Harm Reduction on Campuses in Canada

Harm Reduction on Campuses in Canada

University Affairs reported that the opioid crisis is across the country. It is in the universities and impacting postsecondary students too.
As a result, harm reduction policies continue to gain traction.
Canadian universities may have opioid-blocking medication on-campus more and more. Or they may talk more about harm reduction policies, at least.
The main medication is Naloxone. It is a medication to save lives through prevention of harm, of overdoses for example. This could be on campuses throughout the nation.
As well, these moves reflect the change in the general culture. A change in the culture towards a reduction in zero tolerance or punitive drug policies.
In short, a change that reflects a general change into harm reduction methodologies. The goal is to aim for mature and responsible use of the drugs.
The harm reduction philosophy amounts to an acknowledgment of drugs as a part of society, while also working to reduce the associated harms.
People in a free democratic society use substance. The goal is to aim for mature and responsible use of the drugs. A Canadian CSSDP spokesperson, Michelle Thiessen, talked about harm reduction.
Thiessen founded the UBC-Okanagan chapter of the organization. She said, “There can be some tension between what we think needs to happen to educate people on how to safely use drugs, and the administrators being nervous about putting that information out there because they feel like it endorses substance use.”
In other words, she was speaking on the tension between education safe drug use. But she was also taking into account the understandable caution of administrators on campuses.
Because the association with the substances or drugs continues to be negative. This amounts to a stigma factor.
She was, in essence, talking about the stigma factor from the side of the universities. Because the evidence does note the stigma as an issue. But it is relevant because stigma about drugs creates a barrier to evidence-based policies.
However, the evidence is clearly in support of harm reduction policies. Our universities should act on harm policies in the light of the evidence.
It is, in part, a matter of messaging.
One clinical professor of neuropsychology at the University of British Columbia, Paul Dagg, commented. “There was the old messaging around drugs and the war on drugs. Now we’ve got to talk about safe use of drugs and make people aware that drugs other than marijuana have a higher level of danger attached to them now,” Dagg said.
Dagg explained succinctly, “There’s clear evidence that harm reduction education and interventions do not increase drug use.”
Scott Jacobsen

Scott Jacobsen

Member-at-Large/Writer

(Last Update: September 28, 2016)

Scott Douglas Jacobsen researches and presents independent panels, papers, and posters, and with varied research labs and groups, and part-time in landscaping (lifting, mowing, and raking) and gardening (digging, planting, and weeding). He is the Founder of In-Sight: Independent Interview-Based Journal and In-Sight Publishing. UCI Ethics Center awarded him with the distinction of Francisco Ayala Scholar (2014) for mentoring, presenting, researching, and writing. If you want to contact Scott, you may inquire or comment through e-mail: Scott.D.Jacobsen@Gmail.com.

He published in American Enterprise InstituteAnnaborgiaConatus NewsEarth Skin & EdenFresh Start Recovery CentreGordon Neighbourhood HouseHuffington PostIn-Sight: Independent Interview-Based JournalJolly DragonsKwantlen Polytechnic University Psychology DepartmentLa Petite MortLearning Analytics Research GroupLifespan Cognition Psychology LabLost in SamaraMarijuana Party of CanadaMomMandyNoesis: The Journal of the Mega SocietyPiece of MindProduction ModeSynapseTeenFinancialThe PeakThe UbysseyThe Voice MagazineTransformative DialoguesTreasure Box KidsTrusted Clothes.

Chat with Professor Gordon Guyatt on National Opioid Guidelines

Chat with Professor Gordon Guyatt on National Opioid Guidelines

Professor Gordon Guyatt, MD, MSc, FRCP, OC is a Distinguished University Professor in the Department of Health Research Methods, Evidence and Impact and Medicine at McMaster University. He is a Fellow of the Canadian Academy of Health Sciences.

