Despite the strong rationale for the present study, the efficacy of lithium over placebo in the management of cannabis withdrawal was not demonstrated.

Study Objectives: Sleep disturbance is a hallmark feature of cannabis withdrawal. In this study we explored the effects of lithium treatment supplemented with nitrazepam on objective and subjective measures of sleep quality during inpatient cannabis withdrawal. Methods: Treatment-seeking cannabis-dependent adults (n = 38) were admitted for 8 days to an inpatient withdrawal unit and randomized to either oral lithium (500 mg) or placebo, twice daily in a double-blind RCT. Restricted nitrazepam (10 mg) was available on demand (in response to poor sleep) on any 3 of the 7 nights. Dependent outcome measures for analysis included repeated daily objective actigraphy and subjective sleep measures throughout the 8 day detox, subjective cannabis withdrawal ratings, and detoxifi cation completion rates. S leep diffi culties and cannabis use appears to be a bi-directional relationship. Individuals often start using cannabis when they experience sleep diffi culties during stressful times, often for coping reasons 1 ; and this is a risk factor for cannabis lapse (within the fi rst 2 days out of 7) following a self-guided quit attempt.2,3 The most prevalent sleep disturbances with cannabis withdrawal include diffi culty getting to sleep, staying asleep, nightmares and strange dreams, and night sweats.4 During the withdrawal process, sleep diffi culties predict relapse to cannabis use. [5][6][7][8] There is some evidence that pharmacotherapy during cannabis abstinence attenuates withdrawal related sleep disturbances, 9 including improvements in polysomnographic measures of sleep effi ciency (but not latency) with the nonbenzodiazepine GABA(A) receptor agonist zolpidem.10 While there is a plethora of studies exploring self-reported sleep disturbances associated with cannabis withdrawal, there are very S C I E N T I F I C I N V E S T I G AT I O N Sfew that quantify sleep patterns using objective means, with the exception of the paper by Vandrey et al. 10 Poor sleep is often the last symptom to remit, and recent trials have started to specifi cally target sleep disturbances during withdrawal. Haney and colleagues conducted a small BRIEF SUMMARY Current Knowledge/Study Rationale: Sleep disturbance is the most consistent, prevalent, and severe symptom of cannabis withdrawal. However, there are currently no evidence-based medicines to assist with cannabis dependence or cannabis withdrawal. Study Impact: This formal RCT demonstrates that, contrary to positive open label clinical fi ndings, lithium carbonate does not improve cannabis withdrawal related sleep disturbances. However, the hypnotic benzodiazepine rescue medication nitrazepam signifi cantly improved multiple objective measures of sleep disturbance during cannabis withdrawal.

The response to drug and alcohol problems in a small Australian rural community is described. The town of Nimbin, the centre of this community, is characterized by alternative life-styles. The area has received considerable publicity over illicit drug use, particularly marijuana-growing and a recent increase in injecting drug usage. The town has one medical practice with two general practitioners and this centre has been actively involved in the development of drug and alcohol services. This paper describes the development of a drug and alcohol service from the perspective of a local general practitioner. Reference is made to problems of community resistance, hospital issues and the steps taken to acquire knowledge and skills in the management of patients presenting to the practice. The importance of a multidisciplinary team approach in the development of services which included a needle and syringe exchange and a methadone treatment programme is emphasized.