Daniel Bear, Ashley Hosker-Field, Kelsey Westall, Heath D'Alessio, Marilyn Cresswell
03-28-2025
The concept of harm reduction was a radical departure from a century of stigmatizing demand reduction initiatives targeted at people who use drugs. In fact, since the early 1980′s Harm Reduction has been used with great success to protect the lives and wellbeing of these individuals. When employed with people who use opioids, the relevancy and importance of harm reduction are easy to grasp because the potential dangers are both quite visible and profound. However, promoting harm reduction practices to people consuming cannabis is a more difficult challenge. Cannabis cannot cause death due to overconsumption, is not associated with the spread of communicable diseases, and is overall a relatively harmless drug both to the individual and society when compared with other legal substances such as tobacco and alcohol. Harm reduction campaigns targeted at cannabis consumers run the risk of sounding overly fearful and stigmatizing, ultimately being ignored like many of the old demand reduction initiatives. Cannabis does have potential harms, and teaching people to mitigate those harms is an important public health goal. This commentary argues that cannabis education targeted at young people should employ mindful consumption and benefit maximization (MCBM) language that promotes harm reduction practices but does not focus on harm as the primary issue related to cannabis use. We define what we mean by mindful consumption and benefit maximization, identify their convergence with harm reduction principles, and argue for their use to both promote knowledge and normalize cannabis consumption that incorporates harm reduction practices.
Introduction
Many people enjoy using cannabis. In fact, cannabis is the most widely used drug, with an estimated 219 million consumers worldwide1 (UNODC, 2023). However, enjoyment is not usually discussed in debates about drugs policy. Even progressive approaches such as harm reduction tend to begin discussing drugs consumption by focusing on the potential negative outcomes associated with substance use. But we must posit that the continued growth in the number of people who use cannabis must be at least partially attributable to the enjoyment or benefits derived by at least some who consume it. Given the widespread use of cannabis by young people, we believe it is important to provide information to consumers on how to consume safely and maximize the benefits they experience when consuming cannabis, while also avoiding the potential harms of consumption. In doing so we may more effectively engage young people than by a singular focus on potential harms.
This commentary piece arises from the authors’ reflections on the legacy of Safety First, a novel approach to engaging with young people written by the American drug policy scholar Dr. Marsha Rosenbaum in 1998. Her work was premised on the idea that discussions of drug use with young people must move away from fear-based prevention strategies and equip them with the information they need to avoid harm if they choose to use a particular drug. By presenting the potential dangers of certain drugs and associated harm reduction strategies, Dr. Rosenbaum broke with decades of practice and acknowledged that drugs experimentation by young adults was a relatively common activity, and one which they were woefully undereducated about. For proposing such a radical shift, the National Drug Prevention Alliance called her a “Snake oil salesman”, and suggested that her work would, “…kill more than a few kids, and keep the supply lines open for drugs” (Morgan, 2009).
Much has changed in the 25 years since Safety First was published. Legalization of non-medical/recreational cannabis is widespread across the United States and has been implemented in Canada, Germany, Malta, and Uruguay. Broad decriminalization efforts have sprung up in more than two dozen countries, with Portugal as the most prominent example. Even the United Nations has called for decriminalization of drugs for personal consumption.
The introduction of harm reduction in the 1980s centered on the risks associated with opioid consumption, particularly the threat of HIV/AIDs transmission via shared injection equipment. But the situation that spurred the creation of harm reduction is not the reality experienced by the millions of people who regularly consume cannabis today. Cannabis consumers do not risk death from tainted drugs or virus-carrying paraphernalia. They need not consume in supervised spaces or test their drugs for potentially fatal contaminants. The risk of overdose from cannabis is, in practical terms, non-existent (Rock et al., 2022).
Understanding of the effectiveness of cannabis policy is often based on observed changes in the prevalence and frequency of cannabis use by various groups. For the better part of a century, we have seen efforts to push both those measures downward by two main paradigms: demand reduction and supply reduction. Neither has proven particularly helpful, and cannabis consumption rates by young people remain at consistently high levels around the world (WHO, 2016). In Canada, 43 % of 16- to 19-year-olds, and 27 % of all people over the age of 16 reported using cannabis within the past year (Health Canada, 2024).
