Objectives: To determine incidence and patterns of natural course of cannabis use and disorders as well as cohort effects in a community sample of adolescents and young adults. Method: Cumulative incidence and patterns of cannabis use and disorders were examined in a prospective longitudinal design (mean follow-up period=42 months) in a representative sample (N=2446) aged 14–24 years at the outset of the study. Patterns of cannabis use, abuse and dependence (DSM-IV) were assessed with the Composite International Diagnostic Interview (M-CIDI). Results: (1) Cumulative lifetime incidence for cannabis use (at second follow-up): 47%; 5.5% for cannabis abuse, 2.2% for dependence. (2) Men used and abused cannabis more often than women. (3) The majority of the older participants (18–24 years at baseline) had reduced their cannabis use at follow-up, while younger participants (14–17 years at baseline) more often had increased their use and developed abuse or dependence. (4) The younger birth cohort (1977–1981) tended to start earlier with substance (ab)use compared to the older birth cohort (1970–1977). (5) Cannabis use was associated with increasing rates of concomitant use of other licit and illicit drugs. Conclusions: Cannabis use is widespread in our sample, but the probability of developing cannabis abuse or dependence is relatively low (8%). The natural course of cannabis use is quite variable: about half of all cannabis users stopped their use spontaneously in their twenties, others report occasional or more frequent use of cannabis.

Background: Cannabis use (CU) and disorders (CUD) are highly prevalent among adolescents and young adults. We aim to identify clinically meaningful latent classes of users of cannabis and other illegal substances with distinct problem profiles. Methods: N= 3021 community subjects aged 14–24 at baseline were followed-up over a period ranging up to 10 years. Substance use (SU) and disorders (SUD) were assessed with the DSM-IV/M-CIDI. Latent class analysis (LCA) was conducted with a subset of N= 1089 subjects with repeated illegal SU. The variables entered in the LCA were CU-related problems, CUD, other SUD, and other mental disorders. Results: Four latent classes were identified: “Unproblematic CU” (class 1: 59.2%), “Primary alcohol use disorders” (class 2: 14.4%), “Delinquent cannabis/alcohol DSM-IV-abuse” (class 3: 17.9%), “CUD with multiple problems” (class 4: 8.5%). Range and level of CU-related problems were highest in classes 3 and 4. Comorbidity with other mental disorders was highest in classes 2 and 4. The probability of alcohol disorders and unmet treatment needs was considerable in classes 2–4. Conclusion: While the majority of subjects with repeated illegal SU did not experience notable problems over the 10-year period, a large minority (40.8%) experienced problematic outcomes, distinguished by clinically meaningful profiles. The data underline the need for specifically tailored interventions for adolescents with problematic CU and highlight the potentially important role of alcohol and other mental disorders.

The aim of this study was to examine young adult cannabis users’ attitudes towards cannabis and their perception of the normalization of cannabis. The purpose was also to explore how their views of cannabis correspond with norms regarding cannabis. This study is based on interviews with five young adult cannabis users. The theoretical framework is based on Parker’s normalization thesis, Goffman’s notion of stigma, Becker’s definition of outsiders and the definition of social identity developed by Stone. The theory of cognitive dissonance was also used to analyze the empirics. The result shows that the interviewees experience a normalization of cannabis, although a process of stigmatization cannot be disregarded. The result also indicates that the respondent’s views of cannabis do not conform to society. The main conclusions are that cannabis is normalized in certain groups, which creates a discrepancy between the attitudes of cannabis users and Swedish society. The reasons for using cannabis are individual and one recurrent explanation is that the respondents experience less negative consequences of cannabis, compared to the effects of alcohol. These findings are supported by earlier research. In order to develop a constructive dialogue about cannabis, the understanding of these attitudes is important for social work.

