Untangling medical and non-medical cannabis

Mar 2021

The Cannabis Knowledge Exchange Hub is your professional source for non-medical cannabis resources, but what do we mean when we talk about non-medical cannabis? In your professional practice—whether you work in primary care, public health, mental health and addictions, social services or education—do you differentiate between medical and non-medical cannabis use? Do you think about the intersection of the two?

This article outlines what you need to know about medical and non-medical cannabis, and opens a discussion about the grey area between.


Venn diagram with one circle representing medical cannabis, the other circle representing non-medical cannabis, and a question mark in the centre.

Medical cannabis

DEFINITION: Licensed health care professionals—such as physicians or nurse practitioners—can authorize cannabis for medical purposes. This type of use is sometimes called therapeutic use. Medical cannabis may be authorized to relieve pain and other symptoms associated with chronic conditions that have not responded to conventional medical treatments.1

THE LAW: Medical cannabis was legalized in Canada in 2001. Regulations have since been updated, notably in 2018 with the legalization of non-medical cannabis.2

ACCESS: The federal government regulates the production and sale of medical cannabis. Patients who have authorization from a licensed health care professional can access medical cannabis from a federally licensed seller, by producing cannabis themselves or by designating someone to produce it for them.2 Check out a sample authorization form.

YOUTH: Medical cannabis is not recommended for individuals under the age of 25.1 However, licensed health care professionals can authorize it for any patient regardless of their age.3

Left-hand side: icon of a cannabis store with the statistic 377,024 people registered with a federally licensed seller. Right-hand side: icon of a cannabis plant with the statistic 43,211 people registered for personal or designated cultivation. Citation: Health Canada. (2020). Data on cannabis for medical purposes. Available: https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/research-data/medical-purpose.html

Non-medical cannabis

DEFINITION: Non-medical cannabis use refers to any cannabis consumption outside the medical definition as described in the previous section. This type of use is sometimes called recreational use.

THE LAW: Non-medical cannabis was legalized in Canada in 2018 when the Cannabis Act was implemented.

ACCESS: Each province or territory regulates the sale of cannabis within their own borders. In general, non-medical cannabis may be purchased from either in-person or online stores, which may be government-operated or privately licensed.4

YOUTH: The legal age for non-medical cannabis varies by province/territory and ranges from age 18 in Alberta to 21 in Quebec; the legal age is 19 throughout the rest of Canada.4

Cannabis between the boundaries

Although medical and non-medical cannabis appear to be stark opposites, there is also a complex grey area. Health professionals serving people who use cannabis need to understand this complexity.

Self-medication

Most people who report using cannabis for medical purposes do not have authorization from a licensed health care professional. The Canadian Cannabis Survey 2020 asked Canadians aged 16 years and older about their cannabis use. The findings showed that only 24 per cent of people who said they use cannabis for medical reasons had authorization from a health care professional.5 In other words, most of these participants had self-defined their cannabis use as medical. This type of usage is sometimes called self-medication.

:Infographic percentage chart showing 24 per cent. Caption: Only 24% of people who report using cannabis for medical purposes have authorization from a health care professional. Citation: Health Canada. (2020). Canadian Cannabis Survey 2020: Summary. Available: https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/research-data/canadian-cannabis-survey-2020-summary.htm

Self-medication and mental health

The better people rate their mental health, the less likely they are to use cannabis. Bar graph representing increasing cannabis use as mental health ratings decrease: Excellent (18%), Very good (25%), Good (32%), Fair (46%) and Poor (57%). Citation: Health Canada. (2020). Canadian Cannabis Survey 2020: Summary. Available https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/research-data/canadian-cannabis-survey-2020-summary.html:

Currently there is limited evidence supporting the use of cannabis for therapeutic purposes. However, the number of studies supporting this type of cannabis use is slowly increasing for a handful of symptoms associated with specific disorders.6 There is insufficient evidence to support the use of medical cannabis for mental health conditions in particular; however, they are commonly cited as the reason for using medical cannabis.7,8,9

Infographic percentage chart showing 75 per cent. Caption: 75% of people using cannabis for medical purposes, but without authorization from a health care practitioner, used cannabis to manage their mental health. Citation: Wadsworth, E., Leos-Toro, C., & Hammond, D. (2020). Mental Health and Medical Cannabis Use among Youth and Young Adults in Canada. Substance Use & Misuse, 55(4), 582–589.

The Canadian Cannabis Survey 2020 asked cannabis users about the effect of cannabis on their mental health. The results were evenly split between cannabis use having no effect on mental health or being beneficial to mental health.

What effect does cannabis use have on your mental health? Pie chart with three wedges representing: No effect (47%), Beneficial (46%) and Harmful (6%). Citation: Health Canada. (2020). Canadian Cannabis Survey 2020: Summary. Available: https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/research-data/canadian-cannabis-survey-2020-summary.html

To understand this further, a 2020 study8 asked a similar question but separated the results by type of cannabis use. Among those participants using non-medical cannabis, the majority reported no effects of cannabis on their mental health. In contrast, the majority of participants using cannabis for medical purposes, whether authorized by a healthcare professional or not, reported that cannabis use improved their mental health. There were no significant differences between those with authorization from a health care professional and participants who self-medicate.

