title: An exploratory study of cannabis withdrawal among Indigenous Australian prison inmates: study protocol.
abstract: BACKGROUND
  Cannabis use and dependence is a serious health and criminal justice issue among incarcerated populations internationally. Upon abrupt, enforced cessation of cannabis, prisoners may suffer irritability and anger that can lead to threatening behaviour, intimidation, violence, sleep disturbances and self-harm. Cannabis withdrawal syndrome, proposed for inclusion in the Diagnostic and Statistical Manual of Mental Disorders in 2013, has not been examined in Indigenous populations. Owing to the exceptionally high rates of cannabis use in the community, high proportions of Australian Indigenous prisoners may suffer from withdrawal upon entry to custody.
  
  
  METHODS
  60 male and 60 female Indigenous prisoners (18-40 years) at a high risk of cannabis dependence will be recruited upon entry to custody. A pictorial representation of the standard Cannabis Withdrawal Scale will be tested for reliability and validity. Cortisol markers will be measured in saliva, as the indicators of onset and severity of cannabis withdrawal and psychological distress. The characteristics will be described as percentages and mean or median values with 95% CI. Receiver operator curve analysis will determine an ideal cut-off of the Cannabis Withdrawal Scale and generalised estimating equations modelling will test changes over time. The acceptability and efficacy of proposed resources will be assessed qualitatively using thematic analysis.
  
  
  RESULTS
  A valid and reliable measure of cannabis withdrawal for use with Indigenous populations, the onset and time course of withdrawal symptoms in this population and the development of culturally acceptable resources and interventions to identify and manage cannabis withdrawal.
  
  
  BACKGROUND
  The project has been approved by the James Cook University Human Research Ethics Committee (approval number H4651).The results will be reported via peer reviewed publications, conference, seminar presentations and on-line media for national and international dissemination.
authors.affiliation: School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Cairns and Townsville, Queensland, Australia.
authors.forename: Bernadette
authors.initials: B
authors.lastname: Rogerson
authors.forename: Jan
authors.initials: J
authors.lastname: Copeland
authors.forename: Petra
authors.initials: P
authors.lastname: Buttner
authors.forename: India
authors.initials: I
authors.lastname: Bohanna
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Cadet-James
authors.forename: Zoltan
authors.initials: Z
authors.lastname: Sarnyai
authors.forename: Alan R
authors.initials: AR
authors.lastname: Clough
keywords: Australia; Cannabis; Indigenous; Prisoners; Substance Withdrawal Syndrome