Day 1 :
Health Advocates PLLC, USA
Keynote: Health Policy for Marijuana
Time : 10:00-11:00
Norman S Miller has received his training in Psychiatry at Johns Hopkins Hospital and in Neurology at the University of Minnesota. He is a Board-Certified Psychiatrist, Neurologist, Addiction Psychiatrist, Forensic Psychiatrist and Licensed Attorney. He has practiced General Psychiatry and Addiction Psychiatry at Michigan State University, University of Illinois at Chicago and New York Hospital-Cornell University Medical College. He is the Author and Editor of 250 journal articles and book chapters and 13 books.
Marijuana is a substance that has been used for recreational and addictive purposes since ancient years and is currently purported to have a therapeutic or medical value and claimed to a medicine, popularly known as medical marijuana. In the United States, marijuana is not an approved medication by the Federal Drug Administration (FDA), though currently legally available in its natural smoked and edible plant form in some states, sold as medical marijuana. According to the FDA, marijuana is classified as a Schedule I drug with high risk of addiction and dangerousness with no legitimate medical purpose. However, contrary to US federal law, marijuana is declared legal without a medical approval process in several states ostensibly for deliberating conditions e.g. various pain conditions, depression, anxiety, nail patella, glaucoma and even HIV. However, medical marijuana is also available and used more commonly for various other purposes, particularly, addictive use, even though studies have shown greater harmful effects then beneficial. Especially with marijuana, there is a high rate of misperception in the users that risks for adverse consequences are low and benefits high. In addition, marijuana has a unique pharmacology and pharmacodynamics because of its more than 400 partially unknown components and marijuana is redistributed and stored in the user’s lipophilic tissues and available for release back into the blood stream long after the last use, for persistent effects. While marijuana is legally available in some states and other states are pressured to follow suit, the United States House of Representatives has proposed legislation to legalize marijuana as a beverage, similar to alcohol and the United State Senate had proposed legislation to legalize marijuana as medication, reclassifying marijuana to a Schedule II drug. Marijuana appears here to stay in the US in some form and entrepreneurs line up to profit billions from its anticipated sales and widespread distribution. This article is a systematic review of literature analyzing the current policies, medical facts, legal status and commercial trends as well as politics regarding marijuana and its manufacture, sales and distribution. What is often lost in discussions regarding marijuana is like alcohol, 80% of marijuana is consumed by 20% of the users. And that the current forms of marijuana, licit and illicit are far more potent and contain higher levels of Tetrahydrocannabinol (THC) than marijuana available in the past. The article is focused on the natural form of Tetrahydrocannabinol (THC) derived from the Cannabis sativa plant and not the less sought and the actual medical cannabinoids, both natural and synthetic forms, available for medical use. The aim to provide education, facts and discussions which will lead to safe and healthy public policy for marijuana in whatever form it takes in the future.
- Addiction Medicine | Psychiatry & Mental Health | Alcoholism and Drug Addiction | Addiction induced Brain Disorders | Depression & Anxiety Disorders and Behavioral & Multimedia Addiction
Location: Scandic Jarvenpaa, Finland
South London and Maudsley NHS Foundation Trust, UK
West London Mental Health Trust, UK
West London Mental Health Trust, UK
Title: Substance abuse, addictions and offending in England: A perspective from a forensic psychiatrist
Time : 11:00-11:30
Ian Treasaden is currently the Honorary Consultant Forensic Psychiatrist at West London Mental Health Trust and Visiting Senior Lecturer at Bucks New University England. He has worked as a Consultant Forensic Psychiatrist at the 3 Bridges Medium Secure Unit in London for mentally disordered offenders where he was also a Clinical Director and Honorary Senior Lecturer at Imperial College London.
Dependence on alcohol or drugs alone is not grounds for detention under the Mental Health Act 2007 of England and Wales. Substance misuse or addiction are associated with offending due to: An altered mental state due to intoxication, withdrawal or an organic mental disorder and finance substance misuse and offences under misuse of drugs legislation. Alcohol abuse is present in upto one half of individuals who commit offences of violence. Alcohol dependence syndrome is associated with an eight times higher rate of convictions. About half of those with drug dependence syndrome have convictions before they become dependent. In general, individuals are considered criminally responsible if they voluntarily took drugs and alcohol, exceptions being if they were involuntarily intoxicated or if they were voluntarily intoxicated to a degree that they lacked specific intent (mens rea) or substance misuse has induced a mental illness. In the case of homicides, 7-10% of offenders may be alcohol dependent and 6-8% drug dependent. The association between schizophrenia and violence may be increased by substance misuse by 3-4 times. Offender behavioral programs in prison and community in England include offender substance abuse programs and programs for individual substance misusers (PRISM). There is also a Drug Treatment and Testing Order (DTTO) available as a community court sentence. Other addictions that may lead to offending include pathological gambling, nonparaphilic sexual addiction and Problematic Internet Use (PIU).
