What's new in cannabis?
Study: working with CALD clients with co-existing issues (NSW)
NCPIC and the Drug and Alcohol Multicultural Education Centre (DAMEC) are investigating the pathways and barriers people from culturally and linguistically diverse (CALD) backgrounds experience when accessing services for co-existing mental health and cannabis use issues. DAMEC is interested in workers’ experiences with CALD and non-CALD clients, and in CALD and non-CALD clients’ experiences of these services. The aim of the project is to generate discussion and knowledge around equity of access to services for people from CALD backgrounds who have coexisting cannabis and mental health issues. Contact Ian or Connie at (02) 9699 3552, or at research@damec.org.au for more information.
Communications report
Paul Dillon (National Communications Manager, NCPIC)
At the heart of the NCPIC Communications Strategy is the NCPIC website. Since the site’s original launch we have discussed specific components that we have been working on in various E-Zines and we still have exciting plans to let you know about in the coming months. However, one part of the site that is proving extremely fulfilling to work on is the Indigenous Communities component.
In November 2008, NCPIC staff travelled to Cairns to take part in a workshop targeting Indigenous communities in the far north of Queensland. After presenting at this workshop, and later visiting a number of communities in the area, NCPIC developed the following project to assist in the development of the best quality web-based resource for Indigenous communities and their service providers.
Community consultations suggest that Indigenous cannabis users are unlikely to access a website for information on cannabis. Therefore the target audience for our site are not users themselves, but service providers. Consultation with these workers has suggested that developing resources for users is not likely to be effective. We will therefore be developing web-based materials for workers to ensure that they are well-equipped to deal with any cannabis-related questions that may arise with their clients.
After consultation with key experts in the area, as well as a number of Indigenous communities, we have decided on the theme of ‘Cannabis: It’s not our culture’ for this section of the website. Seven communities have been selected to take part in this project and they are as follows:
- Lockhart River (Qld)
- Thursday Island (Qld)
- Nowra (NSW)
- Griffith (NSW)
- Tabulam (NSW)
- Kintore (Walungurru) – Alice Springs (NT)
- Geelong (Vic)
The first part of the project is based around a commissioned piece of artwork. This piece will be developed around the theme ‘Cannabis: It’s not our culture’ and will be ‘solution-based’ wherever possible, i.e., what can be done about the issue. Along with the artwork we will also ask the community representative to supply a short story outlining the issue and the associated problems, together with any possible solutions (or at least the importance of a solution).
These seven pieces of artwork and their accompanying stories will be the basis for the website, as well as posters, and assist us in the development of further resources for workers in Indigenous communities.
Members of the Communications Team (as well as Dr John Howard who kindly agreed to help us), have visited all the communities in an attempt to develop relationships with the relevant service providers and also meet the artists who have agreed to create a piece of artwork. We are hoping to have the site live by early July and also have a range of new web-based resources for workers available at the same time. Keep an eye-out for announcements in upcoming E-Zines.
Research publications
Relevant publications examining issues to do with cannabis that have been published in the last month include the following:
- Brodie, L., Lyndal, B. & Elias, I.J. (2009). Heavy vehicle driver fatalities: Learning’s from fatal road crash investigations in Victoria. Accident; Analysis and Prevention 41, 557-564.
- Fletcher, A., Bonell, C., Sorhaindo, A., & Rhodes, T. (2009). Cannabis use and ‘safe’ identities in an inner-city school risk environment. International Journal on Drug Policy 20, 244-250.
- Hall, W. & Lynskey, M. (2009). The challenges in developing a rational cannabis policy. Current Opinion in Psychiatry 22, 258-262.
- Hunault, C.C., Mensinga, T.T., Böcker, K.B., Schipper, C.M., Kruidenier, M., Leenders, M.E., de Vries, I., & Meulenbelt, J. (2009). Cognitive and psychomotor effects in males after smoking a combination of tobacco and cannabis containing up to 69 mg delta-9-tetrahydrocannabinol (THC). Psychopharmacology 204, 85-94.
- Muhuri, P.K. & Gfroerer, J.C. (2009).Substance use among women: Associations with pregnancy, parenting, and race/ethnicity. Maternal and Child Health Journal 13, 376-385.
- Ramaekers, J., Kauert, G., Theunissen, E., Toennes, S., & Moeller, M. (2009). Neurocognitive performance during acute THC intoxication in heavy and occasional cannabis users. Journal of Psychopharmacology 23, 266-277.
- Ranganathan, M., Braley, G., Pittman, B., Cooper, T., Perry, E., Krystal, J., & D’Souza, D.C. (2009). The effects of cannabinoids on serum cortisol and prolactin in humans.
Psychopharmacology 203, 737-744. - Ross, A.J. & Davies, J.B. (2009). Cannabis ‘drugspeak’ from young people in Easterhouse, Glasgow. Drugs: Education, Prevention and Policy 16, 152-166.
- Satyanarayana, V. (2009). Mental health consequences of cannabis use. Acta Psychiatrica Scandinavica 119, 411-412.
