Clinical Guidelines
On May 1st and 2nd NCPIC hosted a workshop in Sydney attended by 22 international and national researchers and clinicians to develop clinical guidelines for the management of cannabis use disorder. The guidelines, based on the highest level of evidence, will cover areas such as screening, assessment, withdrawal management, behavioural interventions and mental health issues and will be a ‘how to manual’ for any clinician working with cannabis using clients. The guidelines will be disseminated for comment in the next few months, and be available for use early next year.
Director’s report
April was a very busy month at NCPIC. The website was made available and we’re receiving positive feedback. It is in an embryonic stage with lots of development to be done over the next year or two. We will be focusing on young people and professional information across a number of sectors of service under the Worforce area in the next few months. We will also be developing a brief intervention for cannabis-related problems to be available on our website by the end of the year.
The biggest event in April was our official launch. It was held in the majestic Police and Justice Museum at Circular Quay in an old courtroom and we were also fortunate enough to be able to use some of the exhibition space and a lovely sandstone terrace. We were extremely pleased to welcome the Hon. Nicola Roxon, Minister for Health and Ageing to open the Centre. Following words of welcome by Acting Vice Chancellor of the University of New South Wales, Professor Richard Henry, the Minister endorsed the importance of the Centre’s high quality research on cannabis issues and treatment development, alongside the capacity to translate that evidence into workforce training and community information provision. The Minister was most generous with her time and talked with many of those attending.
Once we were officially launched Professor Alan Budney from the University of Arkansas delivered a well-received lecture on The Cannabis Controversy which canvassed a range of clinical and policy issues. While no media were invited to the launch there was still considerable print and radio coverage. Now that we are officially launched we will have a proactive media presence. I didn’t have sufficient time at the launch the thank our consortium partners and other members of the Management Advisory Group chaired by (Hon) Trish Worth for their assistance in getting the Centre up and running so quickly. I would particularly like to thank my senior staff – Mr Paul Dillon, Dr John Howard, Ms Etty Matalon, Ms Annie Bleeker, Mr Greg Martin, Dr Anthony Arcuri and Ms Gem Mathieu for their support and hard work in delivering such high quality products in so short a time. Please provide feedback on www.ncpic.org.au and advise your colleagues that they can download our resources and join our subscription list.
Research publications
Relevant publications examining issues to do with cannabis that have been published in the last month include the following:
Bertolin-Guillen, J.M., L pez-Arquero, J. & Mart nez-Franco, L. (2008). Cannabis- induced mania? Journal of Substance Use 13, 139-141.
Chung, T., Martin, C.S., Cornelius, J.R., & Clark, D.B. (2008). Cannabis withdrawal predicts severity of cannabis involvement at 1-year follow-up among treated adolescents. Addiction 103, 787–799.
Hall, W. (2008). The contribution of research to the development of a national cannabis policy in Australia. Addiction 103, 712–720.
Litt, M.D., Kadden, R.M., Kabela- Cormier, E., & Petry, N.M. (2008). Coping skills training and contingency management treatments for marijuana dependence: Exploring mechanisms of behavior change. Addiction 103, 638–648.
Lucas, P. G. (2008). Regulating compassion: An overview of Canada’s federal medical cannabis policy and practice. Harm Reduction Journal 5, 5.
Martin, G. & Copeland, J. (2008). The adolescent cannabis check-up: Randomized trial of a brief intervention for young cannabis users. Journal of Substance Abuse Treatment 34, 407-414.
Ream, G.L., Benoit, E., Johnson, B.D., & Dunlap, E. (2008). Smoking tobacco along with marijuana increases symptoms of cannabis dependence. Drug and Alcohol Dependence 95, 199-208.
Trezza, V., Cuomo, V. & Vanderschuren, L.J. (2008). Cannabis and the developing brain: Insights from behavior. European Journal of Pharmacology 585, 441-452.
What’s new with the NCPIC website?
As Professor Copeland mentioned in her Director’s Report, the NCPIC websitewent ‘live’ on Friday, April 18. All of us at NCPIC are very excited about the site and look forward to it becoming the first port of call for those wanting evidence-based cannabis-related information.
Increasingly, an organisation’s webpage is becoming one of the major tools used to communicate messages and distribute resources, and we are hoping that now the website is up we can achieve this in an appropriate and timely manner.
NCPIC management believes that it is imperative that all other communication tools utilized by the Centre link into the website and that the messages are consistent across all areas of the organisation. Although NCPIC’s ‘clearing house’ role is particularly important for distributing resources to those living in rural or remote areas, or to those who may be less inclined to access the internet for cannabis- related information, there are other target groups (particularly young people) who use the world wide web a great deal and the website will be an invaluable communication tool for those audiences.
