Harm Reduction Counseling for Cannabis Use in Pregnancy and Lactation

New data published by investigators in Advances in Drug and Alcohol Research identifies core components of harm reduction counseling, and highlights that patient-centered communication strategies may improve the engagement and disclosure of cannabis use during pregnancy and lactation.¹ Cannabis use remains common among pregnant and breastfeeding patients, even with consistent recommendations for abstinence from major professional organizations, including the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics.²

The data draw attention to structured counseling elements that pharmacists can incorporate into routine practice when addressing cannabis use in perinatal patients.¹

Cannabis Use in Perinatal Care

Among pregnant individuals, cannabis remains one of the most commonly used psychoactive substances, despite shifting perceptions regarding its safety during pregnancy. The primary psychoactive component in cannabis, Δ9-tetrahydrocannabinol (THC), crosses the placenta and presents itself in breast milk, resulting in fetal and neonatal exposure concerns. Patients may receive counseling on potential risks of THC (eg, low birth weight, neurodevelopmental effects, impaired attention in offspring), but regardless, some may continue to use cannabis.³

This emphasizes an ongoing clinical conflict in traditional abstinence-focused counseling, which may not fully address patient behavior or improve disclosure. Health care providers are increasingly evaluating alternative communication models that prioritize engagement and incremental risk reduction rather than abstinence alone.

Harm Reduction Framework in Cannabis Counseling

Harm reduction is a clinical approach that prioritizes reducing negative health outcomes even when complete cessation is not achieved. This model has been widely applied in substance use care, particularly in opioid stewardship and overdose prevention efforts.⁴ In relation to perinatal cannabis use, harm reduction focuses on structured counseling, patient education, and a reinforced use of nonjudgmental communication.

The research published in Advances in Drug and Alcohol Research identifies 5 core components of harm reduction counseling for cannabis-using pregnant and breastfeeding patients, grouped into provider- and patient-facing domains.

Clinicians can utilize the following components¹:

1. Demonstrate skill in facilitating open, nonjudgmental conversation. This can be achieved through creating a stigma-free counseling environment in which patients feel comfortable disclosing cannabis use, supported through empathetic communication, open-ended questioning, and reassurance that care remains nonpunitive and safety-focused.
2. Maintain knowledge. Maintain up-to-date knowledge of cannabis use and associated perinatal risks, including THC pharmacokinetics, fetal and neonatal exposure pathways, and evolving evidence linking prenatal cannabis exposure to adverse outcomes, such as low birth weight and neurodevelopmental impairment.
3. Provide education. Patient education should include cannabis safety and current clinical recommendations by counseling on risks of THC exposure during pregnancy and lactation (eg, placental transfer, breast milk transmission, and potential neonatal outcomes) while reinforcing guideline-based recommendations advising abstinence during pregnancy and breastfeeding.
4. Screen consistently for cannabis use. Screen consistently for cannabis use through incorporating standardized screening into patient encounters, including medication history review and direct, nonjudgmental questioning about cannabis consumption in all pregnant and breastfeeding patients. This approach supports earlier identification of use, improves patient disclosure, and enables timely counseling on potential risks and harm-reduction strategies in prenatal and postpartum care settings.
5. Deliver brief harm reduction interventions tailored to patient needs. This can be accomplished by integrating patient-specific counseling strategies that prioritize reducing cannabis-related risks during pregnancy and lactation. Practitioners may support incremental behavior change by reinforcing evidence-based safety concerns, encouraging reduced exposure when cessation is not achieved, and maintaining an ongoing, supportive counseling relationship grounded in nonjudgmental communication.

Pharmacist Role and Practice Implications

With accessibility and frequent patient interactions across community, ambulatory, and hospital settings, pharmacists are well positioned to implement harm reduction counseling. In opioid stewardship programs, pharmacists already implement similar principles with naloxone counseling, risk screening, and patient education on overdose prevention.⁴ The structured framework provided by these data offers a transferable model for pharmacy practice.

Pharmacists may incorporate cannabis screening into medication histories, provide consistent education on perinatal risks, and use brief motivational interviewing techniques to encourage open discussion without reinforcing stigma. Implementation may require additional training in cannabis pharmacology, perinatal risk assessment, and communication strategies tailored to substance use discussions.

The data provide a foundational framework for harm reduction counseling in perinatal cannabis use through defining core provider and patient-facing elements. As research on cannabis use develops and remains prevalent during pregnancy and lactation, pharmacists help align clinical guidelines with how patients actually use medications and substances in practice.

Cannabis use during pregnancy often occurs in patients who are otherwise engaged in prenatal care but may underreport use because of stigma or fear of judgment. This emphasizes the importance of trust-building communication strategies. Studies in perinatal substance use have demonstrated that nonjudgmental counseling approaches improve disclosure rates and patient engagement compared with directive or punitive messaging.⁵

Through integrating structured, nonjudgmental counseling approaches, pharmacists may improve patient engagement and contribute to safer perinatal care outcomes.

REFERENCES

1. Albanese AM, Cramer ER, Frank HE, Rogers BG. Identifying an initial set of core components for perinatal cannabis use harm reduction counseling: an application of the Consensus on Relevant Elements (CORE) process. Adv Drug Alcohol Res. 2026;6:15935. doi:10.3389/adar.2026.15935

2. Cannabis use during pregnancy and lactation. American College of Obstetricians and Gynecologists. October 2025. https://www.acog.org/clinical/clinical-guidance/clinical-consensus/articles/2025/10/cannabis-use-during-pregnancy-and-lactation

3. Gunn JK, Rosales CB, Center KE, et al. Prenatal exposure to cannabis and maternal and child health outcomes: a systematic review and meta-analysis. BMJ Open. 2016;6(4):e009986. doi:10.1136/bmjopen-2015-009986

4. Naeem AH, Kapadia J, Soske J, et al. Navigating substance use care in the emergency department: a scoping review. J Am Coll Emerg Physicians Open. 2026;7(2):100318. doi:10.1016/j.acepjo.2025.100318

5. Stone R. Pregnant women and substance use: fear, stigma, and barriers to care. Health Justice. 2015;3:2. doi:10.1186/s40352-015-0015-5