{"id":139,"date":"2023-01-22T13:36:49","date_gmt":"2023-01-22T18:36:49","guid":{"rendered":"https:\/\/pressbooks.bccampus.ca\/rebootyourresiliencywithselfcare\/?post_type=chapter&p=139"},"modified":"2023-11-01T18:56:39","modified_gmt":"2023-11-01T22:56:39","slug":"nicotine","status":"web-only","type":"chapter","link":"https:\/\/pressbooks.bccampus.ca\/rebootyourresiliencywithselfcare\/chapter\/nicotine\/","title":{"raw":"Drugs","rendered":"Drugs"},"content":{"raw":"Nicotine<\/strong>\r\n\r\nWe all know that smoking is bad for us, especially wreaking havoc on our respiratory system. Even so, 2017 statistics reveal that 15% of Canadians smoke an average of 13.9 cigarettes per day.[footnote]Canadian Centre On Substance Use and Addiction. (2023). Opioids. Retrieved from: https:\/\/www.ccsa.ca\/opioids[\/footnote]\r\n\r\nNicotine is directly related to lung disease<\/span>, cancer<\/span>, mouth\/gum disease<\/span> and heart issues<\/span>.[footnote]Lore, M. 4 Major Health Risks Linked to E-Cigarette Use. Retrieved from: https:\/\/www.webmd.com\/connect-to-care\/vaping\/vaping-ecigarette-health-risks-lung-heart[\/footnote] In addition to the carcinogenic chemicals present in cigarettes, recent research has found that it harms our immune system as well. Nicotine has been found to have immunosuppressive<\/span> effects on the body, for example, suppressing or decreasing neutrophils phagocytic activity.[footnote]Yamaguchi N. H. (2019). Smoking, immunity, and DNA damage. Translational lung cancer research, 8(Suppl 1), S3\u2013S6. Retrieved from: https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC6546629\/[\/footnote] Nicotine also produces a decrease in inflammation, a decreased antibody response, and a decrease in T-cell functioning.[footnote]Nouri-Shirazi, M., & Guinet, E. (2003). Evidence for the immunosuppressive role of nicotine on human dendritic cell functions. Immunology, 109(3), 365\u2013373. Retrieved from: https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1782971\/[\/footnote] Chemical compounds in cigarette smoke also lowers the amount of protective antioxidants in our blood, increasing our risk of oxidative damage via free radicals throughout the body.[footnote]Foronjy, R., & D'Armiento, J. (2006). The Effect of Cigarette Smoke-derived Oxidants on the Inflammatory Response of the Lung. Clinical and applied immunology reviews, 6(1), 53\u201372. Retrieved from: https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3755630\/[\/footnote]\u00a0 Not only do free radicals accelerate aging, they also damage or mutate cells, activate harmful genes within our DNA, and overload our immune system.[footnote]Dizdaroglu, M., & Jaruga, P. (2012). Mechanisms of free radical-induced damage to DNA. Free radical research, 46(4), 382\u2013419. Retrieved from: https:\/\/www.tandfonline.com\/doi\/abs\/10.3109\/10715762.2011.653969?journalCode=ifra20[\/footnote]\r\n\r\nElectronic Cigarettes<\/strong> (e-cigarettes) or vaping deserves special mention as many people think these are a safe alterative to smoking cigarettes and have no idea of their potential health risks. In 2017, past 30-day use of e-cigarettes was reported by 3% of Canadians over 15 years old and increases to 6% of young adults (age 20-24).[footnote]Health Canada. (2018). Canadian Tobacco Alcohol and Drugs Survey (CTADS): 2017 supplementary tables. Ottawa: Author. Retrieved from: https:\/\/www.canada.ca\/en\/health-canada\/services\/canadian-alcohol-drugs-survey\/2017-summary.html[\/footnote] A large proportion (64%) of e-cigarette users admit that their e-cigarette contains nicotine.[footnote]Health Canada. (2018). Canadian Tobacco Alcohol and Drugs Survey (CTADS): 2017 supplementary tables. Ottawa: Author. Retrieved from: https:\/\/www.canada.ca\/en\/health-canada\/services\/canadian-alcohol-drugs-survey\/2017-summary.html[\/footnote]\r\n\r\nAs vaping is a fairly recent phenomenon, many long-term health effects have yet to be determined. However, research has shown evidence of some health risks thus far. Of course, those that use nicotine in their e-cigarettes have the previously mentioned ramifications of nicotine. Additional issues related to vape oils are the numerous chemicals they contain that are directly harmful to the lungs. A new term has been applied by the CDC - EVALI<\/strong> - which stands for \u2018E-cigarette, or Vaping, product use-Associated Lung Injury<\/strong>\u2019. One of the ingredients used in some e-cigarettes, vitamin E acetate, is a honey-like substance that has been shown to stick to the lungs, causing injury, resulting in numerous hospitalizations and many deaths. [footnote]Center for Disease Control. (2020), Outbreak of Lung Injury Associated with the Use of E-Cigarette, or Vaping, Products. Retrieved from: https:\/\/www.cdc.gov\/tobacco\/basic_information\/e-cigarettes\/severe-lung-disease.html[\/footnote]\r\n\r\nCannabis<\/strong>\r\n\r\nIn October of 2018, Canada became the second country in the world to legalize cannabis (marijuana) use for non-medical purposes.