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CORK Bibliography: Marijuana

90 citations. September 2006 to present

Prepared: December 2006

Agrawal A; Grant JD; Waldron M; Duncan AE; School oferrer JF; Lynskey MT et al. Risk for initiation of substance use as a function of age of onset of cigarette, alcohol and cannabis use: Findings in a Midwestern female twin cohort. Preventive Medicine 43(2): 125-128, 2006. (13 refs.)

Objective. We investigated whether use and early-onset use of cigarettes, alcohol and cannabis contributed an increase in risk for initiation of subsequent psychoactive substances in women (N = 3729, mean age = 21.7). Methods. Drugs were ordered in ascending order of initiation: cigarettes, alcohol, cannabis and other illicit drugs, with early-onset use of each drug used as a time-varving covariate to predict initiation of subsequent drugs. Interactions of use and early-onset use, with age of initiation of subsequent drugs, were evaluated using discrete-time Cox survival analyses. Results. The association between each substance and the early-onset of subsequent drug use was strong (ORs 1.54-19.9). Women who initiated cigarette, alcohol or cannabis use at an early age were at elevated risk for early experimentation with each subsequent drug class. Furthermore, early-onset of more than one substance contributed greater risk for initiation of subsequent drugs. Conclusion. Prevention efforts should target risk factors that contribute to early initiation of cigarette and alcohol use and may subsequently correlate with hard drug involvement.

Alexander D; Leung P. The Marijuana Screening Inventory (MSI-X): Concurrent, convergent and discriminant validity with multiple measures. American Journal of Drug and Alcohol Abuse 32(3): 351-378, 2006. (48 refs.)

This study evaluates the concurrent, convergent and discriminant validity between the MSI-X and five other instruments completed by 107 adults. Pearson correlation analysis with follow-up t-tests found concurrent validity between the MSI-X, Drug Abuse Screening Test (DAST-20), five Substance Abuse Subtle Screening Inventory (SASSI-3) subscales, a Diagnostic Statistical Manual (DSM) IV-TR Guided Marijuana Inventory, and two Addiction Severity Index variables. As evidence of MSI-X discriminant validity, no correlations were found with three alcohol measures. Convergent validity, determined by t-test associations between MSI-X total problems with SASSI-3 substance dependence scores, supported the MSI-X >= 6 scoring cutoff. Overall, the findings support MSI-X concurrent, convergent and discriminant validity.

Apostolidis T; Fieulaine N; Simonin L; Rolland G. Cannabis use, time perspective and risk perception: Evidence of a moderating effect. Psychology & Health 21(5): 571-592, 2006. (48 refs.)

This study explores the relationship between time perspective (TP), cannabis use and risk perceptions associated with this substance. A sample of French students (n = 198) were provided with a valid French version of the Zimbardo Time Perspective Inventory (ZTPI) scale. Risk perceptions linked to cannabis consumption were evaluated from a list of 22 items referring to different risks. Respondents were asked to declare how frequently they consumed this substance. Data analysis was based firstly on ZTPI scores, secondly on declared consumption and finally on the two risk perception indices which were established after factorial analysis. Results showed that TP acted as a significant predictor of both psychoactive substance use and of cannabis consumption frequency. Significant links between consumption and risk perceptions also appeared. A second series of analyses showed that TP moderated the link between cannabis consumption and risk perceptions. These findings highlight the importance of TP when analyzing the complexity of contemporary cannabis use. This is a revised version of a poster communication presented at the 18th Annual Conference of the European Health Psychology Society, University of Helsinki (Finland) in June 2004.

Apostolidis T; Fieulaine N; Soule F. Future time perspective as predictor of cannabis use: Exploring the role of substance perception among French adolescents. Addictive Behaviors 31(12): 2339-2343, 2006. (7 refs.)

This study explored the relation of future time perspective (FTP) to cannabis use and tested the potential mediating role of cannabis perception, with a sample of 276 French adolescents. FTP was assessed using ZTPI subscale, cannabis perception was evaluated from a list of nine items related to drug-oriented perception (DOP), and participants were asked to report both their cannabis use and the level of use. Results showed that FTP acts as a significant predictor of cannabis use, and is significantly linked to DOP. A significant relationship between DOP and cannabis use also appeared. Regression analyses showed that DOP acts as a mediator in the link between FTP and cannabis use. These findings confirm the protective role of FTP in cannabis use and suggest the indirect nature of this role.

Asbridge M. Drugs and driving: When science and policy don't mix. (editorial). Canadian Journal of Public Health 97(4): 283-285, 2006. (40 refs.)

This commentary briefly looks at the Canadian federal government's proposed legislation to strengthen the enforcement of drug-impaired driving, placing special emphasis on cannabis. After outlining the legislation, three issues are examined. Of primary concern is at what level cannabis use impairs driving ability leading to an increased risk of motor vehicle collision. Current epidemiological evidence is reviewed. Equally important is the government's emphasis on the training and implementation of Drug Recognition Experts (DREs), specially trained police officers whose role is to detect drivers under the influence of drugs. Research on the effectiveness of DREs is discussed, along with a dialogue regarding the potential shortcomings of the DRE program. Finally, a brief surveillance of international policy literature on drugs and driving is offered, along with some sober thoughts on the potential difficulties that may emerge in the enforcement of the proposed legislation.

Backovic D; Marinkovic JA; Grujic-Sipetic S; Maksimovic M. Differences in substance use patterns among youths living in foster care institutions and in birth families. Drugs: Education, Prevention and Policy 13(4): 341-351, 2006. (27 refs.)

Aim: The aim of this study was to determine differences in psychosocial context of occurrence of cigarette smoking and alcohol and drugs use between adolescents living in foster homes and those living with parents. Methods: The study examined 58 adolescents (14 - 17 years) living in foster homes and 245 living with parents using an anonymous questionnaire. Findings: Consumption of tobacco and cannabis was more common in the group of children living in foster homes. They tried these substances earlier and used them more frequently. The most important predictor for current smoking was the number of peers who smoked. Another important predictor of current smoking was an expressed feeling of loneliness. The studied groups did not differ significantly in the occurrence of alcohol drinking. Conclusions: These results suggest that suitable prevention programmes with emphases on social groups living under adverse conditions are needed. Further research should be conducted to give more detailed insight into the reasons and psychosocial factors that precipitate the start and perpetuation of these habits in diverse environments.

Barnwell SVS; Earleywine M; Gordis EB. Confirming alcohol-moderated links between cannabis use and dependence in a national sample. Addictive Behaviors 31(9): 1695-1699, 2006. (5 refs.)

The present study confirmed findings that alcohol moderates the link between cannabis use and dependence. The study examined a large, diverse national sample of 856 people who consumed cannabis and alcohol at least twice per week. The study possesses several methodological improvements over past research, including less subjective measures of cannabis use and interview-based data collection. Cannabis use and alcohol consumption interacted to predict cannabis dependence symptoms. Cannabis use covaried with cannabis dependence particularly in people who consumed greater amounts of alcohol. These data further support the hypothesis that alcohol increases problems associated with cannabis use.

Bartu A; Sharp J; Ludlow J; Doherty DA. Postnatal home visiting for illicit drug-using mothers and their infants: A randomised controlled trial. Australian & New Zealand Journal of Obstetrics & Gynaecology 46(5): 419-426, 2006. (15 refs.)

Background: Postnatal home-visiting programs for illicit drug-using mothers have reported some success in reducing harms in some areas but there is a lack of data on their impact on breastfeeding and immunisation rates. Aims: To investigate the effect on breastfeeding, immunisation and parental drug use. The hypothesis was that the outcomes of the home-visiting group (HVG) would be superior to the control group (CG). Method: One hundred and fifty-two illicit drug-using women were recruited at 35-40 weeks gestation from King Edward Memorial Hospitalital, Perth, Western Australia and randomised after delivery to the HVG or the CG. The HVG had eight home visits; the CG had telephone contact at two months and a home visit at six months. The HVG received education and support for parenting, breastfeeding and child development. This was not provided by the research midwives for the CG. Results: The main drugs were heroin, amphetamines, cannabis and benzodiazepines. Immunisation rates were similar for each group. Median duration of breastfeeding for the HVG was eight weeks (95% CI, 3.8-12.2); for the CG ten weeks (95% CI, 7.3-12.7). Drug use was reduced during pregnancy but increased by six months post-partum in both groups. The retention rates were: HVG 93%; CG 86%. Conclusion: The hypothesis for this study was not supported. Long-term studies are urgently required to assess the effects of parental drug use on infant and child development.

Bonn-Miller MO; Zvolensky MJ; Bernstein A. Marijuana use motives: Concurrent relations to frequency of past 30-day use and anxiety sensitivity among young adult marijuana smokers. Addictive Behaviors 32(1): 49-62, 2007. (57 refs.)

The present investigation examined two theoretically relevant aspects of marijuana motives using the Marijuana Motives Measure (MMM) [Simons, J., Correia, C. J., Carey, K. B., & Borsari, B. E. (1998). Validating a five-factor marijuana motives measure: Relations with use, problems, and alcohol motives. Journal of Counseling Psychology 45, 265-273] among 141 (78 female) young adults (Mage = 20.17, S.D. = 3.34). The first objective was to evaluate the incremental validity of marijuana motives in relation to frequency of past 30-day use after controlling for the theoretically relevant factors of the number of years using marijuana (lifetime), current levels of alcohol, as well as tobacco smoking use. As expected, coping, enhancement, social, and expansion motives each were uniquely and significantly associated with past 30-day marijuana use over and above the covariates; conformity motives were not a significant predictor. A second aim was to explore whether coping, but no other marijuana motive, was related to the emotional vulnerability individual difference factor of anxiety sensitivity (fear of anxiety). As hypothesized, after controlling for number of years using marijuana (lifetime), past 30-day marijuana use, current levels of alcohol consumption, and cigarettes smoked per day, anxiety sensitivity was incrementally and uniquely related to coping motives for marijuana use, but not other motives. These results are discussed in relation to the clinical implications of better understanding the role of motivation for marijuana use among emotionally vulnerable young adults.

Boyer CB; Sebro NS; Wibbelsman C; Shafer MA. Acquisition of sexually transmitted infections in adolescents attending an urban, general HMO teen clinic. Journal of Adolescent Health 39(2): 287-290, 2006. (15 refs.)

To determine association between acquisition of sexually transmitted infections (STIs) over a nine-month period among sexually experienced adolescents attending an urban, general HMO teen clinic and African American race, use of marijuana more than once or twice a week, and having had relationships with a sexual partner who is more than four years older.

Brodbeck J; Matter M; Moggi F. Association between cannabis use and sexual risk behavior among young heterosexual adults. AIDS & Behavior 10(5): 599-605, 2006. (26 refs.)

To study the association between cannabis use and frequent sexual risk behavior, we tested the hypothesis of a situational influence of cannabis use in sexual encounters using a combination of global association study and event-level analysis and examined possible mediator variables, including the personality trait of hedonism/risk preference, psychosocial stress, and HIV-related beliefs, using mediation models. The results of a computer-assisted telephone interview of a random sample of 2790 heterosexual men and women aged 16-24 years showed that risky sexual behavior was more frequent in cannabis-using men and women than in non-using persons. The results did not support a situational effect of cannabis intoxication on sexual risk behavior. The more frequent sexual risk behavior among cannabis users was mediated by decreased intentions to use HIV protection, by lower HIV-self-efficacy, and higher risk preference/hedonism. Only among women psychosocial stress was a partial mediator. The findings show that HIV prevention programs for cannabis-using young adults should emphasize the role of person variables instead of situation variables.

Brook JS; Brook DW; Balka EB; Rosenberg G. Predictors of rebellious behavior in childhood: Parental drug use, peers, school environment, and child personality. Journal of Addictive Diseases 25(2): 77-87, 2006. (42 refs.)

This study assesses the interrelationships among several sets of variables and rebellious behavior in a sample of Puerto Rican and African American elementary school-aged children. The independent sets of variables (domains) were child personality attributes, parental attributes, including parental marijuana use, peer factors, school environment, and ethnic identification and discrimination. The dependent or outcome variable was children's rebellious behavior. Children and their mothers were interviewed in their homes. Pearson correlations and hierarchical multiple regression analyses were used to assess the extent to which the independent variables were related to the children's rebellious behavior. Each of the domains was associated with children's rebellious behavior without control on the remaining domains. With control on the remaining domains, child personality accounted for the most variance in childhood rebellious behavior. With control on child personality, only the school environment remained significant. Children with personality traits that are associated with rebellious behavior may have parents who exhibit antisocial behavior and use marijuana. Furthermore, these children may be at risk for other problem behaviors, including legal drug use, and would benefit from interventions which address primarily their personality characteristics, but also their school environments.

