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An overview of Cannabis Use in Canada

Nearly 8% of Canadians aged 15 and up report using cannabis daily, and 15% have used cannabis in the previous 12 months.1
Canadians who reported using cannabis over the past 12 months were asked how frequently they used the substance. Over half (54%) reported using cannabis three days per month or less, and 18% reported daily cannabis use.

According to a recent survey of Canadians aged 18 and above, most people, including those who are new to cannabis, as well as those who have been using it for a long time, report using it for medical purposes.2



Cannabis for Medical Purposes

Of people who reported using cannabis for medical purposes in the past 12 months, the majority (76%) did not have a medical document from a healthcare professional. The most common frequency of use reported was daily (35%).

The three main products used were dried flower (54%), cannabis oil for oral use (48%), and edibles (33%). Other products that weren’t used as often included vape pens, topical compounds, and beverages.



For people using cannabis for medical purposes:

1.     26% reported consuming higher CBD and lower THC
2.     21% reported consuming higher THC and lower CBD
3.     12% reported consuming equal levels of THC and CBD
4.     15% reported consuming CBD only
5.     14% reported consuming mix of different products
6.     7% indicates they did not know the THC and CBD levels



The top five sources to obtain cannabis for medical purposes were:

1.     Legal storefront (44%)
2.     Legal online source (23%)
3.     Health Canada Licensed producer (22%)
4.     A friend (17%)
5.     Growing their own (16%)



Common clinical indications for medical cannabis 3

•       Pain and Inflammation
–  Chronic musculoskeletal pain
– Neuropathic pain
– Arthritic inflammation
– IBS / IBD

•       Sleep, Anxiety, & Seizures
– Certain anxiety, PTSD, and sleep disorders
– Seizures (Dravet Syndrome)

•       Nausea & Vomiting
– N&V due to chemotherapy (CINV)
– Anorexia due to HIV or other treatments
– Appetite stimulant

•       Movement & Spasticity
– Motor disorders (PD, Huntington’s, Tourette’s)
– Spasticity due to MS

The above conditions broadly represent the areas where cannabinoids have demonstrated the most efficacy in symptom management. As you can see, many of these conditions come under the ‘Pain Triad’ arms. See Canada’s opioid overdose crisis and living with chronic pain blog posts for more information. 4

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References:
[1] Government of Canada. (2021). Canadian Cannabis Survey 2020: Summary. Retrieved from: https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/research-data/canadian-cannabis-survey-2020-summary.html
[2] Deloitte. (2021). Seeding new opportunities: Listening to Canada’s cannabis consumer. 2021 Cannabis Consumer Report. Retrieved from https://www2.deloitte.com/ca/en/pages/consumer-business/articles/listening-to-canadas-cannabis-consumer.html?icid=listening-to-canadas-cannabis-consumer_en
[3] National Academies of Sciences, Engineering, and Medicine, Health and Medicine Division, Board on Population Health and Public Health Practice & Committee on the Health Effects of Marijuana: An Evidence Review and Research Agenda. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. (National Academies Press (US), 2017).
[4] CMHA. (2019). Impairment in the workplace: what your organization needs to know. Toronto, ON: CMHA. Retrieved from https://ontario.cmha.ca/wp-content/uploads/2019/05/CMHAOntarioImpairmentPolicy2019.pdf

