Legalization of cannabis in Canada: More users, fewer problems, according to a study

A new study by’American Medical Association (AMA) offers an interesting perspective on the effects of cannabis legalization in Canada. It reveals that while cannabis use in adults increased slightly after legalization, while the problematic consumption have actually decreased.

Posted in JAMA Network Open, This study followed 1,428 Canadians aged 18 to 65 over a five-year period, starting on the eve of legalization. recreational cannabis in Canada in October 2018.

Slight increase in cannabis use overall

The study, financed in part by the Canadian Institutes of Health Research, A slight increase in the overall frequency of cannabis use was observed. On average, participants reported consume cannabis 0.35% of additional days per year, i.e. an increase of 1.75% over the five-year period.

Interestingly, this trend was not uniform among the different consumer groups:

• Daily consumers before legalization recorded the sharpest drop in consumption
• Monthly or occasional consumers tended to increase their consumption slightly
• New consumers, those who had never used cannabis before legalization, showed a slight increase in consumption and signs of abuse.

This evolution in consumption patterns suggests that legalization has not not encouraged a widespread increase in consumption and, in some cases, has even helped to moderate it.

Overall decline in cannabis abuse

One of the study's conclusions stems from the use of the Cannabis Use Disorder Identification Test - Revised (CUDIT-R), which measures cannabis abuse. According to the study, abuse scores declined over time, particularly during the early months of the COVID-19 pandemic.

For example, people who used cannabis every week before legalization saw their CUDIT-R score below the clinical threshold of 6, which indicates that the problematic cannabis abuse. This means that many have switched from potentially harmful consumption to healthier modes of consumption.

The report suggests that age may be a factor in this improvement.

«The apparent discrepancy between the increase in cannabis use and the decrease in cannabis abuse could be explained by young cannabis users,» note the authors, «who generally shift from problematic to non-problematic use as they age.».

Product preferences are changing

Another major change since legalization concerns consumer preferences in cannabis products. Over the past five years, traditional products such as flowers, concentrates, oils, tinctures and topicals have seen their popularity decline. At the same time non-combustible cannabis products have gained ground:

• visit edible products, the beverages and above all vaper cartridges have grown significantly.
• Cartridge and vape pen use rose from 18.4 % before legalization to 33 % five years later.

This development is seen as a health benefits public, because non-combustible forms are generally considered to have fewer health risks than smoking. Quebec, for example, came late to the game, with the introduction of vape pen only available this year.

Impact on public health

The authors of AMA study finally concluded that the effects of legalization are both positive and negative. On the one hand’increased frequency of cannabis use could be considered a risk. On the other hand, the reduced cannabis abuse and the move towards safer consumption methods are undeniable advances.

«From a public health point of view, these results are mixed,» the report notes, «as the increase in consumption can be seen as harmful, while the decrease in abuse is a positive outcome.».

It's also worth noting that while the statistical changes are significant, their clinical relevance is more modest. For example, abuse scores fell by just 0.4 points on a 32-point scale, raising questions about what these changes mean in reality.