March 2008

Just the facts - no exaggerations, misrepresentations, elaborations, or fabrications

Marijuana is in the media frequently, whether      • Habitual cannabis use increased respiratory          held by the reader, on either side of the debate.
it be new studies, laws being debated, or            problems such as lung infections. Chronic            This then influences how they translate and pass
leaders answering (or avoiding!) questions           inflammation has been demonstrated beyond            on the information to others.
about their position and history of use. Many        question in cannabis smokers; this may present
people have an opinion, often quite                  as wheezing, cough, phlegm, or shortness of          Cannabis dependence
passionate, on the issues associated with            breath. The risk of respiratory cancer is higher     Cannabis dependence was once quite
this drug. In this article, we will outline some     in all smokers, including cannabis smoker, than      controversial, and was seen by some people as a
recent research findings.                            in non-users. Cancer risk increases with             myth put forth by those who oppose legalization.
                                                     frequency and duration of use.
About Marijuana                                    • Cannabis use was consistently associated with          Straight-Forward Facts on
Marijuana comes from the cannabis sativa             reduced educational attainment and problems in       Marijuana and the Canadian Law
plant; in this article, we use the terms             school, such as missed classes (both in high         Many people are confused about the current
interchangeably. Over the centuries, the             school and university). Other psychological and      status of Marijuana in Canada. Some of the
plant has been used as a medication, in              social consequences are not supported by             confusion is related to the Marijuana Reform Bill,
religious rites, for its fibres, and as a            strong research.                                     which would have decriminalized the use and
recreational drug. Cannabis alters the             • There is a relationship between marijuana use        possession of small amounts of marijuana for
functioning of the brain to provide sensations       and unplanned sexual behaviours and                  personal use. The bill was introduced several
that are experienced as pleasurable.                 unprotected sex.                                     times in the past years, but was never passed.
                                                   • Research suggests (but does not prove) that          Marijuana is currently not “legal” or
Health effects of Marijuana                                                                               “decriminalized” in Canada. It remains under the
Many people view marijuana use as                    heavy cannabis use increases the risk of
                                                     psychotic symptoms, though the link is complex       Controlled Drugs and Substances Act of 1996.
harmless. However, advances in our                                                                        The law states that it is illegal to possess, obtain,
understanding of the pharmacology and                and multifactoral.
                                                       Science has, to date, not examined the stress-     or traffick (distribute) cannabis. Depending upon
neurobiology of cannabis is swaying many                                                                  the amount of marijuana the individual is found
previously benign views of cannabis.               management effects of Marijuana. However, a
                                                   systematic stress-management approach                  with, and what charges the police lay, the person
Marijuana can cause both short and long-                                                                  may face large fines, time in prison, or both. What
term health problems. Some conclusions             includes both short-and-long-term strategies.
                                                   Short-term strategies address the symptoms of          happens to a person who is found with marijuana
that are supported by high-quality and well-                                                              depends a great deal upon circumstances, the
conducted research are:                            stress, for example elevated pulse and blood
                                                   pressure. They also help decrease the secretion        arresting officer as well as the assigned judge.
• Acute effects (this means when a person is
  directly under the influence of marijuana)       of “stress hormones” including cortisol and            Medical Marijuana
  include slowed reaction times and                adrenaline. Long-term stress-management                Health Canada grants access to marijuana for
  information processing, impaired                 strategies modify ways of thinking that contribute     medical use to people who are suffering from
  perceptual-motor coordination and motor          to stress, and build skills to address the source of   serious illnesses. People who are authorized by
  performance, impaired short-term memory,         the stress. Marijuana’s efficacy as a stress-          Health Canada to use marijuana for medical
  and other impairments.                           management tool would need to be evaluated by          purposes may receive it from Health Canada's
• Acute cannabis use increases heart rate          these criteria.                                        supply (and yes, it is taxed!), or they can apply for
                                                                                                          a production license to grow their own supply.
  and blood pressure. The heart has to work        Challenges in Marijuana Research                       Marijuana remains an illegal and controlled
  harder and demands more oxygen.                  Researchers acknowledge that it is difficult to        substance, like other controlled products. Unlawful
• Acute cannabis intoxication produced             account and address all confounding factors in         possession is a criminal offense.
