This article reports on an exploratory study of medical cannabis users. Interviews were completed with 50 self-identified medical cannabis users recruited through notices in newspapers and on bulletin boards. They reported using cannabis for a variety of conditions including HIV-AIDS-related problems, chronic pain, depression, anxiety, menstrual cramps, migraine, narcotic addiction as well as everyday aches, pains, stresses and sleeping difficulties. A majority also used cannabis for recreational purposes, and many were longer-term cannabis users. However, there were some notable exceptions. Almost all smoked cannabis and many did so two to three times a day. Few admitted negative experiences with cannabis, although some problems evident to the researchers were not clearly admitted. Those who told their doctors about their medical cannabis use found doctors noncommittal or supportive. The results raise questions about the definition of medical cannabis use and about policies that might be developed to accommodate such use. Limitations of the study are noted and further research suggested. Research priorities include population surveys, studies involving larger, more representative samples of medical cannabis users and studies of medical cannabis use among people with HIV-AIDS.

In a mail survey of staff of specialized addiction treatment services in Ontario, respondents from different types of services varied in their level of support for a variety of harm reduction initiatives. Across all types of services support was common for needle exchange services (82-95% in favour) and for short-term non-abstinence goals for clients with alcohol or drug problems (51-98% in favour). However, mean ratings for the effectiveness of methadone maintenance were negative or near zero, and only in assessment/referral and out-patient samples did the majority (61% in each case) have a positive view of methadone maintenance programmes. Only a minority of respondents (15% to 35%) indicated support for the prescription of heroin to heroin addicts. In multivariate analyses, support for harm-reduction strategies was found to be positively related to belief in the effectiveness of pharmacological and cognitive-behavioural interventions and working in an out-patient treatment service, and negatively related to belief in interventions based on the disease model.

This paper presents a framework for the evaluation of activities and programs with harm-reduction objectives that draws attention to the logic, implementation, outcomes, costs, and cost-effectiveness of these initiatives and encompasses stakeholder concerns and theoretical models. Evaluations of harm-reduction initiatives are essential if their proponents wish to establish them as viable alternatives to abstinence-oriented approaches. [Translations are provided in the International Abstracts Section of this issue.]

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