Harm Reduction

Background

Since 2008, when I became aware of the enormous and increasing rates of HIV infection among younger Black MSM in Chicago and other metropolitan areas, I have been working with Professor Ed Laumann and colleagues in the Stouffer-Ogburn Center for Social Organizational Research in the development and testing of questionnaires for determining the specific social and contextual drivers of this increasing epidemic of HIV in such highly vulnerable subpopulations of MSM. This led to a pilot NIDA funded study the develop cultural appropriate measures of the influences of attitudinal, social and risk networks (the revised R-MAS and SRNA assessments) in determining the greatly elevated HIV risk among younger Black and homeless MSM; and the awarding of a NIDA-funded R01 award to prospectively study “Social Network Dynamics, HIV and Risk Reduction Practices Among Younger Black MSM.” Dr Ostrow feels strongly that it is through this type of multi-dimensional, longitudinal study of evolving social drivers and newly emerging ARV-based harm reduction HIV interventions among vulnerable YBMSM and older men (50 yrs), who are both currently being infected at increasingly higher rates than their risk behavior levels would predict, can be developed.

In parallel, by applying the R-MAS and the SRNA assessment instruments to the current new recruits to the MACS of recently infected young Black MSM and older gay/bisexual men and members of their risk networks, we hope to both better understand the social drivers of these uncontrolled HIV epidemics among specific sub-populations of MSM and the effective harm-reduction strategies they are adopting. These findings from the MACS and other longitudinal observational studies using the same instruments can then be translated into targeted HIV interventions that have the potential for reversing the devastating health disparities based on community/social drivers that thrive among persons with specific racial, developmental, lower SES, and other barriers to HIV-related testing, counseling and treatment access. It is this experience in designing standardized data collection methods that can be used to collect valid data across multiple studies that qualifies Dr. Ostrow to lead the development of similar methods to develop a Natonal Community-Based Clinical Cannabis Evaluation and Research Network (the CBCCERN). By conceptualizing this community-based, patient-centered research as a subset of harm reduction intervention evaluation and research, these same methods can be applied to the difficult but necessary task of obtaining data based, valid, longitudinal data on the benefits of harm reduction interventions for substance use and drug control policies.

Since 2002, Dr. Ostrow has been promoting on a National and International basis both drug policy reform that will replace punitive and marginalization drug policies with those based on the same Harm Reduction policies and social re-integration/counseling that he and others pioneered in the earliest attempts at HIV prevention, such as supplying condoms to men having sex with other men (MSM) and clean needles to IV drug users. His efforts helped in getting the AMA, APA and AACP to adopt policies calling for the legal protection of patients participating in State regulated Medical Cannabis MC programs, and increased availability of research grade cannabis for clinical research trials aimed at determining the therapeutic, rather than the negative, effects of cannabis and its component cannabinoids and terpenoids. In 2009 he was a co-founder and has since been the VP for Community Based Research of the American Academy of Cannabinoid Medicine (AACM) and has participated in the creation of the AACM Board Review Course and Certification process for physicians (MDs/DOs) wishing to specialize in quality MC treatment. He was an advisor, through Illinois NORML, and working directly with IL Legislature members, in ensuring that the soon to be started IL MC Pilot Program is focused on providing relief to qualifying patients who currently have to buy their medicine on the underground market and face serious criminal penalties for the growth, purchase and use of illicit medicine. In 2006, he proposed a National Community-Based Clinical Cannabis Research Network that would use standardized data forms and surveys collected on all participants in legal MC Programs to collect confidential (coded) data from patients, cultivation and producers of concentrates/edibles, dispensaries, the recommending and following PHCP and the patients themselves in order to develop a national longitudinal database that can be used for the evaluation of different models of MC treatment, and effectiveness of specific cannabinoid preparations consumed by patients, as well as objective measures of the response of the cardinal symptoms of the qualifying condition or syndrome for which patients with a particular illness are using. With the soon to start IL MCP, which is a “closed” system (no home grown medicine permitted, all products sold at dispensaries have to be analyzed for their active ingredients and relative strengths, and participants must see their recommending and following PHCP on a regular basis to maintain their license for the purchase of MC), we have the potential for the creation of the an IL CBCCRN, which can serve as a model for a National CBCCRN. This confidential but linked longitudinal database on each MC Program participant collected at each stage of their interaction with the IL MCP, can be used to provide blinded evaluation data useful to the State of IL in determining the success and needed changes when the pilot program is up for renewal; data-based MC treatment guidelines for existing and new qualifying conditions; and provide feedback to participating cultivators, dispensaries and recommending physicians on the types of MC products that should be manufactured and supplied to patients using MC as complementary or alternative treatment for specific symptoms, syndromes and illnesses.

Through the David Ostrow Consulting website that you are now perusing, Dr. Ostrow has been providing medical, research and technical support to the Medical Cannabis Industry, particularly persons planning to apply for cultivation and/or dispensary programs in IL and other State Medicinal Cannabis Programs under development. He has also been asked to consult to large regional MC programs (California Society of Cannabinoid Clinicians and the Spokane, WA, Veterans for Compassionate Care) and State programs also under formation (CT and NY) to share the CBCCERN methodology with them. The ultimate goal of this project is the collection of standardized data from many patients in various areas of the country that can be pooled for the analyses needed to develop science-based treatment guidelines and provide guidance for Investigators wishing to pursue randomized controlled clinical trials. In addition, through DavidOstrowConsultants.com, he has been advising medical clinics/hospitals/community clinics wishing to set up Integrated Holistic Wellness Programs that incorporate data-based CM therapies