Cannabis use: context and controversy

Cannabis and its most active ingredient delta-9 tetrahdrocannabinol (THC) are derived from the plants cannabis indica and cannabis sativa which were transported to Trinidad during the indentureship period. Locally referred to as marijuana, ganja, hashish, pot and weed, the substance was originally intended for medicinal purposes but due to its hallucinatory and euphoric effects has found a place in creativity, religion and as a street drug of abuse. The lethality of this drug is increased when the smoke is inhaled directly, facilitating easy entry into the blood stream and quick absorption into the brain. Commercial cannabis is compressed, soaked in embalming oil and spices for removal of the scent in order to facilitate smuggling and these preservatives in themselves may have adverse effects. Despite reports of its use as a drug associated with artistic creativity in the 1970's, cannabis remains today a serious drug of abuse both by adolescents and adults and a major problem in the educational system. This chapter reviews the clinical effects of marijuana use, its relationship with suicide, mood disorders, psychoses and other mental disorders and discusses controversies associated with the decriminalization and de-legalization. Those who support the latter have not looked far enough.

Depression and psychosis associated with cannabis abuse in a developing country

Notwithstanding the increase use of cannabis among adolescents in both developing and developed countries, few studies have looked at cannabis use and mood disorders. In a series of case studies, this research project seeks to investigate patterns of clinical presentations seen among cannabis users in psychiatric outpatients in Trinidad. Five clinical patterns of presentations are identified among cannabis users and abusers based on variables of dosing, age of initial use, duration of use, tolerance and reverse tolerance and poly-drug abuse. All patients in these case studies were standardized for method of use and potency of cannabis used. Patients were screened by urine tests to determine co-morbid use of other substances. Other variables such as environmental factors and genetic vulnerability were reviewed as far as possible from historical accounts of family members. The five patterns described are low, controlled use with mild euphoria and heightened awareness, moderate use with mixed depressive symptoms and suicidal behavior, heavy, short term use with manic symptoms, long term incremental use with psychotic symptoms due to the trumping of depressive symptoms and cannabis mixed with other substances resulting in florid psychosis. Mood disorders appear to be a common finding among adolescents using cannabis. Sensitization to symptomatic presentation and early detection of cannabis use in young adolescents are necessary. Further research is needed on the effect of cannabinoids on emotions, behavior and thinking and its relationship to mental disorders. This study is useful as a guideline for the implementation of public health strategies and legislation concerning the use of cannabis in youths.

Stress, marijuana and addiction in an animal model [abstract]

OBJECTIVE: Acute stress has been shown in rats to increase self-administration for drugs such as cocaine, morphine and amphetamine. We aimed to explore this phenomenon for marijuana extract (ME) and its psychoactive component, 9-tetra-hydrocannabinol ( 9 THC). METHODS: Six female Sprague Dawley rats were followed free access to a black grid-floored chamber and a white one with a floor strewn with wood shavings. The time spent in each chamber indicated a preference for the black chamber. On alternate days of an 8-day conditioning period, six Sprague Dawley rats were first subjected to an acute stress for 10 minutes followed by an intraperitoneal administration of ME (saline vehicle) or 2m/kg 9 THC (oil vehicle). The doses used were those which had been previously shown to have neither aversive nor rewarding effects. The rats were then confined to the white chamber. On the other days, the rats were administered the respective vehicle and confined to the black chamber. After this conditioning period, the rats were once again allowed free access to the chambers and the pre-conditioning period times in each chamber were compared to the post-conditioning times. The stressors were: restraint stress (RS), swimming stress (SS) or acute isolation stress (ACI). RESULTS: When ME was administered with RS, the mean time spent in the drug+stress chamber increased compared with the pre-conditioning time with a significance level of p= 0.07. This result was repeated with 2 mg/kg of 9-tetrahydrocannabinol (p= 0.07). The ACI + ME combination resulted in an increase, which was significant (p< 0.05). CONCLUSIONS: Our results provide some evidence to support a possible influence of acute stress on reward to marijuana. There is also some indication that different types of stressors have different effects on this stress and drug reward association. (AU)

