Cannabis Treatment Demand in Canada

1. Cannabis Treatment Demand in Canada Dr. Brian Rush Karen Urbanoski Dr. Carol Strike Marion Mueller Health Systems Research and Consulting Unit Centre for Addiction and Mental Health Toronto, Ontario, Canada In support of the Canadian Centre on Substance Abuse

2. Cannabis Treatment Demand in Canada • Health care services are administered by provinces • No centralized national reporting system for substance abuse treatment • Existence of provincial reporting systems for substance abuse treatment is variable • No standardized definitions, standard set of criteria collected

3. Cannabis Use in the General Population In 1994: • 29% of Canadian adults reported lifetime cannabis use • 7% reported past-year use • 2% reported using at least weekly in the past year Source: Canada’s Alcohol and Other Drug Survey (CADS) conducted by Statistics Canada

4. Cannabis Use in the General Population In 2000: • 35% of Ontario adults reported lifetime cannabis use • 11% reported past-year use • 68% of lifetime users reported no past-year use • 0.5% met ICD-10 criteria for cannabis dependence Source: CAMH Monitor 2000, conducted by the Centre for Addiction and Mental Health

5. ONTARIO

6. Prevalence of Cannabis Problems in the Ontario Treatment System Of all clients entering substance abuse treatment in Ontario in fiscal 2000 (Apr-1-00 to Mar-31-01; N=47995) • 30.5% (N=14633) identified cannabis as a problem substance • 13.0% (N=6219) identified cannabis as the primary problem substance

7. Prevalence of Cannabis Problems in the Ontario Treatment System Cannabis was identified as a problem substance by: • 32% of men; 27% of women • 69% of clients under age 20 • 41% of those with less than a high school education • 67% of students • 44% of single clients

8. Clients with Primary Cannabis Problems (N=6219) Average Frequency of Cannabis Use in Past Month • 17% no use • 21% less than twice weekly • 16% 3 to 6 times weekly • 45% daily • 1.3% binge only

9. Distinctiveness of Clients with Primary Cannabis Problems Cannabis Total Clients Population (N=6219) (N=47995) Men 74% 70% Under age 20 56% 15% Less than high school 75% 52% Student 43% 13% Single 79% 50%

10. Distinctiveness of Clients with Primary Cannabis Problems Cannabis Total Clients Population (N=6219) (N=47995) Legal problems 39% 32% External pressure to enter treatment 38% 28% Parole or probation 17% 13% School 5% 1% Family 5% 2%

11. Distinctiveness of Clients with Primary Cannabis Problems Cannabis Total Clients Population (N=6219) (N=47995) Past-year use of: Alcohol 72% 77% Cocaine 20% 26% Hallucinogens 30% 10% Heroin 3% 5% Amphetamines 12% 7% 3+ Psychoactive Substances 44% 30% 5+ Psychoactive Substances 5% 5%

12. Sources of Referral Cannabis Total Clients Population (N=6219) (N=47995) Primary Referral Source: Family or friends 16% 9% Medical or psychiatric service 8% 12% Police or legal system 17% 13% School 13% 3% Self 24% 35% Withdrawal management service 3% 6%

13. Is the distinct referral pattern of cannabis clients a factor of age?

14. Prevalence of Cannabis Problems in a Large Treatment Facility Of clients assessed at the Centre for Addiction and Mental Health (CAMH) in Toronto, Ontario between Dec-1-96 and Mar-31-99 (n=4895): • 9% identified cannabis as the primary problem substance (n=426) • Demographic profile: 80% male, 61% under age 30, 77% single

15. CAMH Cannabis Client Profile at Treatment Entry Cannabis-related adverse consequences experienced in the 90 days prior to admission (n=426): • Cognitive impairment………. 50% • Psychological problems…….. 68% • Vocational problems………… 53% • Interpersonal problems……… 62% • Financial problems………….. 60% • Physical health problems……. 40% • Legal problems……………… 18%

16. CAMH Cannabis Client Profile at Treatment Entry Also in the past 90 days: • 27% had been physically or verbally abusive after using cannabis • 35% had sought help for psychological problems • 16% had been charged with a criminal offense

