LECTURE 5

TOBACCO &
MARIJUANA
28th January 2014
Giorgia Pastorin
phapg@nus.edu.sg
1

Before
T/F

How much do you know about Tobacco, Marijuana and

prevention programs?

After
T/F

1. With smokeless tobacco, there is a lower probability

to cause lung cancer but higher risk for mouth cancer
2. Smoking during pregnancy seems to determine smaller
head circumference in the fetus
4. Marijuana is highly addictive
3. SENSITIZATION is the opposite of Tolerance
5. A GATEWAY drug is a substance that induces the
individual to isolate him/herself from the society
6. Marijuana determines memory loss, especially among
the young
7. Marijuanas legalization influences its use, which might
be significantly decreased
8. Marijuana increases violent behavior
9. With drugs of abuse the benefit-cost ratio decreases

10. Preventive programs should be organized only for

those who have never taken addictive drugs
11. Preventive Programs are more effective if performed by
peers rather than police officers (for the young)

Stimulants
Cocaine
Amphetamine
Caffeine

Tobacco

Hallucinogens

Nicotine

LSD

Psychoactive
Drugs

PsychoTherapeutics

Marijuana

Prozac
Haloperidol

Opioids
Morphine
Codeine
Heroin
Methadone

Depressants
Barbiturates
Inhalants
Alcohol

TOBACCO
One of the greatest social Dilemma.

<< It is the most avoidable cause of death in

our society>>
Introduced in Europe in 1529, as Holy
Plant
Its active ingredient, NICOTINE, was

isolated only in 1828

Drugs, society and human behavior, McGraw-Hill Education, 2009, page 244

Mortality ratios (total death, mean age 55 to 64) as a

function of the age at which smoking started and the
5
number of cigarettes smoked per day.

Why? To seem
more alert?

more sexy/macho?

more adults?

- Pleasure
- Curiosity
- Enhanced
performance
- Sensation seeking
- Peer pressure
- Rebellion against
parents
6

Types of Use
Snuff (it replaced the pipe in England)
Chewing tobacco
Cigars (a combination of smoking and
chewing)
Cigarettes

SMOKELESS TOBACCO
There are different kinds of chewing tobacco, as
well as moist snuff = a small pinch is often placed
behind the lower lip.

Advantages:
-It is unlikely to cause lung cancer
-It is less expensive
Disadvantages:
-Increased risk of cancer in the mouth
-Carcinogens (nitrosammines) LEUKOPLAKIA
-Destructive effects on teeth by oral tobacco
8

Nicotine
It is a colorless, highly volatile natural
substance in tobacco
When smoked, nicotine enters the lungs
and is then absorbed into the
bloodstream

When chewed, nicotine is absorbed

through the mucus lining of the mouth
9

MECHANISM OF ACTION

Nicotine mimics acetyl choline by

acting at nicotinic receptors.
http://www.youtube.com/watch?v=xzq160XvAK8

Nicotine also affects Dopamine &

releases adrenaline from adrenal glands

That increases: - dependence

- vasocostriction in the skin
- heart rate

10

ACUTE TOXICITY
Only in the 1990s a tobacco manufacturer finally
admitted that cigarettes have seriously adverse
effects on health
Effects of low level nicotine:
1. nausea and general weackness.
2. Inhaling while smoking decreases hunger.
3. Carbon monoxide combines with hemoglobin in
the blood shortness of breath
In acute poisoning, nicotine causes tremors which
sometimes develop in convulsions.
The (rare) cause of death is suffocation resulting
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from paralysis of the muscles used in respiration.

