Cannabis as a Method for Harm Reduction

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Cannabis as a Method for Harm Reduction

Key Takeaways

  • This past May 2021, the American Journal of Public Health published a report that found that 25% of marginalized individuals use cannabis for harm reduction, adding that study participants were most likely to leverage cannabis as a substitute for stimulants (50%) and illegal opioids (31%).
  • The same journal released a related study the prior year that determined that daily cannabis use was associated with the more rapid cessation of injections of other substances (16%), particularly opioid cessation.
  • In July 2020, PLOS ONE published a qualitative research study that found that many street youths “explicitly framed cannabis as a form of mental health and substance use treatment that was more effective and healthier.”
  • That same year, the journal of Drug Science, Policy and Law released the results of a survey that found that almost all (92.3%) participants stated that cannabis “positively impacted...their physical and/or mental wellbeing” while seeking treatment for substance abuse disorders, adding that more than half (56.4%) of study participants used less of more harmful substances due to their use of cannabis.
  • In 2019, the Harm Reduction Journal published a research study that determined that individuals are most likely to use cannabis as a substitute for prescription medications (69.1%), followed by alcohol (44.5%), tobacco (31.1%) and illicit substances (26.6%).

Introduction

The research team has provided seven additional reports that discuss cannabis as a method for harm reduction for other substances. All of these reports were identified from reputable medical publications. In select cases, slightly dated (2019) studies were provided given the relatively niche nature of the subject matter, and the desire to deliver the most robust inventory of relevant reports possible.

#1: American Journal of Public Health

  • This past May 2021, the American Journal of Public Health published the report “Use of Cannabis for Harm Reduction Among People at High Risk for Overdose in Vancouver, Canada.”
  • Researchers assessed data from three cohorts of marginalized individuals who used drugs in the Vancouver area between 2016-2018 to determine how frequently cannabis was leveraged in informal settings to reduce the harm associated with other substances.
  • Although full details of the report are currently behind a paywall, the publicly available report abstract shared that researchers found that 25% of participating individuals used cannabis to reduce their use of more dangerous substances during the study time frame, thereby making cannabis a “common” harm reduction strategy.
  • Individuals were most likely to leverage cannabis as a substitute for stimulants (50%) and illegal opioids (31%).

#2: American Journal of Public Health

  • Several months prior, in June 2020, the American Journal of Public Health released a similar study entitled “Frequent Cannabis Use and Cessation of Injection of Opioids, Vancouver, Canada, 2005–2018.”
  • The analysis once again reviewed information from three cohorts located in the Vancouver, Canada area, this time between 2005 and 2018.
  • In contrast to the preceding report, this study was aimed at understanding the potential correlation between frequent cannabis use and the cessation/relapse of injections for other substances.
  • The researchers ultimately determined that daily cannabis use was associated with the more rapid cessation of injections of other substances (16%), particularly opioids.
  • Moreover, the use of cannabis was not significantly associated with relapse activity with such injections.

#3: PLOS ONE

  • That same year, in July 2020, PLOS ONE published the report ““Something that actually works”: Cannabis use among young people in the context of street entrenchment.”
  • The study sought to examine the potential impacts of cannabis use on harm reduction within younger communities through a series of “semi-structured, in-depth qualitative interviews” of street youths and youth care providers in Canada between 2017 and 2018.
  • The interviews revealed that most street youths engaged in “daily, intensive” cannabis use at the same time as they experimented/used other substances, such as “alcohol, fentanyl, heroin and meth.”
  • Despite the broad usage of cannabis, no study participants used cannabis on a purely recreational basis; rather, many participants “explicitly framed cannabis as a form of mental health and substance use treatment that was more effective and healthier.”
  • Moreover, cannabis was leveraged to facilitate transitions out of homelessness.
  • Relevant excerpts from the research interviews have been provided directly below for review as desired:
    • "There was a period of time there when I was sober for about–almost 5 months. I still had cravings [for alcohol] but it wasn’t so bad because I was using pot to wean myself off of it. At least I had something, and then [on pot], you know, I’m not flailing off and not remembering anything and a week later I’m in a ditch somewhere–like, have none of my belongings, don’t know what city I’m in. Eventually I was able to maintain a job, I was able to move back with my dad. It’s much better, smoking pot, eating food, going to bed. Like, I just get too relaxed and lazy to want to do anything else. (White Female)."
    • "It’s like harm reduction for me. When I’m sick and I have to have down [heroin], I could take a few bong rips instead and I’m, like, ‘Okay, I’m good.’ If I smoke weed all day, like, I might not even notice that, like, there’s no heroin in me. (While male)."
    • "I don’t wanna [inject meth and heroin] anymore. As soon as I think about it–like, right now, I’m kind of getting a craving for it. But right after [this interview], I’m not gonna go out and pick any up, I’m gonna go to my dispensary and pick up a joint and I’ll be all fine. The methadone and the weed just, like, connects together, and then all the cravings are gone. (White male)."
    • "I’m pretty baked, like, 100 percent of the day every day. Weed blocks the thought of doing dope. Instead of being like, oh, why don’t I just do dope? I don’t think about anything really when I’m high on weed. I’m kind of still taking my Suboxone, but the Suboxone doesn’t really do anything ‘cause the weed just blocks, like, the thought of doing dope. (Indigenous male)."
    • "I haven’t considered going to residential treatment because I can’t use weed there, you know? Because, like, that’s a medicine for me. It’s not a drug. So, like, that’s been a huge barrier in my getting clean and sober. It’s a challenge for those of us who use [weed] medically. (Indigenous non-binary person)."
    • "I’m taking Gabapentin and, uh, Trazodone. I’ve got anxiety and depression, but I don’t wanna be taking pills my whole life. So I’ve been buying the CBD pills a lot. It’s healthier. (White male)."

