What's new in cannabis?
Reduce Your Use
This month we have launched our online intervention program ‘Reduce Your Use’. This innovative, evidence-based program is aimed at helping cannabis users quit or lower their use of the drug. Read the Director’s report below for more information.
Director's report
One of the unique attributes of NCPIC is our capacity to provide evidence-based information resources and clinical tools that we are able to value-add to our communications and training programs. This month saw our paper on the development and validation of the Cannabis Withdrawal Scale, published in Drug and Alcohol Dependence, voted by the American Society of Addiction Medicine as one of the top ten papers for 2011-2012 of the 1600 papers they considered. Congratulations to my collaborators Drs David Allsop, Melissa Norberg, Shanlin Fu and Professor Alan Budney. It took a long time to get this work funded so persistence pays off!
In a similar vein, this month we have soft-launched our online intervention program, ‘Reduce Your Use’. This 6-session intervention was based on our previous face-to-face intervention and is designed to help treatment-seeking cannabis users reduce or abstain from use. Dr Sally Rooke has led this project and we are pleased that we have now submitted for peer reviewed publication, the evidence from the randomised-controlled trial of the intervention to support its efficacy and the need for further work in this area to improve the accessibility and reduce the costs of cannabis treatment. Despite thorough testing of this program by our web developers and ‘dummy’ participants, we ask you to assist us by letting us know of any glitches or bugs as you explore this exciting new delivery method for cannabis treatment. Please feel free to test the tool and email us any feedback to info@ncpic.org.au. The program can be accessed from the NCPIC splash page or directly at www.reduceyouruse.org.au
Another exciting online tool that project manager Tori Barnes writes about in this month’s e-zine is the School Communities Website. This mini-site will be developed over the coming year and aims to provide a user-friendly portal for parents, teachers and students to access information that is relevant to them and easily accessible.
The commentary on research in this issue focuses on the work of a German colleague, Dr Eva Hoch, on the efficacy of a targeted cognitive-behavioural treatment program for cannabis use disorders (CANDIS*). This study explored the importance of treatment intensity. Her team were interested to determine if a 10-session motivational enhancement and cognitive behavioural therapy intervention, targeting mental health concerns, would engender greater treatment outcomes than a less intensive, manual-based, standardised version of the same intervention. They found that participants from both intervention conditions reported a greater reduction in cannabis use frequency and improvements in measures of mental health compared to the delayed treatment control. These results support the argument that intervention trials should employ more specific measures of psychosocial outcomes. The improved integration of mental health and substance use interventions remains a significant challenge.
The program for the Second National Cannabis Conference is almost complete and the successful authors who submitted abstracts have been notified. Unfortunately we have just been advised that Dr Michael Zvolensky is no longer able to attend the meeting but fortunately we have an extremely able replacement in Dr Marcel Bonn-Miller. He is the Director of the Substance Abuse and Anxiety Program at the VA Palo Alto Health Care System. His research interests include examination of the interrelations between cannabis use disorders and anxiety disorders and he is currently running projects on PTSD and HIV treatment adherence in relation to cannabis use. He is a collaborator with Dr Zvolensky and will be able to present the same workshop and keynote paper. Registrations are now open so we recommend you book now.
Commentary on research
Efficacy of a targeted cognitive-behavioral treatment program for cannabis use disorders (CANDIS*) – a comment on Hoch and colleagues (2012)
Few participants of cannabis interventions have reported a statistically significant improvement in their psychological and social functioning as a result of participating in treatment. This may be due to a lack of accurate measurement of the specific constructs of psychosocial health that are affected by treatment, or it may simply reflect a lack of intervention effect. Regardless of changes in psychosocial health, cannabis interventions based on the integration of motivational enhancement techniques (MET) and cognitive behavioural therapy (CBT) have proven efficacy in assisting cannabis users to reduce their cannabis use. Hoch and colleagues (2012) conducted an initial trial to determine the consequence of supplementing a MET+CBT cannabis intervention (referred to as the “CANnabis DISorders” or the “CANDIS” intervention) with an additional problem-solving component targeting psychosocial and mental health concerns.
A total of 133 participants with a cannabis use disorder (79% male, with a mean age of 24 years) were randomly allocated to receive: 1) ten 90-minute sessions of a MET+CBT-based intervention with a component targeting participant psychosocial health (n=39), 2) the same MET+CBT intervention but with the targeting component delivered in less detail (n=51), or 3) a delayed treatment control condition (DTC; n=31). Follow-up comparisons were conducted between the intervention and DTC conditions at treatment end, and between the intervention conditions only at three and six months from baseline (20% of participants were lost to follow-up). The authors chose broad measures of substance use and mental health outcomes common to many cannabis intervention trials – the Addiction Severity Index and the Brief Symptom Inventory. Self-report of cannabis use was validated by urinalysis.
Participants from both intervention conditions reported a greater reduction in cannabis use frequency compared to the DTC condition at the end of treatment, although there was no significant difference between the intervention conditions in the reductions made. In addition, there were no noted significant differences between the intervention groups in cannabis use reductions at the time of three and six month follow-up assessments. Specifically, participants from both interventions reported significant reductions in cannabis use at six months (not three months) and improvements in indices of problems relating to drug use, legal concerns and other general concerns, and in the measure of psychopathology.