La polyconsommation d’alcool et de cannabis est rapportée par un grand nombre de jeunes adultes canadiens (Flight, 2007). Les recherches épidémiologiques suggèrent que le statut de polyconsommateur est associé à certains comportements à risque, dont la consommation excessive d’alcool et la conduite d’un véhicule automobile sous l’influence de l’alcool (Jones et al. 2001; Mohler-Kuo, et al. 2003; Shillington & Clapp, 2006). Les études qui soutiennent le risque accru de comportements à risque pour les polyconsommateurs se focalisent sur l’effet des substances. En rupture avec cette approche, ce mémoire présente une étude situationnelle de la polyconsommation en examinant l’effet du statut de polyconsommateur et, pour ceux-ci l’effet de la consommation simultanée d’alcool et de cannabis, en situant l’action dans son contexte de survenu et en examinant la contribution du contexte. La probabilité d’avoir conduit une voiture sous l’influence de l’alcool et d’avoir consommé excessivement de l’alcool sera examinée auprès d’étudiants universitaires. La contribution respective des substances, des situations et de l’expérience de la vie universitaire sera examinée. La méthodologie employée repose sur la construction de modèles de régression logistique multiniveaux, à la fois chez l’ensemble des buveurs (10 747 occasions, nichées dans 4396 buveurs) et dans le sous-échantillon des polyconsommateurs (2311 occasions de consommation d’alcool, nichées dans 880 polyconsommateurs). Les données sont issues de l’Enquête sur les campus canadiens (2004), menée auprès d’un échantillon représentatif de 6282 étudiants issus de 40 universités. Le statut de polyconsommateur est associé à la consommation excessive d’alcool, mais pas à la conduite d’une voiture suite à la consommation. Cependant, la consommation simultanée d’alcool et de cannabis n’est pas associée à un risque plus élevé de consommer excessivement de l’alcool, et est négativement associée à la conduite d’une voiture après la consommation. Plusieurs caractéristiques situationnelles sont associées aux deux comportements à l’étude et diminuent la force d’association entre ces comportements et le statut de polyconsommateur. / Alcohol and cannabis polydrug use is a common consumption pattern among Canadian young adults (Flight, 2007). Moreover, epidemiological studies suggest that alcohol and cannabis use is associated with other risky behaviours such as binge drinking and driving a vehicle under the influence of both substances (Jones et al. 2001; Mohler-Kuo et al. 2003; Shillington & Clapp, 2006). Studies which have reported an increased risk for polydrug users focus on substance use. The present study propose a situational approach, in which the effect of poly drug use, as well as the effect of simultaneous use on these risky behaviours are investigated while considering the context in which the consumption takes place. The probability of driving under the influence of alcohol, and the probability of binge drinking are examined among a sample of university students. The respective contribution of substance use, university life experience and drinking situations is examined. The methodology used to perform this study is based on multilevel logistic regression models, among drinkers (10 747 occasions, nested within 4396 drinkers) as well as among the polydrug users subsample (2311 drinking occasions, nested within 880 individuals). The data are drawn from the Canadian Campus Survey conducted in 2004 with a random nationally representative sample of 6282 students from 40 universities. Polydrug status is positively associated with episodic binge drinking, but not with driving under the influence of alcohol. However, cannabis use is not associated with binge drinking, among polydrug users. Moreover, for this specific population, cannabis smoking is negatively associated with driving under the influence of alcohol. Several situational characteristics are associated with either one or both studied behaviours and partially explain the relationship between those behaviours and polydrug use.

