What's new in cannabis?
Young people and cannabis use training
NCPIC’s Training Team have recently begun to run a new training session delivered by John Howard, called
Young people and cannabis use. This whole-day session aims to provide information and strategies to those who work with young people to enhance their skills to deal with cannabis use and cannabis use disorder. Topics included in the session are; why young people use cannabis and consequences of use; characteristics of young people and their patterns of drug use; motivational enhancement, the change process and how to assist change; and how to maintain change.
Director’s report
Jan Copeland (PhD) (Professor/Director, NCPIC)
Summer is over and we’re enjoying the fabulous weather that is autumn in Australia. I’ve been fortunate enough to visit our consortium partner NDRI in Perth this month to join a workshop of representatives of Aboriginal Medical Services (AMS) from across the country to assist in the development of the guidelines for the management of cannabis in a primary health care setting. The challenges that the group discussed were not minor but I think the approach developed to be trialled in a number of AMS this year is a good starting point.
With regard to our indigenous art project that is part of our resource development, Paul Dillon, John Howard and Clare Chenoweth are commencing the visits to the participating communities this month. The range of groups and artwork is so exciting and we can’t wait to hold the exhibition (real and virtual) for you all to share. There is so much to be done to assist indigenous communities to address cannabis-related issues and the team at NCPIC is incredibly enthusiastic about our role in progressing this agenda.
This month has seen the publication of NCPIC’s first Technical Report: Barriers and Facilitators to Cannabis Treatment written by Peter Gates and colleagues. The report was based on four studies of different groups of people, those receiving treatment for cannabis use, cannabis users who had not sought treatment (one study was Internet-based and the other in person) and a group of family and friends of cannabis users. People receiving treatment reported positive experiences about the services they received and those who had not sought treatment echoed previous research in stating that ‘the typical cannabis user’ isn’t ready to stop using, believes treatment is unnecessary and that stigma is associated with receiving treatment. Family and friends, along with cannabis users, reported that more education and information about specific cannabis treatments should be available so as to facilitate access to treatment. The report can be downloaded from the NCPIC website in the Publications section.
NCPIC continues to have a presence at a wide range of conferences nationally. Melanie Simpson recently gave a paper at the Australian Psychological Society’s “Advancing Forensic Psychology” conference in Melbourne. Melanie’s paper emphasised the importance of regular monitoring of cannabis and other substance use trends among young offenders across Australia. This work is of particular relevance to NCPIC given that available data suggests an increasing disparity in the level of cannabis use among young people who spend time in detention compared with those in the general community. Her doctoral work is exploring the relationship between cannabis use and crime, focusing in particular on the social factors that contribute to first cannabis use and first involvement in crime and how the two relate to each other and to recent use. Ana Rodas has recently joined NCPIC to work with Melanie on this and related projects. Melanie is collaborating with our consortium partners at the AIC and a wide range of government and non-government agencies on this important work.
Every month NCPIC is establishing new collaborations and we welcome any opportunity to assist those working on cannabis-related issues.
Best wishes
Jan Copeland
Research publications
Relevant publications examining issues to do with cannabis that have been published in the last month include the following:
- Boleda, M.A., Galceran, M.A. & Ventura, F. (2009). Monitoring of opiates, cannabinoids and their metabolites in wastewater, surface water and finished water in Catalonia, Spain. Water Research 43, 1126-1136.
- Caldeira, K.M., Arria, A.M., O’Grady, K.E., Vincent, K.B., & Wish, E.D. (2008). The occurrence of cannabis use disorders and other cannabis-related problems among first-year college students. Addictive Behaviors 33, 397-411.
- Chen, C.Y., Storr, C.L. & Anthony, J.C. (2009). Early-onset drug use and risk for drug dependence problems. Addictive Behaviors 34, 319-322.
- Compton, W.M., Saha, T.D., Conway, K.P., & Grant, B.F. (2009). The role of cannabis use within a dimensional approach to cannabis use disorders. Drug and Alcohol Dependence 100, 221-227.
- Cowan, R.L., Joers, J.M. & Dietrich, M.S. (2009). N-acetylaspartate (NAA) correlates inversely with cannabis use in a frontal language processing region of neocortex in MDMA (Ecstasy) polydrug users: A 3 T magnetic resonance spectroscopy study. Pharmacology, Biochemistry, and Behavior 92, 105-110.
