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A Scoping Review of the Use of Cannabis and Its Extracts as Potential Harm Reduction Strategies: Insights from Preclinical and Clinical Research

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Abstract

Cannabis as a harm reduction strategy (HRS) is supported by evidence demonstrating its efficacy for pain relief and as a substitution for alcohol, illicit drugs, and pharmaceuticals. Animal models show cannabinoids reduce the effects of opiate withdrawal, which contribute to drug-seeking behavior. This scoping review assessed cannabis and its extracts as HRS while identifying critical gaps in preclinical and clinical research. Halas et al.'s (British Medical Journal Open, 5, e006643, 2015) five-stage scoping review methodology was used focusing primarily on “harm reduction” and “harm reduction strategies” related to “cannabis” or “marijuana” and its derivatives “THC” and “cannabidiol.” Across 33 countries, 57 articles were identified demonstrating that cannabinoids (i) enhance opioid analgesia while reducing tolerance and dependence, (ii) interrupt dependence on cocaine, alcohol, and nicotine, and (iii) can be vaporized or eaten to reduce harms associated with smoking. Critical gaps in research include (i) discrepancies due to species and route of administration differences and (ii) the legal status of cannabis. Future research on HRS should examine access to cannabis and its extracts, the effects of varying cannabinoid concentrations, limiting selection bias by recruiting more authorized medicinal and recreational cannabis users, and the various methods cannabis is consumed in humans and animal models of drug dependence.

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Notes

  1. For example, whereas some physicians are opposed or reluctant to prescribe medical cannabis, others actively and publicly promote it (Nussbaum et al. 2011). Legal gray areas also create “backdoor” legal access through memberships in medical cannabis dispensaries. For example, in Vancouver, one can typically obtain a membership in less than an hour and in one case just 65 s (Hager 2014; Kelley 2015). There are also many illegal dispensaries around Canada and online that do not require any membership at all and customers with a valid ID can purchase legal and illegal cannabis products within seconds. Individuals who may be more likely to access cannabis through such dispensaries may also be those in which medical cannabis is contraindicated or with substance use disorders (Kahan and Srivastava 2014).

  2. There is also a growing field of research on cannabis and exercise that could also help uncover how cannabis impacts motivation, obesity, wellbeing, and mental and physical health (Fuss et al. 2015; Gillman et al. 2015; Le Strat and Le Foll 2011; Lorente et al. 2005; Muguruza et al. 2019; Renaud and Cormier 1986; York-Williams et al. 2019). More research on cannabis and motor vehicle incidents/impairment is also required as there is conflicting evidence (Brands et al. 2019; Drummer et al. 2003; Ramaekers et al. 2004, 2009).

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Funding

This work was performed with a Research Award grant to LAM from Wilfrid Laurier University.

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Authors and Affiliations

  1. Department of Psychology, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada

    James Siklos-Whillans

  2. Department of Psychology, Wilfrid Laurier University, 75 University Avenue West, Waterloo, Ontario, N2L 3C5, Canada

    Alia Bacchus & Laurie A. Manwell

  3. Department of Health Sciences, Wilfrid Laurier University, 75 University Avenue West, Waterloo, Ontario, N2L 3C5, Canada

    Laurie A. Manwell

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  1. James Siklos-Whillans
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LAM designed the project, provided the laboratory and resources, and supervised the entire project. LAM, JSW, and AB collected, analyzed, and interpreted the data and co-wrote the manuscript. LAM is the guarantor of the manuscript.

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Correspondence to Laurie A. Manwell.

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Siklos-Whillans, J., Bacchus, A. & Manwell, L.A. A Scoping Review of the Use of Cannabis and Its Extracts as Potential Harm Reduction Strategies: Insights from Preclinical and Clinical Research. Int J Ment Health Addiction 19, 1527–1550 (2021). https://doi.org/10.1007/s11469-020-00244-w

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