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CORK Bibliography: Marijuana

165 citations. June 2008 to present

Prepared: December 2008

Adamczyk A; Palmer I. Religion and initiation into marijuana use: The deterring role of religious friendes. Journal of Drug Issues 38(3): 717-742, 2008. (61 refs.)

Over the last two decades researchers have begun to look at how personal religious beliefs and behaviors influence substance use, finding that more religious teens are less likely to drink, smoke, and use illegal drugs. This study builds on this previous research, combining it with work on religious contextual effects to develop a theoretical model that explains why friends' religion would influence teens' marijuana use, even if teens are not personally religious. Using two waves of data from the National Longitudinal Study of Adolescent Health, this study examines whether individual and friends' religiosity (e.g., religious participation and importance) or born-again identity influence marijuana initiation. Individual and friends' born-again identity appear to independently influence marijuana initiation, which is not significantly mediated by the proportion of in-school friends who have tried marijuana. Findings offer support for the role of micro religious contexts for explaining illegal substance use.

Adeagbo BA; Clark C; Collins KA. Homicides committed by youth assailants: A retrospective study. American Journal of Forensic Medicine and Pathology 29(3): 219-223, 2008. (22 refs.)

The pediatric population has received considerable attention in the forensic community: the youth assailant of homicide, however, is understudied. The authors retrospectively reviewed all cases referred to the Forensic Pathology Section of the Medical University of South Carolina between January 1991 and May 2006. Cases included in the study were homicides in which 1 or more assailants were 19 years of age or younger.The cases were examined as to the cause and manner of death, victim age, gender, race, incident location, weapon used, assailant-victim relationship, assailant age, gender, race, motive, and postmortem toxicology results. Assailant information was obtained from forensic records at Medical University of South Carolina State newspaper archives confirmed by law enforcement reports. The youth assailants were predominantly black men, 15 to 19 years of age (range, 4-19 years). Most victims were black male acquaintances, and the motive was most often an argument. The most common cause of death was cerebral laceration because of a gunshot wound. The incident occurred in the home in 41% of cases, followed by the street in 31%. Victim toxicology was frequently positive for cocaine, marijuana, and alcohol.

Agrawal A; Lynskey MT; Pergadia ML; Bucholz KK; Heath AC; Martin NG et al. Early cannabis use and DSM-IV nicotine dependence: A twin study. Addiction 103(11): 1896-1904, 2008. (70 refs.)

Background: Evidence suggests that cannabis users are at increased risk for cigarette smoking-if so, this may potentially be the single most alarming public health challenge posed by cannabis use. We examine whether cannabis use prior to age 17 years is associated with an increased likelihood of DSM-IV nicotine dependence and the extent to which genetic and environmental factors contribute to this association. Methods A population-based cohort of 24-36-year-old Australian male and female twins (n = 6257, 286 and 229 discordant pairs) was used. The co-twin control method, with twin pairs discordant for early cannabis use, was used to examine whether, after controlling for genetic and familial environmental background, there was evidence for an additional influence of early cannabis use on DSM-IV nicotine dependence. Bivariate genetic models were fitted to the full data set to quantify the genetic correlation between early cannabis use and nicotine dependence. Results: The early cannabis-using twin was about twice as likely to report nicotine dependence, when compared to their co-twin who had experimented with cigarettes but had never used cannabis. Even when analyses were restricted to cannabis users, earlier age cannabis use onset conferred greater risk (1.7) for nicotine dependence than did later onset. This association was governed largely by common genetic liability to early cannabis use and nicotine dependence, as demonstrated by genetic correlations of 0.41-0.52. Conclusions: Early-onset cannabis users are at increased risk for nicotine dependence, but this risk is attributable largely to common genetic vulnerability. There is no evidence for a causal relationship between cannabis use and nicotine dependence.

Agrawal A; Madden PAF; Bucholz KK; Heath AC; Lynskey MT. Transitions to regular smoking and to nicotine dependence in women using cannabis. Drug and Alcohol Dependence 95(1/2): 107-114, 2008. (37 refs.)

Background: While there is substantial support in the literature for an increased prevalence of cannabis use in cigarette smokers, emerging studies allude to the possibility that cannabis users may, in turn, be at significantly elevated risk for rapid transitions in their cigarette smoking trajectories. If there is evidence in its favor, the increased rates of cigarette smoking in cannabis users may prove to be the most significant public health problem associated with cannabis use. Methods: In a sample of 3787 female twins (age range 18-29 years), we examined, using discrete-time survival analyses, whether women who reported cannabis use were at increased risk for regular cigarette smoking and progression to nicotine dependence. Results: After controlling for a large number of potential covariates, we found that women who used cannabis were at 4.4 and 2.8 increased hazards for transitioning from initiation to regular smoking and from regular smoking to nicotine dependence, respectively. Conclusions: Cannabis use is associated with transitions to more involved stages of cigarette smoking in women. This is a source of public health concern, first due to the high mortality associated with cigarette smoking and second, due to the high prevalence of cannabis use in the general population.

Agrawal A; Morley KI; Hansell NK; Pergadia ML; Montgomery GW; Statham DJ et al. Autosomal linkage analysis for cannabis use behaviors in Australian adults. Drug and Alcohol Dependence 98(3): 185-190, 2008. (40 refs.)

Cannabis is the most commonly used illicit drug in developed and in developing nations. Twin studies have highlighted the role of genetic influences on early stages of cannabis use, such as a lifetime history of use, early-onset use and frequent use, however, we are not aware of any genomic studies that have examined these phenotypes. Using data on 2314 families consisting of 5600 adult Australian offspring and their parents, all of whom were scanned using 1399 unique autosomal markers, we conducted autosomal linkage analyses for lifetime history of cannabis initiation, early-onset cannabis use and frequency of use, using a variance components approach in the linkage package MERLIN. Suggestive evidence for linkage was found on chromosome 18 (LOD 2.14 for frequency of use, LOD 1.97 for initiation, at 90-97 cM) and also on chromosome 19 (LOD 1.92 for early-onset at 17 cM). These LOD scores did not meet genome-wide significance. Further replication of these linkage regions in other samples will be required, although these initial results suggest further targeted efforts on chromosome 18 may yield interesting candidate genes for early stages of cannabis-related behaviors.

Agrawal A; Pergadia ML; Lynskey MT. Is there evidence for symptoms of cannabis withdrawal in the national epidemiologic survey of alcohol and related conditions? American Journal on Addictions 17(3): 199-208, 2008. (63 refs.)

We examined the prevalence of 20 individual symptoms of cannabis withdrawal in the U.S. general population. More than 29% of past 12-month cannabis users reported experiencing at least two cannabis withdrawal symptoms, with 8% reporting impairment from at least two symptoms or withdrawal relief. The most common withdrawal symptom was eating more than usual/gaining weight. Co-occurring tobacco use modestly increased the likelihood of reporting certain symptoms, as did other illicit drug use, though to a lesser degree. Even after controlling for intensity of cannabis use, a history of parental alcohol/drug problems was associated with an increased likelihood of experiencing cannabis withdrawal. Evidence from this and prior studies demonstrating withdrawal strongly suggest that future editions of DSM need to reconsider the exclusion of withdrawal from criteria for cannabis dependence.

Aharonovich E; Brooks AC; Nunes EV; Hasin DS. Cognitive deficits in marijuana users: Effects on motivational enhancement therapy plus cognitive behavioral therapy treatment outcome. Drug and Alcohol Dependence 95(3): 279-283, 2008. (23 refs.)

Clinical variables that affect treatment outcome for marijuana-dependent individuals are not yet well understood, including the effects of cognitive functioning. To address this, level of cognitive functioning and treatment outcome were investigated. Twenty marijuana-dependent outpatients were administered a neuropsychological battery at treatment entry. All patients received 12 weekly individual sessions of combined motivational enhancement therapy and cognitive behavioral therapy. The Wilcoxon Exact Test was used to compare cognitive functioning test scores between cornpleters and dropouts, and the Fisher Exact Test was used to compare proportion of negative urines between those with higher and lower scores on the cognitive tests. Marijuana abstinence was unrelated to cognitive functioning. However, dropouts scored significantly lower than completers on measures of abstract reasoning and processing accuracy, providing initial evidence that cognitive functioning plays a role in treatment retention of adult rnarijuana-dependent patients. If supported by further studies, the findings may help inform the development of interventions tailored for cognitively impaired marijuana-dependent patients.

Amos C; Peters RJ; Williams L; Johnson RJ; Martin Q; Yacoubian GS. The link between recent sexual abuse and drug use among African American male college students: It's not just a female problem in and around campus. Journal of Psychoactive Drugs 40(2): 161-166, 2008. (26 refs.)

This study examined the relationship between sexual abuse in or around campus and drug use among young African-American males in college. It offers cross-sectional analysis of data collected from the Alcohol and Substance Abuse Awareness and Use Study (ASAAUS). Data collection took place in October 2004 via a self-administered survey among 181 African-American male students. Males who reported past sexual abuse in or around campus were significantly more likely than nonsexually-abused males to have used tobacco (41% v. 19%, p < .05), alcohol (82% v. 49%, p < .05), marijuana (59% v. 30%, p < .05), and cocaine (18% v. 2%, p < .05) in the 30 day preceding the interview. Logistic regression analyses indicated that sexual abuse history in or around campus was significantly associated with past year (OR = 9.8, p <= 0.001) and past 30 day (OR = 5.0, p <= 0.001) drug use.

Arnett PA. Cannabis bliss? Perhaps not? (editorial). Neurology 71(3): 160-161, 2008. (8 refs.)

Bahr SJ; Hoffmann JP. Religiosity, peers and adolescent drug use. Journal of Drug Issues 38(3): 743-770, 2008. (46 refs.)

In this paper we examined the relationship between religiosity, peer drug use, and adolescent drug use among 4,983 Utah adolescents and the 13,534 respondents from the National Longitudinal Survey of Adolescent Health. Adolescents who were religious were less likely to smoke, drink heavily, and use marijuana than adolescents who were not religious. Adolescents in highly religious schools were less likely to smoke than adolescents in schools low on religiosity. Individual religiosity tended to lessen the influence of peer drug use on respondent drug use for cigarettes, heavy drinking, and marijuana use but not for the use of other illicit drugs. The associations between individual religiosity and the four types of drug use were not affected by the level of school religiosity. The findings were consistent across the two different samples and three types of drugs: cigarettes, heavy drinking, and marijuana. Social learning and social control theories were used to explain these findings.

Barkus E; Lewis S. Schizotypy and psychosis-like experiences from recreational cannabis in a non-clinical sample. Psychological Medicine 38(9): 1267-1276, 2008. (30 refs.)

Background. The relationship between cannabis use and psychosis is still a matter for debate. Accounting for the individual differences in subjective experiences to recreational cannabis use in the general population may hold some clues to the aetiological relationship between cannabis and psychotic symptoms. We hypothesized that schizotypy would account for the individual differences in subjective experiences after cannabis use but not in patterns of use. Method. In a sample of 532 young people who had used cannabis at least once, we examined the relationship between the Cannabis Experiences Questionnaire (CEQ) and the Schizotypal Personality Questionnaire (SPQ). Additionally, we examined the psychometric properties of the CEQ. Results. We replicated our previously reported findings that schizotypy was associated with increased psychosis-like experiences and after-effects, but also found that high-scoring schizotypes reported more pleasurable experiences when smoking cannabis. Using new subscales derived from principal components analysis (PCA), we found that the psychosis-like items were most related to varying rates of schizotypy both during the immediate use of cannabis and in the after-effects of cannabis use. High-scoring schizotypes who used cannabis experienced more psychosis-like symptoms during and after use. Conclusions. Our results suggest that cannabis use may reveal an underlying vulnerability to psychosis in those with high schizotypal traits.

Blanco C; Ogburn E; de los Cobos JP; Lujan J; Nunes EV; Grant B et al. DSM-IV criteria-based clinical subtypes of cannabis use disorders: Results from the National Epidemiological Survey on Alcohol and Related Conditions (NESARC). Drug and Alcohol Dependence 96(1-2): 136-144, 2008. (40 refs.)

Prior research documented high homogeneity of alcohol use disorders (AUDs) as clinical entities. However, it is unknown whether this finding extends to other substance use disorders. We investigated this by examining the prevalence of all possible DSM-IV criteria-based clinical subtypes of current and lifetime cannabis use disorders in the general population. The number of possible (i.e., theoretical) clinical subtypes of cannabis abuse and dependence based on different combinations of the DSM-IV criteria was calculated using the combinatorial function. This number was compared with the subtypes actually observed in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a large U.S. national sample (N = 43,093). Clinical and demographic correlates of the subtypes were examined with chi(2) tests whose target population was the United States civilian non-institutionalized population. All DSM-IV cannabis abuse and dependence criteria were assessed with the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV Version (AUDADIS-IV). Of all possible cannabis dependence subtypes, 29 (69%) were observed in the 12-month timeframe, and 41 (98%) in the lifetime timeframe. The corresponding numbers of subtypes for cannabis abuse were 12 (75%), current and 15 (100%), lifetime. These findings suggest that, in contrast to alcohol disorders, cannabis use disorders were highly heterogeneous. Future research should investigate whether there are differences in the course and treatment response of these clinical subtypes of cannabis use disorders, and the heterogeneity of other substance use disorders.

Bloor RN; Wang TS; Spanel P; Smith D. Ammonia release from heated 'street' cannabis leaf and its potential toxic effects on cannabis users. Addiction 103(10): 1671-1677, 2008. (27 refs.)

Aims" To use selected ion flow tube mass spectrometry (SIFT-MS) to analyse the molecular species emitted by heated 'street' cannabis plant material, especially targeting ammonia. Materials and methods: Samples of 'street' cannabis leaf, held under a UK Home Office licence, were prepared by finely chopping and mixing the material. The samples were then heated in commercially available devices. The air containing the released gaseous compounds was sampled into the SIFT-MS instrument for analysis. Smoke from standard 3% National Institute on Drug Abuse (National Institute on Drug Abuse) cannabis cigarettes was also analysed. Findings: For 'street' cannabis, ammonia was present in the air samples from the devices at levels approaching 200 parts per million (p.p.m.). This is compared with peak levels of 10 p.p.m. using National Institute on Drug Abuse samples of known provenance and tetrahydrocannabinol content (3%). Several other compounds were present at lower levels, including acetaldehyde, methanol, acetone, acetic acid and uncharacterized terpenes. Conclusions: Awareness of the risks of inhaling the smoke directly from burning cannabis has led to the development of a number of alternative methods of delivery, which are claimed to be safer than direct smoking. Ammonia at toxic levels is produced from heating 'street' cannabis in these commercially available devices. Thus, the use of these devices to deliver 'street' cannabis is now open to question and further research is needed to investigate their safety.

Bolla KI; Lesage SR; Gamaldo CE; Neubauer DN; Funderburk FR; Cadet JL et al. Sleep disturbance in heavy marijuana users. Sleep 31(6): 901-908, 2008. (34 refs.)

Study Objective: To determine if recently abstinent, heavy marijuana (MJ) users show differences in polysomnographic (PSG) measures compared with a drug-free control group. Design: A group of carefully selected heavy MJ users were chosen for study inclusion and matched to a drug-free control group. Questionnaire data were collected prior to cessation of MJ use. PSG studies were conducted during 2 consecutive nights after discontinuation of MJ use in our core sleep laboratory. Setting: Baltimore Maryland, General Clinical Research Center (GCRC) core sleep lab. Participants: 17 heavy MJ users discontinuing MJ use and 14 drug-free controls. Men and women were studied, 18 to 30 years. The MJ users reported no other drug use and alcohol use was negligible in both groups. Urine was positive for metabolites of cannabis only. Measurements and Results: The MJ users showed differences in PSG measures (lower total sleep times, and less slow wave sleep than the control group) on both nights; they also showed worse sleep efficiency, longer sleep onset, and shorter REM latency than the control group on Night 2. More sleep continuity parameters were significantly worse for the MJ group than the control group on Night 2 versus Night 1, indicating that sleep in the MJ group was relatively worse on Night 2 compared to Night 1. The MJ group did not show improved sleep after an adaptation night as expected. Withdrawal symptoms, craving, and depression did not appear to influence these findings. Conclusions: During discontinuation of heavy MJ use, PSG measures of sleep disturbance were detected in MJ users compared with a drug-free control group, While this preliminary study cannot identify the extent to which these group differences were present before abstinence, poor sleep quality either prior to or after MJ discontinuation could result in treatment failure for MJ users. Further investigation is necessary to determine the association between the use and cessation of MJ and sleep disturbance.

Bonhomme-Faivre L; Benyamina A; Reynaud M; Farinotti R; Abbara C. Disposition of Delta(9) tetrahydrocannabinol in CF1 mice deficient in mdr1a P-glycoprotein. Addiction Biology 13(3/4): 295-300, 2008. (25 refs.)

P-glycoprotein (P-gp) plays a major role in drug efflux. All the transported substrates are more or less hydrophobic and amphiphatic in nature. Being lipophilic, Delta(9) tetrahydrocannabinol (THC), the main cannabis component, could be a potential P-gp substrate. The aim of this project was to determine the contribution of the mdr1a gene product to THC disposition. Therefore, oral THC and digoxin (substrate test for P-gp) pharmacokinetics have been investigated in the intestinal epithelium and in the brain capillary endothelium of CF1 mdr1a (-/-) mice (mice naturally deficient in P-gp). These pharmacokinetics were compared to THC and digoxin oral pharmacokinetics in wild type mice mdr1a (+/+) (not P-gp deficient). The application of Bailer's method showed that THC total exposure measured by the area under the plasma concentration time curve was 2.17-fold higher in CF1 mice naturally deficient in P-gp than in wild type mice after oral administration of 25 mg/kg of THC, and 2.4-fold higher after oral administration of 33 mu g/kg of digoxin. As a consequence, the oral bioavailability of THC and digoxin was higher in naturally P-gp-deficient mice. We concluded that P-gp limits THC oral uptake and mediates direct drug excretion from the systemic circulation into the intestinal lumen.

Bonn-Miller MO; Vujanovic AA; Zvolensky MJ. Emotional dysregulation: Association with coping-oriented marijuana use motives among current marijuana users. Substance Use & Misuse 43(11): 1656-1668, 2008. (34 refs.)

The present investigation, conducted between 2005 and 2006, examined the relation between emotion dysregulation and motives for marijuana use among 136 (71 women; M-age = 20.61 years) young adult marijuana smokers. As expected, after covarying for theoretically relevant variables, the DERS-total score was significantly related to marijuana use coping motives, but no other motives for marijuana use. Further analysis indicated that the Non-acceptance of Emotional Responses subscale of the DERS accounted for the DERS-total score effect. Results are discussed in relation to better understanding the role of coping-motivated marijuana use within the context of an emotional dysregulation explanatory framework. Limitations of the study are noted.

Brecht ML; Huang D; Evans E; Hser YI. Polydrug use and implications for longitudinal research: Ten-year trajectories for heroin, cocaine, and methamphetamine users. Drug and Alcohol Dependence 96(3): 193-201, 2008. (53 refs.)

A typical approach to categorizing substance users for epidemiologic purposes or to identify substance use problems at treatment admission is by indicating the primary substance used and/or for which treatment is sought. But does such singular focus on the primary drug limit the validity of conclusions from longitudinal analysis of drug use patterns over time? This analysis combined data from five longitudinal studies conducted in California and examined 10-year patterns of heroin, cocaine, methamphetamine (meth), marijuana, and alcohol use for primary users of heroin (n = 629), cocaine (n = 694), and meth (n = 474). Results suggest relatively low levels of use of non-primary heroin, cocaine, and meth, but moderate levels of alcohol and marijuana use. Growth models showed declining primary drug levels for heroin and meth users and relatively consistent levels over 10 years for cocaine users, while levels of non-primary drugs remained at consistently low levels or declined in tandem with the primary drug. Results indicate that group descriptions of primary heroin, cocaine, or meth use trajectories over time may present valid information about drug use patterns in general.

Buckner JD; Schmidt NB. Marijuana effect expectancies: Relations to social anxiety and marijuana use problems. Addictive Behaviors 33(11): 1477-1483, 2008. (27 refs.)

High social anxiety is related to marijuana problems, yet the nature of this relation remains unclear. We examined relations between marijuana effect expectancies, social anxiety, and marijuana among undergraduates (N=337). Social anxiety was related positively to Negative Expectancies and negatively to Tension Reduction Expectancies. Among socially anxious individuals, greater belief that marijuana produces cognitive and behavioral impairment was associated with greater marijuana use rates. Negative expectancies mediated the social anxiety-marijuana problems link. These data provide new insight into problematic marijuana use among this high-risk group.

Burns CD; Cortell R; Wagner BM. Treatment compliance in adolescents after attempted suicide: A 2-year follow-up study. Journal of the American Academy of Child and Adolescent Psychiatry 47(8): 948-957, 2008. (48 refs.)

Objective: To describe mental health services utilization for adolescents after attempted suicide, explore factors related to treatment compliance, and determine the relation between compliance and suicidality. Method: Eighty-five adolescents (ages 13-18) who had attempted suicide and their families were recruited from four psychiatric hospitals and were evaluated for symptoms of psychopathology. Subsequent assessments were conducted every 6 months for 2 years to determine treatment utilization, treatment compliance (nonadherence to medication regimens or nonattendance of psychosocial treatments against provider advice), attitudes toward treatments used, and further suicide attempts and ideation. Results: Adolescents with a disruptive behavior disorder diagnosis were less compliant with individual psychotherapy, as were those with a substance dependence other than alcohol or marijuana. Those with an affective/anxiety disorder diagnosis were less compliant with psychopharmacological interventions (6 months postattempt). Parental perception of treatment as helpful was predictive of greater compliance, whereas adolescents' attitudes toward treatment were not predictive of compliance. Finally, compliance with treatment was not generally predictive of future suicidality. Conclusions: Interventions focused on increasing compliance with mental health treatment for adolescent suicide attempters should focus on specific child psychopathology, as well as parental attitudes toward treatment.

Caldeira KM; Arria AM; O'Grady KE; Vincent KB; Wish ED. The occurrence of cannabis use disorders and other cannabis-related problems among first-year college students. Addictive Behaviors 33(3): 397-411, 2008. (38 refs.)

This study reports the prevalence of cannabis use disorders (CUD) and other cannabis-related problems in a large cohort (n = 1253) of first-year college students, 17 to 20 years old, at one large public university in the mid-Atlantic region of the U.S. Interviewers assessed past-year cannabis use, other drug use, and cannabis-related problems (including DSM-IV criteria for CUD). The prevalence of CUD was 9.4%(wt) among all first-year students and 24.6% among past-year cannabis users (n = 739). Of those endorsing any CUD criteria, 33.8% could be classified as diagnostic orphans. Among 474 "at-risk" cannabis users (>= 5 times in the past year), concentration problems (40.1%), driving while high (18.6%) and missing class (13.9%) were among the most prevalent cannabis-related problems, even among those who endorsed no CUD criteria. Placing oneself at risk for physical injury was also commonly reported (24.3%). A significant proportion of cannabis-using college students meet diagnostic criteria for disorder. Even in the absence of disorder, users appear to be at risk for potentially serious cannabis-related problems. Implications for prevention, service delivery, and future research are discussed.

Callaghan RC; Taylor L; Moore BA; Jungerman FS; Vilela FAD; Budney AJ. Recovery and URICA stage-of-change scores in three marijuana treatment studies. Journal of Substance Abuse Treatment 35(4): 419-426, 2008. (37 refs.)

Data from three outpatient studies of treatment of marijuana dependence were used to lest whether behavior change parallels stage movement in the transtheoretical model of change (TMC). This study examined one putative assumption of the TMC: individuals remaining in the preaction stages of change (i.e., precontemplation and contemplation) across time would show little change in their marijuana use. The University of Rhode Island Change Assessment (URICA) measure and two recent stage assignment algorithms were utilized to assess TMC stage status at baseline and end of treatment. The primary analyses employed paired-sample t tests of statistical equivalence and sign tests, and 34 out of the 36 tests demonstrated that individuals remaining in the preaction stages of change over the treatment period showed clinically important and statistically significant treatment Outcomes. Clinicians and researchers should exercise caution in their use of URICA-based indices as meaningful markers of the recovery process. Better methods to measure stage status and test the TMC are needed if the model is to be used to guide substance abuse interventions.

Cappelli F; Lazzeri C; Gensini GF; Valente S. Cannabis: a trigger for acute myocardial infarction? A case report. Journal of Cardiovascular Medicine 9(7): 725-728, 2008. (35 refs.)

Cannabis smoking is consistently increasing in Europe and after alcohol it is the most common recreational drug in the western world. Users and lay people believe that marijuana or hashish is safe. Over the past four decades, however, it has been well established that cannabis has pathophysiological effects on the cardiovascular system. Information concerning the link between cannabis consumption and myocardial infarction is limited and existing data are controversial on this topic. In our case report, we describe a case of a young man who after smoking marijuana experienced ST elevation myocardial infarction caused by acute thrombosis of the descending artery, submitted to efficacious primary coronary angioplasty.

Chepyala P; Olden KW. Cyclic vomiting and compulsive bathing with chronic cannabis abuse. Clinical Gastroenterology and Hepatology 6(6): 710-712, 2008. (16 refs.)

Cannabis is commonly recognized for its anti-emetric properties. However, chronic cannabis use can lead to paroxysmal vomiting. In some patients this vomiting can take on a pattern identical to cyclic vomiting syndrome. Interestingly cyclic vomiting syndrome has been associated with compulsive bathing which patients report can relieve their intense feelings of nausea and lessen their vomiting intensity. We report a case of a patient with chronic cannabis use who developed symptoms similar to cyclic vomiting syndrome who also engaged in compulsive bathing behavior as observed by members of the medical and nursing staff. The patient reported that frequent hot showers would prevent him from vomiting and also relieve his concomitant abdominal pain. Previous hospitalizations at our hospital for the same complaint also noted similar showering behavior. During the hospital stay, the patient agreed to engage in a outpatient drug rehabilitation program which he subsequently completed. Abstinence from cannabis use caused the patients vomiting symptoms and abdominal pain to disappear completely. Likewise, his compulsive showering behavior also ceased. Other investigators have reported similar findings in patients with cyclic vomiting syndrome who initially used cannabis to treat their vomiting episodes but subsequently found that it contributed to their vomiting. Our patient has lead us to conclude that in patients seen for chronic severe vomiting and abdominal pain which has no obvious structural or chemical etiology and which is accompanied by compulsive showering and/or bathing behavior a diagnosis of cyclic vomiting syndrome with concomitant cannabis abuse needs to be considered.

Chung T; Martin CS; Cornelius JR; Clark DB. Cannabis withdrawal predicts severity of cannabis involvement at 1-year follow-up among treated adolescents. Addiction 103(5): 787-799, 2008. (43 refs.)