Carroll KM; Easton CJ; Nich C; Hunkele KA; Neavins TM; Sinha R et al. The use of contingency management and motivational/skills-building therapy to treat young adults with marijuana dependence. Journal of Consulting and Clinical Psychology 74(5): 955-966, 2006. (70 refs.)

Marijuana-dependent young adults (N = 136), all referred by the criminal justice system, were randomized to I of 4 treatment conditions: a motivational/skills-building intervention (motivational enhancement therapy/cognitive-behavioral therapy; MET/CBT) plus incentives contingent on session attendance or submission of marijuana-free urine specimens (contingency management; CM), MET/CBT without CM, individual drug counseling (DC) plus CM, and DC without CM. There was a significant main effect of CM on treatment retention and marijuana-free urine specimens. Moreover, the combination of MET/CBT plus CM was significantly more effective than MET/CBT without CM or DC plus CM, which were in turn more effective than DC without CM for treatment attendance and percentage of marijuana-free urine specimens. Participants assigned to MET/CBT continued to reduce the frequency of their marijuana use through a 6-month follow-up.

Chabrol H; Chauchard E; Mabila JD; Mantoulan R; Adele A; Rousseau A. Contributions of social influences and expectations of use to cannabis use in high-school students. Addictive Behaviors 31(11): 2116-2119, 2006. (7 refs.)

The aim of the study was to evaluate the relative contributions of peers' cannabis use or non-use, parental approval of such use, adolescents' own beliefs about use, to the prediction of cannabis use. The participants were 559 high-school students who completed questionnaires assessing the frequency of cannabis use, the number of peers using cannabis, the number of peers opposed to cannabis use, parental attitude toward cannabis use, and participants' expectations towards use. The number of peers using cannabis and participants' positive expectations of cannabis use were risk factors for use whereas the number of peers opposed to cannabis use and the negative expectations of use were protective factors. Parental attitudes towards use were not a significant independent predictor of use.

Chung H; Flaherty BP; Schafer JL. Latent class logistic regression: Application to marijuana use and attitudes among high school seniors. Journal of the Royal Statistical Society. Series A. Statistics in Society 169(Part 4): 723-743, 2006. (57 refs.)

Analysing the use of marijuana is challenging in part because there is no widely accepted single measure of individual use. Similarly, there is no single response variable that effectively captures attitudes toward its social and moral acceptability. One approach is to view the joint distribution of multiple use and attitude indicators as a mixture of latent classes. Pooling items from the annual 'Monitoring the Future' surveys of American high school seniors from 1977 to 2001, we find that marijuana use and attitudes are well summarized by a four-class model. Secular trends in class prevalences over this period reveal major shifts in use and attitudes. Applying a multinomial logistic model to the latent response, we investigate how class membership relates to demographic and life style factors, political beliefs and religiosity over time. Inferences about the parameters of the latent class logistic model are obtained by a combination of maximum likelihood and Bayesian techniques.

Clements KW. Pricing and packaging: The case of marijuana. Journal of Business 79(4): 2019-2044, 2006. (21 refs.)

In many markets, unit prices decline as the quantity purchased rises, a phenomenon that can be considered part of the economics of packaging. This article reviews the economic foundations of quantity discounts and proposes new ways of measuring and analyzing them. These ideas are implemented with the prices of marijuana, a product that is shown to be priced in a manner not too different from that used for groceries as well as some other illicit drugs. In broad terms, the results support the following pricing rule: the unit price falls by 2.5% when the package size increases by 10%.

Copeland J. Cannabis use, depression and public health. Addiction 101(10): 1380-1380, 2006. (9 refs.)

Czyzewska M; Ginsburg HJ. Explicit and implicit effects of anti-marijuana and anti-tobacco TV advertisements. Addictive Behaviors 32(1): 114-127, 2007. (63 refs.)

Effects of anti-tobacco and anti-marijuana TV advertisements on explicit (i.e., semantic differential ratings) and implicit (i.e. Implicit Association Test, IAT) attitudes toward tobacco and marijuana were compared. Two hundred twenty nine, 18- to 19-year-old U.S. college students were randomly assigned to anti-tobacco or anti-marijuana PSA viewing conditions. Participants completed a short survey on attitudes to tobacco and marijuana. Afterwards they watched 15 PSAs embedded in a 15-min science program. At the end, all participants completed IAT for marijuana, IAT for tobacco and the assessment of explicit attitudes. Results of ANCOVA revealed a significant interaction between type of TV PSAs watched and implicit attitudes, F(1,223) = 7.12, p < 0.01 when controlling for preexisting attitudes to both substances; the implicit attitudes were more negative toward the substance that corresponded to the content of advertisements watched (i.e., anti-tobacco or anti-marijuana). However, analogical analysis on explicit measures showed that attitudes to marijuana became less negative among students that watched anti-marijuana ads than the group with anti-tobacco ads, F(1,222) = 5.79, p < 0.02. The discussion focused on the practical and theoretical implications of the observed dissociation between implicit and explicit attitudes to marijuana after the exposure to anti-marijuana PSAs.

D'Amico EJ; McCarthy DA. Escalation and initiation of younger adolescents' substance use: The impact of perceived peer use. Journal of Adolescent Health 39(4): 481-487, 2006. (39 refs.)

Purpose: The middle school years are peak years for substance use initiation. The current study assessed the impact of peer influence on both initiation and escalation of cigarette, alcohol, and marijuana use among sixth, seventh, and eighth graders. Methods: Youth (n = 974; 45% male) were surveyed twice over an academic year and reported on their personal substance use and their perception of peer substance use. The sample ranged in age from 10 to 15 years at Time 1 (M age = 11.95) and was 44% White, 26% Latino, 7% Asian American/Pacific Islander, 4% African American, and 14% mixed ethnic origin. Results: Hierarchical regressions examined whether personal and perceived peer substance use predicted later substance involvement, and logistic regressions assessed whether Time 1 perceived peer and personal use of other substances discriminated between initiates and noninitiates. After controlling for personal substance use, perceived peer alcohol use predicted both increased alcohol and marijuana use, and perceived peer marijuana use predicted increased alcohol use. Only perceived peer alcohol use was associated with initiation of alcohol, and both perceived peer alcohol and marijuana use predicted onset of marijuana use. Conclusions: Results highlight the importance of perceived peer use in predicting both onset and escalation of use and suggest utilizing a multifaceted prevention approach that targets multiple substances.

Darke S; Williamson A; Ross J; Teesson M. Reductions in heroin use are not associated with increases in other drug use: 2-year findings from the Australian Treatment Outcome Study. Drug and Alcohol Dependence 84(2): 201-205, 2006. (27 refs.)

Aims: To determine whether reductions in frequency of heroin use were associated with reductions in the use of other drugs over a 24-month period. Design: Longitudinal cohort, with follow-up at 3, 12 and 24 months. Participants: Six hundred and fifteen heroin users recruited for the Australian Treatment Outcome Study. Setting: New South Wales, Australia. Findings: The proportion reporting weekly heroin use declined significantly at 3, 12 and 24 months. Reductions in heroin use were associated with longer periods in both residential rehabilitation (RR) and maintenance treatment (MT). Less frequent use of other opioids, cocaine, amphetamine, cannabis and benzodiazepines were noted over follow-up, with alcohol use remaining stable. Across follow-up, lower frequency heroin use was associated with reduced likelihood of frequent use of other opioids, cocaine, amphetamine and benzodiazepines. Alcohol and cannabis use were unrelated to heroin use. Longer periods spent in RR were associated with declines in the use of all other drug classes, with MT associated with declines in other opioid and alcohol use. Conclusions: There was no evidence for drug substitution in the face of reduced heroin use in this cohort of treatment seekers. The fear that a successful reduction in heroin use amongst treatment seekers will precipitate an increase in the use of other drugs appears ill-founded.

Degenhardt L; Hall W. Is cannabis use a contributory cause of psychosis? (review). Canadian Journal of Psychiatry 51(9): 556-565, 2006. (86 refs.)

Objective: To assess whether cannabis use in adolescence and young adulthood is a contributory cause of schizophreniform psychosis in that it may precipitate psychosis in vulnerable individuals. Method: We reviewed longitudinal studies of adolescents and young adults that examined the relations between self-reported cannabis use and the risk of diagnosis with a psychosis or of reporting psychotic symptoms. We also reviewed studies that controlled for potential confounders, such as other forms of drug use and personal characteristics that predict an increased risk of psychosis. We assessed evidence for the biological plausibility of a contributory causal relation. Results: Evidence from 6 longitudinal studies in 5 countries shows that regular cannabis use predicts an increased risk of a schizophrenia diagnosis or of reporting symptoms of psychosis. These relations persisted after controlling for confounding variables, such as personal characteristics and other drug use. The relation did not seem to be a result of cannabis use to self-medicate symptoms of psychosis. A contributory causal relation is biologically plausible because psychotic disorders involve disturbances in the dopamine neurotransmitter systems with which the cannabinoid system interacts, as demonstrated by animal studies and one human provocation study. Conclusion: It is most plausible that cannabis use precipitates schizophrenia in individuals who are vulnerable because of a personal or family history of schizophrenia.

Delnevo CD; Hrywna M. The relationship of cigars, marijuana, and blunts to adolescent bidi use. Public Health Reports 121(5): 603-608, 2006. (27 refs.)

Objective. Previous research suggests that bidi, cigar, and marijuana use may be interrelated, but to date, this hypothesis has not been empirically tested. Methods. We explored the relationships among use of these products using data from 17,429 youths who completed the 2001 National Household Survey on Drug Abuse. Variables of interest included demographics, tobacco use (i.e., cigarettes, cigars), marijuana use, and blunting (i.e., cigars filled with marijuana). Adjusted odds ratios (AOR) for past-month bidi use were generated for each variable; regression models were also generated separately by race/ethnicity. Results. Overall, 1.1% of the youths surveyed reported past month bidi use; higher prevalence was noted for those who were past-month users of cigarettes (4.6%), cigars (7.0%0), marijuana (5.8%), and blunts (7.3%). Logistic regression yielded significant odds ratios for all tobacco products, marijuana, and blunts, with the greatest odds associated with past-month cigarette use. Interestingly, the pattern varied notably by race. Among white youth, the greatest odds for past-month bidi use were associated with cigarette use (AOR=3.9), while among black youth the greatest odds were associated with blunting (AOR=9.5). Conclusion. The findings demonstrate that the use of cigars and blunts is highly associated with bidi use among youths and these patterns differ by race/ ethnicity. Tobacco control efforts that target youths must address other tobacco products and marijuana and should be tailored appropriately and effectively, with consideration of racial, ethnic, and cultural variations.

Denis C; Lavie E; Fatseas M; Auriacombe M. Psychotherapeutic interventions for cannabis abuse and/or dependence in outpatient settings. Cochrane Database of Systematic Reviews 3(article no: CD005336), 2006. (58 refs.)

BACKGROUND: Cannabis use disorder is the most common illicit substance use disorder in general population. Despite that, only a minority seek assistance from a health professional, but the demand for treatment is now increasing internationally. Trials of treatment have been published but to our knowledge, there is no published systematic review . OBJECTIVES: To evaluate the efficacy of psychosocial interventions for cannabis abuse or dependence. SEARCH STRATEGY: We searched the Cochrane Central Register of Trials (CENTRAL) The Cochrane Library Issue 3, 2004; MEDLINE (January 1966 to August 2004), PsycInfo (1985 to October 2004), CINAHL (1982 to October 2004), Toxibase (until September 2004) and reference lists of articles. We also contacted researchers in the field. SELECTION CRITERIA: All randomized controlled studies examining a psychotherapeutic intervention for cannabis dependence or abuse in comparison with a delayed-treatment control group or combinations of psychotherapeutic interventions. DATA COLLECTION AND ANALYSIS: Two authors independently assessed trial quality and extracted data MAIN RESULTS: Six trials involving 1297 people were included. Five studies took place in the United States, one in Australia. Studies were not pooled in meta-analysis because of heterogeneity. The six included studies suggested that counseling approaches might have beneficial effects for the treatment of cannabis dependence. Group and individual sessions of cognitive behavioral therapy (CBT) had both efficacy for the treatment of cannabis dependence and associated problems, CBT produced better outcomes than a brief intervention when CBT was delivered in individual sessions. Two studies suggested that adding voucher-based incentives may enhance treatment when used in combination with other effective psychotherapeutic interventions. Abstinence rates were relatively small overall but favored the individual CBT 9-session (or more) condition. All included trials reported a statistically significant reductions in frequency of cannabis use and dependence symptoms. But other measures of problems related to cannabis use were not consistently different. AUTHORS' CONCLUSIONS: The included studies were too heterogenous and could not allow to draw up a clear conclusion. The studies comparing different therapeutic modalities raise important questions about the duration, intensity and type of treatment. The generalizability of findings is also unknown because the studies have been conducted in a limited number of localities with fairly homogenous samples of treatment seekers. However, the low abstinence rate indicated that cannabis dependence is not easily treated by psychotherapies in outpatient settings.

