What's new in cannabis?
A recently published NCPIC Research Brief, ‘Evidence-based interventions for cannabis use disorder’, can be found at the following link: www.ncpic.org.au/ncpic/publications/research-briefs/. This Research Brief focuses on treatment options for cannabis use disorder and the need for randomly controlled trials on the effectiveness of treatments such as pharmacological interventions and those designed for psychiatrically comorbid cannabis users. Cognitive behavioural therapy and motivational enhancement therapy, amongst others, have been shown to be most effective in reducing cannabis use, dependence and related problems but more exploration of the effectiveness of other forms of treatments and models of delivery are recommended.
Director's report
Jan Copeland (PhD) (Professor/Director NCPIC)
Over the past month, we have been working on raising awareness of cannabis related issues in the community generally and key target groups, in particular. This month’s E-Zine contains a report from Clare Chenoweth, our communications officer, on the results of our first national school poster competition. We were thrilled by the quality and range of entries from high schools across the country. Congratulations to Amanda Olsson from Blackburn High School on her winning entry. Her poster, based on a marionette being manipulated by his/her cannabis use, was a thoughtful metaphor and will be adopted in our social marketing campaigns in the future. There were some excellent entries from the other four finalists, and all of these posters will be available on the NCPIC website.
In response to our latest NCPIC Bulletin on the low number of presentations to Australian GPs where cannabis is raised as an issue, we have adopted an initiative to assist medical practitioners to assess, inform and intervene for their patients about cannabis related issues. Medical Director is an electronic patient management and prescription writing system used by more than 80% of GPs across Australia. We have purchased advertising space to raise awareness of our website and free national helpline. More importantly, we have developed 10 factsheets, specially designed for medical practitioners, that can be accessed when key words are entered into the patient’s notes. This easily accessed and targeted material should encourage GPs to enquire about patients’ cannabis use when they present with targeted conditions and help to inform their responses.
This month has also seen the launch of one of our young people’s sections of the NCPIC website. This young people’s section is formatted to be similar to pages from Facebook and to provide a series of questions and answers that research tells us young people are keen to know about cannabis. There are a number of exciting developments planned for the website over the coming months, particularly material for use by those interested in workplace and workforce cannabis related issues, as well as materials for clinicians and those working with indigenous populations.
Research publications
Relevant publications examining issues to do with cannabis that have been published in the last month include the following:
Barkus, E. & Lewis, S. (2008). Schizotypy and psychosis-like experiences from recreational cannabis in a non-clinical sample. Psychological Medicine 38, 1267-1276.
Benyamina, A., Lecacheux, M., Blecha, L., Reynaud, M., & Lukasiewicz, M. (2008). Pharmacotherapy and psychotherapy in cannabis withdrawal and dependence. Expert Reviews Neurotherapeutics 8, 479-491.
Crano, W.D., Siegel, J.T., Alvaro, E.M., Lac, A., & Hemovich, V. (2008). The at-risk adolescent marijuana nonuser: Expanding the standard distinction. Prevention Science 9, 129-137.
Dawes, M.A., Richard, D.M., Mathias, C.W., & Dougherty, D.M. (2008). Prospective study of cannabis withdrawal in cannabis-using adolescents. Journal of the American Academy of Child and Adolescent Psychiatry 47, 1095-1096.
Fisk, J. & Montgomery, C. (2008). Real-world memory and executive processes in cannabis users and non-users. Journal of Psychopharmacology 22, 727-736.
Hampson, S.E., Andrews, J.A. & Barckley, M. (2008). Childhood predictors of adolescent marijuana use: Early sensation-seeking, deviant peer affiliation, and social images. Addictive Behaviours 33, 1140-1147.
Harder, V.S., Stuart, E.A. & Anthony, J.C. (2008). Adolescent cannabis problems and young adult depression: Male-female stratified propensity score analyses. American Journal of Epidemiology 168, 592-601.
