Safe cannabis use : proposal of harm reduction strategies

Abstract

Harm reduction (HR) strategies aim to minimise the social and physical harm caused by negative behaviours. With the rise in cannabis use, HR policies are essential for managing associated risks and protecting public health. The aims of this study were to assess national and international HR policies related to illicit drug use and propose a HR strategy for managing cannabis use in Malta. Literature review was conducted using the PRISMA guidelines to identify existing HR policies for illicit drug use. The search was performed using HyDi® and Google Scholar® and was limited to peer-reviewed journal articles, published in English between 2015 until 2024. Articles describing HR strategies, their effectiveness, and the impact of drug policy changes on users were eligible for inclusion. A brochure was developed to educate the public on safer cannabis use. Twenty-eight articles were deemed relevant to the study. International HR strategies identified included supervised consumption rooms (n=5), opioid agonist therapy (n=5), take-home naloxone (n=2), needle and syringe programmes (n=3), cannabis social clubs (n=2) and drug checking services (n=3). Strategies to prevent normalization of cannabis use and minimise its harm, such as educational programmes (n=2) and HR guidelines (n=3) were identified. Strategies implemented mainly regulated the use of cocaine (n=1), cannabis (n=9) and opioids (n=9). Nine articles focused on HR across a range of illicit substances. HR strategies, have been effective in reducing the spread of infectious diseases, minimising public disturbances, decreasing overdose fatalities, and promoting safer drug use. Educational programmes, particularly those targeting youths, were successful in raising awareness about the risks of drug consumption. Despite challenges related to confidentiality concerns and stigma, HR strategies demonstrated potential in reducing risks and promoting safer decision-making among users. The brochure developed for this study is a step towards accessible, evidence-based information on safer cannabis use. The brochure aligns closely with international HR strategies by outlining safer use practices and raising awareness on risks associated with cannabis consumption. Future work should focus on developing targeted public health campaigns, expanding the scope of local cannabis associations, and reforming local policies to address gaps in regulation.