Aims: To investigate the gender differences in the patterns of cannabis use (CU), namely frequency, times of day, social context and methods and in their association with DSM-IV cannabis dependence. Methods: A sample of 3,904 students from German universities was recruited via an internet survey. Logistic regressions and associated areas under the ROC curve (AUC) were calculated among current cannabis users (at least once a month, n = 843). Results: CU using a water pipe was more often reported by males (50 vs. 34.6%). Usual CU ‘before going to sleep at night’ was more often reported by females (47.3 vs. 35.7%). Most CU patterns showed a similar association with DSM-IV cannabis dependence in both genders. The association of CU ‘with strangers’ was stronger in females (AUC 0.68 vs. AUC 0.56). Slightly different multiple models were found (females AUC 0.86, males AUC 0.77). Conclusions: There are considerable gender differences in the CU patterns and, thus, in the way CU functions. In the association of CU patterns with cannabis dependence, the similarities are rather great. Examining the CU patterns might make a considerable contribution to the better detection of high-risk population segments for prevention and early intervention in both genders. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

La malnutrition et la consommation de cannabis font partie des grands problèmes de santé publique.L'objectif de cette thèse était d’étudier les conséquences de ces facteurs externes sur les voies mésocorticolimbiques.Le système endocannabinoïde est un complexe multimoléculaire incluant les endocannabinoïdes (eCB), molécules lipidiques synthétisées à partir des oméga-3, les enzymes de synthèse et de dégradation des eCB, et les récepteurs aux cannabinoïdes de type 1 (CB1R), principale cible du cannabis. Nos travaux montrent qu’une alimentation déficiente en oméga-3, tout comme une exposition prénatale aux cannabinoïdes, altère la signalisation endocannabinoïde dans les régions étudiées. Nous avons découvert des altérations sévères du répertoire comportemental émotionnel et cognitif chez les souris déficientes en oméga-3 corrélées à des déficits spécifiques de la plasticité synaptique dépendante du complexe de signalisation mGlu5/eCB dans le PFC et le NAc. Nous avons mis en évidence une divergence sexuelle des effets à long-terme induits par une exposition prénatale aux cannabinoïdes chez la progéniture à l’âge adulte. Nous avons observé une diminution de l’interaction sociale chez les mâles mais pas chez les femelles exposés in-utero aux cannabinoïdes. Ce déficit comportemental était associé à une hyperexcitabilité des neurones pyramidaux et à l’absence spécifique de la plasticité synaptique endocannabinoïde dans le PFC des mâles. Enfin, dans nos deux modèles d’étude, la potentialisation pharmacologique du complexe macromoléculaire de signalisation mGlu5/eCB normalise les déficits synaptiques et comportementaux, ouvrant la voie sur de nouvelles cibles thérapeutiques. / Malnutrition and the use of cannabis are amongst the public’s most signficant problems. In the past decades, drastic dietary changes are accompanied by low consumption of essential omega-3 polyunsaturated fatty acids (PUFAs). Cannabis is the most frequently used illicit drug by pregnant women and young women of reproductive age. This thesis aimed to study the consequences of these environmental factors on synaptic and behavioral functions of the mesocorticolimbic system, particularly the nucleus accumbens (NAc) and prefrontal cortex (PFC). The endocannabinoid system is a multimolecular complex including endocannabinoids (eCB), lipidic molecules synthesized from PUFAs, eCB synthesizing and degradating enzymes, and cannabinoid receptor type 1 (CB1R), the main target of cannabis. Our work shows that an omega-3 deficiency, as well as PCE, alters endocannabinoid-signaling in the areas of interest.We found severe alterations in the emotional and cognitive behavioral repertoire of omega-3 deficient mice that correlated with specific alterations in synaptic plasticity mediated by mGlu5/eCB signaling complex in PFC and NAc.We showed a sexual divergence in the long-term effects of PCE in adult offsprings. We observed a decrease in social interaction in males but not in females prenatally exposed cannabinoids. This behavioral deficit was associated with hyperexcitability of the pyramidal neurons and a specific lack of endocannabinoid synaptic plasticity in the male PFC.Finally, in our two study models, pharmacological enchancement of the mGlu5/eCB macromolecular signaling complex normalized synaptic and behavioral deficits, illuminating routes to new therapeutic targets.

