Grant: Doctoral Award - Frederick Banting and Charles Best Canada Graduate Scholarships

Canada is facing a growing public health crisis marked by increased opioid (i.e., prescription painkiller and heroin) dependence and opioid-related morbidity and mortality. In British Columbia, opioid overdose has been declared a public health emergency; the problem is particularly pronounced among Vancouver's Downtown Eastside (DTES) neighbourhood, home to a large population of people who use illicit drugs (PWUD). In an effort to tackle this emerging public health challenge, experts across North America have called for innovative prevention and response strategies. Meanwhile, in light of the imminent legalization of cannabis in Canada, there is a push to understand how increased cannabis access and use will influence a range of public health outcomes. Compelling evidence from research of medical cannabis legalization in the United States suggests that cannabis legalization may help reduce opioid use and related morbidity and mortality, possibly through increased use of cannabis over opioids to treat chronic non-cancer pain conditions and/or substitute higher risk drug use, including opioid use. Among illicit drug using populations, the relationship between increasing cannabis use and opioid-related health outcomes has not been fully explored. Using health data from two long-running studies of over 2000 PWUD recruited from Vancouver's DTES, this work will examine relationships between access to/use of cannabis, use of opioids (including prescription opioids), health service utilization, and drug-related morbidity (e.g., overdose and injury). It is hypothesized that increased access to and use of cannabis will be associated with subsequent reduced opioid use, and consequently reduced opioid-related overdose and drug-related injury. Findings from this work will help shape adaptations and evaluations of the framework for cannabis legalization in Canada, and inform clinical guidelines and practices related to opioid and cannabis prescribing among drug using populations.