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Lower-Risk Cannabis Use Guidelines (LRCUG) for reducing health harms from non-medical cannabis use: A comprehensive evidence and recommendations update
Open accessAbstract
BACKGROUND: Cannabis use is common, especially among young people, and is associated with risks for various health harms. Some jurisdictions have recently moved to legalization/regulation pursuing public health goals. Evidence-based 'Lower Risk Cannabis Use Guidelines' (LRCUG) and recommendations were previously developed to reduce modifiable risk factors of cannabis-related adverse health outcomes; related evidence has evolved substantially since. We aimed to review new scientific evidence and to develop comprehensively up-to-date LRCUG, including their recommendations, on this evidence basis. METHODS: Targeted searches for literature (since 2016) on main risk factors for cannabis-related adverse health outcomes modifiable by the user-individual were conducted. Topical areas were informed by previous LRCUG content and expanded upon current evidence. Searches preferentially focused on systematic reviews, supplemented by key individual studies. The review results were evidence-graded, topically organized and narratively summarized; recommendations were developed through an iterative scientific expert consensus development process. RESULTS: A substantial body of modifiable risk factors for cannabis use-related health harms were identified with varying evidence quality. Twelve substantive recommendation clusters and three precautionary statements were developed. In general, current evidence suggests that individuals can substantially reduce their risk for adverse health outcomes if they delay the onset of cannabis use until after adolescence, avoid the use of high-potency (THC) cannabis products and high-frequency/-intensity of use, and refrain from smoking-routes for administration. While young people are particularly vulnerable to cannabis-related harms, other sub-groups (e.g., pregnant women, drivers, older adults, those with co-morbidities) are advised to exercise particular caution with use-related risks. Legal/regulated cannabis products should be used where possible. CONCLUSIONS: Cannabis use can result in adverse health outcomes, mostly among sub-groups with higher-risk use. Reducing the risk factors identified can help to reduce health harms from use. The LRCUG offer one targeted intervention component within a comprehensive public health approach for cannabis use. They require effective audience-tailoring and dissemination, regular updating as new evidence become available, and should be evaluated for their impact.
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“Conversely, recently updated ‘Lower-Risk Cannabis Use Guidelines’ were largely unable to list risk-thresholds for main adverse outcomes due to a lack of adequately quantified exposure data (Fischer et al., 2022).”
From Risk-thresholds for the association between frequency of cannabis use and the development of psychosis: a systematic review and meta-analysis (2023) · cites this paper as Fischer et al., 2022
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Metadata
- Authors
- Fischer, B., Robinson, T., Bullen, C., Curran, V., Jutras-Aswad, D., Medina-Mora, M. E., Pacula, R. L., Rehm, J., Room, R., Brink, W. V. D., & Hall, W.
- Affiliations
- University of Auckland (NZ)
- Simon Fraser University (CA)
- National Institute for Health and Care Research (GB)
- University of Southern California (US)
- Centre for Addiction and Mental Health (CA)
- Stockholm University (SE)
- Amsterdam University Medical Centers (NL)
- The University of Queensland (AU)
- Corresponding author
- Fischer, Benedikt
- ORCID
- Venue
- International Journal of Drug Policy
- Publisher
- Elsevier BV
- Published
- 2022-01
- Volume
- 99
- Pages
- 103381
- ISSN
- 0955-3959 (ISSN-L)
- OpenAlex
- W3196591394
- Cited by
- 236
- References
- 335
- Citations by year
- 2026: 50 · 2025: 65 · 2024: 41 · 2023: 38 · 2022: 38
- FWCI
- 3.83
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- International Journal of Drug Policy (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (submittedVersion, cc-by)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- UCL Discovery (University College London) (submittedVersion)
- Figshare (submittedVersion, cc-by-nc-nd)
- La Trobe University
- Funders
- Health Canada
- Topics
- Health Sciences › Medicine › Pharmacology (medical) › Cannabis and Cannabinoid Research
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Smoking Behavior and Cessation
- Keywords
- cannabis use, non-medical cannabis, modifiable risk factors, high-potency cannabis, THC, cannabis smoking, pregnant women, older adults, comorbidities, public health recommendations, expert consensus
- MeSH terms
- Adolescent, Aged, Cannabis, Female, Humans, Pregnancy, Public Health, Risk Factors, Exercise
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