Duarte R; Escario JJ; Molina JA. Marijuana consumption and school failure among Spanish students. Economics of Education Review 25(5): 472-481, 2006. (44 refs.)

This paper examines the hypothetically bi-directional relationship which links marijuana consumption and school failure among students. To that end, we propose a simultaneous probability model, which is estimated by using the information provided by the three consecutive waves from the Spanish Surveys on Drug Use in the School Population [(1996, 1998 and 2000). Spanish Government's Delegation for the National Plan On Drugs, Madrid, Spain]. Our results confirm that whilst marijuana consumption is a determinant for school failure among Spanish students, we do not find evidence in the opposite direction. Moreover, explanatory variables, such as the presence of smokers at home, a monoparental situation or unhealthy habits, among others, are good predictors for both marijuana consumption and school failure.

Eaton DK; Kann L; Kinchen S; Ross J; Hawkins J; Harris WA et al. Youth Risk Behavior Surveillance - United States, 2005. Journal of School Health 76(7): 353-372, 2006. (13 refs.)

In the United States, 71% of all deaths among persons aged 10-24 years result from 4 causes: motor vehicle crashes, other unintentional injuries, homicide, and suicide. Results from the 2005 national Youth Risk Behavior Survey (YRBS) indicated that during the 30 days preceding the survey, many high school students engaged in behaviors that increased their likelihood of death from these 4 causes: 9.9% had driven a car or other vehicle when they had been drinking alcohol, 18.5% had carried a weapon, 43.3% had drunk alcohol, and 20.2% had used marijuana. In addition, during the 12 months preceding the survey, 35.9% of high school students had been in a physical fight and 8.4% had attempted suicide. Substantial morbidity and social problems among youth also result from unintended pregnancies and sexually transmitted diseases, including human immunodeficiency virus infection. During 2005, a total of 46.8% of high school students had ever had sexual intercourse, 37.2% of sexually active high school students had not used a condom at last sexual intercourse, and 2.1% had ever injected an illegal drug. Among adults aged >= 25 years, 61% of all deaths result from 2 causes: cardiovascular disease and cancer. Results from the 2005 National YRBS indicated that risk behaviors associated with these 2 causes of death were initiated during adolescence. During 2005, a total of 23.0% of high school students had smoked cigarettes during the 30 days preceding the survey, 79.9% had not eaten >= 5 times/day of fruits and vegetables during the 7 days preceding the survey, 67.0% did not attend physical education classes daily, and 13.1% were overweight.

Edwards J; Elkins K; Hinton M; Harrigan SM; Donovan K; Athanasopoulos O et al. Randomized controlled trial of a cannabis-focused intervention for young people with first-episode psychosis. Acta Psychiatrica Scandinavica 114(2): 109-117, 2006. (41 refs.)

Objective: To evaluate a cannabis-focused intervention (cannabis and psychosis therapy: CAP) for patients continuing to use cannabis following initial treatment for first-episode psychosis (FEP). Method: Consecutive admissions to an early psychosis program were screened and consenting individuals using cannabis in the 4 weeks prior to assessment participated. A single-blind randomized controlled trial compared CAP (n = 23) with a clinical control condition (psychoeducation, PE; n = 24). Results: There were no significant differences between the CAP and PE groups on cannabis use at end of treatment and 6 months post-intervention. There were no significant group differences on psychopathology and functional ratings at follow-up. A significant reduction in cannabis use was observed for both groups over time. Conclusion: PE and specific cannabis-focused intervention are associated with similar reductions in cannabis use in an FEP cohort. Simple interventions may therefore be worth considering prior to intensive psychotherapeutic efforts with this population.

Eitle D. Parental gender, single-parent families, and delinquency: Exploring the moderating influence of race/ethnicity. Social Science Research 35(3): 727-748, 2006. (64 refs.)

Despite the great interest in the relationship between family structure and delinquent behavior generally, very little research has explored variation within the family form of single parenting and its implications. The present study examines whether parental gender is associated with delinquent behavior and marijuana, alcohol, and other illicit drug use, and whether the magnitude of an association between parental gender and delinquency is moderated by race/ethnicity. The analyses can be interpreted as supporting either the structural or maternal hypotheses, with parental gender (namely living with a father) being found to increase the risk of alcohol use generally, while females living with their fathers are at an increased risk of being involved in delinquent behavior. The only evidence of race/ethnicity conditioning the relationship between parental gender and deviant behavior was for marijuana use-living with one's father increases the risk of Hispanic/Latino adolescents engaging in marijuana use. While these finding provide further evidence that children living with single fathers may be at an increased risk of being involved in delinquent behavior (under certain conditions), additional research is needed to further evaluate the conditional nature of the single-father-delinquency association.

Faeh D; Viswanathan B; Chiolero A; Warren W; Bovet P. Clustering of smoking, alcohol drinking and cannabis use in adolescents in a rapidly developing country. BMC Public Health 6(article 169), 2006. (45 refs.)

Background: Smoking, alcohol drinking and cannabis use ("risk behaviors") are often initiated at a young age but few epidemiological studies have assessed their joined prevalence in children in developing countries. This study aims at examining the joint prevalence of these behaviors in adolescents in the Seychelles, a rapidly developing country in the Indian Ocean. Methods: Cross-sectional survey in a representative sample of secondary school students using an anonymous self-administered questionnaire ( Global Youth Tobacco Survey). The questionnaire was completed by 1,321 (92%) of 1,442 eligible students aged 11 to 17 years. Main variables of interest included smoking cigarettes on >= 1 day in the past 30 days; drinking any alcohol beverage on >= 1 day in the past 30 days and using cannabis at least once in the past 12 months. Results: In boys and girls, respectively, prevalence (95% CI) was 30% ( 26 - 34)/21% ( 18 - 25) for smoking, 49% ( 45 - 54)/48% ( 43 - 52) for drinking, and 17% ( 15 - 20)/8% ( 6 - 10) for cannabis use. The prevalence of all these behaviors increased with age. Smokers were two times more likely than non-smokers to drink and nine times more likely to use cannabis. Drinkers were three times more likely than non-drinkers to smoke or to use cannabis. Comparison of observed versus expected frequencies of combination categories demonstrated clustering of these risk behaviors in students ( P < 0.001). Conclusion: Smoking, drinking and cannabis use were common and clustered among adolescents of a rapidly developing country. These findings stress the need for early and integrated prevention programs.

Fisher SL; Bucholz KK; Reich W; Fox L; Kuperman S; Kramer J et al. Teenagers are right: Parents do not know much. An analysis of adolescent-parent agreement on reports of adolescent substance use, abuse, and dependence. Alcoholism: Clinical and Experimental Research 30(10): 1699-1710, 2006. (38 refs.)

Background: Previous studies have shown that when assessing child psychopathology, parents tend to report more symptoms than children for externalizing disorders such as attention deficit hyperactivity disorder (ADHD), whereas children tend to report more symptoms for internalizing disorders such as major depression. Whether for clinical or research purposes, parents are also frequently asked to report on their children's experiences with alcohol and drugs. The purpose of this study was to analyze correspondence between adolescent and parent reports of adolescent substance use and abuse or dependence. Methods: In the current study, 591 subjects 12 to 17 years old were interviewed using the child version of the Semi-Structured Assessment for the Genetics of Alcoholism (C-SSAGA) as part of the Collaborative Study on the Genetics of Alcoholism (COGA). One parent was also interviewed about each adolescent using the parent version of the C-SSAGA. Sensitivities, specificities, and kappa coefficients were calculated to assess parental agreement with adolescent reports of lifetime substance use and Diagnostic and Statistical Manual of Mental Disorders-Third Revision substance abuse or dependence. Results: The results indicate that parents are somewhat knowledgeable about their children's use of substances, particularly those that are used most commonly. For example, 55% of adolescents who had smoked cigarettes, 50% who had used alcohol, and 47% who had used marijuana had a parent who knew that they used. However, parents were less aware of substance-related problems experienced by their offspring, agreeing with adolescent reports only 27% of the time for diagnoses of alcohol abuse or dependence and 26% of the time for diagnoses of marijuana abuse or dependence. Parent reports added few cases of substance use for 12- to 13 year-olds and essentially no cases for 16- to 17-year-olds. Parent reports added a nominal number of diagnoses of substance abuse or dependence for older adolescents. Conclusions: Whether for clinical or research purposes, the results emphasize the importance of directly assessing adolescents regarding alcohol and other substance use disorders. Furthermore, investigators should consider the specific disorder(s) being investigated and the ages of the children being studied when determining whether to include parent reports as part of study design.

Fisk JE; Montgomery C; Wareing M; Murphy PN. The effects of concurrent cannabis use among ecstasy users: Neuroprotective or neurotoxic? Human Psychopharmacology. Clinical and Experimental 21(6): 355-366, 2006. (47 refs.)

The research evidence regarding the potential effects of ecstasy suggests that it may be neurotoxic and that its use is associated with cognitive impairment. In recent years evidence has emerged suggesting that cannabinoids, the active ingredients in cannabis, can be neuroprotective under certain conditions. Given that many ecstasy users also consume cannabis at the same time, the possibility emerges that these individuals might be less susceptible to ecstasy-related impairment. The present paper reanalyses the data from a number of previous studies, contrasting the performance of those individuals who generally consume cannabis and ecstasy at the same time with those who generally consume ecstasy on its own. The two ecstasy-using groups are compared with non-ecstasy users on a range of measures including processing speed, random letter generation, verbal and visuo-spatial working memory span, reasoning and associative learning. The two ecstasy user groups did not differ significantly from each other on any of the measures. Both user groups were significantly worse than non-ecstasy users on measures of associative learning, verbal and visuo-spatial working memory and reasoning. The results suggest that consuming cannabis at the same time as ecstasy does not reduce the likelihood of cognitive impairment.

Freeman RM; Adekanmi O; Waterfield MR; Waterfield AE; Wright D; Zajicek J. The effect of cannabis on urge incontinence in patients with multiple sclerosis: a multicentre, randomised placebo-controlled trial (CAMS-LUTS). International Urogynecology Journal 17(6): 636-641, 2006. (29 refs.)

Objective: To test whether cannabinoids reduce urge incontinence episodes without affecting voiding in patients with multiple sclerosis. This was part of the multicentre trial of the Cannabinoids in Multiple Sclerosis (CAMS) study. Subjects and methods: The CAMS study randomised 630 patients to receive oral administration of cannabis extract, Delta(9)-tetrahydrocannabinol (THC) or matched placebo. For this substudy subjects completed incontinence diaries. Results: All three groups showed a significant reduction, p < 0.01, in adjusted episode rate (i.e. correcting for baseline imbalance) from baseline to the end of treatment: cannabis extract, 38%; THC, 33%; and placebo, 18%. Both active treatments showed significant effects over placebo (cannabis extract, p=0.005; THC, p=0.039). Conclusion: The findings are suggestive of a clinical effect of cannabis on incontinence episodes in patients with MS. This is in contrast to the negative finding of the CAMS study, where no difference was seen in the primary outcome of spasticity.

Garton AJ. Casenote: Constitutional Law - Commerce Clause - Regulation of intrastate cultivation of state-authorized medical marijuana is within Congress's commercee power. Cumberland Law Review 36: 179-192, 2006. (109 legal refs.)

