Abstract
OBJECTIVE: To investigate the prevalence of therapeutic cannabis use within a general population sample of adults and to describe various characteristics associated with use.
METHODS: Data were derived from the 2013 and 2014 CAMH Monitor Survey of adults in Ontario, Canada. This repeated cross-sectional survey employed a regionally stratified design and utilized computer-assisted telephone interviewing. Analyses were based on 401 respondents who reported using cannabis.
RESULTS: The data indicated that 28.8% of those who used cannabis in the past year self-reported using cannabis for therapeutic purposes. Of therapeutic users, 15.2% reported having medical approval to use cannabis for therapeutic purposes. Cannabis use for therapeutic purposes was associated with more frequent use of cannabis, a moderate to high risk of problematic cannabis use, and a greater likelihood of using prescription opioids for medical purposes. There was little difference in cannabis use for therapeutic purposes according to sex, age, and marital status after adjusting for opioid use and problematic cannabis use.
CONCLUSION: Findings suggest some potential negative consequences of cannabis use for therapeutic purposes; however, further research is needed to better understand the range and patterns of use and their corresponding vulnerabilities.
Key Words: Medical cannabis use, medical marijuana use, prescription opioids, problematic cannabis use
Résumé
OBJECTIF: Examiner la prévalence de la consommation de cannabis thérapeutique au sein d’un échantillon d’adultes de la population générale et décrire les caractéristiques associées à cette consommation.
MÉTHODE: Nos données provenaient des éditions 201 3 et 2014 du CAMH Monitor Survey. Cette enquête transversale répétée, menée auprès des adultes en Ontario, au Canada, est stratifiée par région et utilise des entretiens téléphoniques assistés par ordinateur. Nos analyses ont été fondées sur les 401 répondants qui ont déclaré consommer du cannabis.
RÉSULTATS: Selon les données obtenues, 28,8 % des personnes ayant consommé du cannabis au cours de l’année écoulée ont dit l’avoir fait à des fins thérapeutiques. De ces consommateurs de cannabis thérapeutique, 15,2 % ont dit détenir une autorisation médicale. La consommation de cannabis à des fins thérapeutiques était associée à une consommation plus fréquente de cannabis, à une probabilité accrue d’appartenir à une catégorie de risque moyen à élevé de consommation abusive de cannabis, et à une probabilité accrue de consommer des opioïdes d’ordonnance à des fins médicales. Après élimination des effets de la consommation d’opioïdes et de la consommation abusive de cannabis, la consommation de cannabis à des fins thérapeutiques différait peu selon le sexe, l’âge et l’état matrimonial.
CONCLUSION: Ces constatations indiquent qu’il pourrait y avoir des conséquences négatives à la consommation de cannabis à des fins thérapeutiques; il faudrait cependant pousser la recherche pour mieux comprendre l’étendue et les habitudes de cette consommation et les vulnérabilités correspondantes.
