Supplier Name: Phoenix SPI
Contract Number: HT372-214981/001/CY
Award Date: 2022-01-07
Contract Value: $249,429.53 (including applicable taxes)
Delivery Date: 2022-10-24
Registration number: POR 093-21
For more information on this report, please contact Health Canada at: hc.cpab.por-rop.dgcap.sc@canada.ca
Ce rapport est aussi disponible en français.
Final Report
Prepared for Health Canada
Supplier name: Phoenix Strategic Perspectives Inc.
October 2022
This public opinion research report presents the results of two online surveys: one conducted with individuals who have used cannabis for medical purposes since legalization in Canada and the other conducted with medical doctors and nurse practitioners from a specialized panel who have authorized cannabis for medical purposes since legalization or who have discussed, treated or referred a patient in relation to cannabis for medical purposes.
This publication may be reproduced for non-commercial purposes only. Prior written permission must be obtained from Health Canada. For more information on this report, please contact Health Canada at:
HC.cpab.por-rop.dgcap.SC@canada.ca or at:
Communications and Public Affairs Branch
Health Canada
200 Eglantine Driveway, Jeanne Mance Building
AL 1915C, Tunney's Pasture
Ottawa, Ontario K1A 0K9
Catalogue number:
H14-422/2022E-PDF
International Standard Book Number (ISBN):
ISBN 978-0-660-46221-9
Related publications (registration number: POR 093-21):
Catalogue number (Final report, French) H14-422/2022F-PDF
ISBN 978-0-660-46222-6
© His Majesty the King in Right of Canada, as represented by the Minister of Health, 2022.
Cette publication est aussi disponible en français sous le titre : Accès au cannabis à des fins médicales au Canada : renseignements sur les perspectives et les pratiques des patients et des professionnels de la santé
The Cannabis Act and Cannabis Regulations came into force on October 17, 2018. Health Canada commissioned Phoenix Strategic Perspectives Inc. (Phoenix SPI) to conduct baseline surveys on access to cannabis for medical purposes.
The primary objective of this research is to gather evidence on the state of access to cannabis for medical purposes in Canada. The target populations were:
Specific objectives for each target population were as follows:
Two surveys were administered as follows:
The results of these surveys are not statistically projectable to the target populations because the sampling method used does not ensure that the sample represents the target population with a known margin of sampling error.
The research findings will be used to better understand the different experiences of 1) individuals who access cannabis for medical purposes and 2) the perspectives and practices of HCPs regarding cannabis for medical purposes.
The contract value was $249,429.53 (including applicable taxes).
I hereby certify as a Senior Officer of Phoenix Strategic Perspectives that the deliverables fully comply with the Government of Canada political neutrality requirements outlined in the Communications Policy of the Government of Canada and Procedures for Planning and Contracting Public Opinion Research. Specifically, the deliverables do not contain any reference to electoral voting intentions, political party preferences, standings with the electorate, or ratings of the performance of a political party or its leader.
Alethea Woods
President
Phoenix Strategic Perspectives Inc.
Phoenix Strategic Perspectives Inc. (Phoenix SPI) was commissioned by Health Canada to conduct baseline surveys on access to cannabis for medical purposes.
Since the late 1990s, Canada has had a system of access to cannabis for medical purposes in some form. The legal framework has evolved considerably over the years as a result of several court decisions and government actions, which have sought to help ensure that Canadians have continued and reasonable access to cannabis, under the supervision of their health care practitioner.
The Cannabis Act and Cannabis Regulations came into force on October 17, 2018. This created a new legal framework for controlling the production, distribution, sale, and possession of cannabis in Canada. The framework now permits adults in Canada to possess and purchase limited amounts of cannabis for non-medical and medical purposes.
Under the Cannabis Regulations, individuals who have the authorization of their health care practitioner are able to access cannabis for medical purposes by 1) purchasing directly from a federally licensed seller; 2) registering with Health Canada to produce a limited amount of cannabis for their own medical purposes; or 3) designating someone to produce it for them. Data suggests, however, that many individuals may be accessing cannabis for therapeutic purposes from other sources outside the medical access program, without health care practitioner authorization.