Summary: Gonzales v. Raich recently addressed the extent of authority the federal government possesses to regulate intrastate cultivation of medical marijuana. In Raich, residents suffering from serious medical conditions used medical marijuana in accordance with California's Compassionate Use Act and thereafter claimed that the federal government violated the Commerce Clause when Drug Enforcement Administration (DEA) agents seized and destroyed a resident's personal cannabis crops. ... In the hope of resolving ensuing federal authority disputes, the Court considered whether the AAA's regulation of production and consumption of wheat exceeded Congress's commerce power. Although Filburn's local wheat consumption "may not be regarded as commerce," the Court held that "it may still . . . be reached by Congress if it exerts a substantial economic effect on interstate commerce. ... The Court's analysis revealed its stance that Filburn's consumption of homegrown wheat reduced his need to purchase wheat in the open market and therefore indirectly "competed with wheat in commerce. ... " Thus, the Morrison holding reiterated the finding in Lopez that the regulation of purely intrastate violence that does not directly affect the "instrumentalities, channels, or goods involved in interstate commerce" is, and should remain, solely within the province of the individual states. In anticipation of future challenges to this ruling by citizens fearing excessive federal authority, the Court in Raich acknowledged alternative avenues through which residents in need of medical marijuana may obtain relief. Most importantly, the Court emphasized the ultimate power of the democratic process through which the voting public may petition Congress to authorize the reclassification of marijuana in the CSA's schedule of controlled substances. 108 Thus, even in the face of America's ever-changing interpretation of federal versus states' rights, the Court maintains a steadfast conviction that the "voices of voters" will continue to "be heard in the halls of Congress."

Hall W; Degenhardt L. What are the policy implications of the evidence on cannabis and psychosis? (review). Canadian Journal of Psychiatry 51(9): 566-574, 2006. (82 refs.)

Objective: To explore the implications for mental health services, for health education about the risks of cannabis use, and for public policy toward cannabis use of observational evidence that cannabis use is a contributory cause of psychosis. Method: Using comparative analyses of similar evidence for the harmful effects of alcohol, tobacco, and amphetamine use, we considered the relation between observational evidence and action on cannabis. We examined arguments on the grounds of public health prudence for discouraging cannabis use by young individuals. With the assumption that the relation may be causal, we considered recommendations for policy in mental health services, health education, and public policy toward cannabis. Results: The observational evidence and biological plausibility of the hypothesis that cannabis is a contributory cause of psychosis is at least as strong as evidence for causal relations between heavy alcohol and amphetamine use and psychosis. On public health grounds, there is a good case for discouraging cannabis use among adolescents and young adults. It remains uncertain how best to discourage use and at whom campaigns to reduce cannabis use should be targeted. Conclusions: We should discourage young adults seeking treatment in mental health services from using cannabis and inform them of the probable mental health risks of cannabis use, especially of early and frequent use. We must exercise caution in liberalizing cannabis laws in ways that may increase young individuals' access to cannabis, decrease their age of first use, or increase their frequency of cannabis use. We should consider the feasibility of reducing the availability of high-potency cannabis products.

Harder VS; Morral AR; Arkes J. Marijuana use and depression among adults: Testing for causal associations. Addiction 101(10): 1463-1472, 2006. (52 refs.)

Aim: To determine whether marijuana use predicts later development of depression after accounting for differences between users and non-users of marijuana. Design: An ongoing longitudinal survey of 12 686 men and women beginning in 1979. Setting: The National Longitudinal Survey of Youth of 1979, a nationally representative sample from the United States. Participants: A total of 8759 adults (age range 29-37 years) interviewed in 1994 had complete data on past-year marijuana use and current depression. Measurements: Self-reported past-year marijuana use was tested as an independent predictor of later adult depression using the Center for Epidemiologic Studies-Depression questionnaire. Individual's propensity to use marijuana was calculated using over 50 baseline covariates. Findings: Before adjusting for group differences, the odds of current depression among past-year marijuana users is 1.4 times higher (95% CI: 1.1, 1.9) than the odds of depression among the non-using comparison group. After adjustment, the odds of current depression among past-year marijuana users is only 1.1 times higher than the comparison group (95% CI: 0.8, 1.7). Similarly, adjustment eliminates significant associations between marijuana use and depression in four additional analyses: heavy marijuana use as the risk factor, stratifying by either gender or age, and using a 4-year lag-time between marijuana use and depression. Conclusions: After adjusting for differences in baseline risk factors of marijuana use and depression, past-year marijuana use does not significantly predict later development of depression. These findings are discussed in terms of their relevance for understanding possible causal effects of marijuana use on depression.

Herman-Stahl MA; Krebs CP; Kroutil LA; Heller DC. Risk and protective factors for nonmedical use of prescription stimulants and methamphetamine among adolescents. Journal of Adolescent Health 39(3): 374-380, 2006. (32 refs.)

Purpose: This article reports on correlates of past-year nonmedical use of prescription stimulants and methamphetamine among adolescents aged 12 to 17 years. Methods: Data from the 2002 National Survey of Drug Use and Health (NSDUH) were used to conduct logistic regression analyses of the demographic, psychosocial, and behavioral correlates of illicit stimulant use. The sample size was 17,709. Results: Analyses revealed that mental health treatment utilization and use of marijuana and other illegal drugs were correlated with nonmedical use of prescription stimulants and methamphetamine among adolescents. Females and adolescents who reported low religiosity, binge drinking, and selling drugs were more likely to use methamphetamine than were males or individuals who did not report these attitudes or behaviors. Additionally, black adolescents were less likely than white adolescents to use methamphetamine. Alternatively, adolescents who reported high family conflict and sensation-seeking were more likely than their counterparts to use prescription stimulants nonmedically, and Hispanic adolescents were less likely to use prescription stimulants nonmedically than white adolescents. Conclusions: Risk for illicit use of stimulants varies by demographic, psychosocial, and behavioral factors. Different intervention mechanisms, populations, and settings should be targeted to prevent nonmedical use of prescription stimulants versus methamphetamine among adolescents.

Hidaka Y; Ichikawa S; Koyano J; Urao M; Yasuo T; Kimura H et al. Substance use and sexual behaviours of Japanese men who have sex with men: A nationwide internet survey conducted in Japan. BMC Public Health 6(article 239), 2006. (26 refs.)

Background: Japanese men who have sex with men (MSM), especially those living in large metropolitan areas such as Tokyo and Osaka, are facing a growing HIV/AIDS epidemic. Although the Internet is used as a new venue for meeting sex partners, it can also serve as a useful research tool for investigating the risk behaviours of Japanese MSM. This Internet survey explored the extent of substance use and its association with sexual risk behaviours among Japanese MSM. Methods: Between 28 February 2003 and 16 May 2003 MSM were recruited through 57 Japanese gay-oriented Web sites, gay magazines, and Internet mailing lists. Participants completed a structured questionnaire anonymously through the Internet. Results: In total, 2,062 Japanese MSM completed the questionnaire. The average age of participants was 29.0 years and 70.5% identified as gay, 20.8% as bisexual, and 8.7% as other. Overall, 34.5% reported never using a substance, 45% reported ever using one type of substance (lifetime reported single substance users), and 19.6% had used more than 1 type of substance (lifetime reported multiple substance users) in their lifetimes. The substances most commonly used were amyl nitrite (63.2%), 5-methoxy-N,N-diisopropyltryptamine (5MEO-DIPT) (9.3%), and marijuana (5.7%). In the multivariate analysis, unprotected anal intercourse, having had 6 or more sexual partners, visiting a sex club/gay venue in the previous 6 months, a lower education level, and being 30 to 39 years of age were associated with both lifetime single and lifetime multiple substance use. Lifetime reported multiple substance use was also correlated with having a casual sex partner, having symptoms of depression, being diagnosed as HIV-positive, and greater HIV/AIDS-related knowledge. Conclusion: This is the first Internet-based research focused on the sexual and substance use behaviours of MSM in Asia. Our findings suggest a compelling need for prevention interventions to reduce HIV risk-related substance use behaviours among Japanese MSM. The results also suggest that the Internet is potentially a useful tool for collecting behavioural data and promoting prevention interventions among this population.

Hides L; Dawe S; Kavanagh DJ; Young RM. Psychotic symptom and cannabis relapse in recent-onset psychosis: Prospective study. British Journal of Psychiatry 189: 137-143, 2006. (40 refs.)

Background: Cannabis use appears to exacerbate psychotic symptoms and increase risk of psychotic relapse. However, the relative contribution of cannabis use compared with other risk factors is unclear. The influence of psychotic symptoms on cannabis use has received little attention. Aims: To examine the influence of cannabis use on psychotic symptom relapse and the influence of psychotic symptom severity on relapse in cannabis use in the 6 months following hospital admission. Method: At baseline, 84 participants with recent-onset psychosis were assessed and 81 were followed up weekly for 6 months, using telephone and face-to-face interviews. Results: A higher frequency of cannabis use was predictive of psychotic relapse, after controlling for medication adherence, other substance use and duration of untreated psychosis. An increase in psychotic symptoms was predictive of relapse to cannabis use, and medication adherence reduced cannabis relapse risk. Conclusions: The relationship between cannabis use and psychosis may be bidirectional, highlighting the need for early intervention programmes to target cannabis use and psychotic symptom severity in this population.

Hii S; Naughton MT; Young A. Marijuana lung. Internal Medicine Journal 36(4): 270+, 2006. (4 refs.)

A 39-year-old man with heavy marijuana use and cigarette smoking was admitted with 3 weeks of weight loss, fevers, dry cough and right-sided pleuritic chest pain. He had neither medical history nor occupational exposure to dust, asbestos or avian products. He started smoking tobacco and marijuana at the age of 12, initially 20 cigarettes and 1 g of marijuana a week and graduated to 3 g of marijuana a day and ongoing tobacco (total 50 packs/year), either through a 'bong' or 'joint'. A CT scan of the lung showed a pattern of large peripheral paraseptal bullae, which is compatible with marijuana smoking and differs to the uniformly distributed centrilobular pattern seen with standard cigarette smoking in a man of similar age and similar cigarette-smoking history. This difference in emphysema pattern can be explained by (i) the physical dynamics of smoking marijuana compared with cigarette smoking: smoking marijuana either through joint or bong requires a longer inhalation and a longer breath holding time that physiologically results in more peripheral airway barotrauma and pleural pressure swing, (ii) the higher temperature of inhaled marijuana through a bong and (iii) the lack of filter tips on the marijuana joints with fourfold greater delivery of tar and a fivefold greater increase in carboxyhaemoglobin per cigarette smoked. [See note.]

Huestis MA; ElSohly M; Nebro W; Barnes A; Gustafson RA; Smith ML. Estimating time of last oral ingestion of cannabis from plasma THC and THCCOOH concentrations. Therapeutic Drug Monitoring 28(4): 540-544, 2006. (21 refs.)

Estimating the time of last cannabis use is important in assessing possible impairment of drivers involved in accidents, in verifying accuracy of court testimony and in the future, helpful in therapeutic monitoring of cannabis agonists. In 1992, Huestis et al developed model 1, based on plasma Delta(9)-tetrahydrocannabinol (THC) concentrations, and model 2, on plasma 11-nor-9-carboxy-Delta(9)-tetrahydrocannbinol/THC ratios, that predicted 95% confidence intervals for time of last cannabis use. These models seemed to be valuable when applied to the small amount of data from published studies of oral ingestion, a route of administration more popular with the advent of cannabis therapies. A study was designed to further validate the models after oral ingestion of THC, and to determine whether they could predict last usage after multiple oral doses. Eighteen subjects in IRB-approved studies participated after providing informed consent. Each of 12 subjects in one group received a single 10 mg oral dose of dronabinol (synthetic THC). In another protocol, 6 subjects received 4 different oral daily doses, divided into thirds and administered with meals for 5 consecutive days. There was a 10-day washout period between each dosing regimen. Daily doses were 0.39, 0.47, and 14.8 mg THC in hemp oil and 7.5 mg dronabinol. Blood specimens were collected throughout the study and analyzed for plasma THC and 11-nor-9-carboxy-Delta(9)-tetrahydrocannbinol by gas chromatography/mass spectrometry with limits of quantification (LOQs) of 0.5 and 1.0 ng/mL, respectively. Actual times between ingestion of THC and blood collection spanned 0.5 to 16 hours. All plasma specimens with analyte concentrations > LOQ (n = 90) were evaluated. Models I and 2 correctly predicted time of last THC ingestion for 74.4% and 90.0% of plasma specimens, respectively. 96.7% of predicted times were correct with one overestimate and 2 underestimates using the time interval defined by the lowest and highest 95% confidence limit of both models. These results provide further evidence of the usefulness of the predictive models in estimating the time of last oral THC ingestion after single or multiple doses.

Huizink AC; Ferdinand RF; Ormel J; Verhulst FC. Hypothalamic-pituitary-adrenal axis activity and early onset of cannabis use. Addiction 101(11): 1581-1588, 2006. (48 refs.)

