Delivery Methods and Dosing:Making the most of your medicine

Medical Cannabisand Harm Reduction

Presenter: Becky DeKeuster, M.Ed, Director of EducationProducer: Ben Gelassen, Digital Marketing Specialist

Potential for the treatment of addiction and symptoms of withdrawal

What is harm reduction?A public health philosophy and set of practices seeking an overall decrease in the negative impacts of drug use

Harm reduction practices and policies seek to reduce the harms associated with drug use*,

without requiring that consumption be reduced

*Harm reduction can be applied to non-drug-related aspects of life

LegalizationAbstinence DRUG

POLICY

Assessing the impacts of use of various drugs

Self

Community

Society

Health

Social

Economic

General harm reduction strategiesPublic health philosophy and set of practices seeking an overall

decrease in the negative impacts of drug use, including those caused by drug control policies themselves

Other interventions

Advocacy for improved drug policiesHIV/AIDS-related interventions

Broader drug treatment optionsDrug use management

Examples of harm reduction in history

Netherlands 1984: First needle exchange program

Late 50s-early 60s: Methadone programs begin in Canada, U.S.

1920s Britain: Rolleston Committee of physicians advocates for drug maintenance programs for some problem drug users

Grew from the belief that the spread of HIV is more harmful to individuals and society than is drug misuse

Today: Narcan for family members, friends, first responders

U.S. approaches to drug policy

Through most of our lifetimes, U.S. stance on “illicit” drugs primarily has been abstinence-based

Typically accomplished via legislation, criminal penalties, and stigmatizing consumers of drugs considered illicit

Policies aim to reduce/eliminate both supply and demand

Source: “CNN: The War on Drugs, 40 Years Later” (via YouTube)

Delivery Methods and Dosing:Making the most of your medicine

How does cannabis fit into a harm reduction approach to the use of other substances?

HR: So how does cannabis fit in?Some would call for strategies (possibly including harm reduction

techniques) to reduce or eliminate marijuana supply and use.

Left: Nancy Reagan advocates for a “drug-free society” in the 1980s. Right: 2012 billboard in Portland, OR.

HR: So how does cannabis fit in?Some would call medical and other cannabis laws part of a harm

reduction strategy for marijuana supply and use.

Source: Good to Know Colorado, 2015

HR: So how does cannabis fit in?Some would call medical and other cannabis laws part of a harm

reduction strategy for alcohol, opioid, and other drug supply and use.

2013 bus advertisement in Portland, ME.

Delivery Methods and Dosing:Making the most of your medicineWhat does modern

medicine and science say about cannabis use as a harm reduction tool?

NIDA on: CannabisPossible Health Effects

Short-termEnhanced sensory perception and euphoria followed by drowsiness/relaxation; slowed reaction time; problems with balance and coordination; increased heart rate and appetite; problems with learning and memory; hallucinations; anxiety; panic attacks; psychosis.

Long-term Mental health problems, chronic cough, frequent respiratory infections.

Other Health-related IssuesYouth: possible loss of IQ points when repeated use begins in adolescence.

Pregnancy: babies born with problems with attention, memory, and problem solving.

In Combination with Alcohol

Increased heart rate, blood pressure; further slowing of mental processing and reaction time.

Withdrawal Symptoms Irritability, trouble sleeping, decreased appetite, anxiety.

Source: National Institute on Drug Abuse (NIDA) https://www.drugabuse.gov/drugs-abuse/commonly-abused-drugs-charts

NIDA on: Alcohol“People drink to socialize, celebrate, and relax. Alcohol often has a strong effect on people—and throughout history, people have struggled to understand and manage alcohol’s power. Why does alcohol cause people to act and feel differently? How much is too much? Why do some people become addicted while others do not?

The National Institute on Alcohol Abuse and Alcoholism is researching the answers to these and many other questions about alcohol. Here’s what is known:

• Alcohol’s effects vary from person to person, depending on a variety of factors, including: How much you drink; how often you drink; your age; your health status; your family history

• While drinking alcohol is itself not necessarily a problem—drinking too much can cause a range of consequences, and increase your risk for a variety of problems.

For more information on alcohol’s effects on the body, please see the National Institute on Alcohol Abuse and Alcoholism’s related web page describing alcohol’s effects on the body.”Source: National Institute on Drug Abuse (NIDA). https://www.drugabuse.gov/drugs-abuse/commonly-abused-drugs-charts

NIAAA on: AlcoholSource: National Institute on Alcohol and Alcoholism (NIAAA). https://www.niaaa.nih.gov/alcohol-health/alcohols-effects-body

Brain:Alcohol interferes with the brain’s communication pathways, and can affect the way the brain looks and works. These disruptions can change mood and behavior, and make it harder to think clearly and move with coordination.

Heart:Drinking a lot over a long time or too much on a single occasion can damage the heart, causing problems including:•Cardiomyopathy – Stretching and drooping of heart muscle•Arrhythmias – Irregular heart beat•Stroke•High blood pressure

Research also shows that drinking moderate amounts of alcohol may protect healthy adultsfrom developing coronary heart disease.