One consideration in access to cannabis for medical purposes is the role that health care practitioners play in facilitating access, specifically medical doctors and nurse practitioners who are permitted to do so. The requirements established by the Cannabis Regulations apply to health care practitioners (HCPs) with respect to the issuance of a medical document or written order that supports the use of cannabis for medical purposes. There is limited research, however, on HCP's authorizing practices, attitudes, beliefs, and knowledge regarding cannabis for medical purposes.
The primary purpose of this research was to gather evidence on the state of access to cannabis for medical purposes in Canada. The target populations were:
Specific objectives for each target population were as follows:
The results of this research will be used to better understand the different experiences of 1) individuals who access cannabis for medical purposes and 2) the perspectives and practices of HCPs about cannabis use for medical purposes.
Below is an overview of the methodologies of both surveys. For a full description of the specifications of each survey, refer to the Appendix: 1. Technical Specifications.
The results of these surveys are not statistically projectable to the target populations because the sampling method used does not ensure that the sample represents the target population with a known margin of sampling error.
A 20-minute online survey was administered to a non-probability sample of 1,205 Canadians aged 16 and older who have used cannabis for medical purposes since it was legalized on October 17, 2018). The sample was drawn from the Leger Opinion panel (LEO), a proprietary Canadian panel with over 400,000 members, including over 5,000 people who say they use cannabis for medical and/or non-medical purposes. The fieldwork was conducted from May 5 to May 13, 2022. The survey data have been weighted by region, age and gender of those who use cannabis for medical purposes using figures from the government of Canada's 2021 Cannabis Survey.
A 15-minute online survey was administered to a non-probability sample of 823 medical doctors and nurse practitioners who have had experiences with patients accessing or inquiring about cannabis for medical purposes since legalization. The sample was drawn from MD Analytics proprietary panel of Canadian health care professionals and augmented by a small sample of nurse practitioners drawn from a provincial health regulator. The fieldwork was conducted from May 19 to July 12, 2022. The survey data have been weighted by region and type of HCP using figures from the Canadian Institute for Health Information (CIHI) Health Workforce data.
This first section of the report presents the findings from an online survey of those who have used cannabis for medical purposes since the broader legalization of cannabis for non-medical purposes in Canada in 2018.
Over two-thirds (71%) of respondents who use cannabis for medical purposes have also used cannabis for non-medical purposes in the past three years. Conversely, just under one-third (29%) of those who completed the survey have not used cannabis for non-medical purposes in the past three years (i.e., since the broader legalization of cannabis for non-medical purposes in Canada).
Use of cannabis for non-medical purposes
I have used cannabis for non-medical purposes in the past 3 years = 71%
I have NOT used cannabis for non-medical purposes in the past 3 years = 23%
I have used cannabis for non-medical purposes but NOT in the past 3 years = 6%
Q7. In the past 3 years, have you used cannabis for non-medical purposes? Base: n= 1,117; all respondents excluding parents responding on behalf of their children.
Those who said they used cannabis for medical purposes prior to the broader legalization of cannabis for non-medical purposes in Canada (79%) were more likely than those who had not (61%) to have used cannabis for non-medical purposes in the past three years. In addition, those who had not discussed the use of cannabis for medical purposes with a health care provider (78%) were more likely than those who had (67%) to report having used cannabis for non-medical purposes in the past three years. Similarly, those who did consult a health care provider but who did not request and/or obtain a medical document authorizing use of cannabis for medical purposes (71%) were more likely than those who obtained a medical document (61%) to have used cannabis for non-medical purposes. Use of cannabis for non-medical purposes was also higher among patients with full or partial insurance coverage for cannabis (78% vs. 68% of respondents uninsured for use of cannabis for medical purposes). Finally, the likelihood of having used cannabis for non-medical purposes in the past three years was lower among respondents who reported using cannabis for medical purposes less than once a month.
Those aged 18 to 34 (89%) were more likely to have used cannabis for non-medical purposes in the last three years, compared to those 55 and older (55%).
