Towards a harm reduction approach to perinatal cannabis use

PROJECT SUMMARY/ABSTRACT
In the United States (US), it is recommended to not use cannabis during pregnancy or while breastfeeding
(referred to as “perinatal cannabis use”) because use during pregnancy has been associated with negative
parental-child outcomes. Also, tetrahydrocannabinol (the principal psychoactive component of cannabis) can
be transferred through breastfeeding. Yet, rates of use as well as perception of cannabis safety are increasing
within the pregnant population. Further, a subset of perinatal people persist in use despite knowledge of the
risks. Medical providers in the US are thus advised to educate and counsel patients about perinatal cannabis
use. This counseling can be particularly complex for patients who are unable or unwilling to entirely discontinue
use even once educated about the risks. However, medical providers currently lack the training support
needed for effectively engaging in discussions about perinatal cannabis use. Harm reduction strategies, which
aim to reduce the negative effects of health behaviors without necessarily discontinuing those behaviors
entirely, have demonstrated effectiveness in promoting health for individuals using substances. Taking a harm
reduction approach to discussing perinatal cannabis use with patients would involve delivering education and
counseling about modifiable risk factors related to cannabis use in a way that aligns with philosophical
principles of harm reduction (e.g., respect for patient autonomy). Despite multiple calls for harm reduction
strategies, such as in the National Institute on Drug Abuse's priority area #2, medical providers in the US have
not adopted a harm reduction approach towards the discussion of perinatal cannabis use with patients. The
proposed study will address this gap by utilizing implementation science methodology to create a toolkit that
enables US provider adoption of a harm reduction approach to the discussion of perinatal cannabis use. A key
feature of this toolkit will be a Canadian evidence-based practice resource on harm reduction for perinatal
cannabis use that we will adapt for a US audience. The study will involve key informants (providers, patients,
and leaders in healthcare and public health) in the creation of this toolkit to ensure that it matches the needs
“on the ground”. The study will take the following steps to build this toolkit: 1) conduct a core components
analysis of the Canadian practice resource, 2) hold interviews with stakeholders to assess: a) understanding of
harm reduction, b) determinants of adopting a harm reduction approach to perinatal cannabis use, and c)
needed adaptions of the Canadian practice resource for a US audience, and 3) bring together information from
the analysis and interviews to create a toolkit to support adoption of a harm reduction approach to US provider
discussion of perinatal cannabis use. This toolkit will be prototyped, presented to providers for feedback, and
refined in accordance with the feedback. In a future hybrid type II R01 study, the toolkit will be tested on its
ability to: 1) impact frequency of discussion and provider skill in discussing perinatal cannabis use, and 2)
increase US provider adoption of a harm reduction approach to the discussion of perinatal cannabis use.

Grant Number: 5R03DA059668-02
NIH Institute/Center: NIH
Principal Investigator: Ariana Albanese