Aims: Controversy exists regarding the inclusion of cannabis withdrawal as an indicator of dependence in the next revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD). This study contrasted the concurrent and predictive validity of three operational definitions of cannabis withdrawal in a sample of treated adolescents. Design: Prospective study of treated adolescents with 1-year follow-up. Setting and participants: Adolescents (n = 214) were recruited from intensive out-patient treatment programs for substance abuse, and followed at 1 year (92% retention). Youth who were included in the analyses reported regular cannabis use. Measurements: The number of DSM-IV cannabis abuse and dependence symptoms at baseline and 1-year follow-up, past year frequency of cannabis use at baseline and follow-up, and periods of abstinence at 1-year follow-up. Cannabis withdrawal was defined based on (i) the presence of two or more cannabis withdrawal symptoms; (ii) a definition proposed by Budney and colleagues (2006) that requires four or more withdrawal symptoms (four-symptom definition); and (iii) the use of latent class analysis to identify subgroups with similar cannabis withdrawal symptom profiles. Findings and conclusions: All three definitions of cannabis withdrawal demonstrated some concurrent validity. Only the four-symptom and latent class-derived definitions of withdrawal predicted severity of cannabis-related problems at 1-year follow-up. No cannabis withdrawal definition predicted frequency of use at follow-up. Further research is needed to determine the clinical utility and validity of the four-symptom definition, as well as alternative definitions of cannabis withdrawal, to inform revisions leading to DSM-V and ICD-11.

Chung T; Martin CS; Clark DB. Concurrent change in alcohol and drug problems among treated adolescents over three years. Journal of Studies on Alcohol and Drugs 69(3): 420-429, 2008. (26 refs.)

Objective: Many adolescents engage in polydrug use; however, little is known about whether alcohol and other drug problems show similar posttreatment trajectories of change. We examined concurrent patterns of change for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, symptoms related to the use of alcohol, marijuana, and other drugs and identified predictors of the most common cross-drug patterns of change. Method: Adolescents (N=542) recruited from addictions treatment were assessed at baseline and at 1- and 3-year follow-up. Latent class mixture modeling identified trajectories for alcohol, marijuana, and other-drug symptoms. Latent class analysis identified cross-drug patterns of change and was used to examine conduct disorder and depression as predictors of cross-drug patterns of change. Results: For alcohol users, three improving groups (72%), stable-low (19%) and stable-high (6%) groups, and groups with increasing trajectories (3%) were identified. For marijuana users, an asymptomatic class (230/6), two improving classes (46%), stable-low (13%) and stable-high (13%) classes, and a class with an increasing trajectory (4%) were found. For users of other drugs, groups with asymptomatic (57%), improving (20%), increasing (12%), and stable-high (11%) trajectories were identified. Latent class analysis of cross-drug patterns of change identified three subtypes representing generally concordant cross-drug patterns of change and one subtype that involved stable-high marijuana problems, decreasing alcohol problems, and increasing other-drug problems. Conduct disorder was associated with greater persistence of substance problems. Conclusions: The majority of treated adolescents had similar cross-drug patterns of change for alcohol, marijuana, and other drugs; however, exceptions exist. Furthermore, adolescents with co-occurring psychopathology may benefit from continuing intervention, because they tend to report more persistent posttreatment substance-related problems.

Colzato LS; Hommel B. Cannabis, cocaine, and visuomotor integration: Evidence for a role of dopamine D1 receptors in binding perception and action. Neuropsychologia 46(5): 1570-1575, 2008. (31 refs.)

The primate cortex represents and produces events in a distributed way, which calls for a mechanism that integrates their features into coherent structures. Visuomotor integration seems to be driven by dopaminergic (DA) pathways but which subsystems are involved is currently unknown. The present study compared the impact of the recreational use of two drugs on visuomotor integration: cannabis, which primarily targets dopaminergic D1 receptors, and cocaine, which mainly targets D2 receptors. Our findings show that cannabis but not cocaine use affects the strength of the binding between task-relevant stimulus features and the accompanying response. In contrast, cocaine but not cannabis use eliminates the inhibition of return. The observed pattern suggests that visuomotor integration is driven by DA/D1, but not DA/D2 receptor systems.

Cooper ZD; Haney M. Cannabis reinforcement and dependence: role of the cannabinoid CB1 receptor. (review). Addiction Biology 13(2): 188-195, 2008. (107 refs.)

Awareness of cannabis dependence as a clinically relevant issue has grown in recent years. Clinical and laboratory studies demonstrate that chronic marijuana smokers can experience withdrawal symptoms upon cessation of marijuana smoking and have difficulty abstaining from marijuana use. This paper will review data implicating the cannabinoid CB1 receptor in regulating the behavioral effects of Delta(9)-tetrahydrocannobinol (THC), the primary psychoactive component of cannabis, across a range of species. The behavioral effects that will be discussed include those that directly contribute to the maintenance of chronic marijuana smoking, such as reward, subjective effects, and the positive and negative reinforcing effects of marijuana, THC and synthetic cannabinoids. The role of the CB1 receptor in the development of marijuana dependence and expression of withdrawal will also be discussed. Lastly, treatment options that may alleviate withdrawal symptoms and promote marijuana abstinence will be considered.

Cornelius JR; Chung T; Martin C; Wood DS; Clark DB. Cannabis withdrawal is common among treatment-seeking adolescents with cannabis dependence and major depression, and is associated with rapid relapse to dependence. Addictive Behaviors 33(11): 1500-1505, 2008. (24 refs.)

Recently, reports have suggested that cannabis withdrawal occurs commonly in adults with cannabis dependence, though it is unclear whether this extends to those with comorbid depression or to comorbid adolescents. We hypothesized that cannabis withdrawal would be common among our sample of comorbid adolescents and young adults, and that the presence of cannabis withdrawal symptoms would be associated with a self-reported past history of rapid reinstatement of cannabis dependence symptoms (rapid relapse). The participants in this study included 170 adolescents and young adults, including 104 with cannabis dependence, 32 with cannabis abuse, and 34 with cannabis use without dependence or abuse. All of these subjects demonstrated current depressive symptoms and cannabis use, and most demonstrated current DSM-IV major depressive disorder and current comorbid cannabis dependence. These subjects had presented for treatment for either of two double-blind, placebo-controlled trials involving fluoxetine. Cannabis withdrawal was the most commonly reported cannabis dependence criterion among the 104 subjects in our sample with cannabis dependence, being noted in 92% of subjects, using a two-symptom cutoff for determination of cannabis withdrawal. The most common withdrawal symptoms among those with cannabis dependence were craving (82%), irritability (76%), restlessness (58%), anxiety (55%), and depression (52%). Cannabis withdrawal symptoms (in the N= 170 sample) were reported to have been associated with rapid reinstatement of cannabis dependence symptoms (rapid relapse). These findings suggest that cannabis withdrawal should be included as a diagnosis in the upcoming DSM-V, and should be listed in the upcoming criteria list for the DSM-V diagnostic category of cannabis dependence.

Crano WD; Siegel JT; Alvaro EM; Lac A; Hemovich V. The at-risk adolescent marijuana nonuser: Expanding the standard distinction. Prevention Science 9(2): 129-137, 2008. (37 refs.)

This research expands the user/nonuser dichotomy commonly used in research on marijuana. By conceptualizing nonusers as homogeneous, vital nuances in susceptibility to risk and protective factors may be overlooked. Research operations tested the predictive validity of a brief measure that divided nonusers into resolute and vulnerable subcategories; determined whether variables that distinguished nonusers and users were more informative when a tripartite classification was used; and with an eye on future prevention, examined variables on which resolute nonusers were similar to vulnerable nonusers or users, and on which they differed from both. A nationally representative sample of respondents (N = 2,111; ages 12-16 years) from the National Survey of Parents and Youth was used in this secondary analysis. Panel data gathered yearly over four rounds included information on intentions and use of marijuana and other illicit substances, along with social, demographic, intrapersonal, and parental variables. The three groups differed significantly on associates' marijuana use, participants' approval of others' use, and cigarette and alcohol use. Resolute nonusers differed from vulnerable nonusers and users alike on religiosity, delinquency (self and friends'), refusal strength, sensation seeking, parental monitoring and warmth, and adult supervision. Results support the utility of distinguishing vulnerable from resolute nonusers, counsel against considering nonusers as a homogeneous group, and provide insight into variables that might prove useful in future prevention efforts.

de Oliveira GL; Voloch MH; Sztulman GB; Neto ON; Yonamine M. Cannabinoid contents in cannabis products seized in Sao Paulo, Brazil, 2006-2007. Forensic Toxicology 26(1): 31-35, 2008. (17 refs.)

A rapid and simple method was optimized for determination of Delta(9)-tetrahydrocannabinol (Delta(9)-THC), cannabidiol (CBD), and cannabinol (CBN) contents in cannabis products by gas chromatography with flame-ionization detection (GC-FID), using diazepam as internal standard. All parameters of validation of the method such as linearity, intraassay precision, and limits of detection and quantification of the analytes were satisfactory. Using the described method, cannabinoid contents of 55 cannabis product samples seized in Sao Paulo City, Brazil, in 2006 and 2007 were measured. Delta(9)-THC content in marijuana and hashish samples varied between 0.08% and 5.5%, with an average of 2.5%. The phenotypic ratio showed that the products were able to be designated as "drug type."

de Win MML; Jager G; Booij J; Reneman L; Schilt T; Lavini C et al. Neurotoxic effects of ecstasy on the thalamus. British Journal of Psychiatry 193(4): 289-296, 2008. (42 refs.)

Background: Neurotoxic effects of ecstasy have been reported, although it remains unclear whether effects can be attributed to ecstasy, other recreational drugs or a combination of these. Aims: To assess specific/independent neurotoxic effects of heavy ecstasy use and contributions of amphetamine, cocaine and cannabis as part of The Netherlands XTC Toxicity (NeXT) study. Method: Effects of ecstasy and other substances were assessed with H-1-magnetic resonance spectroscopy, diffusion tensor imaging, perfusion weighted imaging and [I-123]2 beta-carbomethoxy-3 beta-(4-iodophenyl)-tropane ([I-123]beta-CIT) single photon emission computed tomography (serotonin transporters) in a sample (n=71) with broad variation in drug use, using multiple regression analyses. Results: Ecstasy showed specific effects in the thalamus with decreased [I-123] beta-CIT binding, suggesting serotonergic axonal damage; decreased fractional anisotropy, suggesting axonal loss; and increased cerebral blood volume probably caused by serotonin depletion. Ecstasy had no effect on brain metabolites and apparent diffusion coefficients. Conclusions: Converging evidence was found for a specific toxic effect of ecstasy on serotonergic axons in the thalamus.

Dorard G; Berthoz S; Phan O; Corcos M; Bungener C. Affect dysregulation in cannabis abusers: A study in adolescents and young adults. European Child and Adolescent Psychiatry 17(5): 274-282, 2008. (45 refs.)

Psychiatric comorbidity and impaired emotional functioning have been previously reported in adult substance abusers but have been less well documented in adolescents. Thus, we investigated mental health problems and emotion regulation abilities in adolescents and young adults with cannabis dependence. Moreover, we explored the relationships between consumption modalities and affective style. Therefore, 32 cannabis abusers (CA) and 30 healthy controls completed a battery of self-reports measuring depression (BDI-13), anxiety (STAI-Y), alexithymia (TAS20; BVAQ-B), anhedonia (PAS; SAS), and sensation seeking (SSS). The MINI was administered to evaluate cannabis dependence and axis I DSM-IV comorbid diagnoses. A semistructured clinical interview was given to determine psychoactive substance use. Statistical analyses revealed that more than half of the CA reported at least one other nondrug or alcohol comorbid diagnosis. The most common were mood and anxiety disorders. CA subjects scored significantly higher on all affective dimensions except alexithymia total scores; however, they had greater scores for the two subscales measuring the difficulties in identifying feelings. Logistic regressions demonstrated that CA subjects were more likely to experience high levels of trait anxiety, physical anhedonia and sensation seeking than the controls. Various correlations were observed between the affective scores and the substance considered. The amount of substance use and, particularly, the prevalence of polydrug use we observed are alarming. This study demonstrates that cannabis dependence in adolescents and young adults is related to a great psychological distress and specific emotional dimensions and puts emphasis on the importance of substance use prevention as early as middle school.

Duncan AE; Sartor CE; Scherrer JF; Grant JD; Heath AC; Nelson EC et al. The association between cannabis abuse and dependence and childhood physical and sexual abuse: Evidence from an offspring of twins design. Addiction 103(6): 990-997, 2008. (38 refs.)

Aim This study examines the association between childhood physical abuse (childhood physical abuse) and sexual abuse (CSA) and the development of cannabis abuse and dependence among adolescents and young adults while controlling for genetic and environmental risk factors. Design: To control for familial risk differences related to paternal drug dependence that might confound the relationship between childhood sexual abuse and childhood physical abuse and cannabis abuse/dependence, we created four groups based on father's and uncle's substance use dependence (SUD) status reflecting different degrees of genetic and environmental risks to offspring: (i) high genetic, high environmental risk; (ii) high genetic, low environmental risk; (iii) medium genetic, low environmental risk; and (iv) low genetic, low environmental risk. Participants Adolescent and young adult offspring of monozygotic and dizygotic US military veteran twin fathers (n = 819). Measurements: Data on childhood physical abuse and childhood sexual abuse, DSM-IV offspring cannabis abuse/dependence, other SUD and psychopathology and maternal and paternal SUD and psychopathology were collected via semi-structured telephone interview. Findings: Twenty-three per cent of the offspring sample met life-time criteria for cannabis abuse/dependence and 8.55% and 12.82% reported childhood sexual abuse and childhood physical abuse, respectively. Offspring exposed to childhood sexual abuse, but not childhood physical abuse, were at significantly greater risk of developing cannabis abuse/dependence compared to those who had not experienced childhood sexual abuse (hazard ratio = 2.16; 95% confidence interval = 1.48-3.16) after controlling for genetic and familial environmental risk and offspring gender, alcohol abuse and dependence and conduct disorder. Conclusions: These results indicate that there are effects of childhood sexual abuse on development of cannabis abuse/dependence in addition to the genetic and familial environmental risk imparted by having a drug-dependent father.

Duvall JL; Oser CB; Leukefeld CG. Readiness to change as a predictor of drug-related behaviors in a sample of rural felony probationers. American Journal of Drug and Alcohol Abuse 34(6): 741-748, 2008. (20 refs.)

Objective: Relationships between readiness to change and common drug-related behaviors were explored in a sample (N = 776) of rural probationers in the state of Kentucky. Methods: Self-reported data was gathered on measures of readiness to change, frequency of marijuana use, possession of drugs/related paraphernalia, and driving while under the influence of drugs/alcohol at time periods before and after arrest. Results: Independent of the influence of demographic characteristics such as age, gender, race, and treatment history, increases in readiness to change scores were accompanied by reductions in all three drug-related behaviors. Conclusion: Readiness to change has important implications for treatment involving rural probationers.

Dwivedi S; Kumar V; Aggarwal A. Cannabis smoking and acute coronary syndrome: Two illustrative cases. (letter). International Journal of Cardiology 128(2): E54-E57, 2008. (6 refs.)

Cannabis is a common substance of drug abuse among the young adults because of its euphoric and addictive effects. The pathophysiological effects of cannabis smoking and its relation to adverse cardiovascular events are well known. However, the relative contribution of cannabis smoking when combined with tobacco smoking to coronary artery disease is unclear and has not been well emphasized. We describe two cases of acute coronary syndrome occurring in cannabis smokers who were tobacco smoker too. One, a 23 year old young boy who suffered from hypertension and acute coronary syndrome at a very young age and other, a 50 year old male admitted with acute coronary syndrome, developed asymptomatic dynamic electrocardiographic changes and had beta-blocker induced severe bronchospasm. The modifiable nature of cannabis smoking and cigarette smoking, which often go hand in hand, needs no over emphasis. The cessation of twin smoking habits along with correction of other coronary artery disease risk factors is an important part of primary and secondary prevention.

Eksborg S; Rajs J. Causes and manners of death among users of heroin, methadone, amphetamine, and cannabis in relation to postmortem chemical tests for illegal drugs. Substance Use & Misuse 43(10): 1326-1339, 2008. (22 refs.)

A 12-year medicolegal investigation of deceased illegal drug users (ILDU) in Stockholm, Sweden, classified on the basis of postmortem chemical tests, showed noticeable variations in causes and manners of death as well as in the distribution of suicide methods. This study offers objective information about connection between the postmortem findings of illegal drugs and the causes and manners of death of their users. However, further studies, comparing prevalence of drug use in general population and at the postmortem tests, are needed for more detailed elucidation of this connection.

el Marroun H; Tiemeier H; Jaddoe VWV; Hofman A; Mackenbach JP; Steegers EAP et al. Demographic, emotional and social determinants of cannabis use in early pregnancy: The Generation R study. Drug and Alcohol Dependence 98(3): 218-226, 2008. (47 refs.)

Aims: To ascertain demographic, emotional and social determinants of cannabis use in early pregnancy. Design: This study was embedded in the Generation R study, a multiethnic population-based cohort of parents and their children, followed from pregnancy to childhood. Setting: Rotterdam, The Netherlands. Participants: Mothers enrolled in pregnancy who answered questions about their own and their partners substance use before and during pregnancy (n = 76 10). Measurements: Using self-report questionnaires, information was collected on maternal demographics, psychopathology, delinquency, childhood trauma, social stress, family functioning, and parental alcohol, tobacco and substance use. Multinomial logistic regression analysis was used, with non-using women as reference. Findings: 246 (3.2%) women used cannabis before pregnancy and 220 (2.9%) women used cannabis both before and during pregnancy. The strongest determinant for maternal cannabis use during pregnancy was cannabis use by the biological father of the child (OR = 38.56; 95%CI = 26.14-58.88). Maternal cannabis use during pregnancy was also independently associated with being single (OR = 4.25; 95%CI = 2.33-7.75) or having a partner without being married (OR = 2.75; 95%CI = 1.56-4.85), childhood trauma (OR = 1.39; 95%CI = 1.22-1.57) and delinquency (OR = 3.37; 95%CI = 1.90-5.98), but not with maternal age, ethnicity, psychopathology, family functioning and perceived stress. Being religious was protective (Islam: OR = 0.25; 95%CI = 0.09-0.65) for maternal cannabis use during pregnancy. Additionally, lower educational level determined continued cannabis use in ever-users (OR = 3.22; 95%CI = 1.54-6.74). Conclusions: Our results showed that multiple demographic, emotional and social characteristics were associated with maternal cannabis use. These characteristics should be considered when investigating offspring exposed to cannabis in utero, as they may play an important role in mother-child interaction and child development.

Feingold A; Kerr DCR; Capaldi DM. Associations of substance use problems with intimate partner violence for at-risk men in long-term relationships. Journal of Family Psychology 22(3): 429-438, 2008. (28 refs.)

Associations of substance use problems in men -- defined as a man's meeting at least I criterion of dependence on each of a number of substances by his mid-20s -- with their perpetration of intimate partner violence (IPV) were examined in an at-risk community sample of 150 men in long-term relationships from their late adolescence to their late 20s. Men who had a problem with substances other than sedatives (especially cannabis and hallucinogens) committed more IPV than did men without such problems. Most of the men who had a problem with marijuana also had an alcohol problem, which explains why alcohol was found to have only an indirect association with IPV. The failure of previous alcohol-use studies to control for co-occurrence of alcohol and marijuana problems may explain the discrepancy with conclusions from past research that alcohol problems contribute directly to the perpetration of IPV.

Felt JN; Mcbride DC; Helm HW. Alcohol, tobacco, and marijuana use within a religious affiliated university. Journal of Drug Issues 38(3): 799-820, 2008. (37 refs.)

This study examines the prevalence of alcohol, tobacco, and marijuana use within a religiously affiliated, conservative Christian university to assess whether risk and protective factors for substance use, which have been found to function in general society, also apply within a unique context which prohibits use and has overall lower prevalence rates. Variables examined included perception of normative use, personal religious behaviors, and need for adult approval. Self-reported substance use was low, while perception of normative use was high. Perception of use was positively related to self-reported use while personal religiosity and need for adult approval were Inversely related to use. These data suggest that these risk and protective factors apply not only within general populations, but also within a specific subcultural context, supporting the importance of these models in a religious college context in understanding substance use patterns, variables related to those patterns, and possible prevention programs.

Fendrich M; Mackesy-Amiti ME; Johnson TP. Validity of self-reported substance use in men who have sex with men: Comparisons with a general population sample. Annals of Epidemiology 18(10): 752-759, 2008. (40 refs.)

PURPOSE: To understand the validity of self-reported recent drug use in men who have sex with men (MSM). METHODS: We obtained a probability sample of Chicago men who have sex with men (MSM; n = 216) and administered urine and saliva drug testing after a self-administered interview. Analyses examined participation in drug testing, the agreement between self-reported past month drug use and drug test results, correlates of underreporting, and the relative utility of drug testing versus self-reports in identifying recent marijuana and cocaine use. For marijuana and cocaine, findings were compared with those obtained from a general population sample of men (n = 241). RESULTS: More than three quarters of the participants in both samples provided at least one specimen for drug testing. Self reports in both samples showed a high degree of correspondence with drug tests for marijuana but not for cocaine. Sensitivity for cocaine use reporting was 60% for the MSM sample and 40% for the general-population men. Conditional kappa and sensitivity statistics for marijuana, cocaine, 3,4 methylenedioxymethamphetamine (i.e., MDMA, "ecstacy"), and methamphetamine suggested that self reports among MSM are provided with a high degree of validity. Underreporting was a correlate of social class (education, income, and employment) in the general population but not in the MSM sample. The utility of drug testing was dependent on social class in the general population sample. CONCLUSIONS: Drug testing is feasible in epidemiological surveys of drug use. Self reports among MSM are at least as valid as those provided by a general population sample of men. In some instances (e.g., cocaine use), they may actually be of higher quality. Although the findings support the merit of epidemiological studies of MSM drug use that have relied completely on self-reporting, drug tests may be useful for clarifying club drug ingestion patterns.

Fergusson DM; Boden JM. Cannabis use and later life outcomes. Addiction 103(6): 969-976, 2008. (41 refs.)

Aim To examine the associations between the extent of cannabis use during adolescence and young adulthood and later education, economic, employment, relationship satisfaction and life satisfaction outcomes. Design A longitudinal study of a New Zealand birth cohort studied to age 25 years. Measurements Measures of: cannabis use at ages 14-25; university degree attainment to age 25; income at age 25; welfare dependence during the period 21-25 years; unemployment 21-25 years; relationship quality; life satisfaction. Also, measures of childhood socio-economic disadvantage, family adversity, childhood and early adolescent behavioural adjustment and cognitive ability and adolescent and young adult mental health and substance use. Findings: There were statistically significant bivariate associations between increasing levels of cannabis use at ages 14-21 and: lower levels of degree attainment by age 25 (P < 0.0001); lower income at age 25 (P < 0.01); higher levels of welfare dependence (P < 0.0001); higher unemployment (P < 0.0001); lower levels of relationship satisfaction (P < 0.001); and lower levels of life satisfaction (P < 0.0001). These associations were adjusted for a range of potentially confounding factors including: family socio-economic background; family functioning; exposure to child abuse; childhood and adolescent adjustment; early adolescent academic achievement; and comorbid mental disorders and substance use. After adjustment, the associations between increasing cannabis use and all outcome measures remained statistically significant (P < 0.05). Conclusions The results of the present study suggest that increasing cannabis use in late adolescence and early adulthood is associated with a range of adverse outcomes in later life. High levels of cannabis use are related to poorer educational outcomes, lower income, greater welfare dependence and unemployment and lower relationship and life satisfaction. The findings add to a growing body of knowledge regarding the adverse consequences of heavy cannabis use.

Fergusson DM; Boden JM. Cannabis use and adult ADHD symptoms. Drug and Alcohol Dependence 95(1/2): 90-96, 2008. (37 refs.)

Background: The present study examined the associations between cannabis use in adolescence and young adulthood and self-reported adult attention deficil/hyperactivity disorder (ADHD) symptoms in adulthood. Methods: A 25-year prospective longitudinal study of the health, development, and adjustment of a birth cohort of 1265 New Zealand children. Measures included assessments of adolescent and young adult cannabis use and ADHD symptoms at age 25, measures of childhood socioeconomic disadvantage, family adversity, childhood and early adolescent behavioural adjustment and cognitive ability, and adolescent and young adult other drug use. Results: Cannabis use by age 25 was significantly (p <.0001) associated with increasing self-reported adult ADHD symptoms at age 25. Adjustment of the association for potentially confounding factors from childhood and early adolescence reduced the magnitude of the association, but it remained statistically significant (p<.0001). However, control for the mediating effects of other drug use in adolescence and early adulthood reduced the association between cannabis use and adult ADHD symptoms to statistical non-significance (p >.20). Conclusions: The current study suggested that the association between cannabis use and adult ADHD symptoms was mediated by other substance use that was associated with cannabis use. The results suggest that cannabis use leads to other drug use, which in turn leads to increased ADHD symptoms. However, it should be noted that the potential influence of such factors as genetic predispositions may still be unaccounted for.

Fergusson DM; Boden JM; Horwood LJ. The developmental antecedents of illicit drug use: Evidence from a 25-year longitudinal study. Drug and Alcohol Dependence 96(1-2): 165-177, 2008. (82 refs.)

Background: The present study examined the developmental antecedents of illicit drug use and abuse/dependence. Methods: A 25-year prospective longitudinal study of the health, development, and adjustment of a birth cohort of 1265 New Zealand children. Measures included assessments of adolescent and Young adult illicit drug use and abuse/dependence; cannabis use to age 25; measures of parental adjustment; measures of exposure to childhood sexual abuse, physical abuse, and interparental violence; novelty-seeking; childhood and early adolescent adjustment and substance use; and affiliation with substance-using peers. Results: Illicit drug use and abuse/dependence from ages 16 to 25 were significantly associated (all p values < .05) with a range of parental adjustment measures; exposure to abuse in childhood; individual factors; and measures of childhood and early adolescent adjustment. Analyses using repeated measures logistic regression models suggested that parental illicit drug use, gender, novelty-seeking, and childhood conduct disorder predicted later illicit drug use and abuse/dependence. Further analyses revealed that these pathways to illicit drug use and abuse/dependence were mediated via cannabis use, affiliation with substance-using peers, and alcohol use during ages 16-25. Conclusions: The current study suggested that the illicit drug use and abuse/dependence were associated with a range of early life circumstances and processes that put individuals at greater risk of illicit drug use and abuse/dependence. However, the use of cannabis in late adolescence and early adulthood emerged as the strongest risk factor for later involvement in other illicit drugs.

