Australian Government National Health and Medical Research Council.

Objective: Historically, alcohol use and related harms are more prevalent in men than in women. However, emerging evidence suggests the epidemiology of alcohol use is changing in younger cohorts. The current study aimed to systematically summarise published literature on birth cohort changes in male-tofemale ratios in indicators of alcohol use and related harms. Methods:We identified 68 studies that met inclusion criteria. We calculated male-to-female ratios for 3 broad categories of alcohol use and harms (any alcohol use, problematic alcohol use and alcoholrelated harms) stratified by 5-year birth cohorts ranging from 1891 to 2001, generating 1568 sex ratios. Random-effects meta-analyses produced pooled sex ratios within these 3 categories separately for each birth cohort.Findings: There was a linear decrease over time in the sex ratio for all 3 categories of alcohol use and related harms. Among those born in the early 1900s, males were 2.2 (95% CI 1.9 to 2.5) times more likely than females to consume alcohol, 3.0 (95% CI 1.5 to 6.0) times more likely to drink alcohol in ways suggestive of problematic use and 3.6 (95% CI 0.4 to 30.3) times more likely to experience alcohol-related harms. Among cohorts born in the late 1900s, males were 1.1 (95% CI 1.1 to 1.2) times more likely than females to consume alcohol, 1.2 (95% CI 1.1 to 1.4) times more likely to drink alcohol in ways suggestive of problematic use and 1.3 (95% CI 1.2 to 1.3) times more likely to experience alcohol-related harms.Conclusions: Findings confirm the closing malefemale gap in indicators of alcohol use and related harms. The closing male-female gap is most evident among young adults, highlighting the importance of prospectively tracking young male and female cohorts as they age into their 30s, 40s and beyond.Alcohol use and alcohol-related harms are among the most significant risk factors for burden of disease. Overall, they resulted in around 5 million deaths globally in 2010, and were responsible for more than 161 million years of life lost, equating to 5% of total global health burden.1 Historically, the prevalence of alcohol use and related harms has been between 2 and 12 times higher in men than women.2-7 However, there is emerging evidence to suggest that the gap between men and women in alcohol use and related harms is closing among recently born cohorts. [8][9][10][11] Understanding sex-specific birth cohort trends in the epidemiology of alcohol use is vital as they point to key environmental and social mechanisms associated with population shifts in alcohol use patterns. For example, studies have attributed these generational shifts in sex-specific drinking to changes in traditional gender roles over Strengths and limitations of this study ▪ Prior to this study, the evidence around gender convergence in alcohol use and alcohol-related harms was fragmented. This study systematically summarised all available literature and provided a quantification of the rate of gender convergence through the derivation of a single metric -the m...

No abstract

Regular (particularly daily) adolescent cannabis use is associated consistently with anxiety, but not depressive disorder, in adolescence and late young adulthood, even among regular users who then cease using the drug. It is possible that early cannabis exposure causes enduring mental health risks in the general cannabis-using adolescent population.

Recent analysis of the cannabinoid content of cannabis plants suggests a shift towards use of high potency plant material with high levels of Δ9-tetrahydrocannabinol (THC) and low levels of other phytocannabinoids, particularly cannabidiol (CBD). Use of this type of cannabis is thought by some to predispose to greater adverse outcomes on mental health and fewer therapeutic benefits. Australia has one of the highest per capita rates of cannabis use in the world yet there has been no previous systematic analysis of the cannabis being used. In the present study we examined the cannabinoid content of 206 cannabis samples that had been confiscated by police from recreational users holding 15 g of cannabis or less, under the New South Wales “Cannabis Cautioning” scheme. A further 26 “Known Provenance” samples were analysed that had been seized by police from larger indoor or outdoor cultivation sites rather than from street level users. An HPLC method was used to determine the content of 9 cannabinoids: THC, CBD, cannabigerol (CBG), and their plant-based carboxylic acid precursors THC-A, CBD-A and CBG-A, as well as cannabichromene (CBC), cannabinol (CBN) and tetrahydrocannabivarin (THC-V). The “Cannabis Cautioning” samples showed high mean THC content (THC+THC-A = 14.88%) and low mean CBD content (CBD+CBD-A = 0.14%). A modest level of CBG was detected (CBG+CBG-A = 1.18%) and very low levels of CBC, CBN and THC-V (<0.1%). “Known Provenance” samples showed no significant differences in THC content between those seized from indoor versus outdoor cultivation sites. The present analysis echoes trends reported in other countries towards the use of high potency cannabis with very low CBD content. The implications for public health outcomes and harm reduction strategies are discussed.

No abstract

Among long-term cannabis users in this Australian rural area, cannabis use was an integral part of everyday life and it was primarily used in social situations for the same reasons that alcohol use is used in the wider community.

This paper provides an overview of the epidemiology of cannabis use, cannabis use disorders and its treatment. Cannabis is the most commonly used illicit drug internationally. While use is decreasing in the developed world, it appears to be stable or increasing in developing countries and some indigenous communities. Early initiation and regular adolescent use have been identified as particular risk factors for later problematic cannabis (and other drug) use, impaired mental health, delinquency, lower educational achievement, risky sexual behaviour and criminal offending in a range of studies. It is estimated that approximately one in ten people who had ever used cannabis will become dependent with risk increasing markedly with frequency of use. There has been an increase in the proportion of treatment provided for cannabis use. There are as yet no evidence-based pharmacotherapies available for the management of cannabis withdrawal and craving. Relatively brief cognitive behavioural therapy and contingency management have the strongest evidence of success, and structured, family-based interventions, provide potent treatment options for adolescents. With criminally involved young people and those with severe, persistent mental illness, longer and more intensive therapies provided by interdisciplinary teams may be required.