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Crack Heads and Roots Daughters: The Therapeutic Use of Cannabis in Jamaica

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Abstract

An ethnographic study of women and drug use in inner city neighborhoods in Kingston, Jamaica, revealed that cannabis is commonly used in conjunction with crack cocaine to minimize the undesirable effects of crack pipe smoking, specifically paranoia and weight loss. According to 33 current or former crack using women, who were followed for a period of nine months, cannabis cigarettes (“spliffs”) constitute the cheapest, most effective and readily available therapy for discontinuing crack consumption. The findings of this research suggest the need to reframe “multiple drug use” within thecultural meanings that attend cannabis in Jamaica as a medicine and a sacrament.

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... The use of marijuana (an illicit drug) is embedded in aspects of Caribbean culture (Jules & Maynard, 2016). For example, within the Caribbean Rastafarian community, cannabis use for therapeutic and religious purposes is relatively common (Benard, 2007;Dreher, 2002). Furthermore, regardless of its legal status, research has found that Barbadian youth (12-25 years) perceived alcohol as being a bigger health problem in the community in comparison with marijuana (United Nations International Drug Control Programme, 2002). ...
... Youth can be described as the stage during which an individual is transitioning from dependence (childhood) to independence (adulthood) (Cunningham & McGinnis, 2008) and it is accepted internationally that the age of 24 denotes the end of youth (Commission for Social Development, 2007;Ross, Dick, & Ferguson, 2006;Secretary-General's Report to the General Assembly, 1981, 1985United Nations General Assembly Resolution, 1995, 2002. In the current research, individuals within the upper range of youth (18-24 years), a period known as emerging adulthood (Arnett, 2000), participated in the study. ...
... However, Barbadian participants used the word smoking to indicate the use of marijuana (an illicit drug). It is possible that such reference to smoking for Barbadian emerging adults is indicative of relatively tolerant and in some cases favorable attitudes toward the use of marijuanaattitudes which are reflective of wider Caribbean culture (Benard, 2007;Dreher, 2002;Jules & Maynard, 2016). ...
Article
This study examined the relationship between susceptibility to drug-related online peer influence on Facebook and offline alcohol, tobacco, and marijuana use among emerging adults (18-24 years) enrolled at the university level in Barbados and England. A cross-national comparative, explanatory sequential mixed-methods design was employed with samples of students of African-Caribbean descent and European descent in Barbados and England, respectively. Quantitative data were collected using surveys from 241 students in Barbados and 186 in England. Qualitative focus groups were conducted with 23 Barbadian students and 16 English students. Spearman’s rank-order correlations were conducted to analyze quantitative data and a three-tiered categorization system was used to analyze the qualitative data. Significant positive relationships between students’ susceptibility to online peer influence (SOPI) and alcohol, tobacco, and marijuana use were found. Six qualitative themes emerged representing cross-national similarities, while three themes emerged highlighting some differences between the two contexts. We propose that the relationship between SOPI and offline drug use may be mediated by the interrelated factors of emerging-adult developmental characteristics and the online and offline social environments. We represent these findings diagrammatically to convey that developmental and environmental factors together can provide a holistic understanding of the interplay between online interactions and offline risk behaviors.
... A growing body of evidence has described the key role of the human endocannabinoid system (ECBS) in the neurobiological adaptations and behavioral processes underlying substance use disorders (Prud'homme, Cata, & Jutras-Aswad, 2015). While data from small observational studies and animal models suggest that some cannabinoids may be effective in reducing cravingone of the major predictors of crack cocaine use (Paliwal, Hyman, & Sinha, 2008)more robust data is currently lacking (Dreher, 2002;Fischer, Kuganesan, et al., 2015). Thus, the objective of this study was to investigate the potential impact of the intentional use of cannabis to reduce crack use on the subsequent crack use frequency in a community-recruited sample of people who use illicit drugs (PWUD) in Vancouver, Canada. ...
... Further, similar to our study, cannabis use peaked during the first three months of follow-up, with only occasional use of cannabis reported in the remainder six months of follow-up (Labigalini, Rodrigues, & Da Silveira, 1999). Qualitative studies among crack users in Jamaica and Brazil also indicate that cannabis is frequently used as a self-medication strategy to reduce craving and other undesirable effects of crack (e.g., feelings of paranoia and anxiety) which in turn results in decreased cocaine-seeking behavior (and associated illicit or endangering activities to procure the drug) and use of crack (Dreher, 2002;Goncalves & Nappo, 2015). Conversely, other studies have revealed that long-term cannabis dependence might increase cocaine craving and risk of relapse among individuals with poly-drug substance use disorders (Aharonovich et al., 2005;Fox, Tuit, & Sinha, 2013;Viola et al., 2014), suggesting that patterns of cannabis use and dependence, and the timing of self-medication with cannabis might play a role in explaining the different outcomes across studies. ...
