Use of Cannabis for Harm Reduction Among People at High Risk for Overdose in Vancouver, Canada (2016–2018)

Mok, Janice; Milloy, M‐J; Grant, Cameron; Lake, Stephanie; DeBeck, Kora; Hayashi, Kanna; Socías, M. Eugenia

doi:10.2105/ajph.2021.306168

Cited by 35 publications

(6 citation statements)

References 11 publications

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“…Finally, we also observed a significantly higher prevalence of opioid frequency reduction among people who increased their cannabis use during the pandemic. Although the self-reported use of cannabis to reduce or stop the use of unregulated or nonprescribed opioids and stimulants has been documented across samples of medical cannabis patients (Lucas et al, 2013(Lucas et al, , 2016, people who use drugs (Mok et al, 2021), and a representative sample of the U.S. population (Ishida et al, 2019), we hesitate to interpret our finding as being consistent with these observations as our study did not capture information about the intention to reduce a secondary substance with cannabis.…”

Section: Discussionmentioning

confidence: 74%

Changes in secondary substance use after the onset of the COVID-19 pandemic among people who use cannabis: Findings from a web-based sample of adults in the United States.

Lake¹,

Assaf²,

Gorbach³

et al. 2023

Experimental and Clinical Psychopharmacology

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The coronavirus disease 2019 (COVID-19) pandemic has had widespread impacts on mental health and substance use. Increases in cannabis use have been documented in the United States, but little is known about how other substance use has changed among people who use cannabis. We sought to examine changes in alcohol, tobacco, opioid, and stimulant use during COVID-19 and explore how these changes relate to patterns of cannabis use. Data were obtained from a web-based survey of adults in the United States who use cannabis (n = 1,471) administered in September 2020. Using data reported in retrospective (prepandemic) and time-of-survey assessment periods, we explored changes in the prevalence of regular (≥ weekly) alcohol, tobacco, opioid, and stimulant use during COVID-19 among respondents who used medical and nonmedical cannabis. We used modified Poisson regression to examine cannabis-related correlates of increasing or decreasing secondary substance use during the pandemic. There was a slight but significant increase in ≥weekly alcohol use in the medical use group only (41.4%-47.0%, p = .034). ≥Weekly tobacco, opioid, and stimulant use did not change significantly. Pandemic-concurrent shifts in secondary substance use depended on interacting cannabis-related factors including medical cannabis use, prepandemic cannabis frequency, and pandemic-concurrent frequency changes. For example, ≥weekly prepandemic cannabis use was significantly and positively associated with decreasing opioid use frequency among the medical cannabis use group only. Assessments of the pandemic's effects on substance use should consider relationships between cannabis and other substances, which may differ according to cannabis-specific behaviors, motives, and contexts of use. Public Health SignificanceThis study suggests that, overall, ≥weekly use of tobacco, opioids, and stimulants did not change substantially early after the onset of the coronavirus disease 2019 (COVID-19) pandemic in a sample of people who use cannabis. Modest group-level changes in alcohol use were detected among people who use medical cannabis. On an individual level, interaction between purpose, frequency, and COVIDconcurrent changes in cannabis use influenced the likelihood of increasing or decreasing alcohol, tobacco, opioid, or stimulant use, highlighting cannabis-specific indicators of heightened vulnerability to the pandemic's effects on mental health and substance use.

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Section: Discussionmentioning

confidence: 74%

Changes in secondary substance use after the onset of the COVID-19 pandemic among people who use cannabis: Findings from a web-based sample of adults in the United States.

Lake¹,

Assaf²,

Gorbach³

et al. 2023

Experimental and Clinical Psychopharmacology

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“… 5 , 6 Recent cohort studies revealed that individuals at high risk of overdose commonly substitute cannabis for more harmful drugs (e.g., stimulants and opioids) as a harm reduction strategy. 7 Further, individuals reporting difficulty accessing addiction treatment or who used substances with limited treatment options, such as methamphetamines, had a higher likelihood of using cannabis as a harm reduction strategy. 8 These findings highlight the potential harm-reducing impacts of cannabis among PWUD.…”

Section: Introductionmentioning

confidence: 99%

Cannabidiol as a Harm Reduction Strategy for People Who Use Drugs: A Rapid Review