CHRONIC TOXICITY
1. Smoking causes about 85% of all lung cancers
2. Smoking is related to 30% of premature deaths
per year (included Sudden Infant death
syndrome, SIDS)
3. Smoking causes 80 to 90% of deaths resulting from
chronic obstructive lung disease
4. Smokers have more chronic illnesses,
including:
Emphysema & bronchitis
Cardiovascular disease
Cancer
Bronchopulmonary disease

12

CAUSES FOR CONCERN

Passive smoking:
the smoke from the ash of the
cigarette is higher in many
carcinogens than the one
delivered to the smokers
lungs.
Smoking during pregnancy causes 2
times higher spontaneous abortions
and smaller head circumference, with
effects on the physical and intellectual
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development of the child

NICOTINE DEPENDENCE
Nicotine is the drug in tobacco that causes
addiction; it is the constituent in tobacco that
keeps smokers coming back for more people
report no satisfaction if all the nicotine is removed.
Nicotine affects dopamine, which reinforces the
dependence on nicotine
Research has tried to develop safer cigarettes:
Nicotine replacement therapy and e-cigarettes
14

NICOTINE REPLACEMENT THERAPY (NRT)

Include administration of nicotine by means other than
tobacco. Examples: NICOTINE PATCHES (release of n.
through the skin), NASAL SPRAYS and NICOTINE
GUMS (which orally administers nicotine).
Pros: 1) prevention of the cravings in a smoker while
avoiding the toxic ingredients inside the common
cigarette.
2) easier overcoming of nicotine
addiction.
Cons: Patches may cause skin
irritation. Less satisfaction if the
physical activity of holding and puffing a cigarette is
removed.
Need for a combination of counseling and
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pharmacological treatments.

E-CIGARETTES
Pros: e-cigarettes may help in
smoking cessation and they
seem to be more effective than
traditional pharmacotherapy, as
the physical stimuli of holding and
puffing on the e-cigarette may be better
at improving short term craving.
Cons: The World Health Organization
(WHO) stated that the efficacy in using
electronic cigarettes to aid in smoking
cessation has not been proven
scientifically. No proper regulations.
(July 2013)

http://www.youtube.com/watch?v=XvBVevkb5PU

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Stimulants
Cocaine
Amphetamine
Caffeine

Tobacco

Hallucinogens

Nicotine

LSD

Psychoactive
Drugs

PsychoTherapeutics

Marijuana

Prozac
Haloperidol

Opioids
Morphine
Codeine
Heroin
Methadone

Depressants
Barbiturates
Inhalants
Alcohol
17

Cannabis
Three drugs that come from cannabis:
marijuana,
hashish,
hash oil
The term marijuana refers to the leaves and flowering tops
of the cannabis plant that are dried to produce a tobacco-like
substance. Marijuana is usually smoked in the form of loosely
rolled cigarettes called joints, bongs (sometimes with PCP).

Joint or
bong or
blunt

18

Hashish consists of the resinous material of the cannabis

plant, which is collected, dried, and then compressed into a
variety of forms, such as balls, cakes, or cookie-like sheets.
Pieces are then broken off, placed in pipes, and smoked.
In general hashish is stronger than marijuana.

Hash oil is produced by extracting the cannabinoids from

plant material with a solvent.
In terms of its psychoactive effect, a drop or two of this
liquid on a cigarette is equal to a single joint of
marijuana.

19

The drugs obtained from cannabis are considered as

depressant, (opioid) narcotic and sometimes even
hallucinogen.
Cannabis plant contains more than 400 chemical substances.
About 60 of them are unique and are not found in any other
plant.
These substances are called cannabinoids. The substance
that is most responsible for the physical and psychic effects of
cannabis is THC (delta-9-tetrahydrocannabinol)
THC is the primary mind-altering
ingredient both in hashish and in
marijuana. Usually hashish has a higher
content of THC.
The structure suggests it is soluble in
fats, hence it tends to accumulate in the
body for long time.
20

Pharmacology of THC in Marijuana or hashish

When smoked, THC is rapidly absorbed (orally is slowly
absorbed) into the blood and first distributed to the brain,
then to the rest of the body.
THC blood presence is about 19 hours, while 25-30% of
THC and its metabolites are still in the body after 1 week
The high fats solubility determines a fast storage of THC
and its metabolites and a slow release.

