A safer alternative: Cannabis substitution as harm reduction

Lau, Nicholas; Sales, Paloma; Averill, Sheigla; Murphy, Fiona; Sato, Sye-Ok; Murphy, Sheigla

doi:10.1111/dar.12275

Cited by 127 publications

(79 citation statements)

References 17 publications

(27 reference statements)

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“…Dynamics reported by our study participants are consistent, however, with more recent research in Canada and the USA, which point to cannabis substitution to be a potentially effective harm reduction strategy for PWID [57–60]. Participants also described OAT as a useful method for achieving injection cessation and stabilizing their lives.…”

Section: Discussionsupporting

confidence: 88%

Social-structural factors influencing periods of injection cessation among marginalized youth who inject drugs in Vancouver, Canada: an ethno-epidemiological study

et al. 2017

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BackgroundInjection drug use is associated with HIV and hepatitis C transmission, overdose, and other preventable harms. These harms are heightened for structurally vulnerable injection drug-using populations, as their social conditions pose barriers to safer injecting. Previous research on injection cessation has largely focused on adult drug-using populations. Little qualitative work has examined the social, structural, and environmental factors that shape periods of injection cessation among youth and young adults. Such research is essential to understanding how we can best reduce harms among this vulnerable population as they move in and out of periods of injection cessation.MethodsWe conducted 22 semi-structured, qualitative interviews with street-involved young people who use drugs (SY), focused on characterizing their transitions into periods of injection cessation and perceived barriers to injection cessation. Adopting an ethno-epidemiological approach, participants who had experienced at least 6 months of injection cessation were purposively recruited from an ongoing prospective cohort study of SY in Vancouver, Canada to participate in qualitative interviews. Qualitative interview findings were triangulated with the findings of a longitudinal program of ethnographic research with SY in this setting. This ethno-epidemiological approach allowed for a more robust exploration of contextual factors surrounding drug use patterns than would be possible through traditional epidemiological methods alone.ResultsFindings indicate that periods of injection cessation were influenced by access to harm reduction-informed youth-focused services, transitions in route of administration (e.g., from injecting methamphetamine to the smoking of methamphetamine), and the provision of housing and social supports (e.g., from friends, family, and care providers). Conversely, participants indicated that inadequate social supports and, for some, abstinence-focused treatment methods (e.g., 12-step programs), impeded efforts to cease injecting.ConclusionsTo reduce harms, it is imperative to reorient attention toward the social, structural, and spatial contexts that surround injection drug use and shape periods of injection cessation for SY. There is an urgent need for more comprehensive youth-focused services for those engaged in injection drug use, and further study of innovative means of engaging youth.

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Section: Discussionsupporting

confidence: 88%

Social-structural factors influencing periods of injection cessation among marginalized youth who inject drugs in Vancouver, Canada: an ethno-epidemiological study

et al. 2017

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“…It is important to note that active “substitution” with cannabis may be a conscious decision to reduce harm caused by narcotics 32. Not only may opioid therapy prove ineffective for some patients but it may also induce serious adverse reactions that complicate management, including allodynia or opioid-induced hyperalgesia, also known as “paradoxical pain” 33.…”

Section: Discussionmentioning

confidence: 99%

Cannabis as a substitute for prescription drugs – a cross-sectional study

Corroon¹,

Mischley²,

Sexton

2017

JPR

174

127

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BackgroundThe use of medical cannabis is increasing, most commonly for pain, anxiety and depression. Emerging data suggest that use and abuse of prescription drugs may be decreasing in states where medical cannabis is legal. The aim of this study was to survey cannabis users to determine whether they had intentionally substituted cannabis for prescription drugs.MethodsA total of 2,774 individuals were a self-selected convenience sample who reported having used cannabis at least once in the previous 90 days. Subjects were surveyed via an online anonymous questionnaire on cannabis substitution effects. Participants were recruited through social media and cannabis dispensaries in Washington State.ResultsA total of 1,248 (46%) respondents reported using cannabis as a substitute for prescription drugs. The most common classes of drugs substituted were narcotics/opioids (35.8%), anxiolytics/benzodiazepines (13.6%) and antidepressants (12.7%). A total of 2,473 substitutions were reported or approximately two drug substitutions per affirmative respondent. The odds of reporting substituting were 4.59 (95% confidence interval [CI], 3.87–5.43) greater among medical cannabis users compared with non-medical users and 1.66 (95% CI, 1.27–2.16) greater among those reporting use for managing the comorbidities of pain, anxiety and depression. A slightly higher percentage of those who reported substituting resided in states where medical cannabis was legal at the time of the survey (47% vs. 45%, p=0.58), but this difference was not statistically significant.DiscussionThese patient-reported outcomes support prior research that individuals are using cannabis as a substitute for prescription drugs, particularly, narcotics/opioids, and independent of whether they identify themselves as medical or non-medical users. This is especially true if they suffer from pain, anxiety and depression. Additionally, this study suggests that state laws allowing access to, and use of, medical cannabis may not be influencing individual decision-making in this area.

