Identifying an initial set of core components for perinatal cannabis use harm reduction counseling: An application of the Consensus on Relevant Elements (CORE) process

Cannabis use during pregnancy or lactation is a key topic in healthcare today. It is recommended that patients abstain from perinatal use and healthcare providers are encouraged to discuss use with patients. However, some perinatal individuals continue to use even once educated about the risks. For them, a nuanced approach to counseling that goes beyond warnings of risks is required to promote health and maintain trust. Harm reduction, which views any reduction in harm as a clinical success, is the best evidence-based practice for these patients. However, the essential elements (core components) of this approach have not yet been identified. This limits the approach's readiness for wider implementation, as it is critical that essential elements are maintained during intervention adaptation and scaling. We used the Consensus on Relevant Elements process to generate an initial list of core components for harm reduction counseling of cannabis using-pregnant and breast-feeding patients. We identified five core components within two domains. Within the domain of provider training, the provider 1) is skilled at facilitating conversation, and 2) is educated about cannabis use. Within the domain of patient-facing work, the provider 3) educates patients about cannabis safety and recommendations, 4) screens for cannabis, and 5) provides a brief harm reduction intervention. Future work to achieve a broader consensus of the core components of this approach should be undertaken to confirm these findings. This work serves as an important first step towards equipping healthcare providers to promote health for perinatal cannabis-using patients.