[footnote]Statistics Canada. (2020). What has changed since cannabis was legalized? Retrieved from: https:\/\/www150.statcan.gc.ca\/n1\/pub\/82-003-x\/2020002\/article\/00002-eng.htm[\/footnote] Cannabis use includes using cannabis in its dry form or when mixed or processed into another product, such as an edible or a concentrate.\r\n\r\nResults from a 2021 Canadian Cannabis survey showed that people between the ages of 20-24 years of age reported nearly double the cannabis use (49%) versus those 25 years and older (22%).[footnote]Government of Canada (2021). Canadian Cannabis Survey 2021: Summary. Retrieved from: https:\/\/www.canada.ca\/en\/health-canada\/services\/drugs-medication\/cannabis\/research-data\/canadian-cannabis-survey-2021-summary.html[\/footnote] Overall, 25% of Canadians reported using cannabis within the last 12 months, an increase from 2017's pre-legalization statistics of 15%.[footnote]Government of Canada (2021). Canadian Cannabis Survey 2021: Summary. Retrieved from: https:\/\/www.canada.ca\/en\/health-canada\/services\/drugs-medication\/cannabis\/research-data\/canadian-cannabis-survey-2021-summary.html[\/footnote]\r\n\r\nCanadians were asked in the survey if they knew about the harms related to cannabis. A large majority indicated that they were aware that cannabis smoke can be harmful, daily use increases risk of mental health issues, and that teenagers are at greater risk of harm from using cannabis than adults.[footnote]Government of Canada (2021). Canadian Cannabis Survey 2021: Summary. Retrieved from: https:\/\/www.canada.ca\/en\/health-canada\/services\/drugs-medication\/cannabis\/research-data\/canadian-cannabis-survey-2021-summary.html[\/footnote] The following table shows the percentages:\r\n\r\n \r\n\r\n[caption id=\"attachment_141\" align=\"aligncenter\" width=\"1024\"]\"\"<\/a> Figure 22.1 Knowledge or Beliefs Regarding Cannabis-associated Harms 2021[\/caption]\r\n\r\nWhy do people use cannabis? While the historical portrayal of cannabis users has been likened to unmotivated \u201cstoners\u201d, much research of late has shown a very different story. People across the world have used cannabis for thousands of years for many different reasons, but generally for social, spiritual and medical purposes.\r\n\r\n14% of Canadians aged 16 and older indicate that they use cannabis for medical purposes, with 22% of these having a health care professionals document or prescription. [footnote]Government of Canada (2021). Canadian Cannabis Survey 2021: Summary. Retrieved from: https:\/\/www.canada.ca\/en\/health-canada\/services\/drugs-medication\/cannabis\/research-data\/canadian-cannabis-survey-2021-summary.html[\/footnote] 52% of the people surveyed stated that they were able to decrease their use of other pharmaceutical medications due to using cannabis.[footnote]Government of Canada (2021). Canadian Cannabis Survey 2021: Summary. Retrieved from: https:\/\/www.canada.ca\/en\/health-canada\/services\/drugs-medication\/cannabis\/research-data\/canadian-cannabis-survey-2021-summary.html[\/footnote]\r\n\r\nThe Canadian Cannabis survey did not specify what medical conditions people used cannabis for. However, in 2018, researchers studied self-reported cannabis use for medical purposes across both the USA and Canada via online surveys.\r\n\r\nThe researchers found that amongst those who had self-reported using cannabis for medical purposes<\/strong>, the most frequently reported physical reasons<\/strong> were to \"manage pain<\/strong> (53%), problems sleeping<\/strong> (46%), headaches or migraines<\/strong> (35%), lack of appetite<\/strong> (22%), and nausea or vomiting<\/strong> (21%)\". [footnote]Leung, J., Chan, G., Stjepanovi\u0107, D. et al. (2022).Prevalence and self-reported reasons of cannabis use for medical purposes in USA and Canada. Psychopharmacology 239, 1509\u20131519. Retrieved from: https:\/\/link.springer.com\/article\/10.1007\/s00213-021-06047-8[\/footnote] For those that reported mental health reasons<\/strong>, the most common uses were \"anxiety<\/strong> (52%), depression<\/strong> (40%), post-traumatic stress disorder<\/strong> (PTSD), or trauma<\/strong> (17%)\".