Fergusson DM; Horwood LJ; Boden JM. Is driving under the influence of cannabis becoming a greater risk to driver safety than drink driving? Findings from a longitudinal study. Accident Analysis and Prevention 40(4): 1345-1350, 2008. (41 refs.)

The present study examined the associations driving under the influence of (a) cannabis and (b) alcohol, and motor vehicle collisions during, in a longitudinal study of a New Zealand birth cohort (n=936). Participants reported significantly (p < .0001) greater rates of driving under the influence of cannabis than driving under the influence of alcohol during ages 21-25. Also, there were statistically significant bivariate associations between increasing levels of both: (a) driving under the influence of cannabis and (b) self-reported driving under the influence of alcohol, and increased risks of active motor vehicle collisions (p < .0001). These associations were adjusted for potentially confounding factors including average distance driven and self-reported risky driving behaviours. After adjustment, the associations between driving under the influence of cannabis and motor vehicle collisions remained marginally significant (p=.064), whereas adjustment for confounding factors reduced the association between driving under the influence of alcohol and motor vehicle collisions to statistical non-significance (p > .70). The results of the present study suggest that, for some populations, the risks of driving under the influence of cannabis may now be greater than the risks of driving under the influence of alcohol.

Forrester JE; Tucker KL; Skinner S; Terrin N. Drug use and weight loss in HIV-infected Hispanic men. AIDS Care 20(7): 868-875, 2008. (24 refs.)

Weight loss is an independent risk factor for mortality in HIV but the role of drug use in HIV-related weight loss is not well described. We conducted this study to determine the role of drug use in HIV-related weight loss. Men (n = 304), all of whom were Hispanic, were recruited into one of three groups: HIV-infected drug users; HIV-noninfected drug users; and HIV-infected non-drug users. Bodymass index (BMI) was measured at successive visits. The groups were re-categorized based on self-reported drug use at the current visit into: (1) users of cocaine alone; (2) users of cocaine and opiates; (3) users of opiates alone; (4) former drug users; and (5) those who denied ever using drugs (all HIV-infected). The effect on BMI of the duration of use of the specific drug types was evaluated using repeated-measures analyses. Longer duration of exclusive opiate use or mixed cocaine and opiate use did not affect BMI in the men, regardless of HIV status. Exclusive cocaine use was associated with a decline in BMI among HIV-infected men (-0.070 kg/m(2) per month duration of use; SE = 0.033; p = 0.037) but not among HIV-uninfected men (0.024 kg/m(2) per month; SE = 0.023; p = 0.29). Adjustment for marijuana, cigarette and alcohol use in all men, or for CD4 count, viral load or HIV medication use in the HIV-infected men, did not alter the conclusions. We conclude that the use of opiates or combined opiates and cocaine does not increase the risk of weight loss in the presence or absence of HIV infection. Exclusive cocaine use may exacerbate weight loss in HIV-infection.

Frauger E; Vigneau C; Orleans V; Thirion X; Jolliet P; Micallef J. Consumption of cannabis among subjects with history of abuse/dependence or under an opiate maintenance therapy: OPPIDUM data in 2006 and main trends since 2004. (French). Therapie 63(2): 119-127, 2008. (28 refs.)

The data on consumption of cannabis in the young people are well documented on the other hand this consumption is less described in subjects presenting a drug dependency. The consumption of cannabis in 2006 and the principal tendencies since 2004 were studied from the OPPIDUM (Observation of Illegal Drugs and Misuse of Psychotropic Medications) program's. OPPIDUM is an annual transverse national study pharmaco-epidemiologic which recruits subjects presenting a drug dependency or benefiting of a maintenance treatment. In October 2006, 3743 subjects were included. Thirty eight per cent (n = 1437) of them are consumers of cannabis, among them 27% announced consumed only cannabis and 73% consumed it with other psychoactive substances. The consumers of cannabis alone are younger, have better social-economical indicators and presented consumption of cannabis in term of abuse and dependence more important. This study underlines the problems of the polyconsommation. No change related to the characteristics of consumers of cannabis was observed between 2004 and 2006. This study underline the presence of two groups of consumers of cannabis presented in structures of care who are different on level of the social-economical indicators and its consumptions.

Fromme K; Corbin WR; Kruse MI. Behavioral risks during the transition from high school to college. Developmental Psychology 44(5): 1497-1504, 2008. (23 refs.)

The transition from high school to college is an important developmental milestone that holds the potential for personal growth and behavioral change. A cohort of 2,245 students was recruited during the summer before they matriculated into college and completed Internet-based surveys about their participation in a variety of behavioral risks during the last 3 months of high school and throughout the 1 st year of college. Alcohol use, marijuana use, and sex with multiple partners increased during the transition from high school to college, whereas driving after drinking, aggression, and property crimes decreased. Those from rural high schools and those who elected to live in private dormitories in college were at highest risk for heavy drinking and driving after drinking.

Ghaffar O; Feinstein A. Multiple sclerosis and cannabis: A cognitive and psychiatric study. Neurology 71(3): 164-169, 2008. (40 refs.)

Background: A significant minority of patients with multiple sclerosis (MS) use cannabis, yet no study has examined the possible effects on mentation. Here, we report the emotional and cognitive correlates of street cannabis use in patients with MS. Methods: A sample of 140 consecutive patients with MS were interviewed with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) Axis I disorders (SCID-IV) from which details of cannabis use were recorded. Cognition was assessed using the Neuropsychological Battery for MS supplemented with the Symbol Digit Modalities Test (SDMT), an index of information processing speed, working memory, and sustained attention. Results: Ten subjects (7.7%) were defined as current cannabis users based on use within the last month. Compared to non-cannabis users (n = 130), they were younger (p = 0.001). Each of the 10 current cannabis users was matched on demographic and disease variables to four subjects with MS who did not use cannabis (total control sample n = 40). Group comparisons revealed that the proportion of patients meeting DSM-IV criteria for a psychiatric diagnosis was higher in cannabis users (p = 0.04). In addition, on the SDMT, cannabis users had a slower mean performance time (p = 0.006) and a different pattern of response compared to matched controls (group x time interaction; p = 0.001). Conclusions: Inhaled cannabis is associated with impaired mentation in patients with multiple sclerosis, particularly with respect to cognition. Future studies are required to clarify the direction of this relationship.

Gjerde H; Normann PT; Pettersen BS; Assum T; Aldrin M Johansen U et al. Prevalence of alcohol and drugs among Norwegian motor vehicle drivers: A roadside survey. Accident Analysis and Prevention 40(5): 1765-1772, 2008. (31 refs.)

The objective of the study was to determine the prevalence of alcohol, psychoactive medicinal drugs and illegal drugs among drivers in Norwegian road traffic. Drivers of motor vehicles were selected from April 2005 to April 2006 in the south-eastern part of Norway, surrounding, but not including the capital, Oslo. A stratified two-stage cluster sampling procedure was used. In the first stage, random road sites and time intervals were selected, and in the second stage, drivers were stopped by random at those sites and time intervals. Altogether about 12,000 drivers were asked to provide a sample of oral fluid (saliva) and answer a few questions. Samples of oral fluid were obtained from 88% of the drivers, of whom 30% were females and 70% males. The prevalence of each drug was estimated by a weighted average using weights adjusted for under- or over-sampling compared to traffic statistics. Alcohol or drugs were found in oral fluid samples of 4.5% of the drivers; alcohol in 0.4%, psychoactive medicinal drugs in 3.4%, and illegal drugs in 1.0%. Illegal drugs were found more frequently in samples from younger drivers, while psychoactive medicinal drugs were more frequently found in samples from older drivers. Psychoactive medicinal drugs were more prevalent among females than males, among drivers stopped on working days rather than weekends, and among those who reported annual driving distances less than 16,000 km. The drugs found most frequently were zopiclone (1.4%), benzodiazepines (1.4%), codeine (0.8%), tetrahydrocannabinol (0.6%) and amphetamines (0.3%). Two or more drugs were found in 0.6% of the samples, corresponding to 15% of the drug-positive drivers.

Gonzalez-Pinto A; Vega P; Ibanez B; Mosquera F; Barbeito S; Gutierrez M et al. Impact of cannabis and other drugs on age at onset of psychosis. Journal of Clinical Psychiatry 69(8): 1210-1216, 2008. (40 refs.)

Objective: The aim of this study was to investigate the relationship between age and cannabis use in patients with a first psychotic episode, and to analyze the mediating effect of comorbid use of other drugs and sex on age at onset of psychosis. Method: All consenting patients (aged 15 to 65 years) with a first psychotic episode needing inpatient psychiatric treatment during a 2-year period between February 1997 and January 1999 were considered, confirming a total of 131 patients. Subjects were interviewed using the Structured Clinical Interview for DSM-IV Axis I Disorders, and clinical and demographic data were collected. We used general linear models with age at onset as the response variable and survival Cox models to confirm the results. Both a multivariate linear model and the corresponding Cox model were fitted with a covariate that summarizes the most significant contributors that seemed to decrease age at onset. Results: Regarding the effect of cannabis use, a significant gradual reduction on age at onset was found as dependence on cannabis increased, consisting in a decrement of 7, 8.5, and 12 years for users, abusers, and dependents, respectively, with respect to nonusers (p = .004, p < .001, and p < .001, respectively). Multivariate analysis showed a clear effect of cannabis use on age at onset, which was not explained by the use of other drugs or by gender. The finding was similar in the youngest patients, suggesting that this effect was not due to chance. Conclusion: The major contribution of this investigation is the independent and strong link between cannabis use and early age at onset of psychosis, and the slight or nonexistent effect of sex and comorbid substance abuse in this variable. These results point to cannabis as a dangerous drug in young people at risk of developing psychosis.

Grauwiler SB; Drewe J; Scholer A. Sensitivity and specificity of urinary cannabinoid detection with two immunoassays after controlled oral administration of cannabinoids to humans. Therapeutic Drug Monitoring 30(4): 530-535, 2008. (10 refs.)

For forensic and clinical toxicologic purposes, cannabis consumption is screened using easy-to-handle immunoassays. The sensitivity and specificity of these immunoassays have not yet been established in samples from volunteers receiving oral synthetic tetrahydrocannabinol or cannabis extracts using liquid chromatography-mass spectrometry/mass spectrometry as the reference method. Urine samples were collected in an open, randomized, single-center, three-period crossover study including 18 healthy male volunteers given either 20 mg synthetic tetrahydrocannabinol (Marinol) as a control substance or five different types of Cannabis saliva extracts.

Haberfellner EM. Referrals for psychiatric examination of driving ability: A comparison of illicit drugs and alcohol. (German). Neuropsychiatrie 22(2): 137-142, 2008. (19 refs.)

Introduction: In Austria vehicle drivers impaired by drugs or alcohol have to undergo a psychiatric examination. Drivers who are not accused for impaired driving have to undergo a psychiatric examination too if they are suspected to be alcohol - or drug addicted. Public health officers decide on the need to refer to psychiatric examination. Methods: 145 drivers suspected to be alcohol - or drug addicted had been referred to the author for psychiatric examination between January 2002 and August 2005. The records of these patients were examined for the following criteria: the reason for psychiatric examination (accident, impaired driving, others), the pattern of substance using, abnormal laboratory testing (urine test, lever function test, carbohydrate-deficient transferrin). Alcohol consumers/abusers and drug consumers/abusers were compared. Results: Alcohol consumers/abusers (n=75) had regularly been penalized for impaired driving (86.7%) or for accidents (26.7%) and 88% had consumed alcohol regularly (once a week or more). Only few drug consumers/abusers (n=86, mostly cannabis) had been penalized for impaired driving (7%), none had an accident and 69.8% had consumed illicit drugs once a week or more. In the vast majority of these cases other reasons than impaired driving caused authorities' action. Laboratory tests were abnormal in 37.3% of alcohol consumers/abusers and in 4.7% of drug consumers/abusers indicating ongoing substance use. Conclusion: Although the increasing use of cannabis and amphetamines is a problem, our data indicate that still alcohol is by far the most dangerous psychotropic substance for traffic safety. Authorities seem to overestimate the risk for road safety associated with illicit drug use.

Hall W; Degnhardt L. Cannabis use and the risk of developing a psychotic disorder. World Psychiatry 7(2): 68-71, 2008. (53 refs.)

We briefly review the evidence that cannabis use in adolescence and young adulthood is a contributory cause of schizophreniform psychoses, by summarising longitudinal studies that: a) have examined relationships between cannabis use and the risk of psychosis or psychotic symptoms; and b) have controlled for potential confounders, such as other forms of drug use and personal characteristics that predict an increased risk of psychosis. There is now reasonable evidence from longitudinal studies that regular cannabis use predicts an increased risk of schizophrenia and of reporting psychotic symptoms. These relationships have persisted after controlling for confounding variables such as personal characteristics and other drug use. The relationships did not seem to be explained by cannabis being used to self-medicate symptoms of psychosis. A contributory causal relationship is biologically plausible because psychotic disorders involve disturbances in the dopamine neuro transmitter system with which the cannabinoid system interacts, as has been shown by animal studies and a human provocation study. We briefly explore the clinical and public health implications of the most plausible hypothesis, that cannabis use precipitates schizophrenia in persons who are vulnerable because of a personal or family history of schizophrenia.

Hall WD. Policy Case Studies. The contribution of research to the development of a national cannabis policy in Australia. Addiction 103(5): 712-720, 2008. (79 refs.)

Aims: To describe the formulation of a National Cannabis Strategy in Australia in 2006 and discuss the contribution that research evidence has made to its development. Methods: A description of trends in cannabis use in Australia and policy responses to it from the early 1970s to the present, with an analysis of the evidence and arguments that have been used to support competing policies towards cannabis use. Results: In 1977 an Australian Senate Committee recommended that a national cannabis policy should be developed that removed criminal penalties for personal possession and use. The arguments for the recommendation echoed those used to support similar earlier recommendations made in Canada, the Netherlands, the United Kingdom and the United States in the late 1960s and early 1970s. They were reiterated by a National Cannabis Task Force in 1994, but a national cannabis strategy was not developed until 2006. By default, the strategy supported continued prohibition on the production and sale of cannabis, and left penalties for cannabis use to state governments. It advocated public education campaigns to discourage young people, especially those at high risk, from initiating cannabis use, and to reduce the progression to regular use among young people who had used cannabis. It also supported efforts to reduce the availability of cannabis and to improve treatment for problem cannabis users. The research evidence which was cited as motivating the development of a national cannabis policy was epidemiological data on rising rates of use among young people, and emerging evidence from longitudinal studies in Australian and New Zealand that some adolescent cannabis users experienced harm as a result of their use. Conclusions: The impact that research evidence has had on Australian cannabis policy over the past three decades has, as in many comparable countries, been constrained by the limited policy options under consideration, and by the fact that interpretation of the evidence has been contested by advocates of the limited policy options under debate.

Hall WD. The contribution of research to the development of a national cannabis policy in Australia. Addiction 103(5): 712-720, 2008. (78 refs.)

Aims: To describe the formulation of a National Cannabis Strategy in Australia in 2006 and discuss the contribution that research evidence has made to its development. Methods: A description of trends in cannabis use in Australia and policy responses to it from the early 1970s to the present, with an analysis of the evidence and arguments that have been used to support competing policies towards cannabis use. Results In 1977 an Australian Senate Committee recommended that a national cannabis policy should be developed that removed criminal penalties for personal possession and use. The arguments for the recommendation echoed those used to support similar earlier recommendations made in Canada, the Netherlands, the United Kingdom and the United States in the late 1960s and early 1970s. They were reiterated by a National Cannabis Task Force in 1994, but a national cannabis strategy was not developed until 2006. By default, the strategy supported continued prohibition on the production and sale of cannabis, and left penalties for cannabis use to state governments. It advocated public education campaigns to discourage young people, especially those at high risk, from initiating cannabis use, and to reduce the progression to regular use among young people who had used cannabis. It also supported efforts to reduce the availability of cannabis and to improve treatment for problem cannabis users. The research evidence which was cited as motivating the development of a national cannabis policy was epidemiological data on rising rates of use among young people, and emerging evidence from longitudinal studies in Australian and New Zealand that some adolescent cannabis users experienced harm as a result of their use. Conclusions: The impact that research evidence has had on Australian cannabis policy over the past three decades has, as in many comparable countries, been constrained by the limited policy options under consideration, and by the fact that interpretation of the evidence has been contested by advocates of the limited policy options under debate.

Hampson SE; Andrews JA; Barckley M. Childhood predictors of adolescent marijuana use: Early sensation-seeking, deviant peer affiliation, and social images. Addictive Behaviors 33(9): 1140-1147, 2008. (55 refs.)

This study examined psychosocial mechanisms by which children's early sensation-seeking may influence their later marijuana use. In a longitudinal study, 4th and 5th grade elementary school children (N=420) were followed until they were in 11th and 12th grades in high school with annual or biennial assessments. Sensation-seeking (assessed over the first 4 assessments) predicted affiliating with deviant peers and level of favorable social images of kids who use marijuana (both assessed over the subsequent 3 assessments). Affiliation with deviant peers and the growth in social images predicted marijuana use in 11th and 12th grades. Affiliation with deviant peers mediated the effect of early sensation-seeking on subsequent marijuana use. The theoretical and applied significance of this influence of early sensation-seeking is discussed

Harder VS; Stuart EA; Anthony JC. Adolescent cannabis problems and young adult depression: Male-female stratified propensity score analyses. American Journal of Epidemiology 168(6): 592-601, 2008. (64 refs.)

Cannabis use and depression are two of the most prevalent conditions worldwide. Adolescent cannabis use is linked to depression in many studies, but the effects of adolescent cannabis involvement on young adult depression remain unclear and may differ for males versus females. In this cohort study of youth from a mid-Atlantic metropolitan area of the United States, repeated assessments from 1985 (at age 6 years) through 2002 (at age 21 years) were made for 1,494 individuals (55% female). Measured covariate differences between individuals with and without cannabis problems were controlled via propensity score techniques. The estimated risk of young adult depression for adolescents with cannabis problems was not significantly different from that for comparison adolescents for either females (odds ratio = 0.7, 95% confidence interval: 0.2, 2.3) or males (odds ratio = 1.7, 95% confidence interval: 0.8, 3.6). The evidence does not support a causal association linking adolescent-onset cannabis problems with young adult depression.

Hasin DS; Keyes KM; Alderson D; Wang S; Aharonovich E; Grant BE. Cannabis withdrawal in the United States: Results from NESARC. Journal of Clinical Psychiatry 69(9): 1354-1363, 2008. (45 refs.)

Objective: Although cannabis is the most widely abused illicit drug, little is known about the prevalence of cannabis withdrawal and its factor structure, clinical validity, and psychiatric correlates in the general population. Method: National Epidemiologic Survey on Alcohol and Related Conditions participants were assessed, in 2001-2002, with structured in-person interviews covering substance history, DSM-IV Axis I and 11 disorders, and withdrawal symptoms after cessation of use. Of these, 2613 had been frequent cannabis users (>= 3 times/week), and a "cannabis-only" subset (N = 1119) never binge-drank or used other drugs 3 times/week. Results: In the full sample and subset, 44.3% (SE = 1.19) and 44.2% (SE = 1.75), respectively, experienced ! 2 cannabis withdrawal symptoms, while 34.4% (SE = 1.21) and 34.1% (SE = 1.76), respectively, experienced ! 3 symptoms. The symptoms formed 2 factors, one characterized by weakness, hypersomnia, and psychomotor retardation and the second by anxiety, restlessness, depression, and insomnia. Both symptom types were associated with significant distress/impairment (p < .01), substance use to relieve/avoid cannabis withdrawal symptoms (p < .01), and quantity of cannabis use (among the cannabis-only users p < .05). Panic (p < .01) and personality (p <= .01) disorders were associated with anxiety symptoms in both samples, family history of drug problems was associated with weakness symptoms in the subset (p = .01), and depression was associated with both sets of symptoms in the subset (p < .05). Conclusion: Cannabis withdrawal was prevalent and clinically significant among a representative sample of frequent cannabis users. Similar results in the subset without polysubstance abuse confirmed the specificity of symptoms to cannabis. Cannabis withdrawal should be added to DSM-V, and the etiology and treatment implications of cannabis withdrawal symptoms should be investigated.

Haughey HM; Marshall E; Schacht JP; Louis A; Hutchison KE. Marijuana withdrawal and craving: influence of the cannabinoid receptor 1 (CNR1) and fatty acid amide hydrolase (FAAH) genes. Addiction 103(10): 1678-1686, 2008. (51 refs.)

Aim To examine whether withdrawal after abstinence and cue-elicited craving were associated with polymorphisms within two genes involved in regulating the endocannabinoid system, cannabinoid receptor 1 (CNR1) and fatty acid amide hydrolase (FAAH). Two single nucleotide polymorphisms (SNPs) in the CNR1 (rs2023239) and FAAH (rs324420) genes, associated previously with substance abuse and functional changes in cannabinoid regulation, were examined in a sample of daily marijuana smokers. Participants Participants were 105 students at the University of Colorado, Boulder between the ages of 18 and 25 years who reported smoking marijuana daily Measurements Participants were assessed once at baseline and again after 5 days of abstinence, during which they were exposed to a cue-elicited craving paradigm. Outcome measures were withdrawal and craving collected using self-reported questionnaires. In addition, urine samples were collected at baseline and on day 5 for the purposes of 11-nor-9-carboxy-Delta 9-tetrahydrocannabinol (THC-COOH) metabolite analysis. Findings Between the two sessions, THC-COOH metabolite levels decreased significantly, while measures of withdrawal and craving increased significantly. The CNR1 SNP displayed a significant abstinence x genotype interaction on withdrawal, as well as a main effect on overall levels of craving, while the FAAH SNP displayed a significant abstinence x genotype interaction on craving. Conclusions: These genetic findings may have both etiological and treatment implications. However, longitudinal studies will be needed to clarify whether these genetic variations influence the trajectory of marijuana use/dependence. The identification of underlying genetic differences in phenotypes such as craving and withdrawal may aid genetically targeted approaches to the treatment of cannabis dependence.

Hayatbakhsh MR; Mcgee TR; Bor W; Najman JM; Jamrozik K; Mamun AA. Child and adolescent externalizing behavior and cannabis use disorders in early adulthood: An Australian prospective birth cohort study. Addictive Behaviors 33(3): 422-438, 2008. (56 refs.)

This study examined the association between age of onset and persistence of externalizing behavior and young adults' cannabis use disorders (CUDs). Data were from a 21 year follow-up of a birth cohort study in Brisbane, Australia. The present cohort consisted of 2225 young adults who had data available about CUDs at 21 years and externalizing behavior at 5 and 14 years. Young adults' CUDs were assessed using the CIDI-Auto. Child and adolescent externalizing behavior were assessed at the 5- and 14-year phases of the study. After controlling for confounding variables, children who had externalizing behavior at both 5 and 14 years (child-onset-persistent) (COP) had a substantial increase in risk of CUD at age 21 years (Odds ratio (OR)=2.5; 95% CI: 1.5, 4.2). This association was similar for those who had 'adolescent onset' (AO) externalizing behavior. However, there was no association between 'childhood limited' (CL) externalizing behavior and CUD. Externalizing behavior in adolescence is a strong predictor of subsequent CUD. Smoking and drinking at 14 years partially mediated the link between externalizing behavior and CUD.

Henquet C; Di Forti M; Morrison P; Kuepper R; Murray RM. Gene-environment interplay between cannabis and psychosis. (review). Schizophrenia Bulletin 34(6): 0586-7614, 2008. (104 refs.)

Cannabis use is considered a contributory cause of schizophrenia and psychotic illness. However, only a small proportion of cannabis users develop psychosis. This can partly be explained by the amount and duration of the consumption of cannabis and by its strength but also by the age at which individuals are first exposed to cannabis. Genetic factors, in particular, are likely to play a role in the short- and the long-term effects cannabis may have on psychosis outcome. This review will therefore consider the interplay between genes and exposure to cannabis in the development of psychotic symptoms and schizophrenia. Studies using genetic, epidemiological, experimental, and observational techniques will be discussed to investigate gene-environment correlation gene-environment interaction, and higher order interactions within the cannabis-psychosis association. Evidence suggests that mechanisms of gene-environment interaction are likely to underlie the association between cannabis and psychosis. In this respect, multiple variations within multiple genes-rather than single genetic polymorphisms-together with other environmental factors (eg, stress) may interact with cannabis to increase the risk of psychosis. Further research on these higher order interactions is needed to better understand the biological pathway by which cannabis use, in some individuals, may cause psychosis in the short- and long term.

Henriquez PC; de Carvalho AMP. Perceptions of drugs benefits and barriers to quit by undergraduate health students. Revista Latino-Americana de Enfermagem 16(Special Issuse): 621-626, 2008. (20 refs.)

Several studies have exposed the consumption of drugs by undergraduate students in the health area, who are supposed to be examples of behavior and health educators. This descriptive correlation study aimed to relate the benefits of tobacco consumption and barriers to quit according to the perception of undergraduate students. Eighty third-year students, in three different courses, answered a self-applied questionnaire. The studied variables were: consumption conditions, barriers and benefits regarding drug consumption, family and personal characteristics. One-third of the students reported tobacco use; 5% reported the use of marijuana; 15% alcohol and 6% tranquilizers, more than once a month; 18% reported the consumption of tobacco and 13% reported the use of alcohol even before the age of 15. The perceived benefits were: relaxation, pleasure and social acceptance, whereas barriers for quitting were: habituation and addiction. According to the results, promoting self-responsibility of these future health professionals is recommended in their educational context.

Holler JM; Bosy TZ; Dunkley CS; Levine B; Past MR; Jacobs A. Delta(9)-tetrahydrocannabinol content of commercially available hemp products. Journal of Analytical Toxicology 32(6): 428-432, 2008. (22 refs.)

Delta(9)-Tetrahydrocannabinol (THC) is the main psychoactive compound present in marijuana. THC can also be found, as a contaminant, in some commercially available hemp products marketed in health food stores and on the internet as a good source of essential fatty acids. The products range from oil to alcoholic beverages to nutritional bars to candies, with oil being the most popular and commonly available. The analytical results are separated into two groups, products tested prior to and after publication of 21 CFR Part 1308, "clarification of listing of tetrahydrocannabinols." The data presented are a summary of 79 different hemp products tested for THC. THC was separated by a liquid-liquid or solid-liquid extraction, depending upon the product matrix. THC concentrations range from none detected to 117.5 mg THC/g material. Typical limits of detection for the assay (depending on matrix) are 1.0-2.5 mg THC/g material. Products that were of aqueous base (beer, tea) had much lower limits of detection (2.5 ng/mL). No THC was detected in 58% of the products from group 1 and 86% of the products from group 2. The amounts indicate that THC levels in currently marketed hemp products are significantly lower than in those products available before 2003 and reported in previous studies. The results reported here may be used as a general guideline for the THC content of hemp products recently found in the marketplace today.

