TY - JOUR
T1 - Lower-Risk Cannabis Use Guidelines (LRCUG) for reducing health harms from non-medical cannabis use: A comprehensive evidence and recommendations update
AU - Fischer, Benedikt
AU - Robinson, Tessa
AU - Bullen, Chris
AU - Curran, Valerie
AU - Jutras-Aswad, Didier
AU - Medina-Mora, Maria Elena
AU - Pacula, Rosalie Liccardo
AU - Rehm, J. rgen
AU - Room, Robin
AU - Brink, Wim van den
AU - Hall, Wayne
N1 - Funding Information: The authors make the following declarations of relevant financial activities outside of the submitted work: Prof. B. Fischer has received general research support from the Hugh Green Foundation Chair in Addiction Research, held at the Faculty of Medical and Health Sciences, University of Auckland, New Zealand. In the past 3 years, he has held research grants and contracts in the areas of substance use, health and policy from public funding and government (i.e., public-only) organizations. Prof. C. Bullen has received research support from the Health Research Council of New Zealand, Heart Foundation of New Zealand, and Pfizer. In 2019 he provided consultancy on nicotine dependence for Johnson & Johnson (Japan). Prof. V. Curran declares general research support from the United Kingdom Medical Research Council and the United Kingdom Department of Health. In the past, she has consulted for Janssen Pharmaceuticals on the treatment of resistant depression. Prof. D. Jutras-Aswad has received investigational products (last in 2018) from Insys Therapeutics for a clinical trial funded by the Canadian Institutes of Health Research (CIHR). In the last 36 months, he has received grants/contracts support for substance use-related research from public and governmental agencies and has expert-consulted on related issues with public/government agencies. Prof. W. van den Brink has received financial support from Lundbeck, Novartis, Bioproject, Kinnov Therapeutics, Recordati, Mundipharma, Angelini, Opiant Pharmaceuticals, Indivior, Camurus, and Takeda. Funding Information: This work was supported by Health Canada's Substance Use and Addiction Program [SUAP- 920-HQ-000034]. Publisher Copyright: © 2021
PY - 2021
Y1 - 2021
N2 - Background: Cannabis use is common, especially among young people, and is associated with risks for various health harms. Some jurisdictions have recently moved to legalization/regulation pursuing public health goals. Evidence-based ‘Lower Risk Cannabis Use Guidelines’ (LRCUG) and recommendations were previously developed to reduce modifiable risk factors of cannabis-related adverse health outcomes; related evidence has evolved substantially since. We aimed to review new scientific evidence and to develop comprehensively up-to-date LRCUG, including their recommendations, on this evidence basis. Methods: Targeted searches for literature (since 2016) on main risk factors for cannabis-related adverse health outcomes modifiable by the user-individual were conducted. Topical areas were informed by previous LRCUG content and expanded upon current evidence. Searches preferentially focused on systematic reviews, supplemented by key individual studies. The review results were evidence-graded, topically organized and narratively summarized; recommendations were developed through an iterative scientific expert consensus development process. Results: A substantial body of modifiable risk factors for cannabis use-related health harms were identified with varying evidence quality. Twelve substantive recommendation clusters and three precautionary statements were developed. In general, current evidence suggests that individuals can substantially reduce their risk for adverse health outcomes if they delay the onset of cannabis use until after adolescence, avoid the use of high-potency (THC) cannabis products and high-frequency/-intensity of use, and refrain from smoking-routes for administration. While young people are particularly vulnerable to cannabis-related harms, other sub-groups (e.g., pregnant women, drivers, older adults, those with co-morbidities) are advised to exercise particular caution with use-related risks. Legal/regulated cannabis products should be used where possible. Conclusions: Cannabis use can result in adverse health outcomes, mostly among sub-groups with higher-risk use. Reducing the risk factors identified can help to reduce health harms from use. The LRCUG offer one targeted intervention component within a comprehensive public health approach for cannabis use. They require effective audience-tailoring and dissemination, regular updating as new evidence become available, and should be evaluated for their impact.
AB - Background: Cannabis use is common, especially among young people, and is associated with risks for various health harms. Some jurisdictions have recently moved to legalization/regulation pursuing public health goals. Evidence-based ‘Lower Risk Cannabis Use Guidelines’ (LRCUG) and recommendations were previously developed to reduce modifiable risk factors of cannabis-related adverse health outcomes; related evidence has evolved substantially since. We aimed to review new scientific evidence and to develop comprehensively up-to-date LRCUG, including their recommendations, on this evidence basis. Methods: Targeted searches for literature (since 2016) on main risk factors for cannabis-related adverse health outcomes modifiable by the user-individual were conducted. Topical areas were informed by previous LRCUG content and expanded upon current evidence. Searches preferentially focused on systematic reviews, supplemented by key individual studies. The review results were evidence-graded, topically organized and narratively summarized; recommendations were developed through an iterative scientific expert consensus development process. Results: A substantial body of modifiable risk factors for cannabis use-related health harms were identified with varying evidence quality. Twelve substantive recommendation clusters and three precautionary statements were developed. In general, current evidence suggests that individuals can substantially reduce their risk for adverse health outcomes if they delay the onset of cannabis use until after adolescence, avoid the use of high-potency (THC) cannabis products and high-frequency/-intensity of use, and refrain from smoking-routes for administration. While young people are particularly vulnerable to cannabis-related harms, other sub-groups (e.g., pregnant women, drivers, older adults, those with co-morbidities) are advised to exercise particular caution with use-related risks. Legal/regulated cannabis products should be used where possible. Conclusions: Cannabis use can result in adverse health outcomes, mostly among sub-groups with higher-risk use. Reducing the risk factors identified can help to reduce health harms from use. The LRCUG offer one targeted intervention component within a comprehensive public health approach for cannabis use. They require effective audience-tailoring and dissemination, regular updating as new evidence become available, and should be evaluated for their impact.
KW - Cannabis use
KW - Education
KW - Epidemiology
KW - Guidelines
KW - Health
KW - Legalization
KW - Policy
KW - Prevention
KW - Public health
KW - Risk factors
UR - http://www.scopus.com/inward/record.url?scp=85113825118&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.drugpo.2021.103381
DO - https://doi.org/10.1016/j.drugpo.2021.103381
M3 - Review article
C2 - 34465496
SN - 0955-3959
JO - International journal on drug policy
JF - International journal on drug policy
M1 - 103381
ER -