Gender differences were also evident, with men (77%) more likely than women (65%) to have used cannabis for non-medical purposes in the past three years. In addition, respondents who reported having fair to poor physical health (63%) were less likely than those who characterized their physical health as good (72%) or very good to excellent (77%) to have used cannabis for non-medical purposes.
Among respondents who have used cannabis for non-medical purposes in the past three years (n=808), close to three-quarters (72%) reported doing so at least once a week. Specifically, 37% use cannabis for non-medical purposes daily, or almost daily, 22% do so several times a week, and 13% do so once a week. One in 10 (11%) use cannabis for non-medical purposes several times a month and 16% do so once a month or less.
Frequency of using Cannabis fo non-medical purposes
Daily or almost daily = 37%
Several times a week = 22%
Once a week = 13%
Several times a month = 11%
Once a month= 6%
Less than once a month = 10%
Q8. In a typical month, how often do you use cannabis for non-medical purposes? Base: n=808; respondents who use cannabis for non-medical purposes.
Women were more likely to report daily (or near daily) use of cannabis for non-medical purposes (41% vs. 33% of men). Daily (or nearly daily) use was also higher among those with a high school diploma or less (45%) and those who completed trade school, college, or have some university experience below a bachelor's degree (41%) compared to respondents with a bachelor's degree or above (26%).
Daily (or nearly daily) use was also higher among patients reporting fair to poor mental health (46% compared to 32% of those reporting very good to excellent mental health and 34% of those reporting good mental health).
Those who do not have a medical document (43%) were more likely than those who do (32%) to report also using cannabis for non-medical purposes daily or almost daily. The same was true of those who said they used cannabis for medical purposes prior to the broader legalization of cannabis for non-medical purposes: 47% of them reporting daily or near daily use of cannabis for non-medical purposes vs. 24% of those who said they did not use cannabis for medical purposes prior to legalization.
Just over half (53%) of those surveyed said they used cannabis for medical purposes prior to the broader legalization of cannabis for non-medical purposes in Canada. Conversely, 46% started using cannabis for medical purposes only following legalization of cannabis for non-medical purposes on October 17, 2018.
Use of Cannabis for medical purposes prior to legalization
Yes, I used cannabis for medical purposes prior to legalization = 53%
No, I had not used cannabis for medical purposes prior to legalization = 46%
Q11. Did you use cannabis for medical purposes before cannabis was legalized* (before October 17, 2018)? Base: n=1,205; all respondents. [NR:1%].
The likelihood of using cannabis for medical purposes prior to the legalization of cannabis for non-medical purposes was higher among the following respondents:
Just over half of those surveyed (54%) have been using cannabis for medical purposes for three years or less: 12% for less than one year, 13% for one year, and 29% for two to three years. Those who have been using cannabis for medical purposes for four or more years include 17% who have been doing so for four to five years, 10% who have been doing so for six to nine years, and 18% who have been doing so for 10 or more years.
Figure 4: Length of time using cannabis for medical purposes
Less than 1 year = 12%
1 year = 13%
2 to 3 years = 29%
4 to 5 years = 17%
6 to 9 years = 10%
10 to 15 years = 7%
16 to 19 years =2%
20 or more years =9%
Q12. How long have you been using cannabis for medical purposes? Base: n=1,205; all respondents.
Those reporting fair to poor mental health were more likely to report a longer history of use of cannabis for medical purposes compared to those with very good to excellent mental health – 15% of those with fair or poor mental health have used cannabis for medical purpose six to nine years. Whereas those with very good to excellent (16%), or good (13%) mental health are among those most likely to report commencing use within the last year. The same is true when comparing levels of physical health. That is, 15% of those with very good to excellent physical health began using cannabis for medical purposes in the last year, whereas patients with fair to poor physical health are more likely to have begun use six to nine years ago (14%).
Length of time using cannabis for medical purposes is also affected by the frequency with which respondents reported using cannabis for medical purposes: those who use cannabis daily or almost daily were more likely than less frequent users to have been using cannabis for medical purposes for a longer period.