Aims: To identify early onset cannabis users by measuring basal hypothalamic-pituitary-adrenal (HPA) axis activity, which may be a risk factor for early onset substance use when showing low activity. Design: In a prospective cohort study, adolescents who initiated cannabis use at an early age (9-12 years), those who initiated at a later age (13 14 years) and those who did not use cannabis by the age of 14 were compared with respect to HPA axis activity. Setting and participants Data were used from the first and second assessment wave of the TRacking Adolescents' Individual Lives Survey (TRAILS), that included 1768 Dutch young adolescents aged 10-12 years who were followed-up across a period of 2 years. Measurements Cortisol was measured in saliva samples at awakening, 30 minutes later and at 8 p. m. at age 10-12. Self-reported age at first cannabis use was used. Findings The early onset group had lower cortisol levels 30 minutes after awakening than the late onset group (OR = 0.93, 95% CI: 0.86-0.99). Furthermore, compared to non-users, the early and late onset cannabis users had higher levels of cortisol at 8 p. m. (OR = 1.25, 95% CI: 1.03-1.53 and OR = 1.21, 95% CI: 1.01-1.45, respectively). Conclusions: Some evidence was found for HPA axis hypo-activity at awakening in adolescents with early onset of cannabis use compared to late onset users, which might indicate an increased risk for early onset users of seeking stimulation to restore arousal levels by using substances.

Hung O; Lynch ME; Clark AJ. Cannabinoids and pain management. (editorial). Canadian Journal of Anaesthesia 53(8): 743-746, 2006. (19 refs.)

Jones C; Donnelly N; Swift W; Weatherburn D. Preventing cannabis users from-driving under the influence of cannabis. Accident Analysis and Prevention 38(5): 854-861, 2006. (45 refs.)

Face-to-face, structured interviews were conducted with 320 recent cannabis users in New South Wales, Australia to assess the likely deterrent effects of (a) increasing the certainty of apprehension for driving under the influence of cannabis (DUIC) and (b) doubling the severity of penalties for DUIC. Participants were presented with a drug-driving scenario and asked to indicate their likelihood of driving given that scenario. The perceived risk of apprehension and severity of punishment were manipulated in each scenario to create four different certainty/severity conditions and participants were randomly allocated to one of these four groups. A subsidiary aim was to assess the likely impact of providing factual information about the accident risk associated with DUIC. Recent drug drivers who felt at low risk of accident when DUIC were asked to rate their willingness to drive if convinced that it was dangerous. The results suggested that increasing the certainty but not severity of punishment would produce reductions in cannabis-intoxicated driving among recent cannabis users. Providing factual information about the risks associated with DUIC would appear to have little impact on drug-driving rates among this population.

Jones SE; Merkle S; Wheeler L; Mannino DM; Crossett L. Tobacco and other drug use among high school students with asthma. Journal of Adolescent Health 39(2): 291-294, 2006. (9 refs.)

The 2003 national Youth Risk Behavior Survey data were analyzed to compare drug use among high school students with and without asthma. High school students with current asthma used cigarettes, cigars, marijuana, and inhalants (huffing) at rates equal to or greater than high school students without current asthma.

Karanian DA; Bahr BA. Cannabinoid drugs and enhancement of endocannabinoid responses: Strategies for a wide array of disease states. (review). Current Molecular Medicine 6(6): 677-684, 2006. (126 refs.)

The endogenous cannabinoid system has revealed potential avenues to treat many disease states. Medicinal indications of cannabinoid drugs including compounds that result in enhanced endocannabinoid responses (EER) have expanded markedly in recent years. The wide range of indications covers chemotherapy complications, tumor growth, addiction, pain, multiple sclerosis, glaucoma, inflammation, eating disorders, age-related neurodegenerative disorders, as well as epileptic seizures, traumatic brain injury, cerebral ischemia, and other excitotoxic insults. Indeed, a great effort has led to the discovery of agents that selectively activate the cannabinoid system or that enhance the endogenous pathways of cannabinergic signaling. The endocannabinoid system is comprised of three primary components: (i) cannabinoid receptors, (ii) endocannabinoid transport system, and (iii) hydrolysis enzymes that break down the endogenous ligands. Two known endocannabinoids, anandamide (AEA) and 2-arachidonoyl glycerol (2-AG), are lipid molecules that are greatly elevated in response to a variety of pathological events. This increase in endocannabinoid levels is suggested to be part of an on-demand compensatory response. Furthermore, activation of signaling pathways mediated by the endogenous cannabinoid system promotes repair and cell survival. Similar cell maintenance effects are elicited by EER through inhibitors of the endocannabinoid deactivation processes (i.e., internalization and hydrolysis). The therapeutic potential of the endocannabinoid system has yet to be fully determined, and the number of medical maladies that may be treated will likely continue to grow. This review will underline studies that demonstrate medicinal applications for agents that influence the endocannabinoid system.

Kokkevi A; Gabhainn SN; Spyropoulou M; Risk Behav Focus Grp HBSC. Early initiation of cannabis use: A cross-national European perspective. Journal of Adolescent Health 39(5): 712-719, 2006. (40 refs.)

Purpose: To examine the relationship of the early initiation of cannabis use with other high risk behaviors and with psychosocial and health-related correlates in 15-year-old adolescents in six European countries. Methods: This study reports on nationwide cross-sectional surveys in six European countries in 2001-2002, within the framework of the World Health Organization's collaborative study, Health Behaviour in School-aged Children (HBSC). Data were collected through anonymous questionnaires self-completed in classrooms. Descriptive and multivariate analyses were used to assess differences between countries in age of first cannabis use and associations with health and related psychosocial variables. Results: The prevalences of lifetime and last-year cannabis use ranged from 30.7% and 27.5%, respectively, in the Czech Republic, to 5.4% and 4.1%, respectively, in Greece. Age at first use was lower in the high prevalence countries than in countries with lower prevalence. For 15-year-olds, frequent use of tobacco and alcohol and other risk behaviors were correlated with early (13-15 years old) and especially very early (<= 13 years old) cannabis initiation. Conclusions: Although different patterns of prevalence and age of initiation were observed between participating countries, early cannabis use was almost uniformly associated with higher odds of more frequent use of cannabis and other substances, and with a common set of other problems. Our findings suggest that prevention of drug abuse must commence in preadolescence.

Kratochvil CJ; Wilens TE; Upadhyaya H. Pharmacological management of a youth with ADHD, marijuana use, and mood symptoms. Journal of the American Academy of Child and Adolescent Psychiatry 45(9): 1138-1141, 2006. (18 refs.)

This article provides a case study of a teen referred for academic decline and mood symptoms. Although diagnosed with ADHD 7 years ago, the parents opted not to have it treated. The patient has prominent inattention and distractibility, with complaints of internal restlessness. Grades have declined from Bs to Ds. He also admits to smoking marijuana regularly for the past few months, with daily use of "at least a few hits" and more on weekends. The question posed are how this patient might be treated pharmacologically. Among the elements discussed are abuse potential for medication, monitoring substance use, the role and limitations of laboratory tests, and the use of intergrated treatment (simultaneous treatment of substance use and co-morbid conditions.)

Kuntsche E; Jordan MD. Adolescent alcohol and cannabis use in relation to peer and school factors: Results of multilevel analyses. Drug and Alcohol Dependence 84(2): 167-174, 2006. (50 refs.)

The present study used a multilevel approach with multiple informants to determine whether, at individual level, association with substance-using peer groups, and, at class level, incidences of intoxicated students in school premises, are related to students' own substance use. Additionally, it tested the hypothesis that such school incidences affect the closeness of the relation between association with substance-using peers and students' own substance use. Multilevel regression models were estimated separately for drunkenness and cannabis use on the basis of cross-sectional data from 3925 students of eighth and ninth grades in Switzerland (mean age 15.3, S.D. 0.9) and their teachers (N=220). For both drunkenness and cannabis use, the results confirmed that association with substance-using peers is strongly related to individual substance-use. A higher level of students' own cannabis use and a closer relation between association with cannabis-using peers and the students' own cannabis use were found in classes where students saw others coming cannabis-intoxicated to school or taking cannabis in school premises. Such relations were not found for alcohol. It appears that cannabis use at school or shortly before arriving at school creates an atmosphere that favors cannabis use whether or not students are associated with cannabis-using peers. Establishing an overarching environment of disapproval appears to be an effective means of preventing cannabis use by adolescents.

Laviolette SR; Grace AA. The roles of cannabinoid and dopamine receptor systems in neural emotional learning circuits: Implications for schizophrenia and addiction. (review). Cellular and Molecular Life Sciences 63(14): 1597-1613, 2006. (110 refs.)

Cannabinoids represent one of the most widely used hallucinogenic drugs and induce profound alterations in sensory perception and emotional processing. Similarly, the dopamine (DA) neurotransmitter system is critical for the central processing of emotion and motivation. Functional disturbances in either of these neurotransmitter systems are well-established correlates of the psychopathological symptoms and behavioral manifestations observed in addiction and schizophrenia. Increasing evidence from the anatomical, pharmacological and behavioral neuroscience fields points to complex functional interactions between these receptor systems at the anatomical, pharmacological and neural systems levels. An important question relates to whether these systems act in an orchestrated manner to produce the emotional processing and sensory perception deficits underlying addiction and schizophrenia. This review describes evidence for functional neural interactions between cannabinoid and DA receptor systems and how disturbances in this neural circuitry may underlie the aberrant emotional learning and processing observed in disorders such as addiction and schizophrenia.

Limonero JT; Tomas-Sabado J; Fernandez-Castro J. Perceived emotional intelligence and its relation to tobacco and cannabis use among university students. Psicothema 18(Supplement S): 95-100, 2006. (45 refs.)

The aim of this work has been to analyse the role of Perceived Emotional Intelligence (PEI) in the use of tobacco and cannabis in 133 psychology undergraduates (114 women and 19 men), all aged between 18 and 27, with a mean age of 21.52 yr. (SD = 5.42). PEI was assessed using an abbreviated version of the Trait Meta-Mood Scale (TMMS), developed by Salovey, Mayer, Goldman, Turvey and Palfai (1995) and adapted into Spanish by Fernandez-Berrocal, Extremera, and Ramos (2004). The TMMS assesses an individual's ability to perceive, understand and manage emotion. The principal results obtained point to the fact that the students who consume tobacco or cannabis present lower levels of the Repair component of the TMMS and are those who started consuming tobacco or cannabis at an earlier age. On the other hand, Emotional Clarity appears to be related to the occasional consumption of cannabis, in that the students attaining high scores were those who consumed less. The Emotional Attention component of the TMMS is not involved in the consumption of these substances. These preliminary findings indicate the existing relationship between some components of the TMMS and the consumption of tobacco or cannabis. Nevertheless, we need to further investigate the differing implications of each one of the PEI components in the use of these substances.

Liu A; Kilmarx P; Jenkins RA; Manopaiboon C; Mock PA; Jeeyapunt U et al. Sexual initiation, substance use, and sexual behavior and knowledge among vocational students in northern Thailand. International Family Planning Perspectives 32(3): 126-135, 2006. (60 refs.)

CONTEXT. Thailand has undergone dramatic social changes in the last two decades, yet little is known about factors related to sexual initiation among adolescents. METHODS:A survey using the audio computer-assisted self-interviewing method was conducted to assess social and demographic characteristics, substance use, sexual behavior, and knowledge of HIV and STIs among 1,725 vocational school students aged 15-21 living in northern Thailand. Gender differences for these factors were evaluated using chi-square and Mann-Whitney U tests. Multivariate survival analysis using Cox proportional hazards models assessed associations between these variables and sexual initiation for each gender. RESULTS. Males initiated sexual intercourse at an earlier age than females (median ages of 17 and 18, respectively). At any given age, sexual initiation was associated with having a nonagricultural background and using alcohol or methamphetamine (adjusted rate ratios, 1.3-2.9). For males, initiation was also associated with having parents who did not live together, having a friend as a confidant, tobacco use, high perceived risk for HIV and high STI knowledge (1.3-1.7). For females, other factors associated with earlier initiation were younger age at interview, living away from family, lacking a family member as a confidant, high perceived risk for STIs and ever having smoked marijuana (1.3-2.4). CONCLUSIONS: Interventions to ameliorate the adverse consequences of early sexual initiation need to address social influences such as parents and peer groups. Programs should identify and target high-risk subgroups, such as those who are sexually experienced at an early age and those engaged in patterns of generalized risk-taking.

Lozano BE; Stephens RS; Roffman RA. Abstinence and moderate use goals in the treatment of marijuana dependence. Addiction 101(11): 1589-1597, 2006. (42 refs.)