Ganga: the Jamaican connection

The controversy and issues about the good and evil effects of cannabis has grown exponentially over the last 20 years. Some of the findings have detracted from the issues of criminalization to focus on its potential as a major medicinal agent. This has led to exploratory studies into the theraputic utility of cannabis. At this time a number of areas of potential medicinal applications have been identified and investigated, for example glaucoma, asthma, pain and multiple sclerosis to name a few. The legal minds, usually with little appreciation for science and medicinal investigation, are the ones that usually put obstacles in the path of future development in this very vital area. The present knowledge about these issues is scattered all over the literature. This book is an attempt to present a reader friendly account of the knowledge and issues at this time, with an emphasis on the knowledge and experience about the subject as it relates to Jamaica

Alcohol, cannabis and cocaine usage in patients with trauma injuries

Sera from 111 patients with trauma injuries, who presented to the Accident and Emergency Unit (A&E), University Hospital of the West Indies, during a 3-month period, were screened for blood alcohol. Urine specimens were analysed for metabolites of cannabis and cocaine. Sixty-two percent (62 percent) of patients were positive for at least one substance and 20 percent for two or more. Positivity rates were as follows: cannabis (46 percent), alcohol (32 percent) with 71 percent of these having blood alcohol levels (BAC) greater than 80 mg per decilitre; cocaine (6 percent). Substance usage was most prevalent in the third decade of life. The patients who yielded a positive result were significantly younger than those who were negative. There was no significant difference in age or substance usage between the victims of interpersonal violence or road traffic accidents. In the group designated "other accidents", patients were significantly older and had a lower incidence of substance usage that the other two groups. Cannabis was the most prevalent substance in all groups. Fifty percent (50 percent) and fifty-five percent (55 percent) of victims of road accidents and interpersonal violence, respectively, were positive for cannabis compared with 43 percent and 27 percent for alcohol, respectively. There was no significant difference in Hospital Stay or Injury Severity Score between substance users and non-users.(AU)

Use of illicit drugs among high-school students in Jamaica

Reported are the results of a survey to assess the prevalence of illicit drug use among high school students in Jamaica. A total of 2417 high-school students in 26 schools were covered: 1063 boys and 1354 girls of whom 1317 were grade-10 students (mean age 15.7 years) and 1100 were grade-11 students (mean age 16.8 years). Of the students, 1072 and 1354 were from rural and urban schools, respectively, while 1126 and 1291 were children of parents who were professionals and nonprofessionals, respectively. The following drugs were used by the students: marijuana (10.2 percent), cocaine (2.2 percent), heroin (1.5 percent) and opium (1.2 percent). Illicit drug use among males, urban students and children of professionals was higher than that among females, rural students and children of nonprofessionals, respectively.(Au)

Factors associated with violence against women who attend counselling centres in Kingston and St. Andrew, Jamaica

One of the problems of modern society is the extent to which violence has become a part of everyday life. Daily reports in the news media suggest that the problem is increasing and while previous research findings suggest a number of factors, which contribute to the problem, there is no indication that mitigation measures are actually helping. In fact reported incidents of violence continue to increase both in Jamaica and the world in general. Violence against women has also become a major problem all over the world. Reports indicate that incidents of violence against women range from 22 percent in some countries to a high of 59 percent in others, (Heise, 1994). Measures to address the problem in Jamaica has resulted in the establishment of a Crisis Centre, which seeks to help abused persons, primarily women. This study was carried out at the Crisis Centre and the Family Court located in Kingston in 1998. A total of 87 abused persons who sought help at these facilities within the study period were interviewed. The abuse took many forms and required various degrees of medical and emotional attention. Of weapons used the gun and stick featured prominently. Several reasons were given for the abuse experienced by respondents, however jealousy resulting in quarrels over a third party was the most common reason given for the onset of abuse (81 percent). When asked why they remained in the abusive situation respondents indicated children as the main cause 80.5 percent of the time. Medical attention was received from private medical practitioners 43 percent of the time, while 72.4 percent of respondents expressed a willingness to testify against their abusers in court. The use of alcohol, tobacco, marijuana and cocaine was prevalent, suggesting some link between substance abuse and the violence carried out against female partners. Most respondents indicated that friends and family members were the main sources of support. Very little practical assistance was obtained from the church, an institution of which almost all respondents were members. Respondents cited counselling as the main reason for attending counselling centres. In light of the findings recommendation could include mandatory counselling for males abuse who women and public education programmes to sensitize the society on the consequences of violence against women.(Au)

