Nabilone is a synthetic cannabinoid that has shown promise for the treatment of posttraumatic stress disorder (PTSD)–related insomnia and nightmares as well as efficacy in the management of chronic pain. It has also been proposed for harm reduction in cannabis dependence. Its effectiveness for management of concurrent disorders in seriously mentally ill correctional populations has not been evaluated. This retrospective study of 104 male inmates with serious mental illness prescribed nabilone analyzes the indications, efficacy, and safety of its use. Medications discontinued with the initiation of nabilone were also reviewed. The results showed nabilone targeting a mean of 3.5 indications per patient, thus likely reducing polypharmacy risk. The mean final dosage was 4.0 mg. Results indicated significant improvement in PTSD-associated insomnia, nightmares, PTSD symptoms, and Global Assessment of Functioning and subjective improvement in chronic pain. Medications associated with greater risk for adverse effects or abuse than nabilone were often able to be discontinued with the initiation of nabilone, most often antipsychotics and sedative/hypnotics. There was no evidence of abuse within this high-risk population or reduction of efficacy when nabilone was given in powder form with water rather than as a capsule. This study supports the promise of nabilone as a safe, effective treatment for concurrent disorders in seriously mentally ill correctional populations. Prospective, randomized controlled trials are required to confirm our preliminary results. Follow-up in the community will be required to confirm effectiveness in harm reduction.

Objectives:To investigate the utility of the World Health Organization's Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) Version (V) 3.0 for identifying substance use disorders in pregnancy. Methods:ASSIST V3.0's performance was assessed, focussed on nicotine, alcohol, and cannabis, using a 2-pronged harm categorization: risk to the woman as an individual and risk to the fetus. For the former, risk levels concordant with general population cut-points were utilized. A total of 104 substance users in an Australian public maternity hospital were identified by case-note audit. The ASSIST V3.0 scores were appraised against the scores for established tools-tobacco: the Revised Fagerstrom Tolerance Questionnaire, alcohol: the tolerance, annoyed, cut down, eye-opener, and cannabis: the Timeline FollowBack. Results:Kappa analyses of Specific Substance Involvement Scores for ASSIST V3.0 did not support changing cutpoints for the woman as an individual; however, receiver operating characteristics curves delineated an Specific Substance Involvement Scores of 4 as indicative of fetal risk for both alcohol and cannabis. All nicotine users (98 of the 104 participants) were ''at high risk''; hence a cut-point indicative of fetal risk for nicotine could not be determined. Conclusions:The role of the ASSIST V3.0 is uncertain for this population. Given the predominance of nicotine use, nicotine use screening could be the primary focus, with follow-up screening for alcohol and other substances if tobacco use were identified; there may be a place for a restructured ASSIST in that context. Positive screening results should be followed by ongoing counseling support throughout pregnancy, with the intensity dictated by the severity of use.

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