Academic journal article Canadian Journal of Public Health

Patterns and Factors of Problematic Marijuana Use in the Canadian Population: Evidence from Three Cross-Sectional Surveys

Academic journal article Canadian Journal of Public Health

Patterns and Factors of Problematic Marijuana Use in the Canadian Population: Evidence from Three Cross-Sectional Surveys

Article excerpt

Marijuana is the most widely used illicit drug in the world, as well as the most commonly used illicit drug in Canada.1,2 Over 40% of Canadians have tried marijuana at least once in their lifetime and over 10% have used marijuana within the past year.1 The adverse health effects of marijuana use may include acute psychotic symptoms, mental health disorders,3 abnormal cognitive development,4 lung cancer, and cardiovascular disease.3 Evidence suggests a dose-response relationship exists between increased marijuana use and adverse health effects and those individuals having tried marijuana are at a higher risk for some mental health issues.3 Because marijuana use in North America contributes approximately 81.5 YLDs (years lost due to disability) per 100 000 persons,5 the factors influencing marijuana use have public health and economic ramifications.

Currently the Canadian government is exploring a legalization and regulation framework for marijuana use.6 The Canadian approach to marijuana legalization includes minimizing the harms of use; establishing a safe and responsible supply chain; enforcing public safety and protection; and maintaining medical access.6 Given the strong possibility of recreational marijuana legalization in Canada, as well as the evidence gap to inform policy,6 it is important to understand the current implications of Canadian marijuana use.

While experts agree that marijuana has negative health implications, one fundamental limitation in the research is how to differentiate between problematic and non-problematic marijuana use.7 Chen et al. found that the frequency of marijuana use was the most important factor in predicting drug dependence,8 and therefore only frequency of use is needed to determine problematic use. Another method is the WHO Alcohol, Smoking and Substance Abuse Involvement Screening Test (ASSIST) instrument, scoring individuals from 0 to 39.9 A score of 0-3 indicates non-problematic substance use, 4-26 indicates problematic substance use, and 27 or higher indicates substance dependence. This screening tool may lead to what Degenhardt et al. termed "diagnostic orphans": users who are misclassified.10 Misclassification can occur when an individual exhibits a high frequency of drug use but declares that their use does not interfere with day-to-day living.

Canadian marijuana use literature is quite rare; the available literature focuses on subpopulations such as adolescents, young adults, or First Nations.11 Statistics Canada has attempted to identify correlates of marijuana use, but the study was limited to descriptive statistics.1 The objectives of our study are to describe Canadian marijuana use and explore factors associated with problematic use. Understanding the factors contributing to marijuana use will inform policy preparing for its possible legalization and interventions curtailing problematic use within the Canadian population. The questions explored here include: i) what factors are associated with an individual trying marijuana?; ii) what factors separate nonproblematic and problematic marijuana users?; and iii) what factors are associated with an individual's history of use?

METHODS

Data

A secondary data analysis was conducted using the three most recent circulations (2010-2012) of the Canadian Alcohol and Drug Use Monitoring Survey (CADUMS). CADUMS is a yearly crosssectional population survey on alcohol and other substance abuse in non-institutionalized Canadians 15 years of age or older living in the 10 Canadian provinces. Response rates for the surveys were 50.5% in 2010, 42.8% in 2011 and 39.8% in 2012. Table 1 provides a demographic summary of the combined dataset.

Measures

Outcome Measures

For the first research question, the outcome measure was a binary variable coded from the CADUMS question "canl" asking whether respondents have ever used marijuana in their lifetime. Those who responded "yes" or "no" are respectively categorized as either tried or never used marijuana. …

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