The public health significance of cannabis use in Australia

Cannabis policy in Australia and New Zealand

This paper describes and compares current developments in policies to deal with cannabis in Australia and New Zealand. Both countries are bound by international conventions to control cannabis and in each case cannabis use, possession, cultivation and supply is illegal. In both countries almost all the supply is grown locally and patterns of use and health concerns appear to be similar. Strategies used to deal with cannabis include: demand reduction through enforcement of legislation, drug education and treatment; supply reduction through enforcement of legislation and crop recovery operations; and harm reduction through diversion of some offenders from the courts system, lenient enforcement policies for users and, in Australia, the formal decriminalization of cannabis use in two states/territories and de facto decriminalization in another. Australia has had a co-ordinated national drugs policy with a stated harm reduction focus for over a decade, while in New Zealand efforts to co-ordinate policy have been delayed by ongoing debates about cannabis's harm potential and what constitutes an appropriate approach. However, a national drugs policy with a professed harm reduction focus is currently being finalized. Despite these developments, government cut-backs and international and local prohibitionist influences on policy in both countries suggest that a harm reduction model may not necessarily be secure.

Pot, politics and the press-reflections on cannabis law reform in Western Australia

Windows of opportunity for changing drug laws open infrequently and they often close without legislative change being affected. In this paper the author, who has been intimately involved in the process, describes how evidence-based recommendations to 'decriminalize' cannabis have recently been progressed through public debate and the political process to become law in Western Australia (WA). The Cannabis Control Bill 2003 passed the WA Parliament on 23 September. The Bill, the legislative backing behind the Cannabis Infringement Notice (CIN) Scheme, came into effect on 22 March 2004. This made WA the fourth Australian jurisdiction, after South Australia, the Australian Capital Territory and the Northern Territory, to adopt a prohibition with civil penalties scheme for minor cannabis offences. This paper describes some of the background to the scheme, the process by which it has become law, the main provisions of the scheme and its evaluation. It includes reflections on the role of politics and the press in the process. The process of implementation and evaluation are outlined by the author, foreshadowing an ongoing opportunity to understand the impact of the change in legislation.

The adverse health effects of cannabis use: what are they, and what are their implications for policy?

BACKGROUND

The adverse health effects of cannabis are a source of contention in debates about policies towards the drug.

METHODS

This paper provides a review of epidemiological evidence on the major adverse health effects of cannabis use and considers its implications for policy.

RESULTS

The evidence strongly suggests that cannabis can adversely affect some users, especially adolescents who initiate use early and young adults who become regular users. These adverse effects probably include increased risks of: motor vehicle crashes, the development of cannabis dependence, impaired respiratory function, cardiovascular disease, psychotic symptoms, and adverse outcomes of adolescent development, namely, poorer educational outcomes and an increased likelihood of using other illicit drugs.

CONCLUSIONS

Politically, evidence of adverse health effects favours the status quo in developed countries like Australia where cannabis policy has been framed by the media as a choice between two views: (1) either cannabis use is largely harmless to most users and so we should legalize, or at the very least decriminalize its use; or (2) it harms some of its users so we should continue to prohibit its use.

High rates of substance abuse among long-term travelers to the tropics: an interventional study

BACKGROUND

Drug abuse constitutes a worldwide problem. The purpose of this study was to investigate the characteristics of illicit drug use during long-term travel to the tropics, and to estimate the effects of antidrug brochures provided before travel on the use of drugs during travel.

METHODS

An interventional study was done on 1,000 travelers to the tropics aged 18 to 30 years. Pretravel brochures explaining the hazards of drug abuse were provided to 500 of them. A control group of 500 travelers did not receive the brochures. Questionnaires exploring drug abuse habits were sent to all travelers after their return.

RESULTS

Among 223 travelers (108 and 115 of the intervention and control groups, respectively) who returned their questionnaires, 82 (36.8%, 95% CI 30.5-43.5%) had experienced illicit drug use during their trip, whereas only 52 of them had tried drugs before (p<0.01). More travelers had used drugs in the Far East (43.3%) than in South America (25.6%, p< 0.01). The strongest predictors of drug abuse were: the compound of female gender and travel to Asia (odds ratio (OR), 4.3), education <or=12 school years (OR 3.5), age <or=25 years (OR 2.7), and no malaria prophylaxis (OR 2.6). The brochures failed to decrease the rate of drug abuse (38.9% vs. 34.8% in the control group, p=NS).