Hollis C; Groom MJ; Das D; Calton T; Bates AT; Andrews HK. Different psychological effects of cannabis use in adolescents at genetic high risk for schizophrenia and with attention deficit/hyperactivity disorder (ADHD). Schizophrenia Research 105(1-3): 216-223, 2008. (24 refs.)

Background: Controversy exists regarding whether young people at risk for schizophrenia are at increased risk of adverse mental effects of cannabis use. Methods: We examined cannabis use and mental health functioning in three groups of young people aged 14-21; 36 non-psychotic siblings of adolescents with schizophrenia (genetic high risk group), 25 adolescents with attention deficit hyperactivity disorder (ADHD) and 72 healthy controls. The groups were sub-divided into 'users' and 'non-users' of cannabis based on how often they had used cannabis previously. Mental health functioning was quantified by creating a composite index derived from scores on the Schizotypal Personality Questionnaire (SPQ), Strengths and Difficulties Questionnaire (SDQ) and Global Assessment of Function (GAF). Results: A significant positive association between cannabis use and mental health disturbance was confined to young people at genetic high risk for schizophrenia. To determine whether the relationship was specific to particular dimensions of mental health function, a second composite index was created based on scores from the SPQ Disorganisation and SDQ hyperactivity-inattention sub-scales, Again, there was a significant positive association between cannabis use and factor scores which was specific to the genetic high risk group. There was a trend for this association to be negative in the ADHD group (p=0.07). Conclusions: The findings support the view that young people at genetic high risk for schizophrenia are particularly vulnerable to mental health problems associated with cannabis use. Further research is needed to investigate the basis of relationships between cannabis and mental health in genetically vulnerable individuals.

Hosking RD; Zajicek JP. Therapeutic potential of cannabis in pain medicine. British Journal of Anaesthesia 101(1): 59-68, 2008. (64 refs.)

Advances in cannabis research have paralleled developments in opioid pharmacology whereby a psychoactive plant extract has elucidated novel endogenous signalling systems with therapeutic significance. Cannabinoids (CBs) are chemical compounds derived from cannabis. The major psychotropic CB delta-9-tetrahydrocannabinol (Delta(9)-THC) was isolated in 1964 and the first CB receptor (CB1R) was cloned in 1990. CB signalling occurs via G-protein-coupled receptors distributed throughout the body. Endocannabinoids are derivatives of arachidonic acid that function in diverse physiological systems. Neuronal CB(1)Rs modulate synaptic transmission and mediate psychoactivity. Immune-cell CB2 receptors (CB2R) may down-regulate neuroinflammation and influence cyclooxygenase-dependent pathways. Animal models demonstrate that CBRs play a fundamental role in peripheral, spinal, and supraspinal nociception and that CBs are effective analgesics. Clinical trials of CBs in multiple sclerosis have suggested a benefit in neuropathic pain. However, human studies of CB-mediated analgesia have been limited by study size, heterogeneous patient populations, and subjective outcome measures. Furthermore, CBs have variable pharmacokinetics and can manifest psychotropism. They are currently licensed as antiemetics in chemotherapy and can be prescribed on a named-patient basis for neuropathic pain. Future selective peripheral CB1R and CB2R agonists will minimize central psychoactivity and may synergize opioid anti-nociception. This review discusses the basic science and clinical aspects of CB pharmacology with a focus on pain medicine.

Hughes JR; Peters EN; Callas PW; Budney AJ; Livingston AE. Attempts to stop or reduce marijuana use in non-treatment seekers. Drug and Alcohol Dependence 97(1-2): 180-184, 2008. (26 refs.)

Daily marijuana smokers (n = 19) who intended to quit or reduce in the next month on their own called a phone each night for 28 nights to report marijuana use and reported intentions to change at the end of each week. Outcomes did not differ between those who initially planned to reduce vs. quit in the next month. Participants averaged three attempts to reduce and one attempt to quit during the 28 days. Participants reduced on 11% and abstained on 14% of days. Most participants were successful in reducing or abstaining on half or more of the days they attempted: however, only four participants (21%n) reduced >= 50% for >= 7 consecutive days and only two (10%) abstained for that long. Abstinence or reduction did not appear to change alcohol or caffeine use. We conclude: (a) initial intentions are poor predictors of outcomes, (b) most users make multiple, short-lived attempts to change, (c) reduction was as common as abstinence. (d) many attempts to change are initially successful but few persist. and (e) other drug use does not appear to worsen with marijuana reduction or abstinence.

Hunault C; Mensinga T; de Vries I; Kelholt-Dijkman H; Hoek J; Kruidenier M et al. Delta-9-tetrahydrocannabinol (THC) serum concentrations and pharmacological effects in males after smoking a combination of tobacco and cannabis containing up to 69 mg THC. Psychopharmacology 201(2): 171-181, 2008. (27 refs.)

Delta-9-Tetrahydrocannabinol (THC) is the main active constituent of cannabis. In recent years, the average THC content of some cannabis cigarettes has increased up to approximately 60 mg per cigarette (20% THC cigarettes). The pharmacokinetics of THC after smoking cannabis cigarettes containing more than approximately 35 mg THC (3.55% THC cigarettes) is unknown. To be able to perform suitable exposure risk analysis, it is important to know if there is a linear relation at higher doses. The present study aimed to characterise the pharmacokinetics of THC, the active metabolite 11-OH-THC and the inactive metabolite THC-COOH after smoking a combination of tobacco and cannabis containing high THC doses. This double-blind, placebo-controlled, four-way, cross-over study included 24 male non-daily cannabis users (two to nine joints per month). Participants were randomly assigned to smoke cannabis cigarettes containing 29.3, 49.1 and 69.4 mg THC and a placebo. Serial serum samples collected over a period of 0-8 h were analysed by liquid chromatography electrospray tandem mass spectrometry. Effects on heart rate, blood pressure and 'high' feeling were also measured. Mean maximal concentrations (C (max)) were 135.1, 202.9 and 231.0 mu g/L for THC and 9.2, 16.4 and 15.8 mu g/L for 11-OH-THC after smoking a 29.3-, 49.1- and 69.4-mg THC cigarette, respectively. A large inter-individual variability in C (max) was observed. Heart rate and 'high' feeling significantly increased with increasing THC dose. This study demonstrates that the known linear association between THC dose and THC serum concentration also applies for high THC doses.

Izzo AA; Camilleri M. Emerging role of cannabinoids in gastrointestinal and liver diseases: basic and clinical aspects.(review). Gut 57(8): 1140-1155, 2008. (196 refs.)

A multitude of physiological effects and putative pathophysiological roles have been proposed for the endogenous cannabinoid system in the gastrointestinal tract, liver and pancreas. These range from effects on epithelial growth and regeneration, immune function, motor function, appetite control, fibrogenesis and secretion. Cannabinoids have the potential for therapeutic application in gut and liver diseases. Two exciting therapeutic applications in the area of reversing hepatic fibrosis as well as antineoplastic effects may have a significant impact in these diseases. This review critically appraises the experimental and clinical evidence supporting the clinical application of cannabinoid receptor-based drugs in gastrointestinal, liver and pancreatic diseases. Application of modern pharmacological principles will most probably expand the selective modulation of the cannabinoid system peripherally in humans. We anticipate that, in addition to the approval in several countries of the CB1 antagonist, rimonabant, for the treatment of obesity and associated metabolic dysfunctions, other cannabinoid modulators are likely to have an impact on human disease in the future, including hepatic fibrosis and neoplasia.

Jemionek JF; Copley CL; Smith ML; Past MR. Concentration distribution of the marijuana metabolite Delta(9)-tetrahydrocannabinol-9-carboxylic acid and the cocaine metabolite benzoylecgonine in the Department of Defense urine drug-testing program. Journal of Analytical Toxicology 32(6): 408-416, 2008. (12 refs.)

Urine drug testing has been employed for punitive purposes by the Department of Defense since December 1981 (Memorandum 62884, Deputy Secretary of Defense Frank C. Carlucci). Federal Workplace Drug Testing Programs were initiated in response to Executive Order 12564 issued on September 15, 1986, that required Drug-Free Federal Workplaces be established. In their respective programs, a positive urine drug test may be referred to a military court martial or to an administrative board. To address safety and insurance requirements, the testing of civilians has expanded beyond Federal Programs to include pre-employment and post-accident urine drug testing. During adjudication, an Expert Toxicologist may be asked to opine what can be discerned from the concentration of drug or drug metabolite found in the urine. Little can be opined with certainty from a positive urine drug test as to the amount of drug ingested, when the drug was ingested, and in most instances, whether the individual felt the effects of the drug, or was under the influence of the drug found in the urine. What may be useful to both the Expert and to the Trier-of- Facts is the frequency that a particular urine drug concentration is encountered in positive drug tests. The finding that 50% of all positive marijuana and cocaine urine metabolite concentrations in the military testing program over the three-year period of October 1, 2004 through September 30, 2007, are below a median value of 65 and 968 ng/mL, respectively, provide reference points. A median drug concentration combined with the percentile or frequency that a particular urine drug concentration occurs may provide evaluative information for a determination of the facts and the outcome of judicial or administrative proceedings. This may be especially useful to jurors when the concentration of marijuana or cocaine metabolite is perceptibly low. The information would also be applicable to medical review officers, medical examiners, drug treatment professionals, probation officers, and program analysts coordinating drug policy decisions.

Jofre-Bonet M; Petry NM. Trading apples for oranges? Results of an experiment on the effects of heroin and cocaine price changes on addicts' polydrug use. Journal of Economic Behavior & Organization 66(2): 281-311, 2008. (56 refs.)

This paper studies polydrug use patterns in Heroin and Cocaine addicts from experiments measuring drug elasticities during changes in Heroin and Cocaine prices. Heroin addicts' demand for Heroin is inelastic; Cocaine, Marijuana, and Alcohol are complements, and Valium and Cigarettes are substitutes for Heroin. Heroin addicts' demand for Cocaine is inelastic; Marijuana and Valium are substitutes, and Alcohol is a complement. Cocaine addicts' demand for Cocaine is elastic; complements are Heroin and Alcohol, and substitutes are Marijuana and Valium. Cocaine addicts' demand for Heroin is inelastic; Alcohol is a complement while Cocaine, Marijuana and Valium are substitutes.

Johnson BD; Golub A; Dunlap E; Sifaneck SJ. An analysis of alternatives to New York City's current marijuana arrest and detention policy. Policing 31(2): 226-250, 2008. (67 refs.)

Purpose - During the 1990s, the New York City Police Department (NYPD) instituted a policy of arresting and detaining people for minor offenses that occur in public as part of their quality-of-life (QOL) policing initiative. The purpose of this paper is to examine the pros and cons of the current policy and compare it with possible alternatives including: arrest and issuing of a desk appearance ticket (DAT); issuing of a non-criminal citation (violation); street warnings; and toleration of public marijuana smoking. Design/methodology/approach - The paper reviews several studies of QOL policing and examines the pros and cons of the current NYPD policy, compared to possible alternatives. Findings - The number of NYPD arrests for marijuana in public view (MPV) (with most detained for one or two days) increased from 3,000 in 1994 to over 50,000 in 2000, and have been about 30,000 in the mid-2000s. Most of these arrestees (84 percent) were minority; Blacks were 2.7 more likely and Hispanics 1.8 times more likely to be detained than Whites for an MPV arrest. Minorities received more severe dispositions, even controlling for demographics and prior arrest histories. Originality/value - The paper recommends that the NYPD change to routinely issuing DATs to reduce detention for marijuana violators. Drug policy reformers might wish to further pursue changing statutes regarding smoking MPV into a violation (non-criminal) or encourage the wider use of street warnings, as in Britain. Any of these policy changes would help reduce the number detained and the disproportionate burden on minorities associated with the current arrest and detention policy. These policies could help maintain civic norms against smoking marijuana in public.

Johnson BD; Ream GL; Dunlap E; Sifaneck SJ. Civic norms and etiquettes regarding marijuana use in public settings in New York City. Substance Use & Misuse 43(7): 895-918, 2008. (42 refs.)

This paper shows that active police enforcement of civic norms against marijuana smoking in public settings has influenced the locations where marijuana is smoked. It has subtly influenced the various marijuana etiquettes observed in both public and private settings. The ethnographic data reveal the importance of informal sanctions; most marijuana consumers report compliance with etiquettes mainly to avoid stigma from nonusing family, friends, and associates - they express limited concern about police and arrest.

Johnson KA; Zvolensky MJ; Marshall EC; Gonzalez A; Abrams K; Vujanovic AA. Linkages between cigarette smoking outcome expectancies and negative emotional vulnerability. Addictive Behaviors 33(11): 1416-1424, 2008. (79 refs.)

The present investigation examined whether smoking outcome expectancies, as measured by the Smoking Consequences Questionnaire (SCQ; [Brandon, T.H., & Baker, T.B., (1991). The Smoking Consequences Questionnaire: The subjective expected utility of smoking in college students. Psychological Assessment, 3, 484-491.]), were incrementally related to emotional vulnerability factors among an adult sample of 202 daily cigarette smokers (44.6% women; M-age=23.78 years, SD=9.69 years). After controlling for cigarettes smoked/day, past 30-day marjuana use. current alcohol consumption, and coping style, negative reinforcement/negative affect reduction outcome expectancies were significantly associated with greater levels of negative affectivity, emotional dysregulation, and anxiety sensitivity. The observed effects for negative reinforcement/negative affect reduction also were independent of shared variance with other outcome expectancies. Negative personal consequences outcome expectancies were significantly and incrementally related to anxiety sensitivity, but not negative affectivity or emotional dysregulation. Findings are discussed in terms of the role of negative reinforcement/negative affect reduction smoking outcome expectancies and clinically-relevant negative emotional vulnerability for better understanding cigarette smoking-negative mood problems.

Jungerman FS; Laranjeira R. Characteristics of cannabis users seeking treatment in Sao Paulo, Brazil. Revista Panamericana de Salud Publica 23(6): 384-393, 2008. (41 refs.)

Objectives. This article describes a sample of 160 adults selected to participate in a randomized controlled trial conducted at a specialized outpatient clinic for cannabis users in Brazil. It correlates consumption with several measures of marijuana use, comparing it with other samples. Methods. Instruments used were the Composite International Diagnostic Interview (CIDI) and Wender Utah Rating Scale for screening and demographic data interviews, and the ASI, time-line follow back (TLFB), Marijuana Withdrawal and Marijuana Problem Scales, and Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) Checklist for cannabis dependence. Results. Participants in the study were mostly single, white men; their mean age was 32.3 years. They had a mean of 15.6 years of formal education and 61.6% worked. The cohort started using marijuana at a mean age of 16.5 years and developed daily use by a mean age of 21 years. Subjects in the sample had used marijuana for a mean of 15 years. They used it for 92.2% of the 90 days prior to the interview and smoked a mean of 1.99 marijuana cigarettes per day during this period. Individuals in the group had experimented with other drugs, especially cocaine. Conclusions. Marijuana users in this sample matched the profiles of those investigated elsewhere, although they reported fewer symptoms of dependence. Marijuana users should be considered independently in substance abuse programs, because they require specific attention and treatment. Broader epidemiological studies should be conducted to determine the extent Of marijuana use within the Brazilian population.

Katz G; Durst R; Shufman E; Bar-Hamburger R; Grunhaus L. Substance abuse in hospitalized psychiatric patients. Israel Medical Association Journal 10(10): 672-675, 2008. (23 refs.)

Background: The co-morbidity rate of illicit substance abuse and major mental problems in Israel is far from clear. Objectives: To investigate the extent of drug abuse in a sample of psychiatric patients hospitalized in a psychiatric hospital and in the psychiatric department of a general hospital in Israel, to compare demographic and other background factors in dual-diagnosis patients with those of abuse-free mental inpatients, and to examine the time correlation between drug abuse and the appearance of major mental problems. Methods: Our data were derived from self-report and urine tests. The study population comprised 470 consecutively admitted patients - 250 patients in the mental health center and 220 patients in the psychiatric department of the general hospital. Results: The lifetime prevalence of drug abuse was 24%, cannabis abuse was found in 19.7%, opiates in 5.7%, cocaine in 2.7%, amphetamines in 3.4% and methamphetamine in 1.1%. Active abuse of drugs (during the last month) was registered in 17.3%, cannabis in 11.5%, opiates in 4.9%, amphetamine in 3.8%, cocaine in 1.3% and methamphetamine in 1.1%. We also found that 28.2% of active abusers used two or more substances. In 41.6% the drug abuse appeared prior to symptoms of the mental disorder; in 37.1% the duration of the mental disorders and the drug abuse was relatively similar, and in 21.3% of cases the duration of mental problems was longer than the duration of drug abuse. Dual-diagnosis patients were younger than non-abusers, more often male, unmarried, and of western origin. Conclusions: Substance abuse (especially cannabis) among hospitalized psychiatric patients in Israel is a growing problem.

Khazaal Y; Chatton A; Cochand S; Zullino D. Quality of Web-based information on cannabis addiction. Journal of Drug Education 38(2): 97-107, 2008. (22 refs.)

This study evaluated the quality of Web-based information on cannabis use and addiction and investigated particular content quality indicators. Three keywords ("cannabis addiction," "cannabis dependence," and "cannabis abuse") were entered into two popular World Wide Web search engines. Websites were assessed with a standardized proforma designed to rate sites on the basis of accountability, presentation, interactivity, readability, and content quality. "Health on the Net" (HON) quality label, and DISCERN scale scores were used to verify their efficiency as quality indicators. Of the 94 Websites identified, 57 were included. Most were commercial sites. Based on outcome measures, the overall quality of the sites turned out to be poor. A global score (the sum of accountability, interactivity, content quality and esthetic criteria) appeared as a good content quality indicator. While cannabis education Websites for patients are widespread, their global quality is poor. There is a need for better evidence-based information about cannabis use and addiction on the Web.

Konings M; Henquet C; Maharajh HD; Hutchinson G; Van Os J. Early exposure to cannabis and risk for psychosis in young adolescents in Trinidad. Acta Psychiatrica Scandinavica 118(3): 209-213, 2008. (35 refs.)

Objective: Cannabis use increases the risk for psychosis, but psychotogenic effects of cannabis may be restricted to exposure during early adolescence. Method: Four hundred and seventy-two participants (aged 12-23 years), randomly selected from the general population in Trinidad, completed questionnaires on past and current cannabis use and psychotic symptoms (using the Community Assessment of Psychic Experiences). Results: Cannabis use increased the risk of experiencing psychotic symptoms and this effect was conditional on early exposure, defined around the mean age of onset of cannabis use. Thus, exposure before but not after the age of 14 years predicted psychotic symptoms (respectively beta: 0.71, 95% CI 0.22; 1.19, P = 0.004 and beta: -0.11, 95% CI -0.57; 0.36, P = 0.66). The developmental effect of cannabis use was independent of use of other drugs or current use of cannabis. Conclusion: Early adolescence may be a critical period with regard to the psychotogenic effect of cannabis across geographical settings and ethnic groups.

Korhonen T; Huizink AC; Dick DM; Pulkkinen L; Rose RJ; Kaprio J. 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(1-2): 33-43, 2008. (53 refs.)

Background: Although use of illicit drugs shows varying degree of heritability, the influence of shared and unique environmental factors predominate among adolescents. We explored factors predicting use of cannabis and other illicit drugs among Finnish adolescent twins. Methods: We used longitudinal data from the FinnTwin 12-17 study with baseline at age 11-12 and follow-up at ages 14 and 171/2, including 4138 individuals. The outcome was self-reported ever use of cannabis or other illicit drugs at age 171/2. The potential predictors were measures reported by the twins, their parents or teachers. As individual factors we tested smoking, alcohol use, behavioral and emotional problems; as peer factors: number of smoking friends and acquaintances with drug experience; as family factors: parental substance use, socio-economic status and pre-natal exposure to nicotine. We used logistic regression models, controlling for twinship, age and sex, to compute odds ratios (OR) for each potential predictor. To adjust for within-family confounds, we conducted conditional logistic regressions among 246 twin pairs discordant for drug use. Results: 13.5% of subjects had initiated use of cannabis or other illicit drugs by age of 17.5 years. When adjusted for within-family confounds, smoking, drinking, and aggressiveness, as well as smoking and drug use among peers predicted use of illicit drugs. In the final regression model, the significant predictors were female sex, early smoking onset, drinking to intoxication, having smoking peers and acquaintances with drug experience, father's weekly drinking to intoxication, and aggressive behavior among boys. Smoking initiation by age of 12 was the most powerful predictor among individuals (OR = 26, p < 0.001) and within discordant pairs (OR = 22, p < 0.001). Conclusions: Early onset smoking is a powerful predictor for subsequent use of illicit drugs among Finnish adolescents, but the causal nature of this relationship needs to be clarified.

Kranzler HR; Li TK. What is addiction? Alcohol Research & Health 31(2): 93-95, 2008. (10 refs.)

The issue of Alcohol Research & Health examines addiction to multiple substances-that is, combined dependence on alcohol and other drugs (AODs), including marijuana, cocaine, and opioids. It seems fitting, then, to begin the issue with a look at what constitutes 'addiction." The Oxford English Dictionary (pp. 24-25) traces the term addiction to Roman law, under which addiction was a 'formal giving over by sentence of court; hence, a dedication of person to a master." This notion of relinquishment of control by the addicted person is the central feature of many lay and professional definitions of the term. The study of addictive behavior crosses several disciplines, including, among others, behavioral neuroscience, epidemiology, genetics, molecular biology, pharmacology, psychology, psychiatry, and sociology. Articles in this issue examine aspects of AOD use disorders from the perspective of some of these varied disciplines.

Public Domain

Laker CJ. A literature review to assess the reliability and validity of measures appropriate for use in research to evaluate the efficacy of a brief harm reduction strategy in reducing cannabis use among people with schizophrenia in acute inpatient settings. Journal of Psychiatric and Mental Health Nursing 15(9): 777-783, 2008. (45 refs.)

There is a growing body of evidence looking at the effects of cannabis use on those with schizophrenia with concerning results. This has led to the development of a number of interventions that are intended to improve outcomes for this client group. However, the methodological quality of some dual diagnosis research has been questioned in reviews for using outcome measures that are not tested as reliable and valid in the population for which they are intended for use. This literature review assesses the self-report measures that have been reliability and validity tested in populations of people with schizophrenia who use cannabis and reports on their appropriateness for use in further research studies. An overview of the most appropriate biochemical tests for cannabis is also given.

Laukkanen M; Hakko H; Riala K; Rasanen P. Association of family background with adolescent smoking and regular use of illicit substances among underage psychiatric in-patients. Journal of Addictive Diseases 27(4): 69-79, 2008. (19 refs.)

This study investigated whether adolescent's family type was associated with regular smoking or the use of illicit substances (cannabis or hard drugs) among underage adolescent psychiatric in-patients. The sample consisted of 471 adolescents aged 12-17 years admitted to psychiatric hospital between April 2001 and March 2006 at Oulu University Hospital, Finland. The information on family factors and substance use was based on the Schedule for Affective Disorder and Schizophrenia for School-Age Children, Present and Lifetime interview and the European modification of the Addiction Severity Index questionnaire. Compared to adolescent boys from two-parent families, those from child welfare placement were more likely to regularly use both cannabis (odds ratio [OR] = 4.4; 95% confidence interval [CI] = 1.4-13.7; P = .012) and hard drugs (OR = 8.4; 95% CI = 1.7-42.1; P = .01). Among girls, no association was found between family type and the use of illicit substances. Two-parent or foster family units may protect adolescents from involvement with illicit substances. In clinical adolescent psychiatric practice more attention should be paid to family interventions and parental support.

Le Foll B; Justinova Z; Tanda G; Goldberg SR. Future medications for tobacco and cannabis dependence. (French). Bulletin de l'Academie Nationale de Medicine 192(1): 45-56, 2008. (52 refs.)

Worldwide more than 3 million deaths a year are attributable to smoking, and tobacco use is on the rise in developing countries. Consequently, smoking is one of the few causes of mortality that is increasing, with deaths projected to reach 10 million annually in 30-40 years. Cannabinoids, which are usually used in the form of marijuana, have become the most frequently used illicit drugs, but there is no pharmacological treatment for marijuana dependence. Although the dopaminergic system plays a critical role in reinforcing the effects of drugs of abuse, other neuro transmitter systems are also involved Here we review recent results obtained with antagonists targeting cannabinoid CBI receptors, dopamine D3 receptors and opioid receptors, that directly or indirectly modulate dopaminergic transmission. These promising approaches warrant clinical trials in the treatment of tobacco and marijuana dependence.

Ledgerwood DM; Goldberger BA; Risk NK; Lewis CE; Price RK. Comparison between self-report and hair analysis of illicit drug use in a community sample of middle-aged men. Addictive Behaviors 33(9): 1131-1139, 2008. (32 refs.)

Discrepancies between biological assays and self-report of illicit drug use could undermine epidemiological research findings. Two objectives of the present study are to examine the degree of agreement between self-reported illicit drug use and hair analysis in a community sample of middle-aged men, and to identify factors that may predict discrepancies between self-report and hair testing. Male participants followed since 1972 were interviewed about substance use, and hair samples were analyzed for marijuana, cocaine, opiates, phencyclidine (PCP) and methamphetamine using radioimmunoassay and gas chromatography-mass spectrometry (CC-MS) techniques. Self-report and hair testing generally met good, but not excellent, agreement. Apparent underreporting of recent cocaine use was associated with inpatient hospitalization for the participant's most recent quit attempt, younger age, identifying as African American or other, and not having a diagnosis of antisocial personality disorder. The overestimate of marijuana use relative to hair test was associated with frequent use since 1972 and providing an inadequate hair sample. Additional research is needed to identify factors that differentially affect the validity of both hair drug testing and self-report.

Lee KSK; Clough AR; Jaragba MJ; Conigrave KM; Patton GC. Heavy cannabis use and depressive symptoms in three Aboriginal communities in Arnhem Land, Northern Territory. Medical Journal of Australia 188(10): 605-608, 2008. (20 refs.)