Four factors were identified most often when respondents were asked to consider what contributed to their decision, or motivated them, to start using cannabis for medical purposes. This included a preference for natural treatments (38%), lack of success with other treatments, i.e., not helping or causing unwanted side effects (37%), a friend or family member suggesting cannabis (32%), and the legalization of cannabis in Canada (31%) (multiple responses accepted).
Figure 5: Factors contributing to use of cannabis for medical purposes
Prefer natural treatments = 38%
Other treatments were not helping enough or had side effects = 37%
A friend or family member suggested cannabis = 32%
Cannabis became legal = 31%
Cannabis is more available than other treatment options = 22%
A healthcare provider suggested cannabis = 22%
Read news articles or social media posts about cannabis for my health condition = 21%
Cannabis is less expensive than other treatment options = 18%
Other = 3%
Q13. Which, if any, of the following factors contributed to your decision, or motivated you, to start using cannabis for medical purposes? Multiple responses accepted. Base: n=1,205; all respondents.
This was followed by nearly identical proportions (21-22%) identifying the availability of cannabis compared to other treatment options, a suggestion from a health care provider, and news articles or social media post about cannabis treating their health conditions. Slightly fewer (18%) identified cost (i.e., that cannabis is less expensive than other treatment options).
Those 55 and older were more likely to say they were influenced to start using cannabis for medical purposes because other treatments were not working (46% vs. 29% of 18- to 34-year-olds and 36% of 35- to 54-year-olds).
Regionally, respondents from Quebec (29%) were more likely than those from Ontario (19%) and BC (19%) to attribute their use of cannabis for medical purposes to cannabis being more accessible than other treatment options. Those from the Prairies (40%) were more likely than their counterparts in Atlantic Canada (24%) and Ontario (27%) to point to the legalization of cannabis as a factor.
Women were more likely to attribute their use to a preference for natural treatments (42% vs. 26% of men), lack of efficacy of other treatments (43% vs. 31%), and suggestion from a friend or family member (38% vs. 26%). Men, on the other hand, were more likely to point to the legalization of cannabis as a factor (35% vs. 28%).
Among those motivated to start using cannabis for medical purposes following the broader legalization of cannabis in Canada (n=355), a majority (58%) said that this is because cannabis became more accessible and easier to buy. Approximately half made the decision because more information about cannabis for medical purposes became available following legalization of cannabis for non-medical purposes and because legalization reduced the stigma associated with cannabis use (49% each) (multiple responses accepted).
Figure 6: Reasons legalization motivated use of cannabis for medical purposes
Cannabis is now more available and easier to buy = 58%
There is more information about cannabis for medical purposes = 49%
Legalization reduced the stigma associated with cannabis use = 49%
More types of cannabis products are now available = 43%
Use of cannabis is more mainstream = 40%
I feel more comfortable talking about cannabis with others = 38%
I am now less concerned about cannabis possession = 35%
Access for medical purposes before legalization was = 33%
Curiosity = 18%
Use of cannabis is increasing in popularity = 16%
I can now grow cannabis at home = 12%
Other = 2%
Q14. You said that the legalization of cannabis in Canada was a factor that motivated you to start using cannabis for medical purposes. Why is that? Multiple responses accepted. Base: n= 355; respondents who said the legalization influenced their decision to use Cannabis for medical purposes.
Other frequently given reasons for why the legalization of cannabis for non-medical purposes motivated their use of cannabis for medical purposes included the diversification of available cannabis products (43%), the use of cannabis entering the mainstream (40%), feeling more comfortable talking about cannabis with others (38%), less concerned about possessing cannabis following legalization (35%), and accessing cannabis for medical purposes before legalization being difficult (33%). Less frequently given reasons included curiosity (18%), use of cannabis increasing in popularity (16%), and the ability to grow cannabis at home (12%).
Those 55 and older were significantly more likely than younger respondents to point to the following reasons: cannabis is now more available and easier to buy (71%), there is more information available about using cannabis for medical purposes (63%), the stigma has been reduced (63%), and they feel more comfortable talking about cannabis now (50%).
