Toward a Harm Reduction Approach to Cannabis Use Disorder

This is the authors' abstract. We don't add key points for this paper.

cannabis; harm reduction; substance use disorder; addictionCannabis is now legal for recreational and/or medical use in most U.S. states.Decriminalizing cannabis use and possession is important for eliminating decades-old racist policies, but is occurring alongside increasing consumption, particularly of more potent products (e.g., vape liquids, concentrates).In the U.S., 52.5 million people aged 12+ used cannabis in the past year and every 12 seconds, someone uses cannabis for the first time (1).Most people who use cannabis do not develop problems and, indeed, there can be both subjective and medical benefits of use (2), though perceived medical benefits are often unsubstantiated by evidence.However, there is a growing sub-group experiencing harms.Approximately 22% of those who use cannabis develop a cannabis use disorder, characterized by persistent use despite clinically significant impairment (e.g., failure to fulfill roles) and/or distress (3).Potential negative consequences of excessive cannabis use include physical (e.g., cannabis hyperemesis, respiratory problems), mental (e.g., worsening anxiety, psychosis, cognitive impairments) and social impacts (e.g., academic and family problems), yet treatment rates (~5%) for cannabis use disorder are exceedingly low (4).Cannabis has high public support; most Americans favor some form of legalization and many view cannabis as a benign substance.This social acceptability is accompanied by beliefs that cannabis provides many unproven benefits.Indications for obtaining medical cannabis include conditions with evidential support (e.g., chemotherapy-induced nausea/ vomiting) and conditions with minimal or no evidence (e.g., Parkinson Disease, mental health conditions (2)).This climate makes it challenging for individuals and clinicians to recognize and discuss cannabis-related harms and treatment needs.For example, irritability, anxiety, and sleep problems may not be readily identified as symptoms of cannabis withdrawal, leading patients to resume cannabis to reduce these symptoms.Further,