5. Education, Harm Reduction, and Skills for Engaging with Students

While cannabis use may be harmful, many people also report positive benefits, whether it is with medical or recreational use. It is important to foster an environment where students can talk about both the risks and benefits of cannabis use. The aim is to help students make informed decisions, offer easy access to screening and assessment for potential substance use problems, and provide referrals if they need treatment.

Addressing issues related to cannabis use on campus should be viewed within a public health framework that supports cannabis literacy. It is important to note that taking an “abstinence only” approach to substance use education has proven to be ineffective in reducing cannabis use.^[1]Canadian Students For Sensible Drug Policy. (2018). Sensible Cannabis Education: A Toolkit for Educating Youth. Retrieved from: https://cssdp.org/youthtoolkit/ In addition, strict or punitive policies related to substance use have also proven to be ineffective.^[2]Simons-Morton B, et al. (2010). Cross-national comparison of adolescent drinking and cannabis use in the United States, Canada, and the Netherlands. International Journal of Drug Policy. 21(1):64-9

Harm reduction is a pragmatic, evidence-based approach that can provide students with information and skills to minimize risks and make informed choices about cannabis consumption.^[3]Canadian Students For Sensible Drug Policy. (2018). Sensible Cannabis Education: A Toolkit for Educating Youth. Retrieved from: https://cssdp.org/youthtoolkit/ Harm reduction has been effective with many populations, including students. For example, one study showed that harm reduction interventions can reduce the frequency of risky behaviours among students aged 18-28 who identify as heavy cannabis users.^[4]Fischer, B. Jones, W, Shuper,P, Rehm, J. (2012). 12-month follow-up of an exploratory ‘brief intervention’ for high frequency cannabis users among Canadian university students. Substance Abuse Treatment Prevention Policy. Other effective interventions related to substance use combine support, resources, and educational opportunities.^[5]The Canadian Centre for Substance Use. (2014). Substance Use Prevention and Health Promotion. Retrieved from: http://www.ccsa.ca/Resource%20Library/CCSA-Substance-Use-Prevention-Health-Promotion-Toolkit-2014-en.pdf

For students who choose to use cannabis, there are evidence-based tools that can help them make informed decisions to reduce potential harms. Here is the plain-language version developed by CAMH for youth. See below for the ten recommendations in the Lower-Risk Cannabis Use Guidelines developed by the Canadian Research Initiative in Substance Misuse.^[6]Fischer, B., Russell, C., Sabioni, P., van den Brink, W., Le Foll, B., Hall, W. et al. (2017). Lower-risk cannabis use guidelines (LRCUG): An evidence-based update. American Journal of Public Health, 107(8). They are:

Lower-Risk Cannabis Use Guidelines

Abstinence
Recommendation 1: As with any risky behaviour, the safest way to reduce risks is to avoid the behaviour altogether. The most effective way to avoid any risks of cannabis use is to abstain from use.

Age of Initial use
Recommendation 2: Studies show that initiating cannabis at a young age—primarily before age 16—increases the risks for a variety of adverse health outcomes. The younger a person is when starting cannabis use, the greater the likelihood of developing health problems that are also more severe. Therefore, deferring cannabis use at least until after adolescence is advised.

Choice of cannabis products
Recommendation 3: Higher THC potency is strongly related to increased acute and long-term problems, such as mental health problems, dependence or injuries. It is advisable to use cannabis containing high CBD:THC ratios.

Recommendation 4: Recent reviews on synthetic cannabinoids indicate markedly more acute and severe adverse health effects from the use of these products (including instances of death). The use of these products should be avoided.

Cannabis use Methods and Practices
Recommendation 5: Regular inhalation of combusted cannabis adversely affects respiratory health outcomes. While alternative delivery methods (such as vaporizers or edibles) also carry risks, it is generally preferable to avoid routes of administration that involve smoking

Recommendation 6: People who smoke cannabis should avoid practices such as “deep-inhalation” as it can increase the intake of toxic material into the pulmonary system.

Frequency and Intensity of use
Recommendation 7: Frequent cannabis use is strongly associated with higher risks of experiencing adverse health and social outcomes related to cannabis use. Users should be aware and vigilant to keep their own cannabis use occasional (e.g., use only on one day/week, weekend use only, etc.) at most.

Cannabis Use and Driving
Recommendation 8: Driving while impaired from cannabis is associated with an increased risk of involvement in motor-vehicle accidents. It is recommended that users categorically refrain from driving (or operating other machinery or mobility devices) for at least 6 hours after using cannabis.

Special-Risk Populations
Recommendation 9: There are some populations at probable higher risk for cannabis-related adverse effects who should refrain from using cannabis. These include: individuals with predisposition for, or a first-degree family history of, psychosis and substance use disorders, as well as pregnant women.

Combining Risks or Risk Behaviours
Recommendation 10: While data are sparse, it is likely that the combination of some of the risk behaviours listed above will magnify the risk of adverse outcomes from cannabis use. Preventing these combined high-risk patterns of use should be avoided by the user and a policy focus.

Additional Harm Reduction Strategies

Additional harm reduction strategies can be summarized by “not too much, not too often, and only in safe situations.”^[7]Adapted from Healthy Minds, Healthy Campuses. (2015). Clearing the Air: Lower-Risk Cannabis Use on Campus. Retrieved from: https://healthycampuses.ca/resource/clearing-the-air-lower-risk-cannabis-use-on-campus/ These strategies are:

Not too much

• Take it slow, as it’s difficult to know the THC levels in a cannabis product.
• Know your product and your supplier. Purchase from government-licensed stores, when possible.

Not too often

• Use cannabis occasionally rather than frequently. Especially avoid daily use.

Only in safe situations

• Avoid consuming cannabis with tobacco products.
• Avoid combining cannabis with other substances (such as alcohol or other drugs).
• Know the cannabis laws before you possess or consume

When engaging with students in an open conversation about cannabis keep the following in mind:

• Stay open, objective and non-judgemental when a student speaks about substance use.
• Listen carefully and seriously when a student discusses using either medical or non-medical cannabis for coping with specific symptoms or conditions.
• Be calm, relaxed, and positive. Avoid using shaming, scare tactics, or guilt. Instead, be curious, respectful, and understanding.
• Share accurate information and avoid lecturing. Be compassionate and curious about the student’s perception and experience with cannabis use.
• Educate yourself and use facts where you can.
• Match the language that the student is using. For example, if a student uses the word ”weed,“ do so as well.
• Don’t assume that you know a student’s experiences, feelings, or interest in cannabis.