Notably, at the end of intervention, 49% of intervention participants reported abstinence from cannabis (41% according to urinalysis, and 69% of a subsample of those who completed the intervention) in the past seven days compared to 13% of the control group. This proportion of participants achieving abstinence from cannabis was among the highest proportion previously reported by participants of cannabis interventions without contingency management.
As improvements in psychosocial functioning were noted by both intervention groups, the additional focus on these outcomes was not required to achieve favourable outcomes. These results support the argument that intervention trials should employ more specific measures of psychosocial outcomes. However, the measures used in this trial were common to previous interventions which did not report the improvements shown by Hoch and colleagues. As such, further research is required to determine the precise mechanisms by which cannabis interventions can effect change to psychosocial health. One possibility consistent with the results of Hoch and colleagues is that a certain threshold of abstinence from cannabis may be required to achieve such a change. Further research would benefit with the inclusion of a specific measure of psychosocial functioning to improve our understanding of the mechanisms by which cannabis interventions can effect change in this area.
- Hoch, E., Noack, R., Henker, J., Pixa, A., Höfler, M., Behrendt, S., Bühringer, G., & Wittchen, H.U. (2012). Efficacy of a targeted cognitive-behavioral treatment program for cannabis use disorders (CANDIS*). European Neuropsychopharmacology 22, 267-280.
Research publications
Relevant publications examining issues to do with cannabis that have been published in the last month include the following:
- Fairman, B.J. & Anthony, J.C. (2012). Are early-onset cannabis smokers at an increased risk of depression spells? Journal of Affective Disorders 138, 54-62.
- Han, E., Chung, H. & Song, J.M. (2012). Segmental hair analysis for 11-nor-delta9-tetrahydrocannabinol-9-carboxylic acid and the patterns of cannabis use. Journal of Analytical Toxicology 36, 195-200.
- Hasin, D.S., Fenton, M.C., Beseler, C., Park, J.Y., & Wall, M.M. (2012). Analyses related to the development of DSM-5 criteria for substance use related disorders: 2. Proposed DSM-5 criteria for alcohol, cannabis, cocaine and heroin disorders in 663 substance abuse patients. Drug and Alcohol Dependence 122, 28-37.
- Hoch, E., Noack, R., Henker, J., Pixa, A., Höfler, M., Behrendt, S., Bühringer, G., & Wittchen, H.U. (2012). Efficacy of a targeted cognitive-behavioral treatment program for cannabis use disorders (CANDIS*). European Neuropsychopharmacology 22, 267-280.
- Lile, J.A., Kelly, T.H. & Hays, L.R. (2012). Separate and combined effects of the GABA reuptake inhibitor tiagabine and Δ(9)-THC in humans discriminating Δ(9)-THC. Drug and Alcohol Dependence 122, 61-69.
- Milman, G., Schwope, D.M., Gorelick, D.A., & Huestis, M.A. (2012). Cannabinoids and metabolites in expectorated oral fluid following controlled smoked cannabis. Clinica Chimica Acta 413, 765-770.
- Yap, M.B., Reavley, N.J. & Jorm, A.F. (2012). Young people's beliefs about the harmfulness of alcohol, cannabis and tobacco for mental disorders: Findings from two Australian national youth surveys. Addiction 107, 838-847.
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 Clare Chenoweth at c.chenoweth@unsw.edu.au
Drugs: why some do and some don’t
This article questions why some people who try cannabis continue to use the drug and experience negative consequences such as dependence, while most people do not continue to use the drug after their initial “experimentation.” Clinical forensic psychologist Christopher Lennings suggests the “reason people maintained drug use or became dependent came down to a range of factors, including genetic function which appeared to heighten the positive effects of drugs.” Other contributors may include “ongoing stresses and traumas that they’re unable to successfully resolve” possibly due to environmental factors or their personality type making it harder to “resolve trauma.” Still further reasons that certain people become regular users may include social and economic backgrounds, emotional regulation and mental health issues. NDARC’s Professor Michael Farrell stressed the importance of family support, open communication and maintaining adequate supervision of young people.
Teens switch to alcohol, ecstasy
Research from the National Drug Research Institute (NDRI) suggests that Australian teenagers “appear to be swapping one drug for another” and using more alcohol and ecstasy when their use of cannabis drops. Between 1998 and 2007, fewer 14 to 19-year-olds smoked cannabis but “rates of risky alcohol consumption and ecstasy use increased in the same group.” Interestingly, there was also a reduction in tobacco use which seems to have an influence on reducing other forms of smoking, such as cannabis. Since 2007 however, these trends have changed, with an increase in young people using cannabis and a marked decrease in ecstasy use. It has been suggested that teenagers “just move from one substance to another depending on price and availability.”