The British Medical Journal or BMJ had a list of 117 nominees in 2010 for the Lifetime Achievement Award. Guyatt was short-listed and came in second-place in the end. He earned the title of an Officer of the Order of Canada based on contributions from evidence-based medicine and its teaching.

He was elected a Fellow of the Royal Society of Canada in 2012 and a Member of the Canadian Medical Hall of Fame in 2015. He lectured on public vs. private healthcare funding in March of 2017, which seemed like a valuable conversation to publish in order to have this in the internet’s digital repository with one of Canada’s foremost academics.

For those with an interest in standardized metrics or academic rankings, he is the 14th most cited academic in the world in terms of H-Index at 222 and has a total citation count of more than 200,000. That is, he has the highest H-Index, likely, of any Canadian academic living or dead.

We conducted an extensive interview before: hereherehereherehere, and here. We have other interviews in Canadian Atheist (here and here), Humanist Voicesand The Good Men Project. This interview in Canadian Atheist does mean pro- or anti-religion/pro- or anti-non-religion. It amounts to a specific topical interview. Here we talk about national pharmacare.

Scott Douglas Jacobsen: These opioid guidelines were the national ones. What was your own work here?

Professor Gordon Guyatt: There have been an over prescription of chronic non-cancer pain and a use of excessive doses of opioids for chronic non-cancer pain. And, this has led to narcotic dependency. It has led to the narcotic associated deaths.

Everybody knows this is a problem. An earlier Canadian guideline in the days before people were really waking up to this, basically, did not say when to use opioids. It said, “If you decide to use opioids, what are the best ways? What are the guides for giving out the opioids?”

That might have been reasonable at the time. But, perhaps if anything, it contributed to the opioid overprescribing. So, a couple of years ago, and a few months ago produced, a national guideline for opioid use.

It starts out saying, “Before you use opioids, try non-steroidal, try drugs like Acetaminophen, try a number of other drugs such as those in the anticonvulsant class that have analgesic properties. Some antidepressants have analgesic properties. Bottom line: do not use opioids as your first, second, or third option. Try other things before you move to opioids.”

That was the first thing. The second thing we found out. Somewhat to our surprise: opioids were great for acute pain. If you give them for acute pain, they have substantial effects. But unfortunately, people get used to the opioids’ effects.

When you give opioids chronically, the effect is actually quite limited. On a visual analogue scale, where 0 is no pain and 10 is the worst pain that you have, chronic opioids lower your pain by only 1 unit: 6 to 5, 5 to 4.

Very modest effect, it has lots of side effects. So, the guidelines say, “Do not give large doses of opioids. No extra benefits, extra risks, if you are going to give opioids, first try everything else, then when you try this make the dose modest.”

It also gave guidelines for people currently stuck on opioids to help them reduce their opioid use, maybe get off opioids altogether. A whole set of recommendations for dealing with the over prescription of opioids.

That will hopefully lead to much better prescribing.

Scott Jacobsen

Scott Jacobsen

Member-at-Large/Writer

(Last Update: September 28, 2016)

Scott Douglas Jacobsen researches and presents independent panels, papers, and posters, and with varied research labs and groups, and part-time in landscaping (lifting, mowing, and raking) and gardening (digging, planting, and weeding). He is the Founder of In-Sight: Independent Interview-Based Journal and In-Sight Publishing. UCI Ethics Center awarded him with the distinction of Francisco Ayala Scholar (2014) for mentoring, presenting, researching, and writing. If you want to contact Scott, you may inquire or comment through e-mail: Scott.D.Jacobsen@Gmail.com.

He published in American Enterprise InstituteAnnaborgiaConatus NewsEarth Skin & EdenFresh Start Recovery CentreGordon Neighbourhood HouseHuffington PostIn-Sight: Independent Interview-Based JournalJolly DragonsKwantlen Polytechnic University Psychology DepartmentLa Petite MortLearning Analytics Research GroupLifespan Cognition Psychology LabLost in SamaraMarijuana Party of CanadaMomMandyNoesis: The Journal of the Mega SocietyPiece of MindProduction ModeSynapseTeenFinancialThe PeakThe UbysseyThe Voice MagazineTransformative DialoguesTreasure Box KidsTrusted Clothes.