All of the Centre’s communication tools and marketing activities will be aimed at raising an awareness of the website and the resources available there. The aim will be to create Australia’s most authoritative, and most importantly, credible, source of information and support for a range of target groups to be better informed about cannabis, its associated harms and evidence-based treatment options.
The website has been broken into six basic sections and will be providing information for the following target groups:
- workforce
- cannabis users
- friends and families of cannabis users
- young people
- indigenous communities
- general community
In the coming months, particular emphasis will be given to the ‘young people’ section of the website. This will have a prevention focus and will take the form of a series of real-life stories or scenarios dealing with young people and cannabis. Frequently asked questions on a range of cannabis- related topics will be answered based on the results of extensive consultation and focus testing. Work will also be conducted on developing appropriate information and interventions for ‘early- identified’ young people and those with complex needs.
All of our resources are available electronically and visitors to the site are also able to access NCPIC news and events, as well as up-to-the minute cannabis-related media stories currently making the news around the country.
We value feedback on the site and its contents. If you are having difficulty locating specific information or feel that the website could be improved in some way, we need to hear from you. Please feel free to contact Paul Dillon with your comments and suggestions.
Media stories this issue
Each issue we will examine some of the cannabis-related stories that have received media attention across the country. The headlines are listed below in bold, with a short summary and/or commentary regarding the content of the news story beneath.
If you are interested in obtaining a copy of a particular story, please contact Paul Dillon.
It was a big month of cannabis news – the Centre was officially launched by the Minister and received widespread media attention around the country and the annual Mardi Grass Festival was held in Nimbin, attracting a number of very different stories.
Call to ban sale of bongs
Following on from the SA Government’s decision to outlaw the sale of bongs and other drug paraphernalia, a Victorian MP called for similar changes to the law in that state.
Smaller brains for babies of substance abusers: study
This study received coverage in many of the regional papers across the country. Conducted in the US, the articles stated that a mother’s substance use during pregnancy can mean a smaller brain for her child. Among 35 children aged 10-14 years of age, those whose mothers had used cocaine, drank alcohol or smoked tobacco or cannabis while they were pregnant tended to have a smaller head than their peers who weren’t exposed to the drugs prenatally.
Aussies cut down on cigs, booze and drugs
The release of the 2007 National Drug Strategy Household Survey did notreceive quite as much coverage as it should have, quite possibly because of the decision of the Federal Government to announce that they were to almost double the excise on ‘ready-to-drinks’ the same day. Recent cannabis use continued to drop, from just more than 11 per cent to just more than 9 per cent having used the drug in the previous 12 months.
Mardi Grass ultimatum
Organisers of the Mardi Grass in Nimbin received a letter from the police advising them the festival’s parade could go ahead as long as it followed three pages of conditions. In response, the organisers had a message for police: “Come to Nimbin in peace, or stay away.”
Cannabis risks exposed
NCPIC was officially launched by the Minister for Health and Ageing, Nicola Roxon. Media outlets reported that the Centre was based at the University of NSW and will receive over $12 million over three years to fund treatment, research and a National Helpline.
Dope smokers get addicted to cigarettes
According to research conducted by the North Coast Area Health Service, cannabis use could be the cause of higher rates of cigarette addiction in “alternative lifestyle communities”. A study conducted of young men living on the NSW north coast suggests that high rates of cannabis smoking was responsible for high rates of tobacco use, and not vice versa as was previously thought.
Growers ‘not getting rich’
This interesting article attempts to “explode” the myth that cannabis growers on the north coast of NSW are rich. According to the story a grower, Jamie (not his real name), grows around 30 cannabis plants on his land and earns between $10,000 and $20,000 from his crop each year. This supports himself, his wife and their two children. Jamie said “no-one’s ever going to get rich growing dope because nobody can know and you can’t spend the money anyway.”
Cut cannabis use by selling it at the post office: expert
Dr Alex Wodak from St Vincent’s Hospital in Sydney hit the headlines (and prompted many people to call into radio stations around the country) when he suggested that cannabis should be “sold legally in post offices in packets that warn against the effects”. He originally made the proposal for taxed and legalized cannabis in Nimbin at the Mardi Grass festival but said “he would be happy to express his opinion to the Federal Government.”
Cannabis project labelled a smoke screen by Nimbin pro-pot activist
According to this article, Michael Balderstone, President of Nimbin’s Hemp Embassy, has labelled NCPIC a “waste of money”. He is quoted as saying that “the Government continues to enforce cannabis propaganda to the extent that young people have lost respect for government and the law. Pot smokers are tired of hearing non-pot smokers talk about the harmful effects of cannabis.” He suggested that the money spent on setting up the Centre be better spent on a Medical Cannabis Register, whereby studies focused on users, as opposed to cannabis as a ‘bad drug’.
