Dr. M-J Milloy

Dr. M-J Milloy, PhD

Social/clinical epidemiologist

Associate professor,
Division of Social Medicine, Department of Medicine, University of British Columbia;

Research scientist/Associate director of research,
British Columbia Centre on Substance Use
Unceded and ancestral territories of the Coast Salish Nations

Dr. Milloy’s programme of research focuses on identifying and evaluating ways to  improve the health and well-being of people who use drugs, especially those at risk of serious morbidity and mortality from HIV acquisition, HIV disease progression, and overdose. In partnership with colleagues, trainees, research staff, and people who use drugs (PWUD), he leads observational studies to illuminate the social/structural determinants of drug-related harms, especially the legal/regulatory and economic frameworks surrounding psychoactive substances, and experimental clinical and community-based research to test the safety, feasibility, and efficacy of cannabinoids as an intervention into the overdose crisis. This evidence is generated in order to contribute to efforts to improve clinical and public health practice; reform government policies, regulations, and laws; and change the risk environment for PWUD.

Dr. Milloy is the principal investigator of the AIDS Care Cohort to Evaluate exposure to Survival Services (ACCESS), an ongoing prospective cohort of more than 1,100 people who use drugs and live with HIV. Since 2005, findings from ACCESS have made important and path-breaking contributions to the scientific understanding of HIV disease progression among people who use drugs and the effective clinical management of people living with HIV. This evidence also contributed to the establishment of combined treatment and prevention, also known as 90•90•90, as the foundation of the efforts of the Joint United Nations Programme on HIV/AIDS (UNAIDS) to eliminate the HIV pandemic as a substantial public health concern.

Since 2019, he has held the Canopy Growth professorship for cannabis science at the University of British Columbia, a novel position created through arms’ length gifts to the university from Canopy Growth, a licensed producer of cannabis, and the Government of British Columbia’s Ministry of Mental Health and Addictions. A UBC faculty member, Dr. Milloy has no financial relationship to the cannabis industry. A full list of his funding sources is available upon request.

Dr. Milloy has contributed more than 350 articles to the peer-reviewed scientific literature, including first/second/senior-authored publications in well-cited journals such as Clinical infectious diseases, Addiction, AIDS, and The Lancet. (A full collection is available here). He has focused his work on investigating the longitudinal impact of prevalent social/structural exposures, including homelessness, incarceration, and material deprivation on HIV treatment uptake, adherence, and clinical outcomes. He has also contributed to the scientific evaluations of novel interventions such as the Government of British Columbia’s community-wide effort to seek, test, treat, and retain individuals in HIV treatment and Insite, Vancouver’s supervised injection facility. For example, he authored studies on the impact of Insite on fatal and non-fatal overdose risks including a 2011 study in The Lancet showing that the establishment of the facility preceded a 35% decline in fatal overdose rates around the facility compared to a significantly lower decline (9.3%) in the rest of the City of Vancouver. This work was cited in the Supreme Court of Canada’s unanimous decision to prevent Canada’s federal Minister of Health from closing the facility.

Since 2019, he has led research investigating the potential of cannabis to be a beneficial intervention into the overdose/toxic drug public health emergency. In more than two dozen articles, Dr. Milloy and his coauthors have described possible benefits of cannabis use among people at highest risk of overdose, including significant links between measures of cannabis use and lower rates of important behavioural risk factors for fatal overdose, including using unregulated opioids to address chronic pain, using drugs via injection, exposure to fentanyl, non-fatal overdose, and discontinuation of medication-based treatment for opioid use disorder. This evidence also describes the ad hoc use of cannabis by some PWUD as a harm reduction intervention, for example, to manage withdrawal from unregulated drugs and as an intentional substitute for opioids and stimulants from the toxic drug supply. (A full list of his cannabis-related research is here)

In light of this emerging observational evidence documenting the potential benefits of cannabis for some PWUD at highest risk of overdose, Dr. Milloy and his colleagues have launched a programme of experimental evaluations of innovative cannabis access strategies for PWUD. With Dr. Eugenia Socias, assistant professor of medicine at the University of British Columbia and director of clinical research at the BCCSU, he is the co-principal investigator of a pilot study of the safety and feasibility of co-dispensing medical cannabinoids as an adjunct to medications for opioid use disorder at a rapid access addictions clinic. Funded by a grant from the Canadian Institutes of Health Research, this study is the first time cannabinoids have been experimentally dispensed as a potential treatment for opioid use disorder. Alongside Hilary Black, founder of the Vancouver Compassion Club, he is leading a project to design, implement, and evaluate a low-barrier service to distribute no-cost legal cannabis as a harm reduction intervention into the overdose crisis.

Dr. Milloy is grateful for the support for his research and training via peer-reviewed grants from the Canadian Institutes of Health Research, Michael Smith Health Research BC, the Public Health Agency of Canada, and the United States National Institute on Drug Abuse. He is also grateful to the British Columbia Centre on Substance Use and the University of British Columbia’s Faculty of Medicine for providing a home for his research, education, and service activities. Any of Dr. Milloy’s research studies are available at no cost as PDFs upon request to him at [email protected]. Dr. Milloy is a frequent contributor to media coverage of the overdose crisis, medical cannabis, and related issues and has presented his research at local, national, and international scientific and popular meetings.