis use may precipitate relapse in patients with pre-existing depressive disorder.

Effects on sexual functioning and reproduction

• Men – Reduces level of testosterone– Reduces sperm count – Increases percentage of abnormally formed sperm.

• Women – Reduction in level of lutenizing hormone (LH), a hormone

necessary for fertilized egg to be implemented in the uterus.

Medical Uses for Marijuana

• Glaucoma – Smoking marijuana reduces I.O.P. in normal human subjects.– THC eye drops reduce glaucoma symptoms.

• Asthma – Initial bronchodiltion, followed by bronchoconstriction.

• Nausea – Cancer treatment. – AIDS patient.

Effects of Drugs on Driving

• CoordinationEffects on nerves/muscles - steering, braking, accelerating, manipulation of vehicle

• Reaction TimeInsufficient response - reaction

• JudgmentCognitive effects, risk reduction, avoidance of potential hazards, anticipation, risk-taking behavior, inattention, decreased fear, exhilaration, loss of control

• TrackingStaying in lane, maintaining distance

• AttentionDivided, not focussed. Time-shared task with high demand for info processing

• Perception90% of info processed while driving is visual. Glare resistance, recovery, dark and light adaptation, dynamic visual acuity

Determining “Under the Influence”

A. Driving pattern B. Impairment

Visual Physiological Performance

C. Positive toxicology Ethanol Drugs - blood vs. urine - parent vs. metabolite - quantitation

What the Toxicologist cannot do….

Determine impairment in a specific individual from a blood concentration alone

Determine exactly how much drug was taken

Determine exactly when a drug was taken

Toxicology IssuesQuantitative or Qualitative Analysis?

Therapeutic, toxic, lethal concentration in blood?

High or low dose? Recent use or residual drug? Effect of tolerance, history of drug use Individual sensitivity/response Effect of other drugs?

Drugs in Urine

Good specimen to screen for large number of drugs and drug classes

Typically see metabolites Usually indicates drug use within the past

2-3 days or more Cannot definitively establish impairment “Consistent with” or “Explanation for”

the impairment

Drugs in Blood

If drug is present in the blood, it is assumed to be affecting central nervous system and other target organs

Typically see parent compounds (or both) Quantitation is vital to prosecution

Urine vs Blood

Since urine is an end-product of absorption, distribution and metabolism, a drug in the urine does not show it is still circulating in the body and producing an effect

Cannot say one is “under the influence”

Urine vs Blood

Blood however is circulating throughout the body and one is experiencing the drug’s effects – “under the influence”

But, is one “impaired”? Must know pharmacology Drugs and Driving literature evolving

Medical/Clinical/Forensic Diagnostics

BREATH

As a SUPERVISOR you may note

A person who smokes marijuana on a regular basis builds up a tolerance to the drug, and will need to smoke larger amounts of marijuana in order to achieve a “high.” The intensity of the effects one experiences may vary between individual users. The most common signs associated with marijuana use are: • Rapid, loud talking and bursts of laughter • Sleepy or sluggish appearance • Lack of concentration and coordination. • Forgetfulness • Swelling and redness in whites of eyes. • “Burnt Rope” odor on clothing or breath. • Feeling that time passes slowly. • Craving for sweets. • Increased appetite. • Use or possession of marijuana smoking objects including roach clip, packs of rolling papers, pipes or bongs.

SCC State the Police not you!

The Supreme Court of Canada has ruled in a 5-2 decision that a specially trained police officer has the tools to determine if someone is high on drugs while driving — even if there is no scientific test for drug impairment comparable to the breathalyzer.• The court found that a DRE officer — a Drug Recognition

Expert — can compel someone to undergo a 12-step test checking physical coordination and looking for eye tremors, and secure a blood or urine sample, if there are reasonable grounds to suspect the driver was stoned while in control of a motor vehicle, boat

Are they stoned ?

• The Horizontal Gaze Nystagmus (HGN) test will confirm the possibility of the presence or absence of certain categories "on board," as will the subjects pupil size, and the same is said for the Lack Of Convergence (LOC) of the eyes. LOC is simply the inability to cross one's eyes. However, while it is hailed as a valid and reliable indicator, 40% of the population is naturally unable to converge/cross their eyeballs.

CANNABIS

• The most well-known drug category as it includes marijuana, hashish, and a synthetic compound called Marinol. Recently, K2, spice, and potpourri are newer synthetic versions.– HGN is NOT PRESENT– Pupils are DILATED– LOC is PRESENT – cannot cross eyes

THC and the 30 day bump!

Cannabis presents its own unique hurdles for judging impairment; the drug is estimated to stay in your system for about 30 days, but that number can stumble wildly depending on if you’re a one-time or long-term user. Measuring the buzz, or impairment, can be still harder. Health and Safety warns that while a saliva test is a tempting threshold, it is simply another tool for law enforcement to use to augment their powers of detection.

The current Proposed laws only cover

• Yes the laws are changing but it only covers CANNABIS not all the things it can be mixed with in your drug policy and program

• https://www.documentcloud.org/documents/3565207-Cannabis-Act.html

• https://www.documentcloud.org/documents/3565219-Impaired-Driving.html

Canada and Driving

• As part of an overhaul of Canada's impaired driving laws, it makes it illegal to drive within two hours of having an illegal level of drugs in the blood, with penalties ranging from a $1,000 fine to life imprisonment, depending on the level of drugs in the blood and whether someone was injured or killed as a result of the impairment.

• Does not prevent provinces from allowing sales at the same place as alcohol.

QUESTIONS or Just a Puff