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“…In light of emerging research in similar settings demonstrating the use of cannabis to curb the frequency of other illicit drug use, including opioid use (Kral et al, 2015; Lau et al, 2015; Lucas et al, 2013; Lucas et al, 2015), it is possible that some individuals engage in daily cannabis use as a means of reducing their use of other illicit drugs. If true, this shift in drug use pattern may be accompanied by a higher likelihood of engaging in ART care and adhering optimally to ART simply due to improved management of higher risk illicit drug use (Palepu et al, 2003; Rosen et al, 2013).…”

Section: Discussionmentioning

confidence: 99%

“…However, more recent research suggests that high-intensity cannabis use may be linked to poorer HIV treatment outcomes, including exhibiting a detectable viral load (Bonn-Miller et al, 2014). Emerging research also suggests that some PWUD may use cannabis to substitute for higher-risk drug use patterns, including opioid use (Kral et al, 2015; Lau et al, 2015; Lucas et al, 2013; Lucas et al, 2015). In this sense, cannabis use may prove beneficial for TasP efforts among PWUD, given the known association between illicit opioid use with reduced likelihood of adherence to ART (Azar et al, 2015; Jeevanjee et al, 2014; Rosen et al, 2013; Shannon et al, 2005), and subsequent viral treatment failure (Nolan et al, 2011).…”

Section: Introductionmentioning

confidence: 99%

High-intensity cannabis use and HIV clinical outcomes among HIV-positive people who use illicit drugs in Vancouver, Canada

Lake

Kerr

Capler

et al. 2017

International Journal of Drug Policy

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Background Reforms to the legal status of medical and non-medical cannabis are underway in many jurisdictions, including Canada, as are renewed efforts to scale-up HIV treatment-as-prevention (TasP) initiatives. It has been suggested that high-intensity cannabis use may be associated with sub-optimal HIV treatment outcomes. Thus, using data from a setting with a community-wide treatment-as-prevention (TasP) initiative coinciding with increasing access to medical cannabis, we sought to investigate the possible impact of high-intensity cannabis use on HIV clinical outcomes. Methods Data was derived from the ACCESS study, a prospective cohort of HIV-positive people who use illicit drugs (PWUD) in Vancouver, Canada. Cohort data was confidentially linked to comprehensive clinical profiles, including records of all antiretroviral therapy (ART) dispensations and longitudinal plasma HIV-1 RNA viral load (VL) monitoring. We used generalized estimating equations (GEEs) to estimate the longitudinal bivariable and multivariable relationships between at least daily cannabis use and two key clinical outcomes: overall engagement in ART care, and achieving a non-detectable VL among ART-exposed participants. Results Between December 2005 and June 2015, 874 HIV-positive PWUD (304 [35%] non-male) were included in this study. In total, 788 (90%) were engaged in HIV care at least once over the study period, of whom 670 (85%) achieved non-detectable VL at least once. In multivariable analyses, ≥ daily cannabis use did not predict lower odds of ART care (Adjusted Odds Ratio [AOR]: 1.02, 95% confidence interval [CI]: 0.77–1.36) or VL non-detectability among ART-exposed (AOR: 0.96, 95% CI: 0.75–1.21). Conclusion Our results showed no statistically significant impact of daily cannabis use on the likelihood of ART care or VL non-detectability among ART-exposed HIV-positive PWUD. These findings are reassuring in light of the impending legalization of cannabis in Canada and ongoing efforts to expand TasP initiatives.

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A safer alternative: Cannabis substitution as harm reduction

Abstract: Cannabis substitution can be an effective harm reduction method for those who are unable or unwilling to stop using drugs completely. More research is needed on cannabis as a safer alternative.

Cited by 127 publications

References 17 publications

Social-structural factors influencing periods of injection cessation among marginalized youth who inject drugs in Vancouver, Canada: an ethno-epidemiological study

Social-structural factors influencing periods of injection cessation among marginalized youth who inject drugs in Vancouver, Canada: an ethno-epidemiological study

Cannabis as a substitute for prescription drugs – a cross-sectional study

High-intensity cannabis use and HIV clinical outcomes among HIV-positive people who use illicit drugs in Vancouver, Canada

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A safer alternative: Cannabis substitution as harm reduction

Abstract: Cannabis substitution can be an effective harm reduction method for those who are unable or unwilling to stop using drugs completely. More research is needed on cannabis as a safer alternative.

Cited by 127 publications

References 17 publications

Social-structural factors influencing periods of injection cessation among marginalized youth who inject drugs in Vancouver, Canada: an ethno-epidemiological study

Social-structural factors influencing periods of injection cessation among marginalized youth who inject drugs in Vancouver, Canada: an ethno-epidemiological study

Cannabis as a substitute for prescription drugs &ndash; a cross-sectional study

High-intensity cannabis use and HIV clinical outcomes among HIV-positive people who use illicit drugs in Vancouver, Canada

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Cannabis as a substitute for prescription drugs – a cross-sectional study