Hayatbakhsh, M.R., Mamun, A.A., Najman, J.M., O'Callaghan, M.J., Bor, W., & Alati, R. (2008). Early childhood predictors of early substance use and substance use disorders: Prospective study. Australian and New Zealand Journal of Psychiatry 42, 720-731.
Hayatbakhsh, M.R., O'Callaghan, M.J., Jamrozik, K., Najman, J.M., Mamun, A.A., Alati, R., & Bor, W. (2008). The association between school performance at 14 years and young adults' use of cannabis: An Australian birth cohort study. Journal of Drug Issues 38, 401-418.
Howard, C. (2008). Application of new DNA markers for forensic examination of cannabis sativa seizures: Developmental validation of protocols and a genetic database. NDLERF Monograph Series No. 29. Hobart: National Drug Law Enforcement Research Fund.
Hughes, J.R., Peters, E.N., Callas, P.W., Budney, A.J., & Livingston, A.E. (2008). Attempts to stop or reduce marijuana use in non-treatment seekers. Drug and Alcohol Dependence 97, 180-184.
Johnson, B.D., Ream, G.L., Dunlap, E., & Sifaneck, S.J. (2008). Civic norms and etiquettes regarding marijuana use in public settings in New York City. Substance Use and Misuse 43, 895-918.
Kirkham, T. (2008). Endocannabinoids and the neurochemistry of gluttony. Journal of Neuroendocrinology 20, 1099-1100.
Klein, A. (2008). Cannabis reclassification: A modest plea for a coherent justification. (Editorial). Drugs and Alcohol Today 8, 2-5.
Konings, M., Henquet, C., Maharajh, H.D., Hutchinson, G., & Van Os, J. (2008). Early exposure to cannabis and risk for psychosis in young adolescents in Trinidad. Acta Psychiatrica Scandinavica 118, 209-213.
Korhonen, T., Huizink, A.C., Dick, D.M., Pulkkinen, L., Rose, R.J., & Kaprio, J. (2008). Role of individual, peer and family factors in the use of cannabis and other illicit drugs: A longitudinal analysis among Finnish adolescent twins. Drug and Alcohol Dependence 97, 33-43.
Legleye, S., Ben Lakhdar, C. & Spilka, S. (2008). Two ways of estimating the euro value of the illicit market for cannabis in France. Drug and Alcohol Review 27, 466-472.
Losoya, S.H., Knight, G.P., Chassin, L., Little, M., Vargas-Chanes, D., Mauricio, A., & Piquero, A. (2008). Trajectories of acculturation and enculturation in relation to heavy episodic drinking and marijuana use in a sample of Mexican American serious juvenile offenders. Journal of Drug Issues 38, 171-198.
Mariani, J.J., Horey, J., Bisaga, A., Aharonovich, E., Raby, W., Cheng, W.Y., Nunes, E., & Levin, F.R. (2008). Antisocial behavioural syndromes in cocaine and cannabis dependence. American Journal of Drug and Alcohol Abuse 34, 405-414.
Marie, D., Fergusson, D.M. & Boden, J.M. (2008). Links between ethnic identification, cannabis use and dependence, and life outcomes in a New Zealand birth cohort. The Australian and New Zealand Journal of Psychiatry 42, 780-788.
Mata, I., Rodríguez-Sánchez, J.M., Pelayo-Terán, J.M., Pérez-Iglesias, R., González-Blanch, C., Ramírez-Bonilla, M., Martínez-García, O., Vázquez-Barquero, J.L., & Crespo-Facorro, B. (2008). Cannabis abuse is associated with decision-making impairment among first-episode patients with schizophrenia-spectrum psychosis. Psychological Medicine 38, 1257-1266.
Milin, R., Manion, I. & Walker, S. (2008). Prospective study of cannabis withdrawal in cannabis-using adolescents. Journal of the American Academy of Child and Adolescent Psychiatry 47, 1096.