... Consistent with results from pre-clinical studies, findings from pilot human trials have indicated that single doses of 400 or 800 mg of CBD for three consecutive days were well tolerated and effective in decreasing cue-induced and general craving, as well as anxiety among heroin-dependent individuals, with persistent effects of up to seven days Manini et al., 2015). Although no clinical studies have yet been conducted among individuals with cocaine use disorders, taken together, findings from this study and others (Dreher, 2002;Goncalves & Nappo, 2015;Hurd et al., 2015;Labigalini et al., 1999;Manini et al., 2015;Parker et al., 2004;Prud'homme et al., 2015;Ren et al., 2009) support calls to further investigate the therapeutic potential of cannabinoids to attenuate craving and other cocaine-cessation symptoms (e.g., anxiety), and thus lower rates of relapse (Fischer, Kuganesan, et al., 2015). ...
... Medicinal motivations for marijuana use, such as using marijuana as a substitute for other drugs, e.g., crack, heroin, have been reported in qualitative studies of marijuana users outside of the U.S. prior to the widespread adoption of medical marijuana laws (Dreher, 2002;Sifaneck & Kaplan, 1995). In these studies, the medicinal applications of marijuana were largely discovered by the drug users themselves or through interaction with other marijuana users but without the medical advice of physicians. ...
... The discovery of medicinal effects often happened fortuitously as adolescents prior to becoming MMP and in the course of recreational use or use for pleasure. For instance, while using marijuana with others, participants experienced relief from conditions, such as anxiety, migraines, cramps, or other drugs, that they then attributed to their use of marijuana (Dreher, 2002;Sifaneck & Kaplan, ,1995). However, rather than feeling medicinal effects as a kind of social experience, or one reinforced by other marijuana users, medicinal relief was largely described as an individual experience that was fortified by repeated use, often alone. ...
Article
Background: Since marijuana became legal for medical use in California in 1996, reasons for medical use among medical marijuana patients (MMP) have become increasingly well described in qualitative studies. However, few studies have detailed how the use of marijuana for medical purposes fits into the broader career trajectories of either becoming a marijuana user or becoming a MMP, including the social influences on medical use. Methods: Young adult MMP (N=40) aged 18 to 26 years old were recruited in Los Angeles, CA in 2014-15 and administered a semi-structured interview that included questions focusing on marijuana use practices before and after becoming MMP. Results: MMP were categorized into three trajectory groups: primarily medical users (n=30); primarily non-medical users (n=3); and medical users who transitioned to non-medical users (n=7). Most medical users discovered medicinal effects from marijuana in the context of non-medical use as adolescents prior to becoming MMP. Becoming a mature MMP followed interactions with dispensary staff or further self-exploration of medical uses and often involved a social process that helped confirm the legitimacy of medical use and identity as a medical user. In some cases, MMP transitioned back to non-medical users as health conditions improved or remained primarily non-medical users even after becoming MMP for reasons unrelated to health, e.g., protection against arrest. Conclusion: Becoming a medical marijuana user was an important career trajectory that was influenced by early discoveries of effective medicinal use, interaction with proponents of medical use at dispensaries, experiences with new kinds of medical use, and the demands of particular health condition requiring more or less treatment with marijuana.
... [19][20][21] Although we agree with the limitations of current published research, we believe it is also important to highlight that research employing other methodological approaches (e.g., ethnographic, observational, and qualitative research), studies conducted outside of a North American context, research conducted from a gendered and intersectional theoretical lens, and/or research demonstrating positive health outcomes in relation to cannabis consumption are either limited or have not been included in the body of ''evidence'' used to derive guidelines and inform clinical practices. [25][26][27][28] Furthermore, we echo previous scholars who have noted that cultural, economic, and social factors can shape birth outcomes more broadly. 27,28 Child welfare scholars also agree that research about parenting and cannabis is limited, conflictual, and inconclusive. ...
... Dreher argues for a reframing of ''polysubstance use,'' given the inextricable medicinal, cultural, and social meanings underpinning cannabis consumption. 26 Kozak's study in Canada also illuminates cannabis as a source of pleasure and social connectedness for women; in this research, cannabis consumption enhanced women's perceptions of their social environments vis-à-vis greater sensory awareness and deepening of familial, intimate, and interpersonal relationships. 25 If harm reduction is touted as our best way forward, what does this look like in the context of pregnancy and parenting? ...
Article
Full-text available
Research on women who consume cannabis has predominantly focused on the perinatal period whereby cannabis consumption is problematized, linked to negative perinatal outcomes, and related to substance use and mental health challenges. When this historical literature and research about cannabis consumption is considered through a sociolegal and intersectional lens, questions emerge about how cannabis legalization may benefit and harm women, particularly women who experience marginalization along various axes of identity such as gender, race, and class. Questions also emerge about how women who consume cannabis may be perceived, represented, and treated as part of health and social care practices, particularly while pregnant and parenting. This commentary seeks to untangle what could be at stake for pregnant women and mothers, and what could be emphasized in future research endeavors, in the new era of cannabis legalization in Canada. The authors encourage research initiatives that attend to and reimagine harm reduction philosophies, and that integrate intersectional, feminist, and participatory action research approaches.
... Harm reduction is a set of strategies that aim to minimise problems associated with drug use while recognising that for some users, abstinence may be neither realistic nor desirable. Research suggests cannabis 'substitution' can be an effective method of reducing harms associated with alcohol, illicit drugs and pharmaceuticals [3][4][5][6][7][8][9][10]. Reiman operationalised substitution as a conscious choice made by users to use one drug instead of, or in conjunction with another based on: perceived safety, level of addiction potential, effectiveness in relieving symptoms, access and level of acceptance [9]. ...
