Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences.
Psychol Addict Behav. 2023 Aug;37(5):709-712. doi: 10.1037/adb0000927.
Recent research suggests potential therapeutic benefits of cannabis-derived products, a lower risk profile than other illicit substances, and significant functional improvement from reduced use. Likewise, low abstinence rates and low motivation to achieve abstinence among those with cannabis use disorder (CUD) are the norm. As such, the harm reduction model has gained traction among substance use scientists and health care professionals as a viable alternative approach. Yet, to date no formal definition of cannabis harm reduction has been proposed.
We reviewed the literature, including two recent empirical papers published in the , Sherman et al. (2022) and Borodovsky et al. (2022), which demonstrate that harm reduction is sufficient to achieve functional improvement. We then propose and define a harm reduction approach for cannabis use research and treatment, and argue why this approach is a timely, necessary discussion.
We suggest that a cannabis harm reduction approach includes treatment, research, and education initiatives that reduce the public health burden of cannabis use. This approach includes interventions that reduce functional impairment and risk from cannabis, reduced or managed use, and sometimes, but not necessarily, abstinence. Psychoeducation for treatment providers, legislative barriers, and research recommendations are also discussed.
Research and treatment for CUD has historically focused on cannabis abstinence. Treatment trials rarely yield durable abstinence rates, and reduction has recently been tied to functional improvement. We comment on Sherman et al. (2022) and Borodovsky et al. (2022) and propose a shift toward a cannabis harm reduction approach. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
最近的研究表明，大麻衍生产品具有潜在的治疗益处，其风险比其他非法物质低，且减少使用后功能显著改善。同样，大麻使用障碍（CUD）患者的戒断率低，戒断意愿低也是常态。因此，减少伤害模式在物质使用科学家和医疗保健专业人员中获得了关注，成为一种可行的替代方法。然而，迄今为止，尚未提出大麻减少伤害的正式定义。
我们回顾了文献，包括最近发表在《柳叶刀-精神病学》上的两篇实证论文，Sherman 等人（2022 年）和 Borodovsky 等人（2022 年），这两篇论文表明减少伤害足以实现功能改善。然后，我们提出并定义了一种用于大麻使用研究和治疗的减少伤害方法，并论证了为什么这种方法是一个及时且必要的讨论。
我们认为，大麻减少伤害方法包括减少大麻使用的公共卫生负担的治疗、研究和教育举措。该方法包括减少功能障碍和风险的干预措施、减少或管理使用，有时，但不一定是戒断。还讨论了针对治疗提供者的心理教育、立法障碍和研究建议。
CUD 的研究和治疗历来侧重于大麻戒断。治疗试验很少产生持久的戒断率，最近的研究表明减少使用与功能改善有关。我们评论了 Sherman 等人（2022 年）和 Borodovsky 等人（2022 年）的研究，并提出转向大麻减少伤害方法。