Aims The purpose of this study was to examine the influence of personal goals (abstinence or moderation) on treatment outcomes for marijuana use. Hypotheses regarding self-efficacy for goal attainment were tested. Design: Adult marijuana users seeking treatment were assigned randomly to three treatment conditions: (1) cognitive-behavioral relapse prevention support group; (2) individualized brief motivational enhancement; and (3) delayed treatment control group. Follow-up assessments were conducted at 4, 7, 13 and 16 months. Setting University research offices. Participants: Participants were 291 adult marijuana users. Measurements Marijuana use, personal treatment goals and self-efficacy for achieving one's goal were assessed across the 16-month follow-up. Findings: Greater marijuana related problems and dependence symptoms were associated with an initial goal of abstinence. Participants were more likely to achieve outcomes consistent with their personal goals. Participants with abstinence goals reported greater self-efficacy for goal achievement than those with moderation goals after participating in the abstinence oriented treatment; self-efficacy for goal success predicted goal achievement for both moderate use and abstinence goals. Conclusions: Marijuana users approaching an abstinence-oriented treatment varied in the extent to which they were actively seeking abstinence as the outcome. Differences in goals were predictable from severity of problems related to use. Goal preference and self-efficacy for achieving goals predicted outcomes. Future research should incorporate personal goals into treatment and assess their effects on outcomes.

Martin G; Copeland J; Gilmour S; Gates P; Swift W. The Adolescent Cannabis Problems Questionnaire (CPQ-A): Psychometric properties. Addictive Behaviors 31(12): 2238-2248, 2006. (27 refs.)

Despite the widespread use of cannabis among young people, little research attention has been given to the development of psychometrically sound measures specific to cannabis related problems in this group. The aim of this study was to explore the reliability, validity and factor structure of a multi-dimensional measure of cannabis-related problems among adolescents. The Adolescent Cannabis Problems Questionnaire (CPQ-A) was developed as an assessment tool and treatment outcome measure. A stratified sample of 100 young people (aged 14-18 years) who had used cannabis in the past 90 days were administered the CPQ-A on two occasions 1 week apart. Exploratory factor analysis revealed three factors accounting for 63% of total variance with alpha coefficients of 0.88, 0.72 and 0.73. The CPQ-A was reliable with test-retest correlation for the total CPQ-A being 0.91. CPQ-A score correlated significantly with frequency of cannabis use and number of DSM-IV dependence criteria reported. The findings show promise for the CPQ-A as a reliable, valid and potentially clinically useful measure of cannabis related problems among young people.

Martin BR; Wiley JL; Beletskaya I; Sim-Selley LJ; Smith FL; Dewey WL et al. Pharmacological characterization of novel water-soluble cannabinoids. Journal of Pharmacology and Experimental Therapeutics 318(3): 1230-1239, 2006. (31 refs.)

Presently, there are numerous structural classes of cannabinoid receptor agonists, all of which require solubilization for experimental purposes. One strategy for solubilizing water-insoluble tetrahydrocannabinols is conversion of the phenolic hydroxyl to a morpholinobutyryloxy substituent. The hydrochloride salts of these analogs are water-soluble and active in vivo when administered in saline. The present investigation demonstrated that hydrochloride salts of numerous substituted butyryloxy esters are water-soluble and highly potent. The substitutions include piperidine, piperazine, and alkyl-substituted amino moieties. It was also discovered that incorporation of a nitrogenous moiety in the alkyl side chain increased the pharmacological potency of tetrahydrocannabinol. For example, an analog containing a pyrazole in the side chain ( O-2545) was found to have high affinity and efficacy at cannabinoid 1 ( CB 1) and CB 2 receptors, and when dissolved in saline, it was highly efficacious when administered either intravenously or intracerebroventricularly to mice. A series of carboxamido and carboxylic acid amide analogs exhibited high pharmacological potency, but their hydrochloride salts were not water-soluble. On the other hand, incorporation of imidazoles into the terminus of the side chain led to water-soluble hydrochloride salts that were highly potent when administered in saline to laboratory animals. It is now possible to conduct cannabinoid research with agonists that are water-soluble and thus obviating the need of solubilizing agents.

Martinez-Ortega J; Jurado D; Martinez-Gonzalez MA; Gurpegui M. Nicotine dependence, use of illegal drugs and psychiatric morbidity. Addictive Behaviors 31(9): 1722-1729, 2006. (25 refs.)

The purpose of this study was to examine the association of smoking and nicotine dependence with psychiatric morbidity, controlling for the potential confounding effect of smoking on the relationship between the use of other substances and psychiatric morbidity. A sample of 290 adults were interviewed at a primary health centre (patients, 58%; patients' relatives, 34%; staff, 8%) to inquire about their tobacco, caffeine, alcohol, and illegal drug consumption. Psychiatric morbidity, defined by a score > 6 on the General Health Questionnaire (GHQ-28), showed a strong direct association with nicotine dependence. The use of illegal drugs, but not of alcohol, was also strongly associated with psychiatric morbidity, after controlling for smoking. Both smoking and high nicotine dependence were also associated with use of caffeine, alcohol, cannabis and cocaine. High nicotine dependence may be considered as an expression of individual psychopathologic vulnerability. Tobacco may have a central facilitating role in the use of caffeine, alcohol, and illegal drug.

Massi P; Vaccani A; Parolaro D. Cannabinoids, immune system and cytokine network. (review). Current Pharmaceutical Design 12(24): 3135-3146, 2006. (102 refs.)

How cannabinoids influence immune function has been examined extensively in the last 30 years. Studies on drug-abusing humans and animals, as well as in vitro models employing immune cell cultures, have shown that marijuana, natural and endogenous cannabinoid compounds are immunomodulators. These substances modulate host resistance to bacterial, protozoan and viral infections as well as they can profoundly affect the Th1/Th2 response. Recently, two types of cannabinoid receptor, CB1 and CB2, have been discovered. While CBI is expressed primarily in the brain, CB2 is peculiar of the immune cells. Cannabinoid receptors have been shown to be involved in some but not all of immune effects. Nevertheless, their identification provides a specific mechanism of action in the attempting to find out how exogenous cannabinoids and endogenous cannabinoid system affect the immune apparatus, strengthen the hypothesis of cannabinoids as immunomodulators. As support to this theory, enough evidence exists to suggest that the cannabinoid system significantly affects almost every component of the immune response machinery and impacts the functioning also of the cytokine network. The evaluation of the biological consequences of these drug-induced cytokine changes has also dramatically become important considering not only the impact of cytokines on immune system per se but also envisaging their influence in cancer, inflammation, autoimmune disease, brain injury, hematopoictic colony formation in which cannabinoids have demonstrated a clear role as important modulators.

Mattick RP; McLaren J. Cannabis and psychosis put in perspective. (editorial). Canadian Journal of Psychiatry 51(9): 554-555, 2006. (5 refs.)

Maxwell JC; Tackett-Gibson M; Dyer J. Substance use in urban and rural Texas school districts. Drugs: Education, Prevention and Policy 13(4): 327-339, 2006. (12 refs.)

The aim of this study is to compare substance use between urban and rural secondary school districts in Texas between 1998 and 2003. The differences were analyzed using chi-square and analysis of variance. The analysis found that rural schools had students who reported higher rates of use of tobacco, frequent binge drinking, and driving while drunk and urban schools had students who reported higher rates of use of marijuana and driving while 'stoned.' However, the gaps in illicit drug use and drug use attitudes between urban and rural districts may be closing. Compared to 1998 - 1999, differences in perceptions of dangerousness and parental disapproval of use had narrowed by 2002 - 2003. This trend in rural use may be due to the fact that the percentage of rural schools providing drug education had decreased to levels similar to urban schools.

McCrystal P; Percy A; Higgins K. Drug use patterns and behaviours of young people at an increased risk of drug use during adolescence. International Journal of Drug Policy 17(5): 393-401, 2006. (52 refs.)

The drug use patterns and behaviours of 90 young people who reported cannabis use from the age of 11/12 years when they entered post primary schooling and continued to report its use during three further annual data waves of the Belfast Youth Development Study (a longitudinal study of the onset and development of adolescent drug use) until the age of 15 are examined in this paper. The data collected from these young people revealed high levels of both licit and illicit drug use compared with young people who have not used cannabis by the age of 15. The findings suggest the existence of a 'hidden' high risk group of young people who continue to attend school regularly. This raises the question about the extent to which their needs are being met by existing school based drugs education and prevention initiatives which are often delivered through a standardised strategy for all school aged young people.

McRae AL; Brady KT; Carter RE. Buspirone for treatment of marijuana dependence: A pilot study. American Journal on Addictions 15(5): 404-404, 2006. (4 refs.)

The article focuses on the use buspirone medicine in the treatment of Marijuana addicts. Marijuana is commonly abused drug in the US. According to its users, the drug (Marijuana) relieves anxiety. A study conducted on the use of Buspirone in doses on Marijuana dependants found that the addicts reduced the doses of the drug (Marijuana) after using the medicine. However, the study was not sure whether it was due to medication. The sample size of addicts limit the interpretation of results. The study suggests a comprehensive trial on Buspirone for treatment.

Mohler-Kuo M; Wydler H; Zellweger U; Gutzwiller F. Differences in health status and health behaviour among young Swiss adults between 1993 and 2003. Swiss Medical Weekly 136(29/30): 464-472, 2006. (27 refs.)

Objective: Very few studies specifically have examined the health status of 20-year-olds. The purpose of the present study is to examine the changes in health status and behaviour among young Swiss adults between 1993 and 2003. Methods: The present study used data from the Swiss Federal Surveys of Adolescents, conducted in 1993 and 2003 among 20-year-olds in Switzerland. The study sample included military recruits and a representative community cohort. More than 20,000 subjects participated in each survey. Results: Young adults in 2003 reported fewer traffic- and sports-related accidents, but more work-related and other accidents versus young adults in 1993. A greater percentage of men were over-weight or obese in 2003. Also in 2003, a greater percentage of males and females regularly used alcohol, cigarettes and cannabis. In particular, the number that smoked cigarettes daily increased by almost 30% and daily cannabis users increased more than two-fold. Young adults reported higher rates of inter-personal violence and theft in 2003. Compared to 1993, in 2003 young adults were more likely to report a sense of coherence; they also had fewer thoughts of suicide, but a greater sense that life is meaningless. Conclusions: Our study provides the first Swiss data comparing the health status of 20-year-olds a decade apart. The findings suggest a significant increase in substance use. Health prevention efforts among young adults ages 18-24 should focus on substance use. In addition, developing strategies to decrease interpersonal violence, delinquent behaviour, and obesity should be a major public health priority.

Morris GD; Wood PB; Dunaway RG. Self-control, native traditionalism, and Native American substance use: Testing the cultural invariance of a general theory of crime. Crime & Delinquency 52(4): 572-598, 2006. (95 refs.)

Using a sample of White and Native American high school students, the authors provide a test of (a) self-control theory's invariance thesis and (b) native traditionalism as an explanation of Native American substance use. Self-control significantly influenced all forms of substance use when controlling for race and in race-specific analyses. However z tests by race revealed that self-control is a stronger predictor of marijuana and serious drug use among Native Americans. Beyond this simple comparison across groups, the authors control for native traditionalism (as a proxy for cultural variation) among the Native American respondents. In doing so, self-control remained a consistent predictor of their substance use. Although these findings largely support the invariance thesis of self-control, the racial difference related to marijuana and serious drug use poses a theoretical challenge. With regard to native traditionalism, results suggest that those most attached to their native traditions engage in greater substance use.

Mulvey EP; Odgers C; Skeem J; Gardner W; Schubert C; Lidz C. Substance use and community violence: A test of the relation at the daily level. Journal of Consulting and Clinical Psychology 74(4): 743-754, 2006. (65 refs.)

Prior research has consistently demonstrated an association between substance use and involvement in violence among individuals with mental illness. Yet little is known about the temporal quality of this relationship, largely because longitudinal data required to address this issue are not readily available. This study examined the relationship between substance use (alcohol, marijuana, and other drug use) and violence at the daily level within a sample of mentally ill individuals at high risk for frequent involvement in violence (N = 132). Results support the serial nature of substance use and violence, with an increased likelihood of violence on days following the use of alcohol or multiple drugs, but not the inverse relationship. Implications for the utility of substance use as a risk marker for the assessment of future violence are discussed.

Mura P; Chatelain C; Dumestre V; Gaulier JM; Ghysel MH; Lacroix C et al. Use of drugs of abuse in less than 30-year-old drivers killed in a road crash in France: A spectacular increase for cannabis, cocaine and amphetamines. Forensic Science International 160(2/3): 168-172, 2006. (16 refs.)