Objective: To determine the extent to which depressive symptoms are associated with heavy cannabis use in an Aboriginal population in Arnhem Land, Northern Territory. Design, participants and setting: Cross-sectional study involving interviews with 106 Indigenous participants (57 males, 49 females) aged 13-42 years in three remote Aboriginal communities in Arnhem Land, NT, Australia. Main outcome measures: Measures of depressive symptoms (a raw score of >= 6 out of a possible 18 on a modified version of the Patient Health Questionnaire-9) and self-reported heavy cannabis use (six or more cones daily). Results: After adjusting for other substance use (tobacco, alcohol and lifetime petrol sniffing), age and sex, heavy cannabis users were four times more likely than the remainder of the sample to report moderate to severe depressive symptoms (odds ratio, 4.1; 95% CI, 1.3-13.4). Conclusions: Given its high prevalence in Indigenous populations, the development of clinical and prevention strategies for cannabis misuse are warranted.

Legleye S; Lakhdar CB; Spilka S. Two ways of estimating the Euro value of the illicit market for cannabis in France. Drug and Alcohol Review 27(5): 466-472, 2008. (15 refs.)

Introduction. The most recent health surveys in general population are used in order to estimate the annual market size for cannabis in France in 2005. Methods. Two methods for arriving at an estimate are proposed: the first based on reported consumption, the other on reported expenditure on cannabis. Results. The annual sales figure for cannabis in France is between 746 and 832 million euros. Men's expenditure accounts for between 80 and 85% of total expenditure and those aged between 15 and 24 years account for the greatest part of the size of the cannabis market, between 57 and 60%, depending upon the method. Conclusions. According to these estimates, consumers' average annual expenditure on cannabis is around is an element of 202 in France, compared to estimates obtained for New Zealand and Holland (is an element of 124) and the United States (is an element of 362).

Lemstra M; Bennett NR; Neudorf C; Kunst A; Nannapaneni U; Warren LM et al. A meta-analysis of marijuana and alcohol use by socio-economic status in adolescents aged 10-15 years. Canadian Journal of Public Health 99(3): 172-177, 2008. (72 refs.)

Objectives: A majority of population-based studies suggest prevalence of drug and alcohol risk behaviour increases during late adolescence to early adulthood. The purpose of this systematic literature review is to clarify if socio-economic status (SES) is a determinant of marijuana and alcohol risk behaviour in adolescents between the ages of 10-15 years. Methods: We performed a meta-analysis to identify published or unpublished papers between January 1, 1980 and February 9, 2007 that reviewed marijuana and alcohol risk behaviour by SES in adolescents aged 10-15 years. Synthesis: We found nine studies that fulfilled our inclusion criteria and passed the methodological quality review. The prevalence of marijuana and alcohol risk behaviour was 22% higher (RR = 1.22; 95% CI 1.14-1.31) in adolescents with low SES in comparison to adolescents with higher SES. Stratification by country of origin revealed that American and New Zealand studies had statistically significant variability in the reported effects as compared to European and UK studies. Discussion: The evidence suggests that low SES has an inverse association with the prevalence of marijuana and alcohol risk behaviour in adolescents between the ages of 10-15 years. Higher rates of marijuana and alcohol risk behaviour among lower SES adolescents may impact emotional development, limit future educational and occupational achievement, and increase the likelihood for adult marijuana and alcohol addiction. Conclusion: Lower SES adolescents have higher rates of marijuana and alcohol risk behaviour than higher SES adolescents.

Leventhal AM; Lewinsohn PM; Pettit JW. Prospective relations between melancholia and substance use disorders. American Journal of Drug and Alcohol Abuse 34(3): 259-267, 2008. (16 refs.)

Examining associations between subtypes of major depressive disorder (MDD) and substance use disorders (SUDs) might elucidate mechanisms of comorbidity between MDD and SUDs. This study evaluated prospective relations between SUDs and melancholic MDD. A cohort of community-dwelling participants with lifetime history of MDD (N = 460) were assessed for DSM-IV mental disorders using structured clinical interviews at ages 24 and 30. Stimulant use disorders and melancholic MDD were prospective risk factors for each other over the 6-year-period following the age-24 assessment. Associations were robust when controlling for clinical severity/chronicity. Alcohol and cannabis use disorders were not robustly associated with melancholia.

Levin FR; Kleber HD. Use of dronabinol for cannabis dependence: Two case reports and review. American Journal on Addictions 17(2): 161-164, 2008. (27 refs.)

Marijuana is the most commonly used illicit drug in the United States and throughout the world. Despite this, the number of laboratory studies that have assessed pharmacologic agents to target cannabis withdrawal symptoms or reduce the reinforcing effects of marijuana has been modest. Unlike alcohol, cocaine, opiates, or nicotine, there has been a minimal number of clinical pharmacologic treatment trials that have targeted marijuana use. Based on recent laboratory studies, dronabinol (delta -9- tetrahydrocannabinol) has been shown to reduce cannabis withdrawal symptoms and the subjective effects of marijuana. Given that agonist agents have been found to be effective for opiate and nicotine dependence, the clinical utility of dronabinol for cannabis dependence is a reasonable approach. Two case reports using dronabinol are presented. The potential benefit, as well as questions that arise from the use of this medication in cannabis-abusing populations, is presented. Also,future areas of research that might be explored are discussed.

Leweke FM; Koethe D. Cannabis and psychiatric disorders: It is not only addiction. (review). Addiction Biology 13(2): 264-275, 2008. (103 refs.)

Since the discovery of the endocannabinoid system, a growing body of psychiatric research has emerged focusing on the role of this system in major psychiatric disorders like schizophrenia (SCZ), bipolar disorder (BD), major depression and anxiety disorder. Continuing in the line of earlier epidemiological studies, recent replication studies indicate that frequent cannabis use doubles the risk for psychotic symptoms and SCZ. Further points of clinical research interest are alterations of endocannabinoids and their relation to symptoms as well as postmortem analyses of cannabinoid CB1 receptor densities in SCZ. A possible neurobiological mechanism for the deleterious influence of cannabis use in SCZ has been suggested, involving the disruption of endogenous cannabinoid signaling and functioning. Even though the number of studies is still limited for affective and anxiety disorders, previous results suggest these diseases to be exciting objectives of cannabinoid-associated research. Therefore, it became apparent that cannabis use is not only frequent in patients suffering from BD, but that it also induces manic symptoms in this group. In addition, prior antipsychotic treatment decreased the numerical density of CB1 immunoreactive glial cells in bipolar patients. Although the data on the influence of cannabis use on the development of major depression is controversial, cannabinoid compounds could display a new class of medication, as suggested by the antidepressive effects of the fatty acid amino hydrolase inhibitor URB597 in animal models. With numerous open questions and controversial results, further research is required to specify and extend the findings in this area, which provides a promising target for novel pharmacotherapeutic interventions.

Lindstrom M. Social capital, political trust and experience of cannabis smoking: A population-based study in southern Sweden. Preventive Medicine 46(6): 599-604, 2008. (37 refs.)

Objective. To investigate whether political mistrust in the Riksdag (the national parliament in Sweden) is an independent characteristic of cannabis smokers, or whether it reflects low confidence in people in general, and therefore low social capital. Method. The 2004 public health survey in Skane is a cross-sectional postal questionnaire study answered by 27,757 respondents aged 18-80 with a 59% response rate providing data on political trust, cannabis smoking, and potential confounders. Results. 13.9% of the men and 8.3% of the women had smoked cannabis; 17.3% of the male and 11.6% of the female respondents reported no trust at all in the Riksdag, and another 38.2% and 36.2%, respectively, reported a moderate political trust. Young age, high education, unemployment, low generalized trust in other people, and lower levels of political trust were associated with cannabis smoking, even after multiple adjustments. The groups men with no trust at all in the Riksdag, and women with high trust, not particularly high political trust and no political trust at all had significantly higher odds ratios of cannabis smoking than the very high trust reference category. The results thus somewhat differed between men and women. Conclusion. Low political trust is associated with cannabis smoking, independently of trust in people in general.

Losoya SH; Knight GP; Chassin L; Little M; Vargas-Chanes D; Mauricio A et al. 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(1): 171-198, 2008. (73 refs.)

This study examines the longitudinal relations of multiple dimensions of acculturation and enculturation to heavy episodic drinking and marijuana use in a sample of 300 male, Mexican-American, serious juvenile offenders. We track trajectories between ages 15 and 20 and also consider the effects of participants' time spent residing in supervised settings during these years. Results showed some (although not entirely consistent) support for the hypothesis that bicultural adaptation is most functional in terms of lowered substance use involvement. The current findings demonstrate the importance of examining these relations longitudinally and among multiple dimensions of acculturation and enculturation, and they call into question simple models that suggest that greater acculturation is associated with greater substance use among Mexican-American adolescents.

Low NC; Lee SS; Johnson JG; Williams JB; Harris ES. The association between anxiety and alcohol versus cannabis abuse disorders among adolescents in primary care settings. Family Practice 25(5): 321-327, 2008. (54 refs.)

Background. Both clinical and population-based studies show that anxiety disorders and substance misuse frequently co-occur in adults, whereas among adolescents, less examination of this association has been done. Adolescence is frequently the time of substance use initiation and its subsequent interaction with anxiety disorders has not been fully explored. It is unknown in adolescents whether anxiety is more related to alcohol abuse versus cannabis abuse. In addition, as depression has been implicated in adolescents with both anxiety and substance misuse, its role in the association should also be considered. Objective. To test the association between current anxiety with alcohol versus cannabis abuse disorders. Method. Cross-sectional, clinician-administered, structured assessment-using the Primary Care Evaluation of Mental Disorders-to evaluate anxiety, mood and substance abuse disorders among 632 adolescents recruited from primary care settings. Results. Results show a strong association between current anxiety and alcohol [odds ratio = 3.8; 95% confidence interval (CI) 1.2-11.8], but not cannabis (odds ratio = 1.4; 95% CI 0.4-4.7) abuse. Conclusion. This association in adolescents reflects the importance for increased awareness of anxiety symptoms and alcohol use patterns in primary care. The lack of association of anxiety with cannabis abuse in this group may reflect differences in cannabis' anxiolytic properties or that this young group has had less exposure thus far. Given adolescence is a time of especially rapid psychosocial, hormonal and brain development, primary care may provide an opportunity for further investigation and, potentially, early screening and intervention.

Loxton NJ; Wan VLN; Ho AMC; Cheung BKL; Tam N; Leung FYK et al. Impulsivity in Hong Kong-Chinese club-drug users. Drug and Alcohol Dependence 95(1/2): 81-89, 2008. (48 refs.)

To investigate the relationship between personality, club-drug use and high-risk drug-related behaviour, 360 club-drug users and 303 non-drug users in Hong Kong were assessed on measures of two impulsivity dimensions, reward drive and rash impulsivity, and a related trait of punishment sensitivity. The most frequently used drugs were ketamine, ecstasy, and cannabis, with the majority of participants using two or more drugs on any one occasion. Club-drug users were more rash-impulsive and reward-driven, and less punishment- sensitive than non-drug users (p < 0.001). Rash impulsivity, but not reward drive or punishment sensitivity, was significantly (p < 0.001) associated with risky drug-related behaviour. There was no association between any personality traits and preferred drug. These findings suggest that, while those who use club drugs are generally more impulsive and less punishment-sensitivity, some discrete facets of impulsivity are associated with differing patterns of drug-use behaviour.

Luengo MA; Kulis S; Marsiglia FF; Romero E; Gomez-Fraguela JA; Villar P et al. A cross-national study of preadolescent substance use: Exploring differences between youth in Spain and Arizona. Substance Use & Misuse 43(11): 1574-1596, 2008. (47 refs.)

This study aims to comparatively examine drug use in Arizona and Spain, in order to know if similarities and differences in drug use patterns justify the administration in Spain of U.S. prevention intervention programs. Data were obtained from independent samples of seventh-grade students recruited from urban public schools and surveyed in 1998: 4,035 ethnically diverse Arizona students (Latinos and non-Hispanic Whites), and 2,243 Spanish-White students. Comparisons using Odds ratios and Chi-square tests allowed assessment of differences in drug use rates between preadolescents in Arizona and Spain taking into account gender. Furthermore, ethnicity differences in preadolescent drug use and in psychosocial risk factors were explored using multivariate analysis (ANOVA and logistic regression). Our results showed similar trends in drug use between Arizona and Spain students, with gateway drugs already in use by early adolescents, and with higher rates of drug use among males than among females. However, cross-national differences in marijuana/cannabis use were noteworthy: Arizona preadolescents were over 25 times more likely to report marijuana/cannabis use than preadolescents from Spain. Moreover, when ethnic differences were considered, Latinos in Arizona reported higher marijuana/cannabis use compared with non-Latino students. Drug use patterns among Latino preadolescents, as well as the relevance of some risk factors among the diverse groups, were strongly influenced by their level of acculturation. Study limitations and the implications of our findings for early drug use prevention and future research are discussed.

Mackesy-Amiti ME; Fendrich M; Johnson TR. Prevalence of recent illicit substance use and reporting bias among MSM and other urban males. Addictive Behaviors 33(8): 1055-1060, 2008. (12 refs.)

This paper explores whether elevated rates of self-reported substance use among MSM compared to other males may be an artifact of reporting bias. Past month prevalence rates of marijuana, cocaine, heroin, methamphetamine, Ecstasy. and Ketamine use were compared between a sample of men who have sex with men (MSM), and a general household sample of men, all residing in Chicago. We compared rates of self-reported use, and corrected rates based on the results of drug testing (urine and oral fluid tests). While MSM over 30 years old were significantly more likely than other men in this age group to report past month use of cocaine, test-corrected rates of use were equivalent. On the other hand, test-corrected estimates confirmed elevated rates of Ketamine and Ecstasy use in the MSM sample. Differential disclosure of substance use between MSM and other males may in some cases lead to distorted conclusions about differences in substance use between these groups. The use of biological testing in epidemiological studies of substance use can reduce the uncertainty of such comparisons.

Mariani JJ; Horey J; Bisaga A; Aharonovich E; Raby W; Cheng WY et al. Antisocial behavioral syndromes in cocaine and cannabis dependence. American Journal of Drug and Alcohol Abuse 34(4): 405-414, 2008. (30 refs.)

Antisocial personality disorder (ASPD) is highly associated with substance use disorders (SUD). In addition to the full ASPD syndrome, which requires both childhood conduct disorder and the adult features, other antisocial behavioral syndromes, including conduct disorder (CD) alone without the adult syndrome, and the adult antisocial behavioral syndrome without childhood CD (AABS) are also frequently diagnosed in patients with SUD. The aim of this study was to compare the rates of these various ASPD syndromes between cocaine- and cannabis-dependent individuals seeking treatment. A structured interview for ASPD excluding symptoms that occurred solely in the context of substance use was conducted in 241 outpatients (cocaine dependence, n = 111; cannabis dependence, n = 130). Overall, the proportion of substance-dependent individuals in this study with AABS was significantly larger than the proportion with ASPD (30.9% vs. 17.3%). A diagnosis of CD-only, where CD did not progress to ASPD, was uncommon. No significant differences in the prevalence of antisocial behavioral syndrome diagnoses were found between cocaine-and cannabis-dependent patients. Antisocial behavioral syndrome diagnosis did not influence treatment retention. Antisocial behavioral syndromes are commonly diagnosed in patients with SUD and future research should evaluate prognostic implications of AABS compared to ASPD in a variety of clinical treatment settings.

Marsden J; Farrell M; Bradbury C; Dale-Perera A; Eastwood B; Roxburgh M et al. Development of the treatment outcomes profile. Addiction 103(9): 1450-1460, 2008. (58 refs.)

Aim: To develop the Treatment Outcomes Profile (TOP), a new instrument for monitoring substance misuse treatment. Design: Prospective cohort, psychometric evaluation with 7-day retest and 1-month follow-up to assess inter-rater reliability, concurrent, discriminant and construct validity, and change sensitivity. Participants: A sample of 1021 service users, aged 16-62 years. Recruitment from 63 treatment agencies in England, collectively providing opioid substitution treatment, psychosocial interventions, in-patient detoxification and residential rehabilitation. Measurements Thirty-eight frequency, rating scale and period prevalence measures, with 28-day recall, across substance use, health, crime and social functioning domains, administered as personal interview by 163 treatment keyworkers. Findings: Twenty outcome measures met inter-rater reliability criteria: days used alcohol, opioids, crack cocaine, cocaine powder, amphetamines, cannabis and one other named substance; days injected and period prevalence of direct or indirect needle/syringe sharing; subjective rating of physical and psychological health; days committed shop theft and drug selling, period prevalence of vehicle, property, fraud/forgery and assault/violence offences; rating of quality of life; days worked and attended for education/training; and period prevalence of acute housing problems and risk of eviction. Intraclass correlation coefficients for scale measures and Cohen's kappa for dichotomous measures reached or exceeded 0.75 and 0.61, respectively. There were satisfactory validity assessments and change sensitivity of scale items judged by effect size and smallest detectable difference. The TOP clinical tool contains an additional 10 items for individual treatment planning and review. Conclusions The TOP is a reliable and valid 20-item instrument for treatment outcomes monitoring.

Martens KM; Gilbert DG. Marijuana and tobacco exposure predict affect-regulation expectancies in dual users. Addictive Behaviors 33(11): 1484-1490, 2008. (26 refs.)

In order to better compare affect-related expectancies for tobacco and marijuana smoking, associations of marijuana and tobacco exposure to negative affect reduction (NAR), positive affect enhancement (PAE), and related smoking outcome expectancies were assessed in young individuals who reported smoking both marijuana and tobacco on a regular basis (dual users). More frequent smoking of a given substance was associated with expectations of greater NAR and PAE by that substance while duration of exposure did not reliably predict NAR or PAE drug expectancies. Contrary to expectations, individuals anticipating greater NAR and/or PAE for one substance did not exhibit corresponding expectancies for the other drug. These findings suggest that exposure duration may be less important than current usage levels in influencing affect expectancies and that the affect-related expectancies for tobacco and marijuana are largely independent of each other.

Martinez-Rodriguez JE; Munteis E; Carreno M; Blanco Y; Roquer J; Abanades S et al. Cannabis use in Spanish patients with multiple sclerosis: Fulfilment of patients' expectations? Journal of Neurological Sciences 273(1/2): 103-107, 2008. (15 refs.)

Objective: Medicinal use of cannabis in chronic neurological diseases is a controversial topic of medical research and the subject of intense public debate. The aim of the study was to evaluate the prevalence of cannabis use, related factors, and degree of satisfaction in Spanish patients with multiple sclerosis (MS) prior to the establishment of medically supervised use. Methods: Cross-sectional, questionnaire-based survey provided during routine medical visits to consecutive patients in two university-based neurology clinics. Results: The questionnaire was returned by 175 MS patients (94.1% response rate). The prevalence of ever-use and medicinal cannabis use were 43% and 17.1%, respectively. At the time of the survey, cannabis was being used by 12.5% (5/45) of recreational and 56.7% (17/30) of medical users (p < 0.001). First cannabis consumption was after MS onset in 15 (50%) medicinal users. Clinical improvement was reported by 14 (46.7%) medicinal users. Smoking use, awareness of cannabis potential benefits, pain, higher disability, and lower age were independently associated with the medicinal use of cannabis. Most patients would support a future legalisation of cannabis for the control of their symptoms and were willing to receive cannabis under medical control once legalised (83.4% of never-users, 94.5% of ever-users, p < 0.05). Conclusion: Almost half of our MS patients had tried cannabis at some time. However, medicinal use was low and clinical improvement after cannabis use was only reported by a subset of patients. Overall, MS patients were highly motivated for a future medically controlled use.

Martino SC; Ellickson PL; McCaffrey DE. Developmental trajectories of substance use from early to late adolescence: A comparison of rural and urban youth. Journal of Studies on Alcohol and Drugs 69(3): 430-440, 2008. (36 refs.)

Objective: This study investigated differences in the development of heavy drinking and marijuana use among students in urban and rural areas and assessed whether any such differences can be accounted for by locality differences in racial/ethnic makeup, social disorganization/low social bonding, feelings of despondency and escapism, and the availability of drugs. Method: Drawn from 62 South Dakota middle schools involved in a drug prevention field trial, participating students were assigned to a locality category based on the location of their seventh-grade school. Schools in metropolitan areas were distinguished from schools in nonmetropolitan areas. Schools in nonmetropolitan areas were further distinguished into those in micropolitan (medium and large towns) and noncore (rural areas without towns and with small towns) areas. We used latent growth curve analysis to model the influence of locality on the development of heavy drinking and marijuana use from ages 13 to 19 and to determine whether differences in development across locality were attributable to location-based differences in race/ethnicity, social disorganization/bonding, feelings of despondency and escapism, and alcohol and marijuana availability. Results: Heavy drinking increased at a faster rate among youth living in micropolitan areas compared with youth living in metropolitan areas. Marijuana use increased at a faster rate among youth living in metropolitan and micropolitan areas compared with youth living in noncore areas. Differences in the rate of change in heavy drinking were attributable to differences in the racial/ethnic composition of metropolitan and micropolitan areas. Differences in the rate of change in marijuana use were attributable to differences in residential instability and marijuana availability. Conclusions: This study underscores the diversity of drug use within rural communities, suggesting that living in a very rural area is protective against some forms of drug use but that living in a rural area that includes a medium or large town is not.

Martins SS; Storr CL; Alexandre PK; Chilcoat HD. Adolescent ecstasy and other drug use in the National Survey of Parents and Youth: The role of sensation-seeking, parental monitoring and peer's drug use. Addictive Behaviors 33(7): 919-933, 2008. (60 refs.)

The association between high sensation-seeking, close friends' drug use and low parental monitoring with ecstasy (MDMA) use in adolescence was examined in a sample of US household-dwelling adolescents aged 12 - 18 years (N=5049). We also tested whether associations were of stronger magnitude than associations between these correlates and marijuana or alcohol/tobacco use in adolescence. Data from Round 2 of the National Survey of Parents and Youth (NSPY) Restricted Use Files (RUF) was analyzed via Jackknife weighted multinomial logistic regression models. High sensation-seekers were more likely to be ecstasy, marijuana, and alcohol/tobacco users, respectively, as compared to low sensation-seekers. High sensation-seeking and close friends' drug use were more strongly associated with ecstasy as compared to marijuana and alcohol/tobacco use. Low parental monitoring was associated with marijuana use and alcohol/tobacco use and there was a trend for it to be associated with ecstasy use. Ecstasy use is strongly associated with peer drug use and more modestly associated with high sensation-seeking. School prevention programs should target high-sensation-seeking adolescents and also encourage them to affiliate with non-drug using peers.

Mata I; Rodriguez-Sanchez JM; Pelayo-Teran JM; Perez-Iglesias R; Gonzalez-Blanch C; Ramirez-Bonilla M et al. Cannabis abuse is associated with decision-making impairment among first-episode patients with schizophrenia-spectrum psychosis. Psychological Medicine 38(9): 1257-1266, 2008. (70 refs.)

Background. Cannabis use appears to be a risk factor for schizophrenia. Moreover, cannabis abusers show impaired decision-making capacities, linked to the orbitofrontal cortex (OFC). Although there is substantial evidence that first-episode schizophrenia patients show impairments in cognitive tasks associated with the dorsolateral prefrontal cortex (DLPFC), it is not clear whether decision making is impaired at schizophrenia onset. In this Study, we examined the association between antecedents of cannabis abuse and cognitive impairment in cognitive tasks associated with the DLPFC and the OFC in a sample of first-episode patients with schizophrenia-spectrum disorders. Method. One hundred and thirty-two patients experiencing their first episode of a schizophrenia-spectrum psychosis were assessed with a cognitive battery including DLPFC-related tasks [backward digits, verbal fluency (FAS) and the Trail Making Test (TMT)] and an OFC-related task [the Iowa Gambling Task (GT)]. Performance on these tasks was compared between patients who had and had not abused cannabis before their psychosis onset. Results. No differences were observed between the two groups on the performance of any of the DLPFC-related tasks. However, patients who had abused cannabis before their psychosis onset showed a poorer total performance on the gambling task and a lower improvement on the performance of the task compared to no-abusers. Conclusions. Pre-psychotic cannabis abuse is associated with decision-making impairment, but not working memory and executive function impairment, among first-episode patients with a schizophrenia-spectrum psychosis. Further studies are needed to examine the direction of causality of this impairment; that is, does the impairment make the patients abuse cannabis, or does cannabis abuse cause the impairment?

Maxwell JC. Are we becoming more alike? Comparison of substance use in Australia and the United States as seen in the 1995, 1998, 2001 and 2004 national household surveys. Drug and Alcohol Review 27(5): 473-481, 2008. (33 refs.)

Introduction. This paper reports the results of the 1995, 1998, 2001 and 2004 Australian and US household surveys, with emphasis on changes since 2001. Design and Methods. The US survey data were recalculated to match age groups in the Australian data. Statistically significant changes are reported. Differences in prevalence of use by gender within age group were tested for significance. Results. The past-year use of 'any illicit drug', cannabis, cocaine, tranquillisers and injecting drugs decreased between 2001 and 2004 in Australia, but remained stable for all these drugs except ecstasy between 2002 and 2004 in the United States. The use of hallucinogens decreased in both countries. Alcohol and use of many illicit drugs by teenage girls in both countries increased to rates similar to or higher than boys, and teens in both countries reported binge and heavy drinking in the past month. Australians in their 20s had the highest rates of use, but in the United States, past-year use of many drugs was highest among teenagers. Discussion. More treatment services are needed, particularly for people dependent upon non-opiate drugs. The changes in acceptability of use of different drugs and their perceived availability are related to changes in prevalence rates. Even with the similarities in levels of use, there are differences in patterns of use and preferences for certain drugs in each country, and geographic proximity to drug sources is a factor.

McCambridge J; Slym RL; Strang J. Randomized controlled trial of motivational interviewing compared with drug information and advice for early intervention among young cannabis users. Addiction 103(11): 1809-1818, 2008. (24 refs.)

Aim: To test the effectiveness of motivational interviewing (MI) in comparison with drug information and advice in opportunistically securing reductions in drug-related risk among young cannabis users not seeking help. Design: Randomized controlled trial. Setting: Eleven London further education colleges. Participants: A total of 326 students aged 16-19 years who smoked cannabis weekly or more frequently. Interventions: Participants were randomized to a single-session intervention of motivational interviewing or drug information and advice-giving. Measurements: Cannabis use, cigarette smoking and alcohol consumption and harm outcomes were assessed after both 3 and 6 months. Findings: No differences were found between motivational interviewing and drug information and advice, although motivational interviewing fidelity was not high. There were wide-ranging individual practitioner effects on observed outcomes and a practitioner-intervention interaction was detected in relation to cannabis cessation after 3 months. Change over time was more pronounced for cannabis use than for other drug use. Conclusions: Further study of the nature and consequences of motivational interviewing fidelity, and individual practitioner effects more generally, is needed. Advice may be an effective brief intervention with young cannabis users in its own right and should be evaluated further in trials.

McHale S; Hunt N. Executive function deficits in short-term abstinent cannabis users. Human Psychopharmacology. Clinical and Experimental 23(5): 409-415, 2008. (38 refs.)

