Saturday 10 March 2007

Combining cannabis and tobacco - NRT can help quitters

Drug agencies report that the majority of cannabis in the England is smoked and combined with tobacco i.e. in a ‘joint’, although exact figures are hard to come by, and there is very little research in this area.

Research tends to focus on America and the USA experience where tobacco is not used.

Evidence of the link between smoking cigarettes and ill health has been documented for more than 50 years. Wynder and Graham's (1950) study of 650 men with lung cancer found that 95% had been smoking for 25 years or more. In 1951, Sir Richard Doll and Sir Austin Bradford Hill's study examined 5,000 patients in British Hospitals, of which 1,357 men with lung cancer, 99.5% were smokers.

Global research since that time irrefutably states the considerable negative impact of smoking cigarettes on health and life expectancy, with one in two smokers dying from the affects of smoking, and overall 106,000 people dying last year alone in the UK.

There is no completely safe tobacco and around 80% of the health risks come from inhaling the smoke. Bronchitis, chronic pulmonary disease, carbon monoxide and lung cancer all come from inhaling the smoke, while also reducing the amount of vitamins in your body (ASH,2006). Also, from a deprivation perspective, if two parents smoke cigarettes and cannabis, it is likely they will be spending in excess of £3,500 a year on cigarettes (if purchased legally), plus up to £1,500 a year on cannabis. This raises fundamental child poverty issues in cases where a family is existing on benefits or other low income.

Smoking cannabis ‘joints’ should really be seen as the same as smoking a large cigarette, in that it is harmful to health. In some ways the public perception of this issue is the same as in the early days of smoking, in that the health impacts were not taken seriously by either health professionals or the public, and took many years to filter down into society's consciousness.


The negative effects of smoking cannabis on mental health and memory has been well documented, while it is interesting to note that the effects of the tobacco in ‘joints’ has been almost entirely ignored, it is therefore time to combine what we know of the affects of each drug in combination. There is a lot of evidence linking mild and mild-to-moderate cannabis use with schizophrenia, loss of short-term memory, anxiety and depression.

While the general population is aware of the health impact of smoking, it appears that certain sections of the community view the use of cannabis as benign and its use is seen as acceptable and normalised amongst certain sections of the population. This perception should be challenged, not least because of the development of new, hybrid forms of cannabis (e.g. super-skunk’) which contain much higher THC content than traditionally encountered in the 1970s, 1980s and early 1990s.

Those who use cannabis in this form and want to quit have access to behavioural support through specialist services; although support is sketchy and many do not know it is available.
These clients have had no recourse to medical interventions like Nicotine Replacement Therapy (NRT), as in cigarette use, with ‘cold turkey’ or reduction technique being the only options.

Nicotine Addiction and Cannabis Use

The physically addictive part of a cigarette is nicotine, which is more addictive than either heroin or crack cocaine. However it is relatively harmless, the dangerous parts of a cigarette are tar, carbon monoxide, plus the 4000+ chemicals, some of which are carcinogenic.

The majority of cannabis users are addicted to often very high levels of nicotine without probably being aware, as one large cannabis joint is equal to approximately 5 to 12 cigarettes, but this is difficult to measure exactly as all are individually rolled. There is also strong psychological addiction associated with cannabis use. Simply put, you get 5- 12 times the amount of nicotine, tar, carbon monoxide and the 4000+ additional chemicals.


Furthermore cannabis is smoked differently from cigarettes, usually with no effective filter and cannabis burns at a higher temperature than cigarettes, damaging the delicate structure of the lungs, and joints are generally inhaled more deeply and held in the lungs for far longer than a cigarette.

Cigarettes are notoriously difficult to give up with only a 2- 3% success rate for those quitting without support, mostly due to the nicotine withdrawal symptoms. Using NRT (or Zyban) on prescription as an aid to quitting plus behavioural support, is nearly five times more successful than going it alone in the long term.

Many quit attempts fail where the user smokes both cigarettes and cannabis. The user often stops smoking cigarettes, but cannabis consumption goes up to compensate for the nicotine carvings. Often, the smoker doesn’t understand that the nicotine addiction is being maintained whilst combining nicotine with cannabis. Thus, the physical withdrawal symptoms never go away, and are often further exacerbated.

