Cannabidiol as a Harm Reduction Strategy for People Who Use Drugs: A Rapid Review.

OBJECTIVE: The drug poisoning crisis throughout North America necessitates novel harm reduction approaches. Emerging evidence suggests that cannabidiol (CBD) may have some utility as a harm reduction modality for those with problematic substance use. This rapid review aimed to synthesize available evidence on CBD as a potential harm reduction tool for people who use drugs while providing clinical and research insights. METHOD: A systematic search in EMBASE, MEDLINE, CENTRAL, and CINAHL was completed in July 2022. For inclusion, studies had to meet the following criteria: (1) drawn from an adult population of people who use drugs; (2) investigates CBD as an intervention for problematic substance use or harm reduction-related outcomes; (3) be published after the year 2000 and in English; and (4) be primary research or a review article. A narrative synthesis was used to group outcomes relevant to harm reduction and provide clinical and research insights. RESULTS: We screened 3,134 records, of which 27 studies (5 randomized trials) were included. The evidence remains limited, but available studies support the potential utility of CBD to reduce drug-induced craving and anxiety in opioid use disorder. There were low-quality studies suggesting that CBD may improve mood and general well-being of people who use drugs. Evidence suggests that CBD monotherapy may not be an adequate harm reduction strategy for problematic substance use but rather an adjunct to the standard of care. CONCLUSION: Low-quality evidence suggests that CBD may reduce drug cravings and other addiction-related symptoms and that CBD may have utility as an adjunct harm reduction strategy for people who use drugs. However, there is a significant need for more research that accurately reflects CBD dosing and administration regimens used in a real-world context.

Stigma-related barriers to medical cannabis as harm reduction for substance use disorder: Obstacles and opportunities for improvement.

Emerging evidence on substituting cannabis for more harmful drugs has led to cannabis becoming a novel harm-reduction strategy for combating the current drug poisoning crisis. However, the authorization of medical cannabis as part of a harm-reduction approach and recovery strategy has significant implementation barriers rooted in longstanding stigma towards cannabis. Through a multi-discipline collaboration of Canadian clinicians and academic researchers, we highlighted stigma barriers and opportunities to address these barriers to elicit improved delivery of medical cannabis as a harm-reduction therapy within existing therapeutic frameworks. Evidence from existing literature and real-world experiences converged on three key themes related to stigma barriers: (1) Lack of medical cannabis education within the healthcare community, (2) lack of consensus and coordination among harm-reduction services and (3) access to medical cannabis. We highlight potential solutions to these issues, including improved healthcare education, better coordination between care teams and suggestions for improving access. Through this discussion, we hope to contribute to reducing the stigma around using medical cannabis as a harm-reduction strategy for individuals with a substance use disorder and consider new perspectives in policy development surrounding recovery services.

Nursing Students and Cognitive Rehearsal Training as an Antibullying Strategy: A Canadian National Study.

BACKGROUND: Bullying in nursing is a well-documented phenomenon and is a factor in job satisfaction, nurse retention, and client safety. Both nursing students and nursing staff experience these negative interactions in clinical settings. METHOD: This study was conducted to refine and improve the cognitive rehearsal training (CRT) intervention. Experiential workshops were conducted with third-year or equivalent baccalaureate nursing students at five different schools of nursing across Canada (N = 329). RESULTS: Students supported the CRT approach as a first response toward dealing with bullying behavior in the health care workplace and offered advice for its improvement. CONCLUSION: Currently, schools of nursing and health authorities typically use theoretical and online approaches to address bullying. The CRT intervention described in this study is novel as it involves role-play, which promotes learning at a deeper level than didactic approaches. [J Nurs Educ. 2022;61(2):80-87.].

Impact of Cognitive Rehearsal Training Over Time for New Registered Nurses.

Background New RNs are most at risk for being bullied in health care. Cognitive rehearsal training (CRT) as an anti-bullying intervention is a novel approach to address the issue using role-play to respond to scenarios involving bullying. Previous studies (Griffin, 2004; O'Connell et al., 2019) show that students find the CRT strategy useful to increase their confidence and competence when managing a bullying situation. Method New RNs (N = 15) who had attended a CRT workshop 1 to 2 years previously answered an in-depth survey as to how they had used the training in the interim period. Results Seventy-one percent of the participants were able to recognize bullying behavior, and 64% had been able to stop from reacting immediately. Half of the participants reported taking time to reflect on the context of the bullying and manage their emotions and then respond in a professional manner. Conclusion Nurses in this study requested further CRT to solidify their learning, which could result in more prosocial responses to bullying. [J Contin Educ Nurs. 2022;53(5):203-211.].