Cannabis regraded
The UK Government rejected recommendations from its own drug advisors and have raised cannabis to a Class B drug, with a maximum five-year jail term for users. The Home Secretary, Jacqui Smith said that the decision arose from concern about “the alarming use of skunk, a stronger strain of the narcotic that now dominates the market.” The independent advisory council had heard evidence that the potency of homegrown herbal cannabis tended to be two and a half times that of imported resin which had previously been popular, but they had believed that users now often moderated their intake in response.
Interestingly, since cannabis was downgraded in 2004 the proportion of young people using it has fallen each year from 25.3% in 2003-04 to 20.9% now. Among those aged 16 to 59, the proportion over the same period has fallen from 10.8% to 8.2%, according to the British Crime Survey.
What do we know?
Cannabinoids: what do we know?
There are approximately 483 natural components found within the Cannabis sativa plant, of which 66 have been classified as ‘cannabinoids’, i.e., chemicals unique to the plant. The most well known and researched of these, delta-9-tetrahydrocannabinol (Δ9-THC), is the substance primarily responsible for the psychoactive effects of cannabis. The effects of Δ9-THC may, however, be moderated by the influence of the other 482 components, most particularly by the cannabinoids.
The cannabinoids are separated into subclasses:
- cannabigerols (CBG)
- cannabichromenes (CBC)
- cannabidiols (CBD)
- tetrahydrocannabinols (THC)
- cannabinol (CBN) and cannabinodiol(CBDL)
- other cannabinoids (such ascannabicyclol (CBL), cannabielsoin(CBE), cannabitriol (CBT) and othermiscellaneous types
Like opiates, cannabinoids work by interacting with specific receptors, located in the brain. Cannabinoids are somewhat unusual drugs in that they are soluble in lipids (fats) rather than in water. Thus, with repeated dosage, cannabinoids tend to accumulate in fatty tissues and remain in the body for several days. The actual effects that the cannabinoids have reflect the areas of the brain they interact with, i.e., the parts of the brain that controls memory, cognition and psychomotor performance, the feelings of reward and pain perception.
The major differences between the cannabinoids are determined by the extent to which they are psychologically active. Three classes of cannabiniods, the CBG, CBC and CBD are not known to have such an effect. However, THC, CBN, CBDL and some other cannabinoids are known to be psychologically active to varying degrees.
CBD is probably the most abundant cannabinoid, contributing up to 40% of cannabis resin. Interestingly, CBD may actually have anti-anxiety effects and lessen the psychotropic effects of THC, although it is not clearly understood how this occurs. That is, a plant with a greater percentage of CBD may reduce the effects of the THC, which in effect lowers the potency of the plant. Use of a cannabis plant without CBD has been shown to have an increased psychological effect and incidence of anxiety reactions. The non-psychotropic aspects of CBD are of particular interest in therapeutic settings.
Δ9-THC is oxidized by exposure to air which reduces to form CBN. CBN is only very weakly psychotropic and not unlike CBD interacts with THC to reduce its effects. Cannabis that has been left out unused will have increasing amounts of CBN and decreasing amounts of THC and thus lose potency.
Cannabinoids appear to be of greatest therapeutic value when treating the following conditions:
- nausea and vomiting associated with cancer treatments
- weight control in anorexia
- HIV/AIDS patients and in obesity
- muscle spasm due to spinal chord injury or multiple sclerosis
Medicinal, non-smoked cannabinoid preparations may also have potential for use as anti-inflammatories or in pain management and the treatment of asthma, glaucoma, Parkinson’s disease, migraines and also alcohol and cocaine addiction. These therapeutic applications have not been well tested and further work is needed in this area.
‘The munchies’: what do we know?
Most people who have ever tried cannabis have experienced ‘the munchies’ at some time or another. This is when the user of the drug gets a feeling of increased appetite (usually craving sweet foods such as chocolate or ice cream) during cannabis intoxication.
Why does cannabis have this effect on appetite? For a long time it was believed to be due to a lowering of blood sugar levels, making the user crave sweet foods so as to retain the appropriate balance. This has now been disproved. It is now believed that it has to do with endogenous cannabinoids (those that exist inside us). These are also known as endocannabinoids, they work like neurotransmitters and are produced as part of the built-in apparatus that inform the brain that it’s time to eat.
The particular receptor linked to cannabis use and appetite regulation is CB1. To date the CB1 receptor has been found to be active in several areas of the body known to stimulate eating behaviour, particularly the hypothalamus, and the region of the brain that plays a pivotal role in appetite regulation.
So put simply, when someone uses cannabis, they are replicating an effect the body produces for itself, only much more intensely – thereby stimulating appetite.
