Action is required to reduce kava supply in Arnhem Land . . . again!
Explore the source record for details and available documents.
Drug and Narcotic Control↗
Biomedical subjects
Alan R Clough
Publications and source records attributed to Alan R Clough.
Some costs and challenges of conducting follow-up studies of substance use in remote Aboriginal communities: an example from the Northern Territory.
The objective of this study was to describe some costs and challenges for conducting follow-up interviews about substance use in Indigenous groups in northern Australia. In a remote region in the Northern Territory in 2001, 131 Indigenous people (aged 13 - 36 years) were approached for interview regarding their substance use. Of these, 108 (54 males, 54 females) were interviewed successfully. Follow-up interviews were attempted in 2004. Study records traced progress and costs. In 2001, the response rate was 82% (108/131). In 2004, 22 participants could not be found after four attempts although they were known by health workers to still reside in the region. Fifteen were not residing in the region during 2004 and were lost to follow-up, four were in prison and three were deceased. Fourteen contacted either refused directly (n = 1) or repeatedly postponed interview (n = 13). Fifty follow-up interviews were completed, a response rate of 78% among 64 participants contacted. The overall response rate in those approached was 64% (0.82 * 0.78). Costs for 108 interviews were 45 person-days and Dollars A19,000 (32% = travel/associated costs). Costs for 50 follow-up interviews were 60 person-days and Dollars A25,500 (39% = travel/associated costs). Such follow-up studies in these settings could be complemented by retrospective case - control approaches and by using proxy respondents to increase study efficiency.
Adolescent↗
Changes in cannabis use and its consequences over 3 years in a remote indigenous population in northern Australia.
BACKGROUND: Few studies describe cannabis use in indigenous populations, and no longitudinal studies are available in Australia. We conducted 3-year follow-up interviews and assessments in Aboriginal communities in Arnhem Land (Northern Territory, NT). METHODS: A randomly selected sample (n = 161; 80 males, 81 females aged 13-36 years) was assessed in October 2001 and then reassessed in September 2004. An opportunistically recruited sample (n = 104; 53 males, 51 females aged 13-36 years) was also interviewed in 2001 and followed-up in 2004. Cannabis and other substance use were determined by combining proxy assessments by local Aboriginal health workers, medical records and data from interviews. Changes in cannabis use and symptoms of misuse were assessed using McNemar's test for paired proportions and the Wilcoxon signed rank test. Logistic regression assessed associations between clinical presentations and cannabis use at both time-points. RESULTS: Those who used cannabis at both baseline and follow-up were at greater risk than those who never used it to have suffered: auditory hallucinations; suicidal ideation; and imprisonment. In the randomly selected cohort there were fewer cannabis users at follow-up than at baseline (P = 0.003). The reduction was evident in females generally (P = 0.008) and older males (aged = 16 at baseline) (P = 0.007). In those interviewed at both baseline and follow-up we measured no statistically significant reduction in frequency and levels of use, although fewer cannabis users reported symptoms of misuse such as: fragmented thought processes; memory disruption; difficulties controlling use; and auditory and visual hallucinations. CONCLUSIONS: Modest reductions in cannabis use and its consequences in this population were demonstrated. These may be the result of enhanced supply control and broader socio-political changes.
Adolescent↗
Adverse mental health effects of cannabis use in two indigenous communities in Arnhem Land, Northern Territory, Australia: exploratory study.
OBJECTIVE: We investigated adverse mental health effects and their associations with levels of cannabis use among indigenous Australian cannabis users in remote communities in the Northern Territory. METHOD: Local indigenous health workers and key informants assisted in developing 28 criteria describing mental health symptoms. Five symptom clusters were identified using cluster analysis of data compiled from interviews with 103 cannabis users. Agreement was assessed (method comparison approach, kappa-statistic) with a clinician's classification of the 28 criteria into five groups labelled: 'anxiety', 'dependency', 'mood', 'vegetative' and 'psychosis'. Participants were described as showing 'anxiety', 'dependency' etc., if they reported half or more of the symptoms comprising the cluster. Associations between participants' self-reported cannabis use and each symptom cluster were assessed (logistic regression adjusting for age, sex, other substance use). RESULTS: Agreement between two classifications of 28 criteria into five groups was 'moderate' (64%, kappa = 0.55, p < 0.001). When five clusters were combined into three, 'anxiety-dependency', 'mood-vegetative' and 'psychosis', agreement rose to 71% (kappa = 0.56, p < 0.001). 'Anxiety-dependency' was positively associated with number of 'cones' usually smoked per week and this remained significant when adjusted for confounders (p = 0.020) and tended to remain significant in those who had never sniffed petrol (p = 0.052). Users of more than five cones per week were more likely to display 'anxiety-dependency' symptoms than those who used one cone per week (OR = 15.8, 1.8-141.2, p = 0.013). A crude association between the 'mood-vegetative' symptom cluster and number of cones usually smoked per week (p = 0.014) also remained statistically significant when adjusted for confounders (p = 0.012) but was modified by interactions with petrol sniffing (p = 0.116) and alcohol use (p = 0.276). There were no associations between cannabis use and 'psychosis'. CONCLUSIONS: Risks for 'anxiety-dependency' symptoms in cannabis users increased as their level of use increased. Other plausible mental health effects of cannabis in this population of comparatively new users were probably masked by alcohol use and a history of petrol sniffing.
