Prescribing cannabis for harm reduction

Collen, Mark

doi:10.1186/1477-7517-9-1

Cited by 41 publications

(60 citation statements)

References 48 publications

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“…Physicians in primary care, pain management, hospital emergency departments, and other clinical settings can deliver overdose prevention training and prescribe naloxone to patients at risk of opioid overdose (Beletsky et al, 2007; Burris et al, 2001; Mayet et al, 2011) though the practice is relatively uncommon, particularly among those who are not familiar or comfortable with the health concerns of people who use drugs (Beletsky et al, 2007). The criminal justice system is another venue where drug users at high risk for opioid overdose could be targeted for OEND interventions, in light of calls for the criminal justice system to align with public health goals (Silverman et al, 2012) and increased attention to the role that law enforcement officers can play in responding to the epidemic of opioid overdose death (Banta-Green et al, 2013; Davis et al, 2014; Green et al, 2013b; Ray et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

Association between non-fatal opioid overdose and encounters with healthcare and criminal justice systems: Identifying opportunities for intervention

Wagner

Liu

Davidson

et al. 2015

Drug and Alcohol Dependence

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Background Accidental overdose, driven largely by opioids, is a leading cause of death among people who inject drugs (PWIDs). We conducted secondary analysis of data from a cohort of PWIDs to identify venues where high-risk PWID could be targeted by overdose education/naloxone distribution (OEND) programs. Methods 573 PWIDs completed a quantitative survey between June, 2012 and January, 2014, which was analyzed using multivariable logistic regression. The dependent variable was a dichotomous indicator of experiencing a heroin/opioid-related overdose in the past six months. Independent variables included: demographics, drug use behavior, and encounters with two venues – the health care and criminal justice systems – that could serve as potential venues for OEND programs. Results Almost half (41.5%) reported ever experiencing a heroin/opioid overdose, and 45 (7.9%) reported experiencing at least one heroin/opioid overdose in the past six months. In the final multivariable model, receiving care in a hospital in the past six months (Adjusted Odds Ratio [AdjOR] 4.08, 95% Confidence Interval [C.I.] 2.07 -- 8.04, p<0.001) and being arrested for drug possession in the past six months (AdjOR 5.17, 95% C.I. 2.37 – 11.24, p<0.001) were associated with experiencing an opioid overdose in the past six months. Conclusions Identifying venues outside of those that traditionally target services to PWIDs (i.e., syringe exchange programs) will be critical to implementing OEND interventions at a scale sufficient to address the growing epidemic of heroin/opioid related deaths. Clinical settings, such as hospitals, and drug-related encounters with law enforcement officers are promising venues for the expansion of OEND programs.

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Section: Introductionmentioning

confidence: 99%

Association between non-fatal opioid overdose and encounters with healthcare and criminal justice systems: Identifying opportunities for intervention

Wagner

Liu

Davidson

et al. 2015

Drug and Alcohol Dependence

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“…According to one study, 30% of methamphetamine users were forcibly sent to a centre by local authorities, with the median stay 90 days [11]. The 2010 Village/Commune Safety Policy, focused on “cleaning” Cambodia's streets, resulted in increased harassment, detention or arrest [12]. Following its introduction in 2011, drug-related arrests quadrupled and prison populations grew approximately 14% annually, with national prisons reaching 179% over capacity [13].…”

Section: Introductionmentioning

confidence: 99%

“…Widespread consensus exists among government, UN agencies, NGOs and health and social service providers that in order to halt national HIV epidemics an enabling environment must be created to support HIV prevention and treatment while also ensuring law enforcement and public safety [12,18]. Therefore, to prevent further spread of HIV in Cambodia, as is the aim of the National Centre for HIV/AIDS, Dermatology and STD Control [7], it is critical to create an enabling environment in which key populations are able to access HIV and drug-related prevention, care and treatment.…”

Section: Introductionmentioning

confidence: 99%

Determining barriers to creating an enabling environment in Cambodia: results from a baseline study with key populations and police