Characteristics of HIV-infected pregnant women in the Bahamas

The Commonwealth of the Bahamas has one of the highest rates of acquired immunodeficiency syndrome (AIDS) in the English-speaking Caribbean. A seropositive study of the pregnant women attending antenatal clinics in New Providence in 1990-91 showed that of 3,914 pregnant women tested, 2.9 percent were human immunodeficiency virus (HIV) infected. Women born in the Bahamas constituted 79.2 percent of the women tested; 17.7 percent were born in Haiti. The rate of HIV infection was 2.5 percent in the Bahamian women as compared with 4.5 percent in those born in Haiti. The highest incidence was in women aged 25-34 years and in women who had multiple pregnancies. There was a significant association with a history of crack cocaine use by the Bahamian women. There was also a significant association between a lack of education and HIV infection in this group. There was a lower rate of condom use among women with less education and also among women in common-l

The prevalence of cannabis abuse in trauma patients presenting to the University Hospital of the West Indies

During a three-month period patients aged 16 years and over, admitted to the University Hospital of the West Indies (UHWI) via the emergency room, were screened for the metabolites of cannabis in the urine. Forty-six per cent were positive for cannabis. Patients testing positive were significantly younger than those who tested negative (p<0.001), the mean ages (95 percent confidence interval CF) being 28 (25-30) years and 35 (29-39) years, respectively. Patients were placed into one of three groups depending on whether they were victims of motor vehicle accidents, interpersonal violence or "other accidents". The prevalence of cannabis abuse was significantly less in the "other accidents" group compared with victims of motor vehicle accidents and interpersonal violence. Fifty per cent of the road traffic accident victims (95 percent CI, 35-52 percent), 55 per cent due to interpersonal violence (95 percent CI, 39-69 percent) and 16 per cent of the "other accidents" group (95 percent CI, 4-38 percent) tested positive for cannabis. There was no significant difference in hospital stay (HS), Revised Trauma Score (RTS) or Injury Severity Score (ISS) between cannabis abusers and nonusers. We conclude that there is a high incidence of cannabis abuse among trauma victims in Jamaica and postulate that it may play an important role in the aetiology of motor vehicle accidents and interpersonal violence (AU)

Drug abuse in all age schools

Drug abuse is a serious problem in Jamaica and around the world, affecting people from all walks of life. The most significant impact is among our youths who remain the most affected by drug abuse. A survey designed to assess knowledge, attitude and practice of students with regard to drug use was undertaken in schools. The study was conducted among 200 students in four all age schools, in the metropolitan area. In order to do the study a random sample was selected and a self administered questionnaire was used to collect the data. The results revealed that drug abuse was rising and was more common in males than females, in some cases the male to female ratio being four to one. Alcohol was the most commonly used drug, followed by tobacco, cannabis and inhalants. 90 percent of alcohol users became regular users. Among the illicit drugs, cannabis was most prevalent. For both crack and cocaine, the prevalence for current usage had increased significantly since 1987. Twenty percent of students believed there was no risk involved in taking drugs. In general the trend of drug use and abuse is on the rise and fifty percent of students taking drugs began before ten year of age. The author concluded that the problem of drug use and abuse had risen and made recommendations, including that institutions should be set up to deal with drug abuse in adolescents and existing educational programmes be strengthened and targeted at the lower age groups. (AU)

Children and women: special health and social problems related to substance abuse