CONCLUSIONS

More than one-third of young Israelis who travel to the tropics use illicit drugs. For many, the trip was their first encounter. Brochures as a sole agent are inadequate, and further means are needed to reduce this alarming trend.

Respiratory health effects of cannabis: position statement of the Thoracic Society of Australia and New Zealand

Both the gaseous and the particulate phases of tobacco and cannabis smoke contain a similar range of harmful chemicals. However, differing patterns of inhalation mean that smoking a 'joint' of cannabis results in exposure to significantly greater amounts of combusted material than with a tobacco cigarette. The histopathological effects of cannabis smoke exposure include changes consistent with acute and chronic bronchitis. Cellular dysplasia has also been observed, suggesting that, like tobacco smoke, cannabis exposure has the potential to cause malignancy. These features are consistent with the clinical presentation. Symptoms of cough and early morning sputum production are common (20-25%) even in young individuals who smoke cannabis alone. Almost all studies indicate that the effects of cannabis and tobacco smoking are additive and independent. Public health education should dispel the myth that cannabis smoking is relatively safe by highlighting that the adverse respiratory effects of smoking cannabis are similar to those of smoking tobacco, even although it remains to be confirmed that smoking cannabis alone leads to the development of chronic lung disease.

The impact of continuing illegal drug use on teenage pregnancy outcomes--a prospective cohort study

OBJECTIVE

To evaluate the impact of continuing illegal drug use on teenage pregnancy outcomes.

DESIGN

Prospective cohort study.

SETTING

Three Australian obstetric hospitals.

SAMPLE

Four hundred and fifty-six teenage antenatal patients.

METHODS

Teenage antenatal patients were interviewed and completed questionnaires to establish their pattern of non-prescription drug use before and during pregnancy. Illegal drug use data provided by the participants were validated in a subgroup of 180 who were interviewed six months postpartum. Antenatal, intrapartum and postnatal outcomes were collated independently. Data were analysed using SAS.

MAIN OUTCOME MEASURES

Antenatal co-morbidity, delivery and newborn outcomes.

RESULTS

In the cohort, 20.3% used marijuana throughout their pregnancy. However, 33.5% of these were multidrug users. The remaining 79.6% did not use illegal drugs throughout pregnancy (non-users). However, half the 'non-users' were 'ex-users' who ceased drug use immediately before or during early pregnancy. Illegal drug use was associated with an increased incidence of concurrent cigarette and alcohol use (both OR > 4.1 and P < 0.0001) and social and psychiatric morbidity (all OR > 1.95 and P < 0.001). Multidrug use was associated with a significant increase in the incidence of chlamydial and other endocervical infections (chlamydia: OR = 4.2,95% CI = 1.6-10.9; endocervical infections: OR = 2.6,95% CI = 1.1-5.7). After controlling for significant covariates, and in the setting of good antenatal care, the only difference in outcome was a significant linear trend towards an increased incidence of threatened preterm labour across the three groups (P = 0.02). Of note, there were no effects on birthweight, birthweight ratio or preterm birth.

CONCLUSION

Good antenatal care may be able to ameliorate many adverse pregnancy outcomes in teenagers who use illegal drugs throughout pregnancy. The high levels of coexisting psychosocial morbidity are a concern for future mothercrafting.

A prospective cohort study of the impact of domestic violence on young teenage pregnancy outcomes

INTRODUCTION

The incidence of domestic violence among pregnant Australian teenagers is higher than rates reported for the general community. However, there are limited data that address the impact of this abuse upon pregnancy outcome. We have examined the significant antenatal associations of domestic violence in young teenage pregnancy, and the impact of this abuse upon pregnancy outcome.

DESIGN, SETTING, PARTICIPANTS

A multicenter prospective cohort study was performed between January 1, 1997 and June 30, 1999. Patients were interviewed and completed questionnaires in the antenatal period to establish whether they were victims of domestic violence. Labor and delivery details were independently collated after discharge for mother and infant. Data were analyzed using an analysis of variance, with a P-value of 0.05 considered significant.