Sensible Cannabis Toolkit

Sensible Cannabis Toolkit

We are excited to share our newest resource, “Sensible Cannabis Education: A Toolkit for Educating Youth,” after 8 months of hard work. With legalization around the corner and drug policy crises around the world, it’s important we take smart first steps towards educating youth, starting with the evidence. We’d like to thank Canopy Growth Corporation for supporting this youth cannabis education project through an unrestricted grant to Canadian Students for Sensible Drug Policy!

 

Sensible approaches to legalization and education

Aligning with CSSDP’s mandate to support drug education efforts and building upon youth consultations on cannabis legalization conducted in Canada, this toolkit responds to calls for the development of realistic and evidence-based cannabis education for youth. Created for educators, as well as parents, this resource aims to support adults in having informed and non-judgmental conversations with young people.

Protecting youth

Given that cannabis remains the most popular illegal drug consumed by young people in Canada, as well as Canada’s pending legalization and regulation of cannabis, the development of new cannabis education for youth is of critical importance, and a key aspect of developing young people’s health literacy. The legalization of cannabis in Canada provides an opportunity to revise our approach to cannabis education for youth and consider pragmatic youth education which is inclusive of both prevention and harm reduction to maximize effectiveness and protect all youth.

Evidence-based education

Generally, the central purposes of drug education are to provide accurate information and awareness of resources, develop decision making skills and health literacy, reduce risks of consumption, and support increasing an individual’s risk competency. However, this toolkit goes beyond these mandates.

 

The Sensible Cannabis Education toolkit

The toolkit is broken into two parts. The first section highlights ten guiding principles for conducting cannabis education with young people. In this section, the concepts and values important to the delivery and implementation of cannabis education for youth are discussed. Although outlined in the context of cannabis, these principles are also applicable to education on other substances. Emerging from our review of the available literature, we offer ten guiding principles for cannabis education:

  • Education grounded in evidence-based information
  • Non-judgmental, open dialogue that uses interactive approaches
  • Meaningful inclusion
  • Delivery by a trained facilitator or peer
  • Starting education earlier with age-appropriate content
  • Supporting parents to have age appropriate and open conversations
  • Inclusion of harm reduction
  • Education tailored to the specific context
  • Ongoing education available to youth
  • Attention to overlapping issues of racism, social justice, and stigma

The second section focuses on content that merits inclusion in a comprehensive cannabis education curriculum for young people, including evidence-based information about cannabis, its use and effects, as well as harm reduction strategies. This is meant to help educators and parents familiarize themselves with cannabis and cannabis use, and can be used as a resource to assist in the information delivery component of a comprehensive cannabis education program. This section also addresses many common claims made about youth cannabis use, such as what the research can tell us about the impacts on the developing brain, the gateway theory, and provides educators with a background on legalization, particularly as it pertains youth, to help ground their approach. We believe this approach can allow for flexibility and provide insights into how youth cannabis education can be operationalized in practice, as well as further refined and improved.

Below, we highlight some key points from our review, in addition to our ten principles for approaching drug education. Happy reading!

The CSSDP Team

Key points around sensible cannabis education:

Legalization

Legal regulation of cannabis offers an opportunity for more pragmatic “cannabis conversations”– the same old approach repackaged will likely miss the mark.

Education

In light of relatively high use rates among youth, we need education within a legalized context which serves youth who don’t use cannabis – but also youth who are already using cannabis. Drug education and cannabis conversations should be inclusive of both prevention and harm reduction in order to maximize effectiveness and protect all youth. “Just say no” might work for some youth, some of the time, but does a disservice to youth who may already be using cannabis.