Regionally, 70% of Canadians living in Ontario reported that cannabis is now more available and easier to buy compared to half the respondents from Quebec (51%) and BC (51%).
Gender differences were pronounced with women more likely than men to say that cannabis is more available now (67% vs. 52%), there is more information available about using cannabis for medical purposes (61% vs. 38%), legalization reduced the stigma (60% vs. 40%), there are more types of cannabis products available (50% vs. 38%), use of cannabis is more mainstream (49% vs. 32%), and increased comfort talking about cannabis since it was legalized (47% vs. 30%).
The most frequently identified symptoms for which respondents reported using cannabis for medical purposes to manage are, problems sleeping (52%) and for feelings of anxiety (43%). Approximately one-quarter of respondents reported using cannabis for feelings of depression (26%), chronic non-cancer pain (26%), acute pain (24%), and headaches/migraines (23%) (multiple responses accepted). The only other symptoms identified by 10% or more of respondents included muscle spasms (17%) and nausea/vomiting (10%). The graph below identifies the full set of symptoms identified.
Figure 7: Use of Cannabis for Medical Purposes – Symptoms
Problems sleeping = 52%
Feelings of anxiety = 43%
Feelings of depression = 26%
Chronic non-cancer pain = 26%
Acute pain = 24%
Headaches/migraines = 23%
Muscle spasms = 17%
Nausea/vomiting = 10%
Wasting/weight loss and/or lack of appetite = 5%
Alcohol withdrawal symptoms = 3%
Cancer pain = 3%
Seizures = 3%
Opioid withdrawal symptoms = 2%
Palliative care = 1%
Symptoms of PTSD = 1%
Other = 4%
Prefer not to say = 0.5%
Q9. For which of the following symptoms have you used cannabis for medical purposes? Multiple responses accepted. Base: n=1,205 all respondents.
The likelihood of using cannabis to treat feelings of anxiety and depression was higher among those aged 18-34 (56% vs. 31% of those 55 and older), as was the likelihood of using it to treat depression (35% vs. 17% of those 55 and older). Women were more likely than men to report using cannabis to treat problems sleeping (58%), feeling of anxiety (47%), chronic non-cancer pain (31%), and headaches/migraines (26%).
In addition to symptoms, respondents were also asked for which diseases or disorders they have used cannabis for medical purposes. Respondents most often identified insomnia (31%), followed by anxiety disorder (27%), arthritis (25%) and depression (22%). Recall that the top two symptoms identified were trouble sleeping and feelings of anxiety. A variety of other disorders identified less frequently (fewer than 10% of respondents) are listed in the graph below.
Figure 8: Use of Cannabis for Medical Purposes – Disorders
Insomnia = 31%
Other anxiety disorders = 27%
Arthritis = 25%
Depression = 22%
PTSD = 9%
ADHD/ADD = 6%
Irritable bowel syndrome = 6%
Obesity = 5%
Inflammatory bowel diseases = 5%
Pain/Injury (not specified) = 4%
Multiple sclerosis, ALS, spinal cord injury = 4%
Skin diseases = 3%
Diabetes = 3%
Cancer = 3%
Glaucoma = 3%
Epilepsy = 2%
Fibromyalgia = 2%
Autism = 2%
Liver disease = 2%
HIV/AIDS = 1%
Schizophrenia/psychosis = 1%
Dystonia = 1%
Alzheimer's disease/dementia = 1%
Huntington's disease = 1%
Parkinson's disease = 1%
Tourette's syndrome = 1%
Other = 8%
Prefer not to say = 6%
Q10. For which of the following diseases or disorders have you used cannabis for medical purposes? Multiple responses accepted. Base: n=1,205; all respondents.
Those who have used cannabis for non-medical and medical purposes were more likely to report using cannabis for medical purposes to treat anxiety disorder (31% vs. 20% of those who have only used cannabis for medical purposes in the last three years), and depression (24% vs. 16%). Conversely, those who have only used cannabis for medical purposes in the last three years were more likely to report using cannabis to treat arthritis (37% vs. 22% of those who have used cannabis for non-medical purposes).