  significant decrease in ability to react to      marijuana research (confounding factors are
  sudden emergencies during driving. (It is        things that could influence the outcome of a study                     In this issue
  sometimes argued that drivers under the          or be another explanation for a study’s findings).                             Anger
  influence of marijuana are aware that they       Furthermore, many studies on cannabis have
  are impaired and compensate for it by            significant limitations e.g. poor study designs or       MIcrowaved Stuffed Peppers and Yummy Tofu Soup
  slowing down. Whether this may be so             small sample sizes. Finally, the way research is                             Sun Safety
  does not change the fact that they require       interpreted is greatly influenced by the biases
  more time to respond.)                                                                                                 Sexual Communication
                                                       However, addiction and marijuana research has               concern about the behaviour.
  o f         t h e            m o n t h
                                                       increased our understanding of cannabis
                                                       dependence. Cannabis dependence is
                                                       acknowledged by many experts in the field of
                                                                                                                   There are a great many other issues under the
                                                       addiction throughout the world, as well as the              rubric of marijuana, such as: environmental and
These two recipes are favorites of the nurses at                                                                   social justice concerns created by illegal farms,
Health Services. Both are delicious and nutritious!    American Psychological Association and the
                                                       World Health Organization.                                  the ethical and societal ramifications of supporting
 Microwave Stuffed Peppers                                  The reality is that many people are seeking            drug cartels, the extremely complex debate of
1 lb. ground lean beef, pork, chicken, or meatless     treatment for cannabis dependence. Perhaps one              legalization, including benefits versus harms, and
ground like Textured Vegetable Protein or Yves         of the biggest signs that any behaviour or                  so much more. Realistically, Health Notes can
(available at many grocery stores)                     substance use is a problem is the fact that a               only introduce a few of the related issues.
1 medium onion, chopped                                                                                            However, we hope that this article will encourage
                                                       person is asking whether he or she has a
2 cans (8oz. each) tomato sauce                                                                                    you to consider the issues, discuss them with
                                                       problem. This suggests that either the person’s
¼ cup water                                                                                                        people you trust, and seek out more information
3 tbsp. Parmesan cheese
                                                       life has been disrupted in some way by the
                                                       substance or behaviour, or that a loved one,                from reliable resources as you develop your own
salt and pepper                                                                                                    understanding of marijuana.
½ cup uncooked instant rice or cooked brown rice       friend, or health professional has expressed
4 medium green peppers                                                    The Marijuana Self-Assessment Quiz
Combine ground beef and onions, and cook in
microwave on high for around 5 min. Stir in 1 can      The following quiz can provide you with insight into your marijuana use. It is based on the Marijuana Screening
                                                       Inventory (Alexander, 2004). For each question, answer “yes” or “no” ( the box for yes).
tomato sauce, water, 1 tbsp. cheese; salt and
pepper to taste. If making vegetarian, this is             1. Have you had difficulty remembering something while using marijuana, so that it bothered you or bothered a
where you add in your meatless ground. Cook for                close friend?
another 5 min., until sauce is a bit thickened. Stir       2. Have you ever had difficulty with either stopping or controlling your use of marijuana?
in rice and set aside.                                     3. Has using marijuana ever created problems between you and a close person, spouse, or a relative?
                                                           4. Has using marijuana ever interfered with any part of your work or occupation?
Cut peppers in half and remove seeds. Arrange
peppers, cut-side up, in a dish that fits in your          5. Do you ever feel bad about your marijuana use?
microwave. Cook on high for 5 min. or until                6. Have you ever been arrested, even for a few hours, while using marijuana? (Not for possession or dealing)
peppers are slightly tender. Spoon in ground/rice          7. Have you ever been arrested for drunk driving or the like, where alcohol or other drugs really were not
filling into each half.                                        involved, but where you yourself know that marijuana was?
                                                           8. Have you ever been arrested for possession of, or for dealing of, marijuana?
Top with 2nd can of sauce and 2 tbsp. cheese.