Lo,

MacCallum,

Nanson

et al. 2023

Can J Psychiatry

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Objective The drug poisoning crisis throughout North America necessitates novel harm reduction approaches. Emerging evidence suggests that cannabidiol (CBD) may have some utility as a harm reduction modality for those with problematic substance use. This rapid review aimed to synthesize available evidence on CBD as a potential harm reduction tool for people who use drugs while providing clinical and research insights. Method A systematic search in EMBASE, MEDLINE, CENTRAL, and CINAHL was completed in July 2022. For inclusion, studies had to meet the following criteria: (1) drawn from an adult population of people who use drugs; (2) investigates CBD as an intervention for problematic substance use or harm reduction–related outcomes; (3) be published after the year 2000 and in English; and (4) be primary research or a review article. A narrative synthesis was used to group outcomes relevant to harm reduction and provide clinical and research insights. Results We screened 3,134 records, of which 27 studies (5 randomized trials) were included. The evidence remains limited, but available studies support the potential utility of CBD to reduce drug-induced craving and anxiety in opioid use disorder. There were low-quality studies suggesting that CBD may improve mood and general well-being of people who use drugs. Evidence suggests that CBD monotherapy may not be an adequate harm reduction strategy for problematic substance use but rather an adjunct to the standard of care. Conclusion Low-quality evidence suggests that CBD may reduce drug cravings and other addiction-related symptoms and that CBD may have utility as an adjunct harm reduction strategy for people who use drugs. However, there is a significant need for more research that accurately reflects CBD dosing and administration regimens used in a real-world context.

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“…Cannabis is a green leafy plant that humans have used for millennia due to its psychoactive and medicinal properties. A growing body of literature has identified a potential role for cannabis in reducing the harms associated with using other substances, including alcohol, opioids and stimulants (Lucas et al, 2020; Mok et al, 2021; Scavone et al, 2013; Socías et al, 2017). Indeed, recent research indicates that cannabis use can potentially play a therapeutic role for many people who use drugs (PWUD), including those at high risk of drug‐related harms such as overdose.…”

Section: Introductionmentioning

confidence: 99%

“…Several small trials in individuals with opioid use disorder showed reduced opioid craving for up to a week following a three-day treatment regimen with CBD (Hurd et al, 2015(Hurd et al, , 2019Suzuki et al, 2022). However, despite the devastating toll of overdose and other consequences of the ongoing drug poisoning epidemic, the application of medical cannabis therapies as part of a harm-reduction approach and recovery strategy has encountered significant barriers (Belle-Isle et al, 2014;Lo et al, 2023;Lucas, 2017;Mok et al, 2021Mok et al, , 2022. The present perspective piece examines obstacles that have impeded the implementation of cannabinoid therapies in the context of problematic substance use and addiction services.…”

mentioning

confidence: 99%

Stigma‐related barriers to medical cannabis as harm reduction for substance use disorder: Obstacles and opportunities for improvement

Fehr,

Lo,

Nelson

et al. 2023

Int J Mental Health Nurs

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Emerging evidence on substituting cannabis for more harmful drugs has led to cannabis becoming a novel harm‐reduction strategy for combating the current drug poisoning crisis. However, the authorization of medical cannabis as part of a harm‐reduction approach and recovery strategy has significant implementation barriers rooted in longstanding stigma towards cannabis. Through a multi‐discipline collaboration of Canadian clinicians and academic researchers, we highlighted stigma barriers and opportunities to address these barriers to elicit improved delivery of medical cannabis as a harm‐reduction therapy within existing therapeutic frameworks. Evidence from existing literature and real‐world experiences converged on three key themes related to stigma barriers: (1) Lack of medical cannabis education within the healthcare community, (2) lack of consensus and coordination among harm‐reduction services and (3) access to medical cannabis. We highlight potential solutions to these issues, including improved healthcare education, better coordination between care teams and suggestions for improving access. Through this discussion, we hope to contribute to reducing the stigma around using medical cannabis as a harm‐reduction strategy for individuals with a substance use disorder and consider new perspectives in policy development surrounding recovery services.

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Use of Cannabis for Harm Reduction Among People at High Risk for Overdose in Vancouver, Canada (2016–2018)

Cited by 35 publications

References 11 publications

Changes in secondary substance use after the onset of the COVID-19 pandemic among people who use cannabis: Findings from a web-based sample of adults in the United States.

Changes in secondary substance use after the onset of the COVID-19 pandemic among people who use cannabis: Findings from a web-based sample of adults in the United States.

Cannabidiol as a Harm Reduction Strategy for People Who Use Drugs: A Rapid Review

Stigma‐related barriers to medical cannabis as harm reduction for substance use disorder: Obstacles and opportunities for improvement

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