Listening to what Indigenous people in remote communities say about alcohol restrictions and cannabis use: “Good thing that the alcohol’s gone, but the gunja has kept going”

To the Editor: In Cape York Indigenous communities, alcohol restrictions started in 2002–2003, with local prohibition in some communities since 2008.1 These restrictions may have halved alcohol-related injuries,1 a historically important change. However, residents of Cape York Indigenous communities suggest that there has been an accompanying rise in cannabis use over this period (Box 1). During consultations in 2011 for Minister Macklin’s controversial Stronger Futures in the Northern Territory Act 2012, concerns about cannabis use were also raised by Northern Territory Aboriginal people.2 While the Northern Territory Emergency Response2 (NTER) promised stronger alcohol restrictions, the concerns of Aboriginal people about cannabis use in their communities have been ignored.

Some observers are concerned that the positive effects of NTER alcohol restrictions may be undermined if these controls are blamed for causing an epidemic of cannabis use.3 Unfortunately, in the NT, links between recent alcohol restrictions and cannabis use cannot be established retrospectively, because alcohol has generally been controlled in remote communities since 1978 under the restricted area provisions of the NT Liquor Act 1978.3 This predates a documented rise in cannabis use from the mid to late 1990s in remote NT communities.4 But in Cape York, alcohol restrictions commenced after cannabis was introduced, so possible links can be investigated.

In three Cape York communities where alcohol was abruptly restricted in mid 2003 and prohibited in 2008, we recently interviewed 431 people aged 15–49 years about cannabis. This provided the first opportunity to understand the effect of alcohol restrictions on cannabis use with quantitative data. The number of people taking up cannabis increased markedly after 2003 across the communities (Box 2) (incidence rate ratio [IRR], 2.93; 95% CI, 2.20–3.91; P < 0.001). A concerning number of women began using cannabis after alcohol restrictions were introduced (IRR, 4.51; 95% CI, 2.60–7.83; P < 0.001), and there has been a significant increase in the number of men taking up cannabis (IRR, 2.81; 95% CI, 2.11–3.74; P < 0.001) (Box 2).

Most of our interview group were aged less than 25 years. Recent data links cannabis use with psychosis in more than 50% of patients in Cape York.5 Much attention is rightly focused on controlling alcohol consumption in remote Indigenous communities. Indigenous people in both NT and Cape York communities have expressed concern about interlinked substance misuse issues and, particularly in Cape York, the impact on crucial segments of the population (young women and their children). Immediate, inclusive policy review is required to address these concerns.

2 Year of starting cannabis use for 199 current and former cannabis users* in three remote Cape York Indigenous communities, 1978–2011†

* 125 male and 74 female. † Data compiled in 2010–2011 from a community sample of 431 people aged 15–49 years.