- D’Souza, D.C., Pittman, B., Perry, E., & Simen, A. (2009). Preliminary evidence of cannabinoid effects on brain-derived neurotrophic factor (BDNF) levels in humans. Psychopharmacology (Berl) 202, 569-578.
- Farquhar-Smith, W.P. (2009). Do cannabinoids have a role in cancer pain management? Current Opinion in Supportive and Palliative Care 3, 7-13.
- Fergusson, D.M., Horwood, L.J. & Boden, J.M. (2008). Is driving under the influence of cannabis becoming a greater risk to driver safety than drink driving? Findings from a longitudinal study. Accident; Analysis and Prevention 40, 1345-1350.
- Fletcher, A., Bonell, C., Sorhaindo, A., & Rhodes, T. (2009). Cannabis use and ‘safe’ identities in an inner-city risk environment. International Journal of Drug Policy 20, 244-250.
- Gillespie, N.A., Neale, M.C., Jacobson, K., & Kendler, K.S. (2009). Modeling the genetic and environmental association between peer group deviance and cannabis use in male twins. Addiction 104, 420-429.
- Gillespie, N.A., Neale, M.C. & Kendler, K.S. (2009). Pathways to cannabis abuse: A multi-stage model from cannabis availability, cannabis initiation and progression to abuse. Addiction 104, 430-438.
- Henry, K.L., Thornberry, T.P. & Huizinga, D.H. (2009). A discrete-time survival analysis of the relationship between truancy and the onset of marijuana use. Journal of Studies on Alcohol and Drugs 70, 5-15.
- Kay-Lambkin, F.J., Baker, A.L., Lewin, T.J., & Carr, V.J. (2009). Computer-based psychological treatment for comorbid depression and problematic alcohol and/or cannabis use: A randomized controlled trial of clinical efficacy. Addiction 104, 378-388.
- López, R. & Baelum, V. (2009). Cannabis use and destructive periodontal diseases among adolescents. Journal of Clinical Periodontology 36, 185-189.
- Montgomery, C., Fisk, J.E. & Craig, L. (2008). The effects of perceived parenting style on the propensity for illicit drug use: The importance of parental warmth and control. Drug and Alcohol Review 27, 640-649.
- Reinarman, C. (2009). Cannabis policies and user practices: Market separation, price, potency, and accessibility in Amsterdam and San Francisco. International Journal of Drug Policy 20, 28-37.
- Richer, I. & Bergeron, J. (2009). Driving under the influence of cannabis: Links with dangerous driving, psychological predictors, and accident involvement. Accident; Analysis and Prevention 41, 299-307.
- Schaub, M., Fanghaenel, K., Senn, C., & Stohler, R. (2008). Cannabis using schizophrenia patients treated with atypical neuroleptics: Do their symptoms differ from those of cannabis abstainers? Substance Use and Misuse 43, 2045-2052.
- Veselska, Z., Geckova, A.M., Orosova, O., Gajdosova, B., van Dijk, J.P., & Reijneveld, S.A. (2009). Self-esteem and resilience: The connection with risky behavior among adolescents. Addictive Behaviors 34, 287-291.
- Xiao, Z. (2008). Sensation seeking and impulsivity: The direct and indirect effects of adolescent marijuana use. Journal of Substance Use 13, 415-433.
Commentary on research
Computer-based psychological treatment for comorbid depression and problematic alcohol and/or cannabis use: A randomized controlled trial of clinical efficacy – a comment on Kay-Lambkin, Baker, Lewin & Carr (2009)
Substance use disorders and depression often co-occur. Individuals with both conditions rarely present for treatment, and when they do, they benefit less from standard treatment than individuals with either substance abuse or depression alone. Kay-Lambkin, Baker, Lewin, and Carr1 attempted to address these issues by conducting a randomized controlled trial of computer- versus therapist-delivered integrated behaviour therapy for depression and problematic alcohol or cannabis use.