[footnote]Leung, J., Chan, G., Stjepanovi\u0107, D. et al. (2022).Prevalence and self-reported reasons of cannabis use for medical purposes in USA and Canada. Psychopharmacology 239, 1509\u20131519. Retrieved from: https:\/\/link.springer.com\/article\/10.1007\/s00213-021-06047-8[\/footnote] Physical and mental issues were also interrelated, such as depression and anxiety was often associated with problems sleeping. The following table depicts the breakdown of data :\r\n\r\n \r\n\r\n[caption id=\"attachment_142\" align=\"aligncenter\" width=\"1024\"]\"\"<\/a> Figure 22.2 Physical or Mental Health Reasons for Cannabis Use[\/caption]\r\n\r\nWhile many individuals believe that cannabis use is not habit forming, it\u2019s not as benign as many people think. Teens who begin using cannabis before the age of 18 are four to seven times more likely to develop a marijuana use disorder.[footnote]Winters, K. C., & Lee, C. Y. (2008). Likelihood of developing an alcohol and cannabis use disorder during youth: association with recent use and age. Drug and alcohol dependence, 92(1-3), 239\u2013247. Retrieved from: https:\/\/www.sciencedirect.com\/science\/article\/abs\/pii\/S0376871607002979?via=ihub[\/footnote] Marijuana use disorder is often associated with dependence<\/strong>, where a person experiences withdrawal symptoms such as mood and sleep issues, cravings and other forms of discomfort when not taking the drug. We know the brain has its own endocannabinoid neurotransmitters, and when it adapts to large amounts of the drug over time, it can experience tolerance<\/strong> by reducing production and sensitivity to these receptors.[footnote]Gorelick, D. A., Levin, K. H., Copersino, M. L., Heishman, S. J., Liu, F., Boggs, D. L., & Kelly, D. L. (2012). Diagnostic criteria for cannabis withdrawal syndrome. Drug and alcohol dependence, 123(1-3), 141\u2013147. Retrieved from: https:\/\/pubmed.ncbi.nlm.nih.gov\/22153944\/[\/footnote] [footnote]Rotter, A., Bayerlein, K., Hansbauer, M., Weiland, J., Sperling, W., Kornhuber, J., & Biermann, T. (2013). CB1 and CB2 receptor expression and promoter methylation in patients with cannabis dependence. European addiction research, 19(1), 13\u201320. Retrieved from: https:\/\/pubmed.ncbi.nlm.nih.gov\/22948261\/[\/footnote] Marijuana use disorder can take the form of\u00a0addiction<\/strong>\u00a0in severe cases, where being unable to stop using interferes in many aspects of the persons life.\r\n\r\nOpioid Crisis<\/strong>\r\n\r\nCanadian statistics show increasingly elevated numbers of opioid-related overdose and deaths<\/strong> since surveillance began in 2016, with an exacerbation since the pandemic began.[footnote]Government of Canada. (2022). Opioid and Stimulant-related Harms in Canada. Retrieved from: https:\/\/health-infobase.canada.ca\/substance-related-harms\/opioids-stimulants\/[\/footnote] \u00a0Opioids are a class of psychoactive drugs that are often used for pain management, including fentanyl, morphine, heroin, and oxycodone.[footnote]Centers for Disease Control and Prevention. (2022). Opioid Basics. National Center for Injury Prevention and Control. Retrieved from: https:\/\/www.cdc.gov\/opioids\/basics\/index.html[\/footnote] Many individuals can use opioids for pain relief for short periods of time without concern.\u00a0 However, illegal use of these drugs has led to significant harm across Canada in recent years, including deaths due to overdose.\r\n\r\nIn the first half of 2022 (January to July), 20 opioid deaths per day<\/em> were recorded in Canada<\/span>, compared to 8 in 2016, and the majority of these deaths occurred in British Columbia (BC), Alberta and Ontario.[footnote]Government of Canada. (2022). Opioid and Stimulant-related Harms in Canada. Retrieved from: https:\/\/health-infobase.canada.ca\/substance-related-harms\/opioids-stimulants\/[\/footnote] \u00a0In October 2022 in BC alone, there were an average of 6 deaths per day from opioid use<\/span>.[footnote]British Columbia Coroners Service. (2022). Illicit Drug Toxicity Deaths in BC. Retrieved from: https:\/\/www2.gov.bc.ca\/assets\/gov\/birth-adoption-death-marriage-and-divorce\/deaths\/coroners-service\/statistical\/illicit-drug.pdf[\/footnote] Statistics on the polysubstance nature of this crisis reveal that 47% of deaths across Canada in the same time period (January to July 2022), also involved a stimulant such as cocaine and methamphetamines.[footnote]Government of Canada. (2022). Opioid and Stimulant-related Harms in Canada. Retrieved from: https:\/\/health-infobase.canada.ca\/substance-related-harms\/opioids-stimulants\/\u00a0[\/footnote]\r\n\r\nThe Canadian Centre on Substance Use and Addiction states that the opioid crisis is a consequence of numerous complex factors that include:\r\n
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