Cannabis use, dependence and withdrawal in indigenous male inmates
Bernadette Rogerson, Susan P. Jacups, and Nerina Caltabiano
Journal of Substance Use, 2014, 1–7
ISSN: 1465-9891 (print), 1475-9942 (electronic)
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 (p50.01), indicating detectable cannabis dependence and withdrawal in a unique indigenous inmate population. Multivariate analysis revealed statistically significant associations between LCU and cannabis dependence (OR¼8.1; 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.
Keywords : Cannabis, incarceration, indigenous
Introduction and background
In many Western countries cannabis has a reputation of being a soft drug (Murray et al., 2007) and although illicit, its use is prevalent (Ross, 2007; Vandrey et al., 2008). The available evidence suggests that cannabis use within indigenous groups is double their non-indigenous counterparts (Adlaf et al., 2005; Australian Institute of Health & Welfare, 2010; Ministry of Health, 2007; Substance Abuse and Mental Health Services Administration, 2011) and high prevalence of cannabis use in indigenous inmates (Richmond et al., 2013).
In addition to the harms caused to individuals, families and communities, cannabis is an economic burden to the nation costing billions of dollars each year in policing, legal processing and imprisonment (Begg et al., 2007). Cannabis dependence requires the presence of selective cognitive, behavioural and physiologic symptoms indicating tolerance with continual use, despite substance-related problems (Hall, 2006). Regular cannabis use at a young age is a risk factor for future cannabis dependence, depression,
anxiety and psychosis (American Psychiatric Association, 2010). Cannabis use disorders have now been included in the Diagnostic Statistical Manual (DSM-5) and the Mental Disorders criteria indicated that one third of users met ‘‘dependency criteria’’, and most dependent cannabis users were young (18–24 years old) and unemployed (Allsop et al., 2012; American Psychiatric Association, 2010). One consequence of severe cannabis dependence is an increased occurrence of ‘‘cannabis withdrawal’’, commonly experienced as a combination of symptoms upon abrupt cessation of the drug (Budney & Moore, 2002). In regular high-dose users, cannabis withdrawal syndrome, recently included in the DSM-5 for the first time, is characterised by symptoms of: increased irritability, insomnia, anxiety,
restlessness, and decreases in mood and appetite. These symptoms typically peak within a few days and last for several weeks (Hall, 2001). Presently, Australian correctional facilities do not clinically manage or have treatment for cannabis withdrawal, nor are there additional safety measures insitu. The objectives of this study are to investigate cannabis use, dependence and withdrawal in indigenous male inmates. Findings can improve cannabis withdrawal management for individuals experiencing abrupt cessation.