Kay-Lambkin and colleagues recruited 97 adults who scored at least a 17 on the Beck Depression Inventory II (BDI-II), and consumed alcohol above recommended daily levels in Australia or consumed cannabis at least weekly. All participants completed a one session, brief intervention (BI) before they were randomly assigned to receive either nine sessions of intensive integrated computer-delivered (CD) or therapist-delivered (TD) behaviour therapy. The CD and TD interventions occurred weekly and were identical in content. The latter incorporated a 15-minute check-up with a therapist at the end of each session. Follow-up assessments were completed three, six, and 12 months after the baseline assessment.
The majority (69 percent) of participants completed all three follow-up assessments, with comparable completion rates across conditions and no significant differences between those who did or did not complete all assessments. More (78 percent) of participants in the TD condition attended all of their allocated sessions compared to 52 percent of participants in the CD condition. TD participants evidenced the quickest reductions in BDI-II scores, but also the highest rates of relapse. At the 12-month follow-up, BI and TD participants reported BDI-II scores of moderate severity, while CD participants reported mild depression. However, CD participants reported less severe depression at baseline than did the other two groups. The TD intervention produced the largest reductions in alcohol use (M drinks per day = 9.6 versus 2.5), while the CD intervention produced the largest reductions in cannabis use (M joints/bongs per day = 11.9 versus 3.3). Although BI reduced their drinking by 50 percent from the baseline assessment to the 12-month follow-up, they evidenced almost no change in their cannabis use (M joints/bongs per day = 9.2 versus 8.6).
In summary, the data suggest that depression responds better to integrated intensive treatment than to a BI, and that CD and TD intensive interventions may produce equivalent depression outcomes in the long-term. Substantial reductions in problematic drinking can occur after only a BI, and even greater reductions can occur with a TD intensive treatment. Cannabis use reductions among depressed individuals may be harder to achieve; they may require an intensive, integrated treatment to reduce their cannabis use even minimally. Although the integrated treatments examined by Kay-Lambkin and colleagues led to considerable reductions in cannabis use, participants continued to use cannabis at risky levels. Future research should consider additional methods to improve outcomes, such as more sessions, different therapeutic techniques, or adjunctive medication. Despite not achieving superior depression and cannabis reductions, the results of Kay-Lambkin and colleagues’ study show promise for an integrated treatment for co-occurring depression and substance abuse, delivered via therapist or computer.
1. Kay-Lambkin, F.J., Baker, A.L., Lewin, T.J., & Carr, V.J. (2009). Computer-based psychological treatment for comorbid depression and problematic alcohol and/or cannabis use: A randomized controlled trial of clinical efficacy. Addiction 104, 378-388.
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
Drug dealers beware
This editorial speaks in support of police “taking a strong approach with Strike Force Aster to combat the cultivation and supply” of cannabis in Port Macquarie. It comments on the links between long-term cannabis use and mental health as well as the “knock-on effects” such as crime and “poor social interaction”. The article claims that “A cannabis user is six times more likely to develop schizophrenia” and that the disease is on the increase among today’s teenagers.
However, to correct misleading statements about cannabis and psychosis that commonly feature in media articles, Dan Lubman, Associate Professor in Addiction Psychiatry at the University of Melbourne, emphasises that schizophrenia is not on the increase. It is a serious mental disorder with a prevalence of around 1 percent. Smoking cannabis increases the risk of developing schizophrenia by about twofold, although there is some evidence that the risk is greater if cannabis use commences during adolescence.
When the days grow shorter
The links between depression and alcohol use are dealt with in this article, which discusses findings of “recent work supported by beyondblue”. Clinical adviser for the organisation, Associate Professor Michael Baigent, mentions the links between cannabis use and mental illnesses such as anxiety and schizophrenia. Depression is also noted as a possible product of cannabis use.
A toker’s guide
The disparity among worldwide approaches to law enforcement in relation to illicit drugs is debated in this article. UN conventions stipulating that the “selling and possession of narcotics” is prohibited, bind signatory nations to this edict, however it is stated that some nations have “grown frustrated, and are finding ways of bending the rules”. It mentions that a caveat in the UN conventions has allowed decriminalisation of some drug offenses to occur in these nations, and notes that some Australian states have decriminalised certain cannabis offenses. Various UN agency reports’ findings are highlighted, with conflicting conclusions about the benefits and disadvantages of these law enforcement approaches.