Adolescent↗
Associations between tobacco and cannabis use in remote indigenous populations in Northern Australia.
AIMS: To assess whether cannabis use, recently taken up by many indigenous Australians in remote communities, has reinforced tobacco use. DESIGN: Cross-sectional study. SETTING: Three eastern Arnhem Land communities (Northern Territory, NT); total population = 3384, in 2001. PARTICIPANTS: From 1247 people aged 17-36 years, 190 (120 males, 70 females) were opportunistically recruited. MEASUREMENTS: Self-reported life-time and current tobacco, cannabis and other substance use were confirmed by local health workers and using clinic records. Participants reported level of substance use, frequency and duration (years used). Associations with tobacco use were calculated (odds ratios: OR) using logistic regression with age, sex, alcohol use and a history of petrol sniffing as confounders. FINDINGS: In univariate analyses current tobacco users were more likely than non-users to be using cannabis (OR = 3.1, 1.5-6.2, P = 0.002) and this association remained in multivariate analyses (OR = 3.0, 1.4-6.8, P = 0.006). Tobacco use was associated with the number of years of cannabis use (P = 0.035). The likelihood that tobacco users were also cannabis users increased as quantity of cannabis used increased (P = 0.008). Current tobacco use was no more likely in those who initiated cannabis from 1998 onwards than in those who initiated cannabis before 1998 (OR = 1.1, 0.4-3.2, P = 0.881). One-third of life-time users of both tobacco and cannabis initiated their use at or near the same time, and very few of these (12%) had discontinued either cannabis or tobacco. CONCLUSIONS: Cannabis appears to have influenced the continued use of tobacco in these populations with possible additional burdens for cardiovascular and respiratory diseases and challenges for interventions.
Adolescent↗
Policy approaches to support local community control over the supply and distribution of kava in the Northern Territory (Australia).
The health consequences of kava abuse in Arnhem Land Aboriginal populations in the Northern Territory (NT) and the persistence of an illegal kava trade with its associated social harms have been a cause for concern for 20 years. Despite these concerns, some Arnhem Land groups seek to continue using kava and to control its sale, distribution and the profits from the enterprise. In response, policy makers in the NT have embraced principles of harm reduction and created regulatory mechanisms to address broader public concerns and to support local management of kava supply while reinforcing control over the consequences of its use. This paper describes the kava regulatory system now being implemented in the NT which features kava management plans developed in consultation between Aboriginal communities and licensing authorities. It complements the earlier Harm Reduction Digest 9 by McDonald & Jowitt which looked at Kava in the South Pacific.
Catchment Area, Health↗
Emerging patterns of cannabis and other substance use in Aboriginal communities in Arnhem Land, Northern Territory: a study of two communities.
A recent rise in cannabis use in Indigenous communities in northern Australia may have compounded existing patterns of other substance use. This paper describes these patterns in Arnhem Land in the 'Top End' of the Northern Territory (NT). Economic impacts of the cannabis trade are also described. In a descriptive cross-sectional study, random samples included 336 people (169 males, 167 females) aged 13 - 36 years. Consensus classification of lifetime and current use of cannabis, alcohol, tobacco, kava, inhalants (petrol) and other drugs was derived based on health workers' proxy assessments. A sample (n = 180, aged 13 - 36) was recruited opportunistically for interview. Lifetime cannabis users among those interviewed (n = 131, 81 males, 50 females) described their current cannabis use, usual quantities purchased and consumed, frequency and duration of cannabis use and other substance use. In the random samples, 69% (63 - 75%) of males and 26% (20 - 31%) of females were lifetime cannabis users (OR = 7.4, 4.5 - 12.1, p < 0.001). The proportion of males currently using cannabis was 67% (60 - 73%) while the proportion of females currently using cannabis was 22% (16 - 27%) (OR = 7.9, 4.8 - 13.1, p < 0.001). Current cannabis users were more likely than non-users to be also using alcohol (OR = 10.4, 4.7 - 23.3, p < 0.001), tobacco (OR = 19.0, 7.9 - 45.8, p < 0.001) and to have sniffed petrol (OR = 9.1, 4.6 - 18.0, p < 0.001) but were less likely to be using kava (OR = 0.4, 0.2 - 0.9, p < 0.001). Among those interviewed, higher tobacco consumption in current users and greater alcohol use in lifetime users was associated with increased cannabis use. Action is required to reduce cannabis use, especially in combination with other substances.
