Cannabis Dependence as a Primary Drug Use–Related Problem: The Case for Harm Reduction–Oriented Treatment Options

Abstract

Few studies have focused on cannabis dependence as compared to other drugs more commonly acknowledged as presenting a substantial need for treatment. This paper presents findings from a 2004–2005 study of drug user treatment clients in Southern Ontario, Canada. Clients with cannabis (n = 128) or cocaine (n = 300) as their primary drug problem were compared on psychosocial and demographic characteristics, drug effects, and clinical impairment. There are more similarities than differences between groups, with DAST and DSM scores showing high rates of “dependence” and reported symptoms of “abuse.” However, cannabis consistently scored lower on these items, supporting the idea of a continuum of risk on which its rank compared with other potentially misused drugs holds across a wide range of symptoms of impairment. The less disruptive nature of cannabis use–related problems poses greater challenges for drug user treatment providers guided by strict abstinence agendas. The authors call for the expansion of harm reduction treatment options and educational initiatives beyond primary prevention that acknowledge benefits of moderate controlled use when addressing cannabis misuse.

Keywords:

• Cannabis dependence
• drug effects
• harm reduction

Notes

¹ The often used nosology “drugs of abuse” is both unscientific and misleading in that (1) it mystifies and empowers selected active chemicals into a category whose underpinnings are neither theoretically-anchored nor evidence-informed and which is based upon “principles of faith” held and transmitted by a range of stakeholders representing a myriad of agendas and goals, and (2) active chemical substances of any types-“drugs”- are used or misused; living organisms can be and are all-too-often abused; Editor's note.