Message is in the bin
This opinion piece by Colleen Egan about police in WA trialling drug-disposal bins at the Rock-It festival discusses the divergent approaches of harm minimisation and the “just say no” approach of the WA Premier, Colin Barnett. She doesn’t support the new government’s decision to “reverse Labor’s decriminalisation of cannabis, despite being unable to disprove figures that suggest marijuana use had decreased under the less-punitive laws”. She believes that realistically, “the message to Rock-It concert goers today cannot just be to ‘say no’”, and she gives some tips to reduce the risk of drug taking such as “take care of each other and go home safe”.
Cannabis forum targets teens
A Batemans Bay Community Health counsellor believes that “primary aged children need education to keep them safe from cannabis”. He encourages local parents to “attend a forum focused on adolescent cannabis use...regardless of the age of their child”. It is hoped that by targeting parents of younger children, and the children themselves, it will delay or prevent future cannabis use more effectively. Organiser of the forum, Taylor Huntley said “the concern is that the younger the kids start using, the higher the risk they will develop mental and social problems”.
Our domestic violence shame
Research conducted by the Queensland Centre for Domestic and Family Violence Research has shown that “more than 11 percent of Mackay women are suffering from physical abuse.” In terms of cannabis, “a woman’s likelihood of having experienced any form of physical abuse at some point in her current relationship was increased by 20.9 percent if her partner consumed marijuana at least twice a month compared to 4.8 percent if she consumed marijuana at least twice a month”.
UK: Cannabis laws cause harm, Aust academic tells UN
Professor Robin Room, a sociologist from the University of Melbourne has “told the United Nations the laws against cannabis use are causing people more harm than the drug itself...and they’re not working anyway”. He believes “prohibition does little to influence the number of cannabis users...[and that] a lot of young people’s lives get messed up because of arrests over a drug that it’s almost impossible to overdose with”. He thinks the poor are overrepresented in the legal system than their richer counterparts.
Cannabis fires schizophrenia, says Ratcliff
Launceston’s “most senior psychiatrist”, Dr Eric Ratcliff, believes that “cannabis use has seen schizophrenia take off ‘like a rocket’ during the past 20 years”. Dr Ratcliff was one of a six-member panel of witnesses at the recent Legislative Council select committee mental health legislative measures hearing in Launceston. He states that “cannabis makes schizophrenia more chronic, more severe and more common and if a person keeps using cannabis it is almost impossible to get a person into remission”. The article states that one in 10 people have the “schizophrenia gene”, which increases their vulnerability to developing the condition but that “something has to happen to fire the gene off”.
Again however, Dan Lubman, Associate Professor in Addiction Psychiatry at the University of Melbourne, emphasises that rates of schizophrenia, a major psychotic illness, have remained around 1 percent for many decades. Cannabis use has been shown to increase the risk of developing schizophrenia by about twofold, and there is also consistent evidence that cannabis use substantially worsens the clinical course and treatment outcomes of individuals with psychosis.
Case backs theory on cannabis illness
This article was one of several which discussed the apparent discovery of a “cannabinoid hyperemesis” syndrome affecting a very small number of heavy cannabis users, largely reported by one group of clinicians in Adelaide. This was the first case report in the USA. Sufferers seem to gain relief from “nausea, stomach pain and bouts of vomiting” by “having a hot shower or bath”. Professor Jan Copeland, Director of NCPIC however was noted as cautioning that “more cases would need to emerge before it could be considered a new syndrome linked to very high levels of regular cannabis use”.
In addition, Professor Copeland explains that “given the relatively high prevalence of cannabis dependence, we would expect to have a far higher rate of reporting of this alleged syndrome if it were related to acute cannabis toxicity alone. The patient featured in the article was an extremely heavy cannabis smoker (1-2 hourly on a daily basis) which is noteworthy in, and of, itself. It is not unusual for there to be significant mental and physical health complications with this level of cannabis use”.
