Study Protocol: Measuring Cannabis Withdrawal in Indigenous Australian Prisoners | Research

The takeaway

A protocol was developed to study cannabis withdrawal in Indigenous Australian prisoners, a population with exceptionally high cannabis use rates, using a pictorial withdrawal scale and cortisol biomarkers.

Read this if you are interested in cannabis withdrawal in diverse populations or in culturally appropriate health assessment.

First study protocol to examine cannabis withdrawal in Indigenous populations

What the researchers found

This study protocol addressed a critical gap: cannabis withdrawal has never been examined in Indigenous populations despite exceptionally high community cannabis use rates. When incarcerated, Indigenous Australians face abrupt enforced cannabis cessation, which can lead to irritability, anger, threatening behavior, violence, sleep disturbances, and self-harm.

The protocol planned to recruit 60 male and 60 female Indigenous prisoners (ages 18-40) at high risk of cannabis dependence upon entry to custody. A pictorial representation of the Cannabis Withdrawal Scale would be tested for reliability and validity. Salivary cortisol would be measured as a biomarker for withdrawal onset and severity.

Why it matters

Cannabis withdrawal in custodial settings is a safety issue: irritability and anger from withdrawal can escalate to violence and self-harm. Indigenous Australians are disproportionately incarcerated and have high cannabis dependence rates, making culturally appropriate assessment and management tools essential.

The numbers in context

Planned sample: 60 male + 60 female Indigenous prisoners. Ages 18-40. Pictorial withdrawal scale for cross-cultural validity. Salivary cortisol as biomarker.

How the study worked

Study protocol for prospective observational study. 120 Indigenous prisoners (60 male, 60 female). Pictorial Cannabis Withdrawal Scale. Salivary cortisol markers. Generalized estimating equations for changes over time. Qualitative assessment of culturally acceptable interventions.

What this study cannot tell us

This is a study protocol, not a results paper. The challenges of research in custodial settings (consent, access, trust) are substantial. The pictorial withdrawal scale had not yet been validated. Salivary cortisol is influenced by many factors beyond cannabis withdrawal.

How to read the evidence

Study protocol only; no results reported.

When this study was published

Published in 2013. Cannabis withdrawal was included in the DSM-5 the same year.

The bigger picture

This protocol represents an important step toward equitable health research. Cannabis withdrawal has been studied primarily in Western, college-educated populations, and assessment tools may not be valid across cultures. Developing pictorial tools that work cross-culturally could benefit global cannabis withdrawal research.

Questions still open

Is cannabis withdrawal more severe in populations with higher baseline use? Does the pictorial scale perform as well as text-based scales? Could culturally appropriate withdrawal management reduce custodial violence? Do cortisol patterns during withdrawal predict symptom severity?

Common questions

Why study cannabis withdrawal in prisoners?

When people with cannabis dependence are incarcerated, they are forced to stop using abruptly. This can cause withdrawal symptoms including irritability, anger, and sleep disturbances, which in a custodial setting can escalate to violence and self-harm. Understanding and managing withdrawal in this context is both a health and safety issue.

Why is a pictorial withdrawal scale needed?

Standard cannabis withdrawal scales use text-based questions that may not be valid across cultures and literacy levels. Indigenous Australian populations may benefit from pictorial representations of symptoms that do not depend on Western medical terminology. This approach could also be valuable for other populations where language or literacy barriers exist.

Read the original research

An exploratory study of cannabis withdrawal among Indigenous Australian prison inmates: study protocol.

BMJ open, 3(5)

View on PubMed ↗Publisher’s paper ↗

Citation

Rogerson, Bernadette; Copeland, Jan; Buttner, Petra; Bohanna, India; Cadet-James, Yvonne; Sarnyai, Zoltan; Clough, Alan R. (2013). An exploratory study of cannabis withdrawal among Indigenous Australian prison inmates: study protocol.. BMJ open, 3(5). https://doi.org/10.1136/bmjopen-2013-002951