Trends in treatment of problematic cannabis use in Ontario’s specialized addiction treatment system from 2010/11 to 2015/16: a repeated cross-sectional study of a health administrative database

Abstract

Background: Little is known about trends in the treatment of problematic cannabis use in Canada. Trends in treatment utilization for problematic cannabis use were examined, as well as trends in the associated sociodemographic characteristics and frequency of cannabis use. Methods: This was a repeated cross-sectional study using data from the Drug and Alcohol Treatment Information System, capturing utilization of all community funded addiction treatment services in Ontario, Canada. Clients in treatment for their own problematic cannabis use from 2010/11 to 2015/16 were included. Two distinct groups were formed: clients with problematic cannabis use only (the cannabis-only group) and clients with problematic use of cannabis and other substances (the cannabis-plus group). Estimates of the number of clients in each of these groups and their cannabis use frequency (past 30 days) were characterized over time by new admissions and total caseload (new admissions plus carryovers). Results: There were 152 984 admissions for 83 621 clients over the study period. The number of clients with new admissions in the cannabis-only group decreased from 2954 (95% confidence interval [CI] 2848-3062) in 2010/11 to 2342 (95% CI 2248-2439) in 2015/16. Similar downward trends were observed in the number of clients in the total caseload of this group. The number of clients with new admissions in the cannabis-plus group was stable, but the total caseload increased from 20 139 clients (95% CI 19 862-20 419) in 2011/12 to 21 816 (95% CI 21 527-22 107) in 2015/16. Proportions of daily cannabis use increased among clients in both groups. Interpretation: The number of clients in treatment for problematic cannabis use only decreased over the study period, but the frequency of cannabis use increased among clients in both groups. Given the potential reductions in treatment that is unnecessary from a clinical standpoint, alignment of treatment programming with disorder severity may be warranted.

Changes in Rates of Hospitalizations due to Cannabis Harms in Ontario, Canada Before the Legalization of Nonmedical Cannabis: Retrospective Population-level Study Between 2003 and 2017

“…This possibility is supported by data from Statistics Canada, which estimated that the volume of cannabis consumed per year was stable through 2000 and 2009 and showed a rapid increase between 2010 and 2015, coinciding with the time period in our study when all ages and sexes saw increases in hospitalizations due to cannabis harms in Ontario 23 . In addition, while data from Ontario’s specialized addiction treatment system from 2010/11 to 2015/16 noted a decrease in the number of clients in treatment for problematic cannabis use they found an increase in the proportion reporting daily cannabis use 24 . Similarly, increases in cannabis potency, which has been well documented in other jurisdictions such as the U.S. and Europe between 2008 and 2017 may be driving increases in cannabis harms 25 .…”

“…23 In addition, while data from Ontario's specialized addiction treatment system from 2010/11 to 2015/16 noted a decrease in the number of clients in treatment for problematic cannabis use they found an increase in the proportion reporting daily cannabis use. 24 Similarly, increases in cannabis potency, which has been well documented in other jurisdictions such as the U.S. and Europe between 2008 and 2017 may be driving increases in cannabis harms. 25 The observed increases may also be partially explained by better awareness in diagnostic coding practices of cannabis-related harms by physicians (eg, cannabis hyperemesis syndrome).…”

“…First, increases in hospitalizations due to cannabis harms are consistent with data showing a large increase in self-reported cannabis use in the Canadian population. 6 However, data also indicates that self-reported past-year cannabis use in groups of individuals experiencing the largest increase in hospitalizations due to cannabis harms, those aged 15 to 24, have either decreased (aged [15][16][17] or not changed (18)(19)(20)(21)(22)(23)(24) between 2004 and 2017. These findings suggest that factors other than the number of persons who use cannabis are contributing to or driving the observed trends.…”

Cannabis and public health: a global experiment without control

“…However, as the authors acknowledge, there are many confounding determinants involved in such evaluations, including access to and availability of treatment, coercion, potency of used products, use of synthetic cannabinoids, help‐seeking behavior, stigmatization and public perception of cannabis use and associated problems. For instance, despite the liberalization of cannabis in Canada, with increases in use over the past years, there have been decreases in treatment rates, partly because liberalization seems to have led to higher thresholds for treatment seeking, as use per se is no longer considered problematic 3 . As long as these confounding determinants cannot be disentangled, treatment demand data should probably not be used as an indicator to evaluate the public health effects of legalization.…”