... Dreher's ethnographic study of women who used crack in Jamaica found cannabis was used in conjunction with crack to minimise undesirable effects of crack pipe smoking. Cannabis was also the most effective and readily available therapy for discontinuing crack use [3]. Mikuriya and Mandel documented how the use of cannabis ended debilitating drug use in their own patients [6,7]. ...
Article
Substitution is operationalised as a conscious choice made by users to use one drug instead of, or in conjunction with another based on: perceived safety, level of addiction potential, effectiveness in relieving symptoms, access and level of acceptance. Harm reduction is a set of strategies that aim to minimise problems associated with drug use while recognising that for some users, abstinence may be neither a realistic nor a desirable goal. In this paper, we aim for deeper understandings of older adult cannabis users' beliefs and substitution practices as part of the harm reduction framework. We present selected findings from our qualitative study of Baby Boomer (born 1946-1964) marijuana users in the San Francisco Bay Area. Although the sample consisted of primary cannabis users, many had personal experience with other drugs throughout their lifetimes. Data collection consisted of an audio-recorded, semi-structured in-depth life history interview followed by a questionnaire and health survey. Qualitative interviews were analysed to discover users' harm reduction beliefs and cannabis substitution practices. Study participants described using cannabis as a safer alternative for alcohol, illicit drugs and pharmaceuticals based on their perceptions of less adverse side effects, low-risk for addiction and greater effectiveness at relieving symptoms, such as chronic pain. Cannabis substitution can be an effective harm reduction method for those who are unable or unwilling to stop using drugs completely. More research is needed on cannabis as a safer alternative. [Lau N, Sales P, Averill S, Murphy F, Sato S, Murphy S. A safer alternative: Cannabis substitution as harm reduction. Drug Alcohol Rev 2015]. © 2015 Australasian Professional Society on Alcohol and other Drugs.
... Ajoutons qu'aujourd'hui, dans le contexte d'une é pidé mie de consommation de crack qui s'é tend à l'ensemble des îles Caraïbes, le cannabis est utilisé à titre expé rimental pour ré duire ces consommations et leurs effets secondaires (cachexie) -ceci avec des ré sultats positifs significatifs [10]. ...
... Dans le traitement des addictions, et notamment de l'alcoolisme, les antagonistes CB1 et les agonistes CB2 pourraient avoir un potentiel thé rapeutique centré sur la ré duction des rechutes via une diminution des comportements de recherche de drogues et des pulsions de consommation [3]. Ceci conforterait les ré sultats de recherches ethnographiques dé crivant la dimension auto-thé rapeutique du cannabis consommé par des usagers quotidiens d'hé roïne et de cocaïne [10,23]. ...
Article
Full-text available
We pay tribute to Moreau (de Tours) for his work on haschish and the early clinical trials he has been conducting. Cannabis is known for its therapeutic properties for at least 6000 years. We examine the ethnobotanical, biological and clinical data which support such uses. The recent identification of the first cannabinoids and their mechanisms of action via CB1 and CB2 receptors have led to the discovery of a complex endocannabinoid system involved in many areas of life: the regulation of pain and inflammatory processes, motor spasticity, anxiety, eating behavior, immune systems. The discovery of the endocannabinoid system opens new therapeutic perspectives, but also presents complex scientific and clinical management challenges related to their interactions with other endogenous neurotransmission systems.
... Medicinal motivations for marijuana use, such as using marijuana as a substitute for other drugs, e.g., crack, heroin, have been reported in qualitative studies of marijuana users outside of the U.S. prior to the widespread adoption of medical marijuana laws (Dreher, 2002;Sifaneck & Kaplan, 1995). In these studies, the medicinal applications of marijuana were largely discovered by the drug users themselves or through interaction with other marijuana users but without the medical advice of physicians. ...
... The discovery of medicinal effects often happened fortuitously as adolescents prior to becoming MMP and in the course of recreational use or use for pleasure. For instance, while using marijuana with others, participants experienced relief from conditions, such as anxiety, migraines, cramps, or other drugs, that they then attributed to their use of marijuana (Dreher, 2002;Sifaneck & Kaplan, ,1995). However, rather than feeling medicinal effects as a kind of social experience, or one reinforced by other marijuana users, medicinal relief was largely described as an individual experience that was fortified by repeated use, often alone. ...
... An ethnographic, participant observation-based study in Jamaica with a community-recruited sample of former (n = 14) or active (n = 17) female crack-cocaine users reported using cannabis in conjunction with crack-cocaine to minimize undesirable effects, specifically paranoia and weight loss. Most of the former crack-users (92%) attributed their ability to quit crack-cocaine use to cannabis use and characterized it as the cheapest, most effective and readily available therapeutic intervention practically available to them ( Dreher, 2002 ). ...
