Dirección Xeral de Saúde Pública Galicia

Tabacco and cannabis

Abstract: Abstract The inhalation route is the only current way of consuming both substances jointly, involving risks and damages inherent to the alveolar route and the high-speed of absorption of this route. Nicotine is the psychoactive compound present in the tobacco plant, responsible for creating addiction. Tetrahydrocannabinol is the cannabinoid compound with the greatest psychoactive capacity and the one that contributes most to the addictiveness of cannabis. Both nicotine and tetrahydrocannabinol produce complex pharmacological effects on the central nervous system, cardiovascular system, respiratory system, etc. Tobacco addiction is possibly the most common unwanted effect affecting cannabis users.

Keywords: tobacco and cannabis; addiction

INTRODUCTION

The use of psychoactive substances among the young has become one of the problems that most concerns parents and educators today. The youth in developed countries are exposed to contact with addictive substances from a very early age, and it is not uncommon among young individuals to consume several drugs (polysubstance use), even simultaneously.

A clear example of these types of consumption is the association of tobacco and cannabis, commonly referred to as “joints”.

Animal tests are currently being conducted to study different aspects of these associated drug consumptions: interrelated additive effects, the compensatory effects of withdrawal symptoms, etc. However, these are still only hypotheses that still need to be confirmed.

EPIDEMIOLOGICAL EVIDENCE

Data from the 2016 ESTUDES report show that 82.3% of students between the ages of 14-18 who smoke cannabis do so in combination with tobacco.

The majority of the adolescent population that uses cannabis derivatives have experimented with tobacco before (for six months on average). Only in a very small percentage, cannabis use is previous to or independent from tobacco.

The percentage of consumers between the ages of 15 and 17 years old is more than twice the percentage of consumers over 35 (12.6% vs. 5.5%), with a mean consumption of 3.2 joints per day.

Many of those who smoke joints do not “recognise” the associated use of tobacco, and therefore are not aware of the risk and consequences of consuming it. (Ministerio de Sanidad Consumo y Bienestar Social, 2018)

BIOLOGICAL EFFECTS

The simultaneous use of tobacco and cannabis might produce complementary, antagonistic, or synergistic effects. For example, the relaxation of the central nervous system (CNS) produced by cannabis may be compensating for the activation of the CNS produced by tobacco.

The possibility of developing addiction might also be increased by the interaction of both consumptions, with the occurrence of tobacco addiction being more frequent in cannabis users.

It is very difficult to pinpoint the organic damage produced by each of the substances in simultaneous consumptions.

In these tobacco+cannabis users, health professionals must make a simultaneous or sequential intervention to achieve cessation. There is scientific evidence of improved cessation outcomes when withdrawal is simultaneous.

ADRESSING BOTH SUBSTANCES DURING CONSULTATION

The terms used during consultations when referring to the consumption of these substances must be dealt with special care. Talking about habits, vices, responsible consumption, social consumption, or excessive consumption may lead to confusion or generate a low or null perception of the risk associated with the consumption of these drugs.

As confirmed by scientific evidence, it is always necessary to bear in mind that we are talking about the consumption of drugs that cause addiction and pose serious health risks.

The following recommendations are valid for both substances, whether consumed individually or combined, and may help to establish a suitable atmosphere for intervention:

1) Do not sound alarming by using threatening or catastrophic messages.
2) Listen actively, showing interest in what you are being told and without being dismissive of the child’s or teenager’s concerns.
3) Answer the questions or doubts expressed by the minor. It is not only about what the health professional thinks the child should know, but also about what arouses the child’s curiosity.
4) Give a clear, simple, understandable, and unmistakable messages about the NON-existence of a safe use of tobacco and/or cannabis.
5) Reinforce the views of “non-use of psychoactive substances”.
6) Use brief motivational interviews for conducting opportunistic interventions with young individuals.

Acknowledgements

RINSAD

Journal of Childhood and Health (RINSAD), ISSN-L: 2695-2785, is a the collaboration between administrations Portugal, Galicia, Castilla y León, Extremadura and Andalusia within the project Interreg Spain-Portugal RISCAR ‚ and aims to disseminate scientific articles related to child health, contributing to researchers and professionals in the field a scientific basis where to know the advances in their respective fields.

The RISCAR project is co-financed by the European Regional Development Fund (ERDF) through the Interreg Program V-A Spain-Portugal (POCTEP) 2014-2020, with a total budget of € 649,699.

Journal Interreg Spain - Portugal RISCAR with the Universidad de Cádiz ‚ and the Departamento Enfermería y Fisioterapia de la Universidad de Cádiz .

License Creative Commons Atributtion-NonCommercial-ShareAlike 4.0 Internacional.

References

Ministerio de Sanidad Consumo y Bienestar Social, 2018Sanidad Consumo y Bienestar Social, Ministerio de, Portal plan nacional sobre drogas - encuestas y estudios, http://www.pnsd.mscbs.gob.es/profesionales/sistemasInformacion/sistemaInformacion/encuestas_ESTUDES.htm.
Burkhart et al, 2018Gregor , Burkhart, Manuel, Isorna, Carmen, Barreriro, & Varela, . (2018). Consumo de cannabis entre adolescentes: patrón de riesgo, implicaciones y posibles variables explicativas. Adicciones , Adicciones, 31 (1), http://adicciones.es/index.php/adicciones/article/view/1212.
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