Tag: The Guardian

Mixing cannabis with tobacco increases dependence risk, suggests study

Selected coverage: The Guardian, Culture Magazine, Daily Mail

People who mix tobacco with cannabis are less motivated to seek help to quit

Tobacco and cannabis are two of the world’s most popular drugs, used respectively by 1 billion and 182 million people worldwide (World Health Organization; United Nations Office on Drugs and Crime). The adverse health effects of tobacco are well known. Short-term effects of cannabis are transient impairments in motor function and working memory, planning, and decision-making, while possible long-term health effects of heavy cannabis use include physical and psychological dependence, permanent reductions in cognitive performance, cardiovascular and respiratory diseases, and some cancers (WHO).

Many users mix cannabis with tobacco, not only to save money but also because tobacco can increase the efficiency of cannabis inhalation. But such mixing can increase the risk of dependence, suggests a new study in Frontiers in Psychiatry.

“Cannabis dependence and tobacco dependence manifest in similar ways, so it is often difficult to separate these out in people who use both drugs,” says lead author Chandni Hindocha, a doctoral student at the Clinical Psychopharmacology Unit of University College London. “Cannabis is less addictive than tobacco, but we show here that mixing tobacco with cannabis lowers the motivation to quit using these drugs.”

Together with collaborators from University College London, the University of Queensland, King’s College London, and the South London and the Maudsley NHS Trust, Hindocha analyzed responses from 33,687 cannabis users who participated in the 2014 Global Drug Survey, an anonymous online survey of drug use, conducted each year in partnership with international media such as Die Zeit, The Guardian, Libération, and the Huffington Post. Participants came from a total of 18 countries in Europe, North and South America, and Australasia. The new study is the first to survey the popularity of different methods of cannabis consumption – so-called routes of administration – around the world.

Routes of administration vary widely between countries, show Hindocha and colleagues. For example, tobacco routes for cannabis – for example in joints, blunts, or pipes — are much more popular in Europe than elsewhere. Depending on the country, between 77.2% and 90.9% of European cannabis users use tobacco routes, while only 51.6% of Australian and 20.7% of New Zealand cannabis users do. Tobacco routes are least popular in the Americas, used by only 16% of Canadian, 4.4% of US, 6.9% of Mexican, and 7.4% of Brazilian cannabis users. In contrast, the use of cannabis vaporizers, a strictly non-tobacco route, is quite common in Canada (13.2% of cannabis users) and the United States (11.2%), but rare everywhere else (0.2 to 5.8%).

Importantly, preferences for routes of administration strongly affected the motivation to quit and to seek professional help for doing so. In particular, cannabis users who favor non-tobacco routes had 61.5% higher odds of wanting professional help to use less cannabis, and 80.6% higher odds of wanting help to use less tobacco, than users who prefer tobacco routes. Similarly, cannabis users who prefer non-tobacco routes had 10.7% higher odds of wanting to use less tobacco, and 103.9% higher odds of actively planning to seek help to use less tobacco.

These results suggest that people who regularly mix tobacco with cannabis are more at risk of psychological dependence than people who use cannabis and tobacco separately, without mixing them.

“Our results highlight the importance of routes of administration when considering the health effects of cannabis and show that the co-administration of tobacco and cannabis is associated with decreased motivation to cease tobacco use, and to seek help for ceasing the use of tobacco and cannabis,” says Michael T. Lynskey, Professor of Addictions in the National Addictions Centre of the Institute of Psychiatry, Psychology & Neuroscience at King’s College London. “Given a changing legislative environment surrounding access to cannabis in many jurisdictions, increased research focus should be given to reducing the use of routes of administration that involve the co-administration of tobacco.”

Other results include:

  • Worldwide, the most popular tobacco route of administration for cannabis is the joint, preferred by 93.4% of users of tobacco routes.
  • Pipes are the most popular non-tobacco route, preferred by 11.7% of users of non-tobacco routes.
  • Non-inhaled routes, such as bucket bongs, hot knifes, or in food or drink, were uncommon in every country surveyed (2.4% of cannabis users worldwide).
  • Men are more likely (68.2% of surveyed male cannabis users) than women (63.8% of surveyed female cannabis users) to use tobacco routes.
  • Users of tobacco routes tend to be younger (mean 26.2 years) than users of non-tobacco routes (mean 30.8 years).
  • 16.3% of respondents had never tried smoking tobacco independently of cannabis.

