The effects of cannabis use on health and social adjustment are profound.
Substance misuse by Indigenous people has long been recognised
as one of the devastating consequences of contact with
Western culture. Misuse of tobacco, alcohol and petrol
among Indigenous Australians has received much attention. Cannabis,
by contrast, has not been viewed as a major problem. But
since the 1990s, it has become apparent that heavy cannabis use is
common in some remote Indigenous communities.1 The associated
health and social burdens are now being recognised.
Indigenous Australians, whether living in urban or rural
settings, are more likely than other Australians to report cannabis
use. Recent reports suggest that cannabis use is also relatively
high among Indigenous populations in New Zealand, Canada
and North America. Limited data are available on patterns of
cannabis use among Indigenous Australians. However, a recent
5-year study of adolescents and young adults in three remote
communities in Arnhem Land in the Northern Territory has
found that not only is cannabis use common in remote Indigenous
settings, but its effects on health and social adjustment are
profound. These three communities are close to one another but very
isolated, being over 550 kilometres from the nearest city. There is
one local Indigenous language, and English is a secondary language.
Tobacco use was found to be the norm in these communities,
with over 90% of adolescents and young adults smoking.
Because of restricted access to alcohol, problem drinking was
uncommon. In contrast, cannabis use was endemic, with over
70% of males and 20% of females being current users. Cannabis
was typically consumed mixed with tobacco and smoked using a
locally fashioned “bucket bong” that gives the user a rapid and
intense dose with little smoke lost. Regular heavy use (_6
“cones” daily) was found in almost 90% of users. This is around
twice the consumption of regular cannabis users elsewhere in
Australia. Furthermore, about 90% of the Indigenous users
reported symptoms of cannabis dependence. This compares with
about 20% of users aged 18 or over in the general Australian
population.3 Of even greater concern was a suggestion that, for
most Indigenous users, cannabis was not a passing adolescent
phase. After 5 years of follow-up, the great majority reported
continuing heavy use.
Cannabis use was linked to substantial health problems and
social burdens in these communities, which are already disadvantaged
by isolation and poverty. Up to 10% of the communities’
total income and between 31% and 62% of a user’s median weekly
income was spent on cannabis. Cannabis users were less likely
than non-users to participate in education or training and more
likely to report auditory hallucinations, suicidal ideation, symptoms
of depression, and having been imprisoned. Community
violence increased when cannabis supplies were scarce. The
effects on traditional life were described by one NT Indigenous
mental health clinician in the following way:
Too many of my people are chained to [cannabis]. They don’t
go out hunting or spend time by the river with their family.
They just sit and smoke [cannabis], then look for money to buy
more [cannabis] and get into fights when they can’t get any
(Muriel Jaragba, personal communication).
What accounts for the unusual patterns of cannabis misuse in
these remote Indigenous communities? There is little evidence that
cannabis is grown locally, but much anecdotal evidence that
market networks supplied by dealers based in urban or regional
centres are extensive and resilient, making cannabis readily available
(A R C, unpublished observation). Alcohol restrictions have
been effective in reducing problem drinking within communities,
but may have had the undesirable consequence of encouraging an
increase in cannabis use where it could be easily obtained. As
with risks for other forms of substance misuse in these communities,
the social context is important. Limited employment and
education opportunities; crowded, poor-quality housing; community-
wide feelings of disempowerment; and grief and loss related
to high mortality, morbidity and incarceration rates are all likely
risk factors for substance misuse. Cannabis misuse is likely to be
both a consequence of this type of social disadvantage and a
perpetuating influence.
Cannabis misuse in remote Indigenous communities has been
overlooked for too long. It is now clear that it is yet another major
problem for these already disadvantaged communities, with evidence
of cannabis misuse across a broad area of northern Australia.
As well as in the NT, concerns about the level of cannabis
use have recently been noted in Cape York and anecdotally in
other parts of remote and regional Australia. Further research is
needed to investigate the impact of cannabis use on urban
Aboriginal and Torres Strait Islander Australians.
Effective responses will not be easy. Controls on supply by
state- or territory-based police are one of the few available
measures. In order to be effective, policymakers and service
providers would need to work collaboratively with local communities
to tie in local prevention and treatment initiatives with
existing supply control initiatives. Such programs would need to
use Indigenous language and cultural frameworks, build capacity
of local Indigenous professionals, and improve understanding of
the harms associated with cannabis misuse. Ultimately, tackling
the misuse of cannabis and other substances in remote settings
will depend on creating opportunities for social development
and for continuing education, training and employment of
adolescents and young adults.

Source: 228 MJA • Volume 190 Number 5 • 2 March 2009