RESULTS

Of 537 patients enrolled in the study, 157 (29.2%) were victims of domestic violence; 380 (70.8%) were not and acted as pregnant teenage controls. Key findings were that teenage victims of domestic violence (VDV) were more likely to smoke, drink alcohol, or use illegal drugs than controls (P < 0.0001). VDV had a higher incidence of infectious morbidity and Pap smear abnormalities (P < 0.007) and psychosocial pathology (P < 0.0001) than controls. A higher incidence of puerperal and neonatal morbidity was observed in VDV and their newborns compared to controls (P < 0.007). The estimated cost of hospital care for teenage VDV was double that of the Australian average.

CONCLUSION

We need to identify all teenage mothers exposed to domestic violence and provide them with expert intervention services. Early intervention programs are likely to be cost effective.

Adolescent pregnancy: psychopathology missed

OBJECTIVES

Few data exist that explore the level of psychosocial problems and drug abuse in an Australian, adolescent, antenatal population. We set out to audit these data from a population of pregnant Western Australian adolescents. We also set out to examine whether social issues and the use of non-prescription drugs are routinely addressed in general public antenatal clinics.

METHODS

One hundred and sixty patients were involved in the prospective cohort study. In the assessed group, 100 consecutive patients from the King Edward Memorial Hospital Adolescent Antenatal Clinic were interviewed during the antenatal period to determine if any major psychosocial issues or a history of non-prescription drug abuse was present. The control group consisted of 60 adolescent patients who delivered in general antenatal clinics at three Perth metropolitan hospitals.

RESULTS

Sixty percent of the assessed group were identified as having a major psychosocial problem that interfered with their ability to carry out acts of daily living. Consumption of cigarettes, alcohol, marijuana, heroin and solvents were higher than that reported for the general Australian adolescent population. Of note, in the control group, many patients did not have a social, psychological, or drug use history taken by their caregivers.

CONCLUSION

Failure to identify psychosocial problems and drug abuse during the antenatal period will result in missed opportunities for positive intervention. These problems are common in this population and interventions are required to offer these women alternative foundations upon which to base their mothercraft skills.

Concentration of marijuana metabolites in the urine after ingestion of hemp seed tea

To determine whether ingestion of hemp seed tea could result in positive urine drug screens for cannabinoids, volunteers were recruited to donate urine after consuming hemp seed or placebo tea. Among the 22 participants, 10 ingested 12 ounces of hemp seed tea, 10 ingested 24 ounces, and 2 ingested 12 ounces of placebo tea. Urine cannabinoid specimens were obtained at baseline and at 4, 8, and 24 hours after ingestion. A total of 10 specimens had trace quantities of cannabinoids detected in 7 subjects on gas chromatography/mass spectrometry testing, all below the Department of Transportation cutoff level of 15 ng/mL. These results demonstrate that under the conditions of this study, hemp seed tea consumption can result in detectable urine cannabinoids but would not trigger a positive EMIT or gas chromatography/mass spectrometry urine drug test for cannabinoids.

The health of a group of young Australians in a New South Wales juvenile justice detention centre: a pilot study

OBJECTIVE

To consider the health profile of a sample of young, largely male Australians as assessed on their admission to a New South Wales Juvenile Justice Detention Centre.

METHOD

A retrospective analysis of primary care nurse health records for 100 sequential admissions.

RESULTS

Of the 97 males and three females (mean age = 15.9 years), 30 were Aboriginal and 39 did not live with either parent at the time of admission. Respiratory illness, such as bronchitis and asthma were common. These diagnoses were overshadowed by histories of significant physical injury. The sample was at high risk of sexually transmitted disease. Forty-six per cent had prior contact with a mental health professional, 26% reported they had thought of suicide and 9% reported having attempted suicide. There was a high prevalence of substance abuse.

CONCLUSION

The health of these young Australians is at risk from every perspective. Improving the quality of their health assessments is an important issue for the clinicians who attend them as individuals and for policy makers who aim to reduce the considerable social and economic cost of juvenile crime. The discussion of these results from one centre has revealed opportunities to make such improvements. There is a need for a gathering of expertise to address the issue, preferably on a national basis.