Urine testing: for THC metabolites (some tests are very

sensitive, so positive even for passive inhalation).
Limit: they do not indicate when marijuana was smoked and
which was the impairment of the individual at that time 21

Mechanism of action
Cannabinoids modulate the availability of a variety of
neurotransmitters:

Acetyl choline
Norepinephrine
Dopamine

Serotonin
http://learn.genetics.utah.edu/content/addiction/mouse/

through the interaction of THC with cannabinoid

receptors (CB1 and CB2) similarly to endogenous

molecules (Anandamide), which blocks inhibitory molecules and
thus allows the delivery of Dopamine

22

Rapid effects of Marijuana/Hashish

Depend on: 1) concentration (Quality); 2)
Inhalation; 3) How long in the lungs; 4) Time
between 2 marijuana cigarettes
Intensification of the emotional situation you are in
Increase in Heart rate

Increased euphoria, elongation of events

Appetite stimulus (food kick) and an uncontrollable
fit of laughter (laugh kick)
Anticonvulsant activity- muscle relaxation
Reduction of eyes pressure in glaucoma

Reduction of nausea

23

Chronic effects of Marijuana/hashish

Tolerance may not develop uniformly:
Even SENSITIZATION!! (reverse tolerance)

No obvious Physical dependence. Psychological

dependence in some marijuana smokers (other
drugs?)

24

Acute Toxicity
No human deaths have been reported from
overdose of cannabis

Little evidence that drivers who use marijuana

are more likely involved in an accident (peoples

characteristics and internal events)

Some panic reactions
Abstinence syndrome: withdrawal effects within
12 hours, with hot flashes, irritability and
insomnia (milder effects than heroin or cocaine)25

Chronic Toxicity
Respiratory effects: difficult to compare with
tobacco: - lower amount of marijuana cigarettes
- not filtered
1 marijuana cigarette corresponds to:

- 5 cigarettes for the amount of Carbon monoxide

- 4 cigarettes in terms of tar intake
- 10 cigarettes in terms of cell damage

26

Chronic Toxicity (continues)

Sexual functioning: in men it reduces
testosterone; in women it enhances chances of
abortion. Lower weight and shorter
muscle/skeletal length in newborns

Cognitive effects: AMOTIVATIONAL SYNDROME

(diminished inspiration to participate in social situations
and activities), depression and loss of memory:

more in young people

http://www.videojug.com/interview/marijuana-side-effects-2#doesmarijuana-cause-depression
27

Medical Uses
In multiple sclerosis it provides relief since
cannabinoids have anti-inflammatory, muscle
relaxant properties
Reduction in Nausea in patients taking anticancer drugs (chemoteraphy)
Treatment of appetite loss (AIDS)
Asthmatic relief (dilates bronchioles in the
lungs)

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http://www.youtube.com/watch?v=IwNjFLPpnYA
Marijuana for medical use: not
for legalization, but to give
more options to patients and
medical doctors

http://www.ebaumsworld.com/video/watch/129068/
Marijuana Vending machines

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History of marijuana
CONTROVERSIES AND DEMONIZATION
Despite a lack of scientific evidence, in 1930s the
Federal Bureau of Narcotics (FBN) initiated an antimarijuana propaganda. Effects ranged from temporary
elation to the most violent of all sexual stimulants.
Some movies in the 1930s and 1940s demonized the
substance (demon weed)
The Marijuana Tax Act of 1937 was passed. It was a tax
law so it did not outlaw marijuana- just taxed it

In 1942 some beneficial medical applications were

identified

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REASONS FOR PROHIBITION

1) Scientific American reported in 1939 that marijuana
when combined with intoxicants makes the user have
a desire to fight and kill. The problem was that there
was no medical evidence to support the relationship
between marijuana and crime
2) In the 1960s some articles in journals reported
misconceptions about the drug: study on 38
individuals showed 13 females exhibiting sexual
promiscuity. Due to female hormone estrogen in
marijuana?
3) An important factor is Amotivational Syndrome=
unwillingness to participte in normal social activities.
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Symptom or cause?

