Academic journal article Canadian Journal of Public Health

Prevalence of Problematic Cannabis Use in Canada: Cross-Sectional Findings from the 2013 Canadian Tobacco, Alcohol and Drugs Survey

Academic journal article Canadian Journal of Public Health

Prevalence of Problematic Cannabis Use in Canada: Cross-Sectional Findings from the 2013 Canadian Tobacco, Alcohol and Drugs Survey

Article excerpt

Cannabis is the most widely used illicit substance in the world, though rates of use have stabilized according to global estimates.1 In 2013, approximately 10% of Canadians 15 years and older reported using cannabis in the past year.2 Cannabis use is characterized by marked differences among age groups: whereas 8% of Canadians over the age of 25 reported past-year use of cannabis, approximately one quarter (26%) of those younger than 25 years of age reported using cannabis in the past year.2 Data from the Canadian Alcohol and Drug Use Monitoring Survey (CADUMS), a nationally representative annual survey of alcohol and illicit drug use among Canadians, and the Canadian Addiction Survey in 2004, indicated a modest decrease in the prevalence of self-reported cannabis use between 2004 and 2012.3

In addition to its therapeutic effects, cannabis use has several adverse health effects. In particular, frequent cannabis use increases the risk of poor respiratory health (from chronic smoking), schizophrenia and other psychoses, low birth weight when used during pregnancy, and motor vehicle crashes from driving after use.4 In addition, chronic use of cannabis in adolescence is associated with neuroanatomical developmental harm itself associated with a number of mental and physical health concerns, including cognitive and motor function impairment, decline in motivation, as well as negative academic and social outcomes and decreased IQ scores that may take the form of reduced school performance or school leaving.5-7 Most of the adverse health effects from cannabis are associated with frequent, heavy use; therefore, the majority of cannabis users do not experience negative social or clinical repercussions.7-9 Overall, approximately 5%-9% of all cannabis users will develop dependence at some point in their lives.10,11 Early age of initiation is a risk factor to the likelihood of cannabis dependence among users.4 Nearly 17% of individuals who initiate cannabis consumption in adolescence have been observed to experience a cannabis-related dependence syndrome, and the proportion increases to 25%-50% with greater frequency of use.11

To date, there is no consensus on how to define problematic cannabis use.11 A recent systematic review highlighted the range of different measures that have been used to assess cannabis dependence and its problematic use, including the DSM-5, the Severity of Dependence Scale (SDS), the Cannabis Abuse Screening Test (CAST), the Cannabis Use Disorders Identification Test (CUDIT), and the Problematic Use of Marijuana (PUM).12-14 Each of these measures assesses some element of dependence, with respect to compulsive use and a loss of individual control. However, the measures differ in the extent to which they assess other aspects of problematic use. The most commonly used criteria include frequency of use and consumption levels; however, the measures used to assess frequency of use and "dose" or consumption amount vary widely.12,14 National health organizations such as the Canadian Centre on Substance Abuse (CCSA) and the Centre for Addiction and Mental Health (CAMH) also use different definitions of problematic cannabis use or do not operationalize the concept at all.7,15 CCSA defines harmful use as "a pattern of psychoactive use that causes physical or mental damage", while CAMH does not have a definition per se, opting instead for listing potential effects of cannabis use.7,16

The Alcohol Smoking and Substance Involvement Screening Test (ASSIST) was developed in 1997 as a screening instrument used to detect and manage substance use and risky behaviours in an effort to improve surveillance of problematic substance use.17-19 ASSIST has been adapted to alcohol, cannabis and a variety of drugs of interest. The widespread implementation of ASSIST has the potential to provide an objective, standardized and systematic way of reporting problematic cannabis consumption in Canada, as well as international comparisons with other countries in which ASSIST has been implemented. …

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