Article
Full-text available
Cocaine use entails severe health-and social-related harms globally. Treatment options for cocaine dependence are highly limited. Benefits of cannabinoids for addiction have been documented , making it opportune to examine existing data on the possible outcomes associated with cannabinoids and cocaine co-use. We conducted a systematic scoping review following the PRISMA guidelines of peer-reviewed, English-language studies published from 2000 to 2021 in four databases (Medline, Web-of-Science, CINAHL Plus, and PsycInfo), assessing the co-exposure of cannabis/cannabinoids with cocaine on behavioural, biological or health outcomes. Both quantitative and qualitative, as well as humans and pre-clinical animals' studies (n = 46) were included. Pre-clinical studies (n = 19) showed mostly protective effects of cannabidiol (CBD) administration on animal models of addiction (e.g., cocaine-craving,-relapse, and-withdrawal) and cocaine-toxicity. Tetrahydrocannabinol (THC) had more inconsistent results, with both protective and counter-protective effects. Human studies (n = 27) were more heterogeneous and assessed natural ongoing cannabis and cocaine use or dependence. Quantitative-based studies showed mostly enhanced harms in several outcomes (e.g., cocaine use, mental health); two available clinical trials found no effect upon CBD administration on cocaine-related treatment outcomes. Qualitative data-based studies reported cannabis use as a substitute for or to alleviate harms of crack-cocaine use. While pre-clinical studies suggest a potential of cannabinoids, especially CBD, to treat cocaine addiction, the few trials conducted in humans found no benefits. Cannabis co-use by cocaine users commonly presents a risk factor , entailing enhanced harms for users. More rigorous, controlled trials are still necessary to investigate cannabinoids' potential considering pre-clinical findings and reported benefits from specific drug users.
... Some benefit of oral THC has been noted in cannabis withdrawal (Hart et al., 2002;Haney et al., 2004). More intriguing, perhaps, are claims of improvement on other substance dependencies, particularly cocaine (Labigalini et al., 1999;Dreher, 2002). The situation with CBD is yet more promising. ...
Article
Full-text available
Tetrahydrocannabinol (THC) has been the primary focus of cannabis research since 1964, when Raphael Mechoulam isolated and synthesized it. More recently, the synergistic contributions of cannabidiol to cannabis pharmacology and analgesia have been scientifically demonstrated. Other phytocannabinoids, including tetrahydrocannabivarin, cannabigerol and cannabichromene, exert additional effects of therapeutic interest. Innovative conventional plant breeding has yielded cannabis chemotypes expressing high titres of each component for future study. This review will explore another echelon of phytotherapeutic agents, the cannabis terpenoids: limonene, myrcene, α-pinene, linalool, β-caryophyllene, caryophyllene oxide, nerolidol and phytol. Terpenoids share a precursor with phytocannabinoids, and are all flavour and fragrance components common to human diets that have been designated Generally Recognized as Safe by the US Food and Drug Administration and other regulatory agencies. Terpenoids are quite potent, and affect animal and even human behaviour when inhaled from ambient air at serum levels in the single digits ng·mL -1. They display unique therapeutic effects that may contribute meaningfully to the entourage effects of cannabis-based medicinal extracts. Particular focus will be placed on phytocannabinoid-terpenoid interactions that could produce synergy with respect to treatment of pain, inflammation, depression, anxiety, addiction, epilepsy, cancer, fungal and bacterial infections (including methicillin-resistant Staphylococcus aureus). Scientific evidence is presented for non-cannabinoid plant components as putative antidotes to intoxicating effects of THC that could increase its therapeutic index. Methods for investigating entourage effects in future experiments will be proposed. Phytocannabinoid-terpenoid synergy, if proven, increases the likelihood that an extensive pipeline of new therapeutic products is possible from this venerable plant.
... There is also emerging evidence to suggest that cannabis may be used by some individuals to intentionally reduce the use of "high-risk substances" including crack-cocaine and opioids [59,60]. Cannabis has been used intentionally and effectively to reduce cocaine-related craving symptoms and the use of crack-cocaine among people who use illicit drugs [61]. Frequent cannabis use has also been associated with decreased illicit opioid use and exposure to fentanyl among people who use drugs [62,63]. ...
Article
Full-text available
Background There is concern that cannabis use negatively affects vulnerable groups such as youth; however, the relationship between cannabis use and health care utilization has not been well characterized in this population. We longitudinally evaluated the association between daily cannabis use and hospitalization among a prospective cohort of street-involved youth. Methods Data were collected from the At-Risk Youth Study (ARYS) in Vancouver, Canada, from September 2005 to May 2015. Participants were interviewed semi-annually and multivariable generalized estimating equation (GEE) logistic regression was used to examine the relationship between daily cannabis use and hospitalization. Results A total of 1216 participants (31.2% female) were included in this analysis, and 373 (30.7%) individuals reported hospitalization at some point during the study period. In a multivariable GEE analysis, daily cannabis use was not significantly associated with hospitalization (Adjusted Odds Ratio [AOR] = 1.17, 95% Confidence interval [CI] = 0.84, 1.65). We did observe a significant interaction between daily cannabis use and sex (AOR = 0.51, 95% CI = 0.34, 0.77), whereby cannabis use was associated with a decreased odds of hospitalization among males (AOR = 0.60, 95% CI = 0.47, 0.78), yet was not significantly associated with hospitalization among females (AOR = 1.19, 95% CI = 0.84, 1.67). Conclusions The finding that daily cannabis use was not associated with hospitalization among street-involved youth is encouraging given the high rates of cannabis use in this population and the expansion of cannabis legalization and regulation. Future studies, however, are warranted to monitor possible changes in the consequences of cannabis use as cannabis legalization and regulation increase internationally.