A collaborative study was conducted in France in order to determine the prevalence of cannabinoids, opiates, cocaine metabolites and amphetamines in blood samples from drivers killed in road accidents in 2003 and 2004 and to compare these values with those of a previous study performed during the period 2000-2001 involving 900 drivers. Blood samples were provided from 2003 under 30-year-old drivers, killed in a traffic accident. Drugs of abuse were determined by gas chromatography-mass spectrometry using the same analytical procedures in all the 12 laboratories. The most frequently observed compounds were by far cannabinoids, that tested positive in 39.6% of the total number of samples. Delta(9) tetrahydrocannabinol (THC), the most active of the principle constituents in marijuana (cannabis sativa), was detected in the blood of 28.9% drivers and was the single drug of abuse in 80.2% of the positive cases. It was associated with amphetamines in 7.4% and with opiates and cocaine in 1.9 and 4.8%, respectively. Amphetamines were present in 3.1% of the total number of samples, cocaine metabolites in 3.0% and opiates in 3.5%. When comparing these results with those of a previous study performed 3 years before, a significant increase is observed for THC (28.9% versus 16.9%), cocaine metabolites (3.0% versus 0.2%) and amphetamines (3.1% versus 1.4%). This study demonstrates the critical necessity of implementing in France as soon as possible systematical roadside testing for drugs of abuse.

Naar-King S; Wright K; Parsons JT; Frey M; Templin T; Ondersma S. Transtheoretical Model and substance use in HIV-positive youth. AIDS Care 18(7): 839-845, 2006. (33 refs.)

The purpose of the study was to test constructs of the Transtheoretical Model (TTM) for predicting alcohol and other drug use in HIV-positive youth (ages 16-25). Questionnaires and interviews about alcohol and other drug use, stage of change, self-efficacy, emotional distress and social support were obtained from 64 HIV-positive youth. Structural equation modeling with standard errors determined by methods appropriate to small samples, demonstrated that self-efficacy mediated the relationship between stage of change and alcohol use and between social support and alcohol use. The same pattern of results emerged for marijuana use. The models predicted 47% of the variance in alcohol use and 69% of the variance in marijuana use. Results supported the TTM and highlight the potential of interventions that seek to boost self-efficacy and social support specific to reducing substance use.

Noto AR; Pinsky I; Mastroianni FD. Drugs in the Brazilian print media: An exploratory survey of newspaper and magazine stories in the year 2000. Substance Use & Misuse 41(9): 1263-1276, 2006. (32 refs.)

Print media is one of the key factors for defining public opinion and setting public policies regarding drugs. Therefore, surveying its content should provide us with a better understanding of the situation. The few existing surveys on this issue in Brazil point out discrepancies between print media and public health. The objective of the present survey is to enhance the analysis of drug-related stories in the Brazilian print media, based on a new time frame, in the year 2000. Major newspapers and magazines of all Brazilian state capitals have been surveyed throughout year 2000, with 4,669 stories presenting drugs as their main topic. A random sample of 964 stories underwent content analysis. Approximately half the stories (49.6%) dealt with smuggling- and repression-related issues. The remainder of the stories (50.4%) approached health, legislation, and public policy issues. Tobacco was the most widely discussed drug, with stories focusing mainly on damage caused by use and on measures for reducing consumption rates among the population. Articles about cocaine, also featured frequently in the print media, dealt mainly with the issues of drug dealing and of damage caused by cocaine use. Regarding marijuana, in addition to the law enforcement repressive approach, some articles dealt with decriminalization and therapeutic use. Articles about alcoholic beverages, featured less frequently in the print media, approached the subject matter from various angles. The number of stories on solvents and psychotropic medication was negligible. The results confirm discrepancies between print media coverage and epidemiology. They also indicate that each drug is approached differently, allowing for a better understanding of the "social climate in Brazil regarding each drug. Of all possible social interventions for dealing with the issue repression stands out, whereas stories about treatment and damage reduction are relatively scarce. These findings suggest the need for improved communication between journalists and health professionals.

Patton GC; Coffey C; Carlin JB; Sawyer SM; Wakefield M. Teen smokers reach their mid-twenties. Journal of Adolescent Health 39(2): 214-220, 2006. (40 refs.)

Purpose: Most outcome studies of adolescent smokers have focused on tobacco use in the short term. Few have reported on the health of adolescent smokers as they reach young adulthood. Methods: The design was a 10-year, eight-wave cohort study of a state-wide community sample of 1943 participants in Victoria, Australia. Participants were initially aged 14 to 15 years. Tobacco use was assessed with self-reported frequency of use and a seven-day retrospective diary. The Fagerstrom Test for Nicotine Dependence was used to define nicotine dependence in young adulthood. A computerized interview assessment was used during the teens and in young adulthood. Results: Former daily smokers in adolescence accounted for most cases of nicotine dependence and high-dose (10+ cigarettes per day) smoking in young adulthood. Other substance abuse and psychiatric morbidity in young adulthood were also markedly elevated in this group. This was most clearly evident for cannabis dependence, where close to two-thirds of all cases were formerly daily tobacco smokers. Male smokers were more likely to continue as young adults. Persistent symptoms of depression and anxiety during the teens predicted progression to nicotine dependence, as did having a parent smoking daily. Conclusions: The poor health outcomes of daily adolescent smokers as they reach young adulthood provide a rationale for greater tobacco control initiatives directed at early users. Clinical interventions might usefully consider factors such as psychiatric morbidity and parental smoking.

Perret G; Abudureheman A; Perret-Catipovic M; Flomenbaum M; La Harpe R. Suicides in the young people of Geneva, Switzerland, from 1993 to 2002. Journal of Forensic Sciences 51(5): 1169-1173, 2006. (25 refs.)

Suicides in Geneva in those less than 25 years old, from 1993 to 2002, were reviewed. Scenes investigations, autopsy findings, toxicology results, and psychiatric history (when available) were examined. There were 65 cases. The average annual suicide rate was 11/100,000. Seventy-seven percent were male, and 23% were female. The youngest was 12 years old and most of the victims were 18 years old and over (89%). For men, the use of firearms was the most common method (38%), followed by fall from height (16%) and drowning (10%). For women, fall from height was the most frequent (40%), followed by firearms and medication overdoses (20% each), hanging (13%), and drowning (7%). Toxicological analysis was performed in 41% of the cases and showed that alcohol was present in 26% and other drugs in 67% of these cases. The most common drugs present were benzodiazepines, cannabis, and cocaine.

Peterson PL; Baer JS; Wells EA; Ginzler JA; Garrett SB. Short-term effects of a brief motivational intervention to reduce alcohol and drug risk among homeless adolescents. Psychology of Addictive Behaviors 20(3): 254-264, 2006. (58 refs.)

The short-term results of a randomized trial testing a brief feedback and motivational intervention for substance use among homeless adolescents are presented. Homeless adolescents ages 14-19 (N = 285) recruited from drop-in centers at agencies and from street intercept were randomly assigned to either a brief motivational enhancement (ME) group or I of 2 control groups. The I-session motivational intervention presented personal feedback about patterns of risks related to alcohol or substance use in a style consistent with motivational interviewing. Follow-up interviews were conducted at I and 3 months postintervention. Youths who received the motivational intervention reported reduced illicit drug use other than marijuana at I-month follow-up compared with youths in the control groups. Treatment effects were not found with respect to alcohol or marijuana. Post hoc analyses within the ME group suggested that those who were rated as more engaged and more likely to benefit showed greater drug use reduction than did those rated as less engaged. Limitations of the study are discussed as are implications for development of future substance use interventions for this high-risk group.

Quickfall J; Crockford D. Brain neuroimaging in cannabis use: A review. Journal of Neuropsychiatry and Clinical Neurosciences 18(3): 318-332, 2006. (95 refs.)

In this study, the authors systematically reviewed structural and functional neuroimaging studies of cannabis use. Structural abnormalities generally have not been identified with chronic use. Regular users demonstrate reciprocal changes in brain activity globally and in cerebellar and frontal regions. Abstinence results in decreases, and administration results in increases correlating with subjective intoxication. Chronic use and cannabis administration result in attenuated brain activity in task-activated regions or activation of compensatory regions. Findings correlate partially with neuropsychological data, but generalization is limited by the lack of use of diagnostic criteria, appropriately paired neuropsychological testing or means to better quantify cannabis use and abstinence.

Ramchand R; Pacula RL; Iguchi MY. Racial differences in marijuana-users' risk of arrest in the United States. Drug and Alcohol Dependence 84(3): 264-272, 2006. (18 refs.)

A recent study of arrest data show that African Americans are 2.5 times more likely to be arrested for marijuana possession offences than Whites, even though general prevalence estimates show that they are no more likely to be using. The current study investigates the purchase patterns of marijuana users from the 2002 National Survey on Drug Use and Health (NSDUH) to evaluate whether differences in purchasing behaviors exist across racial groups. Although in general people who purchase marijuana are more likely to buy in private settings and from someone they know, this analysis shows that African Americans are statistically more likely to engage in risky purchasing behaviors that increase their likelihood of arrest. Using trivariate probit regression with demographic, drug use, and drug market covariates, analyses reveal that African Americans are nearly, twice as likely to buy outdoors (0.31 versus 0.14), three times more likely to buy from a stranger (0.30 versus 0.09), and significantly more likely to buy away from their homes (0.61 versus 0.48). These results provide an additional explanation for the differential in arrest rates between African Americans and Whites.

Ranganathan M; D'Souza DC. The acute effects of cannabinoids on memory in humans: A review. (review). Psychopharmacology 188(4): 425-444, 2006. (135 refs.)

Rationale Cannabis is one of the most frequently used substances. Cannabis and its constituent cannabinoids are known to impair several aspects of cognitive function, with the most robust effects on short-term episodic and working memory in humans. A large body of the work in this area occurred in the 1970s before the discovery of cannabinoid receptors. Recent advances in the knowledge of cannabinoid receptors' function have rekindled interest in examining effects of exogenous cannabinoids on memory and in understanding the mechanism of these effects. Objective The literature about the acute effects of cannabinoids on memory tasks in humans is reviewed. The limitations of the human literature including issues of dose, route of administration, small sample sizes, sample selection, effects of other drug use, tolerance and dependence to cannabinoids, and the timing and sensitivity of psychological tests are discussed. Finally, the human literature is discussed against the backdrop of preclinical findings. Results Acute administration of Delta-9-THC transiently impairs immediate and delayed free recall of information presented after, but not before, drug administration in a dose- and delay-dependent manner. In particular, cannabinoids increase intrusion errors. These effects are more robust with the inhaled and intravenous route and correspond to peak drug levels. Conclusions This profile of effects suggests that cannabinoids impair all stages of memory including encoding, consolidation, and retrieval. Several mechanisms, including effects on long-term potentiation and long-term depression and the inhibition of neurotransmitter (GABA, glutamate, acetyl choline, dopamine) release, have been implicated in the amnestic effects of cannabinoids. Future research in humans is necessary to characterize the neuroanatomical and neurochemical basis of the memory impairing effects of cannabinoids, to dissect out their effects on the various stages of memory and to bridge the expanding gap between the humans and preclinical literature.

Rassool GH; Villar-Luis M; Carraro TE; Lopes G. Undergraduate nursing students' perceptions of substance use and misuse: a Brazilian position. Journal of Psychiatry and Mental Health Nursing 13(1): 85-89, 2006. (20 refs.)

Alcohol, cocaine and cannabis are the substances most commonly abused in Brazil. There is limited evidence on the perceptions of undergraduate nursing students towards substance misuse. Negative attitudes, in combination with the lack of appropriate knowledge and skills, may result in minimal care provided to substance misusers. The alms of the study are to examine the knowledge and attitudes of undergraduate nursing students towards substance misusers and consider the implications of these attitudes for nursing education. The Nurse Education in Alcohol and Drug Educational Faculty Survey (NEADA) questionnaire on knowledge and education, nursing interventions, attitudes and values was distributed to undergraduate nurses (n = 227) in the south and south-eastern part of Brazil. The findings showed that there is a lack of adequate education in drug and alcohol use and misuse, including competency skills, but the participants were positive about treatment interventions. A paradigm shift in nurse education curricula and further research studies on attitudes and values towards substance misuse should be on the educational agenda. These are challenges faced by nurses to meet the healthcare needs of substance misusers.

Rebellon CJ; Van Gundy K. Can social psychological delinquency theory explain the link between marijuana and other illicit drug use? A longitudinal analysis of the gateway hypothesis. Journal of Drug Issues 36(3): 387-411, 2006. (44 refs.)

