Bernadette Rogerson

An exploratory study of cannabis withdrawal among Indigenous Australian prison inmates: study protocol.

Introduction Cannabis use and dependence is a serious health and criminal justice issue among incarcerated populations internationally. Upon abrupt, enforced cessation of cannabis, prisoners may suffer irritability and anger that can lead to threatening behaviour, intimidation, violence, sleep disturbances and self-harm. Cannabis withdrawal syndrome, proposed for inclusion in the Diagnostic and Statistical Manual of Mental Disorders in 2013, has not been examined in Indigenous populations. Owing to the exceptionally high rates of cannabis use in the community, high proportions of Australian Indigenous prisoners may suffer from withdrawal upon entry to custody. Methods and analysis 60 male and 60 female Indigenous prisoners (18–40 years) at a high risk of cannabis dependence will be recruited upon entry to custody. A pictorial representation of the standard Cannabis Withdrawal Scale will be tested for reliability and validity. Cortisol markers will be measured in saliva, as the indicators of onset and severity of cannabis withdrawal and psychological distress. The characteristics will be described as percentages and mean or median values with 95% CI. Receiver operator curve analysis will determine an ideal cut-off of the Cannabis Withdrawal Scale and generalised estimating equations modelling will test changes over time. The acceptability and efficacy of proposed resources will be assessed qualitatively using thematic analysis. Outcomes A valid and reliable measure of cannabis withdrawal for use with Indigenous populations, the onset and time course of withdrawal symptoms in this population and the development of culturally acceptable resources and interventions to identify and manage cannabis withdrawal. Ethics and dissemination The project has been approved by the James Cook University Human Research Ethics Committee (approval number H4651).The results will be reported via peer reviewed publications, conference, seminar presentations and on-line media for national and international dissemination.

Cannabis use, dependence and withdrawal in indigenous male inmates

Abstract Background: No studies have investigated cannabis withdrawal in indigenous or incarcerated populations, and there is currently no standard treatment for cannabis withdrawal in Australian prisons. Aims: This cross sectional survey examines cannabis use, dependence and involuntary (abrupt cessation) withdrawal in incarcerated indigenous males for the purpose of improving clinical management. Methods: 101 consenting inmates (18–40 years) from an Australian correction centre were interviewed. Demographic characteristics, lifetime cannabis use (LCU), severity of dependence, cannabis withdrawal symptoms, psychological well-being and alcohol use were measured and compared using univariate and multivariate analyses. Results: Cannabis withdrawal symptoms were reported in 57% of current cannabis users compared with 16% of non-users (p < 0.01), indicating detectable cannabis dependence and withdrawal in a unique indigenous inmate population. Multivariate analysis revealed statistically significant associations between LCU and cannabis dependence (OR = 8.1; 95% CI: 2.2–29.1) when controlling for psychological well-being and alcohol consumption. Conclusions: Upon admission to a correction centre, cannabis users should be assessed and monitored for physical and psychological symptoms of withdrawal. Implications: Routine cannabis withdrawal monitoring will maximise staff and inmate safety. This improvement to policy will ensure appropriate risk management of staff and inmates.

Lifetime Influences for Cannabis Cessation in Male Incarcerated Indigenous Australians

Abstract Introduction: Urban non-indigenous populations report life events (marriages, employment) as influences for self-initiated cannabis cessation. However, this hasn’t been investigated in remote indigenous populations with different social paradigms. Methods: We investigate cannabis use, harms, and poly-substance misuse in 101 consenting male incarcerated indigenous Australians. Interviews applied quantitative and qualitative questions assessing demographic characteristics, criminal history, drug use, the Marijuana Problems Inventory (MPI), and cannabis-cessation influences. Comparisons used Chi Square, Analysis of Variance, and Nvivo software. Results: Cannabis use groups (current users, ex-users, and never users) were demographically similar except that current users reported more juvenile legal problems, younger school departure, and lower school achievement (p < 0.05). Mean cannabis consumption was 12.3 cones/day. Incarceration and family responsibilities were the strongest cessation influences. Employment responsibilities and negative self-image were rarely cited as influences. Discussion: High cannabis use, with its associated problems, is concerning. These identified influences indicate incarceration should be used for substance reduction programs, plus post-release follow-up. Community-based programs focusing on positive influences, such as family responsibilities and social cohesion, may be successful within indigenous populations with strong kinship responsibilities, rather than programs that focus solely on substance harms.

“Stressing out”: defining severity of cannabis withdrawal symptoms in Australian indigenous inmates

Abstract Background: No previous studies have investigated cannabis withdrawal severity in indigenous or incarcerated populations. Aims: We sought to quantify life-time cannabis use, report cannabis withdrawal symptoms and severity, and define the holistic experience of cannabis withdrawal. Methods: Seventy consenting males (18–40 years) from an Australian correctional center were interviewed about lifetime cannabis use and experience of withdrawal upon incarceration. Results: Findings indicate that participants smoked on average 12.3 cones or joints/day (95%CI: 9.5–15.2) for 9.4 years (95%CI: 7.6–11.1). Cannabis withdrawal symptoms most frequently reported were; physical symptoms (52.9%), insomnia (52.9%) and depressed mood (47.1%). The most severe symptoms were insomnia (22.9%), nervousness/anxiety (17.1%) and aggression (14.3%). Analysis further revealed the construct of “stressing out”, defined as a highly anxious state with increased aggression. Conclusions: Insomnia and physical symptoms were the most commonly reported symptoms with insomnia and nervousness/anxiety the most severe. Psychological symptoms were also voiced by this population sample; however, they were less frequent than the combined aggregated physical symptoms of “stressing out”. Implications: The identification of severe withdrawal symptoms, especially aggression, will facilitate identification and treatment to new inmates upon incarceration. The recognition of “stressing out” will enable safety measures and treatments to be prescribed in this setting.

