Research paper
Medical cannabis access, use, and substitution for prescription opioids and other substances: A survey of authorized medical cannabis patients

https://doi.org/10.1016/j.drugpo.2017.01.011Get rights and content

Abstract

Background

In 2014 Health Canada replaced the Marihuana for Medical Access Regulations (MMAR) with the Marihuana for Medical Purposes Regulations (MMPR). One of the primary changes in the new program has been to move from a single Licensed Producer (LP) of cannabis to multiple Licensed Producers. This is the first comprehensive survey of patients enrolled in the MMPR.

Methods

Patients registered to purchase cannabis from Tilray, a federally authorized Licenced Producer (LP) within the MMPR, were invited to complete an online survey consisting of 107 questions on demographics, patterns of use, and cannabis substitution effect. The survey was completed by 271 respondents.

Results

Cannabis is perceived to be an effective treatment for diverse conditions, with pain and mental health the most prominent. Findings include high self-reported use of cannabis as a substitute for prescription drugs (63%), particularly pharmaceutical opioids (30%), benzodiazepines (16%), and antidepressants (12%). Patients also reported substituting cannabis for alcohol (25%), cigarettes/tobacco (12%), and illicit drugs (3%). A significant percentage of patients (42%) reported accessing cannabis from illegal/unregulated sources in addition to access via LPs, and over half (55%) were charged to receive a medical recommendation to use cannabis, with nearly 25% paying $300 or more.

Conclusion

The finding that patients report its use as a substitute for prescription drugs supports prior research on medical cannabis users; however, this study is the first to specify the classes of prescription drugs for which cannabis it is used as a substitute, and to match this substitution to specific diagnostic categories. The findings that some authorized patients purchase cannabis from unregulated sources and that a significant percentage of patients were charged for medical cannabis recommendations highlight ongoing policy challenges for this federal program.

Section snippets

Background

The past two decades have witnessed a resurgence of interest in the therapeutic potential of cannabis, with several nations and jurisdictions developing regulations to allow for access to cannabis for medical purposes (Fischer, Murphy, Kurdyak, Goldner, & Rehm, 2015). One potential salutary consequence of these developments is the substitution of cannabis for other substances (Allsop et al., 2014, Lucas et al., 2013, Lucas et al., 2016). Indeed, examinations of jurisdictions with legal access

Design and methods

A password protected 107 question online cross-sectional survey was made available in French and English for a 2 week period in July 2015 to patients of Tilray—a licensed producer of cannabis. 1310 participants were notified of the opportunity to participate in this study via direct email to patients that had opted in to receive online communication from Tilray upon registration. Participants were compensated $10 credit for Tilray cannabis. The study was approved by Institutional Review Board

Findings

The survey was started by 301 participants, and completed by over 90% of respondents (n = 271). The 30 non-completers only filled out the demographic section of the study, and based on this information did not differ on age, gender, education, income or work status compared to those that completed the survey. The primary demographics of respondents corresponds with the greater Tilray patient population but was more male and Caucasian, single, disabled and of lower income than the general Canadian

Interpretation

The finding that patients using cannabis to treat pain-related conditions have a higher rate of substitution for opioids, and that patients self-reporting mental health issues have a higher rate of substitution for benzodiazepines and antidepressants has significant public health implications. In light of the growing rate of morbidity and mortality associated with these prescription medications (Bachhuber et al., 2014; Fischer, Rehm, Goldman, & Popova, 2008), cannabis could play a significant

Conclusions

The high rate of substitution for prescription drugs among patients with pain-related and mental health conditions suggests that medical cannabis may be an effective adjunct or substitute treatment to prescription drugs used to treat these conditions. Further research into the comparative efficacy of cannabis relative to front-line treatments for theses conditions is warranted, and longitudinal research would help elucidate the context of cannabis substitution effect, and the potential impact

Limitations

The relatively low response rate to the survey (21%) leaves open the possibility this could potentially be an unrepresentative sample. It is not possible to confirm the impact of cannabis substitution on quantity of use of prescription drugs, alcohol or illicit drug use. Additionally, all data regarding the cannabis substitution effect in this study were self-reported by patients and did not benefit from biological drug detection to confirm use or non-use of a substance. In light of this

Declaration of interest

This study was funded by Tilray, a federally authorised medical cannabis production and research company. Philippe Lucas is currently employed as Vice-President, Patient Research and Advocacy for Tilray; however, his compensation is not tied in any way to the outcomes of this study.

Zach Walsh is currently the Primary Investigator in a Tilray-sponsored randomized clinical trial of medical cannabis and PTSD, but he receives no financial compensation for that study nor for assisting with the

Acknowledgements

Funding for this study was provided by Tilray. We would like to thank all of the Tilray patients that have shared their thoughts and experiences with us, as well as Kim Crosby for assisting with some of the data analysis of this survey.

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