Extensive research suggests that marijuana use tends to precede the use of other illicit substances among adolescents. At the same time, there remain two viable interpretations of such research. First, marijuana use may cause an increase in one's probability of using other drugs. Second, the correlation between marijuana use and other drug use may be spurious, reflecting the influence of one or more "third variables" that simultaneously cause both behaviors. The present paper provides an empirical assessment of each view using panel data from three waves of the National Youth Survey. Even after adjusting for the influence of variables derived from strain theory,use patterns/ social bonding theory and differential association theory a series of longitudinal logistic regression analyses fail to disconfirm the hypothesis that marijuana use exerts a causal influence on one's probability of using other illicit substances. A three-wave panel model adjusting for the influence of unmeasured variables yields similar results.

Reis AD; Figlie NB; Laranjeira R. Prevalence of substance use among trauma patients treated in a Brazilian emergency room. Revista Brasileira de Psiquitatria 28(3): 191-195, 2006. (21 refs.)

Objective: Although there is a considerable amount of data in the literature regarding the association between alcohol consumption and injuries treated in emergency rooms, little is known about the relationship between such injury and the use of other substances. The objective of this study was to estimate the prevalence of substance use in patients admitted to the emergency room for non-fatal injuries. Method: A prospective cross-sectional study assessing all patients admitted to the emergency room within 6 hours after a non-fatal injury was conducted over a three-month period. The following were used as measures of alcohol and drug use: a standardized World Health Organization questionnaire; a self-administered questionnaire related to drug consumption within the 24 hours preceding contact; the Drug Abuse Screening Test; urine screens for cannabis, cocaine and benzodiazepines; and determination of blood alcohol concentration. Descriptive analyses were performed and the confidence interval used was 95%. Results: A total of 353 patients were included. Cannabis and cocaine screens were conducted for 242 patients and benzodiazepine screens were conducted for 166. Blood alcohol concentrations reached the level of positivity in 11% (n = 39), and 10% (n = 33) presented some degree of intoxication. Among the 242 patients screened, 13.6% (n = 33) tested positive for cannabis, and 3.3% (n = 8) tested positive for cocaine, whereas 4.2% (n = 7) of the 166 patients screened tested positive for benzodiazepines. Conclusions: Substance use was highly prevalent among these individuals. In this sample, the frequency for the use of cannabis (an illicit drug) was comparable to that of alcohol. More studies are needed in order to characterize such use among Brazilians and to develop proper approaches to such cases, with the aim of reducing substance use and its consequences.

Rodondi N; Pletcher MJ; Liu K; Hulley SB; Sidney S. Marijuana use, diet, body mass index, and cardiovascular risk factors (from the CARDIA Study). American Journal of Cardiology 98(4): 478-484, 2006. (29 refs.)

Marijuana use has been associated with increased appetite, high caloric diet, acute increase in blood pressure, and decreases in high-density lipoprotein cholesterol and triglycerides. Marijuana is the most commonly used illicit drug in the United States, but its long-term effects on body mass index (BMI) and cardiovascular risk factors are unknown. Using 15 years of longitudinal data from 3,617 black and white young adults participating in the Coronary Artery Risk Development in Young Adults (CARDIA) study, we assessed whether marijuana use was associated with caloric intake, BMI, and cardiovascular risk factors. Of the 3,617 participants, 1,365 (38%) reported ever using marijuana. Marijuana use was associated with male gender, tobacco smoking, and other illicit drug use. More extensive marijuana use was associated with a higher caloric intake (2,746 kcal/day in never users to 3,365 kcal/day in those who used marijuana for >= 1,800 days over 15 years) and alcohol intake (3.6 to 10.8 drinks/week), systolic blood pressure (112.7 to 116.5 mm Hg), and triglyceride levels (84 to 100 mg/dl or 0.95 to 1.13 mmol/L, all p values for trend < 0.001), but not with higher BMI and lipid and glucose levels. In multivariate analysis, the associations between marijuana use and systolic blood pressure and triglycerides disappeared, having been mainly confounded by greater alcohol use in marijuana users. In conclusion, although marijuana use was not independently associated with cardiovascular risk factors, it was associated with other unhealthy behaviors, such as high caloric diet, tobacco smoking, and other illicit drug use, which all have long-term detrimental effects on health.

Schaub M; Boesch L; Stohler R. Association between aggressiveness, schizotypal personality traits and cannabis use in Swiss psychology students. Psychiatry Research 143(2-3): 299-301, 2006. (15 refs.)

Associations between aggressiveness, schizotypal traits, and self-declared cannabis consumption were explored in Swiss psychology students (n=205). Higher hostility levels were strongly associated with more pronounced schizotypal traits, whereas frequency of cannabis use was not. Therefore, earlier reported correlations might be due to a subgroup of hostile consumers.

Schwilke EW; dos Santos MIS; Logan BK. Changing patterns of drug and alcohol use in fatally injured drivers in Washington State. Journal of Forensic Sciences 51(5): 1191-1198, 2006. (31 refs.)

We have previously reported on patterns of drug and alcohol use in fatally injured drivers in Washington State. Here we revisit that population to examine how drug use patterns have changed in the intervening 9 years. Blood and serum specimens from drivers who died within 4 h of a traffic accident between February 1, 2001, and January 31, 2002, were analyzed for illicit and therapeutic drugs and alcohol. Drugs when present were quantitated. Samples suitable for testing were obtained from 370 fatally injured drivers. Alcohol was detected above 0.01 g/100 mL in 41% of cases. The mean alcohol concentration for those cases was 0.17 g/100 mL (range 0.02-0.39 g/100 mL). Central nervous system (CNS) active drugs were detected in 144 (39%) cases. CNS depressants including carisoprodol, diazepam, hydrocodone, diphenhydramine, amitriptyline, and others were detected in 52 cases (14.1%), cannabinoids were detected in 47 cases (12.7%), CNS stimulants (cocaine and amphetamines) were detected in 36 cases (9.7%), and narcotic analgesics (excluding morphine which is often administered iatrogenically in trauma cases) were detected in 12 cases (3.2%). For those cases which tested positive for alcohol c. 40% had other drugs present which have the potential to cause or contribute to the driver's impairment. Our report also considers the blood drug concentrations in the context of their interpretability with respect to driving impairment. The data reveal that over the past decade, while alcohol use has declined, some drug use, notably methamphetamine, has increased significantly (from 1.89% to 4.86% of fatally injured drivers) between 1992 and 2002. Combined drug and alcohol use is a very significant pattern in this population and is probably overlooked in DUI enforcement programs.

Shillington AM; Clapp JD. Heavy alcohol use compared to alcohol and marijuana use: Do college students experience a difference in substance use problems? Journal of Drug Education 36(1): 91-103, 2006. (23 refs.)

This study examines the risk for alcohol and other drug (AOD) problems resulting from alcohol plus marijuana use compared to alcohol-only use. Data are from telephone interviews with 1113 randomly selected college students attending two large urban universities in the southwestern United States. Alcohol and marijuana users (dual users) were more likely to be younger and report a higher mean number of drinks per occasion and experiencing all AOD problems studied compared to alcohol-only users. Multivariate logistic regression analysis findings reveal the relationship between dual-substance use and increased risk for AOD problems remained after controlling for demographics and alcohol use behaviors. Such problems include greater odds of legal problems and riding with or being an intoxicated driver. College students using alcohol and marijuana are at much higher risk for AOD problems than are students who use alcohol only, even when heavy drinking is taken into account.

Simons JS; Carey KB. An affective and cognitive model of marijuana and alcohol problems. Addictive Behaviors 31(9): 1578-1592, 2006. (45 refs.)

This study examined a six-month prospective model of marijuana and alcohol problems among college students. Among marijuana users, there was an indirect positive association between use utility and Time 1 (T1) marijuana-related problems through T1 marijuana use, whereas there was a direct positive association between affect lability and T1 marijuana-related problems. A multi-group analysis of alcohol problems compared models for users of alcohol and marijuana and users of alcohol only. For both groups, there was a direct positive association between T1 use utility and T2 alcohol consumption and an indirect association with T2 alcohol problems via alcohol consumption. Impulsivity was directly and positively associated with T1 alcohol problems among the alcohol-only group. For the alcohol-only group, impulsivity moderated the association between T2 consumption and problems, making it stronger. Associations between affect lability and alcohol problems as well as alcohol consumption and problems were stronger in the alcohol and marijuana group. Results support differential pathways to substance-related problems, an indirect pathway, in which problems are an unintended consequence of goal-directed use activity, as well as direct and interactive pathways in which problems may be viewed as consequences of broader regulatory problems.

Skosnik PD; Krishnan GP; Aydt EE; Kuhlenshmidt HA; O'Donnell BF. Psychophysiological evidence of altered neural synchronization in cannabis use: Relationship to schizotypy. American Journal of Psychiatry 163(10): 1798-1805, 2006. (68 refs.)

Objective: Cannabis use may produce neurophysiological disturbances similar to those observed in schizophrenia, particularly in relation to altered neural synchronization. Therefore, the current experiment examined the effect of cannabis use on EEG neural synchronization using the auditory steady-state evoked potential. Method: Auditory steady-state evoked potentials were assessed using varying rates of stimulation ( auditory click-trains of 20, 30, 40 Hz) in current cannabis users (N=17) and drug-naive comparison subjects (N=16). EEG spectral power and signal-to- noise ratio at each stimulation frequency were compared between groups. Results: Cannabis users showed decreased EEG power and signal-to- noise ratio at the stimulation frequency of 20 Hz. In addition, current cannabis users demonstrated increased schizotypal personality characteristics as assessed with the Schizotypal Personality Questionnaire, which positively correlated with total years of cannabis use. Finally, within the cannabis group, 20-Hz power values were negatively correlated with Schizotypal Personality Questionnaire scores. Conclusions: These data provide evidence for neural synchronization and early-stage sensory processing deficits in cannabis use. This finding, along with the observed increased rates of schizotypy in cannabis users, adds support for a cannabinoid link to schizophrenia spectrum disorders.

Steentoft A; Teige B; Holmgren R; Vuori E; Kristinsson J; Hansen AC et al. Fatal poisoning in Nordic drug addicts in 2002. Forensic Science International 160(2-3): 148-156, 2006. (12 refs.)

The present study from 2002 includes medicolegally examined fatal poisonings among drug addicts in the five Nordic countries: Denmark, Finland, Iceland, Norway and Sweden. A common definition "drug addict" is applied by the participating countries. The number of deaths, age, sex, place of death, main intoxicant and other drugs present in the blood are recorded in order to obtain national data, as well as comparable Nordic data and data comparable to earlier studies from 1997 and 1991. The Icelandic results are commented on separately due to the low number of cases. The most fatal overdoses are seen in Norway, in both the death rate (number per 100,000 inhabitants = 8.44) and in absolute number (n = 232). The comparable figures for the other four countries are Denmark 5.43 (n = 175), Iceland 3.6 (n = 6), Finland 2.93 (n = 94) and Sweden 2.56 (n = 136). In earlier studies from 1991 and 1997, the highest death rate is seen in Denmark, with Norway as number two. Denmark is the only country where the death rate decreases from 1997 to 2002. A relatively large increase in deaths in the younger age groups(< 30 years) is noted from 1997 to 2002, except in Denmark, where only a small increase in overdose deaths in very young people (15-19 years) is observed. Females account for 12-20% of the overdoses (three out of six deaths in Iceland). Relatively fewer deaths are recorded in the capital areas in 2002 than in 1997 and 199 1, suggesting more geographically widespread drug use in the Nordic countries. Heroin/morphine is the single most frequently encountered main intoxicant, varying from 10% of the cases in Finland to 72% of the cases in Norway. Finland differs from the other countries in that a high percentage of the fatal overdoses in Finland are not caused by an illicit drug; buprenorphine, overdoses are seen, and relatively few deaths resulting from heroin are seen. Methadone is the main intoxicant in 41% of the Danish overdose cases, 15% of the Norwegian cases, 4% of the Swedish cases and none of the Finnish overdose cases, an observation probably linked to different national prescription rules for methadone. The analytical screening reveals extended polydrug use. Frequently seen substances, in addition to the main intoxicant are amphetamine, tetrahydrocannabinol (THC), benzodiazepines and ethanol.

Tan C; Hatam N; Treasure T. Bullous disease of the lung and cannabis smoking: Insufficient evidence for a causative link. (review). Journal of the Royal Society of Medicine 99(2): 77-80, 2006. (37 refs.)

The Research Committee of the British Thoracic Society was asked in June 2004 to investigate the supposed association between cannabis smoking and pneumothorax associated with giant lung bullae. The authors undertook the task. The findings are reported here, It was agreed that there was insuff