Withdrawal symptoms from cannabis smoked and combined with tobacco has similar challenges to that of cigarettes, while in some cases the withdrawal symptoms can be more extreme than that of giving up smoking cigarettes, using NRT can help relieve some of the unpleasant withdrawal symptoms and it provides an opportunity to break the link between cannabis and nicotine.

The use of NRT is sometimes recommended for withdrawal symptoms by FRANK, the UK national drugs helpline, while the majority of front line drug agencies and public are unaware that it could be helpful.

A minority of cannabis users may be aware of the benefits of NRT but are reluctant to seek out support from their GP or local Stop Smoking Services, while the majority of Smoking Cessation staff don't have the experience or confidence in working with this client group and probably would require additional training.


Usage of Cannabis

Figures from the ‘The Home Office, Drug Misuse Declared: Findings from the 2004/2005 Crime Survey’, state that for that year, 29.7% of 16-59 year olds reported using cannabis, and 23% of 16- 24 year olds. Overall drug misuse generally was higher amongst men (IPCP: LAA People Project: Key findings to date, October 2006). Other research has made a link between cigarette and cannabis use potentially leading to the use of other stronger substances, i.e. the gateway effect.


Cannabis and the law

Cannabis is illegal; it's a Class C drug. If you’re caught with cannabis the police will always take action.

Possession Information in this section from FRANK: www.talktofrank.com

If you’re caught with even a small amount of cannabis on you, you can be arrested. What the police will do depends on the circumstances and how old you are. Usually, you’ll get a warning and the police will confiscate the drug and if you’re under 18, your parent or guardian will also be contacted.

The police are more likely to arrest you if: you are blatantly smoking in public and/or have been caught with cannabis before. If you continue to break the law, you can end up with a criminal record which could affect your chances of getting a job. It could also affect whether you can go on holiday to some countries.

The maximum penalty for possession is two years in prison plus an unlimited fine.

Supply

Dealing is a serious offence. In the eyes of the law, this includes giving drugs to friends. People who grow cannabis in their homes or carry large amounts on them also risk being charged with intent to supply.

The maximum penalty for supply is 14 years in prison plus an unlimited fine.

Did you know?

Drug driving is as illegal as drink driving. You could go to prison, get a heavy fine or be disqualified.

Allowing people to take cannabis in your house or any other premises is illegal. If the police catch someone smoking cannabis in a club they can prosecute the landlord, club owner or person holding the party.

Using cannabis to relieve pain is also an offence. Possession is illegal whatever you’re using it for.

To speak to a friendly advisor, call FRANK on 0800 77 66 00
Article by George Gallagher (Islington PCT Smoking Cessation Advisor) and Martin Lever (Public Health Consultant).

Water or shisha pipe smoking: The health effects

Is smoking a water pipe harmful to my health?
by Neda Hormozi, Hammersmith & Fulham Primary Care Trust's Stop Smoking Coordinator

Using a waterpipe (otherwise known asshisha; hookah pipe) to smoke tobacco poses a serious potential health hazard to smokers and others exposed to the smoke emitted. Smoke that comes from a waterpipe contains numerous toxins known to cause diseases including lung cancer, heart disease, respiratory disease and problems during pregnancy [i].

Smoking a waterpipe verses smoking a cigarette.

Smoking any substance, in any form, including:

  • manufactured cigarettes
  • hand-rolled cigarettes
  • pipes and cigars
  • herbs
  • waterpipes (otherwise known as shisha; hookah) is harmful to your health.

A waterpipe smoking session may expose the smoker to more smoke over a longer period of time than occurs when smoking a cigarette. Typically, waterpipe smoking sessions last 20 – 80 minutes, during which time the smoker may take 50 – 200 puffs. The waterpipe smoker may therefore inhale as much smoke during one session as a cigarette smoker would inhale consuming 100 or more cigarettes [ii]. Chronic respiratory problems including symptoms of bronchitis were reported at a younger age among shisha smokers than among cigarette smokers.