A majority of respondents said they use other medications to treat a disease or disorder (59%) or to manage symptoms (55%), though it is not possible to determine whether they use these medications to treat the same condition for which they are using cannabis. Just over one-quarter (26%) report using other therapies to treat a disease or disorder, while slightly more (30%) use such therapies to manage symptoms. Few report using substances, illegal or otherwise, to treat their disease or disorder or to manage symptoms.
Figure 9: Use of other medications, therapies or substances
To treat a disease or disorder:
Yes, other medications = 59%
Yes, other therapies = 26%
Yes, illegal substances = 3%
Other substances = 4%
Do not use other medications, therapies, substances = 28%
To manage the symptoms experienced because of a disease or disorder:
Yes, other medications = 55%
Yes, other therapies = 30%
Yes, illegal substances = 3%
Other substances = 5%
Do not use other medications, therapies, substances = 27%
Q15. Excluding cannabis, do you use other medications, therapies, or substances to: Multiple responses accepted. Base: n=1,205; all respondents.
Those 55 and older were more likely to report using other medications to treat their disorder/disease (67% vs. 56% of 35-54-year-olds and 50% of 18-34-year-olds) and manage the associated symptoms (66% vs. 56% of 35-54-year-olds and 43% of 18-34-year-olds). Women were more likely to report using other medications to manage the symptoms they experience because of their disease or disorder (59% vs. 51%).
Those using cannabis only for medical purposes were more likely than those who use cannabis for medical and non-medical purposes to report using other medications (64% vs. 56%) as well as other therapies (34% vs. 22%) to treat their disease or disorder. The same applies to those who discussed the use of cannabis with a health care provider. They were more likely than those who did not consult with a health care provider to report using other medications (64% vs. 49%) and therapies to treat their disorder (31% vs. 16%). The pattern was the same among those who used other medications and therapies to manage the symptoms they experience as a result of their disease or disorder.
Two-thirds of those surveyed discussed the use of cannabis for medical purposes as a potential treatment option with a medical doctor and/or nurse practitioner, though they were most likely to do so with a medical doctor (47%).
Figure 10: Discussed cannabis for medical purposes with a medical doctor or nurse practitioner
Discussed it with a medical doctor = 47%
Discussed it with a nurse practitioner = 11%
Discussed it with a medical doctor and nurse practitioner = 8%
Did not discuss it with a medical doctor or nurse practitioner = 34%
Q16. Did you discuss using cannabis for medical purposes with a medical doctor or nurse practitioner? Base: n=1,205; all respondents.
A few respondents noted they did not discuss the use of cannabis with a medical doctor or nurse practitioner but did consult another health care provider (n=46).[3] The single largest proportion of these patients said they consulted a nurse (28%). Other health care providers consulted include physiotherapists (14%), naturopaths (13%), chiropractors (12%), and psychiatrists (10%).
Respondents aged 18-34 years were less likely than older respondents to have discussed the use of cannabis for medical purposes with a medical doctor or nurse practitioner (38% vs. 51% of those aged 35-54 and 50% of those 55 and older).
The likelihood of consulting a medical doctor is higher among patients in Ontario (53% vs. 44% of patients in Quebec and 38% in British Columbia), those who used cannabis for medical purposes before the broader legalization in 2018 (51% vs. 42%), those with a medical document (77% vs. 67%), those with full or partial insurance coverage (61% vs. 44%), and those who use daily or near daily (54%) compared to weekly (45%), monthly (44%), or less than monthly (32%).
Those who did not discuss the use of cannabis with a medical doctor or nurse practitioner (n=426) provided a variety of reasons for not doing so. Fear and apprehension are common themes among many of these patients – 22% did not think the medical doctor or nurse practitioner would be willing to talk about cannabis as an option, 21% feared being judged, and 18% were not comfortable asking about cannabis (multiple responses accepted).