Objectives: Few cognitive tasks are adequately sensitive to show the small decrements in performance in abstinent chronic cannabis users. In this series of three experiments we set out to demonstrate a variety of tasks that are sufficiently sensitive to show differences in visual memory, verbal memory, everyday memory and executive function between controls and cannabis users. Methods: A series of three studies explored cognitive function deficits in cannabis users (phonemic verbal fluency, visual recognition and immediate and delayed recall, and prospective memory) in short-term abstinent cannabis users. Participants were selected using snowball sampling, with cannabis users being compared to a standard control group and a tobacco-use control group. Results: The cannabis users, compared to both control groups, had deficits on verbal fluency, visual recognition, delayed visual recall, and short- and long-interval prospective memory. There were no differences for immediate visual recall. Conclusions: These findings suggest that cannabis use leads to impaired executive function. Further research needs to explore the longer term impact of cannabis use.

McLaren J; Swift W; Dillon P; Allsop S. Cannabis potency and contamination: A review of the literature. (review). Addiction 103(7): 1100-1109, 2008. (82 refs.)

Aims: Increased potency and contamination of cannabis have been linked in the public domain to adverse mental health outcomes. This paper reviews the available international evidence on patterns of cannabis potency and contamination and potential associated harms, and discusses their implications for prevention and harm reduction measures. Methods: A systematic literature search on cannabis potency and contamination was conducted. Results Cannabis samples tested in the United States, the Netherlands, United Kingdom and Italy have shown increases in potency over the last 10 years. Some countries have not shown significant increases in potency, while other countries have not monitored potency over time. While there are some grounds to be concerned about potential contaminants in cannabis, there has been no systematic monitoring. Conclusion: Increased potency has been observed in some countries, but there is enormous variation between samples, meaning that cannabis users may be exposed to greater variation in a single year than over years or decades. Claims made in the public domain about a 20- or 30-fold increase in cannabis potency and about the adverse mental health effects of cannabis contamination are not supported currently by the evidence. Systematic scientific testing of cannabis is needed to monitor current and ongoing trends in cannabis potency, and to determine whether cannabis is contaminated. Additionally, more research is needed to determine whether increased potency and contamination translates to harm for users, who need to be provided with accurate and credible information to prevent and reduce harms associated with cannabis use.

McPartland JM; Blanchon DJ; Musty RE. Cannabimimetic effects modulated by cholinergic compounds. Addiction Biology 13(3/4): 411-415, 2008. (13 refs.)

This report is based upon a clinical case series describing five patients who volitionally adultered cannabis with a variety of compounds that shared a common trait -- cholinergic modulation. They included a nicotinic agonist, muscarinic antagonist and antiacetylcholinesterase compounds. Some of these compounds (e.g. tobacco) are known to exert pharmacokinetic effects upon cannabinoids (e.g. improved drug absorption). Contrarily, our patients claimed that the compounds altered pharmacodynamic 'cannabimimetic' effects. The case series was supported by forensic identification of adulterants and by use of a symptom causality algorithm. A survey of the gray literature and drug culture web sites indicated that the case series portended a larger social phenomenon. Furthermore, many clinical reports, animal behaviour studies and in vitro mechanistic studies substantiated our observations. In conclusion, we provide empirical data regarding a new trend in the drug culture -- cholinergic modulation of cannabinoid effects-- that presents new research directions.

McWhirter PT. Enhancing adolescent substance abuse treatment engagement. Journal of Psychoactive Drugs 40(2): 173-182, 2008. (27 refs.)

Trends in adolescent drug use are encouraging and suggest the importance of preventative programs for youth. Yet, among those who become involved with illicit substances and seek treatment, only a fraction report positive outcomes. This article describes an approach to enhance adolescent participation in substance abuse treatment. Aspects of the transtheoretical model are integrated into a treatment program designed to meet the unique developmental needs of adolescent alcohol and marijuana abusers. The result is a treatment that better engages adolescents in participation, thereby increasing the likelihood for treatment success.

Merline AC; Schulenberg JE; O'Malley PM; Bachman JG; Johnston LD. Substance use in marital dyads: Premarital assortment and change over time. Journal of Studies on Alcohol and Drugs 69(3): 352-361, 2008. (41 refs.)

Objective: The purpose of this study was to examine change in substance use with marriage, premarriage similarity in substance use between spouses, and the role of spouse use in predicting changes in use with marriage. Method: Nationally representative samples of high school seniors were followed longitudinally through age 35. The sample consisted of 2,169 adults from eight senior-year cohorts (1977-1984) from the Monitoring the Future study who completed a questionnaire at least once before their first marriage and at 2-year intervals at four consecutive points in time after marriage. Results: Results indicate significant reductions in use with marriage for cigarette smoking, heavy drinking, and marijuana use. Both men and women reported reductions in all three substances following marriage. Changes in women's use followed a linear pattern. Although men's decreases in cigarette smoking and heavy drinking were initially rapid and then decelerated, their decrease in marijuana use accelerated over time. Declines in use for both genders were associated with getting married to individuals who also decreased their use. Those with higher premarriage levels of substance use experienced greater reductions in use. A significant association between respondent and spouse premarital use suggests assortative mating takes place for all three substances. Conclusions: This study affirms and further qualifies the presence of a marriage effect on substance use using multiwave and multicohort national data. Results suggest that the effects of marriage on smoking, heavy drinking, and marijuana use are related to one's own initial levels of use and the direction of change in the spouse's use. These findings have important implications for life span theoretical advances as well as interventions aimed at the marital dyad.

Merlo LJ; Goldberger BA; Kolodner D; Fitzgerald K; Gold MS. Fentanyl and propofol exposure in the operating room: Sensitization hypotheses and further data. Journal of Addictive Diseases 27(3): 67-76, 2008. (50 refs.)

Inflated rates of opioid addiction among anesthesiologists may be caused by chronic exposure to low doses of aerosolized anesthetic/analgesic agents in the operating room. Such secondhand exposure produces neurobiological sensitization to the reinforcing effects of these substances, making later addiction more likely. This article extends findings that fentanyl and propofol are detectable in the air of the operating room and demonstrates that fentanyl is also detectable on surfaces in the operating room. Secondhand exposure could, therefore, occur by inhalation and skin absorption. Additionally, data show that many physicians with opiate addiction have a family history of addiction, suggesting genetic vulnerability to the effects of secondhand exposure. Other new data demonstrate that the rates of marijuana and tobacco smoking are much higher among opioid-addicted physicians, suggesting that prior exposure to THC (the psychoactive component of cannabis) or nicotine might increase vulnerability to secondhand effects. Suggestions for reducing secondhand exposure in the operating room are discussed.

Miller WR. It all depends. (commentary). Addiction 103(11): 1819-1820, 2008. (10 refs.)

This commentary is in response to "Randomized controlled trial of motivational interviewing compared with drug information and advice for early intervention among young cannabis users" (p 1809-1818), by McCambridge, Slym, and Strang.

Mushtaq F; Mondelli V; Pariante CM. The metabolic implications of long term cannabis use in patients with psychosis. Journal for Epidemiology and Psychiatric Sciences 17(3): 221-226, 2008. (44 refs.)

Aims - The aim of this paper is to summarise the effects of cannabis use on appetite and energy balance, and to subsequently investigate the possible implications this may have in patients with psychosis, in whom a high prevalence of cannabis use has been reported. Methods - A narrative review based on the recent literature regarding cannabis use in the general population and patients with psychosis. Results - The short-term abilities of cannabis to increase appetite and body weight, through actions on the endogenous endocannabinoid system, have been well characterised throughout the literature. The long term effects of cannabis use are however unclear and only a minority of studies have been conducted in the genera. population with overall conflicting results. In terms of the effects of cannabis in patients with psychosis, there has only been one study to date that has investigated this and interestingly found cannabis use to be associated with increased body weight and blood glucose levels, thus providing evidence that cannabis use may be an important contributing factor to the reduced life expectancy, as is Currently observed in this vulnerable patient group. Conclusions - It is clear from the literature that patients with psychosis are at a high risk of metabolic and cardiovascular disease in comparison to the general population. However the contribution of cannabis use to this risk is as of yet undetermined and further long term studies are need to confirm current findings and evaluate hypothesised mechanisms.

Neighbors C; Geisner IM; Lee CM. Perceived marijuana norms and social expectancies among entering college student marijuana users. Psychology of Addictive Behaviors 22(3): 433-438, 2008. (26 refs.)

This research examined the relationships among perceived social norms, social outcome expectancies, and marijuana use and related consequences among entering college freshman marijuana users. Students (N = 312, 55% female) completed online assessments of their marijuana use, related consequences, perceived norms, and social expectancies related to marijuana use. Results suggested that perceptions of friends' marijuana use were most strongly associated with marijuana use (d = 0.68), in comparison with perceived injunctive norms (d = 0.30) or expectancies (d = 0. 19), and that the perception that other used marijuana more frequently was more strongly associated with use among students who also perceived other students as more approving of marijuana. In addition, the relationships between perceived descriptive and injunctive norms and marijuana use were stronger among students who reported more positive social marijuana expectancies. Descriptive norms and expectancies were both positively associated with marijuana-related consequences, but, at high levels of both of these variables, injunctive norms were negatively associated with consequences. Results highlight the importance of distinguishing between descriptive and injunctive norms and between marijuana use and related consequences.

Office of Applied Studies, Substance Abuse and Mental Health Services Administration. The NSDUH Report. Trends in Substance Use, Dependence or Abuse, and Treatment among Adolescents: 2002 to 2007. (December 4, 2008). Rockville MD: Substance Abuse and Mental Health Services Administration, 2008. (1 refs.)

Trends in past month substance use show that while there was little change in past month use of cigarettes, alcohol, and illicit drugs among adolescents between 2006 and 2007, the rates generally declined between 2002 and 2007 (cigarettes from 13.0 to 9.8 percent, alcohol from 17.6 to 15.9 percent, and illicit drugs from 11.6 to 9.5 percent). The decline in past month illicit drug use can be attributed primarily to a decline in marijuana use, with 8.2 percent of adolescents using marijuana in 2002 compared with 6.7 percent in 2007. The two other most commonly used illicit drugs among adolescents are inhalants and the nonmedical use of prescription-type drugs. Use of inhalants remained stable, while nonmedical use of prescription-type drugs declined from 4.0 to 3.3 percent over the 6-year period covered in this report. Past year dependence on or abuse of alcohol remained relatively stable among adolescents between 2002 and 2007, but dependence on or abuse of illicit drugs declined from 5.6 to 4.3 percent. What Are the Trends in Substance Use Treatment? Among adolescents who needed treatment for alcohol use in the past year, the percentage who received treatment at a specialty facility fluctuated between 5.9 and 8.1 percent from 2002 through 2007. The percentages for treatment for illicit drug use fluctuated between 8.5 and 11.3 percent. There were no statistically significant changes between 2002 and 2007 for either of these treatment indicators. Comments: The findings in this report present mixed results. On the positive side, past month use of cigarettes, alcohol, and illicit drugs declined among adolescents between 2002 and 2007, as did dependence on or abuse of illicit drugs. On the other hand, the rates of alcohol dependence or abuse remained fairly steady. In addition, given that the rate of adolescents receiving specialty treatment remained unchanged between 2002 and 2007, it is necessary to look at strategies to expand the continuum of care to engage adolescent problem users who cannot or will not go to specialty substance use treatment programs.

Public Domain

Office of National Drug Control Policy. Who's Really in Prison for Marijuana?. Washington DC: Office of National Drug Control Policy, undated. (66 refs.)

This government document, directed to the general public, is intended to counter claims of "marijuana legalizers [who] claim that thousands of people are imprisoned for marijuana 'possession' ... whose crime was simply having in their possession a little bit of dope." Rather the document states that in reality those "technically serving time for marijuana possession were actually sent to prison on much more serious charges." In reality it is said, "The [those imprisoned] are criminals who have been found guilty of trafficking, manufacturing, selling or distributing the drug, or who were convicted of multiple offenses that happened to include a marijuana charge." The document discusses both state and federal laws and endeavors to clarify sources of misunderstandings, e.g. by clarifying distinctions between jails and prisons, or possession versus trafficking, the roll of plea bargains in distorting data. Tables are included with data on prison populations and marijuana offenders sentenced in federal courts. Several illustrative cases are included.

Okoli CTC; Richardson CG; Ratner PA; Johnson JL. Adolescents' self-defined tobacco use status, marijuana use, and tobacco dependence. Addictive Behaviors 33(11): 1491-1499, 2008. (37 refs.)

Aims: To examine differences in tobacco use and dependence between adolescents who are and are not marijuana users. Design: Cross-sectional analysis of existing survey data. Participants: Data were obtained from 7440 adolescents who completed the British Columbia Youth Survey of Smoking and Health II (BCYSOSH-II), a school based survey conducted in 2004. Measures: Responses to demographic, current smoking, alcohol use, self-defined tobacco and marijuana use status questions, perceived physical and mental addiction to tobacco, modified-Fagerstrom Tolerance Questionnaire (M-FTQ), and the Dimensions of Tobacco Dependence Scale (DTDS) were obtained. Findings: Marijuana users were 5.9 times more likely to be current tobacco smokers and reported higher levels of perceived addiction to tobacco as compared with marijuana nonusers. After controlling for demographics, life-time tobacco use, and alcohol use, marijuana use was associated with the nicotine dependent and sensory dimensions of tobacco dependence. Conclusions: Adolescents who concurrently use tobacco and marijuana may be more tobacco dependent than are marijuana non-users. Concurrent use of marijuana may be a factor associated with tobacco dependence among a sub-group of concomitant drug-using adolescents.

O'Phelan K; McArthur DL; Chang CWJ; Green D; Hovda DA. The impact of substance abuse on mortality in patients with severe traumatic brain injury. Journal of Trauma, Injury, Infection and Critical Care 65(3): 674-677, 2008. (31 refs.)

Background. Drug and alcohol use are common in neurotrauma patients. Despite growing methamphetamine use there are few studies of the impact of methamphetamine use on outcome after traumatic brain injury (TBI). Methods: We conducted a retrospective review of 5-years of data from a trauma database. Inclusion criteria included severe TBI and diagnosis codes indicating head injury. The entire database was analyzed and then a subset of patients with complete toxicology data were examined separately. Primary outcome was mortality. Results. Four hundred eighty-three patients were included. Toxicology resuits were available for 52.6% of patients. Alcohol, amphetamines, and cannabis were the most commonly detected substances. Overall mortality was 50.9%. When the group with complete tox screen data were analyzed, a toxicology screen that was positive for alcohol or amphetamine was associated with decreased mortality with an odds ratio of 0.23 (CI: 0.10-0.56, p = 0.001) and 0.25 (CI: 0.08-0.79, p = 0.02), respectively. When the subset of patients for whom toxicology data were available was analyzed the amphetamine-positive group was more likely to use cannabis and less likely to use alcohol. Conclusions. We unexpectedly found alcohol and methamphetamine use to be associated with decreased mortality. Neurotoxic and possible neuroprotective mechanisms of these substances are discussed as well as possible interactions between cannabis and methamphetamine. The potential influence of psycho-social factors are also considered. Prospective studies are needed to further investigate the effects of drug and alcohol use on outcome after severe TBI.

Pavlovic Z; Jakovljevic B. Frequency and risk factors of the use of psychoactive substances among the young. (Serbian). Vojnosanitetski Pregled 65(6): 441-448, 2008. (17 refs.)

Background/Aim. Socio-economic changes that occured in the wake of dismemberment of former Yugoslavia resulted in the appearance of social pathology, one of which was the increase in the use of psychoactive substances. The overwhole epidemiological research in the use of psychoactive substances has not been conducted so far. The aim of this study was to establish the type and form of the use of psychoactive substances considering sex and age, as well as risk factors for the use of psychoactive substances among the children and adolescents. Methods. The research was carried out among 1011 elementary school children (seventh and eighth grades) and secondary school children (all four grades) in the area of Belgrade from October 2003 to January 2004. Out of the total number 457 (45.2%) were elementary school pupils and 554 (54.8%) secondary school pupils. There were 524 (51.8%) boys and 487 (48.2%) girls, aged from 12 to 18 years (the average age being 15.3 years). The method used was the European School Survey Project on Alcohol and Other Drugs Questionaire. Chisquare test, Mann-Whitney, Student's t test and Logistic Regression test were used in statistical processing of the data. Results. Totally 14.2% examinees tried psychoactive substances. The most frequent drug used at the first contact was marijuana (10.8%) at the age of 15 tried by 12.7% examinees, inhalants (4.4%), amphetamines (4.1%), sedatives (3.7%), alcohol combined with marijuana (3.9%), then cocaine (2.8%), heroin (2.3%), alcohol combined with sedatives (2.2%), and ecstasy (1.6%), followed by anabolic steroids, heroin, diethilamid lisergic acid (LSD) and magic mushrooms. It was determined that going out in the evening, smoking and binge form drinking were directly connected with the use of psychoactive substances. Conclusion. Totally 14.2% of the exameneers used psychoactive substances, mostly marijuana, followed by amphetamines and others. New tendencies of use characterized by the increase in the use are of synthetic substances, simultaneous use of more psychoactive substances and younger age. The risk factors are going out in the evening, smoking, binge drinking and use of synthetic substances among peers. Our research indicates the neccessity of primary prevention.

Peretti-Watel P. Sports and drugs: Further interpretative hypotheses are necessary. (commentary). Addiction 104(1): 150-151, 2009

Potvin S; Kouassi E; Lipp O; Bouchard RH; Roy MA; Demers MF et al. Endogenous cannabinoids in patients with schizophrenia and substance use disorder during quetiapine therapy. Journal of Psychopathology 22(3): 262-269, 2008. (53 refs.)

Disturbances in the endogenous cannabinoid (ECB) system in schizophrenia may contribute to their enhanced sensitivity to psychoactive substances, and the beneficial effects of second-generation antipsychotics for substance abuse in schizophrenia may involve modulatory effects on ECB. To verify these two assumptions, 29 patients (24 completers) with schizophrenia and substance use disorders (SUD) were treated with quetiapine for 12 weeks, and peripheral ECB levels were measured, using high-performance liquid chromatography/ mass spectrometry, in patients (weeks 0, 6 and 12) and 17 healthy volunteers. Baseline anandamide levels were significantly higher in patients, relative to controls. This result is consistent with studies describing ECB dysfunctions in schizophrenia. SUD parameters improved during treatment, but no changes in ECB occurred over time. Improvements in substance abuse were probably not mediated by modulatory effects of quetiapine on ECB. Lastly, baseline anandamide predicted endpoint SUD scores (alcohol/cannabis). Anandamide is a potential target for medications aimed at relieving SUD in schizophrenia.

Puskar KR; Bernardo LM; Switala J; Chughtai RL. Adolescent substance use in rural America: Current profile. Journal of Addictions Nursing 19(3): 150-155, 2008. (23 refs.)

Adolescent substance use in rural America has changed over the past decade. The purpose of this article is to describe the current profile of alcohol and drug use in a sample of adolescents in rural Pennsylvania. A total of 193 students (average = 15.6 years, SD = .93) from three high schools in rural western Pennsylvania were surveyed. Alcohol was reported at the highest percentage of use (49%), followed by painkillers (30.6%), and marijuana (13.6%). No significant difference in substance use was found between males and females, except for marijuana use (x(2) = 4.293, p value = .042). The results of this study have implications for the development of health education programs.

Rathbone J; Variend H; Mehta H. Cannabis and schizophrenia. (review). Cochrane Database of Systematic Reviews 3(article CD004837), 2008. (75 refs.)

Background: Many people with schizophrenia use cannabis and its effects on the illness are unclear. Objectives: To evaluate the effects of cannabis use on people with schizophrenia and schizophrenia-like illnesses. Search strategy: We searched the Cochrane SchizophreniaGroup Trials Register (April 2007) which is based on regular searches of BIOSIS, CENTRAL, CINAHL, EMBASE, MEDLINE and PsycINFO. Selection criteria: We included all randomised trials involving cannabinoids and people with schizophrenia or schizophrenia-like illnesses. Data collection and analysis: We extracted data independently. For dichotomous data we calculated relative risks (RR) and their 95% confidence intervals (CI) on an intention-to-treat basis, based on a fixed effects model. We calculated the numbers needed to treat/harm( NNT/NNH). For continuous data, we calculated weighted mean differences (WMD) again based on a fixed effects model. Main results: We identified one randomised trial. No significant differences were found between the Cannabis and Psychosis Therapy ( CAP) intervention group and the Psychoeducaton ( PE) intervention for use of cannabis at three months assessment ( n= 47, RR 1.04 CI 0.6 to 1.7). BPRS-extended scale scores at three months assessment ( n= 47, WMD-3.60 CI -12.8 to 5.6) and nine months assessment ( n= 47, WMD 0.80 CI -7.5 to 9.1) were non-significant between CAP and PE. We found no significant improvement in social functioning in the CAP group compared with PE ( at 3 months, n= 47, WMD -0.80 CI -10 to 8.4) and ( at 9 months, n= 47, WMD -4.70 CI -14.5 to 5.1). Author's conclusion: At present, there is insufficient evidence to support or refute the use of cannabis/cannabinoid compounds for people suffering with schizophrenia. This review highlights the need for well designed, conducted and reported clinical trials to address the potential effects of cannabis based compounds for people with schizophrenia.

Ream GL; Benoit E; Johnson BD; Dunlap E. Smoking tobacco along with marijuana increases symptoms of cannabis dependence. Drug and Alcohol Dependence 95(3): 199-208, 2008. (43 refs.)

Aim: User practices/rituals that involve concurrent use of tobacco and marijuana - smoking blunts and "chasing" marijuana with tobacco - are hypothesized to increase cannabis dependence symptoms. Design: Ethnographers administered group surveys to a diverse, purposive sample of marijuana users who appeared to be 17-35 years old. Setting: New York City, including non-impoverished areas of Manhattan, the transitional area of East Village/Lower East Side, low-income areas of northern Manhattan and South Bronx, and diverse areas of Brooklyn and Queens. Participants: 481 marijuana users ages 14-35, 57% male, 43% female; 27% White, 30% Black, 19% Latino, 5% Asian, 20% of other/multiple race. Measurements: Among many other topics, group surveys measured cannabis dependence symptoms; frequencies of chasing, blunt smoking, joint/pipe smoking, using marijuana while alone, and general tobacco use; and demographic factors. Findings: Blunt smoking and chasing marijuana with tobacco were each uniquely associated with five of the seven cannabis dependence symptoms. Across symptoms, predicted odds were 2.4-4.1 times greater for participants who smoked blunts on all 30 of the past 30 days than for participants who did not smoke blunts in the past 30 days. Significant increases in odds over the whole range of the five-point chasing frequency measure (from never to always) ranged from 3.4 times to 5.1 times. Conclusions: Using tobacco with marijuana - smoking blunts and "chasing" marijuana with tobacco - contributes to cannabis dependence symptoms. Treatment for cannabis dependence may be more effective it addresses the issue of concurrent tobacco use.

Ronen A; Gershon P; Drobiner H; Rabinovich A; Bar-Hamburger R; Mechoulam R et al. Effects of THC on driving performance, physiological state and subjective feelings relative to alcohol. Accident Analysis and Prevention 40(3): 926-934, 2008. (28 refs.)

Background: The effects of marijuana or THC on driving has been tested in several studies, but usually not in conjunction with physiological and subjective responses and not in comparison to alcohol effects on all three types of measures. Objective: To assess the effects of two dosages of THC relative to alcohol on driving performance, physiological strain, and subjective feelings. Method: We tested the subjective feelings and driving abilities after placebo, smoking two dosages of THC (13 mg and 17 mg), drinking (0.05% BAC) and 24 h after smoking the high dose THC cigarette, while monitoring physiological activity of the drugs by heart rate. Fourteen healthy students, all recreational marijuana users, participated in the study. Results: Both levels of THC cigarettes significantly affected the subjects in a dose-dependent manner. The moderate dose of alcohol and the low THC dose were equally detrimental to some of the driving abilities, with some differences between the two drugs. THC primarily caused elevation in physical effort and physical discomfort during the drive while alcohol tended to affect sleepiness level. After THC administration, subjects drove significantly slower than in the control condition, while after alcohol ingestion, subjects drove significantly faster than in the control condition. No THC effects were observed after 24 h on any of the measures.

Rowe CL; Liddle HA. Multidimensional family therapy for adolescent alcohol abusers. Alcoholism Treatment Quarterly 26(1/2): 81-103, 2008

Multidimensional Family Therapy (MDFT) has been empirically supported in a series of randomized clinical trials over 20 years. These studies have demonstrated the potency of MDFT in achieving outcomes across functional areas of the teen's life, including reductions in alcohol-other drug use, behavioral problems, emotional symptoms, negative peer associations, school failure, and deficits within the family. This article describes our approach to refining and testing MDFT with teens who abuse alcohol. Drawing from the research base on risk and protective factors for teen alcohol abuse and relapse patterns, a strong case can be made for using a family-based approach for adolescent alcohol problems. MDFT shows promising preliminary results with teens who have alcohol and marijuana use disorders. Specific change targets within this empirically supported family-based intervention for adolescent alcohol problems are outlined.

Sartor CE; Xian H; Scherrer JF; Lynskey MT; Duncan AE; Haber JR et al. Psychiatric and familial predictors of transition times between smoking stages: Results from an offspring-of-twins study. Addictive Behaviors 33(2): 235-251, 2008. (90 refs.)

The modifying effects of psychiatric and familial risk factors on age at smoking initiation, rate of progression from first cigarette to regular smoking, and transition time from regular smoking to nicotine dependence (ND) were examined in 1269 offspring of male twins from the Vietnam Era Twin Registry. Mean age of the sample was 20.1 years. Cox proportional hazard regression analyses adjusting for paternal alcohol dependence and ND status and maternal ND were conducted. Both early age at first cigarette and rapid transition from initiation to regular smoking were associated with externalizing disorders, alcohol consumption, and cannabis use. Rapid escalation from regular smoking to ND was also predicted by externalizing disorders, but in contrast to earlier transitions, revealed a strong association with internalizing disorders and no significant relationship with use of other substances. Findings characterize a rarely examined aspect of the course of ND development and highlight critical distinctions in risk profiles across stages of tobacco involvement.

Scherrer JF; Grant JD; Duncan AE; Pan H; Waterman B; Jacob T et al. Measured environmental contributions to cannabis abuse/dependence in an offspring of twins design. Addictive Behaviors 33(10): 1255-1266, 2008. (50 refs.)

