Bernie Pauly1,2, Meaghan Brown3,4, Clifton Chow1,5, Ashley Wettlaufer1,6, Brittany Graham1,7,8, Karen Urbanoski1,9, Russell Callaghan10,11, Cindy Rose12, Michelle Jordan13, Tim Stockwell1,14, Gerald Thomas15, Christy Sutherland16,17. 1. Canadian Institute for Substance Use Research, University of Victoria, Technology Enterprise Facility, 2300 McKenzie Ave, Victoria, BC, V8P 5C2, Canada. 2. School of Nursing, University of Victoria, Victoria, BC, Canada. 3. Canadian Institute for Substance Use Research, University of Victoria, Technology Enterprise Facility, 2300 McKenzie Ave, Victoria, BC, V8P 5C2, Canada. mbrown25@uvic.ca. 4. School of Nursing, University of Victoria, Victoria, BC, Canada. mbrown25@uvic.ca. 5. Vancouver Coastal Health, Victoria, BC, Canada. 6. Centre for Addiction and Mental Health, Toronto, Ontario, Canada. 7. Vancouver Area Network of Drug Users (VANDU), Vancouver, BC, Canada. 8. British Columbia Centre for Disease Control, Vancouver, BC, Canada. 9. School of Public Health and Social Policy, University of Victoria, Victoria, BC, Canada. 10. Northern Medical Program, University of Northern British Columbia (UNBC), Prince George, BC, Canada. 11. School of Population and Public Health, University of British Columbia (UBC), Vancouver, BC, Canada. 12. Canadian Mental Health Association Sudbury/Manitoulin, Sudbury, Ontario, Canada. 13. Shelter House, Thunder Bay, Ontario, Canada. 14. Department of Psychology, University of Victoria, Victoria, BC, Canada. 15. Ministry of Health, Province of British Columbia, Victoria, BC, USA. 16. PHS Community Services Society, Vancouver, BC, Canada. 17. Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
Abstract
BACKGROUND: While there is robust evidence for strategies to reduce harms of illicit drug use, less attention has been paid to alcohol harm reduction for people experiencing severe alcohol use disorder (AUD), homelessness, and street-based illicit drinking. Managed Alcohol Programs (MAPs) provide safer and regulated sources of alcohol and other supports within a harm reduction framework. To reduce the impacts of heavy long-term alcohol use among MAP participants, cannabis substitution has been identified as a potential therapeutic tool. METHODS: To determine the feasibility of cannabis substitution, we conducted a pre-implementation mixed-methods study utilizing structured surveys and open-ended interviews. Data were collected from MAP organizational leaders (n = 7), program participants (n = 19), staff and managers (n = 17) across 6 MAPs in Canada. We used the Consolidated Framework for Implementation Research (CFIR) to inform and organize our analysis. RESULTS: Five themes describing feasibility of CSP implementation in MAPs were identified. The first theme describes the characteristics of potential CSP participants. Among MAP participants, 63% (n = 12) were already substituting cannabis for alcohol, most often on a weekly basis (n = 8, 42.1%), for alcohol cravings (n = 15, 78.9%,) and withdrawal (n = 10, 52.6%). Most MAP participants expressed willingness to participate in a CSP (n = 16, 84.2%). The second theme describes the characteristics of a feasible and preferred CSP model according to participants and staff. Participants preferred staff administration of dry, smoked cannabis, followed by edibles and capsules with replacement of some doses of alcohol through a partial substitution model. Themes three and four highlight organizational and contextual factors related to feasibility of implementing CSPs. MAP participants requested peer, social, and counselling supports. Staff requested education resources and enhanced clinical staffing. Critically, program staff and leaders identified that sustainable funding and inexpensive, legal, and reliable sourcing of cannabis are needed to support CSP implementation. CONCLUSION: Cannabis substitution was considered feasible by all three groups and in some MAPs residents are already using cannabis. Partial substitution of cannabis for doses of alcohol was preferred. All three groups identified a need for additional supports for implementation including peer support, staff education, and counselling. Sourcing and funding cannabis were identified as primary challenges to successful CSP implementation in MAPs.
BACKGROUND: While there is robust evidence for strategies to reduce harms of illicit drug use, less attention has been paid to alcohol harm reduction for people experiencing severe alcohol use disorder (AUD), homelessness, and street-based illicit drinking. Managed Alcohol Programs (MAPs) provide safer and regulated sources of alcohol and other supports within a harm reduction framework. To reduce the impacts of heavy long-term alcohol use among MAP participants, cannabis substitution has been identified as a potential therapeutic tool. METHODS: To determine the feasibility of cannabis substitution, we conducted a pre-implementation mixed-methods study utilizing structured surveys and open-ended interviews. Data were collected from MAP organizational leaders (n = 7), program participants (n = 19), staff and managers (n = 17) across 6 MAPs in Canada. We used the Consolidated Framework for Implementation Research (CFIR) to inform and organize our analysis. RESULTS: Five themes describing feasibility of CSP implementation in MAPs were identified. The first theme describes the characteristics of potential CSPparticipants. Among MAP participants, 63% (n = 12) were already substituting cannabis for alcohol, most often on a weekly basis (n = 8, 42.1%), for alcohol cravings (n = 15, 78.9%,) and withdrawal (n = 10, 52.6%). Most MAP participants expressed willingness to participate in a CSP (n = 16, 84.2%). The second theme describes the characteristics of a feasible and preferred CSP model according to participants and staff. Participants preferred staff administration of dry, smoked cannabis, followed by edibles and capsules with replacement of some doses of alcohol through a partial substitution model. Themes three and four highlight organizational and contextual factors related to feasibility of implementing CSPs. MAP participants requested peer, social, and counselling supports. Staff requested education resources and enhanced clinical staffing. Critically, program staff and leaders identified that sustainable funding and inexpensive, legal, and reliable sourcing of cannabis are needed to support CSP implementation. CONCLUSION: Cannabis substitution was considered feasible by all three groups and in some MAPs residents are already using cannabis. Partial substitution of cannabis for doses of alcohol was preferred. All three groups identified a need for additional supports for implementation including peer support, staff education, and counselling. Sourcing and funding cannabis were identified as primary challenges to successful CSP implementation in MAPs.
Entities:
Keywords:
Alcohol harm reduction; Cannabis substitution; Harm reduction; Homelessness; Managed alcohol programs; Severe alcohol use disorder
Authors: Nadine Ezard; Michael E Cecilio; Brendan Clifford; Eileen Baldry; Lucinda Burns; Carolyn A Day; Marian Shanahan; Kate Dolan Journal: Drug Alcohol Rev Date: 2018-04-17
Authors: Russell C Callaghan; Marcos Sanches; Robin M Murray; Sarah Konefal; Bridget Maloney-Hall; Stephen J Kish Journal: Can J Psychiatry Date: 2022-01-12 Impact factor: 5.321