Figure 11: Reasons for not discussing cannabis with a medical doctor or nurse practitioner
No reason = 25%
Didn't think they would be willing to talk about cannabis as an option = 22%
Fear of being judged = 21%
Did not need advice, already knew how to use cannabis for medical purposes = 20%
Was not comfortable asking = 18%
Do not have a medical doctor or nurse practitioner = 11%
Concerned about privacy = 7%
They were too busy = 3%
Other = 3%
I can't recall = 5%
Q17. Why did you not discuss using cannabis for medical purposes with a medical doctor or nurse practitioner? Multiple responses accepted. Base: n=426; respondents who did not discuss the using cannabis for medical purposes with a medical doctor or nurse practitioner.
One in five (20%) said they did not need advice on the subject, 11% reported not having a medical doctor or nurse practitioner, 7% cited privacy concerns, and 3% said they were too busy. One-quarter (the most common response) said there was no reason for opting not to discuss the use of cannabis with a medical doctor or nurse practitioner and an additional 5% could not recall.
Among those who discussed the use of cannabis for medical purposes with a medical doctor or nurse practitioner (n=779), just over half (54%) consulted one such health care professional. Just over one-quarter (28%) consulted two health care professionals, while 16% consulted three or more medical doctors and/or nurse practitioners on the use of cannabis for medical purposes.
Figure 12: Number of medical doctors and/or nurse practitioners consulted
1 = 54%
2 = 28%
3 = 10%
4 = 4%
5 + = 2%
I can't recall = 3%
Q20. How many medical doctors or nurse practitioners did you consult on the use of cannabis for medical purposes? Base: n=779; respondents who discussed the use of cannabis for medical purposes with a medical doctor or nurse practitioner.
Respondents who did not obtain a medical document to authorize the use of cannabis (60%) were more apt than those who have a medical document (49%) to have consulted only one health care provider.
Three-quarters of respondents who discussed the use of cannabis for medical purposes with a medical doctor or nurse practitioner (76%) said the health care professional was supportive of using cannabis to treat their condition. Eight percent of those who consulted more than one medical doctor or nurse practitioner noted that some were supportive of using cannabis to treat their condition, while others were not. Few (10%) reported that the medical doctor or nurse practitioner they consulted was not supportive of the use of cannabis to treat their condition.
Figure 13: Perceived support received from medical doctor or nurse practitioner
They WERE supportive = 69%
SOME were supportive = 19%
They were NOT supportive = 10%
I can't recall = 2%
Q21/Q22. Was your medical doctor or nurse practitioner supportive of using cannabis to treat your condition? Base: n=779; respondents who discussed the use of cannabis for medical purposes with one medical doctor or nurse practitioner.
Older respondents who consulted a single health care professional were more likely to report receiving support from their HCP (88% of those 55 and older vs. 73% of those aged 18-34 and 76% of those aged 35-54). The same pattern applied to respondents who said they consulted more than one health care provider on the use of cannabis for medical purposes.
As the graph below shows, recommendations from medical doctors and nurse practitioners regarding the levels of THC and CBD varied, although the findings suggest a preference for CBD among HCPs.[4] Nearly one-third (31%) of respondents who discussed using cannabis for medical purposes with a doctor or nurse practitioner who was supportive of this treatment option said that this health care provider recommended higher levels of CBD with lower levels of THC. In addition, nearly one in five (19%) said they were recommended CBD only. Conversely, 17% said their health care provider recommended higher levels of THC and lower levels of CBD, while 8% said they were recommended THC only. Approximately one-quarter (24%) said their medical doctor or nurse practitioner recommended equal levels of THC and CBD. Sixteen percent of respondents said their medical doctor or nurse practitioner did not make a recommendation regarding the levels of THC and CBD.
Figure 14: Levels of THC and CBD recommended
Higher CBD, lower THC = 31%
Equal levels of THC and CBD = 24%
CBD only = 19%
Higher THC, lower CBD = 17%
They did not make a recommendation = 16%
THC only = 8%
I can't recall = 5%
Q24. What levels of THC and CBD did your medical doctor or nurse practitioner recommend? Multiple responses accepted. Base: n=652; respondents who discussed using cannabis for medical purposes with a medical doctor or nurse practitioner and who reported that their health care provider was supportive of using cannabis as a treatment.