- Scuderi, C., Filippis, D.D., Iuvone, T., Blasio, A., Steardo, A., & Esposito, G. (2009). Cannabidiol in medicine: A review of its therapeutic potential in CNS disorders. Phytotherapy Research 23, 597-602.
- Sewell, R.A., Poling, J. & Sofuoglu, M. (2009). The effect of cannabis compared with alcohol on driving. The American Journal on Addictions 18, 185-193.
- Wu, L.T., Pan, J.J., Blazer, D.G., Tai, B., Stitzer, M.L., Brooner, R.K., Woody, G.E., Patkar, A.A., & Blaine, J.D. (2009). An item response theory modeling of alcohol and marijuana dependences: A National Drug Abuse Treatment Clinical Trials Network study. Journal of Studies on Alcohol and Drugs 70, 414-425.
- Zaldívar Basurto, F., García Montes, J.M., Flores Cubos, P., Sánchez Santed, F., López Ríos, F., & Molina Moreno, A. (2009). Validity of the self-report on drug use by university students: Correspondence between self-reported use and use detected in urine. Psicothema 21, 213-219.
Commentary on research
Neurocognitive performance during acute THC intoxication in heavy and occasional cannabis users – a comment on Ramaekers, Kauert, Theunissen, Toennes, and Moeller (2009)
Although research indicates that heavy, long-term cannabis users may develop tolerance to the subjective and physiological effects of HC, it remains unclear whether they develop tolerance to the performance impairing effects of THC. Seeking to clarify this issue, Ramaekers and colleagues1 (2009) randomly administered 500 μg/kg THC and a placebo cigarette to 24 young adults (12 occasional and 12 regular, heavy users of cannabis) on two separate occasions, at least one week apart. Participants were monitored and assessed repeatedly for eight hours following drug administration (and placebo). Participants’ ‘subjective high’, systolic and diastolic blood pressure, and heart rate were measured,as well as neurocognitive ability. Systolic and diastolic blood pressure remained constant in both groups following THC administration, while occasional users evidenced an increased heart rate and a greater ‘subjective high’ than heavy users. Heavy users showed minimal performance decrements in neurocognitive ability, other than slower reaction time and possible impulse control difficulties at higher THC concentrations. On the other hand, occasional users showed poorer performance on most assessments, including tracking performance, divided attention, and inhibitory control. For this group, deficits were evident at lower THC concentrations, with a worsening of performance at higher concentrations. Further, a longer history of use predicted decreased deficits in the heavy user group.
Although the sample size was relatively small, this study provides initial evidence for an acquired tolerance to the acute,performance impairing effects of THC in young individuals. The authors suggested that the heavy users might learn to recruit alternate brain structures in the completion of the tasks over time, as standard structures are overloaded regularly by consistent exposure to THC. This explanation is consistent with emerging evidence of the ability of an impaired brain to form new neural pathways in the completion of tasks that would otherwise require the use of affected areas. This appears to be in a manner that, while possibly less efficient, is still viable.
As the participants in this study were young adults, they were more likely to have increased cognitive reserves for the formation of new neural pathways. A lack of older participants though prevents examination of any age-related effects. Based on the study’s findings, the authors speculated that occasional cannabis users may be over-represented compared to regular users of cannabis, among those involved in motor vehicle accidents. While both groups showed deficits in skills required for driving when under the influence of cannabis, this was more evident for the occasional users. It should be noted, however, that the heavier cannabis users, while demonstrating some neuroadaptation, still had performance deficits that could contribute to road traffic accidents.
- Ramaekers, J.G., Kauert, G., Theunissen, E.L., Toennes, S.W., & Moeller, M.R. (2009). Neurocognitive performance during acute THC intoxication in heavy and occasional cannabis users. Journal of Psychopharmacology 23, 266-277.
Media stories this issue
âĞEach 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
Online mental health education for all Australian adolescents: ‘climate schools’
This article features ‘Climate Schools’, a “collection of web-based courses to teach students about health and well being”, that the National Drug and Alcohol Research Centre at the University of New South Wales has developed. It has “been delivered in its first two years to thousands of students across Australia” and “results of randomized trials have shown significant improvements in knowledge and behaviour amongst participating students.” One of the courses in the collection is cannabis specific, titled ‘Alcohol and Cannabis’.
8-year-olds smoking pot
This article somewhat sensationally discusses a paper presented to parliament by the president of the Australian Parents for Drug Free Youth, Herschel Mills Baker, and member for Maryborough, Chris Foley, on the topic of cannabis use amongst Australian youth. The paper claims that “children as young as 8 are starting to experiment” with cannabis and that the “average age of first cannabis use had dropped from 17.4 years old in 1988 to 12 years old in 2009.” Links between cannabis use and mental health issues are highlighted, along with the claim that “cannabis is a gateway drug – early cannabis smokers are up to five times more likely to move onto the harder drugs.” Baker further states that “cannabis potency has doubled”.
“This paper is a concerning mix of truth, half-truth and ‘just plain wrong’” says Professor Jan Copeland, Director of NCPIC. The average age of first cannabis use is 18.8 years in the 2007 National Drug Strategy Household Survey and even among those aged 12-15 years is 13.6 years. While cannabis users, particularly those who start before the age of 16 are much more likely to use other illicit drugs, the strongest evidence is for a common cause hypothesis that makes it more likely for someone to use any drugs at a very early age and be more of a risk-taker in all areas of their lives.
