Harm Reduction Part 3: Cannabis as a harm reduction tool

So far in this series we have discussed the approach of harm reduction and how to reduce the potential harms of consuming cannabis. But, cannabis works on the other side of harm reduction as well, as a harm reduction tool. 

In 2004, I was at my doctor’s office to get my medical cannabis card renewed and I was filling out the paperwork. One of the questions on the intake form asked if I was using cannabis as a substitute for prescription drugs, alcohol or illicit drugs. This concept was very interesting to me and not something I had seen covered in cannabis research (which at the time was very limited). Since cannabis had always been touted as a “gateway drug”, the idea that it could help people move away from hazardous substance use was something I wanted to explore. So, the next year when I was designing the survey for my dissertation research, I decided to add the question about substitution in there. In my sample of 130 medical cannabis patients, a little over half reported using cannabis instead of alcohol, and 75% reported using it instead of prescription drugs. Wanting to see if that result was real or just related to my particular sample of patients, I did another study a few years later and increased my sample size to 350. I got the same results and published them in the Harm Reduction Journal. This was one of the first times a researcher had suggested that cannabis could be used as a substitute for alcohol and other drugs by people looking to reduce or eliminate their use. The study was then replicated again in Canada and the results stayed the same. We were now confident that using cannabis as a harm reduction tool was happening and subsequent research confirmed this. In the decades that followed, patient reports illustrated the use of cannabis instead of prescription drugs and the ability of patients to reduce or eliminate their use of prescription drugs once they had access to cannabis. 

The top reasons given for using cannabis as a substitute were:

1. Fewer negative side effects with cannabis
2. Better symptom management with cannabis
3. Less risk of overdose and dependence with cannabis

How it works

There are three main ways that cannabis can be used as a substitute for alcohol, illicit or prescription drugs. However, people who are interested in using cannabis as a substitute should always consult with their physician before reducing/stopping any prescription medications. Also, if you have a physical dependency on alcohol or other illicit/prescription drugs, please consult a health care provider before stopping their use as withdrawals may require medical attention.

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1. As a treatment substitute. Probably the most common use of cannabis as a substitute is as an alternative to alcohol or prescription medications. Many people choose cannabis instead of alcohol because it helps them relax without the calories, hangover or lapses in judgment. For prescription drugs, cannabis can ease symptoms without incapacitation and other medication side effects (constipation with opiates for example). 
2. As a withdrawal medication. For folks who are physically dependent on prescription drugs, alcohol or illicit substances, the experience of withdrawals can increase the likelihood of relapse. And while some prohibitionists believe that the pains of withdrawal are deterrents to relapse, this is not true. Some people also believe that withdrawal is a punishment for using drugs and that a person needs to fully experience this punishment to know that their behavior is “bad”. But, harm reduction does not support this approach and rather sees humanity and compassion in helping people change their behaviors for the better. Some of the most common symptoms of withdrawal are trouble sleeping and eating, nausea, irritability, and tremors. Cannabis has been shown as an effective treatment for these symptoms and can help ease the pain of withdrawal.
3. As a maintenance medication. While complete abstinence from all mind altering substances is a choice that works for some people, it does not work for everyone. Harm reduction supports the idea of personal choice and the reality that many people are able to consume substances in a non-problematic way, even if they have experienced harmful substance use episodes in the past. The term “Cali-sober” has come to describe those who abstain from all substances except cannabis (and sometimes psychedelics), and many credit cannabis with their ability to stay off of the substances that caused them problems. 

Bottom line: All drugs are not created equal when it comes to safety and dependence risk. And, the legal status of a drug tells us very little about its overall safety. The goals of harm reduction include supporting the personal choice to reduce/eliminate hazardous substance use while providing alternatives and strategies for improving the life experience. Cannabis can fit into this plan as a substitute for alcohol, prescription and illicit drugs. If you are wishing to reduce your alcohol intake, or see if cannabis is a better fit than Ambien for sleep, talk to your doctor and/or find a group dedicated to cannabis as a harm reduction tool.