Stronger, fake dope alert in Perth
According to this article, “new strains of synthetic cannabis up to 100 times stronger than the real thing are being sold on Perth’s streets.” Despite synthetic cannabis being made illegal in Western Australia (WA) last year, “illicit manufacturers are finding new ways to produce the drugs and skirt the law.” Dr Reynolds, a chemist working at ChemCentre, a chemical and forensic science facility, says effects of the drug can include elevated heart rate and blood pressure as well as “paranoia and irrational behaviour.” A significant concern of his is that people using the drug do not know what it is made from, how strong it is or the side effects it is likely to cause. WA Mental Health Minister, Helen Morton, believes the “new forms of synthetic cannabis emerging in WA [are] banned under existing laws... or will be captured in the new legislation being put in place by the Therapeutic Goods Administration.”
Synthetic marijuana drug sales hitting a high
This article claims that a “proposed tough new law banning the sale of products ‘intended to have a similar pharmacological effect’ to cannabis (synthetic cannabis), lapsed with the change of government” in Queensland. According to The Sunday Mail, tobacconists have been selling synthetic cannabis and making up to $1000 a day. The drug is said to be popular among miners as it is less likely to be detected in standard workplace drug testing.
Addicts sought for world-first cannabis trial
NCPIC’s Sativex Study is featured in this article. The study requires 50 people who are dependent on cannabis to take part in the trial where they are either given a placebo or Sativex in the form of an oral spray to “see if it helps them manage their withdrawal symptoms.” Professor Jan Copeland is quoted in the article saying that the study “will have ramifications around the world” and that “it will be a complete game-changer for the treatment of cannabis dependence.” For more information contact Dr David Allsop on (02) 9385 0448 during office hours, or email: cannabiswithdrawal@unsw.edu.au
Greens back call for APY marijuana date
Green’s senator Rachel Siewert wants the State Government to “consider collecting data” on cannabis use in South Australia’s remote Aboriginal lands. There has been anecdotal evidence from the NPY Women’s Council that cannabis use is a “big concern” but as Senator Siewert says, “If we don’t collect that information we have no evidence then on which to base any work that needs to be done or any resource expenditure to address the issue.” The State Government says that it is currently collecting information from client referrals in the APY Lands but that this “does not reflect trends in drug use.”
Half of young adult tobacco smokers also have used marijuana in the last 30 days
According to a recent Facebook-based survey conducted by University of California – San Francisco (UCSF) researchers, “half of young adult tobacco smokers also have smoked marijuana in the last 30 days.” This suggests there may be a “greater prevalence of marijuana and tobacco co-use among smokers aged 18-25 than previously reported.” The researchers wanted to try a novel approach to recruiting participants and chose to use social networking instead of the more traditional face-to-face interviews. They found that by using this medium, cannabis use “rates were much higher, which shows the problem might be larger than we realise.” The anonymity of the internet was thought to encourage more honesty in participants’ reporting of their drug use.
Gabapentin drug helps people to quit cannabis
Researchers at the Scripps Research Institute have found “clinical evidence that the drug gabapentin, currently on the market to treat neuropathic pain and epilepsy, helps people to quit smoking” cannabis. The drug “targets stress systems in the brain that are activated by withdrawal.” Treatment-seeking cannabis using participants who took part in a 12-week trial and were given gabapentin “used less cannabis, experienced fewer withdrawal symptoms such as sleeplessness, and scored higher on tests of attention, impulse control, and other cognitive skills, compared to patients who received a placebo.”
Tourists lose out as Dutch cannabis law upheld
A “controversial” new law that outlaws tourists from purchasing cannabis from coffee shops in the Netherlands has been upheld by a Dutch judge. The new law will take effect at the end of this year and “targets the many foreigners who have come to see the country as a soft drugs paradise and to tackle a rise in crime related to drug trade.”
NCPIC school communities website project
The NCPIC School Communities Website is a project being developed to target whole school communities – students, teachers and parents, and will initially be a portal for information on cannabis.
The project commenced in July 2011 and one of our first activities was inviting representatives from jurisdictional Drug Education Departments to a meeting in Sydney on 9th September 2011 with the aim of collecting information on best practice drug education on cannabis prevention. We then conducted an audit of available Australian cannabis-only information to identify what was out there and what gaps there were. Phase Two – Opinion testing in schools, commenced in February 2012.
Eight schools were visited across four different states (NSW, VIC, TAS and SA) in February and March by teams of two to three NCPIC Communications Team staff members. A total of 22 focus groups were conducted with parents, teachers and students to ascertain their views on a proposed school community website about cannabis.
Participants provided feedback on the content, layout, visual aspects and expected purpose of the proposed website. A full report on the findings from these visits was prepared and will be used to inform the next stage of the project. A great deal of important and varied data was collected which will help us with content development. Some of the key themes that arose from the focus group testing are as follows:
- Students would like the website to have video content and minimal text, be helpful for school assignments and assist them with helping a friend they may be concerned about.
- Parents would like the website to be a point of referral, contain unbiased information and be easy to navigate.
- Teachers would like the website to assist them with lesson planning and be helpful for referral.
In Phase Three we will begin to develop the content for the website and collaborate with web designers about the possible look and feel of the site. Before the end of June we aim to focus test these ideas with a selection of schools in Sydney.