Genetic and environmental factors are known to contribute to cannabis abuse/dependence (CAD). We sought to determine the magnitude of the contribution from measured environmental variables to offspring cannabis dependence in a design that controls for familial vulnerability. Data come from a study of 725 twin members of the Vietnam Era Twin Registry, 720 of their biological offspring (age 18-32 years) and 427 mothers. Data were obtained on offspring perception of family and peer support and substance use behaviors and offspring CAD. After adjusting for familial risk, and environmental covariates, CAD was significantly more likely among male offspring (OR=2.73; 95% Cl: 1.69-4.41). Offspring CAD was associated with reporting: siblings used illicit drugs (OR=3.40; 95% Cl: 1.81-6.38). a few friends used drugs (OR=2.72; 95% Cl: 1.04-7.09), a quarter or more friends used drugs (OR=8.30; 95% Cl: 3.09-22.33) and one-half or more 12th grade peers used drugs (OR=3.17; 95% Cl: 1.42-7.08). Perceived sibling, friend and school peer substance use are strongly associated with CAD in young adults even after accounting for latent familial risk and for multiple measured intra-family and extra-family environmental influences.

Schneider M; Schomig E; Leweke FM. Acute and chronic cannabinoid treatment differentially affects recognition memory and social behavior in pubertal and adult rats. Addiction Biology 13(3/4): 345-357, 2008. (51 refs.)

Although cannabis belongs to the most widely used drugs among adolescents, little is known about its acute and lasting neurobehavioral effects during critical developmental periods. In the present study we investigated acute and long-term behavioral effects of the cannabinoid agonist WIN 55,212-2 (WIN) in pubertal and adult rats. Chronic WIN (1.2 mg/kg)/vehicle treatment was extended over 25 days throughout puberty, from postnatal day (pd) 40 to pd 65, or for a similar time period in adult rats (> pd 80). All animals were tested at three time points for object/social recognition memory, social interaction and spontaneous social behavior. First, acute cannabinoid effects were investigated directly after the first injection. Additionally, behavioral performance was retested 24 hours and 15 days after cessation of WIN treatment. Chronic pubertal WIN treatment induced persistent object/social recognition deficits, indicating a general impairment in short-term information processing. Lasting disturbances in social behavior, social play and self-grooming were also found. Furthermore, behavioral deficits seen after acute WIN administration were more pronounced in pubertal than in adult rats. These results confirm our recent findings that chronic pubertal cannabinoid treatment leads to lasting behavioral alterations in adulthood, and they show that acute cannabinoid administration induces more severe behavioral deficits in pubertal rats than in mature animals. We therefore conclude that an immature brain is more susceptible to the acute and chronic effects of exogenous cannabinoids than an adult organism, which might be explained by an overactive endocannabinoid system and concomittant maturational disturbances in further neurotransmitter systems during pubertal development.

Simons JS; Dvorak RD; Batten BD. Methamphetamine use in a rural college population: Associations with marijuana use, sensitivity to punishment, and sensitivity to reward. Psychology of Addictive Behaviors 22(3): 444-449, 2008. (42 refs.)

This study examined predictors of methamphetamine use in a 6-month prospective study of 2.270 rural young adults. Sensitivity to punishment (SP), sensitivity to reward (SR). and gender were exogenous Variables in an observed variable path analysis with 3 endogenous criteria: Time 1 (T1) marijuana use and methamphetamine use at T1 and Time 2 (T2). SP was negatively associated with marijuana use at T1. and this association was attenuated by SR. Mate gender was positively associated with marijuana use. T1 marijuana use and SR were positively, and male gender negatively. associated with T1 methamphetamine use. T1 methamphetamine use, T1 marijuana use, and SP were positively associated with T2 methamphetamine use. Methamphetamine use prevalence and the role of distal predictors and proximal indicators of drug involvement are discussed.

Sneider JT; Pope HG; Silveri MM; Simpson NS; Gruber SA; Yurgelun-Todd DA. Differences in regional blood volume during a 28-day period of abstinence in chronic cannabis smokers. European Neuropsychopharmacology 18(8): 612-619, 2008. (46 refs.)

Cerebral blood volume (CBV) studies have provided important insight into the effects of illicit substances such as cannabis. The present study examined changes in regional blood volume in the frontal and temporal lobe, and the cerebellum during 28 days of supervised abstinence from cannabis. Dynamic susceptibility contrast MRI (DSCMRI) data were collected on 15 current, long-term cannabis users between 6 and 36 h after the subjects' last reported cannabis use (Day 0), and again after 7 and 28 days of abstinence. Resting state CBV images were also acquired on 17 healthy comparison subjects. The present findings demonstrate that at Day 7, cannabis users continued to display increased blood volumes in the right frontal region, the left and right temporal regions, and the cerebellum. However, after 28 days of abstinence, only the left temporal area and cerebellum showed significantly increased CBV values in cannabis users. These findings suggest that while CBV levels begin to normalize with continued abstinence from cannabis, specifically in frontal areas, other temporal and cerebellar brain regions show slower CBV decreases.

Stirling J; Barkus EJ; Nabosi L; Irshad S; Roemer G; Schreudergoidheijt B et al. Cannabis-induced psychotic-like experiences are predicted by high schizotypy. Psychopathology 41(6): 371-378, 2008. (37 refs.)

Background: Cannabis use has been identified as a possible risk factor for developing schizophrenia. In a previous paper we reported preliminary evidence that cannabis use increases the likelihood of psychosis-like experiences in non-clinical respondents who scored highly on a measure of schizotypy. We now present findings from pooled data from 3 new follow-up studies comprising a sample of 477 respondents, of whom 332 reported using cannabis at least once. Sampling and Methods: As in our previous study, the psychological effects of cannabis were assessed with the Cannabis Experiences Questionnaire, from which 3 subscales can be derived; encompassing pleasurable experiences, psychosis-like experiences and after-effects. The respondents also completed the brief Schizotypal Personality Questionnaire. Results: Cannabis use was reported by 70% of the sample. Use per se was not significantly related to schizotypy. However, high scoring schizotypes were more likely to report both psychosis-like experiences and unpleasant after-effects of cannabis use were not related to schizotypy. Exploratory factor analysis of the pooled data from this study and our previous report (providing a sample of >400 cannabis users) suggested a 3-factor solution. These were characterised as a psychotic-dysphoric index (factor 1), an expansive index (factor 2) and an intoxicated index (factor 3). Schizotypy was highly correlated with factors 1 and 3, though not with factor 2. Conclusion: High scoring schizotypes who use cannabis are more likely to experience psychotic-dysphoric phenomena and intoxicating effects during and after use. Our results confirm and expand the findings reported in our previous study. They are consistent with the hypothesis that cannabis use may be a risk factor for full psychosis in this group.

Suris JC; Michaud PA; Akre C; Sawyer SM. Health risk behaviors in adolescents with chronic conditions. Pediatrics 122(5): E1113-E1118, 2008. (56 refs.)

OBJECTIVE. The objective of this study was to compare the frequency of risk behaviors and to measure the extent of co-occurrence of these behaviors in chronically ill and healthy adolescents. METHODS. Data were drawn from the 2002 Swiss Multicenter Adolescent Survey on Health database, a nationally representative survey of 7548 adolescents in postmandatory school aged 16 to 20 years. There were 760 subjects who reported a chronic illness and/or a disability. The comparison group consisted of 6493 subjects who answered negatively to both questions. We defined 8 risk behaviors: daily smoking, alcohol misuse, current cannabis use, current use of any other illegal drug, early sexual debut, eating disorder, violent acts, and antisocial acts. We analyzed each behavior and the sum of behaviors, controlling for age, gender, academic track, parents' education level, depression, and health status. Results: are given as adjusted odds ratios using the comparison group as the reference category. RESULTS. Youth with a chronic condition were more likely to smoke daily, to be current cannabis users, and to have performed violent or antisocial acts. Youth with a chronic condition were also more likely to report 3 or >= 4 risk behaviors. CONCLUSIONS. These results indicate that having a chronic condition carries additional risks for engaging in health risk behaviors and emphasize the importance of health risk screening and preventive counseling for young people in general and among those suffering from chronic conditions in particular.

Swift W; Coffey C; Carlin JB; Degenhardt L; Patton GC. Adolescent cannabis users at 24 years: Trajectories to regular weekly use and dependence in young adulthood. Addiction 103(8): 1361-1370, 2008. (39 refs.)

Aims To examine the association between cannabis use by 18 years and problematic cannabis use at 24 years, considering possible mediating and confounding factors. Design Ten-year representative prospective study with data from six time-points in adolescence (mean age 14.9-17.4 years) and two in young adulthood (mean age 20.7 and 24.1 years) Setting Victoria, Australia. Participants Inception cohort of 1943 secondary school students (95.6% response rate), with 1520 (78% of adolescent participants) interviewed in the final wave. Measurements Participants reported frequency of cannabis use for the past 6 months at each time-point in adolescence (age 14-17 years). Cannabis exposure was defined as: maximum frequency of use (occasional, weekly, daily), number of waves of use (1 or 2; 3-6) and first wave of use (early use: first waves 1-3). Young adult (24 years) outcomes were: weekly+cannabis use and DSM-IV cannabis dependence, referred to collectively as problematic use. Findings Of those interviewed at age 24 (wave 8), 34% had reported cannabis use in adolescence (waves 1-6), 12% at a level of weekly or more frequent use; 37% of these adolescent cannabis users were using at least weekly at wave 8, with 20% exhibiting dependence. Persistent adolescent cannabis and tobacco use as well as persistent mental health problems were associated strongly with problematic cannabis use at 24 years, after adjustment for potential confounding factors. Conclusions: Heavy, persistent and early-onset cannabis use were all strongly predictive of later cannabis problems. Even so, occasional use was not free of later problems. Where there was co-occurring tobacco use or persistent mental health problems, risks for later problem cannabis use was higher.

Taylor S. Medicalizing cannabis-science, medicine and policy, 1950-2004: An overview of a work in progress. Drugs: Education, Prevention and Policy 15(5): 462-474, 2008. (75 refs.)

Cannabis has been the subject of much policy and media attention in the last few years and the 2004 legal changes under the Misuse of Drugs Act in the UK, were widely, although incorrectly, presented as liberalization or legalization of the drug. Current debates over the classification of cannabis as Class C or B serve to emphasize the controversies that surround the drug. This paper provides an overview of a Wellcome Trust three-year project that is currently in progress. Framed as a history of science and policy making, the project aims to study the process whereby boundaries shift between illicit 'drug' and licit 'medicine' and the issues and interests that are involved in that transaction. Specifically, the project aims to analyse the trajectory of research since the 1950s, the interests involved, in particular the role of scientific research and allied professions; industry; drug technology; and lay knowledge and user activism. It aims to analyse the interaction of science and medicine with policy through the examination of the policy role of expert committees and their membership. The impact of international agencies will also be considered. Lastly, it will assess the overall impact of medicalization on the policy environment. Standard historical methodology will be applied and a wide variety of published and archival source material, as well as semi-structured oral history interviews, will be utilized.

Terry-McElrath YM; O'Malley PM; Johnston LD. Saying no to marijuana: Why American youth report quitting or abstaining. Journal of Studies on Alcohol and Drugs 69(6): 796-805, 2008. (29 refs.)

Objective: This article aims to contribute to the literature by reporting on a nationally representative study of U.S. youths regardirug their self-reported reasons for abstaining from or quitting marijuana use and the relationships between such reason,,; and individual sociodemographic characteristics of gender and race/ethnicity. Method: This article uses data from in-school surveys obtained from nationally representative cross-sectional samples of U.S. high school seniors from 1977 to 2005 (N = 82,106). Results: Results indicate the following: (1) 50% of those reporting past-12-month marijuana use felt they should either stop or reduce their use; (2) among those saying they would not use marijuana in the coming year, the most frequently reported reasons cited were psychological and physical damage and not wanting to get high (reported by more than 60%), whereas the least frequently reported reasons included expense, concerns of having a bad trip, and availability (reported by fewer than 25%): and (3) clear differences existed in reported reasons by gender and race/ethnicity. Conclusions: A significant percentage of U. S. high school seniors who are recent marijuana users wish to either reduce or stop their marijuana use and are basing such desires on a wide variety of reasons that show significant gender and racial/ethnic variation.,Marijuana prevention and cessation policy and programming could potentially be strengthened by incorporating the findings from these analyses.

Thatcher DL; Clark DB. Adolescents at risk for substance use disorders. Alcohol Research & Health 31(2): 168-176, 2008. (51 refs.)

Adolescents with alcohol-related problems often also use cigarettes and marijuana. Furthermore, early childhood characteristics that increase the risk for adolescent alcohol use disorders also increase the risk for problematic drug use. Identifying these characteristics early in childhood can be important for the prevention of alcohol and other drug (AOD) use disorders. As a result, researchers are seeking to) identify liability factors and observable characteristics (i.e., phenotypes) that can predict substance use disorders (SUDs) across drug categories. Other studies are focusing on endophenotypes-characteristics that cannot be openly observed but which link a person's genetic makeup, or genotype, and disease. Both predictive behavioral phenotypes and endophenotypes may reveal pathways connecting heritable predispositions and early environmental influences to later SUDs. One suggested predictive phenotype is psychological dysregulation, which is characterized by cognitive, behavioral, and emotional difficulties in childhood. An endophenotype that has been studied extensively is a particular brain wave called the P300 event-related potential. For people who are at high risk of AOD use based on these characteristics, adverse environmental conditions frequently lead to SUDs. Given the strong evidence that childhood psychological dysregulation predicts problematic AOD use, effective interventions for preventing adolescent SUDs may need to target the environmental features that put adolescents with this behavioral constellation at increased risk.

Public Domain

Torrealday O; Stein LAR; Barnett N; Golembeske C; Lebeau R; Colby SM et al. Validation of the Marijuana Effect Expectancy Questionnaire - Brief. Journal of Child & Adolescent Substance Abuse 17(4): 1-17, 2008. (27 refs.)

The purpose of this study was to evaluate a brief version of the Marijuana Effect Expectancy Questionnaire (MEEQ; Schafer & Brown, 1991). The original MEEQ was reduced to 6 items (MEEQ-B). Principal component analysis (PCA) was performed and two factors were identified (positive effects and negative effects) accounting for 52.3% of the variance. Internal consistencies (0.42 to 0.60) were slightly lower than those of the original MEEQ. The negative effect expectancy scale correlated with criterion variables that assess marijuana use (p <= .05). This measure is a helpful tool for clinicians to use when assessing youth expectancies. Replication across different samples of adjudicated youth is recommended.

Torres LR; Pena JB; Westhoff WW; Zayas LH. Across-national comparison of adolescent alcohol and drug use behaviors: U. S. Hispanics and youth in the Dominican Republic. Journal of Drug Issues 38(1): 149-170, 2008. (31 refs.)

The prevalence of substance use behaviors during adolescence is an important concern in the United States and internationally. Of particular importance to the U.S. is our ability to compare prevalence estimates and trends with those of neighboring countries, particularly those that feed our immigrant population and have a circulatory migration pattern with us. One of the fastest-growing Hispanic groups is Dominicans, who are also a young group, with a third of Dominicans in the United States under age 18. However cross-national comparisons of the substance use rates of youth in the U. S. and the Dominican Republic have not been done. Our study represents, to our knowledge, the first such comparison. We conducted a secondary data analysis comparing data from the U.S. Center for Disease Control and Prevention's (CDC) 1997 Youth Risk Behavior Survey (YRBS), a biennial survey in the U.S., to data from a survey conducted by the Ministry of Education of the Dominican Republic in 1997. The Dominican Republic survey used a similar sampling methodology and the Spanish version of the YRBS, piloted and modified to ensure linguistic and cultural appropriateness. Youth in the United States in general, and U.S. Hispanic youth in particular, consistently reported higher lifetime and recent use of alcohol, marijuana, and cocaine than youth in the Dominican Republic. Our study supports other cross-national comparisons that have found rates of substance use for youth in Latin America lower than those for youth in the United States. Cross-national comparisons of this nature help each individual country inform its social policies around prevention. They may also allow us to examine the impact of immigration, acculturation, and return migration processes on adolescent substance use in both countries.

Tu AW; Ratner PA; Johnson JL. Gender differences in the correlates of adolescents' cannabis use. Substance Use & Misuse 43(10): 1438-1463, 2008. (57 refs.)

Adolescents' gender-specific cannabis use rates and their correlates were examined. Data were obtained via a cross-sectional survey conducted in 2004 in British Columbia, Canada, funded by the Canadian Institutes of Health Research. School districts were invited to participate, and schools within consenting districts were recruited. In total, 8,225 students (50% male) from Grades 7 to 12 participated. About 73% were White, and 47% had used cannabis in their lifetime. Cannabis users were grouped according to their frequency of use: never users, frequent users, or heavy users. Male heavy cannabis users (14.3% of boys) were more likely to be in Grade 9 or higher; be Aboriginal; report poorer economic status; never feel like an outsider; frequently use alcohol and tobacco; and have lower satisfaction with family, friends, and school compared with boys that never used. Female heavy users (8.7% of girls) were more likely to be in a higher grade; report poorer economic status, mental health, and academic performance; frequently use alcohol and tobacco; and have lower satisfaction with their school compared with female never users. Three important gender differences in the multivariate analysis of the correlates of cannabis use were noted: school grade (for boys only), Aboriginal status (for boys only), and mental health (for girls only). Despite the limitations of relying on self-reports, a subset of youth appears to be at risk for excessive cannabis use that may impair life opportunities and health. The gender differences may be important in the design and implementation of prevention or treatment programs for adolescents.

Van Dam NT; Earleywine M; DiGiacomo G. Polydrug use, cannabis, and psychosis-like symptoms. Human Psychopharmacology: Clinical and Experimental 23(6): 475-485, 2008. (56 refs.)

Objective: To examine psychosis-like symptoms in users of legal and illicit drugs. Methods: Schizotypal Personality Questionnaire (SPQ) scores were compared in groups of people with different exposure to cannabis. with the use of other drugs serving as a covariate. Supplemental analyses compared users of legal and illicit drugs with cannabis use as a covariate. Results Weekly (n = 111) and monthly (n = 136) cannabis users had higher scores on. the SPQ than former (n = 143) and non-users (n = 81). The use of other drugs accounted for the links between cannabis and schizotypy. Lifetime use of psychomotor stimulant drugs plus ecstasy accounted for associations between cannabis and scores on the SPQ and its different subscales. Dividing groups by type of drug use revealed that those who used only cannabis and legal drugs (CLDs) (n = 126) were no different from those who used only legal drugs (LDs) (n = 74) but both groups scored significantly lower on the SPQ than polydrug users (n = 247). When controlling for marijuana use in the last month, the significant difference across drug use groups remained. Conclusions: The results suggest that research on marijuana and schizotypy requires careful assessment of the use of other drugs. especially psychomotor stimulants and ecstasy.

Van der Kooy F; Pomahacova B; Verpoorte R. Cannabis smoke condensate I: The effect of different preparation methods on tetrahydrocannabinol levels. Inhalation Toxicology 20(9): 801-804, 2008. (13 refs.)

Cannabis sativa contains more than 400 known compounds, of which the terpene chemicals, called cannabinoids, are unique to this species. The cannabinoids, which occur as the corresponding acids in the plant material, are the major psychoactive components in this species. The compounds are decarboxylated from the inactive acidic form into the active form by means of smoking. Previous research has made use of the tobacco industry's standard method and adaptations thereof to produce a cannabis smoke condensate. In this study the method of smoke production, which includes the puff frequency, puff length, and puff volume, was tested and the concentration of the major cannabinoid, 9-tetrahydrocannabinol (THC), and the amount of by-products produced under the different conditions were quantified. This study aimed at combining the existing methodology and at providing quantitative results on the influence of the preparation method on the concentration of THC in the smoke. The results indicate that the method of smoke production influences the amount of THC produced (e.g., longer puff length yielding a higher amount of THC). The THC concentration in the smoke condensate varied between 22.17 mg/g of cannabis and 54.00 mg/g, while the amount of by-products produced varied between 25.57 mg/g and 107.40 mg/g.

Vaughn M; Wallace J; Perron B; Copeland V; Howard M. Does marijuana use serve as a gateway to cigarette use for high-risk African-American youth? American Journal of Drug and Alcohol Abuse 34(6): 782-791, 2008. (18 refs.)

Background/Objectives: The purpose of this investigation was to test whether the gateway hypothesis of drug initiation sequencing applies equally well to high-risk African-American and Caucasian youth. Methods: The study sample (N = 618, mean age = 15.5, SD = 1.2) represented the population of residents in the Missouri Division of Youth Services (DYS) who had initiated marijuana and nicotine use. Results: As hypothesized, African-American youth were significantly more likely to initiate marijuana use before cigarette use. Over one-third of African Americans reported initiating marijuana before cigarettes (37.9%), compared to less than one-quarter of youth in the other ethnic groups (Caucasian = 17.3%, Latino/Latina = 21.7%, Biracial/Other = 20.8%). Further, multinomial simulation and logistic regression models revealed that African-American youth were significantly more likely than other ethnic groups to initiate marijuana before cigarettes (Adjusted OR = 3.53, CI = 1.92-6.46). Conclusions/Scientific Significance: Findings suggest that the hypothesized gateway sequence may not apply equally well to African-Americans, and that prevention efforts based on this theory may need to be amended for these youth.

Veling W; Mackenbach JP; van Os J; Hoek HW. Cannabis use and genetic predisposition for schizophrenia: A case-control study. Psychological Medicine 38(9): 1251-1256, 2008. (16 refs.)

Background. Cannabis use may be a risk factor for schizophrenia. Part of this association may be explained by genotype-environment interaction, and part of it by genotype-environment correlation. The latter issue has not been explored. We investigated whether cannabis use is associated with schizophrenia, and whether gene-environment correlation contributes to this association, by examining the prevalence of cannabis use in groups with different levels of genetic predisposition for schizophrenia. Method. Case-control study of first-episode schizophrenia. Cases included all non-Western immigrants who made first contact with a physician for schizophrenia in The Hague, The Netherlands, between October 2000 and July 2005 (n = 100; highest genetic predisposition). Two matched control groups were recruited, one among siblings of the cases (n = 63; intermediate genetic predisposition) and one among immigrants who made contact with non-psychiatric secondary health-care services (n = 100; lowest genetic predisposition). Conditional logistic regression analyses were used to predict schizophrenia as a function of cannabis use, and cannabis use as a function of genetic predisposition for schizophrenia. Results. Cases had used cannabis significantly more often than their siblings and general hospital controls (59, 21 and 21%, respectively). Cannabis use predicted schizophrenia [adjusted odds ratio (OR) cases compared to general hospital controls 7.8, 95%, confidence interval (CI) 2.7-22.6; adjusted OR cases compared to siblings 15.9 (95% CI 1.5-167.1)], but genetic predisposition for schizophrenia did not predict cannabis use [adjusted OR intermediate predisposition compared to lowest predisposition 1.2 (95% CI 0.4-3.8)]. Conclusions. Cannabis use was associated with schizophrenia but there was no evidence for genotype-environment correlation.

Vlachou S; Stamatopoulou F; Nomikos GG; Panagis G. Enhancement of endocannabinoid neurotransmission through CB1 cannabinoid receptors counteracts the reinforcing and psychostimulant effects of cocaine. International Journal of Neuropsychopharmacology 11(7): 905-923, 2008. (93 refs.)

Cannabinoids, in contrast to typical drugs of abuse, have been shown to exert complex effects on behavioural reinforcement and psychomotor function. We have shown that cannabinoid agonists lack reinforcing/rewarding properties in the intracranial self-stimulation (ICSS) paradigm and that the CB, receptor (CB1R) agonist WIN55,212-2 attenuates the reward-facilitating actions of cocaine. We sought to determine the effects of the endocannabinoid neurotransmission enhancer AM-404 (1, 3,10, 30 mg/kg) on the changes in ICSS threshold and locomotion elicited by cocaine and extend the study of the effects of WIN55,212-2 (0.3, 1, 3 mg/kg) on cocaine-induced hyperlocomotion. AM-404 did not exhibit reward-facilitating properties, and actually increased self-stimulation threshold at the highest dose. Cocaine significantly reduced self-stimulation threshold, without altering maximal rates of responding. AM-404 (10 mg/kg) attenuated this action of cocaine, an effect which was reversed by pretreatment with the selective CB1R antagonist SR141716A. WIN55,212-2 decreased locomotion at the two highest doses, an effect that was blocked by SR141716A; AM-404 had no effect on locomotion. Cocaine caused a significant, dose-dependent increase in locomotion, which was reduced by WIN55,212-2 and AM-404. SR141716A blocked the effects of WIN55,212-2 and AM-404 on cocaine-induced hyperlocomotion. SR141716A alone had no effect on ICSS threshold or locomotion. These results indicate that cannabinoids may interfere with brain reward systems responsible for the expression of acute reinforcing/rewarding properties of cocaine, and provide further evidence that the cannabinoid system could be explored as a potential drug discovery target for the treatment of psychostimulant addiction and pathological states associated with psychomotor overexcitability.

Wagner KD; Ritt-Olson A; Soto DW; Unger JB. Variation in family structure among urban adolescents and its effects on drug use. Substance Use & Misuse 43(7): 936-951, 2008. (32 refs.)

Family structure is one factor that can help explain drug use among adolescents. In 2005 a study was conducted with 255 ninth-grade students from an urban, predominantly Latino Los Angeles area high school. Students were 83% Latino, 58% female, and from mostly low SES households. Half of all students reported having ever used alcohol, 30% had ever smoked a cigarette, and 18% had ever used marijuana. Family structure was measured using a single open-ended question and logistic regression was employed to determine the effects of various family structures on the use of alcohol, cigarettes, and marijuana. The presence of older siblings in the home was associated with alcohol and marijuana use, and living with a cousin was associated with marijuana use. Results suggest that influential others, including siblings and cousins, should be included in measures of family structure. Study limitations are noted.

Walden N; Earleywine M. How high? Quantity as a predictor of cannabis-related problems. Harm Reduction Journal 5(1): e-article 20, 2008. (36 refs.)

Background: Research on cannabis use has emphasized frequency as a predictor of problems. Studies of other drugs reveal that frequency relates to psychological and physiological outcomes, but quantity also plays an important role. In the study of cannabis, quantity has been difficult to assess due to the wide range of products and means of consumption. Methods: The present study introduces three new measures of quantity, and examines their contribution to cannabis-related problems. Over 5,900 adults using cannabis once or more per month completed an internet survey that inquired about use, dependence, social problems and respiratory health. In addition to detailing their frequency of cannabis use, participants also reported three measures of quantity: number of quarter ounces consumed per month, usual intensity of intoxication, and maximum intensity of intoxication. Results: Frequency of use, monthly consumption, and levels of intoxication predicted respiratory symptoms, social problems and dependence. What is more, each measure of quantity accounted for significant variance in outcomes after controlling for the effects of frequency. Conclusion: These findings indicate that quantity is an important predictor of cannabis-related outcomes, and that the three quantity measures convey useful information about use.

