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The respiratory health effects from tobacco smoking are well described. Cannabis smoke contains a similar profile of carcinogenic chemicals as tobacco smoke but is inhaled more deeply. Although cannabis smoke is known to contain similar harmful and carcinogenic substances to tobacco smoke, relatively little is understood regarding the respiratory health effects from cannabis smoking. There is a need to integrate research on cannabis and respiratory health effects so that gaps in the literature can be identified and the more consistent findings can be consolidated with the purpose of educating smokers and health service providers. This review focuses on several aspects of respiratory health and cannabis use (as well as concurrent cannabis and tobacco use) and provides an update to (i) the pathophysiology; (ii) general respiratory health including symptoms of chronic bronchitis; and (iii) lung cancer. [ABSTRACT FROM AUTHOR]

Cannabis is the most frequently used illicit drug by Australian secondary school students yet there is scant research investigating school staff responses to student cannabis use. As such, this study surveyed 1,692 school staff who attended Generation Next seminars throughout Australia. The self-complete survey identified that the majority of school staff had discussed cannabis use at least once in the past year, although teachers were less likely to report having cannabis-related discussions compared to other school staff. Staff drug education training was consistently associated with an increased prevalence of cannabis-related discussion and assistance. These findings highlight a need for drug education among school staff and particularly among teachers. [ABSTRACT FROM AUTHOR]

The high prevalence of cannabis use by Australian secondary school students makes schools an ideal setting for the delivery of substance use prevention programs. Although efficacious school-based cannabis prevention programs exist, there is scant research investigating the perceived role legitimacy and role importance of school staff. As such, this study surveyed a sample of 1691 Australian school staff by utilizing Generation Next seminars which are attended by professionals working with young people. The self-completed survey identified that, despite elevated contact with students relative to other school staff, teachers reported the least role importance and legitimacy of all school staff. Further, teachers reported the lowest level of staff drug education training, which was an important predictor of an increased feeling of role importance and legitimacy among school staff. [ABSTRACT FROM AUTHOR]

Aims To evaluate the efficacy of a telephone-based intervention consisting of four sessions of motivational interviewing ( MI) and cognitive behavioural therapy ( CBT) designed to assist individuals to reduce their cannabis use and related problems. Design Random allocation to intervention or delayed treatment control with 4- and 12-week follow-up assessments. Setting Counsellors from the Cannabis Information and Helpline ( CIH), an Australian reactive telephone service, delivered the intervention to callers seeking treatment. Participants A total of 160 participants were recruited by the CIH, with 110 participants completing the final follow-up assessment (69% retention). Measurements Cannabis use, dependence and related problems and other substance use were assessed at baseline and follow-up. Findings Intervention participants reported greater reductions in dependence symptoms [ P < 0.001, d = 0.9 (0.5-1.3)] and related problems [ P < 0.001, d = 0.5 (0.1-0.9)] compared with control participants at both follow-up assessments. Compared with control, intervention participants reported greater confidence to reduce cannabis use at 4 weeks [ P = 0.002, d = 0.5 (0.1-0.9)], and in turn reported a greater percentage of abstinent days at 12 weeks [ P = 0.019, d = 0.6 (0.2-1.0)]. Conclusions A brief course of motivational interviewing plus cognitive behavioural therapy delivered by telephone can help to reduce cannabis dependence and promote abstinence in the short term. [ABSTRACT FROM AUTHOR]

Introduction and Aims. Despite its continued widespread use, relatively few individuals with cannabis use disorders present to treatment services. There is a dearth of research examining the reasons for this observed underutilisation of treatment. The aim of this paper is to examine barriers and facilitators to entry into cannabis treatment. Design and Methods. Three surveys of regular cannabis users in treatment (n = 100), in the community (n = 100) and from a widespread Internet sample (n = 294). Results. Perceived barriers included: not being aware of treatment options; thinking treatment is unnecessary; not wanting to stop using cannabis; and wanting to avoid the stigma associated with accessing treatment. Perceived facilitators included: improving available information on treatment; keeping treatment specific to cannabis; offering additional services, such as telephone support; and simplifying treatment admission processes. Discussion and Conclusions. Participant's perceptions differed significantly depending on their age, gender and treatment status. Participants in treatment typically reported barriers intrinsic to the individual while participants from the community reported barriers relating to the treatment available. Reported facilitators were more homogenous and most commonly related to availability of information. [Gates P, Copeland J, Swift W, Martin G. Barriers and facilitators to cannabis treatment. Drug Alcohol Rev 2012;31:311-319] [ABSTRACT FROM AUTHOR]

Background: The New South Wales State Government recently proposed a trial of the medical use of cannabis. Australians who currently use cannabis medicinally do so illegally and without assurances of quality control. Given the dearth of local information on this issue, this study explored the experiences of medical cannabis users. Methods: Australian adults who had used cannabis for medical purposes were recruited using media stories. A total of 147 respondents were screened by phone and anonymous questionnaires were mailed, to be returned by postage paid envelope. Results: Data were available for 128 participants. Long term and regular medical cannabis use was frequently reported for multiple medical conditions including chronic pain (57%), depression (56%), arthritis (35%), persistent nausea (27%) and weight loss (26%). Cannabis was perceived to provide "great relief" overall (86%), and substantial relief of specific symptoms such as pain, nausea and insomnia. It was also typically perceived as superior to other medications in terms of undesirable effects, and the extent of relief provided. However, nearly one half (41%) experienced conditions or symptoms that were not helped by its use. The most prevalent concerns related to its illegality. Participants reported strong support for their use from clinicians and family. There was almost universal interest (89%) in participating in a clinical trial of medical cannabis, and strong support (79%) for investigating alternative delivery methods. Conclusion: Australian medical cannabis users are risking legal ramifications, but consistent with users elsewhere, claim moderate to substantial benefits from its use in the management of their medical condition. In addition to strong public support, medical cannabis users show strong interest in clinical cannabis research, including the investigation of alternative delivery methods. [ABSTRACT FROM AUTHOR]

A response from the authors of the article "Randomized controlled trial of a novel cannabis use intervention delivered by telephone," in the Ausust 10, 2012 issue is presented.