Cover (with lid or microwavable plastic wrap), and         9. Of the times you have sex, are you usually (more than half the time) using marijuana?
cook at high for 10-12 min., until peppers are             10. Has using marijuana ever interfered with any part of your education, learning, or doing your job?
tender. Let stand for around 5 min., while you’re          11. Have others pointed out to you how marijuana may be affecting you in negative ways?
throwing together a quick green salad. Yum!                12. Have you ever consulted a health or mental professional concerning problems or potential problems
                                                               associated with marijuana use?
Remember, all microwaves are different. The first
time you make this, check on it frequently until           13. If you do not smoke cigarettes, have you ever had a cough that lasted more than three months while
you figure out the correct cook times. You can                 smoking marijuana?
make this in 2 batches if your microwave is small.         14. Do you use marijuana every day, several days in a row?
                                                           15. Do you ever use marijuana before noon?
         Yummy Tofu Soup                                   16. Do you ever use marijuana all day long?
1 tsp. olive oil
6 cups chicken or vegetable stock (from a can,             17. Do you ever experience nervousness, headache, or irritability after stopping marijuana?
box, bouillon cube/powder, or home-made)                   18. When you have important things to talk about with someone, does using marijuana interfere, so that often the
2 carrots sliced thin                                          important things don’t get resolved?
4 green onions sliced thin                                 19. Have you ever lost a friend or girlfriend/boyfriend because of your marijuana use?
8 mushrooms sliced thin                                    20. Have you ever had difficulty getting your work done because of using marijuana?
One package baby or regular spinach, cleaned,              21. Do you often use marijuana secretly or lie to close friends or to your partner about your marijuana use?
thick stalks removed                                       22. Do you often find yourself needing to smoke more marijuana, or larger amounts than in the past, to get high?
1 tablespoon fresh ginger                                  23. Do you often feel that using marijuana keeps you from getting things done that you need to do?
1-1½ teaspoon lemongrass
                                                           24. Have you ever been to a self-help group meeting such as Narcotics Anonymous or Alcoholics Anonymous
¼ bunch fresh coriander minced
                                                               because you were concerned about your marijuana use?
(prepared, ready-to-use ginger, lemongrass and
                                                           25. Have you ever gotten into trouble at school or the job where using marijuana was part of the problem?
coriander can be bought at many grocery stores -
frozen or in a jar)                                        26. Have you ever had difficulty getting your schoolwork, home tasks, or job done because you were high from
1 tsp. soya sauce                                              marijuana?
1 450 gm. block of medium or firm tofu, diced              27. Do you ever wake up in the morning after using marijuana (and no other drugs) the night before and don’t
1oz. noodles broken up                                         feel rested?
                                                           28. Do you ever use marijuana to feel better when you are nervous or depressed?
Put 1 tsp. oil in a pot. Saute green onions over
                                                           29. Have you ever had an accident (in a vehicle or at home) while using marijuana?
medium for a few min. until soft. Add chicken
stock and bring to boil. Add ginger, lemongrass,           30. Have you ever had a negative experience or felt very anxious and paranoid while using marijuana?
coriander, and soya sauce. Let simmer over med-            31. Do you ever use marijuana to feel normal?
low. Taste and adjust seasoning to what you like.      If you answered “yes” to 3 or more of the above questions, you may have a problem with marijuana. If you would
Add carrots, mushrooms and noodles, and cook           like to discuss this, or any other issue with a health professional, come to Health Services. You will be treated with
until carrots are tender and noodles are cooked.       respect, consideration, dignity and empathy.
Add spinach and tofu,and simmer until spinach is       You can also speak with a trained counselor at the Ministère de la Santé et des Services Sociaux du Québec’s Help
wilted. Taste again, and adjust seasoning. Serve       and Referral Line: (514) 527-2626. This service is free, bilingual, confidential and anonymous, and is for people who
and enjoy.                                             have problems with drugs, or are concerned about a friend or loved one.
Everyone gets angry sometimes, and some
people get angry more often than others. In
                                                      These three means of expressing anger are
                                                      associated with poorer health outcomes.