Cannabis: The battle rages
This special, in-depth feature in the Health section of the West Australian, features commentary on the issues surrounding cannabis and the upcoming “overhaul of cannabis laws” by the newly elected WA State Government. Experts featured include; Dr Paul Skerritt, psychiatrist and Australian Medical Association Psychiatry spokesman; Dan Lubman, Associate Professor in Addiction Psychiatry at the University of Melbourne; Professor Wayne Hall of the School of Population Health at the University of Queensland; Dr Wendy Swift of the National Drug and Alcohol Research Centre; Professor Simon Lenton, Deputy Director of the National Drug Research Institute; and Professor Jan Copeland, Director of the National Cannabis Prevention and Information Centre among others. If you would like a copy of the article, please contact Clare Chenoweth at c.chenoweth@unsw.edu.au
Careful – teenage brain on board
In this article, new research findings from a brain-imaging study of the teenage brain are covered in detail. University of Melbourne neuroscientist Professor Stephen Wood, comments that “the younger people start drinking or using cannabis, the worse it is for their brains.” In addition, the article states that the “earlier they start, the more likely they are to become addicted because the substances can affect the way the brain’s control mechanisms develop”.
Pills and alcohol a toxic mix
This article highlights trends in ecstasy use evident in findings from the annual Ecstasy and Related Drugs Reporting System (EDRS). Among the findings is the increase in poly-drug use, with cannabis and ecstasy being the most typical combination. Dr Kinner, Principal EDRS investigator from the Queensland Alcohol and Drug Research and Education Centre, “says users try to offset the comedown from ecstasy often punctuated by anxiety, depression and disorientation – with cannabis, more alcohol or benzodiazepines such as Valium”.
NCPIC website update: young people section
The NCPIC website is continuing to prove popular with a wide range of audiences right across the country. Alcohol and other drug workers, counselors, teachers and a range of other service providers are accessing the site and downloading information, ordering free resources and signing up to receive the NCPIC E-Zine and Bulletins.
I have been fortunate enough to be travelling the country presenting to different groups and introducing them to the site. One of the most popular sections of the site with many of the service providers continues to be the Young People component which features nine real-life stories from young Australians and answers a series of questions relevant to that topic. The topics covered include ‘greening out’, hydro or bush buds, psychosis, cannabis and driving, dependence and passive smoking. These topics were not chosen randomly. Extensive consultation with young people from around the country was conducted last year and nine topics were selected based on these discussions.
Many of the young people interviewed said that they were given a great deal of information on the short and long-term harms associated with using cannabis but there were a range of topics that they were unclear about. They wanted basic information, written in a non-judgmental way, which could answer their questions on these topics.
One of the most important elements as far as the young people were concerned was how the website information was presented. Whilst interviewing, we quickly realized that the acceptance of the design of this section of the NCPIC site would be critical to its success. We worked extremely hard with our web designers to get a ‘look’ to which young Australians would respond positively. It was decided that with the popularity of social networking sites such as Facebook and MySpace, each young person’s story should be embedded in a series of photographs and items, thus giving the reader some idea of the interests and personality of the person described.
Personal stories were regarded by those we interviewed as the most effective way to deliver the cannabis information. Many of them said that many websites usually provided factsheets and although these were great for school projects, if they really wanted to find out something for themselves they related to real-life stories. The length of information provided was also extremely important. Those interviewed said that they would not read a story that was any longer than 250 words and ‘drop-down’ answers could not be any longer than 5 lines. Put simply, if there was any more than that they simply wouldn’t read it. We also discovered that sound and moving images on a youth website are not features that are always as popular with the target audience as some of us may think. Young people said that sometimes too much content results in a site that takes too long to download and simple ‘static’ sites are preferred when they are attempting to access basic information. Without doubt the site that young people regarded as most useful in regards to accessing information was Wikepedia – the design is simple and straightforward, not too many colours or distractions and it is easy to download. One of the most important features for a website as far as young people are concerned is that the page doesn’t take too much time to download on the home computer.
Teachers have been particularly impressed with the site and have commented that it will prove to be useful in a classroom setting. We are hoping that teachers across the country will introduce their students to the site and let them read the stories and access the wide range of information provided. We are currently working on developing a series of classroom lessons to accompany the site that will assist teachers and provide valuable learning activities for students.
We have learnt a great deal putting together the NCPIC website and as a result Clare Chenoweth and I will be presenting a paper titled ‘Developing and promoting NCPIC’s website: Challenges and successes’ at the Australian Health Promotion Association 18th Annual Conference to be held in Perth later this year.
