Cannabis is currently the most commonly used illicit drug in the world and one of the earliest plants cultivated by humans. Early evidence of cannabis use in medicine has been found in China and India for religious and medicinal uses. Archaeological research shows early civilization cultivation of hemp in India to create a variety of products from ropes, textiles and paper. In countries, such as Nepal and China, cannabis seeds are still used today both as a pharmaceutical as well as a food enhancer.  As cannabis use increases and more states legalize use in the US, there are concerns surrounding the use of cannabis and its effects on job performance and safety. There are also concerns that the concentration of THC have increased over the past 50 years, thereby increasing the effects of the drug. The Controlled Substances Act of 1970 currently lists cannabis as a Schedule 1 drug, deeming it to be a substance with high risk of dependence, abuse and no (supervised) medical uses. The CATO institute estimates that legalizing drugs would save $41 billion per year along with $46.7 billion in revenue, if taxed at the same rates as alcohol and tobacco. For those companies that have received federal grants and have federal contracts over $100,000, they follow The Drug Free Workplace Act of 1988, a comprehensive policy, which includes drug prevention methods, information about employee assistance programs and disciplinary consequences of drug use in the workplace Federal agencies are required to use the Substance Abuse and Mental health Services Administration (SAMHSA) procedures for testing and recommend private employers use the same criteria for consistency  The policy requires employees to report any criminal drug violations in the workplace to the employer within 5 calendar days which may subsequently result in discipline including termination, regardless of state law  Colorado Court of Appeals in Beinor v Industrial Claim Appeals Agreed with the employer and held that unemployment insurance benefits could be withheld due to the violation of the employer’s zero tolerance drug policy. Worker was a sweeper using cannabis legally outside of working hours  Colorado State statue “disqualifies an individual from receiving unemployment benefits after the presence of a controlled substance was not medically prescribed was found in the worker’s system during worker hours.” Cannabis has unique pharmacokinetics and metabolism which makes it a challenge to drug test for acute impairment vs recent use. THC is deposited in fat and can be detectable in urine for up to a month or more. However, it is not always an indicator of acute impairment. Further there are privacy concerns, from invasive blood testing for compounds, under the 4th Amendment of the US constitution. Variability in study designs, ethical dilemma of safety and productivity, work type and drug metabolism in users. When smoked, blood levels of THC immediately rise and are distributed primarily in the lungs and brain. • THC is metabolized to the transient psychoactive substance THC-OH, which is finally converted to THC-COOH, the physiologically inactive metabolite  The immediate euphoria and subsequent impairment from THC-OH, as suggested by older studies may last about 6 hours, with some limited studies showing impairment lasting as long as 24 to 48 hours Specific studies that assess driving and impairment show a return to "...nonimpaired state within 3-6 hours  “ Quickly sequestered into fat tissues therefore decreasing blood concentration Ingesting cannabis has much longer magnified effect of the drug The method of testing cannabis in urine can be misleading, due to the potential for interpreting a positive result for THC-COOH, as an indicator of acute impairment. Lack of concentration, impaired learning and memory, alterations in thought formation, expression and sedation. Physiological signs include tachycardia, dilated pupils with injected conjunctiva, dry mouth and increased appetite Studies have also confirmed that impairment is related on a dose response relationship. Challenges for healthcare providers FSMB (Federal State Medical Boards) after reviewing over 50 major studies in the field, have offered these 10 recommendations  1)Thoroughly document patient’s visit prior to considering cannabis use for those with good compliance Inadequacy of response to other treatment, comprehensive history and physical  2) Don’t treat close friends or family  3) Inform risks and benefits  4) Compliance Contract, concerns of diversion  5) Regular Visits  6) No relationships with dispensaries or cannabis companies  A large study in France of over 10,000 crashes, concluded an odds ratio of 2.18 for THC level less than 1 ng/ml up to 4.72 for THC 5 ng/ml for being involved in a crash  Some researchers such as Donzé N, Ménétrey have considered categorizing impairment as the sum of THC, THC-OH and THC-COOH, which would be more accurate for assessing impairment since it would include the active metabolite; however, more research is needed along with better point of care detection  Some Norwegian studies have suggested that individuals with levels of 2-5 ng/mL experienced “moderate established impairment” and levels of THC above 5 -10 ng/ml was likely to be severe impairment. The consensus from a meta-analysis study shows that serum levels of an average of 3.8 (ranging from 3.1 to 4.5) for oral cannabis and an average of 3.8 (ranging from 3.3 to 4.5) for smoker cannabis cause a similar impairment to a BAC of around 0.05g/dL, i.e. a 5 ng/mL cutoff would resemble the level of impairment allowed for alcohol under federal testing laws  However, since the presence of metabolites does not automatically indicate impairment, an immediate physical exam by a physician is advised to correlate findings clinically to diagnose impairment Category:Cannabis and health Category:Occupational safety an