                                                                                                            H E A LT H          b i t s
recent years we have been hearing a great deal        • Anger-discuss: anger is discussed with a
about uncontrolled anger; from stars throwing           supportive listener. This is the mode of anger     Talking through a conflict with a friend or loved one can
things at photographers, to road rage, to               expression that has a positive correlation with    be very helpful in resolving the issue and can even
aggressiveness at sports games from both                health.                                            strengthen the relationship, if it is done properly. Below
athletes and fans. While these episodes make                                                               are some Do’s & Don’ts of expressing anger.
headlines, many people can benefit from               Anger in men and women
                                                      Research has found that women report                 1. Describe the situation that makes you angry.
learning to effectively manage their anger. This
                                                      becoming angry as frequently, with the same          DO:
article provides a general introduction to anger.
                                                      intensity, and generally for the same reasons as     • Be very specific.
Why do we get angry?                                  men. However, men and women differed in two          • Say exactly what happened, where and how often.
Anger is an emotional state of displeasure; it        areas: women are more likely to express anger        DON'T:
can vary from mild irritation or annoyance to         with anger-symptoms and are also more likely         • Describe your emotional reaction to it yet.
intense fury or rage. The current understanding       to talk about their anger (anger-discuss).           • Use abstract or vague terms.
on the causes of anger suggests that how a                                                                 • Generalize.
person appraises a situation (their perception)       Dealing with anger                                   • Guess about the other person's intentions or motives.
will determine whether or not they experience         Because anger may lead to ill health or other        2. Say how you feel about the situation.
anger. Anger is commonly provoked if a person         consequences it is important to deal with it         DO:
perceives an event as unjust or believes that         before it gets too serious. The following are        • Speak calmly.
they are kept from reaching their goals. Anger        some ways that can help you manage anger in          • State your feelings in a positive way.
may also be linked to frustration, loss, threats to   a positive, effective way:                           • Say how you feel about the situation, not about the
well-being, or the sense of loss of control.          • Admit that you are angry. Bottling up your           person.
    Genetics and physiology may also play a             anger will not make it go away.                    DON'T:
role in how quickly a person becomes angry;           • Remember that when people are angry they           • Deny your feelings.
there is some evidence that low levels of               may not be able to think clearly and rationally.   • Unleash emotional outbursts.
serotonin can contribute to a person being more         Therefore, take time to “cool down” before         • Put the other person down.
easily provoked to anger. Finally, anger is also a      taking action or making decisions. This can be     3. Tell the other person exactly what you want
symptoms of certain psychiatric and                     achieved by removing yourself from the             him/her to do.
neurological disorders.                                 situation, exercising, talking things out with     DO:
                                                        someone, or by using relaxation techniques         • Request one or two changes at a time.
    Expressing anger is a way of communicating
                                                        such as deep breathing or visualization.           • Say exactly what behaviours you would like changed
and is not necessarily undesirable. However,
                                                      • Step back and examine the situation from             or continued.
anger can become a problem if it remains with a
                                                        another person’s perspective. You may see          • Ask for something the person can actually do.
person for a long time, or if the way it is
                                                        that the situation isn’t as bad as you thought.    DON'T:
expressed affects their enjoyment of life, their
                                                      • If your anger is a result of a situation you       • Merely imply that you'd like a change.
work, or their relationships. Anger could also
                                                        can’t change (such as a traffic jam),              • Ask for too many changes or too big of a change.
become a problem if it causes a person to do
                                                        acknowledge that there is little you can do.       • Ignore the other person's needs.
vengeful things or if it provokes them act
                                                        Using positive self talk, try to conjure up        4. Tell the other person why.
violently towards others or towards themself.
                                                        pleasant thoughts to get your mind off the         DO:
How does anger affect health?                           situation or use relaxation techniques.            • Say exactly how their change in behaviour will help or
The relationships between anger and health are        • Identify the source of your anger and ask            relieve distress for you.
complex, and are mediated, or linked, by a              yourself why this is making you angry.             • Say exactly how the change will be good for him/her.
variety of factors. However, research suggests          Understanding the reason anger can help you        • Say why you want the change.
that poorly controlled and ineffectively                focus your energy in the right direction as you    DON'T:
expressed anger is associated with increased            try to resolve the situation.                      • Threaten.
blood pressure, cardiovascular diseases, and          • If another person’s words are causing your         • Bully.