Adolescent↗
Kava hepatotoxicity with Western herbal products: does it occur with traditional kava use?
Explore the source record for details and available documents.
Chemical and Drug Induced Liver Injury↗
Saccade and cognitive impairment associated with kava intoxication.
Kava is an extract from the Piper methysticum Forst. f. plant that has social and spiritual importance in Pacific islands societies. Herbal remedies that contain kava are used for the psychiatric treatment of anxiety and insomnia. Laboratory studies have found only subtle, if any, changes on cognitive or motor functions from the acute effects of consuming small clinical doses of kava products. Intoxication from recreational doses of kava has not been studied. The performance of individuals intoxicated from drinking kava (n=11) was compared with a control group (n=17) using saccade and cognitive tests. On average, intoxicated individuals had consumed 205 g of kava powder each (approximately 150 times clinical doses) in a group session that went for 14.4 h and ended 8 h prior to testing. Intoxicated kava drinkers showed ataxia, tremors, sedation, blepharospasm and elevated liver enzymes (GGT and ALP), together with saccadic dysmetria, saccadic slowing and reduced accuracy performing a visual search task that only became evident as the task complexity increased. Kava intoxication is characterized by specific abnormalities of movement coordination and visual attention but normal performance of complex cognitive functions. Saccade abnormalities suggest disruption of cerebellar and GABAergic functions.
Adult↗
Saccade and cognitive function in chronic kava users.
Kava is an extract from the Piper methysticum Forst. f. plant that has been consumed in the Pacific islands for millennia and more recently, among indigenous populations, in northern Australia and throughout the Western world as an herbal medicine. Through alterations on neuronal excitation, kava induces muscle relaxation, anasthesia, and has anxiolytic properties. There have been several isolated reports of psychotic syndromes, severe choreoathetosis and possible seizures following kava use. However, there is no conclusive evidence that kava interferes with normal cognitive processes. We tested a group of current, ex, and nonkava users among an indigenous population in northern Australia, using saccade and cognitive tests that have proven cross-cultural validity and are sensitive to subtle disruptions of the brain arising from substance abuse or neuropsychiatric illness. Despite collecting data from among the heaviest reported kava drinkers in the world, we found no impairment in cognitive or saccade function in individuals who were currently heavy kava users (and had been for up to 18 years), nor was there any impairment in individuals who had been heavy kava users in the past but had abstained for longer than 6 months. Current and ex-kava users showed a higher rate of kava dermopathy, lower body mass index, lowered blood lymphocytes and, in addition, current kava users showed elevated liver enzymes. While there has recently been increasing concern about potentially fatal liver damage attributed to kava use, we have found no evidence of brain dysfunction in heavy and long-term kava users.
Adolescent↗
Liver function test abnormalities in users of aqueous kava extracts.
INTRODUCTION: Hepatic toxicity from manufactured herbal remedies that contain kava lactones has been reported in Europe, North America, and Australia. There is no evidence for serious liver damage in kava-using populations in Pacific Island societies or in Indigenous Australians who have used aqueous kava extracts. This article presents evidence that liver function changes in users of aqueous kava extracts appear to be reversible. Data from one Arnhem Land community [Northern Territory (NT), Australia] with 340 indigenous people older than 15 years of age in 2000 are used. METHODS: This study was a cross-sectional study with 98 participants, 36 of whom had never used kava. Among 62 kava users, 23 had discontinued kava at least 1 year before the study. Continuing users had not used kava for 1 to 2 months (n = 10) or 1 to 2 weeks previously (n = 15). Some (n = 14) had used kava within the previous 24 hr. Liver function tests were compared across these groups, taking into account differences due to age, sex, alcohol, and other substance use. RESULTS: The average quantity of kava powder consumed was 118 g/week, and median duration of use was 12 years (range, 1-18 years). Kava usage levels were less than one-half of those found in previous studies. More recent kava use was independently associated with higher levels of liver enzymes gamma-glutamyl transferase (GGT) (p < 0.001) and alkaline phosphatase (ALP) (p < 0.001), but not with alanine aminotransferase or bilirubin, which were not elevated. In those who were not heavy alcohol users, only those who used kava within the previous 24 hr showed GGT levels higher than nonusers (p < 0.001), whereas higher ALP levels occurred only in those who last used kava 1 to 2 weeks (p = 0.015) and 24 hr previously (p = 0.005). DISCUSSION: Liver function changes in users of aqueous kava extracts at these moderate levels of consumption appear to be reversible and begin to return to baseline after 1 to 2 weeks abstinence from kava. No evidence for irreversible liver damage has been found.