The prevalence of substance abuse among 1187 women, 15-50 years, in a national sample and 1074 children 10-18 years in eight schools in Jamaica, using a modified Drug Use Screening Inventory (DUSI) questionnaire are used to indicate the likely health and social problems that may result. Painkillers (48.4 percent) were the most popular substances used by children followed by alcohol (36.9 percent) and painkillers (39.2 percent). In both samples inhalants and marijuana by rank are the most popular illicit substances used. Inhalant use was 1.9 percent for women and 9.0 percent for children in a ratio of 1:5 and marijuana 2.8 percent and 2.5 percent respectively. Cocaine/crack use is 50 percent more among children (1.0 percent) compared to women (0,5 percent). LSD-25 use was only reported by children (0.2 percent). Women under 20 years in the national sample, by rank, were the heaviest users of inhalants (52.2 percent), marijuana (30.0 percent), painkillers (24.4 percent) and alcohol (23.0 percent). Differences in use of tranquilizers (p=0.0008) and inhalants (p=0.008) were statistically significant for women among the age groups under 20 years, 20-24, 25-29, 30-34 and 35 and over. Among children differences by age for substances used were insignificant. Drug involvement evidence reported by children were withdrawal symptoms 10.4 percent, 16.9 percent playing drinking games at parties and 8.9 percent having a craving or strong desire for alcohol or drugs, corresponding proportions for women were 3.3 percent, 0.1 percent and 0.1 percent. Psychosocial factors in both samples which correlated strongly with drug use were behaviour patterns, behavioural disorders, social competence and family system. Substance use and its effects on health are reflected in reported health problems. Children (43.1 percent) reported too much or too little sleep and 25-29 percent reported weight change of 10 pounds or more, abdominal pain and nausea, trouble with breathing and coughing and deficient energy. Corresponding proportions for women reporting similar problems were 15-17 percent. The paper discusses the likely impact of drug use on the health and social well being of women and children and the size of the problem in relation to the proportions reporting use. (AU)

Some health issues on the Cave Hill Campus, U.W.I. - abstract

In response to concerns expressed about drug abuse among students attending the Cave Hill Campus, a survey was conducted among the entire campus community to determine views about a wide range of health related issues. The survey was conducted by a pretested, self-administered, anonymous questionnaire, and was done on a single day on campus. The sample was chosen as a stratified sample of the campus personnel from the staff and student lists. Thirty-six per cent of the 1 in 4 sample responded to the questionnaire (7.9 per cent of all students, and 14 per cent of all staff). The age, sex, race and religious affiliations of the respondents were representative of the campus community. The numbers of responding students, administrative, academic and clerical staff were sufficient for their conclusions to be considered in the analysis. Staff and students generally considered themselves to be in good health. They were conscious of the bad effects on health of smoking cigarettes, and the use of ganja or cocaine. They also considered being overweight, worry and stress as being bad for health. Drugs were not a regular subject for discussion on the campus. While 3 of 5 respondents said they could recognise cocaine, crack or speed. Less than 1 per cent admitted to the use of any of these drugs and 80 per cent said they had never used cigarettes. Alcohol use was far more frequent, particularly among members of the academic staff, as was the use of cigarettes. Generally, members of the campus community were aware of the lifestyles that were at high risk for HIV, although 30 per cent of respondents considered lesbians as being at high risk. Using "one night stands" as indicative of high-risk sexual behaviour, 28.6 per cent of academics and 14.5 per cent of students said they had had such experiences within the last five years. Respondents reported a reduction in sexual partners compared to the previous year, and five years before. As regards problems which students considered may affect their health, concerns were expressed about stress, overwork, and insufficient money. Academics and students considered drug use as a minor problem among students, while clerical staff were more concerned about this as a problem. Generally, students did not consider themselves to be sexually harassed, although administrative and clerical staff expressed concerns in this regard. The campus emerges as a relatively abstemious one in every regard. However, both students and staff expressed significant concerns about stress and underfunding of students (AU)

Some factors associated with substance abuse among secondary school students in Trinidad and Tobago - abstract

The aim of this study done in 1988 was to explore the relationship between substance abuse and attitudes of youth towards education, religion and family life in secondary school students, aged 14 to 18 years in Trinidad and Tobago. A random stratified sampling technique resulted in a selection of 30 secondary schools and 2000 students. Data were collected from 1,603 (80 per cent) students, using a self-administered questionnaire completed in the classroom and supervised by trained survey workers. Analysis of the data, using the Chi-square test, indicated a significant association (p<.001) between involvement in substance abuse (defined as regular or occasional usage of alcohol, marijuana or cocaine) and the following factors: grades at school, importance of religious involvement, amount of spending money obtained, confidence placed in parents/peers, parental involvement in alcohol consumption and educational expectations. Generally, the study indicated that youths who were less committed to traditional values, showed a greater tendency to be involved in substance abuse. Involvement also appeared to be associated with low self-esteem and low educational expectations (AU)

Five-year follow-up of rural Jamaican children whose mothers used marijuana during pregnancy