South London and Maudsley NHS Foundation Trust, UK
Title: A study of the use and misuse of gabapentinoids in prison, including their co-prescription with opioids
Time : 11:30-12:00
Anju Soni is a Specialist Trainee Registrar in Forensic Psychiatry based at South London and Maudsley trust and Broadmoor High Secure Hospital. She is an Honorary Clinical Senior Lecturer in the Faculty of Medicine, Imperial College London. She is qualified in medicine from Government Medical College, Patiala (Punjab), India in December 1999. She has completed training (CCT) in General Adult Psychiatry with special experience in Psychiatric Rehabilitation in June 2012 on the Charing Cross General Psychiatric Training scheme in London where she worked as a Consultant in General Adult Psychiatry and Forensic Psychiatry. Author of papers on General Psychiatry including the pharmacological management of aggressive challenging behavior, provision and practice of Art therapy for people with schizophrenia, the dangers of using testosterone and other steroid supplements in athletes and muscle builders and in psychiatric services improvement projects including using management tools such as the Appreciative Enquiry approach a. Her current research interests include substance misuse in prison and learning from those in alcohol recovery.
Introduction & Aim: The aim of this study was to establish the prevalence of the prescription of gabapentinoids in a category B men’s prison in London. In addition, the prevalence of co-prescription of gabapentinoids with opioids was also assessed in light of the increased risk of respiratory depression resulting in death when these drugs are used in combination. In the light of this study it was hoped to establish the standards for the prescription for gabapentinoids in prison. Gabapentinoids, especially Pregabalin, appear in practice to be increasingly used recreationally in prison. Compared to Gabapentin, Pregabalin has a higher potency, is more quickly absorbed and has greater bio availability making it more likely to be abused. The issue of dependence on Pregabalin and Gabapentin in prisons is under-recognized and leads to misuse, diversion of prescriptions and bullying in prisons. Perhaps reflecting the lack of awareness of the risks of misuse of and dependence on gabapentinoids, this study highlighted that it is often unclear from prison medical records when, where and why gabapentinoids were being prescribed.
Method: A retrospective, case-file based survey was undertaken in a category B prison for males (Capacity 1500 prisoners; Average turnover of prisoners up to 6000 per year), including to establish practice standards related to the prescription of gabapentinoids in the prison and determine the compliance with these.
Results: 109 cases were identified of prisoners having been prescribed gabapentinoids. Pregabalin was prescribed in 66 cases (61%) and Gabapentin in 43 (39%). In 72 cases (66%) the indication for the use of gabapentinoids was documented. In 30 of the cases (27%), gabapentinoids were prescribed for the licensed indication for neuropathic pain, but for a further 36 cases (33%) prescriptions were for unlicensed (off-label) indications, mainly for non-neuropathic pain. In 51 cases (47%), gabapentinoids were prescribed with Opioid substitutes such as methadone or buprenorphine and in 19 cases (17%) with antidepressants. In 38 of these cases (75%), there was no documentation in the records of the risks of such co prescribing nor had that such risks been discussed with the prisoners. In 13 cases (12%), there was documented evidence of prescribed gabapentinoids being concealed, or being diverted to the other prisoners.
Conclusion: For those prescribed gabapentinoids in prison, the indications for such use especially if off label should be reviewed, their use minimized and where relevant and available compared to NICE guidelines. Less harmful alternative drugs are often available. Initiation of gabapentinoids in prison should be avoided unless recommended by a specialist.
For patients who are also receiving Opioid substitutes or are abusing opiates, consideration should be given as to whether it is safe to continue on gabapentinoids, given the risks of misuse and death. Issues raised by the study are likely to apply to other prisons and secure forensic psychiatric facilities.
Fire Mountain Residential Treatment Center, US
Title: Dragons, warriors and the mythical saga: Archetypal psychology and why it works with teens in recovery?
Time : 12:30-13:30
After ten years directing children’s camps, Teen Rites of Passage events, and empowerment programs around the world, Aaron Huey found there were numerous cries for serious help from parents of struggling teens. Aaron realized the need to turn his efforts towards teens suffering from drugs, alcohol, and the behaviors and issues related to their addiction. So, in 2009, he opened Fire Mountain Residential Treatment Center to work with kids and families on a deeper level. An addict in recovery since 1998, he knows full well the results of at-risk behaviors as well as recovery and made it his mission to create real change. Since then his treatment center and workshops have helped thousands of families through school talks, free parenting webinars, and through his podcast “Beyond Risk and Back”, Colorado’s #1 Parenting Podcast.