Previous Article
A Clinical Framework on Evaluating Cannabis Product Quality and Safety
With the rise in medical cannabis demand and product availability, establishing if a product fulfils acceptable quality standards has become more important. Patients can use the proposed framework when evaluating a cannabis product. 1.     Type of product Common product types used for medical purposes are ingestibles (i.e., Oil capsules, oral spray, edibles), topicals (i.e., Compounds & transdermal patches), and inhalation (i.e., dried cannabis flower and vapes). Dabs, waxes, and shatters, among other typical cannabis concentrates, are considered higher-risk products and are generally not recommended for medical usage. 2.     Product labelling Adequate health warning labels should be given for any health product, including cannabis. Indications of appropriate storage requirements can help in product quality preservation. 3.     Listed Cannabinoid content The content of cannabinoids is crucial in determining the appropriateness of cannabis and the risk associated with it. It's important to think about the amount of THC and/or CBD listed, whether it's in percentages, concentrations, or weight. According to Health Canada, the maximum amount of cannabis allowed in a medicinal cannabis format is as follows: -       Dried flower: <30g per package. -       Topicals/Extracts: THC level is <1000mg per container. -       Edibles: THC quantity <10mg per package. 4.     Listed product/manufacturing details Product specifications that are detailed are useful in ensuring product quality. Components of labelling include: -       packaging date -       expiry date -       lot number -       net weight/volume -       listed ingredients -       decontamination methods -       evidence of third-party testing The aforementioned information can be found on product packaging or in the Licensed Provider's own website's product description. 5.     Product packaging Health Canada requires particular packaging considerations or security elements. The following factors should be considered when determining whether or not the package is safe to use -       Child-resistant -       Made of Opaque material -       Designed with Non-desirable image or logo -       Sealed and secure before use References: Health Canada. (209). Final Regulations: edible cannabis, cannabis extracts, cannabis topicals. Retrieved from https://www.canada.ca/content/dam/hc-sc/documents/services/drugs-medication/cannabis/resources/final-regulations-edible-cannabis-extracts-topical-eng.pdf MacCallum CA, Lo LA, Pistawka CA, Boivin M (2022) A clinical framework for evaluating cannabis product quality and safety, Cannabis and Cannabinoid Research X:X, 1–8, DOI: 10.1089/can.2021.0137.
Next Article
Understanding Substance Use and Impairment in the Workplace
The Canadian Mental Health Association’s (CMHA) Impairment in the Workplace (2019) has been used as a guide in the following section.1 Individuals who use potentially intoxicating and addictive substances may progress along this spectrum. It’s critical to understand that substance use is not the same as having a substance use disorder (commonly known as addiction). Substance use, however, can be both beneficial and problematic. Although many regularly used intoxicants should be considered (i.e., alcohol, stimulants, hallucinogens), the focus of this report will be on cannabis, and primarily medical cannabis. What is impairment? Impairment can arise from a variety of factors, including fatigue, traumatic shock, sleep deprivation, as well as from medical conditions or treatments, all of which have the potential to impair a person's ability to perform their work. Potential implications of Impairment Impairment could potentially have the following implications: -        Diminished judgement or decision-making| -        Decreased motor coordination, reaction time or perception The appearance of impairment (depending on the substance) may include the following observations: -        Odour of alcohol or drugs -        Glassy or red eyes -        Unsteady gait -        Slurring -        Poor co-ordination To ensure that medical cannabis is treated equally with other prescriptions, a clear definition of ‘impairment’ should be established, and all prescription medicine policies should be enforced equally. Safety-sensitive positions The Canadian Centre on Substance Use and Addiction defines safety-sensitive positions as: “Organizations or positions where impaired employee performance could result in a significant incident affecting the health and safety of the individual, other employees, customers or the public, or could cause property damage”.2 A definition of a safety-sensitive position must be included in the organizational impairment policy. Being ‘fit for duty’ ‘Fit for duty’ is defined as an employee’s ability to be able to do their job safely and effectively without impairment. Organizations should define 'fit for duty' in their own terms within their policies, which will vary depending on the needs of the workplace, and the role of the employees. Suspected problematic substance use in the workplace Problematic substance use in the workplace can raise several concerns such as absenteeism, lower productivity, increased costs, and safety concerns. The Canadian Centre on Substance Use and Addiction believes that addressing substance use in the workplace through comprehensive, well-developed policies sends the message that substance use and its possible implications are serious concerns. Strong policies also show that the company is committed to preventing impairment in the workplace, stigma, and discrimination, as well as assisting employees in their recovery.3 Accommodations in the workplace Organizations may be required to prevent and move barriers and must provide accommodations for individuals that have a disability, short of undue hardship. According to the Ontario Human Rights Commission (OHRC), an employee has the right to be accommodated to the point of undue hardship if they are prescribed medication that may cause impairment because of a medical condition.4 The accommodation is made on an individual, case-by-case basis to fit the employee's needs, with no preferences. If two accommodations that respond equally to the employee's needs in a dignified manner are available, the employer has the right to choose the one that is less expensive or disruptive to the organization.5 With regards to accommodating medical cannabis, considerations may include: 1. Concerns related to cannabis scents 2. Permitted places of consumption 3. The impact of consumption on clients References: [1] CMHA. (2019). Impairment in the workplace: what your organization needs to know. Toronto, ON: CMHA. Retrieved from https://ontario.cmha.ca/wp-content/uploads/2019/05/CMHAOntarioImpairmentPolicy2019.pdf [2] Meister, S.R. (2018). A Review of Workplace Substance Use Policies in Canada: Strengths, Gaps and Key Considerations. Ottawa, ON: Canadian Centre on Substance Use and Addiction. [3] Canadian Centre on Substance Use and Addiction. (2018). A Review of Workplace Substance Use Policies in Canada. [4] Ontario Human Rights Commission. (2016) Policy on Drug and Alcohol Testing. Section 3: Code Protection. [5] Ontario Human Rights Commission. (2016). Policy on ableism and discrimination based on disability.

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