Academic journal article Canadian Journal of Public Health

Therapeutic Use of Cannabis: Prevalence and Characteristics among Adults in Ontario, Canada

Academic journal article Canadian Journal of Public Health

Therapeutic Use of Cannabis: Prevalence and Characteristics among Adults in Ontario, Canada

Article excerpt

Cannabis is the most popular illicit drug worldwide, with prevalence rates in North America exceeding the global average.1 In the United States, 13.5% of those 12 years of age and older reported past year use in 2015,2 whereas 11% of those 15 years and older in Canada reported such use in 2013.3 In the past, much of the attention on cannabis focused on the recreational nature of use. However, more recent changes to laws and regulations in Canada and parts of the US have increased access to cannabis for the treatment of various medical conditions.4

Since 2001, Canada has had various regulations for medical access to cannabis. More recent regulations include, for example, the 2013 Marihuana for Medical Purposes Regulations (MMPR) that allowed commercial producers licensed by Health Canada to supply cannabis to adults with medical authorization to use it.5 This required that therapeutic users obtain a written authorization for cannabis use from a health care practitioner that clearly stated the period of authorization and the quantity of product for daily use.6 As of August 2016, the Access to Cannabis for Medical Purposes Regulation (ACMPR) replaced the MMPR. The ACMPR includes the aforementioned licensed commercial producers and suppliers of cannabis and the need for medical authorization that were included within the MMPR, and also allows for individuals to produce limited amounts of cannabis for their own therapeutic use, or to designate someone to produce cannabis for them.5 Additional regulations governing therapeutic cannabis use are also included within the ACMPR.

There has been much debate surrounding cannabis use for therapeutic purposes (CUTP). Those who support CUTP emphasize the broad therapeutic and healing benefits of cannabis. Others, however, encourage caution because of the harms associated with cannabis use and the many unknowns with regard to clinical effectiveness and the impact on broader cannabis use.7,8 Of particular concern is the wide variety of medical conditions that cannabis is purported to treat and the lack of empirical evidence to support the efficacy of cannabis for many of these conditions.4,9,10 The cannabis plant contains numerous cannabinoids, some of which have been shown to be effective in attenuating the nausea and vomiting associated with cancer chemotherapy, stimulating appetite and relieving certain types of pain.11-15 A recent meta-analysis, however, found that cannabis (defined in the review as "... the use of cannabis or cannabinoids as medical therapy to treat disease or alleviate symptoms" (p. 2457)), was moderately effective for reducing chronic pain and for reducing spasticity due to multiple sclerosis, but the evidence for other conditions such as anxiety, depression, sleep disorders, nausea due to chemotherapy, greater weight gain in HIV cases, and Tourette's Syndrome was poor.9 Another concern with CUTP is that it may have short-term adverse effects, such as nausea, vomiting, dizziness and hallucinations, about which individual users are not adequately informed.9 Cannabis use may also develop into problem use or cannabis use disorder, which in severe cases may develop into addiction.16 Data on cannabis use disorder or dependence among cannabis users vary widely, from estimates of 11%-16%17 to more recent estimates of 30% among current users in 2012-2013,18 and 37% among daily or near daily users.19

Although there is some debate about the merits of cannabis use therapeutically, there is little surveillance data on CUTP at the population level. Such data are necessary to monitor and better understand the scope of the issue, as well as contribute to policy and education. The current study utilized population-level data to examine the prevalence of CUTP and the demographic and healthrelated characteristics of those who engage in such use.

METHODS

Data were derived from the 2013 and 2014 cycles of the CAMH Monitor, an annual survey of non-institutionalized adults 18 years of age and older within Ontario. …

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