This talk will explore the different archetypes, use them as a personality identification tool, teach participants how to recognize them in people and know what their natural strengths and common challenges are. It will give valuable insights to everyone and should be considered essential education for parents, teachers, therapists, mentors, and anyone working to understand or help a diverse population of people, because recognizing someone's core archetype is a key to understanding their unique needs and challenges, and helping them grow. This talk also gives special insight into which clinical intervention is most efficient and effective for each of the Four Prime Archetype personalities. Do you know how the oldest story of trauma and recovery was told? The pathway to recovery is hidden within the Archetypes of the world’s most popular myth! Are you a Warrior? A Wizard? Maybe you are a Bard...or a Jester! This fun and intriguing talk gets the audience pointing fingers at each other, thinking about their clients in a more meaningful way, and even shows us how to predict human behaviors!
Faculdade de Medicina de Lisboa, Portugal
Title: Digital addiction and the challenges of studying the effects of technology on human behavior: The experience at NUPI- A problematic internet use clinic
Time : 14:30-15:00
Carolina Sereijo has completed her Master degree from Faculty of de Medicine University of Lisbon. She is currently pursuing her Internship of Psychiatry at Psychiatry and Mental Health Unit at CHLN, EPE Santa Maria Hospital in Lisbon.
Despite the recent recognition of gaming disorder as a diagnosis by The World Health Organization, there is still no scientific consensus on what the phenomenon of digital addiction is what its boundaries are and, if like gambling, it belongs on the spectrum of behavioral addiction disorders. Given the current immersion of our daily lives in technology, especially for digital natives, it becomes increasingly difficult to define the boundaries of what is pathological and what is the new normal. Researchers thus often prefer the term problematic internet use instead of digital addiction. We share our experience with patients with problematic internet use at NUPI (Núcleo de Utilização Problemática de Internet), based in Lisbon, Portugal.
Pomeranian Medical University, Poland
Title: Genetic determinants of psychoactive substances addiction research on the endophenotype associated with a lack of the reward system in the drug: Addicted population
Time : 15:00-15:30
Anna Grzywacz is a Biologist at the Institute of Human Genetics, University of Hamburg. She has completed her Degree of Laboratory Diagnostician and PhD in Medical Biology and after completion of her Post-doctoral degree she worked as a Professor at the Pomeranian University of Szczecin.
Chemical compounds, which are potentially addictive, are distinguished by their capacity to stimulate dopamine release, e.g. in the nucleus accumbens and via other neural pathways. Additionally, a combination of unfavorable external factors, including stress and failure, with hereditarily weakened dopaminergic conductivity in the reward system results in a heightened sensitivity to the occurrence of addictions. We define impulsivity as 'acting under pressure', which follows the definition provided by Baratt in 1990. Impulsivity is more and more often recognized as a psychological trait and feasible endophenotype. In the search for endophenotypes of addiction to psychostimulants, which can be related to impulsivity, it was observed that not only does it result from the very contact with a substance, but it is a factor which increases the risk of this substance abuse. Impulsivity is highly heritable. It is not always that the addicted take a particular substance because it gives them pleasure, but they do it because they are under pressure created by a strong motivation originating from sensitization. A repetitive intake of a substance results in consolidated neuroadaptive changes which can trigger craving for drugs in response to the conditional stimuli from the environment. The consolidated receptor changes in the dopaminergic system on which sensitization is based can contribute to the increased risk of recurrence.
1. Identifying the phenotype related to the dopamine transmission deficiency in the OUN which predisposes to addiction to psychoactive substances.
2. Indicating the necessity for extending screening diagnostics for a predisposition to addiction with psychobiological parameters (impulsivity, attention deficit, hyperactivity).
Scientific benefits: 1. Our research would make it possible to extend knowledge on biological reasons for susceptibility to the occurrence of disorders related to narcotic substances abuse and addiction to them. 2. Our research corresponds with the research tendencies in the modern neuropsychiatry in which endophenotypes recognized as markers of susceptibility to the occurrence of a particular mental disorder in the context of susceptibility- stress model are incessantly searched for. 3. Identification of the marker of susceptibility to the occurrence of addiction in the dopaminergic system would provide reasons to extend diagnostics of the addicted people with disorders which relate to the weakened dopaminergic conductivity and therefore extend possibilities of preventive and the therapeutic measures.