 

Youth inclusion

It’s critical to involve youth in program design and implementation to ensure key messaging resonates with their experiences – these approaches and programs must be prioritized.

Youth education

While there is no silver bullet approach to talking to youth, access to evidence based drug education is critical for young people, their health literacy and well-being – globally, pragmatic drug education is critical for young people to achieve the highest attainable standard of health.

Harm reduction

It is also important to note some youth will choose to use cannabis no matter what resource or information is provide – cannabis will remain an illegal substance for youth under the age of 18 or 19, but what can change is our approach to educating youth on what will be a legal and regulated substance in Canada.

Key points around harms:

Please see summary chart, p.67 of toolkit and full report (Section 2.5) for references.

Frequency

It’s important to acknowledge harms and risks around cannabis and youth is still developing, but most young people who use cannabis do so infrequently and do not experience significant harms.

Adult use

We need to consider how we can establish norms around “appropriate adult use” of cannabis much like we have with alcohol consumption.

More research

More long term controlled studies are needed to truly assess the impact of cannabis on youth and to make claims around causality, and much of the available literature pertains to samples of youth who are frequent or chronic cannabis use, which is not representative of the majority of youth who use cannabis.

Cognition

Research suggests a relationship exists between early, heavy cannabis use and impairments in cognition, as well as mental health outcomes, but any strong conclusions around causality (i.e. that cannabis was the direct cause of outcome), direction (i.e. which came first? are some youth more inclined to seek out risk behaviours?), and magnitude (i.e. strength of relationship) are not available, mostly due to lack or research.

Confounders

Critical to this conversation is thinking about the role of confounders which are not often accounted for in this discussion. For example, we know social demographics, such as socio-economic status, as well as the use of other substance use (such as alcohol), are critical to this conversation and outcomes (i.e. growing up in a poor neighbourhood or using alcohol also has impacts on brain development in and of themselves which are often not accounted for in this work).

IQ/Intelligence

Preliminary evidence suggests heavy cannabis use during youth may be linked to lower IQ, but there is also additional work to suggest this is reversed after a period of abstinence. Again, the research is unclear around if cannabis is the cause, and there is also evidence that suggests when confounders (such as socio-economic status) are considered, cannabis use is not associated with a decline in IQ or educational attainment.

Schizophrenia

Research has found an association between cannabis use and schizophrenia, but causality, direction, or strength of that relationship is still unclear. It may be the case that early initiation of cannabis use leads to an increased risk of early onset of schizophrenia, especially for those with a preexisting vulnerability and those who use cannabis daily. Third variables (i.e., sociodemographic factors, poly-substance use) make it more difficult to depict a clear picture. It may also be the case that some youth are using cannabis to alleviate symptoms of mental illness or to self-medicate.

The gateway theory

The majority of people who use cannabis do not transition to “harder” illegal drugs. While people who use cannabis (particularly early onset and/or regular users) are more likely to report having used other drugs compared to non-users, there is no evidence to suggest that the use of cannabis causes an increase in the risk of using other drugs. Some have suggested a variety of alternative explanations, such as thrill-seeking behaviours more generally.

Lung Cancer

The evidence of a causal relationship between cannabis and lung cancer remains inconclusive. The evidence is also limited because many relevant studies do not account for simultaneous tobacco use, which has a proven causal relationship to lung cancer. Studies have suggested tobacco and cannabis smoke are not equally carcinogenic.

Key risks

Finally, there is evidence to support that early onset of use and the frequency of use are key risk factors, and associated with the most adverse outcomes, including substance misuse. We believe a preventative approach is appropriate for youth, however, a preventative approach should not be mutually exclusive from offering youth additional tools such as harm reduction education and resources and critical to the protection of all youth.

Sensible Cannabis Education: A Toolkit for Educating Youth

Created for educators, as well as parents, this resource aims to support adults in having informed and non-judgmental conversations with young people about cannabis.