EurekAlert! PR: http://www.eurekalert.org/pub_releases/2016-07/f-mcw070116.php

Study: http://journal.frontiersin.org/article/10.3389/fpsyt.2016.00104/full

 

Energy drinks may pose danger to public health

Selected coverage: The Guardian, TIME, BMJ, The Times, Yahoo!, Reuters, NHS Choices, Daily Telegraph

The heavy consumption of energy drinks risks becoming a significant public health problem, especially among young people, warns a team of researchers from the World Health Organization.

Increased consumption of energy drinks may pose danger to public health, especially among young people, warns a team of researchers from the World Health Organization Regional Office for Europe in the open-access journal Frontiers in Public Health.

Energy drinks are non-alcoholic beverages that contain caffeine, vitamins, and other ingredients for example, taurine, ginseng, and guarana. They are typically marketed as boosting energy and increasing physical and mental performance.

João Breda, from the WHO Regional Office for Europe, and colleagues reviewed the literature on the health risks, consequences and policies related to energy drink consumption.

“From a review of the literature, it would appear that concerns in the scientific community and among the public regarding the potential adverse health effects of the increased consumption of energy drinks are broadly valid,” write the authors.

Energy drinks first hit European markets in 1987 and the industry has since boomed worldwide. In the US, sales increased by around 10% per year between 2008 and 2012, and almost 500 new brands hit the market in 2006. The European Food Safety Authority estimates that 30% of adults, 68% of adolescents, and 18% of children below 10 years consume energy drinks.

High Caffeine in Energy Drinks

Part of the risks of energy drinks are due to their high levels of caffeine. Energy drinks can be drunk quickly, unlike hot coffee, and as a result they are more likely to cause caffeine intoxication. In Europe, a European Food Safety Authority (EFSA) study found that the estimated contribution of energy drinks to total caffeine exposure was 43% in children, 13% in teenagers and 8% in adults.

Studies included in the review suggest that caffeine intoxication can lead to heart palpitations, hypertension, nausea and vomiting, convulsions, psychosis, and in rare cases, death. In the USA, Sweden, and Australia, several cases have been reported where people have died of heart failure or were hospitalized with seizures, from excess consumption of energy drinks.

Research has shown that adolescents who often take energy drinks are also more likely to engage in risky behaviours such as sensation seeking, substance abuse, and binge drinking.

Mixing Energy Drinks and Alcohol

Over 70% of young adults (aged 18 to 29 years) who drink energy drinks mix them with alcohol, according to an EFSA study. Numerous studies have shown that this practice is more risky than drinking alcohol only, possibly because these drinks make it harder for people to notice when they are getting drunk.

According to the National Poison Data System in the United States, between 2010 and 2011, 4854 calls to poison information centers were made about energy drinks. Almost 40% involved alcohol mixed with energy drinks. A similar study in Australia demonstrated a growth in the number of calls about energy drinks. Breda and colleagues say a similar investigation would be useful in Europe.

Energy drinks can be sold in all EU countries, but some countries have introduced regulations, including setting rules for sales to children. Hungary introduced a public health tax that includes energy drinks in 2012. In Sweden, sales of some types of energy drinks are restricted to pharmacies and sales to children are banned.

Way Forward

“As energy drink sales are rarely regulated by age, unlike alcohol and tobacco, and there is a proven potential negative effect on children, there is the potential for a significant public health problem in the future,” the authors conclude.

They make the following suggestions to minimize the potential for harm from energy drinks:

  • Establishing an upper limit for the amount of caffeine allowed in a single serving of any drink in line with available scientific evidence;
  • Regulations to enforce restriction of labelling and sales of energy drinks to children and adolescents;
  • Enforcing standards for responsible marketing to young people by the energy drink industry;
  • Training health care practitioners to be aware of the risks and symptoms of energy drinks consumption;
  • Patients with a history of diet problems and substance abuse, both alone and combined with alcohol, should be screened for the heavy consumption of energy drinks;
  • Educating the public about the risks of mixing alcohol with energy drinks consumption;
  • Further research on the potential adverse effects of energy drinks, particularly on young people.

EurekAlert! PR: http://www.eurekalert.org/pub_releases/2014-10/f-edm100914.php

Study: http://journal.frontiersin.org/article/10.3389/fpubh.2014.00134/full