Since the 1990s, cannabis users in Europe have developed proposals to reduce legal insecurity and to improve access to high-quality products [15]. For example, collective cannabis plantations and Cannabis Social Clubs (CSCs) were introduced by activists in Spain as an alternative to the black market. CSC’s are non-profit associations whose members are adult cannabis users. People who join a club have to satisfy certain conditions and together organise the professional cultivation of cannabis to cover their personal needs, against the backdrop of security and quality checks [11].

The CSC model has been emulated in Belgium and Uruguay as well as other countries. There is evidence of experimentation with this model in Chile, Colombia, Argentina, the United Kingdom, France, Slovenia, Switzerland, New Zealand, and Italy [18]. Researchers have argued that CSCs minimise the risks to cannabis users by helping them to avoid legal problems, by providing a high-quality product, protecting minors, making information available, and reducing the stigma associated with cannabis use [14, 29].

Obradors-Pineda et al. (2021) examine the harm reduction practices introduced by 15 CSCs in Catalonia. Most of these had between 50 and 200 members and half had a member of staff who had received training on cannabis risk reduction. Decorte [18, p. 123] describes CSCs as occupying a meaningful middle ground between cannabis prohibition and commercial legalisation. The European Coalition for Just and Effective Drug Policies (ENCOD) promotes the CSC model and has produced a set of guidelines that highlight the ability of CSCs to provide information and advice, facilitate interactions between members, organise workshops and talks, promote alternatives to smoking and refer members to treatment services [21, p. 32].

Several risks have been identified in relation to CSCs, starting with the possibility that they can become opportunistic, profit-seeking organisations [18, 19]. There is a risk of displacing chaotic users into non-controlled environments, while excessive regulation of CSCs could curb users’ willingness to take part in them [15].

One way to deal with a lack of legal access to cannabis is to turn to home-growing or to rely on home-grown cannabis supplied by others. In overall terms, there has been a shift in recent years from imported cannabis to domestic production, involving both small-scale and large-scale growers [31, 35]. The trend towards domestic production utilising more technically advanced methods began in earnest in the 1990s and accelerated in the early 2000s due to easier access to information and equipment. Many growers regulate the potency of their cannabis, are proud of the quality of their plants and cultivate cannabis to avoid having to pay drug dealers for poor quality products [35]. One benefit of this model is that it reduces or eliminates the risks associated with large plantations, including the exploitation of workers who are forced to operate in dangerous environments.

Interest in using cannabis to manage the symptoms of medical conditions has also increased in recent years, and one survey found that 24% of growers in Denmark and 59% of those in Finland were producing cannabis for medical purposes [22]. The majority of medical growers in Australia, Belgium, Denmark, Finland, Germany and the UK have a medical diagnosis and approximately one in five report that their doctor suggested using cannabis. Potter & Klein [35] report that up to a million people in the UK could be using cannabis (illegally) for medical purposes, with a substantial number growing their own plants.

In Belgium, small-scale cultivation for personal use is tolerated, and legislative reform in 2003–2004 made the possession of 3 g of cannabis and the cultivation of one female plant for personal use tolerable (albeit still criminal) offences. The aim was to separate cannabis from other drugs and to grant the prosecution service more discretion when tackling cannabis-related offences [31]. In 2004, Western Australia became the fourth Australian state to implement a civil penalties scheme for minor cannabis offences. Those apprehended with small amounts of the drug could, depending on the circumstances, be eligible for a fine or infringement notice instead of being arrested. The scheme also allowed adults to grow two cannabis plants outdoors, or to possess up to 30 g of dried cannabis flowers without risking arrest. There was no evidence of an increase in cannabis use following introduction of the scheme and no evidence of an increase in the amount of cannabis being cultivated [26], although this policy was later reversed after a change in government [44].

Home cultivation capitalises on the spontaneous health-promoting behaviour of non-commercial growers, many of whom are embedded in a cannabis culture that values the natural qualities of this drug [13]. At the same time, unregulated home cultivation could make it easier for minors to access cannabis and reduce the ability of the state to collect taxes and to regulate access and pricing.

Researchers have drawn attention to the positive features of systems for the distribution of cannabis which involve a combination of national regulation and local control. An example is the Dutch coffee-shop model, which was made possible by the decision to not enforce criminal sanctions for the sale and possession of small quantities of cannabis. The objective of Dutch cannabis policy is to limit risks for cannabis users and to reduce harms to the wider society. In particular, it aims to prevent cannabis users from becoming marginalised, stigmatised and criminalised, and to reduce access to more harmful substances by separating the supply lines of these substances.

Coffee-shops are café-like places where the sale of cannabis is tolerated as long as there is no advertising, no hard drugs, no nuisance to other people, no access for minors and as long as no more than 5 g of cannabis is purchased [27]. Although their number is gradually decreasing, coffee shops are still a widespread phenomenon in the Netherlands and it is estimated that in municipalities with officially tolerated coffee-shops, around 70% of cannabis consumed is purchased from these outlets. The coffee-shop system appears to be successful in separating the hard and soft drug markets; where there is a lower density of coffee-shops, there are more illicit dealers [27]. Survey data show that both last year and last month prevalence rates in the Netherlands have remained stable in recent years and are well below the European average.

The production and sale of cannabis in wholesale quantities remains illegal in the Netherlands, which makes it difficult for coffee-shops to exert control over the quality of the product they sell. Cannabis samples from Dutch coffee-shops have at times been found to be contaminated with mould, bacteria, pesticides, heavy metals or additives. Moreover, coffee-shops can encourage cannabis tourism, an issue which is increasingly attracting the attention of policy-makers [27].

Dispensaries emerged in Canada prior to the legalisation of medical cannabis, emulating the local dispensaries that were established following the 1996 medical cannabis ballot in California. Their purpose was to provide high-quality cannabis to patients with a medical condition for which cannabis had been recommended by a licenced health care provider. For older adults, in particular, dispensaries represented an accessible and non-stigmatising source of medical cannabis. The dispensaries formed an association and adopted a form of self-regulation, like CSCs in Europe.

The study by Lau et al. [25] provides insights into the potential role of dispensaries in terms of harm reduction. They interviewed almost 100 older adults living in San Francisco who were born between 1946 and 1964 and had used cannabis a minimum of 24 times over the past six months. Those who had access to medical cannabis dispensaries were found to be more knowledgeable about alternative delivery systems and the use of edibles. The people Lau et al. interviewed were engaged in sensible, continuing, controlled use which was perceived as relatively unproblematic by the individuals concerned.

People working in cannabis dispensaries often provide information to consumers and have been identified as an important resource in delivering harm reduction initiatives and advice [17]. There are roughly 4,000 budtenders in Washington State alone, and Carlini et al. [17] studied their orientations and practices using focus groups. Both medical and non-medical customers purchase cannabis in the same stores, and budtenders with certified medical consultant training can serve both kinds of customer. When asked about how they help people, budtenders talked about helping clients to avoid the risk of acute cannabis intoxication and to understand the need for safe cannabis storage.