Smoking a water-pipe as a social activity

Water-pipe smoking is often social and two or more people may share the same water-pipe. Additional dangers not associated with cigarettes arise from infectious disease including tuberculosis and hepatitis, with pipe-sharing [iii].

For further information on how to quit smoking tobacco, cigarettes or shisha pipes, please contact your local Stop Smoking Service on 0800 169 0169 or visit http://www.gosmokefree.co.uk/

Advice in Arabic is available from: http://www.gosmokefree.co.uk/downloads/Arabic.pdf

Quotations

“Most people misleadingly believe shisha does not contain tobacco and that when they smoke they inhale herbal products … It is the added flavours that make them feel they are smoking herbs, while they are actually taking in tobacco … Smoking from a shisha pipe is far more dangerous than cigarette smoking because the amount of nicotine can not be measured due to packing differences’ (The Khaleej Times, Arab Emirates, 4th June 2006).

'The risks to people who smoke shisha appear to be as great, if not more pronounced, than from smoking cigarettes' (Respiratory, July 2006) .

Refs
[i] World Health Organisation (2005) Waterpipe Tobacco Smoke: Health Effects, research needs and recommended actions by regulators.

[ii] Knishkowy et al (2005) Waterpipe Smoking: An Emerging Health Risk Behaviour PEDIATRICS Vol. 116 No. 1 July 2005, pp. e113-e119

[iii] Knishkowy et al (2005) Waterpipe Smoking: An Emerging Health Risk Behaviour PEDIATRICS Vol. 116 No. 1 July 2005, pp. e113-e119

Friday 9 March 2007

Lovely legislation - England goes smokefree on July 1st

Lovely Legislation

From July 1st 2007, smoking in enclosed public places will be prohibited. This represents one of the most important post-war public health acts and follows the lead taken by Ireland and Scotland.

Why ban smoking in public places?

Smoking is now the principal avoidable cause of preventable illness and premature deaths in the UK. Smoking kills over 120,000 people in the UK a year - more than 13 people an hour. The UK Government has set new targets for health improvement. One of the targets is to reduce cancer deaths. Another is to reduce heart disease deaths. Cancer and heart disease are the two most common fatal diseases in this country. Smoking is a major cause of cancer and heart disease.

Most non-smokers are not exposed to levels of second-hand smoke sufficient for them to incur significant extra risk, many thousands are, such as those living with smokers or working in particularly smoky atmospheres for long periods of time. Several hundred people a year in the UK are estimated to die from lung cancer brought about by inhaling second-hand smoke. Second-hand smoke almost certainly also contributes to deaths from heart disease - an even bigger killer than lung cancer.

Exposure to second-hand smoke can cause illness. Asthma sufferers are more prone to attacks in smoky atmospheres. Children, more vulnerable than adults and often with little choice over their exposure to tobacco smoke, are at particular risk.

Children whose parents smoke are much more likely to develop lung illness and other conditions such as asthma than children of non-smoking parents. The Royal College of Physicians has estimated that as many as 17,000 hospital admissions in a single year of children under 5 are due to their parents smoking. They also estimate that up to 25% of cot deaths might be caused by mothers smoking. Women who smoke while pregnant are likely to reduce the birthweight, and damage the health, of their baby.

What is second-hand smoke? downloaded from: www.smokefreeengland.co.uk

Secondhand smoke is simply other people’s tobacco smoke and is also known as passive smoke or ‘environmental’ tobacco smoke. Secondhand smoke consists of side stream smoke from the burning tip of the cigarette, and mainstream smoke exhaled by the smoker. Side stream smoke typically makes up nearly 85% of the smoke in a smoky environment. This type of smoke contains a much higher concentration of toxins, such as hydrogen cyanide, ammonia, carbon monoxide and acrolein, than mainstream smoke. Secondhand smoke contains a cocktail of over 4,000 different chemicals, many of which are toxic and harmful including more than 50 known carcinogens such as benzo(a)pyrene, chromium, vinyl chloride, and benzene.