17. CAMH Cannabis Client Profile at Treatment Entry In addition, primary problem cannabis clients self-reported history included: • Suicidal ideation…………. 39% • Sexual abuse…………….. 24% • Physical abuse…………… 33% • Depressive symptoms…… 36% • Anxiety symptoms…… …. 13%

18. CAMH Cannabis Client Profile at Treatment Entry Other psychoactive substances used in the 90 days prior to the assessment interviews: • Alcohol………….. 79% • Hallucinogens…… 18% • Cocaine………….. 18% • Opiates…………… 17% • Benzodiazepines…. 14%

19. Despite the high rate of poly-drug use… • 64% of primary problem cannabis users reported no secondary or tertiary problem substances • 22% reported alcohol as a secondary problem substance; however: • Only 10% reported drinking on >45 of the last 90 days • 50% reported drinking on 5 or fewer days • Unlikely that clients were attributing problem related to alcohol and other drug use to their cannabis use

20. SASKATCHEWAN

21. Prevalence of Cannabis Problems in the Saskatchewan Treatment System Trend in % of admissions reporting cannabis-related problems:

22. Prevalence of Cannabis Problems in the Saskatchewan Treatment System Of all admissions to substance abuse treatment in Saskatchewan in Fiscal 2000 (Apr-1-00 to Mar-31-01; N=18832) • 25% (n=4672) reported that their use of cannabis was creating problems • Second most prevalent problem substance after alcohol (reported by 10355 clients, 55%)

23. Prevalence of Cannabis Problems: Fiscal 2000 (N=4672) • Men 24% • Women 28% • < 20 years 47% • 20-29 years 29% • 30-39 years 23% • 40-49 years 13% • 50 + years 3%

24. Distinctiveness of Clients with Primary Cannabis Problems Cannabis Total Clients Population (N=4672) (N=18832) Men 67% 70% < 20 years 31% 16% 20-29 years 34% 29% 30-39 years 24% 26% 40-49 years 10% 19% 50 + years 1% 10%

25. ALBERTA

26. Prevalence of Frequent Cannabis Use in the Alberta Treatment System Trend in % of admissions reporting cannabis as the most frequently used substance in the past year:

27. Prevalence of Cannabis Problems in the Alberta Treatment System Of all admissions to substance abuse treatment in Alberta in Fiscal 2002 (Apr-1-02 to Mar-31-03; N=31863) • 22% (n=5437) reported cannabis as a substance of concern in the past year • In comparison, 54% reported concerns with alcohol, 33% with cocaine, 14% with opiates

28. Distinctiveness of Clients with Primary Cannabis Problems Cannabis Total Clients Population (N=5437) (N=31863) Men 73% 69% < 20 years 25% 19% 20-29 years 29% 22% 30-39 years 28% 28% 40-49 years 15% 22% 50 + years 2% 10%

29. Qualitative Study of Therapists: Initial Impressions • Guidelines • What is a safe level? • Relative to other drugs and tobacco • Considerable variation in what is considered harmful (daily use; consequences) • Self-report during assessment perhaps more accurate • Cannabis Mental health? But who cares?

30. Conclusions • Clients with cannabis-related problems constitute a non-trivial proportion of clients many Canadian substance abuse treatment systems • Rates of cannabis-related problems are stable in at least some jurisdictions • Have a baseline to monitor impact of anticipated change in legislation

31. Conclusions • Clients who seek help with cannabis-related problems may be a demographically distinct sub-population within the larger substance abuse treatment population • Unique social position of the young, single, male, with low educational attainment may affect treatment needs/outcomes

32. Conclusions • Those who seek treatment for cannabis-related problems may present with a host of issues that could potentially affect treatment needs/outcomes • High rates of legal system involvement, psychiatric symptoms, external pressure to treatment, cannabis-related psychosocial problems

33. Future Areas of Research • Need outcome studies (e.g., comparing cannabis-specific and non-specific treatment interventions) • Need training and information for harm reduction approaches