Mots Clés: Consommation de cannabis médical, consommation de marijuana médicale, opioïdes d’ordonnance, consommation abusive de cannabis
References
- 1.United Nations Office on DrugsCrime. World DrugReport. New York, NY: UNODC; 2014. [Google Scholar]
- 2.Center for Behavioral Health StatisticsQuality. Results From the 2015 NationalSurveyonDrugUseandHealth:DetailedTables. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2016. [Google Scholar]
- 3.Health Canada. Summary of Results for 2013: Canadian Tobacco Alcohol and Drugs Survey (CTADS) Ottawa, ON: Health Canada; 2015. [Google Scholar]
- 4.Hill KP. Medical marijuana for treatment of chronic pain and other medical and psychiatric problems: A clinical review. JAMA. 2015;313(24):2474–83. doi: 10.1001/jama.2015.6199. [DOI] [PubMed] [Google Scholar]
- 5.Health Canada. Understanding the New Access to Cannabis for Medical Purposes Regulations. Ottawa, ON: Health Canada; 2016. [Google Scholar]
- 6.Health Canada. Procedures for Accessing Marijuana for Medical Purposes Under the Marihuana for Medical Purposes Regulations. Ottawa, ON: Health Canada; 2016. [Google Scholar]
- 7.Kalant H. Marihuana: Medicine, addictive substance or both? A common-sense approach to the place of cannabis in medicine. Can J Addict. 2013;4(3):4–8. [Google Scholar]
- 8.Reid A. Medical marihuana: More knowledge and clinical guidance needed. Can JAddict. 2013;4(3):21–22. [Google Scholar]
- 9.Whiting PF, Wolff RF, Deshpande S, Nisio MD, Duffy S, Hernandez AV, et al. Cannabinoids for medical use: A systematic review and meta-analysis. JAMA. 2015;313(24):2456–73. doi: 10.1001/jama.2015.6358. [DOI] [PubMed] [Google Scholar]
- 10.Health Canada. Information for Health Care Professionals: Cannabis (Marihuana, Marijuana) and the Cannabinoids. Ottawa, ON: Health Canada; 2013. [Google Scholar]
- 11.Kalant H, Porath-Waller A. Clearing the Smoke on Cannabis: Medical Use of Cannabis and Cannabinoids. Ottawa, ON: Canadian Centre for Substance Abuse; 2014. [Google Scholar]
- 12.Grotenhermen F, Müller-Vahl K. The therapeutic potential of cannabis and cannabinoids. Deutsch Arzteblatt Int. 2012;109:29–30. doi: 10.3238/arztebl.2012.0495. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13.Karst M, Wippermann S, Ahrens J. Role of cannabinoids in the treatment of pain and (painful) spasticity. Drugs. 2010;70(18):2409–38. doi: 10.2165/11585260-000000000-00000. [DOI] [PubMed] [Google Scholar]
- 14.Elikkottil J, Gupta P, Gupta K. The analgesic potential of cannabinoids. J Opioid Manag. 2009;5(6):341–57. doi: 10.5055/jom.2009.0034. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.Narang S, Gibson D, Wasan AD, Ross EL, Michna E, Nedeljkovic SS, et al. Efficacy of dronabinol as an adjuvant treatment for chronic pain patients on opioid therapy. J Pain. 2008;9(3):254–64. doi: 10.1016/j.jpain.2007.10.018. [DOI] [PubMed] [Google Scholar]
- 16.Budney AJ, Roffman R, Stephens RS, Walker D. Marijuana dependence and its treatment. Addict Sci Clin Pract. 2007;4(1):4–16. doi: 10.1151/ASCP07414. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.Anthony JC. The epidemiology of cannabis dependence. In: Roffman RA, Stephens RS, editors. Cannabis Dependence: Its Nature, Consequences and Treatment. Cambridge, UK: Cambridge University Press; 2006. pp. 58–105. [Google Scholar]