Montisci, M., Thiene, G., Ferrara, S.D., & Basso, C. (2008). Cannabis and cocaine: A lethal cocktail triggering coronary sudden death. Cardiovascular Pathology 17, 344-346.
Noller, G. (2008). High in the saddle: Cannabis-affected driving. Matters of Substance 18, 20-21.
Perkonigg, A., Goodwin, R.D., Behrendt, S., Beesdo, K., Lieb, R., & Wittchen, H.U. (2008). Cannabis use - do we have solutions? A reply to Macleod. Addiction 103, 1575.
Rhodes, W.A., Peters, R.J. Jr., Perrino, C.S., & Bryant, S. (2008). Substance use problems reported by historically Black college students: Combined marijuana and alcohol use versus alcohol alone. Journal of Psychoactive Drugs 40, 201-205.
Sewell, R.A., Cohn, A.J. & Chawarski, M.C. (2008). Doubts about the role of cannabis in causing lung cancer. The European Respiratory Journal 32, 815-816.
Stirling, J., Barkus, E.J., Nabosi, L., Irshad, S., Roemer, G., Schreudergoidheijt, B., & Lewis, S. (2008). Cannabis-induced psychotic-like experiences are predicted by high schizotypy. Confirmation of preliminary results in a large cohort. Psychopathology 41, 371-378.
Swan, M., Schwartz, S., Berg, B., Walker, D., Stephens, R., & Roffman, R. (2008). The teen marijuana check-up: An in-school protocol for eliciting voluntary self-assessment of marijuana use. Journal of Social Work Practice in the Addictions 8, 284-302.
Swift, W., Coffey, C., Carlin, J.B., Degenhardt, L., & Patton, G. (2008). Adolescent cannabis users at 24 years: Trajectories of ongoing and problematic use. Addiction 103, 1361-1370.
Toennes, S.W., Ramaekers, J.G., Theunissen, E.L., Moeller, M.R., & Kauert, G.F. (2008). Comparison of cannabinoid pharmacokinetic properties in occasional and heavy users smoking a marijuana or placebo joint. Journal of Analytical Toxicology 32, 470-477.
Veling, W., Mackenbach, J.P., van Os, J., & Hoek, H.W. (2008). Cannabis use and genetic predisposition for schizophrenia: A case-control study. Psychological Medicine 38, 1251-1256.
Walley, A.Y., Krupitsky, E.M., Cheng, D.M., Raj, A., Edwards, E.M., Bridden, C., Egorova, V.Y., Zvartau, E.E., Woody, G.E., & Samet, J.H. (2008). Implications of cannabis use and heavy alcohol use on HIV drug risk behaviours in Russian heroin users. AIDS and Behaviour 12, 662-669.
Xian, H., Scherrer, J.F., Grant, J.D., Eisen, S.A., True, W.R., Jacob, T., & Bucholz, K.K. (2008). Genetic and environmental contributions to nicotine, alcohol and cannabis dependence in male twins. Addiction 103, 1391-1398.
Commentary on research
Are cannabis use and anxiety unrelated in adolescents?
In response to a gap in the adolescent comorbidity literature, Low et al.1 examined the degree to which anxiety disorders are associated with cannabis and alcohol abuse disorders among adolescents.
To do this, they conducted clinical telephone interviews with 632 13-19 year-olds recruited from primary care settings in Eastern, Midwestern and Western regions of the United States. In their interviews, the authors screened for the current presence of an anxiety disorder (panic disorder, generalized anxiety disorder, or anxiety disorder not otherwise specified), cannabis abuse, alcohol abuse, and/or a mood disorder (major depressive episode, dysthymia, or minor depression), using the Primary Care Evaluation of Mental Disorders (PRIME-MD) instrument.