Schneiders

Weissman

2016

Journal of the International AIDS Society

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IntroductionCambodian law enforcement's limited acceptance of harm reduction has hindered HIV program effectiveness. With funding from the Australian Department of Foreign Affairs and Trade, FHI 360 supported the Ministry of Interior to implement the Police Community Partnership Initiative (PCPI) in Cambodia's capital Phnom Penh. To guide this, FHI 360 conducted a baseline study examining police and key populations’ attitudes and practices towards one another, including fear and occurrence of arrest.MethodsBetween December 2012 and January 2013, a cross-sectional survey of 199 police post officers, 199 people who use drugs (PWUD) including people who inject drugs (PWID), 199 men who have sex with men (MSM), 200 transgender women (TGW) and 200 female entertainment workers (FEW) was conducted in five Phnom Penh districts. Eligible participants were ≥18 years, members of a key population from selected hotspots or police officers, deputy chiefs or chiefs.ResultsKey populations’ median age was 25 years (IQR: 22–30); 40% had completed only primary school. Police were male (99.5%), with median age 43 years (IQR: 30 to 47), and 45 and 25% high school and university completion rates, respectively. Key populations feared arrest for carrying needles and syringes (67%), condoms (23%) and 19% felt afraid to access health services. Close to 75% of police reported body searching and 58% arresting key populations in the past six months for using drugs (64%), selling or distributing drugs (36%) or being violent (13%). Self-reported arrests (23% PWUD, 6% MSM, 6% TGW, 12% FEW; p<0.05), being verbally threatened (45% PWUD, 21% MSM, 25% TGW, 27% FEW; p<0.001) and body searched (44% PWUD, 28% MSM, 23% TGW, 8% FEW; p<0.001) was significantly higher among PWUD than other key populations. The majority (94%) of police believed arrest was an appropriate solution to reduce HIV and drug use and reported selling sex (88%) and carrying needles and syringes (55%) as valid reasons for arrest.ConclusionsKey populations’ fear of accessing harm reduction and health services and police's negative attitudes and practices towards key populations present major barriers to HIV prevention efforts in Cambodia. To create an enabling environment and ensure police are allies in the Cambodian HIV response, interventions should tackle underlying negative attitudes among police towards key populations and vice versa.

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“…Finally, a British study showed that the overall harm score for user and society for recreational cannabis (score: 20) is less than that for amphetamines (score: 23), tobacco (score: 26), cocaine (score: 27), methamphetamines (score: 33), crack cocaine (score: 54), heroin (score: 55), and alcohol (score: 72) 92 . Because medical cannabis generally tends to have a higher ratio of cbd to thc, it would be expected to be associated with a lower predilection to diversion, less addiction potential, and lower overall harm scores than those for recreational cannabis 93 .…”

Section: Cannabinoid Therapies As a Harm Reduction Strategymentioning

confidence: 99%

A User’s Guide to Cannabinoid Therapies in Oncology

Maida

Daeninck

2016

Current Oncology

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ABSTRACT"Cannabinoid" is the collective term for a group of chemical compounds that either are derived from the Cannabis plant, are synthetic analogues, or occur endogenously. Although cannabinoids interact mostly at the level of the currently recognized cannabinoid receptors, they might have cross reactivity, such as at opioid receptors.Patients with malignant disease represent a cohort within health care that have some of the greatest unmet needs despite the availability of a plethora of guideline-driven disease-modulating treatments and pain and symptom management options. Cannabinoid therapies are varied and versatile, and can be offered as pharmaceuticals (nabilone, dronabinol, and nabiximols), dried botanical material, and edible organic oils infused with cannabis extracts. Cannabinoid therapy regimens can be creative, involving combinations of all of the aforementioned modalities. Patients with malignant disease, at all points of their disease trajectory, could be candidates for cannabinoid therapies whether as monotherapies or as adjuvants.The most studied and established roles for cannabinoid therapies include pain, chemotherapy-induced nausea and vomiting, and anorexia. Moreover, given their breadth of activity, cannabinoids could be used to concurrently optimize the management of multiple symptoms, thereby reducing overall polypharmacy. The use of cannabinoid therapies could be effective in improving quality of life and possibly modifying malignancy by virtue of direct effects and in improving compliance or adherence with disease-modulating treatments such as chemotherapy and radiation therapy.

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Prescribing cannabis for harm reduction

Cited by 41 publications

References 48 publications

Association between non-fatal opioid overdose and encounters with healthcare and criminal justice systems: Identifying opportunities for intervention

Association between non-fatal opioid overdose and encounters with healthcare and criminal justice systems: Identifying opportunities for intervention

Determining barriers to creating an enabling environment in Cambodia: results from a baseline study with key populations and police

A User’s Guide to Cannabinoid Therapies in Oncology

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