In the best-case scenario cannabis consumers are engaged by public health professionals employing a harm reduction paradigm that was created to mitigate the harms of far more dangerous drugs. Such efforts are to be commended, and the authors of this piece have all been part of the development of various harm reduction education campaigns for cannabis, but it is time to move into a new paradigm.
The ideas of Safety First were a departure from the norms in place in the US at that time, but it still relied on the understanding that drugs consumption was potentially dangerous. While Dr. Rosenbaum and others have pointed out that this danger often results from or is amplified by the effects of prohibition, potential harm resulting from consumption remained the primary focus of even the most progressive public education efforts. However, given that many people enjoy drugs, discussions that begin and end with minimizing harms may not ring true to consumers (Coggans et al., 2020), and therefore will be less effective than more comprehensive discussions about how and why people may choose to or choose not to consume a particular drug. In short, harm reduction is not a fulsome enough approach to ensure safe and enjoyable experiences for people who consume cannabis.
This departure from harms-focused practices is where mindful consumption and benefit maximization (MCBM) become relevant. 'Mindful consumption' involves the intentional and thoughtful use of substances, (Bahl et al., 2016; Firefly, 2017). On the other hand, 'benefit maximization' seeks to enhance the positive aspects of substance use, such as therapeutic effects and pleasure/enjoyment (Sage & Michelow, 2016; Tupper, 2008). When coupled together, MCBM enables individuals to make informed choices that not only enhance their safety but also maximize the enjoyment or beneficial use of substances.
In the ensuing pages we will discuss the benefits and risks of cannabis use, the history of cannabis education in the context of harm reduction, and more fully conceptualize what a new MCBM approach to cannabis education might look like.
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Benefits and risks of cannabis use
The necessity of implementing a new wave of education that includes MCBM with people who use cannabis is especially important given the perceived physical, mental, and social benefits that have been associated with cannabis use. Notably, people who use cannabis have reported that consumption increases relaxation and sociability, reduces stress, anxiety, and depression, and can increase general appreciation of food, nature, music, and sex (Hall, 2020; NASEM, 2017; Nguyen et al., 2022; Sexton et
History and effectiveness of drug/cannabis education and harm reduction
As noted, in the pre harm reduction era, drug education campaigns traditionally employed abstinence-based messages that leveraged fear and stigma to dissuade consumption. Such approaches have beenlargely ineffective (Fischer et al., 2017; Lynam et al., 1999; Rosenbaum & Hanson, 1998) as they fail to mobilize tangible information and develop skills to make informed decisions about substance use (Ennett et al., 1994; Midford & Cahill, 2020).
At its core, harm reduction is a framework designed to
Mindful consumption and benefit maximization (MCBM)
In contrast to the conventional harm reduction approach, which primarily focuses on harm minimization, 'benefit maximization' directs its primary focus toward enhancing the positive aspects of substance use, including its potential medicinal benefits, social and recreational enjoyment, and significance in spiritual or cultural practices (Sage & Michelow, 2016; Tupper, 2008). This perspective reshapes harm reduction practices to be non-judgmental, free from stigmatization, and supportive of the
Current research on mindful consumption and benefit maximization
The principles of both mindful consumption and benefit maximization are not new but have received less attention than harm reduction, likely due to substance use stigma and drug prohibitions . Previous discussions of benefit maximization have primarily focused on specific substances, such as psychedelic drugs like ayahuasca (Tupper, 2008; Pilecki et al., 2021). In one article addressing the globalization of ayahuasca, Tupper (2008) suggests a transition from harm reduction to benefit
Applying MCBM concepts to cannabis education
Given cannabis’ relatively low risk compared to alcohol and tobacco, providing harm-focused education may be counterproductive (Lucas, 2009). This is particularly true for young people, as harms-focused messaging does not resonate with their own experiences and the way they engage with cannabis (Watson et al., 2019). Therefore, when educating young people about cannabis, it's essential to use MCBM language to promote harm reduction practices without making harm the primary focus of cannabis
Conclusion
In Canada, people as young as 18 years old are able to purchase legally produced cannabis. If we can help shape the foundational consumption practices and the way young people approach decisions around cannabis consumption, it may be possible to prevent people more effectively from experiencing the potential long-term consequences of cannabis use. The introduction of MCBM practices in secondary and post-secondary schools, public health campaigns, and in the home, may create a new generation of
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