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No. of bitstreams: 2 Dissertação - Ana Caroline Marques Vilela - 2016.pdf: 15043058 bytes, checksum: 3f85b0439af84d598899344d64bfc48c (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2016-08-13 / Background: Adolescence is evidenced as one of the age groups the incidence of drug users is high and growing, and this finding suggests the study and research on a variety of questions about the possible relationship between these two phenomena. Attempts to characterize adolescent drug users and the various aspects of its use are of particular importance to contribute to the understanding of substance abuse patterns among young people, as well as provide data for guidance and prevention in the field of problems relating to drugs. Aim: Describe the epidemiology, identify the factors associated with drug use and the presence of dual pathology in adolescents hospitalized in the Midwest of Brazil. Methods: Cross-sectional study of adolescent (10-18 years) drug users hospitalized in Children's Mental Health Association of Goiás between 2010 and 2015. Data were collected retrospectively by chart review. Only patients with chemical dependence on licit or illicit substances as the reason for hospitalization were selected for data collection. Sociodemographic variables and sample characterization, drug usage profile, environmental factors and dual pathologies were collected in a standardized form. Descriptive analysis and association of drug use profile for sex by Chi-square test or Fisher's exact with an alpha of 5% was performed. Results: Among the 214 adolescents studied, 70.2% were male. An early onset of drug use was detected, with a mean age of 13 ± 2 years. Approximately 50% of patients dropped out of school due to drugs and were involved in illegal acts to obtain drugs. The cannabis was the psychoactive substance responsible for most admissions in males, while in females was crack (p = 0.031). Cannabis was the first drug used in life for most individuals, followed by tobacco and alcohol. The main dual pathologies were disruptive behavior disorders (50.0%) and mood disorders (46.7%). Conclusion: This study found a high prevalence of dual disorders, high dropout rates from school due to drug use, involvement in illicit activities to obtain drugs and early onset of substance abuse. / Introdução: A adolescência evidencia-se como uma das faixas etárias cuja incidência de usuários de drogas é alta e crescente, e esta constatação sugere o estudo e pesquisa de uma variedade de questões sobre as possíveis relações entre estes dois fenômenos. Tentativas para caracterizar os adolescentes usuários de drogas bem como os diferentes aspectos relativos ao seu consumo são particularmente importantes para contribuir ao entendimento de padrões de dependência química entre os jovens, assim como também prover dados para a orientação e prevenção no campo dos problemas relativos às drogas Objetivo: Descrever o perfil epidemiológico, identificar os fatores associados ao uso de drogas e a presença de patologias duais em adolescentes hospitalizados no Centro-Oeste Brasileiro. Metodologia: Estudo transversal com adolescentes (10 a 18 anos) usuários de drogas hospitalizados na Associação de Saúde Mental Infantil de Goiás entre 2010 e 2015. Os dados foram obtidos retrospectivamente por meio de revisão de prontuário. Apenas os pacientes que apresentaram dependência química de substâncias lícitas ou ilícitas como motivo de internação foram selecionados para coleta de dados. Variáveis sociodemográficas e de caracterização da amostra, perfil de uso de drogas, fatores ambientais e patologias duais foram coletadas em formulário padronizado. Foi realizada análise descritiva dos dados e de associação do perfil de uso de drogas por sexo pelo teste Qui-quadrado de Pearson ou Exato de Fisher com alfa de 5%. Resultados: Dentre os 214 adolescentes avaliados, 70,2% eram do sexo masculino. Detectou-se início precoce do uso de drogas, com idade média de 13 ± 2 anos. Aproximadamente 50% dos indivíduos abandonaram os estudos devido às drogas e se envolveram com atos ilícitos para obtenção de drogas. A cannabis foi a substância psicoativa responsável pela maioria das internações principal no sexo masculino, enquanto no sexo feminino a principal foi o crack (p=0,031). A cannabis foi a primeira droga utilizada na vida pela maioria dos indivíduos, seguida por tabaco e álcool. As principais patologias duais foram transtornos disruptivos do comportamento (50,0%) e transtornos de humor (46,7%). Conclusão: O presente estudo encontrou alta prevalência de patologias duais, altas taxas de abandono dos estudos devido ao uso de drogas, envolvimento com atos ilícitos para obtenção de drogas e início precoce do abuso de substâncias químicas.