REASONS FOR PROHIBITION (continues)

4) Carcinogenic effects?
So why tobacco is allowed?

5) The predominant factor is as GATEWAY drug.

Those using marijuana are more likely to
switch to more dangerous drugs. 3 facts
support that: 1) evidence of progression 2)
results from heavy users 3) contact with bad
individuals.
Anyway, for the majority marijuana is a
terminus rather than a gateway
http://www.youtube.com/watch?v=0GSRYnO1RSw
32

IS PROHIBITION THE REAL SOLUTION?

CASE STUDY: THE NETHERLANDS
The Netherlands in 1976 allowed for sale and
use of marijuana in coffee shops

33

IS PROHIBITION THE REAL SOLUTION?

CASE STUDY: THE NETHERLANDS (continues)
Illegal Drugs

Marijuana
Cocaine
Ecstasy
LSD
Heroin

USA

36.9 (16 y.o.)

12.3
3.6
9.0
1.4

The
Netherlands
17.0 (20 y.o.)
2.9
2.9
1.0
0.4

2001 National Household Survey

Explanations: 1) low rates of poverty in the Netherlands and

superior health care system
2) Success of Dutch in separating cannabis and hard drug
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markets

Marijuana: Trends in perceived availability, perceived risk of

regular use, and prevalence of use in the past 30 days for high
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school students (USA)

Legality of Cannabis in the world

36

Penalties in Singapore
Possession or consumption of Cannabis:
Up to 10 years of imprisonment or S$20,000 fine or
BOTH

Illegal traffic, import or export of:

Cannabis of more than 500 grams > DEATH
Cannabis resin of more than 200 grams > DEATH
Cannabis mixture of more than 1,000 grams > DEATH
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PREVENTION AND TREATMENT OF

DRUGS OF ABUSE
Psychoactive drugs are not a recent phenomenon:
use/misuse/abuse can be traced back to the
historical origin of the humanity. But increased in the
last 50 years
BENEFIT-COST RATIO
Positive effects, thats why drugs are taken

Negative effects: Tolerance

Dependence
Withdrawal effects
Toxicity

Ratio
deteriorates
Faster with
more
addictive
drugs
(cocaine)38

PREVENTION AND TREATMENT OF

DRUGS OF ABUSE
Primary prevention: for young people, who
havent tried yet the substance in question or
just a few times
Useful, but also dangerous because there is the
risk of introducing new itemsso increased
curiosity!!
Secondary prevention: for young people, who
have tried the substance in question. Useful to
avoid the use of others
Tertiary prevention: to avoid relapse. For
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alcoholic, heroin and cocaine addicts

PROGRAMS
Universal program: for the delivery to the entire
population

Selective program: for people at high risk (e.g.

students)

Indicated program: targeted at individuals who

show signs of developing problems
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WHERE and HOW?

Knowledge-Attitude-Behaviour Model: providing
information about drugs would increase knowledge
about their effects, determining changes in attitudes
about drugs and decreasing the drug-use behaviour.
Increased curiosity?
Depends on the purpose: to avoid or to make rational
decisions?
Social-Influence Model: e.g. smoking: presenting
information or videos about the dangerous
consequences of smoke is ineffective. Better teen
leaders. And adults? DARE (Drug Abuse Resistance
Education, by police officers).
Peer-Parents-Community Model: alcohol free parties,
field tripslearning with fun +trusting +not alone

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SINGAPORE

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DRUG PLUS PSYCHOLOGICAL

THERAPY: the OPTIMAL
THERAPEUTIC PACKAGE
Drugs alone only relieve the CORE symptoms
Psychological intervention
alone might be
counterproductive, especially in those who are
susceptible to stress
Therapeutic drugs and psychological
intervention are both needed in order to achieve
the optimal outcome of complete social
43
integration