Cannabis withdrawal among Indigenous detainees and inmates

Issue: Harmful use of alcohol is a leading cause of disease burden for young Australians. Little is known about the context of adolescent alcohol initiation and the development of harmful patterns of consumption. This research reports descriptive baseline data from a national Australian longitudinal cohort. Approach: Parent-child dyads were recruited nationally via NSW, Tasmanian and WA secondary schools. During 2010/11, 1929 parent–child dyads completed baseline surveys. Measures include: alcohol use and harms; rules; parental style and monitoring; family relationships, confl ict and relations; peer substance use and approval; and delinquency. Key Findings: Sixty-eight percent of adolescents (M = 12.5 yrs) had tried alcohol. Parent factors including frequency and quantity of alcohol consumption (÷2 (3, N=1880) = 79.27, P < 0.00005; ÷2 (3, N=1879) = 63.75, P < 0.00005), drinking alcohol in the presence of their child (÷2 (3, N=1879) = 81.63, P < 0.00005) and younger age of alcohol initiation (÷2 (1, N=1785) = 20.13, P < 0.00005) were associated with adolescent alcohol initiation. Children with higher levels of rule breaking and aggressive behaviour (÷2 (1, N=1903) = 44.43, P < 0.0005; ÷2 (1, N=1893) = 13.40, P = 0.0003), who were male (÷2 (1, N=1904) = 6.72, P = 0.0095) and who had at least some friends who had tried alcohol (÷2 (3, N=1896) = 506.94, P < 0.00005) and who approved of drinking alcohol (÷2 (2, N=1903) = 91.21, P < 0.00005) were more likely to have tried alcohol themselves. Implications: To address current levels of binge drinking and long term harms from alcohol, it is essential to understand the context of early-adolescent alcohol use and how harmful trajectories may develop. Conclusion: Future analyses of this cohort will provide insight into the impact of contextual factors on adolescent alcohol use and inform public health policy and prevention.

HIGH PREVALENCE OF CANNABIS USE, MENTAL HEALTH IMPACTS, AND POTENTIAL INTERVENTION STRATEGIES: DATA FROM THE CAPE YORK CANNABIS PROJECT

Introduction and Aims: High rates of cannabis use and dependence are significant issues in remote Indigenous communities. We have previously shown extremely high rates of cannabis use, dependence and adverse mental health impacts in Arnhem Land. This study reports the first data on cannabis use and its mental health impacts in Cape York. Design and Methods: We interviewed over 300 Aboriginal people aged 16–40 years in three remote Cape York communities. Data was gathered on rates of cannabis use, mental health impacts including dependence and withdrawal, and reasons for quitting. Results: One in two individuals interviewed was using cannabis, with most using cannabis daily or weekly. Approximately 70% reported cannabis dependence. Encouragingly, more than 70% of current users were considering quitting/cutting down or had made previous attempts. In current users, seeking or starting employment was the most common motivation for wanting to quit, whilst former users quit primarily for family reasons. Users reported negative mental health impacts of cannabis. One in four reported ‘stressing out’ when cannabis was unavailable, suggesting withdrawal. Anger/ irritability, paranoia, auditory hallucinations, thoughts of suicide/ self-harm and memory impairment were reported in up to 10% of users. Discussion and Conclusions: Rates of use and dependence are much higher than national rates (4.9% of males and 2.2% of females nationally used cannabis in the past week, 21% exhibiting dependence), and are similar to Northern Territory rates. One in four Aboriginal users in remote communities may be suffering mental ill health. Interventions should enhance quit support and employment opportunities and strengthen families.Introduction and Aims: Wastewater analysis has become a useful technique for monitoring illicit drug use in communities. Findings have been reported from different countries in Europe and North America. We applied this technique to gauge the illicit drug consumption in an urban catchment from South East Queensland, Australia. Design and Methods: The sampling campaigns were conducted in 2009 (21st November – 2nd December) and 2010 (19th – 25th November). We collected daily composite wastewater samples from the inlet of the sewage treatment plant using continuous flow-proportional sampling. Ten illicit drug residues (parent compounds and key metabolites) in the samples were measured using liquid chromatography coupled to tandem mass spectrometer. Results: Seven compounds were quantified in all the samples. Our data indicated higher drug consumption on weekends. Cannabis was the highest used drug in both sampling periods. Compared to the first sampling campaign which indicated that cocaine and methamphetamine use exceeded ecstasy usage, the second sampling campaign suggested the use of methamphetamine exceeded that of ecstasy which in turn exceeded cocaine use. Discussion and Conclusions: The observed weekly trend of drug use in our study is in agreement with findings in other studies. The variation between two sampling periods in the prevalence of drug use may relate to the availability and prices of the drugs on markets. The cocaine use we estimated in 2009 was much greater than estimations obtained through the national household survey [1], implying under- reporting of cocaine use in surveys. Future work is underway to tackle methodological challenges for more accurate estimation.