In relation to cannabis abuse in particular, Low et al. found that 11.1% of the participants with an anxiety disorder also had cannabis abuse disorder, and 9.1% of those with cannabis abuse disorder also had an anxiety disorder. In addition, the authors discovered that after controlling for the presence of a mood disorder and other potential confounds, there was a strong association between current alcohol abuse and an anxiety disorder, but no association between a current anxiety disorder and cannabis abuse.
Before it can be concluded, however, that there is no association between cannabis abuse and anxiety, a number of this study’s methodological limitations ought to be taken into consideration. The cross-sectional nature of this study, where current point-in-time substance abuse, anxiety and mood disorders were measured, fails to take into consideration the fluctuating nature of psychological disorders, and furthermore fails to establish causality where associations exist.
Moreover, only a subset of anxiety disorders was screened for. Several were ignored, including those with avoidant features, such as social phobia and other phobic disorders; however, sufferers of these disorders may be disinclined to engage with primary health care settings. Indeed, drawing samples of adolescents from primary care settings may exclude multiple populations with cannabis use, anxiety and other disorders of varying severity and specification.
Despite these and other limitations, however, this study indicates that cannabis abuse and anxiety disorders may not be associated in a highly accessible group of adolescents with a limited subset of anxiety disorders. Perhaps more significantly, this study highlights the importance of clarifying the association between cannabis use and anxiety disorders across multiple populations of adolescents.
- Low, N.C., Lee, S.S., Johnson, J.G., Williams, J.B., & Harris, E.S. (2008). The association between anxiety and alcohol versus cannabis abuse disorders among adolescents in primary care settings. Family Practice, 7 pages. Advance online publication. Retrieved September 8, 2008. doi:10.1093/fampra/cmn049.
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
Illicit drug use on decline
This article discusses the recent results from the Australian Institute of Health and Welfare’s National Drug Strategy Household Survey, including the finding that from 2004 to 2007, cannabis use in New South Wales fell from 10.7 per cent to 8 per cent. The survey also found that use of illicit drugs has dropped from 14.6% in 2004 to 12.1% in 2007.
Mental health and drug abuse
Collaborative meetings between two specialty services, Drug and Alcohol and Mental Health, operated by Hunter New England Health, are being video-linked to Newcastle where they are chaired by clinical nurse consultant for NSW Health’s dual diagnosis service, Richard Clancy. He acknowledges that the good will of all parties and the sharing of resources is allowing the “best possible treatment options for shared patients” to come about. In terms of cannabis use, he says previous studies have shown that “the younger a person was when they tried cannabis the more likely they were to develop mental health problems during their life.” NSW Health is now creating clinical guidelines of recommended treatments derived from the work of representatives of both the mental health and drug and alcohol sectors from around the state.
Smoke alarm: dope use hooks puff daddies onto nicotine
Cigarette smoking amongst North Coast males aged between 25 and 34 has been found to be the highest in NSW, according to a study done by the North Coast Area Health Service and the University of Sydney. Three in five of these men smoke, and the widespread practice of “mulling”, or the mixing of cannabis with tobacco, is thought to be a contributing factor to their higher rates of nicotine dependence.
Nice one
This report states that there is a "new drug that could relieve pain like marijuana does without affecting the brain. Imperial College London researchers studied two kinds of receptors in the nervous system - CB1 and CB2. Marijuana activates those, blocking pain signals. Because CB1s are found in the brain as well as other parts of the body, blocking them affects the brain. But blocking CB2s could stop pain without clouding thinking or leading to dependency and abuse, the researchers claimed."
Youth living on the brink
A number of articles featured results from the Australian Temperament Project, a 23-year, federally funded study involving 2400 young people that gives an insight into this group of Australians, now in their mid-20s. The results included the finding that “one-fifth use marijuana, other illegal drugs or are regular binge drinkers”.