No Brasil, em 2014, os acidentes de trânsito contabilizaram mais de 44 mil óbitos. Já foi relatado na literatura científica a relação entre o uso de drogas por motoristas de caminhão a fim de manterem a exaustiva jornada de trabalho a que são submetidos. O presente estudo teve como objetivo avaliar a frequência do uso de drogas ilícitas por motoristas de caminhão através de análises toxicológicas em amostras de fluido oral. Motoristas de caminhão foram abordados de forma aleatória por policiais rodoviários federais e convidados a participar dos Comandos de Saúde nas Rodovias, evento de promoção à saúde dos caminhoneiros. Os motoristas que aceitaram participar do estudo doaram uma amostra de fluido oral, coletado com o dispositivo Quantisal(TM), e responderam a um questionário estruturado para coleta de dados sociodemográficos. As amostras de fluido oral foram submetidas à análise de triagem para cocaína, anfetamina e delta9-tetrahidrocanabinol (delta9-THC) por ELISA, sendo esse estudo pioneiro na utilização dessa técnica para triagem de amostras de fluido oral no trânsito. As amostras que apresentaram resultados positivos foram confirmadas por cromatografia gasosa acoplada à espectrometria de massas (GC-MS). No período de desenvolvimento desse estudo foi possível o envio das amostras positivas na etapa de triagem para o Instituto Norueguês de Saúde Pública para confirmação por cromatografia líquida de ultra eficiência acoplada à espectrometria de massas em tandem (UPLC-MS/MS). Além das três substâncias já pesquisadas no estudo foram analisadas a presença de outras 29, dentre drogas ilícitas e medicamentos psicoativos. Foram incluídos 762 motoristas. Das amostras analisadas, 5,2% (n=40) apresentaram resultado positivo para algum tipo das drogas estudadas. A cocaína foi a droga mais encontrada (n=16), seguida pela anfetamina (n=11) e delta9-THC (n=4). Ainda, três amostras apresentaram resultados positivos para cocaína e ?9-THC e uma amostra para cocaína e anfetamina. Além da cocaína, anfetamina e ?9-THC, com a confirmação por UPLC-MS/MS foram detectados outros fármacos psicoativos, o meprobamato e o alprazolam, (duas amostras testaram positivo para anfetamina e meprobamato uma para anfetamina e alprazolam e outra amostra para cocaína e meprobamato). Os motoristas com amostras positivas eram mais jovens, com menos escolaridade, mais inexperientes, possuíam uma jornada de trabalho mais extensa e percorriam percursos mais longos. Esse fato alerta, sem dúvida, a necessidade da ampliação de estudos nacionais sobre o uso de substâncias psicoativas, incluindo as ilícitas e medicamentos, para melhor entendimento na comunidade científica e permitindo a implementação de políticas públicas voltadas à prevenção e fiscalização do uso dessas substâncias, com o objetivo de reduzir a morbimortalidade resultante dos acidentes de trânsito nacionais / In Brazil, in 2014 it caused more than 44 thousand deaths. In Brazil is already described in the literature the use of psychoactive substances by truck drivers to maintain their extensive work schedule and stay awake for several hours. Important highways cross through Sao Paulo to other regions from Brazil and to countries from Latin America. This study aims to demonstrate the prevalence of illicit drug use by truck drivers on the State of Sao Paulo through toxicological analyses on oral fluid. Truck drivers were randomly stopped by police officers on federal roads during morning hours. Oral fluid samples were collected using the Quantisal(TM) device. In addition, a questionnaire concerning sociodemographic characteristics and health information was administered. Oral fluid samples were screened for amphetamine, cocaine, and tetrahydrocannabinol (?9-THC) by ELISA. The samples were confirmed by GC-MS, using validated methods for the substances of interest. During the development of this study we had the opportunity to send the positive samples to the Norwegian Institute of Public Health for confirmation using UPLC-MS/MS. Besides cocaine, amphetamine and delta9-THC the samples were tested for others 29 samples, including illicit drugs and psychoactive medicines. 762 drivers agreed to participate. Of the total samples 5.2% (n = 40) tested positive for drugs. Cocaine was the most found drug (n = 16), followed by amphetamine (n = 11) and delta9-THC (n = 4). Furthermore, three samples tested positive for cocaine and delta9-THC and one sample for cocaine and amphetamine. The confirmation using UPLC-MS/MS pointed another two substances that were not tested previously, meprobamate and alprazolam (two samples tested positive for amphetamine and meprobamate, one for amphetamine and alprazolam and another one for cocaine and meprobamate). Drivers presenting positive samples were younger, with less education, less experienced, had a longer work schedule and drove longer distances. This fact shows that, undoubtedly, there is need for more national studies regarding the use of psychoactive substances, illicit and medicines, for a better understand by the scientific community and those responsible for implementation of public policies aiming the control of the use of these substances, in order to, one day, we were able to indeed reduce traffic accidents mortality in our country