- 18.Hasin DS, Saha TD, Kerridge BT, Goldstein RB, Chou SP, Zhang H, et al. Prevalence of Marijuana use disorders in the United States between 2001–2002 and 2012–2013. JAMA Psychiatry. 2015;72(12):1235–42. doi: 10.1001/jamapsychiatry.2015.1858. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19.van der Pol P, Liebregts N, de Graaf R, Korf DJ, van den Brink W, van Laar M. Predicting the transition from frequent cannabis use to cannabis dependence: A three-year prospective study. Drug Alcohol Depend. 2013;133(2):352–59. doi: 10.1016/j.drugalcdep.2013.06.009. [DOI] [PubMed] [Google Scholar]
- 20.Ialomiteanu A, Hamilton HA, Adlaf EM, Mann RE. CAMH Monitor eReport: Substance Use, Mental Health and Well-Being Among Ontario Adults, 1977–2013 (CAMH Research Document Series No. 35) Toronto, ON: Centre for Addiction and Mental Health; 2014. [Google Scholar]
- 21.Health Canada. Canadian Alcohol and Drug Use Monitoring Survey (CADUMS): Summary of Results for 2012. Ottawa, ON: Health Canada; 2014. [Google Scholar]
- 22.Centers for Disease ControlPrevention. Behavioral Risk Factor Surveillance System: 2013 Summary Data Quality Report. Atlanta, GA: Centers for Disease Control and Prevention; 2014. [Google Scholar]
- 23.Ialomiteanu A, Adlaf E. CAMH Monitor 2013 Metadata User’s eGuide. Toronto, ON: Centre for Addiction and Mental Health; 2014. [Google Scholar]
- 24.WHO ASSIST Working Group. Alcohol, smoking and substance involvement screening test (ASSIST): Development, reliability and feasibility. Addiction. 2002;97:1183–94. doi: 10.1046/j.1360-0443.2002.00185.x. [DOI] [PubMed] [Google Scholar]
- 25.McDowell I. Measuring Health: A Guide to Rating Scales and Questionnaires. 3rd. New York, NY: Oxford University Press; 2006. [Google Scholar]
- 26.Statacorp. Stata Statistical Software: Release 13.1. College Station, TX: StataCorp; 1985. [Google Scholar]
- 27.Adlaf EM, Begin P, Sawka E. Canadian Addiction Survey (CAS): Prevalence of Use and Related Harms: Detailed Report. Ottawa, ON: Canadian Centre on Substance Abuse; 2005. [Google Scholar]
- 28.Adlaf E, Begin P, Deguire AE, Garlick R, Racine S, Sawka E, et al. Canadian Addiction Survey: Public Use Microdata File. Ottawa, ON: Canadian Centre for Substance Abuse; 2004. [Google Scholar]
- 29.Asbridge M, Duff C, Marsh DC, Erickson PG. Problems with the identification of ’problematic’ cannabis use: Examining the issues of frequency, quantity, and drug use environment. Eur Addict Res. 2014;20(5):254–67. doi: 10.1159/000360697. [DOI] [PubMed] [Google Scholar]
- 30.Abrams DI, Couey P, Shade SB, Kelly ME, Benowitz NL. Cannabinoid-opioid interaction in chronic pain. Clin Pharmacol Ther. 2011;90(6):844–51. doi: 10.1038/clpt.2011.188. [DOI] [PubMed] [Google Scholar]
- 31.Ware MA. Clearing the smoke around medical marijuana. Clin Pharmacol Ther. 2011;90(6):769–71. doi: 10.1038/clpt.2011.241. [DOI] [PubMed] [Google Scholar]
- 32.Bradford AC, Bradford WD. Medical marijuana laws reduce prescription medication use in medicare part D. Health Aff. 2016;35(7):1230–36. doi: 10.1377/hlthaff.2015.1661. [DOI] [PubMed] [Google Scholar]
- 33.Boehnke KF, Litinas E, Clauw DJ. Medical cannabis use is associated with decreased opiate medication use in a retrospective cross-sectional survey of patients with chronic pain. J Pain. 2016;17(6):739–44. doi: 10.1016/j.jpain.2016.03.002. [DOI] [PubMed] [Google Scholar]
- 34.Piper BJ, DeKeuster RM, Beals ML, Cobb CM, Burchman CA, Perkinson L, et al. Substitution of medical cannabis for pharmaceutical agents for pain, anxiety, and sleep. J Psychopharmacol. 2017;31:569–75. doi: 10.1177/0269881117699616. [DOI] [PubMed] [Google Scholar]
- 35.Lucas P, Walsh Z. Medical cannabis access, use, and substitution for prescription opioids and other substances: A survey of authorized medical cannabis patients. Int J Drug Policy. 2017;42:30–35. doi: 10.1016/j.drugpo.2017.01.011. [DOI] [PubMed] [Google Scholar]