Marijuana – "Smoking hot" harm reduction guidelines.

Given the last few blogs focused on obscurely released hidden national public health gems, the release of the safe cannabis consumption guidelines in the Canadian Journal of Public Health Sept/Oct edition has gotten much more attraction and interest. (unfortunately you either have to wait for your mailed copy, figure out how as a subscriber you can access the current edition on-line, or wait until the current edition is archived and available to the general public) 

Combined with the INsite court decisions, the focus on harm reduction and learning to work with the problem instead of ignore it is a clear message that is being transmitted.   If I can believe what the media are reporting, the receptivity to the harm reduction messages at the senior levels of government is lacking.  The war on drugs is to be fought with major artillery and at a cost of lives, rather than through intelligence and diplomacy.  

There is not much in the guidelines that common sense would not suggest, but finally someone has the good sense to write down what common sense should look like.   CPHA abstract of cannabis guidelines  .   The actual article (when or if you can find it) goes into details on known effects of cannabis and is a very good review of the current understanding of the science.  It is worth reading for updating an understanding of one of the most commonly used psychotropic drugs in the country.

One in 10 Canadians has used cannabis in the last year, one in three young adults.  The report does focus on the evidence that cannabis is not an innocuous drug and use at a young age, frequent use, use before driving are all associated with significant health risks.  The risk in pregnancy is not known leading to an appropriate precautionary recommendation to abstain throughout pregnancy and some evidence of potential negative consequences like lower birth weights. 

There is evidence that the stimulatory effects of cannabis are associated with an almost 5 times increase in the risk of myocardial infarction during the hour after inhalation.   Psychotic episodes are more likely to occur amongst cannabis users where family history of psychosis exists. The risk for motor vehicle collisions after consuming cannabis is increased, though not as much as for alcohol impairment.  There is also evidence that earlier age of onset of use is associated with multiple negative outcomes.

Canada desperately needs a comprehensive strategy to address psychoactive drug use.  There are excellent examples of “four pillar” strategies in prevention, treatment, harm reduction and enforcement that lay solid foundations.   Enforcement currently devours 75-80% of most four pillar strategies, and is known to be the least effective of the interventions.  How to rebalance these efforts is a national challenge.  Regrettably it is unlikely that the “Harper” government will recognize as the politically smart direction.  

Meanwhile, efforts to reduce harm and increase knowledge of the effects should be welcomed whole heartedly.  Thanks to Dr. Benedikt Fisher from Simon Fraser for leading this initiative.