poor quality of life. Some experts also believe         anger, deal with them in a direct, non-            • Be ashamed to explain how important this is to you.
that experiencing anger ineffectively can               threatening way. Take time to listen to what
weaken the immune system. Most importantly,             the other has to say.                              Sun safety is important all year round, not just in the
anger can damage personal relationships, which                                                             summer months! UVA and UVB — the invisible but
are vital to a healthy, satisfying life. There are    Finally...                                           intense rays of the sun — can damage the skin, eyes,
several ways to express anger, with some              Counseling and therapy can help you gain             and may even weaken the immune system.
having a better effect on health than others.         insight into the situations that provoke anger           The amount of UVA remains relatively consistent
                                                      and can help you develop more effective ways         throughout the year, while UVB varies in intensity from
Modes of anger expression                             of appraising and responding to these                season to season. UV radiation levels can be high
The ways in which people express anger can be         situations. Counseling can also help you learn       even on rainy and overcast days; up to 80% of solar
divided into 4 general categories. They are:          how to respond effectively to a loved one who        UV radiation can penetrate light cloud cover. A certain
• Anger-in: anger is suppressed and turned            has difficulty managing their anger. Health          amount of UV rays also pass through car glass and
  inward, e.g. when a person acts as if nothing       Services, Counselling and Development, and           windows, so even if your activities keep you indoors,
  has happened.                                       Multi-faith Chaplaincy are all resources at          you are exposed to small amounts of UV. Brief sun
• Anger-out: anger is expressed outwardly in a        Concordia that you can help you. The Health          exposures all year round can add up to significant
  blaming or attacking way.                           Services Lending Library and the Concordia           damage. So practice sun safety all year round; this
• Anger-symptoms: anger is expressed                  Library have numerous helpful books on anger.        includes limiting your time in the sun, using a broad-
  physically such as through a headache or            Finally, check out the web site      spectrum sunscreen every day, and wearing proper
  back pain.                                          under Select Topic, click “Anger Management”.        eye protection.
                                             SEXUAL COMMUNICATION
Humans are social creatures. As such, our                    Furthermore, sexual response is inhibited when                decide together when you will continue the
relationships are critical to our existence: we need         a person experiences stress, and one excellent                conversation.
each other.                                                  stress management strategy is to talk things out              Do not try to have an important discussion
    Sexuality is an important part of healthy life. Yet      with your partner.                                            about sex when you are drunk or under the
our culture does not encourage frank discussions           • Reduce the risk of being the victim or the                    influence of drugs. Alcohol and drugs
of sexuality. This has contributed to a society              perpetrator (the person who commits a crime or                influence a person's ability to give and
where many young people and adults have never                injury) of an unwanted sexual experience, such                receive information properly; your discussion
been given models of what healthy relationships or           as acquaintance, or “date” rape.                              is unlikely to go well.
healthy sexual communication looks like.                                                                                   Talking during sex is a personal preference,
    Establishing good relationships contributes to a       Tips for better sexual communication                            but letting your partner know when you are
better life experience. Healthy relationships have         Here are just a few strategies that can help you                enjoying what they are doing can be helpful.
been linked to better physical and mental health.          build better sexual communication skills.                       Talking after sex can be a good time to tell
Although many factors contribute to establishing            • Don’t accept stereotypes and myths that limit                your partner what you liked or some things
and maintaining healthy relationships, using good             healthy sexual communication (e.g. that men                  you would prefer next time.
communication skills is arguably the most                     are expected to express interest in sex and are        • Be appropriate. What you talk about will likely
important.                                                    to be tough and dominating, while women are              change as the relationship develops. Early in a
    This article will focus on healthy sexual                 to avoid conflict and be agreeable). It’s OK for a       relationship it is important to discuss safer sex
communication with sexual partners. However,                  man to express a lack of interest in sex, just as        practices and other parameters about sex
healthy sexual communication may also include                 it is healthy for a woman to initiate sex.               (when, where, how often etc.). As the
answering questions about sex from your kids, or            • Use assertive communication skills. This                 relationship develops, the talk may become
discussing with your health professional the                  style is based on respect and leads to a win-win         more intimate, where feelings, fears and hopes
questions or concerns you have about sexuality.               situation where both partners get what they              are shared. Getting “too deep” too quickly may
For more info on these issues, see the box for                want. When communicating assertively:                    be detrimental to the relationship.
some helpful links.                                               Make eye contact; declares that you mean           • Listening can be just as important as talking.