The thesis studies linking rural youth in the production of Cannabis sativa in the region of dry border of Paraguay and Brazil. In the 1980s, criminal organizations started to explore the production of the drug, taking advantage of the advantages agro-climatic regional actions and the lack of effective control. The region has become a major producer of drugs and began to incorporate rural youth in illicit activities. The objective of the research is to understand the reasons why rural youth link up the activities of production, processing and transportation of cannabis, highlighting the conditions and risks of illicit work. The research follows a qualitative approach and the survey was conducted at the Department of Amambay in the municipalities of Pedro Juan Caballero and Capitán Bado. The main technique of data collection was semi-structured interviews, conducted for ten young rural sixteen key informants and two-parent families. The interviews were complemented with free observation, the literature search and survey documents. Linking young people in the production of cannabis is associated with lack of profitable alternative licit agricultural production and qualification of young people working for other occupations that offer opportunities to build personal autonomy and a promising future. The lack of public policies for rural youth is exploited by criminal organizations to incorporate youth in impoverished rural production, processing and transportation of drugs. It is concluded that alternatives to the problem of rural youth involvement in the production of cannabis pass through the institutionalization of the reform, juvenile credit policy, education and vocational training for young people and for the legalization of cannabis growing. / A tese estuda a vinculação de jovens rurais na produção da Cannabis sativa na região de fronteira seca do Paraguai com o Brasil. Na década de 80, organizações criminais passaram a explorar a produção dessa droga, aproveitando-se das vantagens agroclimatológicas regionais e da falta de ações eficazes de controle. A região tornou-se importante produtora da droga e passou a incorporar jovens rurais nas atividades ilícitas. O objetivo da pesquisa é compreender as razões que levam os jovens rurais a se vincularem nas atividades de produção, processamento e transporte da cannabis, destacando as condições e os riscos do trabalho ilícito. A pesquisa segue uma abordagem qualitativa, e o levantamento dos dados foi realizado no Departamento de Amambay, nos municípios de Pedro Juan Caballero e Capitán Bado. A principal técnica de coleta de dados foi a entrevista semiestruturada, dirigida para dez jovens rurais, 16 informantes-chave e dois pais de família. As entrevistas foram complementadas com a observação livre, a pesquisa bibliográfica e o levantamento documental. A vinculação dos jovens na produção de cannabis está associada à falta de alternativa rentável na produção agrícola lícita e de qualificação dos jovens para outras ocupações laborais, que ofereçam possibilidades de construir a autonomia pessoal e um futuro promissor. A carência de políticas públicas para a juventude rural é aproveitada pelas organizações criminais para incorporar jovens rurais empobrecidos na produção, processamento e transporte da droga. Conclui-se que as alternativas para o problema do envolvimento de jovens rurais na produção de cannabis passam pela institucionalização de programas de reforma agrária, de políticas de crédito juvenil, de educação e qualificação profissional dos jovens e pela legalização do cultivo da cannabis.

Aims: To investigate the gender differences in the patterns of cannabis use (CU), namely frequency, times of day, social context and methods and in their association with DSM-IV cannabis dependence. Methods: A sample of 3,904 students from German universities was recruited via an internet survey. Logistic regressions and associated areas under the ROC curve (AUC) were calculated among current cannabis users (at least once a month, n = 843). Results: CU using a water pipe was more often reported by males (50 vs. 34.6%). Usual CU ‘before going to sleep at night’ was more often reported by females (47.3 vs. 35.7%). Most CU patterns showed a similar association with DSM-IV cannabis dependence in both genders. The association of CU ‘with strangers’ was stronger in females (AUC 0.68 vs. AUC 0.56). Slightly different multiple models were found (females AUC 0.86, males AUC 0.77). Conclusions: There are considerable gender differences in the CU patterns and, thus, in the way CU functions. In the association of CU patterns with cannabis dependence, the similarities are rather great. Examining the CU patterns might make a considerable contribution to the better detection of high-risk population segments for prevention and early intervention in both genders. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.