Background Canada legalized cannabis use for medical purposes in 1999. Legalization of cannabis for recreational purposes in October 2018 offered the opportunity to assess the impact of recreational legalization on cancer patients’ patterns of use to identify learning points that could be helpful to other countries considering similar legislation.Method Two identical anonymous cross-sectional surveys were administered to cancer patients in British Columbia (2 months before and 3 months following legalization), with the same eligibility criteria. The prevalence of medical cannabis use, the distribution of symptoms leading to use, the most common types of cannabis products and sources, reasons for stopping using cannabis, and barriers to access were assessed.Results The overall response rate was 27%. Both cohorts were similar regarding age (median= 66yrs), gender (53% female), and education (approximately 85% of participants had an education level of high school graduation and higher). Respondents had multiple motives for taking cannabis, including to manage multiple symptoms, to treat cancer, and for recreational reasons. The majority of patients in both surveys did not use the legal medical access system. Comparison of the two cohorts showed that after legalization the prevalence of current cannabis use increased by 26% (23·1% to 29·1%, p-value 0·01), including an increased disclosure of recreational motive for use, from 32% to 40%. However, in the post-legalization cohort more Current Users reported problems getting cannabis (18%) than the pre-legalization cohort (8%), (p-value <0·01). The most common barrier cited was lack of available preferred products, including edibles, as these were only available from illegal dispensaries.Conclusions Results showed that legalization of cannabis for recreational purposes may have an impact on those who use medical cannabis. Impacts include an increase in prevalence of use; problems accessing preferred products legally; higher cost, and difficulties using a legal access system. The desired goal of regulation in reducing harms from use of illegal cannabis products are unlikely to be achieved if the legal process is less attractive to patients than use of illegal sources.
Background Canada legalized cannabis use for medical purposes in 1999. Legalization of cannabis for recreational purposes in October 2018 offered the opportunity to assess the impact of recreational legalization on cancer patients’ patterns of use to identify learning points that could be of use to other countries considering similar legislation.Method Two identical anonymous cross-sectional surveys were administered to cancer patients in British Columbia(2 months before and 3 months following legalization), with the same eligibility criteria. The prevalence of medical cannabis use, the distribution of symptoms leading to use, the most common types of cannabis products and sources, reasons for stopping using cannabis, and barriers to access were assessed.Results The overall response rate was 27%. Both cohorts were similar regarding age (median= 66yrs), gender (53% of participants were female), and education (one-third of participants had an education level of high school or less). Respondents had multiple motives for taking cannabis, including to manage multiple symptoms, to treat cancer, and for recreational reasons. The majority of patients in both surveys did not use the legal medical access system, but sought products that have a low potential for euphoria, such as edibles. Comparison of the two cohorts showed that after legalization the prevalence of current cannabis use increased by 26% (23·1% to 29·1%, p-value 0·01), including an increased disclosure of recreational motive for use, from 32% to 40%. However, in the post-legalization cohort more Current Users reported problems getting cannabis (18%) than the pre-legalization cohort (8%), (p-value <0·01). The most common barrier cited was lack of available preferred products, including edibles, as these were only available from illegal dispensaries.Conclusions Results showed that legalization of cannabis for recreational purposes may have an impact on those who use medical cannabis. Impacts include an increase in prevalence of use; problems accessing preferred products legally; higher cost, and difficulties using a legal access system. The desired goal of regulation in reducing harms from use of illegal cannabis products are unlikely to be achieved if the legal process is less attractive to patients than use of illegal sources.
BackgroundCanada legalized cannabis use for medical purposes in 1999. Legalization of cannabis for recreational purposes in October 2018 offered the opportunity to assess the impact of recreational legalization on cancer patients' patterns of use to identify learning points that would be of use to other countries considering similar legislation. MethodTwo identical anonymous cross-sectional surveys were administered to cancer patients in British Columbia, 5 months apart (2 months before and 3 months following legalization), with the same eligibility criteria. The prevalence of medical cannabis use, the distribution of symptoms leading to use, the most common types of cannabis products and sources, reasons for stopping using cannabis, and barriers to access were assessed. ResultsThe overall response rate was 27% with 821 and 852 individuals returning the first and second surveys respectively. Both cohorts were similar regarding participants' characteristics, including age (median= 66yrs), gender (53% of participants were female), and education (one-third of participants had an education level of high school or less). Comparison of the two cohorts showed that legalization increased the prevalence of current cannabis use by 21% (23·1% to 29·1%, p-value 0·01). However, after legalization, Current Users reported more issues in getting cannabis (18% compared to 8%, pvalue: <0·01). The most common barrier cited was lack of available preferred products, from closure of illegal dispensaries. ConclusionsResults showed that legalization of access to cannabis for recreational purposes will have an unintended negative impact on those who use cannabis products for medical purposes. These should be anticipated and mitigated in the design and implementation of new legislation.
Background Canada legalized cannabis use for medical purposes in 1999. Legalization of cannabis for recreational purposes in October 2018 offered the opportunity to assess the impact of recreational legalization on cancer patients’ patterns of use to identify learning points that could be helpful to other countries considering similar legislation.Method Two identical anonymous cross-sectional surveys were administered to cancer patients in British Columbia (2 months before and 3 months following legalization), with the same eligibility criteria. The prevalence of medical cannabis use, the distribution of symptoms leading to use, the most common types of cannabis products and sources, reasons for stopping using cannabis, and barriers to access were assessed.Results The overall response rate was 27%. Both cohorts were similar regarding age (median= 66yrs), gender (53% female), and education (approximately 85% of participants had an education level of high school graduation and higher). Respondents had multiple motives for taking cannabis, including to manage multiple symptoms, to treat cancer, and for recreational reasons. The majority of patients in both surveys did not use the legal medical access system. Comparison of the two cohorts showed that after legalization the prevalence of current cannabis use increased by 26% (23·1% to 29·1%, p-value 0·01), including an increased disclosure of recreational motive for use, from 32% to 40%. However, in the post-legalization cohort more Current Users reported problems getting cannabis (18%) than the pre-legalization cohort (8%), (p-value <0·01). The most common barrier cited was lack of available preferred products, including edibles, as these were only available from illegal dispensaries. Conclusions Results showed that legalization of cannabis for recreational purposes may have an impact on those who use medical cannabis. Impacts include an increase in prevalence of use; problems accessing preferred products legally; higher cost, and difficulties using a legal access system. The desired goal of regulation in reducing harms from use of illegal cannabis products are unlikely to be achieved if the legal process is less attractive to patients than use of illegal sources.
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