This research provides data on the development of 59 Jamaican children, from birth to age 5 years, whose mothers used marijuana during pregnancy. Approximately one-half of the sample used marijuana during pregnancy and were matched with non-users according to age, parity, and socioeconomic status. Testing of the children was done at 1, 3, and 30 days of age with the Brazelton Neonatal Behavioral Assessment Scales and at ages 3 and 5 years with the McCarthy Scales of Children's Abilities. Data about the child's home environment and temperament were collected from direct observations as well as from standardized questionnaires. The results show no significant differences in developmental testing outcomes between children of marijuana-using and non-using mothers except at 30 days of age when the babies of users had more favourable scores on two clusters of the Brazelton Scales: autonomic stability and reflexes. The developmental scores at ages 4 and 5 were significantly correlated to certain aspects of the home environment and to regularity of basic school (preschool) attendance. (AU)

Crack: new directions in drug research. Part 1. Differences between the marijuana economy and the cocaine/crack economy

Crack use and trafficking in low-income, minority communities in New York City have pushed into prominence many aspects of drug use/misuse and distribution which had formerly received inadequate attention. For example, the generation and reinvestment of drug incomes are important determinants of how various drugs are experienced. While in retrospect marijuana trafficking appears to have been an almost benign affair, crack trafficking is fast-paced, ruthless, steeped in violence, and improvishes everyone who becomes engaged in it. In this part the differences between rates, volumes, and methods of income generation related to the use and distribution of marijuana and cocaine are elaborated. The contrast raises a question: Do economies like drug distribution follow a particular rhythmic pattern (capital accumulation during the benign marijuana passage followed by capital depletion in the overheated crack era), and how is it related to the changing demands of the regional economy? Viewed from this perspective, drug distributors and users appear not so much as "deviant" or "alienated" or as a "reserve pool of labor," but rather as a type of labor force which does indispensable work for the whole society. (AU)

From Ganja to crack: Caribbean participation in the underground economy in Brooklyn, 1976-1986. Part 2. Establishment of the cocaine (and crack) economy

Shortages in the supply of marijuana, which became acute around 1981, caused Rastafari marijuana distributors very reluctantly to disregard religious injunctions against the use of any psychoactive substance except marijuana, and to experiment with the use and distribution of cocaine hydrochloride powder for intranasal administration and, later, for smoking (freebase and crack). This experimentation became ruinous, and many were retired ignominiously from drug distribution. In the crack era they have been succeeded by completely new social, cultural, and economic arrangements. (AU)

Alcohol and drug abuse among secondary schoolchildren in Trinidad and Tobago - abstract

A questionnaire survey of a stratified, randomized sample of 1,603 (80 percent of sample) secondary school students, aged 14-18 years, on substance abuse, was conducted in Trinidad and Tobago in 1988. The life-time prevalence rate for alcohol was 84 percent, tobacco 34.8 percent, marijuana 8.0 percent and cocaine 2.0 percent. Alcohol was the substance most consistently used and students' first exposure to drinking alcohol was by family members in childhood (46.1 percent) or experimentation later. Transitions from primary to secondary schools and from junior to senior schools were associated with increased alcohol use. Ethnic reversals of substance abuse among high school students were observed by a high use of alcohol among Indo-Trinidadian and low use among Afro-Trinidadian students (Xý = 56.00 df=1). Similarly, the use of marijuana was high in Afro-Trinidadian students when compared to Indo-Trinidadians (Xý = 28.00 df=1). The use of alcohol by students was positively correlated to its use by fathers and negatively with religious activities. The simultaneous use of drugs among students appears to be a growing problem. Secondary school students in Trinidad and Tobago are foremost among users of alcohol, tobacco and cocaine in the Caribbean region. There is a need for the implementation of culturally relevant educational and prevention programmes in schools (AU)

Schizophrenia in British Afro-Caribbeans: two debates confused?

The concept and aetiology of schizophrenia remain controversial issues. Epidemiological studies reveal considerable variations in rates of diagnosed cases between groups. British Afro-Caribbeans show high rates. At the same time, their psychiatric experience is marked by a high level of conflict with the psychiatric services. The two debates--that surrounding the concept of schizophrenia, and that considering the psychiatric experiences of British Afro-Caribbeans--need to be separated so that each receives appropriate consideration. Studies based on the experiences of people diagnosed as schizophrenic may confuse rather than advance the first debate if due care is not paid to the reliability of the diagnosis. The second debate has consequences for the development of psychiatric services. Further unaddressed questions referring to the mental health of ethnic minorities are suggested. (AU)