Harm reduction interventions as a potential solution to managing cannabis use in people with psychosis: A call for a paradigm shift

Cannabis consumption is widespread in individuals with psychosis, with 60% of individuals with psychosis reporting lifetime cannabis use ( Colizzi et al., 2018 ).Continued cannabis use after a first episode of psychosis is associated with more psychotic relapses, more severe psychotic episodes, and longer hospitalizations compared to people with psychosis who stopped using or never used cannabis ( Schoeler et al., 2016 ).We want to highlight the critical need to complement existing treatment options with harm reduction strategies to help improve the well-being and prognosis for people with psychosis who use cannabis.Many health guidelines and scientific literature nominate cannabis cessation or reduction in individuals with psychosis ( Fischer et al., 2022 ), and interventions and therapeutic approaches for cannabis use primarily focus on abstinence and use reduction.Cannabis abstinence or at least reduction are theoretically the ideal intervention targets for people with psychosis who use cannabis and seek help.When achieved, these targets are associated with better clinical outcomes in people with psychosis ( Schoeler et al., 2016 ).Unsurprisingly, targeting abstinence or reduction aligns with what is largely promoted in clinical practice.Further, addiction service providers and health practitioners tend to support abstinence-oriented prevention measures and treatment goals ( Ekendahl et al., 2018 ;Rosenberg et al., 2020 ).Despite guideline recommendations and clinical practice favoring abstinence or use reduction, there are few known effective interventions to achieve these targets.Systematic reviews examining cannabis pharmacological or psychosocial interventions for people with severe mental illness report having insufficient evidence to support any one intervention over another for cannabis cessation or reduction outcomes, with overall relatively limited efficacy of these interventions for reducing cannabis use ( Hunt et al., 2019 ;Temmingh et al., 2018 ).The current state of research may leave health practitioners with limited guidance about which interventions to offer and may leave many people with psychosis and ongoing cannabis use with inadequate support.A potential complementary and obvious alternative option for people with psychosis who use cannabis and seek help is harm reduction.In past decades, harm reduction interventions have been accepted as a critical part of the therapeutic arsenal for many substance use disorders.Rather than focusing on ceasing use completely or reducing use, harm reduction approaches seek to reduce the negative consequences

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