Providence Research Profiles: Dr. M-J Milloy

Many scientists at Providence Research are leading influential research shaping the future of health and medicine. In this edition of our Providence Research Profiles series, we feature Dr. M-J Milloy, whose work focuses on identifying and evaluating ways to improve the health and well-being of people who use drugs, with an emphasis on the social and structural factors that contribute to drug-related harms. His research generates evidence to inform clinical practice, guide public health strategies, and influence policy reform.

Dr. Milloy is an Associate Professor in the Department of Medicine and Canopy Growth Professor of Cannabis Science at the University of British Columbia (UBC). This year, he was appointed as Interim Director of Research with the BC Centre on Substance Use (BCCSU).

"Dr. Milloy has a long and prolific history of generating scientific evidence that has had real, on-the-ground impacts for people who use substances. His work has and continues to inform public health strategies. I also know him to be a wonderful collaborator and leader. We're very lucky to have him in this new leadership role,” says Cheyenne Johnson, BCCSU Executive Director.

Transitioned from journalism to academia

Before entering the research field, Dr. Milloy worked as a journalist in Montreal, writing for an alternative weekly newspaper and Radio-Canada. As opportunities for that work became less frequent, he returned to academia, obtaining his Master’s and PhD from the UBC School of Population and Public Health. He went on to complete a postdoctoral fellowship at UBC and Harvard University. He has been a research scientist at the BCCSU since its establishment in 2017.

“I think that what I’m doing now is not as dissimilar from journalism as you might think. At the end of the day, science is, in some ways, about telling a story. It’s about investigating what the world is like and trying to tell stories that help us understand it,” says Dr. Milloy. 

His experiences as a journalist inspired his research focus on substance use. In the 1990s, before cannabis legalization, he visited a compassion club distributing medicinal cannabis. 

“It really struck me, that here were regular, ordinary citizens putting their lives, their liberty, on the line to try and help other folks access a consistent, dependable, safe supply of cannabis,” says Dr. Milloy. 

Contributed to influential Insite evaluation

As a graduate student, Dr. Milloy worked with BCCSU scientists Drs. Thomas Kerr and Evan Wood, as they conducted the scientific evaluation of Insite, North America’s first supervised drug injection site. 

Insite was established in 2003 to prevent overdose deaths, reduce the spread of HIV and other bloodborne illnesses, and provide access to medical care, particularly substance use disorder treatment. The clinic was given a federal exemption from the Controlled Drugs and Substances Act in order to operate. 

The evaluation found that there were no overdose deaths at Insite in its first 2.5 years of operation. Over two decades later, this remains true. Rates of fatal overdose in the surrounding community fell by 35%, compared to 9% in the rest of Vancouver. These findings were cited by the Supreme Court of Canada in their unanimous decision to order the Federal Minister of Health to keep the facility open. 

Investigating cannabis as potential harm-reduction tool

Dr. Milloy’s research explores medical applications of cannabis, particularly its potential as a harm reduction tool to help prevent fatal overdoses. His studies have made several key findings about cannabis use among people who use drugs.

He has found that cannabis use is associated with significantly reduced rates of injection drug use, and a higher likelihood of stopping injection drug use altogether. Daily cannabis users are also less likely to engage in behaviors linked to an increased risk of overdose and death. Among people living with chronic pain, those who used cannabis regularly were less likely to use unregulated opioids for pain management.

Strikingly, cannabis use was a strong predictor that at-risk youth would not begin injection drug use. 

“To us, this was an example of gateway theory in reverse,” says Dr. Milloy. The gateway theory suggests that young people who use cannabis are more likely to progress to higher-risk forms of drug use. “What we saw was the opposite – that folks who were using cannabis were far less likely to progress to injecting drugs.”

Appointed as BCCSU Interim Director of Research

Dr. Milloy has been appointed as the BCCSU’s Interim Director of Research for an 18-month term. In this role, he focuses on removing barriers and supporting researchers to continue their vital work, with the goal of creating better systems of care for people who use substances.

“We’re nine years into the overdose crisis, and although there have been small declines in the number of deaths, we’re still losing far too many of our fellow citizens every day to a preventable cause,” says Dr. Milloy. “I’m very glad to be able to contribute my time and effort as Interim Director of Research, to advance the work that many folks across Providence, particularly at the BCCSU, are doing to address the overdose crisis.”

Throughout his career, he has kept in mind something that Dr. Kerr said to him in their first meeting: “We don’t do this work to fill library shelves.” With the Insite evaluation, Dr. Milloy saw the potential of well-developed evidence to drive change. Given the severity of the overdose crisis, he believes that it’s important to transform systems contributing to drug-related harms.

“To be able to work with folks who use drugs, to try and advance things that will improve their health and well-being, that’s a challenge and a privilege that I’m very fortunate to be a part of,” says Dr. Milloy.