#4: Drug Science, Policy and Law

  • At the beginning of 2020, the journal of Drug Science, Policy and Law released the results of a survey entitled “Can prescribed medical cannabis use reduce the use of other more harmful drugs?”
  • To answer this question, researchers surveyed 39 British individuals who were both using cannabis as well as accessing a specialist treatment service for substance misuse.
  • Notably, almost all (92.3%) of survey participants stated that cannabis “positively impacted...their physical and/or mental wellbeing” while seeking treatment for substance abuse disorders.
  • Moreover, more than half (56.4%) reported that they used less of more harmful substances due to their use of cannabis.
  • The researchers concluded that, despite the relatively small sample size of this analysis, cannabis had a “notable potential positive impact” as a harm reduction agent.

#5: Harm Reduction Journal

  • In 2019, the Harm Reduction Journal published the research study “Medical cannabis patterns of use and substitution for opioids & other pharmaceutical drugs, alcohol, tobacco, and illicit substances.”
  • Researchers distributed a 239-question cross-sectional survey in 2017 to registered medical cannabis patients in Canada to better understand the patterns of cannabis use and its impact on their use of other substances such as “prescription drugs, illicit substances, alcohol, and tobacco.”
  • Researchers determined that study participants were most likely to use cannabis as a substitute for prescription medications (69.1%).
  • Cannabis also reduced the use of alcohol (44.5%), tobacco (31.1%) and illicit substances (26.6%) among a substantial portion of those medically authorized to use cannabis.
  • Notably, women were more likely to use cannabis as a substitute to reduce harm from other substances than men.

#6: Advances in Psychedelic Medicine

  • That same year saw the release of the book “Advances in psychedelic medicine: state-of-the-art therapeutic applications.”
  • Although the full contents of the book are available only for purchase, the publicly available book abstract reveals that the authors provide a synopsis of medical research related to the use of cannabis for harm reduction.
  • Generally speaking, the authors acknowledge that over a decade of preclinical and clinical studies have demonstrated “evidence that cannabidiol (CBD) could be a treatment option for substance-related disorders.”
  • In particular, evidence indicates that cannabis is effective to “improve quality of life or as a substitute for more dangerous drugs such as cocaine and heroin.”
  • However, the authors acknowledge that cannabis may not be a solution to achieve “complete abstinence” from other drugs.

#7: Frontiers in Pharmacology

  • More recently in April 2021, the journal of Frontiers in Pharmacology released the report “Practical Strategies Using Medical Cannabis to Reduce Harms Associated With Long Term Opioid Use in Chronic Pain.”
  • Unlike the preceding reports, this article presents a “clinical tool to serve as a foundational clinical guideline for the initiation of medical cannabis in the management of CNCP patients using chronic opioid therapy.”
  • The researchers state that cannabis can and should be introduced in appropriate chronic non-cancer pain scenarios to manage the use of chronic opioid therapy and reduce associated harm.
  • Generally speaking, the report states that the introduction of cannabis treatment leads to “better pain control clinically with lower doses of opioids, improved pain related outcomes and reduced opioid related harm.”

Research Strategy

For this research on cannabis as a method for harm reduction for other substances, the research team leveraged the most reputable sources available in the public domain, including the American Journal of Public Health, PLOS ONE, the journal of Drug Science, Policy and Law and Harm Reduction Journal. In select cases, slightly dated (2019) studies were provided given the relatively niche nature of the subject matter, and the desire to provide the most robust inventory of relevant reports possible.

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