Background: Cannabis is the most widely used illicit substance, and multiple treatment options and avenues exist for managing its use. There has been an increase in the development of clinical practice guidelines (CPGs) to improve standards of care in this area, many of which are disseminated online. However, little is known about the quality and accessibility of these online CPGs. Objective: The purpose of study 1 was to determine the extent to which cannabis-related CPGs disseminated online adhere to established methodological standards. The purpose of study 2 was to determine if treatment providers are familiar with these guidelines and to assess their perceived quality of these guidelines. Methods: Study 1 involved a systematic search using the Google Scholar search engine and the National Drugs Sector Information Service (NDSIS) website of the Alcohol and Other Drugs Council of Australia (ADCA) to identify CPGs disseminated online. To be included in the current study, CPGs needed to be free of charge and provide guidance on psychological interventions for reducing cannabis use. Four trained reviewers independently assessed the quality of the 7 identified guidelines using the Appraisal of Guidelines for Research and Evaluation (AGREE II) tool. Study 2 assessed 166 Australian cannabis-use treatment providers' (mean age = 45.47 years, SD 12.14) familiarity with and opinions of these 7 guidelines using an online survey. Treatment providers were recruited using online advertisements that directed volunteers to a link to complete the survey, which was posted online for 6 months (January to June 2012). Primary study outcomes included quality scores and rates of guideline familiarity, guideline use, and discovery methods. Results: Based on the AGREE II, the quality of CPGs varied considerably. Across different reporting domains, adherence to methodological standards ranged from 0% to 92%. Quality was lowest in the domains of rigor of development (50%), applicability (46%), and editorial independence (30%). Although examination of AGREE II domain scores demonstrated that the quality of the 7 guidelines could be divided into 3 categories (high quality, acceptable to low quality, and very low quality), review of treatment providers' quality perceptions indicated all guidelines fell into 1 category (acceptable quality). Based on treatment providers' familiarity with and usage rates of the CPGs, a combination of peer/colleagues, senior professionals, workshops, and Internet dissemination was deemed to be most effective for promoting cannabis use CPGs. Lack of time, guideline length, conflicts with theoretical orientation, and prior content knowledge were identified as barriers to guideline uptake. Conclusions: Developers of CPGs should improve their reporting of development processes, conflicts of interest, and CPGs' applicability to practice, while remaining cognizant that long guidelines may deter implementation. Treatment providers need to be aware that the quality of cannabis-related CPGs varies substantially. [ABSTRACT FROM AUTHOR]

Abstract: The Severity of Dependence Scale (SDS) is a five-item scale that has been reported to be a reliable and valid screening instrument for dependence and a measure of dependence severity in adults across several substance classes. To date no data have been reported on its performance in a population of adolescent cannabis users. The current study assessed the psychometric properties of the SDS in a community sample of 14–18-year-old adolescent cannabis users (n =100). Internal consistency (α =0.83) and test–retest coefficients (ICC=0.88) were high and a principal components analysis of the scale found all items to load on a single factor. Total SDS score correlated significantly with frequency of cannabis use and number of DSM-IV dependence criteria met, indicating good concurrent validity. Receiver Operating Characteristic curve analysis was used to determine the most appropriate SDS cut-off score for use as an indicator of cannabis dependence, with optimal discrimination at an SDS score of 4. These findings indicate that the SDS is a reliable and valid measure of severity of cannabis dependence among adolescents, has high diagnostic utility, and that an SDS score of 4 may be indicative of cannabis dependence. [Copyright &y& Elsevier]

Abstract: Aim: To develop a multi-dimensional valid and reliable measure of cannabis-related problems. Method: The Cannabis Problems Questionnaire (CPQ) was developed from the Alcohol Problems Questionnaire to measure cannabis treatment outcome. The CPQ was administered on two occasions 1 week apart to a stratified sample of adults who had used cannabis at least once in the previous 3 months. Exploratory factor analyses were conducted and the relationship between items of the CPQ and measures of daily use and dependence assessed. The reliability of the CPQ was also assessed using a test–retest and inter-rater reliability methodology. Results: Exploratory factor analyses revealed a three factor solution best described the data accounting for 57% of the variance in the larger item set. The CPQ is highly reliable with test–retest tetrachoric correlations of between 0.92 and 1.00 and inter-rater reliability correlations between 0.74 and 1.00. The total CPQ score classified DSM-IV cannabis dependence with 84% specificity and sensitivity and daily cannabis use with 83% specificity and 55% sensitivity. Conclusions: The 22-item CPQ is a valid, reliable and sensitive measure of cannabis-related problems for use with clinical and research populations of current cannabis users. [Copyright &y& Elsevier]