NIAAA on: AlcoholLiver:Heavy drinking takes a toll on the liver, and can lead to a variety of problems and liver inflammations including:•Steatosis, or fatty liver•Alcoholic hepatitis•Fibrosis•Cirrhosis

Pancreas:Alcohol causes the pancreas to produce toxic substances that can eventually lead to pancreatitis, a dangerous inflammation and swelling of the blood vessels in the pancreas that prevents proper digestion.

Source: National Institute on Alcohol and Alcoholism (NIAAA). https://www.niaaa.nih.gov/alcohol-health/alcohols-effects-body

Cancer:Drinking too much alcohol can increase your risk of developing certain cancers, including cancers of the:•Mouth•Esophagus•Throat•Liver•Breast

Immune System:Drinking too much can weaken your immune system, making your body a much easier target for disease. Chronic drinkers are more liable to contract diseases like pneumonia and tuberculosis than people who do not drink too much. Drinking a lot on a single occasion slows your body’s ability to ward off infections – even up to 24 hours after getting drunk.

NIDA on: Prescription OpioidsPossible Health Effects

Short-term Pain relief, drowsiness, nausea, constipation, euphoria, confusion, slowed breathing, death.

Long-term Unknown.

Other Health-related Issues

Pregnancy: Miscarriage, low birth weight, neonatal abstinence syndrome.

Older adults: higher risk of accidental misuse or abuse because many older adults have multiple prescriptions, increasing the risk of drug-drug interactions, and breakdown of drugs slows with age; also, many older adults are treated with prescription medications for pain.

Risk of HIV, hepatitis, and other infectious diseases from shared needles.

In Combination with Alcohol Dangerous slowing of heart rate and breathing leading to coma or death.

Source: National Institute on Drug Abuse (NIDA). https://www.drugabuse.gov/drugs-abuse/commonly-abused-drugs-charts

NIDA on: Prescription OpioidsWithdrawal Symptoms

Restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, cold flashes with goose bumps ("cold turkey"), leg movements.

Treatment Options

Medications•Methadone•Buprenorphine•Naltrexone (short- and long-acting)

Behavioral Therapies Behavioral therapies that have helped treat addiction to heroin may be useful in treating prescription opioid addiction.

Source: National Institute on Drug Abuse (NIDA). https://www.drugabuse.gov/drugs-abuse/commonly-abused-drugs-charts

Cannabis substitution for alcohol“Substituting cannabis for prescription drugs, alcohol and other substances among medical cannabis patients.” Lucas P, Walsh Z, et al. Drug and Alcohol Review, May 2016

“Substituting cannabis for one or more of alcohol, illicit drugs or prescription drugs was reported by 87% (n = 410) of respondents, with 80.3% reporting substitution for prescription drugs, 51.7% for alcohol, and 32.6% for illicit substances. Respondents who reported substituting cannabis for prescription drugs were more likely to report difficulty affording sufficient quantities of cannabis, and patients under 40 years of age were more likely to substitute cannabis for all three classes of substance than older patients.”

Cannabis substitution/supplement for opioids

“Prescribing cannabis for harm reduction.” Collen M, Harm Reduction Journal, 2005

“…a number of articles have reported on interactions between cannabinoid and opioid receptors which may result in enhanced analgesia and a synergistic effect when CC is added to opioids... This may translate into patients being able to reduce their opioid intake with adjuvant cannabinoid therapy...”

“There is sufficient evidence of safety and efficacy for the use of (therapeutic cannabis) in the treatment of nerve pain relative to opioids and as Carter et al write, "From a pharmacological prospective, cannabinoids are considerably safer than opioids..."”

The future of cannabis for HR

Legalstatus

Socialapproval

Increasing legalization of cannabis = expanded

acceptance

Residual resistance to positives associated with

any cannabis use

Longer-term data on social benefits & costs

Opponent messaging focused on risks

Medical, legal, and treatment barriers

Positive individual experiences with cannabis

as substitute/treatment

Kennebec Journal, July 27, 2016

Sources & Resources

www.pubmed.comwww.drugpolicy.org www.harmreduction.org

Harm Reduction: National and International Perspectives. James A. Inciardi and Lana D. Harrison. SAGE Publications, Oct 11, 1999.

Collen, Mark. Prescribing cannabis for harm reduction. Harm Reduction Journal 2012; 9: 1. Accessed July 5 2016 at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3295721/

Video: Cannabis as Substitute for Other Drugs. Amanda Reiman, PhD MSW. Webinar presentedSeptember 12, 2013, Center for Behavioral Health Policy at the University of California at Berkeley.Accessed July 5, 2016 at https://www.youtube.com/watch?v=7FPyZhNtHss

Delivery Methods and Dosing:Making the most of your medicine

Thank you for your time and attention!

What are your remaining questions & concerns?

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