                                                                   what you are saying.                                Attend to what the other is saying, encourage
Sexual communication                                              Use I statements; “I like, I want, I prefer when     the other to continue by nodding, ask questions
Some topics are easier to talk about than others.                  you...”                                             to clarify what you have heard, and don’t think
For many reasons, sex can be a difficult thing to                 Be honest. There is no point talking about           of other things or plan your response…just
talk about. These reasons may include your                         sex if you are not going to express your            listen.
cultural views of sex and sexuality, fear of being                 feelings honestly. This does not mean
rejected or feeling ashamed, how sex was viewed                    insulting your partner; it means being            Finally...
in your family (e.g. something that was not talked                 sincere.                                          The work you invest into improving your sexual
about versus a part of frank, regular discussions).               Use body language that is consistent with          communication skills will have a positive impact
    Despite the fact that we are exposed to sexual                 what you say. When there is a mismatch            upon other areas of your life and relationships.
images every day in advertising, television,                       between non-verbal and verbal                     The patience, assertiveness, and openness that
movies, videos and on the Internet, having an                      communication, people tend to believe the         needs to be developed for healthy sexual
honest discussion about sex can seem awkward,                      non-verbal.                                       communication will certainly support other
uncomfortable or embarrassing. This is perhaps                    It is appropriate to be aggressive in a            challenging discussions that you will have to have
why there are so many jokes about sex — it                         situation where you feel your safety is           during your life!
makes it easier when we can laugh about it.                        threatened.
                                                            • Be positive. Talk about what you want and like,           For more information on
Benefits of good sexual communication                         rather than what you don’t want or don’t like, for     healthy sexual communication
There are many reasons to work towards building               example, you may say, “I love it when you kiss         with your partner, your kids, or
your sexual communication skills. Good sexual                 me gently”, rather than saying, “Stop sticking            your health professional:
communication skills can:                                     your tongue down my throat”.                            From the Society of Obstetricians and
 • Help shift our attitudes about sex to those that         • Pick the appropriate time and place to talk.            Gynaecologists of Canada
   are conducive to healthy sexuality;                            Choose a time and place where you are               Click on PARENTS or TEENS.
 • Lead to increased use of safer sex practices,                   comfortable, and where you can talk in
   which reduces risk of unwanted pregnancy and                    private without being disturbed.          An educational site by
   getting (or spreading) a sexually transmitted                  Negotiating safer sex (such as the use of           Wendy Maltz M.S.W, a certified sex therapist.
   infection;                                                      condoms) should happen before you get into Lots of good info and
 • Help express affection and enhance intimacy;                    the “heat of the moment”.                          links from the California Family Health Council.
 • Lead to greater relationship satisfaction;                     You do not need to make a final decision
 • Lead to better sex, because you get what you                    during your first discussion. Sex is a big         communication.pdf A good article of healthy sexual
   want and your partner gets what they want.                      topic. Take your time, and if you need,            communication.

                                                   Health Services Locations                                          Health Notes is published monthly from September to March by Concordia
                                                                                                                      University Health Services. Copies are available at stands throughout the
                                                   Sir George Williams Campus                                        University. Current and back issues are available in the waiting rooms of both
                                              2155 Guy St., Room 407, 514-848-2424 ext.3565                                  Health Services locations and on the Health Services website.
                                                        Monday-Friday, 9am-5pm                                                                Address correspondence to:

                                                                                                                                          Owen Moran, Health Educator
                                                             Loyola Campus                                                             Concordia University Health Services
                                       Administration Building, Room AD 103, 514-848-2424 ext.3575                                       1455 de Maisonneuve Blvd. West
                                                                                                                                                    Room ER-407
                                                Monday-Friday, 9am-11:30am, 1pm-4:30pm                                                     Montreal, Quebec, H3G 1M8
                                                                                                                                               tel: 848-2424 ext. 3572

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