Giving out free cannabis through harm reduction organizations could both reduce drug overdose deaths and improve users’ quality of life, according to new research published this week in the Harm Reduction Journal.
The case study, which examined a marijuana donation program in rural Michigan, says it’s the first to document the harm reduction practice in the United States and concludes that the approach has “potential for sustainability dependent on state laws.”
“While the policies surrounding the regulation and distribution of cannabis can still present barriers towards this practice,” authors wrote, “harm reduction staff working in the field see the potential benefits of cannabis, which include reduced premature death, improved quality of life, pain moderation, increased recovery outcomes, and improved safety for clients and community.”
The observation period, from September 2021 through May 2023, included ten “cannabis-experienced harm reduction clients” who received marijuana weekly through pickups or deliveries, “with clinical staff determining client interest and appropriateness.”
When staff reported their interactions with clients, many pointed to benefits they’d observed.
One person, described as 50 or older, “had spinal fusion neck surgery (with the installation of two steel rods, three connectors, and six bolts) five months into the study,” authors wrote.
“Before the surgery, this person had not used opioids for two years (as evidenced by criminal legal mandated urine drug screens) but reported frequent struggles in denying himself alcohol,” they continued. “With their use of the products donated by this program, this individual reported complete abstinence from alcohol while recovering from their surgery and since. They expressed gratitude for topical pain relief with cannabis pain cream, cannabis vape cartridges, and flower for smoking.”
Another participant “in her 20s was pregnant, homeless, and a methamphetamine and opioid dependent injector at the beginning of the study,” the case study says. “She reported that with the use of products donated in this program, she used methamphetamine and opioids less frequently, and actively worked with harm reduction agency staff to get on MOUD [medications for opioid use disorder] while pregnant.”
Researchers also looked at data from a cannabis company that provided marijuana for the program, shedding light on product types and the scale of donations.
“This administrative data suggests that while flower products constitute most of the adult and medical sales, edible, oil, and topical products predominated donations,” the study says. “Further, cost analysis suggests that donations represent only 1% of total gross sales and account for much less than the expected yearly donation amount.”
The five-author team behind the paper includes researchers at the nonprofit RTI International, the Rutgers University School of Social Work and San Francisco General Hospital.
They described their findings as a “starting point for inquiry into cannabis donation as a harm reduction strategy,” but said further research is needed “to fully understand the individual-level outcomes, public health impacts, necessary legal regulations, and best practices for cannabis donation.”
“Until then, given the ongoing overdose mortality stemming from illicitly produced fentanyl and other synthetic contaminants saturating the unregulated drug market, and the potential benefits of cannabis in reducing this unregulated substance use,” the report says, “harm reduction practitioners will continue to support client self-determination, and mutual aid in all forms, including available safe psychoactive substances, for persons who use drugs.”
The analysis does not attempt to draw conclusions about the overall outcomes of such harm reduction efforts, instead drawing on interviews with administrators of the rural Michigan program.
“While this is the first study to document the donation of cannabis as a harm reduction practice in the US, it is exploratory and not designed or intended to assess the outcomes associated with this practice,” it says. “Instead, we focus on describing how this process has been organically occurring in a state where there is the provision of cannabis and statutes that allow for donation.”
It says the findings show the feasibility of such programs, including the fact that donations from commercial marijuana companies make up just a tiny portion of the businesses’ overall product—about 1 percent of gross sales.
The case study comes on the heels of recent research out of Canada showing an association between marijuana legalization and declines in beer sales, suggesting a substitution effect where consumers shift from one product to the other.
Other studies have linked cannabis legalization with reductions in the use of both prescription and nonprescription opioids.
A report published last November, for example, linked legalizing medical marijuana with a “lower frequency” of nonprescribed pharmaceutical opioid use.
In August, a federally funded study found that marijuana was significantly associated with reduced opioid cravings for people using them without a prescription, suggesting that expanding access to legal cannabis could provide more people with a safer substitute.
A separate study last year found that legal access to CBD products led to significant reductions in opioid prescriptions, with state-level drops of between 6.6 percent and 8.1 percent fewer prescriptions.
Another linked medical marijuana use to lower pain levels and reduced dependence on opioids and other prescription medications, while yet another, published by the American Medical Association (AMA), found that chronic pain patients who received medical marijuana for longer than a month saw significant reductions in prescribed opioids.
AMA also released research showing that about one in three chronic pain patients report using cannabis as a treatment option, and most of that group has used cannabis as a substitute for other pain medications, including opioids.
State-level marijuana legalization is associated with major reductions in prescribing of the opioid codeine specifically, too, according to a study that leveraged data from the federal Drug Enforcement Administration (DEA).
A 2022 study similarly found that giving people legal access to medical cannabis can help patients reduce their use of opioid painkillers, or cease use altogether, without compromising quality of life.
There’s also no deficit of anecdotal reports, data-based studies and observational analyses that have signaled that some people use cannabis as an alternative to traditional pharmaceutical drugs like opioid-based painkillers and sleep medications.
As for alcohol, a separate study published last November found that marijuana legalization may be linked to a “substitution effect,” with young adults in California “significantly” reducing their use of alcohol and cigarettes after the cannabis reform was enacted.
Data from a Gallup survey published last August also found that Americans consider marijuana to be less harmful than alcohol, cigarettes, vapes and other tobacco products.
A separate survey released by the American Psychiatric Association (APA) and Morning Consult last June also found that Americans consider marijuana to be significantly less dangerous than cigarettes, alcohol and opioids—and they say cannabis is less addictive than each of those substances, as well as technology.
In 2022, a survey showed that Americans believe that cannabis is less dangerous than alcohol or tobacco.
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Photo courtesy of Philip Steffan.
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