Walley AY; Krupitsky EM; Cheng DM; Raj A; Edwards EM; Bridden C et al. Implications of cannabis use and heavy alcohol use on HIV drug risk behaviors in Russian heroin users. AIDS and Behavior 12(4): 662-669, 2008. (43 refs.)

Cannabis and heavy alcohol use potentially increase HIV transmission by increasing risky drug behaviors. We studied 404 subjects entering treatment for heroin dependence, in St. Petersburg, Russia. We used the HIV Risk Assessment Battery (RAB) drug subscale to measure risky drug behavior. Although all heavy alcohol users had risky drug behaviors, their drug RAB scores did not differ from non-heavy alcohol users in unadjusted or adjusted analyses. Cannabis use was significantly associated with drug RAB scores in unadjusted analyses (mean difference 1.7 points) and analyses adjusted for age, sex, and employment (mean difference 1.3 points). When also adjusting for stimulant use, the impact of cannabis use was attenuated and no longer statistically significant (mean difference 1.1 points). Because of the central role of risky drug behaviors in the Russian HIV epidemic, it is important to understand how the use of multiple substances, including cannabis and alcohol, impacts risky drug behaviors.

Wallner C; Stollberger C; Hlavin A; Finsterer J; Hager I; Hermann P et al. Electrocardiographic abnormalities in opiate addicts. Addiction 103(12): 1987-1993, 2008. (29 refs.)

To determine in a cross-sectional study the prevalence of electrocardiographic (ECG) abnormalities in opiate addicts who were therapy-seeking and its association with demographic, clinical and drug-specific parameters. In consecutive therapy-seeking opiate addicts, a 12-lead ECG was registered within 24 hours after admission and evaluated according to a pre-set protocol between October 2004 and August 2006. Additionally, demographic, clinical and drug-specific parameters were recorded. Included were 511 opiate-addicts, 25% female, with a mean age of 29 years (range 17-59 years). One or more ECG abnormalities were found in 314 patients (61%). In the 511 patients we found most commonly ST abnormalities (19%), QTc prolongation (13%), tall R- and/or S-waves (11%) and missing R progression (10%). ECG abnormalities were more common in males than in females (64 versus 54%, P < 0.05), and in patients with positive than negative urine findings for cannabis (68 versus 57%, P < 0.05). Patients with ST abnormalities were more often males than females (21 versus 11%, P < 0.05), had a history of seizures less often (16 versus 27%, P < 0.05), had positive than negative urine findings for cannabis more often (26 versus 15%, P < 0.01) and had negative than positive urine findings for methadone more often (21 versus 11%, P < 0.05). QTc prolongation was more frequent in patients with high dosages of maintenance drugs than in patients with medium or low dosages (27 versus 12 versus 10%, P < 0.05) and in patients whose urine findings were positive than negative for methadone (23 versus 11%, P < 0.001) as well as for benzodiazepines (17 versus 9%, P < 0.05). Limitations of the data are that in most cases other risk factors for the cardiac abnormalities were not known. ECG abnormalities are frequent in opiate addicts. The most frequent ECG abnormalities are ST abnormalities, QTc prolongation and tall R- and/or S-waves. ST abnormalities are associated with cannabis, and QTc prolongation with methadone and benzodiazepines.

Wechsberg WA; Luseno WK; Karg RS; Young S; Rodman N; Myers B et al. Alcohol, cannabis, and methamphetamine use and other risk behaviours among Black and Coloured South African women: A small randomized trial in the Western Cape. International Journal of Drug Policy 19(2): 130-139, 2008. (51 refs.)

Background: There is a pressing need for brief behavioural interventions to address the intersection of high HIV prevalence, increasing substance use, and high-risk sex practices among South African women. The primary aim of this pilot, randomized trial was to examine whether an adapted evidence-based intervention would be equally, more, or less effective at reducing HIV risk behaviours when delivered using an individual or group format. The secondary aim was to examine differences between Black and Coloured South African women across pre- and post-intervention measures of alcohol and illicit drug use and sex risk behaviours. Methods: The Cape Town Women's Health CoOp was adapted from an evidence-based intervention known as the Women's CoOp. Study participants included Black (n = 60) and Coloured (n = 52) women living in the township communities of Cape Town, South Africa, who reported using illicit drugs and alcohol. Results: Coloured women reported greater methamphetamine use (13 days in the past 30 days) and Black women reported mostly cannabis use (27 days in the past 30 days). Although both groups reported having unprotected sex under the influence of alcohol and/or other drugs, Black women reported greater condom use and having one partner; Coloured women reported having more than one sex partner. One-month post-intervention assessments indicated significant reductions in substance use and sex risk behaviours. After controlling for baseline measures, there were no significant differences between the two intervention conditions. Conclusion: Significant differences in risk behaviours were observed between Black and Coloured South African women. However, both ethnic groups were responsive to the adapted intervention and no differences were found by intervention assignment. These findings support the assertion that group interventions may be more cost-effective in reaching at-risk women in resource-scarce environments. Larger studies are needed to show efficacy and effectiveness of woman-focused group prevention interventions.

Weinstein A; Brickner O; Lerman H; Greemland M; Bloch M; Lester H et al. A study investigating the acute dose - response effects of 13 mg and 17 mg Delta 9-tetrahydrocannabinol on cognitive - motor skills, subjective and autonomic measures in regular users of marijuana. Journal of Psychopharmacology 22(4): 441-451, 2008. (35 refs.)

Heavy use of marijuana is claimed to damage critical skills related to short-term memory, visual scanning and attention. Motor skills and driving safety may be compromised by the acute effects of marijuana. The aim of this study was to investigate the acute effects of 13 mg and 17 mg Delta 9-tetrahydrocannabinol (THC) on skills important for coordinated movement and driving and on subjective and autonomic measures in regular users of marijuana. Fourteen regular users of marijuana were enrolled. Each subject was tested on two separate days. On each test day, subjects smoked two low-nicotine cigarettes, one with and the other without THC. Seventeen mg THC was included in the cigarette on one test day and 13 mg on the other day. The sequence of cigarette types was unknown to the subject. During smoking, heart rate and blood pressure were monitored, and the subjects performed a virtual reality maze task requiring attention and motor coordination, followed by 3 other cognitive tasks (Wisconsin Card Sorting Test (WCST), a "gambling" task and estimation of time and distance from an approaching car). After smoking a cigarette with 17 mg THC, regular marijuana users hit the walls more often on the virtual maze task than after smoking cigarettes without THC; this effect was not seen in patients after they smoked cigarettes with 13 mg THC. Performance in the WCST was affected with 17 mg THC and to a lesser extent with the use of 13 mg THC. Decision making in the gambling task was affected after smoking cigarettes with 17 mg THC, but not with 13 mg THC. Smoking cigarettes with 13 and 17 mg THC increased subjective ratings of pleasure and satisfaction, drug "effect" and drug "high". These findings imply that smoking of 17 mg THC results in impairment of cognitive-motor skills that could be important for coordinated movement and driving, whereas the lower dose of 13 mg THC appears to cause less impairment of such skills in regular users of marijuana.

Weiss PA. Does smoking marijuana contribute to the risk of developing lung cancer? (editorial). Clinical Journal of Oncology Nursing {Dartmouth e-journal} 12(3): 517-519, 2008. (11 refs.)

Wells JE; McGee MA. Violations of the usual sequence of drug initiation: Prevalence and associations with the development of dependence in the New Zealand Mental Health Survey. Journal of Studies on Alcohol and Drugs 69(6): 789-795, 2008. (32 refs.)

Objective: For 3 decades, studies have reported that the usual sequence of drug initiation is licit drugs, then cannabis, and then other illicit drugs. This article describes the prevalence of violations of this sequence, the predictors of violations, and the relationship between violations and the onset of alcohol or drug dependence. Method: The New Zealand Mental Health Survey is a nationally representative sample with 12,992 face-to-face interviews carried out in 2003-2004, The response rate was 73.3%. The World Health Organization Composite International Diagnostic Interview (CIDI 3.0) was used in the survey. Reports of the age at first use were obtained for alcohol and drugs but not for smoking. Results: Violations of the usual sequence of drug initiation were uncommon in the population (2.6%). Use of other illicit drugs before cannabis was the main violation, found in 2.3% of alcohol users, 3.0% of cannabis users, 8.6% of cocaine users, and 16.7% of those who had used other illicit drugs. Use of other illicit drugs before cannabis was more predominant in younger cohorts and those with more early-onset internalizing disorders. Violations had little association with the development of dependence in users when other important predictors such as age at onset of use and the number of illicit drugs used were taken into account. Internalizing disorders and early-onset bipolar disorder also predicted dependence. Conclusions: In New Zealand, violations of the gateway sequence are not common and they are not markers of progression to dependence.

Werch CE; Moore MJ; Bian H; DiClemente CC; Ames SC; Weiler RM et al. Efficacy of a brief image-based multiple-behavior intervention for college students. Annals of Behavioral Medicine 36(2): 149-157, 2008. (66 refs.)

Epidemiologic data indicate most adolescents and adults experience multiple, simultaneous risk behaviors. The purpose of this study is to examine the efficacy of a brief image-based multiple-behavior intervention (MBI) for college students. A total of 303 college students were randomly assigned to: (1) a brief MBI or (2) a standard care control, with a 3-month postintervention follow-up. Omnibus treatment by time multivariate analysis of variance interactions were significant for three of six behavior groupings, with improvements for college students receiving the brief MBI on alcohol consumption behaviors, F(6, 261)=2.73, p=0.01, marijuana-use behaviors, F(4, 278)=3.18, p=0.01, and health-related quality of life, F(5, 277)=2.80, p=0.02, but not cigarette use, exercise, and nutrition behaviors. Participants receiving the brief MBI also got more sleep, F(1, 281)=9.49, p=0.00, than those in the standard care control. A brief image-based multiple-behavior intervention may be useful in influencing a number of critical health habits and health-related quality-of-life indicators of college students.

Wiley JL; Evans RL; Grainger DB; Nicholson KL. Age-dependent differences in sensitivity and sensitization to cannabinoids and 'club drugs' in male adolescent and adult rats. Addiction Biology 13(3/4): 277-286, 2008. (46 refs.)

Lifelong substance abuse is often initiated during adolescence; yet, most pre-clinical research in this area has been conducted in adult animals. Substantial evidence exists that the brain development that continues throughout adolescence may result in pharmacological responses that differ in a crucial manner from those of adults. The goal of this study was to evaluate age differences in motor activity following acute and repeated administration of drugs that are commonly abused by adolescents, including cocaine, Delta(9)-tetrahydrocannabinol (Delta(9)-THC), and the club drugs, ketamine and 3,4-methylenedioxymethamphetamine (MDMA). Adolescent and adult male rats were injected once daily with saline or with a dose of one of the test drugs for two 5-day dosing periods, separated by a 2-day drug holiday during which they remained in their home cages. Following each injection, rats were placed in a locomotor chamber for a 20-minute session. The potencies of cocaine, ketamine and MDMA for producing motor stimulation were less in male adolescents than in male adults. Furthermore, sensitization to the club drug, ketamine, developed after repeated dosing in adults, but not adolescents. In contrast, adolescents were initially more sensitive to the stimulatory effects of low doses of Delta(9)-THC than were adults, although rapid tolerance occurred. These results suggest that adolescents are less sensitive to the acute and repeated stimulant effects of some, but not all, of the drugs that are preferentially abused by this age group. This differential sensitivity may contribute to the different patterns of use that have been noted in adolescent versus adult drug abusers.

Wilsey B; Marcotte T; Tsodikov A; Millman J; Bentley H; Gouaux B et al. A randomized, placebo-controlled, crossover trial of cannabis cigarettes in neuropathic pain. Journal of Pain 9(6): 506-521, 2008. (76 refs.)

The Food and Drug Administration (FDA), Substance Abuse and Mental Health Services Administration (SAMHSA), and the National Institute for Drug Abuse (NIDA) report that no sound scientific studies support the medicinal use of cannabis. Despite this lack of scientific validation, many patients routinely use "medical marijuana," and in many cases this use is for pain related to nerve injury. We conducted a double-blinded, placebo-controlled, crossover study evaluating the analgesic efficacy of smoking cannabis for neuropathic pain. Thirty-eight patients with central and peripheral neuropathic pain underwent a standardized procedure for smoking either high-dose (7%), low-dose (3.5%), or placebo cannabis. In addition to the primary outcome of pain intensity, secondary outcome measures included evoked pain using heat-pain threshold, sensitivity to light touch, psychoactive side effects, and neuropsychological performance. A mixed linear model demonstrated an analgesic response to smoking cannabis. No effect on evoked pain was seen. Psychoactive effects were minimal and well-tolerated, with some acute cognitive effects, particularly with memory, at higher doses. Perspective: This study adds to a growing body of evidence that cannabis may be effective at ameliorating neuropathic pain, and may be an alternative for patients who do not respond to, or cannot tolerate, other drugs. However, the use of marijuana as medicine may be limited by its method of administration (smoking) and modest acute cognitive effects, particularly at higher doses.

Wong FL; Rotheram-Borus MJ; Lightfoot M; Pequegnat W; Comulada WS; Cumberland W et al. Effects of behavioral intervention on substance use among people living with HIV: the Healthy Living Project randomized controlled study. Addiction 103(7): 1206-1214, 2008. (40 refs.)

Aim: Reductions in substance use were examined in response to an intensive intervention with people living with human immunodeficiency virus (HIV) (PLH). Design, setting and participants: A randomized controlled trial was conducted with 936 people living with human immunodeficiency virus who had recently engaged in unprotected sexual risk acts recruited from four US cities: Milwaukee, San Francisco, New York and Los Angeles. Substance use was assessed as the number of days of use of 19 substances recently (over the last 90 days), evaluated at 5-month intervals over 25 months. Intervention A 15-session case management intervention was delivered to people living with human immunodeficiency virus in the intervention condition; the control condition received usual care. Measurements An intention-to-treat analysis was conducted examining reductions on multiple indices of recent substance use calculated as the number of days of use. Findings: Reductions in recent substance use were significantly greater for intervention people living with human immunodeficiency virus compared to controls: alcohol and/or marijuana use, any substance use, hard drug use and a weighted index adjusting for seriousness of the drug. While the intervention-related reductions in substance use were larger among women than men, men also reduced their use. Compared to controls, gay and heterosexual men in the intervention reduced significantly their use of alcohol and marijuana, any substance, stimulants and the drug severity-weighted frequency of use index. Gay men also reduced their hard drug use significantly in the intervention compared to the control condition. Conclusions A case management intervention model, delivered individually, is likely to result in significant and sustained reductions in substance use among people living with human immunodeficiency virus.

Wu ZH; Baillargeon JG; Berenson AB; Holzer CE. Self-reported psychopathology among young, low-income, female ecstasy users. Journal of Addictive Diseases 27(4): 81-90, 2008. (41 refs.)

This study examined the association of ecstasy (methylenedioxy-methylamphethamine) use with psychopathology among young, low-income females who sought care at university family planning clinics in Texas between December 2001 and May 2003. Participants reported drug use history and eight problem behavior syndromes by using the Young Adult Self-Report. The prevalence of ecstasy use was approximately 15%. About 90% of ecstasy users reported having used other drugs. Overall, ecstasy users were more likely to have exhibited delinquent behaviors and thought problems than exclusive marijuana users. Ecstasy users who continued to use any illicit drugs showed the most severe psychopathology. These findings indicate that elevated rates of self-reported psychopathology among ecstasy users may be partly attributable to the use of multiple drugs. Furthermore, it will also be important for future studies to assess the extent to which delinquent behaviors and thought problems mediate the transition of marijuana use to ecstasy use.

Wu ZHL; Eschbach K; Grady JJ. Contextual influences on polydrug use among young, low-income women: Effects of neighborhood and personal networks. American Journal on Addictions 17(2): 135-144, 2008. (61 refs.)

This study assessed contextual risks for polydrug use in a triethnic sample (non-Hispanic white, African American, Hispanic) of young women with a low income. For the current analysis, a total of 712 young women aged 18 to 31 years who sought care in state-funded family planning clinics in southeast Texas from December 2001 to May 2003 participated in the survey. The main outcome of the study was the number of illicit drugs (including marijuana, MDMA [ecstasy], crack cocaine, and other hard drugs) used in the last 12 months. Of the 712 subjects, 198 (28%) reported using illicit drugs it? the past 12 months. Neighborhood socioeconomic status was significantly associated with drug use in a bivariate model. The proportion of women living in the most advantaged neighborhoods who reported drug use was more than twice that of women living in the most disadvantaged neighborhoods. However, the significance of neighborhood socioeconomic status was eliminated after controlling for ethnicity or for personal network characteristics in a multivariate ordinal logistic regression model. In contrast, in multivariate models, personal network indicators, such as a larger number of monthly contacts with friends (odds ratio [OR] = 1.32, 95% confidence interval [CI] = 1.11, 1.56) and a target-number of friends who used illicit drugs (OR = 1.47, 95% CI = 1.33, 1.62) were associated with increased drug use. In addition, not being currently married (vs. being married) (OR = 2.73, 95% CI = 1.44, 5.16) was associated with a larger number of drugs used in the last 12 months. In conclusion, we found that neighborhood socioeconomic status was not directly associated with more drug use when controlling for ethnicity or for personal network characteristics. Personal networks may mediate the relationships between neighborhood and drug use. Strategies to reduce polydrug use should target personal networks where friends use illicit drugs.

Xian H; Scherrer JF; Grant JD; Eisen SA; True WR; Jacob T et al. Genetic and environmental contributions to nicotine, alcohol and cannabis dependence in male twins. Addiction 103(8): 1391-1398, 2008. (39 refs.)

Aims: To compute the common and specific genetic and environmental contributions to nicotine dependence (ND) alcohol dependence (AD) and cannabis dependence (CD). Design Twin model. Participants: Data from 1874 monozygotic and 1498 dizygotic twin pair members of the Vietnam Era Twin Registry were obtained via telephone administration of a structured psychiatric interview in 1992. Measurements: Data to derive life-time diagnoses of DSM-III-R ND, AD and CD were obtained via telephone administration of the Diagnostic Interview Schedule. Findings The best-fitting model allowed for additive genetic contributions and unique environmental influences that were common to all three phenotypes. Risks for ND and AD were also due to genetic and unique environmental influences specific to each drug. A specific shared environmental factor contributed to CD. Conclusions These results suggest that the life-time co-occurrence of ND, AD and CD is due to common and specific genetic factors as well as unique environmental influences, and vulnerability for CD is also due to shared environmental factors that do not contribute to ND and AD. The majority of genetic variance is shared across drugs and the majority of unique environmental influences are drug-specific in these middle-aged men. Because differences between models allowing for specific genetic versus shared environment were small, we are most confident in concluding that there are specific familial contributions - either additive genetic or shared environment - to CD.

Yamaguchi ET; Cardoso MMSC; Torres MLA; de Andrade AG. Drug abuse during pregnancy. (review) [Portuguese]. Revista de Investigacion Clinica 35(Supplement 1): 44-47, 2008. (41 refs.)

Background: Despite the fact that it has being a growing problem worldwide, very few works and papers have been published on drug use during pregnancy. Objectives: To objectively address the most commonly abused drugs (alcohol, cocaine, marijuana, and tobacco) by women of a reproductive age. Methods: A literature review (MEDLINE, LILACS) of the most recent papers on drug abuse by women of reproductive age was carried out. Results: The primary consequences of drug abuse both for the mother and the infant are described. Conclusions: This is a little discussed major public health issue which requires the involvement of a multidisciplinary team. The publication of a greater number of papers on the problem is necessary in order to establish the best strategy for addressing intervention in this population.

Yazulla S. Endocannabinoids in the retina: From marijuana to neuroprotection. (review). Progress in Retinal and Eye Research 27(5): 501-526, 2008. (271 refs.)

The active component of the marijuana plant Cannabis sativa, Delta(9)-tetrahydrocannabinol (THC), produces numerous beneficial effects, including analgesia, appetite stimulation and nausea reduction, in addition to its psychotropic effects. THC mimics the action of endogenous fatty acid derivatives, referred to as endocannabinoids. The effects of THC and the endocannabinoids are mediated largely by metabotropic receptors that are distributed throughout the nervous and peripheral organ systems. There is great interest in endocannabinoids for their role in neuroplasticity as well as for therapeutic use in numerous conditions, including pain, stroke, cancer, obesity, osteoporosis, fertility, neurodegenerative diseases, multiple sclerosis, glaucoma and inflammatory diseases, among others. However, there has been relatively far less research on this topic in the eye and retina compared with the brain and other organ systems. The purpose of this review is to introduce the "cannabinergic" field to the retinal community. All of the fundamental works on cannabinoids have been performed in non-retinal preparations, necessitating extensive dependence on this literature for background. Happily, the retinal cannabinoid system has much in common with other regions of the central nervous system. For example, there is general agreement that cannabinoids suppress dopamine release and presynaptically reduce transmitter release from cones and bipolar cells. How these effects relate to light and dark adaptations, receptive field formation, temporal properties of ganglion cells or visual perception are unknown. The presence of multiple endocannabinoids, degradative enzymes with their bioactive metabolites, and receptors provides a broad spectrum of opportunities for basic research and to identify targets for therapeutic application to retinal diseases.

Zammit S; Moore THM; Lingford-Hughes A; Barnes TRE; Jones PB; Burke M et al. Effects of cannabis use on outcomes of psychotic disorders: Systematic review. (review). British Journal of Psychiatry 193(5): 357-363, 2008. (34 refs.)

Background: It is unclear if research findings support clinical opinion that cannabis use leads to worse outcomes in people with psychosis, or whether this impression is confounded by other factors. Aims: To systematically review the evidence pertaining to whether cannabis affects outcome of psychotic disorders. Method: We searched 10 relevant databases (to November 2006) reference lists of included studies and contacted experts. We included 13 longitudinal studies from 15303 references. Data extraction and quality assessment were conducted independently and in duplicate. Results: Cannabis use was consistently associated with increased relapse and non-adherence. Associations with other outcome measures were more disparate. Few studies adjusted for baseline illness severity, and most made no adjustment for alcohol, or other potentially important confounders. Adjusting for even a few confounders often resulted in substantial attenuation of results. Conclusions: Confidence that most associations reported were specifically due to cannabis is low. Despite clinical opinion, it remains important to establish whether cannabis is harmful, what outcomes are particularly susceptible, and how such effects are mediated. Studies to examine this further are eminently feasible.

Zuardi AW. Cannabidiol: from an inactive cannabinoid to a drug with wide spectrum of action. (review). Revista Brasileira de Psiquiatria 30(3): 271-280, 2008. (119 refs.)

Objective: The aim of this review is to describe the historical development of research on cannabidiol. Method: This review was carried out on reports drawn from Medline, Web of Science and ScienceELO. Discussion: After the elucidation of the chemical structure of cannabidiol in 1963, the initial studies showed that cannabidiol was unable to mimic the effects of Cannabis. In the 1970's the number of publications on cannabidiol reached a first peak, having the research focused mainly on the interaction with delta9-THC and its antiepileptic and sedative effects. The following two decades showed lower degree of interest, and the potential therapeutic properties of cannabidiol investigated were mainly the anxiolytic, antipsychotic and on motor diseases effects. The last five years have shown a remarkable increase in publications on cannabidiol mainly stimulated by the discovery of its anti-inflammatory, anti-oxidative and neuroprotective effects. These studies have suggested a wide range of possible therapeutic effects of cannabidiol on several conditions, including Parkinson's disease, Alzheimer's disease, cerebral ischemia, diabetes, rheumatoid arthritis, other inflammatory diseases, nausea and cancer Conclusion: In the last 45 years it has been possible to demonstrate that CBD has a wide range of pharmacological effects, many of which being of great therapeutic interest, but still waiting to be confirmed by clinical trials.

Zuurman L; Roy C; Schoemaker RC; Hazekamp A; den Hartigh J; Bender JCME et al. Effect of intrapulmonary tetrahydrocannabinol administration in humans. Journal of Psychopharmacology 22(7): 707-716, 2008. (49 refs.)

This randomised, double-blind, placebo-controlled, cross-over study was designed to identify which pharmacodynamic parameters most accurately quantify the effects of delta-9-Tetrahydrocannabinol (THC), the predominantly psychoactive component of cannabis. In addition, we investigated the acceptability and usefulness of a novel mode of intrapulmonary THC administration using a Volcano (R) vaporizer and pure THC instead of cannabis. Rising doses of THC (2, 4, 6 and 8 mg) or vehicle were administered with 90 minutes intervals to twelve healthy males using a Volcano (R) vaporizer. Very low between-subject variability was observed in THC plasma concentrations, characterising the Volcano (R) vaporizer as a suitable method for the administration of THC. Heart rate showed a sharp increase and rapid decline after each THC administration (8 mg: 19.4 bpm: 95% CI 13.2, 25.5). By contrast, dose dependent effects of body sway (8 mg: 108.5%: 95% CI 72.2%, 152.4%) and different subjective parameters did not return to baseline between doses (Visual Analogue Scales of alertness' (8 mg: -33.6 mm: 95% CI -41.6, -25.7), 'feeling high' (8 mg: 1.09 U: 95% CI 0.85, 1.33), 'external perception' (8 mg: 0.62 U: 95% CI 0.37, 0.86)). PK/PD-modeling of heart rate displayed a relatively short equilibration half-life of 7.68 min. CNS parameters showed equilibration half-lives ranging between 39.4 - 84.2 min. Some EEG-frequency bands, and pupil size showed small changes following the highest dose of THC. No changes were seen in saccadic eye movements, smooth pursuit and adaptive tracking performance. These results may be applicable in the development of novel cannabinoid agonists and antagonists, and in studies of the pharmacology and physiology of cannabinoid systems in humans.

Zvolensky MJ; Lewinsohn P; Bernstein A; Schmidt NB; Buckner JD; Seeley J et al. Prospective associations between cannabis use, abuse, and dependence and panic attacks and disorder. Journal of Psychiatric Research 42(12): 1017-1023, 2008. (39 refs.)

The present study prospectively evaluated cannabis use, abuse, and dependence in relation to the development of panic attacks and panic disorder. Participants at the start of the study were adolescents (n = 1709) with a mean age of 16.6 years (SD = 1.2; time 1) and were re-assessed 1 year later (time 2) and then again as young adults (time 3; mean age = 24.2 years, SD = 0.6). Results indicated that cannabis use and dependence were significantly prospectively associated with an increased odds for the development of panic attacks and panic disorder. However, cannabis was not incrementally associated with the development of panic after controlling for daily cigarette smoking. The theoretical and clinical implications of these findings are discussed.