... Like alcohol, the use of marijuana (also known as cannabis, 'ganja' or 'weed') is embedded in aspects of the culture of some countries in the region, even though it is illegal. For example, the use of cannabis for therapeutic and religious purposes is nothing new to some social groups of Jamaican society (Benard, 2007;Dreher, 2002); as the Rastafarian community of Jamaica (and the wider Caribbean), 'has adopted ganja as its sacrament-substance... [one that is] in harmony with the environment, natural (or 'ital') and indigenous', (Dreher, 2002: 121). Many religions specifically teach that a healthy body, mind and spirit are important (Casey, 2009) and therefore in the cases where alcohol and marijuana are used within the context of religious and spiritual sacrament only small quantities are ingested. ...
Article
Although a sizable body of research has examined the socio- demographic correlates of religious involvement within the African Diaspora, few have been conducted about spirituality among Black Caribbean youth. This study: (a) interrogates the construct of 'spirituality'; (b) discusses the positive role of interfaith youth groups within the Caribbean; (c) posits a psychological explanation of the period of emerging adulthood and the associated psychosocial characteristics which facilitate spiritual development among this demographic; and, (d) quantitatively explores the relationships among spirituality, drug use, peer associations and family relations in Black Caribbean emerging adults. It was found that with an increase in the level of spirituality, the greater the likelihood that an emerging adult would experience healthy family functioning, positive peer associations and be less likely to engage in alcohol and marijuana use.
... However, 90-day substance use comparisons between MMP and NPU were different than lifetime comparisons. In particular, lower recent sedative/opioid misuse among MMP compared to NPU provides some support for the "stepping off" phenomena (Dreher, 2002;Mikuriya, 2004;Reiman, 2009;Sifaneck and Kaplan, 1995), whereby medical marijuana may serve as a substitute or replacement for other substances (Lucas et al., 2016;Richmond et al., 2015). Other studies comparing older MMP and NPU report varying results on other recent drug use among MMP, i.e., lower (Richmond et al., 2015), higher (Woodruff and Shillington, 2016). ...
Article
Full-text available
Background: Little is known about young adult medical marijuana patients (MMP) and their marijuana using patterns and practices, which includes frequency of use, sourcing of marijuana products, forms/modes of administration, and patterns of illicit/prescription drug misuse, compared to non-patient marijuana users (NPU). Methods: Young adults (N=366) aged 18-26 years old were sampled in Los Angeles in 2014-15 and segmented into NPU (n=156), marijuana users who never had a medical marijuana (MM) recommendation, and MMP (n=210), marijuana users with a current, verified MM recommendation. Differences regarding self-reported marijuana and other drug use during the past 90days are expressed as unadjusted risk ratios or differences in means. Results: MMP reported significantly greater mean days of use (76.4 vs. 59.2, p<0.001) and mean dollars spent on marijuana products (564.5 vs. 266.9, p<0.001) than NPU. Approximately one-quarter (22.6%) of both MMP and NPU report selling marijuana obtained from a dispensary to someone else in the past 90days. MMP were more likely to report vaporization modalities for concentrates (URR=1.5, 95% C.I.=1.2, 2.0) and for marijuana (URR=1.5, 95% C.I.=1.1, 2.1) than NPU. Though not significant, trends toward lower misuse of prescription drugs in the past 90days were observed among MMP compared to NPU. Conclusion: MMP reported greater access to marijuana via dispensaries, more frequent and intensive use of marijuana, and greater use of non-combustible forms of marijuana compared to NPU. MMP reported less recent misuse of prescription drugs compared to NPU.
... Early published references to the prophylactic, therapeutic and sacramental use of cannabis in Jamaica are indicative of the same findings that would be common in other Caribbean jurisdictions as research progressed. "Ganja tonics, teas and other infusions are household medicines used […] by all ages, both sexes and a wide range of socioeconomic levels" (Dreher, 2002). ...
Article
Purpose The purpose of this paper is to present evidence of the therapeutic value of cannabis as a harm reduction intervention with people who smoke crack cocaine. Design/methodology/approach A desk study of published peer-reviewed material supporting the use of cannabis as therapeutic in mitigating some of the harms associated with crack cocaine smoking. Findings The use of cannabis as a harm reduction strategy for crack cocaine use has been commented on in the scientific literature since the 1980s. The officially scheduling of cannabis as having no medicinal value hampered further study despite the reporting of positive findings and numerous calls for more research. Practical implications There are currently no approved pharmaceutical substitutions for crack cocaine. Cannabis has shown itself effective in mitigating harms for 30–40 per cent of people. Cannabis is inexpensive and readily available and should be allowed for those people who want to use it. Originality/value Poly drug use is often framed in a negative context. In this paper, the author shows that with cannabis and crack, the poly drug use is actually a valid harm reduction strategy.
