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A 2019 study out of the University of Michigan found that 44 percent of medical cannabis users stopped taking traditional pharmaceuticals, used less of one, or both. While the combination of medical cannabis and mainstream health care remains a contentious topic, the UM research is one of the first of its kind to honestly investigate that relationship. We caught up with Dr. Daniel Kruger, who headed the research, to discuss public health, harm reduction, and the future of cannabis research. The following is an edited transcript of that discussion.

Can you describe your mandate at the Population Studies Center?

Though the research I do at the U of M has quite a wide range, most of it involves using evolutionary biology to understand human psychology in the theoretical sense, and applied research working with communities on practical solutions to health concerns and other social challenges. We look at community health patterns, community relations, and other social issues. At the same time, I advocate for theoretical advancement in understanding some of the areas of public health issues, health behaviours, and other social challenges.

What first motivated you to study cannabis?

This isn’t something that I wouldn’t have anticipated doing even five years ago. Basically, I’ve been working in the field of public health for almost 20 years now and I’d been a bystander previously on these issues. From what I saw, academic public health was operating in the prohibition era, so most of the focus was on abstinence programs for cannabis and investigations of adverse effects. I definitely see the value in preventing minors from using mind-altering substances and the definite risks that come from driving while intoxicated, but my perception is that public health hasn’t properly acknowledged the beneficial aspects of cannabis and the fact that millions of people are using cannabis to treat a medical or health condition, even before this was legal.

How do we address the present dearth in cannabis research?

The legal environment is changing rapidly. We think that all policy should be informed by science, including health and drug policies, but in the United States this is very difficult to do because cannabis is still illegal at the federal level and listed as a Schedule I drug. So, we haven’t been able to do clinical trials and the kind of research that you’d want to do if you were testing out a new pharmacotherapy. We’ve been able to make some progress, not by doing drug-trial studies, but by addressing the larger issues surrounding medical cannabis, particularly its relationship to the mainstream healthcare system.

What methodology did you apply to your research? 

Conveniently enough, we have a cannabis-advocacy rally on our own campus every April. I was able to design a survey instrument of two pages to be able to maximize the information that we could gather and minimize participant burden. We set up a table at the event and invited people to participate. I’m not sure how many people were actually drawn to us because we had food there, but I think it was a nice incentive for people to fill out the surveys.

Were you surprised with the results of your study?

I wouldn’t have been able to predict the number of people who said they had stopped taking a pharmaceutical drug or reduced the use of a pharmaceutical drug. Just from anecdotal experience, I know people who have done that, but we think this is one of those issues that needs to be investigated further.

What are the public health implications of your research?

Cannabis can be considered as an alternative or complementary medicine. That’s something outside of mainstream medicine right now, but our opinion is that it would be better to integrate the systems so that we don’t have issues like primary-care providers not knowing that their patients are using medical cannabis. That can lead to a number of issues like drug interactions. These are things that need to change so that both the education and science for the mainstream health system can be informed by evidence-based policies and practices. We need this now, because the legal environment for cannabis is changing very rapidly and its availability is continuing to rise. 

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