Cannabis is currently the most commonly used illicit drug in the world and one of the earliest plants cultivated by humans. Early evidence of cannabis use in medicine has been found in China and India for religious and medicinal uses. Archaeological research shows early civilization cultivation of hemp in India to create a variety of products from ropes, textiles and paper. In countries, such as Nepal and China, cannabis seeds are still used today both as a pharmaceutical as well as a food enhancer. Lack of concentration, impaired learning and memory, alterations in thought formation, expression and sedation have been associated with cannabis use. Physiological signs include tachycardia, dilated pupils with injected conjunctiva, dry mouth and increased appetite Studies have also confirmed that impairment is related on a dose response relationship. As cannabis use increases and more states legalize use in the US, there are concerns surrounding the use of cannabis and its effects on job performance and safety. There are also concerns that the concentration of THC have increased over the past 50 years, thereby increasing the effects of the drug. The Controlled Substances Act of 1970 currently lists cannabis as a Schedule 1 drug, deeming it to be a substance with high risk of dependence, abuse and no (supervised) medical uses. The CATO institute estimates that legalizing drugs would save $41 billion per year along with $46.7 billion in revenue, if taxed at the same rates as alcohol and tobacco. For those companies that have received federal grants and have federal contracts over $100,000, they follow The Drug Free Workplace Act of 1988, a comprehensive policy, which includes drug prevention methods, information about employee assistance programs and disciplinary consequences of drug use in the workplace Federal agencies are required to use the Substance Abuse and Mental health Services Administration (SAMHSA) procedures for testing and recommend private employers use the same criteria for consistency . The policy requires employees to report any criminal drug violations in the workplace to the employer within 5 calendar days which may subsequently result in discipline including termination, regardless of state law . Colorado Court of Appeals in Beinor v Industrial Claim Appeals agreed with the employer and held that unemployment insurance benefits could be withheld due to the violation of the employer’s zero tolerance drug policy. Worker was a sweeper using cannabis legally outside of working hours . Colorado State statue “disqualifies an individual from receiving unemployment benefits after the presence of a controlled substance was not medically prescribed was found in the worker’s system during worker hours.” Cannabis has unique pharmacokinetics and metabolism which makes it a challenge to drug test for acute impairment vs recent use. THC is deposited in fat and can be detectable in urine for up to a month or more. However, it is not always an indicator of acute impairment. Further there are privacy concerns, from invasive blood testing for compounds, under the 4th Amendment of the US constitution. Variability in study designs, ethical dilemma of safety and productivity, work type and drug metabolism in users. When smoked, blood levels of THC immediately rise and are distributed primarily in the lungs and brain. THC is metabolized to the transient psychoactive substance THC-OH, which is finally converted to THC-COOH, the physiologically inactive metabolite . The immediate euphoria and subsequent impairment from THC-OH, as suggested by older studies may last about 6 hours, with some limited studies showing impairment lasting as long as 24 to 48 hours Specific studies that assess driving and impairment show a return to "...nonimpaired state within 3-6 hours . “ The method of testing cannabis in urine can be misleading, due to the potential for interpreting a positive result for THC-COOH, as an indicator of acute impairment. Challenges for healthcare providers FSMB (Federal State Medical Boards) after reviewing over 50 major studies in the field, have offered these 10 recommendations : 1)Thoroughly document patient’s visit prior to considering cannabis use for those with good compliance . Information on the inadequacy of response to other treatment, comprehensive history and physical condition should be included. 2) Don’t treat close friends or family . 3) Inform risks and benefits . 4) Compliance Contract, concerns of diversion . 5) Regular Visits are recommended. 6) No relationships with dispensaries or cannabis companies . A large study in France of over 10,000 crashes, concluded an odds ratio of 2.18 for THC level less than 1 ng/ml up to 4.72 for THC 5 ng/ml for being involved in a crash . Some researchers such as Donzé N, Ménétrey have considered categorizing impairment as the sum of THC, THC-OH and THC-COOH, which would be more accurate for assessing impairment since it would include the active metabolite; however, more research is needed along with better point of care detection . Some Norwegian studies have suggested that individuals with levels of 2-5 ng/mL experienced “moderate established impairment” and levels of THC above 5 -10 ng/ml was likely to be severe impairment. The consensus from a meta-analysis study shows that serum levels of an average of 3.8 (ranging from 3.1 to 4.5) for oral cannabis and an average of 3.8 (ranging from 3.3 to 4.5) for smoker cannabis cause a similar impairment to a BAC of around 0.05g/dL, i.e. a 5 ng/mL cutoff would resemble the level of impairment allowed for alcohol under federal testing laws . However, since the presence of metabolites does not automatically indicate impairment, an immediate physical exam by a physician is advised to correlate findings clinically to diagnose impairment Category:Cannabis and health Category:Occupational safety and health Category:Dru
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Lack of concentration, impaired learning and memory, alterations in thought formation, expression and sedation have been associated with cannabis use. Physiological signs include tachycardia, dilated pupils with injected conjunctiva, dry mouth and increased appetite Studies have also confirmed that impairment is related on a dose response relationship.
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Quickly sequestered into fat tissues therefore decreasing blood concentration
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Ingesting cannabis has much longer magnified effect of the drug
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Lack of concentration, impaired learning and memory, alterations in thought formation, expression and sedation. Physiological signs include tachycardia, dilated pupils with injected conjunctiva, dry mouth and increased appetite Studies have also confirmed that impairment is related on a dose response relationship.
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Inadequacy
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condition should be included.
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are recommended.
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and health Category:Dru