The invisible killer

Evidence shows that ventilation cannot control exposure to secondhand smoke:

• We know that 85% of secondhand smoke is invisible and odourless
• Secondhand smoke is made up of gases and microscopic particles
• Research has shown that to remove the risks of secondhand smoke, an enclosed premises would need wind tunnel-like rates of ventilation.
• Ventilation can actually distribute secondhand smoke throughout buildings

Dramatic reduction in exposure to secondhand smoke

• Irish hospitality workers experienced significant reductions in the levels of both levels of airborne pollutants and levels of carbon monoxide concentrations (70% decrease) during the first 6 weeks after the introduction of a smokefree policy in Ireland
• Levels of carbon monoxide decreased by 45% in non-smoking Irish bar workers one year after the legislation was introduced
• Before smokefree legislation was in place, 68% of Irish workers reported having over 21 hours of secondhand smoke exposure per week. This changed to 70% of workers reporting no exposure to secondhand smoke at work
• In a survey of 104 hospitality workers in New York, subjects reported an 89% decrease in exposure to secondhand smoke at work as a result of the Clean Indoor Air Act; this was confirmed by cotinine tests of the workers. Cotinine is an indicator of exposure to tobacco smoke
• A report issued on the third anniversary of New York’s smokefree law showed that New Yorkers' exposure to secondhand smoke had declined by 50% overall

Measurable improvement to workers’ health

• A Dundee University study showed bar workers’ lung function increased by as much as 10% just two months after smokefree legislation was introduced. Those showing secondhand smoke-related symptoms fell from 80% to fewer than half
• The Journal of the American Medical Association documented a significant improvement documented in respiratory health among bartenders after the passage of the Californian smokefree workplace legislation

Marked decrease in air pollution

• A Global Study of Irish Pubs found the level of air pollution inside Irish pubs in smokefree cities was 93% lower than the level in pubs in cities where smoking is permitted
• A Global Air Monitoring Study of 1,212 indoor workplaces in 24 different countries found that the level of indoor pollution was 89% lower in places that were smokefree compared to those where smoking was observed

Smoking and inequalities

Smoking more than any other identifiable factor contributes to the gap in healthy life expectancy between those most in need, and those most advantaged. While overall smoking rates have fallen over the decades, for the least advantaged they have barely fallen at all. In 1996, 12 per cent of men in professional jobs smoked, compared with 40 per cent of men in unskilled manual jobs.

Such differences are reflected in the impact of smoking on health. A higher rate of smoking among people in manual jobs is matched by much higher rates of disease such as cancer and heart disease. Between 1991 and 1993, among men aged 20 to 64 in professional work, 17 in every 100,000 died of lung cancer, compared with 82 per 100,000 in unskilled manual work. For the same period and age group, among professional workers, 81 per 100,000 died from coronary heart disease compared with 235 per 100,000 in unskilled manual jobs.

The close link between smoking and health inequalities was highlighted again in the Acheson Report, an independent inquiry into health inequalities chaired by Sir Donald Acheson. The report concluded that the relatively stable rate of smoking in the least advantaged groups suggests that simply intensifying current approaches would not be sufficient to tackle the problem.

In addition to these emerging challenges, there are longstanding problems that need fresh approaches. We also need to focus specifically on tackling inequalities in health. Although on average we are living healthier and longer lives, health and life expectancy are not shared equally across the population. Despite overall improvements, there remain big – and in some communities increasing – differences in health between those at the top and bottom ends of the social scale. Some parts of the country have the same mortality rates now as the national average in the 1950s (Choosing Health).

I’m a smoker, what should I do?

The best way to protect your family and others from secondhand smoke is to give up smoking. For anyone considering stopping there is plenty of help and support available. Call the free NHS Smoking Helpline on 0800 169 0 169 for practical advice, including a free information pack on how to stop smoking and the different options available.

To find about the local NHS Stop Smoking Service nearest you, phone the NHS Smoking Helpline free on 0800 169 0 169 or in the following ways:

• Web: http://www.gosmokefree.co.uk/

• Mobile: text ‘GIVE UP’ and your full postcode to 88088
• In person: ask at your local GP practice, pharmacy or hospital