... Notwithstanding these significant controversies, many authors still advocate the use of psychoactive cannabinoids compounds and smoked cannabis as harm-reduction therapeutic options for cocaine addiction (Dreher, 2002;Fischer et al., 2015a). That should be a concern since there is an absence of evidence-based data regarding effectiveness, safety, and side-effects of this association in the long-term. ...
... The study reports benefits of cannabis in preventing paranoia and loss of appetite. Also, cannabis appears to soften the effects of crack cocaine, reduces craving and withdrawal, and decreases engagement in risky behaviours, helping to regulate crack use (Dreher 2002). Similarly, in Brazil, among people who use freebase cocaine, the consumption of cannabis is considered a form of protection against negative aspects of crack cocaine use; for instance it is used as a sleeping aid and to overcome eating disorders, thereby increasing PWUS quality of life (Andrade et al. 2011;Gonçalves and Nappo 2015;Ribeiro, Sanchez, and Nappo 2010). ...
Book
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This report presents an overview on harm reduction interventions for problematic stimulant use. In it, we focus predominantly on interventions for people who smoke methamphetamine and freebase cocaine. While we initially aimed at addressing other amphetamine-type substances (ATS), cathinones and cocaine hydrochloride, as well as other non-injection routes of administration, most of the available harm reduction literature and interventions turned out to address smoked methampetamine and crack cocaine. The main contributions of the present study are twofold. First, it provides a worldwide literature review of harm reduction interventions for PWUS. Second, it documents, describes and analyses seven cases of good harm reduction practices for PWUS in different world regions.
... Additionally, cannabinoid receptor blockade by CBD may well reduce addiction potential [36], and support its usage as an 'anti-addictive' compound [72]. Interestingly, THC and CBD have both been demonstrated to potentiate the extinction of cocaine and amphetamine conditioned incentive learning in rats, supporting clinical studies claiming benefit of cannabis on cocaine addiction in Brazil [89] and Jamaica [90]. ...
Article
Full-text available
This study examines the current knowledge of physiological and clinical effects of tetrahydrocannabinol (THC) and cannabidiol (CBD) and presents a rationale for their combination in pharmaceutical preparations. Cannabinoid and vanilloid receptor effects as well as non-receptor mechanisms are explored, such as the capability of THC and CBD to act as anti-inflammatory substances independent of cyclo-oxygenase (COX) inhibition. CBD is demonstrated to antagonise some undesirable effects of THC including intoxication, sedation and tachycardia, while contributing analgesic, anti-emetic, and anti-carcinogenic properties in its own right. In modern clinical trials, this has permitted the administration of higher doses of THC, providing evidence for clinical efficacy and safety for cannabis based extracts in treatment of spasticity, central pain and lower urinary tract symptoms in multiple sclerosis, as well as sleep disturbances, peripheral neuropathic pain, brachial plexus avulsion symptoms, rheumatoid arthritis and intractable cancer pain. Prospects for future application of whole cannabis extracts in neuroprotection, drug dependency, and neoplastic disorders are further examined. The hypothesis that the combination of THC and CBD increases clinical efficacy while reducing adverse events is supported.
... Notwithstanding these significant controversies, many authors still advocate the use of psychoactive cannabinoids compounds and smoked cannabis as harm-reduction therapeutic options for cocaine addiction (Dreher, 2002;Fischer et al., 2015a). That should be a concern since there is an absence of evidence-based data regarding effectiveness, safety, and side-effects of this association in the long-term. ...
... In an ethnographic study (Dreher, 2002) of 33 Jamaican working-class women (many of whom were prostitutes who were crack cocaine dependent or in recovery from crack cocaine use), subjects were monitored for nine months, during which time their drug use, lifestyles, and personal and social relations were recorded. Female crack users are especially stigmatized in Jamaica by the Rastafarian culture, and this stigma is further increased in the case of prostitutes, despite the fact that the majority of these women had been initiated into crack use by men. ...
Chapter
The history of the use of cannabis for the treatment of substance-related disorders and harm reduction is relatively recent. Although evidence of the use of cannabis for the treatment of multiple disorders, including such varied conditions as pain and malaria, has been documented across time and cultures (Landa, Jurica, Sliva, Pechackova, & Demlova, 2018), the use of herbal cannabis for the treatment of drug abuse and dependence emerged with the legalization of medicinal cannabis in Canada and several states of the United States in the last 20 years. California was the first state to legalize medical cannabis in 1996. Since then evidence has emerged from preclinical research, ethnographical research, observational studies, and a few clinical trials, some of them still in development. Moreover, in the last decade, several preclinical and clinical studies are showing evidence that cannabidiol (CBD) could be a treatment option for substance-related disorders. After delta9-tetrahydrocannabinol (or simply THC), CBD is the second most abundant cannabinoid in the cannabis plant. In contrast to THC, CBD does not produce euphoria or cognitive deficits, and so has no potential for abuse. In this chapter we will discuss both the treatment of substance use disorders and harm reduction, acknowledging that these are concepts that refer to completely different issues and practices. We decided to use this approach because almost all evidence coming from observational studies suggests that herbal cannabis is not always used to reach complete abstinence from other drugs, but rather to improve quality of life or as a substitute for more dangerous drugs such as cocaine and heroin.