The pulse
A recent study published in the Canadian Medical Association Journal has found that people who smoke cannabis as well as tobacco cigarettes are more likely to have lung problems such as chronic obstructive pulmonary disease than those who smoke tobacco alone.
High incidence of drug use among arrested women
Research by the Australian Institute of Criminology has found that “for women, drug use often leads to crime, but for men it is crime that leads to drug use.” Women detained by police were likely to be found using “injectable drugs such as amphetamines and methlyamphetamines or heroin”, while men “were more likely to have been using alcohol and cannabis than other illicit drugs when they were first arrested.”
You must be stupid to do this to your brain
A new book, ‘Change your brain, change your life’, written by neuroscientist and psychiatrist Daniel Amen at the University of California, shows brain scan images which reveal that “the effects of long-term and heavy use of alcohol and coffee can be just as striking as the damage caused by illegal drugs such as cannabis or cocaine.” He says that use of these substances, especially in large amounts, can cause a lack of blood supply to parts of the brain, “reducing activity and affecting the patient’s behaviour.” The article shows a brain scan from a 16-year-old boy who used cannabis daily, for two years. The temporal lobes, an area responsible for memory, are shown to be damaged.
Polluted air’s high quality
A study of air pollution in Madrid and Barcelona has found that the air in these cities is “laced with large amounts” of cocaine. Other substances found included amphetamines, heroin and cannabis. The article states that these levels “were far higher than elsewhere in Europe.”
MPs set up probe into drugs
Cannabis will be one of the main focuses of an investigation into illicit drug use by a “bipartisan parliamentary committee.” The newly formed Social Development Committee will conduct the investigation which was voted for in favour, by the Queensland Government in May. The committee “will investigate how drugs get into society, their impact and potential solutions.”
Drug testing in schools
Queensland Independent MP, Peter Wellington’s fellow “89 state MPs [have] supported his parliamentary motion to refer Drug Free Australia’s report, ‘Cannabis: suicide, schizophrenia and other ill-effects’ research paper for investigation.” He suggests that “testing for cannabis use in Queensland secondary schools could soon become a reality.” However, Queensland Council of P & C president, Margaret Black, does not support drug testing at schools, saying it is expensive and that “energy and effort should be put into education and prevention and targeting the traffickers.”
Tackle issue at grassroots
A seminar run by GP and Generation Next youth program founder Ramesh Manocha, aims to assist parents to deal with issues caused by young people using cannabis. He aims to give young people “alternatives and teach them, at a young age, the risks associated with consuming” drugs such as cannabis and alcohol.
Mulling it over: Cannabis intervention in primary health care
NCPIC was recently invited to be part of an exciting initiative produced by the Rural Health Education Foundation (RHEF) funded by the Australian Government Department of Health and Ageing. The television program, Mulling It Over: Cannabis Intervention in Primary Health Care, which aired on Tuesday 26th May was designed to improve the knowledge, skills and capacity of health professionals to detect and treat cannabis use problems and associated harms. The hour-long program examined the latest research, interventions and best practice treatment options and outlined the principles of a brief intervention, and was designed to assist primary health care practitioners to recognise and screen high-risk groups.
Run as a panel discussion chaired by Dr Norman Swan, Presenter of the Health Report on ABC Radio National, the program featured some leading cannabis researchers and practitioners including NCPIC Director, Professor Jan Copeland and one of our collaborators, Associate Professor Alan Clough from the School of Public Health, Tropical Medicine & Rehabilitation Science and School of Indigenous Australian Studies at James Cook University in Cairns. Other panel members were Ms Tess Finch, Manager of the Sutherland Cannabis Clinic, SESIAHS, in Sydney and Dr Fares Samara, a General Practitioner and Fellow of the Chapter of Addictions Medicine in Kempsey, NSW.
“Cannabis is still the easiest to obtain, most widely used and least disapproved of illicit drug in Australia, and its use is increasing in our Indigenous communities,” said Rural Health Education Foundation CEO Don Perlgut. “But there is growing evidence that cannabis use is associated with mental health problems, respiratory disorders, road accidents, and other illicit drug use.”“This new program explores the role of primary health care professionals in rural practice and the issues they face in dealing with cannabis use,” Mr Perlgut said. “It also provides effective evidence-based interventions for the prevention and treatment of cannabis-related problems.” The best news for those who did not get to see the program when it aired is that the RHEF plans to make a DVD version available in the near future.
The program will also be available free on the Internet for viewing via webstreamed video or listening via an audio podcast. For more information about this program – including presenter details, access instructions and associated educational resources – refer to the online program summary or contact the Foundation by email at rhef@rhef.com.au.
Mulling It Over: Cannabis Intervention in Primary Health Care complements the Foundation’s 2006 program The Can Do Initiative: Managing Mental Health and Substance Use in General Practice, which provides an introduction to the ADGP’s Can Do Initiative and explores the needs of patients with mental health and substance use issues and how they can be recognised and effectively managed.