Left-hand side: Non-medical cannabis users. Pie chart with three wedges representing: No effect (71.8%), Improved (20.5%) and Worsened (7.7%). Right-hand side: Unauthorized medical cannabis users. Pie chart with three wedges representing: No effect (37.4%), Improved (59.4%) and Worsened (3.2%). Citation: Wadsworth, E., Leos-Toro, C. & Hammond, D. (2020). Mental health and medical cannabis use among youth and young adults in Canada. Substance Use & Misuse, 55(4), 582–589.

Combining medical and non-medical cannabis

Study findings suggest that a significant proportion of people who use cannabis for medical purposes also use non-medical cannabis. The National Cannabis Survey 2019 asked Canadians aged 15 years and older about their main reason for using cannabis, and a third of them identified both medical and non-medical uses.10

Infographic percentage chart showing 33 per cent. Caption: 33% of Canadians said their main reason for using cannabis was both medical and non-medical. Citation: Statistics Canada. (2019). Number and Percentage of People Reporting Non-medical, Medical, and both Medical and Non-medical Cannabis use by Age Group, Canada (Provinces only), Second and Third Quarters Combined 2019. Available: https://www150.statcan.gc.ca/n1/daily-quotidien/191030/t002a-eng.htm

Similarly, a 2020 Ontario-based study9 investigated adults’ cannabis use. The vast majority (81 per cent) of participants who self-reported using cannabis for medical purposes also used non-medical cannabis.

A very small proportion of people use cannabis exclusively for medical purposes. Pie chart with three wedges representing: Non-medical only (61.3%), Medical only (7.5%) and Both (31.2%). Citation: Turna, J., Balodis, I., Munn, C., Van Ameringen, M., Busse, J. & MacKillop, J. (2020). Overlapping patterns of recreational and medical cannabis use in a large community sample of cannabis users. Comprehensive Psychiatry, 102, 152188.

How can you use this information?

This article describes the basic definitions of medical and non-medical cannabis to help you understand the concepts for your professional practice. However, it is equally important to consider the intersections of medical and non-medical cannabis use as a way to better serve your clients.

Self-medicating with cannabis is common, particularly for individuals experiencing mental health-related symptoms. Although there is currently insufficient scientific evidence to support the use of medical cannabis for mental health conditions, many cannabis users attribute improved mental health to their cannabis use. In addition, viewing medical and non-medical cannabis as two independent issues does not take into account the reality that many people are using cannabis for both purposes.

Professionals in primary care, public health, mental health and addictions, social services and education sectors are encouraged to learn more about the intersections of medical and non-medical cannabis, and to discuss overlapping patterns of use with their clients.

References

  1. Health Canada. (2016). Consumer Information – Cannabis (Marihuana, marijuana). Available: https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/licensed-producers/consumer-information-cannabis.html
  2. Health Canada. (2020). Cannabis for Medical Purposes under the Cannabis Act: Information and Improvements. Available: https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/medical-use-cannabis.html
  3. Canadian Paediatric Society. (2018). Canadian Paediatric Surveillance Program 2017 Results. Available: https://www.cpsp.cps.ca/uploads/publications/CPSP-2017-Results_1.pdf
  4. Health Canada. (2021). Cannabis in the Provinces and Territories. Available: https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/laws-regulations/provinces-territories.html
  5. Health Canada. (2020). Canadian Cannabis Survey 2020: Summary. Available: https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/research-data/canadian-cannabis-survey-2020-summary.html
  6. Health Canada. (2018). Information for Health Care Professionals: Cannabis (marihuana, marijuana) and the Cannabinoids. Available: https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/information-medical-practitioners/information-health-care-professionals-cannabis-cannabinoids.html
  7. Walsh, Z., Gonzalez, R., Crosby, K., Thiessen, M.S., Carroll, C. & Bonn-Miller, M.O. (2017). Medical cannabis and mental health: A guided systematic review. Clinical Psychology Review, 51, 15–29. doi: 10.1016/j.cpr.2016.10.002
  8. Wadsworth, E., Leos-Toro, C. & Hammond, D. (2020). Mental health and medical cannabis use among youth and young adults in Canada. Substance Use & Misuse, 55(4), 582–589.
  9. Turna, J., Balodis, I., Munn, C., Van Ameringen, M., Busse, J. & MacKillop, J. (2020). Overlapping patterns of recreational and medical cannabis use in a large community sample of cannabis users. Comprehensive Psychiatry, 102, 152188.
  10. Statistics Canada. (2019). Number and Percentage of People Reporting Non-medical, Medical, and both Medical and Non-medical Cannabis use by Age Group, Canada (Provinces only), Second and Third Quarters Combined 2019. Available: https://www150.statcan.gc.ca/n1/daily-quotidien/191030/t002a-eng.htm
  11. Health Canada. (2020). Data on Cannabis for Medical Purposes. Available: https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/research-data/medical-purpose.html

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