Cannabis for Harm Reduction: Recommendations for Integration

On April 23, 2024, Dr. Marion McNabb, Founder and President of the Cannabis Center of Excellence (CCOE), hosted the second part of a webinar series that aims to provide an in-depth discussion on the potential of medical cannabis to be used as a harm reduction alternative to other substances, including opioids. Contributing to the discussion was Dr. Peter Grinspoon, a primary care provider at Massachusetts General Hospital and author of “Seeing though the Smoke: A Cannabis Specialist Untangles the Truth about Marijuana.” This webinar discussed recommendations for patients and healthcare providers interested in understanding how medical cannabis can be integrated as a harm reduction alternative.

To begin the webinar, Dr. McNabb provided updates on the opioid crisis in Massachusetts, plus a summary of the 2023 CCOE study, “Cannabis as an Alternative Medicine for Harm Reduction,” which aimed to understand how patients consume cannabis as a way to reduce other substances including prescription drugs, alcohol, tobacco, opioids, and recreational drugs. Overlapping with this topic, Dr. Grinspoon provided a summary of one of his book’s chapters: “Cannabis Instead of Opioids: Bigger Isn’t Always Better,” and explained the research for implementing cannabis as an alternative to harmful substances, drawing on his 25 years of treating his own patients.

Notably, Dr. Grinspoon explained five ways in which cannabis can help with the opiate crisis from a clinical perspective:

1. For new chronic pain patients, start with medical cannabis instead of opiates
2. For existing chronic pain patients, offer to voluntarily taper down opiates and transition to using medical cannabis instead
3. Combine medical cannabis with lower doses of opioids to provide pain relief
4. Use cannabis to help with withdrawal symptoms when tapering off opioids
5. Potentially use cannabis directly instead of other medications to treat opiate use disorder, though more research is needed in this area

In summary, he stated: “I really do think that cannabis is integral to helping address the opiate overdose crisis, though I do think that it’s more helpful if you use it to treat the symptoms of withdrawal of the symptoms of chronic pain or anxiety or insomnia rather than directly using it to replace the opiates.”

Dr. McNabb then held a live Q&A discussion session with Dr. Grinspoon, covering topics such as the challenges faced by patients in maintaining their opiate prescriptions; the unique challenges faced by new users, particularly the growing demographic of the geriatric population; and cannabis as an alternative to alcohol and tobacco. Dr. Grinspoon also advocated for more physician education on cannabis and the endocannabinoid system to help provide common ground for patients and caregivers.

As parting advice, Dr. Grinspoon described his most important recommendations for doctors and patients on cannabis and harm reduction. “If you’re a doctor, no matter what you think of cannabis—if you’re anti, if you’re neutral, agnostic, if you’re pro—you need to know enough about it and have a good enough attitude to meet the patient where they are and to have a sensible discussion.” He also added that “both doctors and patients need to make a very big effort to have helpful, thorough, open, honest communication. I think this will make the whole enterprise a lot safer and more productive.”

Find more information on the next installment of this CCOE webinar series here.

Read our summary of the first installment in this webinar series here.