Article
The term cannabinoids encompasses compounds produced by the plant Cannabis sativa, such as Δ 9-tetrahydrocannabinol, and synthetic counterparts. Their actions occur mainly through activation of cannabinoid type 1 (CB1) receptors. Arachidonoyl ethanolamide (anandamide) and 2-arachidonoyl glycerol (2-AG) serve as major endogenous ligands (endocannabinoids) of CB1 receptors. Hence, the cannabinoid receptors, the endocannabinoids, and their metabolizing enzymes comprise the endocannabinoid system. Cannabinoids induce diverse responses on anxiety- and fear-related behaviors. Generally, low doses tend to induce anxiolytic-like effects, whereas high doses often cause the opposite. Inhibition of endocannabinoid degradation seems to circumvent these biphasic effects by enhancing CB1 receptor signaling in a temporarily and spatially restricted manner, thus reducing anxiety-like behaviors. Pharmacological blockade or genetic deletion of CB1 receptors, in turn, primarily exerts anxiogenic-like effects and impairments in extinction of aversive memories. Interestingly, pharmacological blockade of Transient Receptor Potential Vanilloid Type-1 (TRPV1) channel, which can be activated by anandamide as well, has diametrically opposite consequences. This book chapter summarizes and conceptualizes our current knowledge about the role of (endo)cannabinoids in fear and anxiety and outlines implications for an exploitation of the endocannabinoid system as a target for new anxiolytic drugs.
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Objectives: High levels of morbidity and mortality associated with injection drug use continue to represent a significant public health challenge in many settings worldwide. Previous studies have shown an association between cannabis use and decreased risk of some drug-related harms. We sought to evaluate the association between high-intensity cannabis use and the frequency of injection drug use among people who inject drugs (PWID). Methods: The data for this analysis were collected from three prospective cohorts of PWID in Vancouver, Canada, between September 2005 and May 2018. Generalized linear mixed-effects models were used to analyze the association between daily cannabis use and the frequency of injecting illegal drugs (i.e., self-reported average number of injections per month). Results: Among the 2,619 active PWID, the frequency of injection drug use was significantly lower among people who use cannabis daily compared with people who use it less than daily (adjusted odds ratio [AOR]=0.84, 95% confidence interval [CI]: 0.73-0.95). Sub-analyses indicated that this effect was restricted to the frequency of illegal opioid injection (AOR=0.78, 95% CI: 0.68-0.90); the association between daily cannabis use and the frequency of illegal stimulant injection was not significant (AOR=1.08, 95% CI 0.93-1.25). Discussion: The findings from these prospective cohorts suggest that people who use cannabis daily were less likely to report daily injection of illegal drugs compared with people who use it less than daily. These results suggest the potential value of conducting experimental research to test whether controlled administration of cannabinoids impacts the frequency of illegal opioid injection among PWID.
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simple relationships in favor of more abstract assignations [3]: “…the word Vayu , does not imply ‘Wind’ in Ayurvedic literature, but
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Particularly interesting are the opposite effects of the newly developed cannabinoid antagonists. These compounds have been shown to decrease food intake and to regulate body-weight gain, and are expected to provide a new therapeutic approach to treat obesity, a condition that affects up to 27% of the US population and is now considered by the World Health Organization as a global epidemic that poses a serious threat to world health, particularly in adolescents [2]. However, the mechanism by which the cannabinoid system modulates food intake is far from fully understood, and its elucidation is the subject of much research at the moment.
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Background Cannabinoids may have an important therapeutic potential for the treatment of dependence on crack cocaine. Cannabidiol (CBD), in particular, has anxiolytic, antipsychotic and anticonvulsant properties and plays a role in regulating motivation circuitry and controlling sleep disorders. Several studies were performed evaluating CBD in experimental models for cocaine. This systematic review aims evaluate the potential use of CBD in the treatment of cocaine use disorder. Method Five databases (Scielo; Medline/PubMed; PsycINFO; Cochrane Library; Virtual Health Library-VHL) were searched up to January 2020. Full-text reports published in English were included if they were experimental studies that administered CBD to human and/or adult animals in use or with a history of crack/cocaine administration. The risk of bias of each study selected was appraised by two independent reviewers following the Systematic Review Centre for Laboratory Animal Experimentation (SYRCLE) protocol. Major findings Fifty-one studies were analyzed, and 14 were selected. No studies conducted with humans were found; only one clinical trial was ongoing. The results were grouped into the following categories: cocaine self-administration, brain-stimulation reward, conditioned place preference, neuronal proliferation, anxiety, hepatic protection, anticonvulsant effect and locomotor sensitization response Only four studies had a low risk of bias. CBD promotes reduction on cocaine self-administration. Also, it interferes in cocaine induce brain reward stimulation and dopamine release. CBD promotes alteration in contextual memory associated with cocaine and in the neuroadaptations, hepatotoxicity and seizures induced by cocaine. Conclusion The evidence indicates that CBD is a promising adjunct therapy for the treatment of cocaine dependence due to its effect on: cocaine reward effects, cocaine consumption, behavioral responses, anxiety, neuronal proliferation, hepatic protection and safety. Moreover, clinical trials are strongly required to determine whether the findings in animal models occur in humans diagnosed for cocaine or crack cocaine use disorder.