Cannabis infects remote life
This article describes Professor Alan Clough’s assessment of the use of cannabis in remote indigenous communities. Professor Clough, of James Cook University, is reported as saying, “almost a quarter of indigenous people in remote Northern Territory communities are regular cannabis users, with 90 per cent of those being classed as addicts.” The article states that indigenous children in these areas, from the age of 10, are starting to smoke cannabis and “some people are spending as much as 60 per cent of their income on the drug”. Professor Clough is developing a study with Queensland Police to reveal how widespread the problem is in Cape York. He believes that education about the risks of cannabis to mental health, together with “law enforcement and control of the supply” are the best ways to tackle this issue.
Malcom’s no dope
Malcolm Turnbull, leader of the Opposition, has been praised by cannabis experts, including NCPIC’s Professor Jan Copeland, for his “refreshingly honest” admission that he has smoked cannabis, although he “added that it was a mistake”. She goes on to say that this admission was “credible and responsible”. Her comments on the issue were widely publicised in papers and on radio stations across Australia.
Depression, psychosis strike dope smokers
NCPIC’s Bulletin, ‘The management of cannabis use in Australian general practice’, received extremely widespread coverage in Australian newspapers and on radio stations. This article, like many others, focussed on the findings in the BEACH study (Bettering the Evaluation and Care of Health), that “cannabis smokers are more likely to suffer depression, anxiety, and psychosis than those people who take stimulants.” The article goes on to say that, “of patients who mentioned cannabis use to their GP, 48% had a psychological problem, including 19% with depression and 9% with psychosis...six per cent had anxiety.” While our media release about the Bulletin focussed on the main finding of the study, that Australian GPs report a low number of presentations where cannabis is raised as an issue, the articles instead highlighted the mental health related aspects.
Poster competition results
The 2008 NCPIC Poster Competition generated some wonderfully creative, innovative, and thoughtful responses from over 130 high school students from around Australia. The judging panel was impressed with the standard of entries received and the wide range of ideas and concepts used to portray the message in the brief, namely, the importance of seeking help if you or a friend have been experiencing problems with cannabis.
The criteria that the posters were judged on included creativity, design, originality, and effectiveness in conveying a message on the topic.
Congratulations to our winner, Amanda Olsson of Blackburn High School, Victoria, whose poster ‘Marionette’ really stood out and conveyed a powerful and effective message about seeking help. Congratulations also to the other finalists. Extracts from the entrants’ explanations of their posters are also included.
Winner:
Marionette
“I wanted to show how cannabis makes you lose control over yourself, like a puppet being manipulated. Her blank face represents how she has hidden away from those around her, not showing her true state. I used a fairly simple design, because I thought it needed to convey the message without distractions. The cannabis leaf is made to represent a puppeteer’s ‘cross’ that controls her actions.”
Finalists:
Don’t dice with your life
“My entry is to make people aware of the effects of smoking cannabis. For the people who are using it or maybe thinking about it, the poster is set out as the well known game ‘snakes and ladders’, either climb the ladder for help, or slide down the snake to either prison, effects or impaired judgement. The ladder leads to help, help from NCPIC.”
Not thinking - sinking!
“I made sure that my poster was eye-catching with contrast. It is not supposed to be literal but it just means that your life will go downhill... I also liked the ad how this drunk guy falls into the ocean and tries to swim to the surface but he drowns. It turns out that he was swimming down not up. It really got the message through and I hope to do the same.”
My cannabis poster
“My entry shows a girl, called Lily, who is worried about her older brother because he’s dependent on cannabis. So she looks up the helpline on the internet, gives her brother the number and phone and after a few weeks everything is fine.”
Smoking cannabis can affect sex life
“Because of the attitude of...teenage males (in particular the stereotype that use cannabis), I decided it would be hard to portray a message that this group would take seriously. After extensive research I discovered that smoking cannabis can affect a male’s ability to perform sexually/their sexual drive... Being able to perform well sexually is very important for a male, therefore I decided this would be the most appropriate message to portray through my poster as it would be realistic for teenage males. My poster portrays the image of the top friends on Myspace of males. I chose Myspace because I know teenagers of this generation.”