Adult↗
Rising cannabis use in indigenous communities.
Explore the source record for details and available documents.
Adolescent↗
The neurobehavioural effects of kava.
OBJECTIVE: This review considers the context in which kava is used, together with its underlying psychopharmacological mechanisms, to investigate the neurobehavioural effects associated with kava use. METHOD: We conducted a systematic search using the computerized databases MEDLINE, OVID and PsychLIT for all articles containing any of the following words: kava, kavain, kawa and Piper methysticum. In the opinion of the authors, all articles from this collection containing data that could inform the neurological and cognitive sequelae of kava use were included for the purpose of this review. RESULTS: The use of kava occurs among indigenous populations in the South Pacific and in northern Australia, while also being used throughout the western world as a herbal medicine. Animal studies show that kava lactones alter neuronal excitation through direct interactions with voltage-dependent ion channels, giving rise to kava's muscle relaxant, anaesthetic, anxiolytic and anticonvulsive properties. Several isolated cases of psychotic and severe dystonic reactions following kava use suggest that kava also has psychoactive properties, yet there is no conclusive evidence that kava interferes with normal cognitive processes. CONCLUSIONS: Kava is effective in the treatment of tension and anxiety. There may be risk-factors for severe motor and psychiatric responses to kava use, although these are not well-understood. Given the increasingly widespread use of kava, further investigation is necessary to gain an understanding of its immediate neuropsychiatric effects and long-term cognitive effects.
Adult↗
Diversity of substance use in eastern Arnhem Land (Australia): patterns and recent changes.
The objective of this study was to describe patterns of substance use among remote Aboriginal community populations. The setting was the eastern Arnhem Land ('Miwatj') region of the Northern Territory's (NT) 'Top End', with a population of 4217 Aboriginal people over 15 years of age using a cross-sectional description and comparison. Sample 1 (n = 689) from the region used data from health-worker consensus classification of kava, alcohol, tobacco, petrol and cannabis use. Sample 2 (n = 101) from one community used self-reported use, age at commencement, duration, amounts consumed and expenditure. In 1999 (sample 1), 46% of males and 18% of females were kava users, alcohol: 53% males, 12% females, tobacco: 68% males, 65% females, and cannabis: 31% males, 8% females. Less than 5% sniffed petrol. In one community in 2000, 39% males and 20% females reported using cannabis during the previous month. In this community between 1999 and 2000, the proportion of current kava users among men declined (77-52%, p = 0.015) with a tendency in women for a decrease in the proportion of tobacco users (87-69%, p = 0.096). The increase in the proportion of cannabis users in men (21-39%, p = 0.068) was not statistically significant. However, in women the increase was significant (0-20%, p = 0.013). Gross expenditure on tobacco and kava were similar in 2000: both greater than cannabis and alcohol. Median years used ranged from 4 years for cannabis and 20 years for tobacco. The data supported anecdotes of a recent rise in cannabis use, especially in women. Kava use declined in men. Tobacco use patterns in women may have been changing. Average per capita consumption of alcohol was low compared with other 'Top End' areas. Such varied and dynamic substance use patterns pose challenges for research and policy.
Cross-Sectional Studies↗
Validity and utility of community health workers' estimation of kava use.
OBJECTIVE: Estimating illicit substance use in epidemiological studies is challenging, particularly across ethical, cultural and language barriers. While developing the methods for a case-control study of the effects of heavy kava consumption among Aboriginal people in remote Northern Territory (NT), we examined the validity and utility of alternative methods for estimating exposure. METHODS: We assessed the level of agreement between a consensus of Aboriginal health workers in two different communities using interviews conducted with community members and health workers and individuals' self-reported kava consumption. Exposure measures included history of kava use, current kava use and history of heavy use. Agreement between a health worker consensus classification and individuals' self-report was analysed and agreement among several health workers in a consensus classification without self-report was assessed. RESULTS: Health workers concurred about an individual's history of kava use (k=0.83), current use (k=0.43) and also level of use (k=0.33). There was very good agreement between health workers' consensus and self-reported history of use (k=0.77). Agreement among health workers about current kava use was poor (k=0.08), while there was fair agreement between health workers and self-reported heavy kava users (k=0.36). Data from review of clinic patient notes supported agreement between consensus classification and self-reported history and level of use (k=0.39). CONCLUSIONS: Self-reported kava use may be a poor estimate of current use especially when obtained from interviews away from a confidential clinic setting. Consensus classification by knowledgeable Aboriginal health workers provided comprehensive coverage, efficiently and with greater reliability and assisted to identify 'excessive' kava use.
Community Health Workers↗