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This analysis examined the role of impactful life events/stressful contextual factors and cannabis use in the patterns of illicit drug use. It utilized semi-structured qualitative interviews with 40 young adult medical cannabis patients and 22 non-patient users collected in Los Angeles during 2014–2015. Three patterns of illicit drug use emerged based on participants’ narratives: regular/problematic, recreational/occasional, and never users. Among regular/problematic users, a common theme was the lasting impact of traumatic life events or stressful contextual factors on transition to and away from problematic drug use, and using cannabis to cope with negative after effects of drug use. In contrast, most recreational/occasional and never users, who reported impactful life events or stressful contextual factors, used cannabis to cope with those experiences. Family history of addiction and acceptance of cannabis use within a family as protective factors against illicit drug use among some recreational/occasional and never users was an unexpected finding.
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This study ensued from clinical observations based on spontaneous accounts by crack abusers undergoing their first psychiatric assessment, where they reported using cannabis in an attempt to ease their own withdrawal symptoms. Throughout a period of nine months, the researchers followed up on 25 male patients aged 16 to 28 who were strongly addicted to crack, as diagnosed through the Composite International Diagnostic Interview (CIDI), according to CID-10 and DSM-IV diagnostic criteria. Most of the subjects (68%, or 17 individuals) ceased to use crack and reported that the use of cannabis had reduced their craving symptoms, and produced subjective and concrete changes in their behavior, helping them to overcome crack addiction. The authors discuss some psychological, pharmacological and cultural aspects of these findings.
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This article, based on ethnohistorical research, describes the drinking practices of the Winnebago Indians from the early 1860s, when they moved into Nebraska, until the early 1920s and relates these drinking practices to the changing sociocultural environment. The major focus is on the manner in which the Peyote religion helped control excessive drinking. The discussion examines Peyotism as a native therapeutic system and compares it to other such native systems and to Western regimens. It is argued that common elements in these diverse approaches are responsible for the successful control or "treatment" of excessive drinking.
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For many recovering alcoholics/addicts, the 12-Step recovery process is experienced as the single most powerful transformative force in their lives: the one supplying the most guidance and diverse resources for change. This article reviews some of the misconceptions that exist outside of these programs as well as some of the controversies within them that make referral to 12-Step groups a complex task. Among the nonrecovering community, misconceptions about the nature and working of 12-Step programs and their processes have led many to reject this approach to recovery. The concept of spirituality and how it can be applied is a major area of difficulty that will be explored in detail. Other issues, such as the misunderstanding about the appropriate use of psychotropic medication, may result from the fact that the strong opinions of vocal members in particular 12-Step meetings may come to be seen as representing a mandate from Alcoholics Anonymous (AA), despite being completely at variance with the organization's stated position (Report from a Group of Physicians in AA 1984). Within the recovering community itself, certain controversies (e.g., about dual addiction) tend to decrease accessibility and effectiveness as well. Although some of the questions involved are universal in nature, these controversies may vary in different geographical areas, from fellowship to fellowship, and from individual to individual. This article describes several key areas of difficulty surrounding 12-Step programs. Hopefully, it will clarify which are the result of misunderstanding and which are the unsettled questions resulting from the fast-moving change processes affecting 12-Step programs today.
This paper suggests that the concept of intra cultural diversity is a more useful framework for understanding non-conforming behavior among Jamaican rural women than social psychological explanations of deviance from culturally approved sex roles. A comparison of female cannabis smoking in two rural communities, permits us to identify some of the social processes which underly variation in the nature and extent of marijuana use by women in the two settings.
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This article, based on ethnographic research, discusses the dynamic relationship between ganja (marijuana) and cocaine in five areas within Montego Bay, an urban-tourist center in Jamaica, West Indies. The focus is on the contrasting and conflicting social perceptions related to the current role of each substance in the society, as well as the interrelationship between these two substances. Of particular interest in the analysis of use and distribution patterns of each substance is the seemingly conflicting moral versus economic dilemma surrounding the drug trade; perceptions related to the effects of these two substances on the body and mind; and perceptions related to the role these substances play in local crime and physical violence. Community-level social perceptions will be compared to official discourse and actions regarding demand reduction, prevention, and enforcement of "drug" laws.
Article
Social relationships play a significant role in drug use and recovery, perhaps especially for women. Research on social relationships among crime-involved women drug users is reviewed, including both well established findings and more recent topics of inquiry. Several open questions about social relationships of women drug users are then examined in data from a study conducted in the Miami (Florida) metropolitan area in 1994-1996. For a study of barriers to drug treatment for crime-involved women cocaine users, over 400 women were interviewed in treatment programs and an equal number were recruited on the street. Respondents were asked about their social relationships during the last 30 days on the street in regard to both legal and illegal activities. This included crime partnerships, help obtaining cocaine, living arrangements, help with living expenses, children and help with child care, help with several ordinary problems, and pressures to enter treatment. The analysis looks at how much social support crime-involved women cocaine users have in their ordinary daily activities, who provides this support, and findings from this data set relative to open questions in the literature.
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