Grant: Catalyst Grant: Cannabis Research in Urgent Priority Areas

While there is an abundance of evidence for strategies to reduce the harms of illicit substance use for populations affected by poverty and homelessness. there is less evidence of alcohol harm reduction strategies that focus on reducing harms of severe alcohol use and homelessness. In 2011, we established the first national study of the effectiveness and implementation of managed alcohol programs (MAP) to reduce the twin harms of severe alcohol use and homelessness for those with alcohol problems that are treatment resistant. The Canadian Managed Alcohol Program Study (CMAPS) has produced evidence of the effectiveness of MAPs in reducing acute and social harms. However, questions remain about the long term impacts of MAPs including prolonged effects of continuous drinking and chronic health problems. Cannabis has been identified as a potentially effective substitute for alcohol for those with severe alcohol problems. Cannabis has also found to help with other problems that poor and homeless people often experience including trauma, pain, depression, and anxiety. In CMAPS, we have identified that participants in MAPs often use cannabis as a substitute for alcohol when it is available and affordable to assist with managing alcohol use. The purpose of this project is to assess the feasibility of cannabis substitution to reduce alcohol related harms within MAP. First, we will gain approval in principle from Canadian MAP decision makers before proceeding with surveys of MAP participants and staff as to the acceptability and feasibility of cannabis substitution. Following this we will explore practical, financial, legal and ethical issues of acceptable and feasible options for cannabis substitution. Then we obtain feedback on proposed cannabis substitution program options from MAP participants and staff. Together with MAP leaders we will develop a rigorous protocol for a future pilot study and clinical trial of the effectiveness of cannabis substitution in MAPs.