The most common type of cannabis recommended by medical doctors and nurse practitioners were cannabis oils and extracts: 42% of these respondents said their doctor or nurse practitioner recommended that they take cannabis in this form. Following this, in declining order of frequency, were edibles (26%), capsules (24%), dried cannabis (23%), vaporizers (15%), and topical cream (11%).
Figure 15: Type of cannabis recommended
Oil or extract = 42%
Edible = 26%
Capsule = 24%
Dried cannabis = 23%
Vaporizer = 15%
Topical cream = 11%
Some other type of cannabis = 1%
I can't recall = 2%
They did not recommend a type = 18%
Q25. What type(s) of cannabis did your medical doctor or nurse practitioner recommend you take? Multiple responses accepted. Base: n= 652; respondents who discussed using cannabis for medical purposes with a medical doctor or nurse practitioner and who reported that their health care provider was supportive of using cannabis as a treatment.
Eighteen percent of those who discussed using cannabis for medical purposes with their doctor or nurse practitioner who was supportive of this treatment option said they did not recommend a type of cannabis.
Cannabis oils and extracts were more likely to be identified by those who use cannabis only for medical purposes: 50% of these respondents said their health care provider recommended oil or extracts compared to 38% of those who have also used cannabis for non-medical purposes.
Asked how often their medical doctor or nurse practitioner recommended that they use cannabis to treat their medical condition, the largest single proportion (41%) said their health care provider recommended cannabis use on an "as needed" basis. Among those who were recommended a specific frequency of use, 23% said their health care provider recommended use of cannabis multiple times a day to treat their medical condition and 21% said use once a day was recommended to them. Twelve percent said their doctor or nurse practitioner did not recommend a specific frequency.
Figure 16: Frequency of cannabis use recommended
Multiple times a day = 23%
Once a day = 21%
As needed = 41%
Some other frequency = 1%
Did not recommend a frequency of use = 12%
I can't recall = 2%
Q26. How often did your medical doctor or nurse practitioner recommend that you use cannabis to treat the medical condition? Base: n=652; respondents who were prescribed cannabis for medical purposes and who reported that their health care provider was supportive of using cannabis as a treatment.
Older respondents were more likely to say that their medical doctor or nurse practitioner recommended that they use of cannabis multiple times a day to treat their condition (29% vs. 18% of those 34 and younger). Women were more likely to report a recommended use of multiple times a day (28% vs. 15% of men) while men were more likely to report having been prescribed once a day use (27% vs. 12% of women).
Among respondents who discussed using cannabis for medical purposes with an HCP (n=779), the vast majority (90%) said the HCP discussed a number of topics within the appointment. In terms of what was discussed, respondents most often reported discussing their medical history (62%). This was followed at a distance by the medical condition for which cannabis use was being sought (46%), use of other medications to treat their condition (35%), potential side effects of cannabis (28%), and potential follow-up appointments (25%) (multiple responses accepted). One in 10 respondents either said nothing was discussed (6%) or could not recall (4%) what was discussed.
Figure 17: Discussion of medical needs with medical doctor or nurse practitioner
Medical history = 62%
Medical condition for which cannabis use was being sought = 46%
Use of other medications to treat the condition = 35%
Potential side effects of cannabis = 28%
Follow up appointments = 25%
Did NOT discuss medical needs = 6%
I can't recall = 4%
Q27. Did the medical doctor or nurse practitioner discuss your medical needs? Multiple responses accepted. Base: n=779; respondents who discussed the use of cannabis for medical purposes with a medical doctor or nurse practitioner.
While 64% of adults said they discussed their medical history with their doctor or nurse practitioner, only 43% of children did the same (as reported by their parent or guardian). Women were more likely to report having discussed follow up appointments (31% vs. 21% of men).
Respondents with a medical authorization to use cannabis were more likely than those who may have discussed cannabis for medical purposes with their HCP but don't have an authorization for it, to report discussing the following: medical history (68% vs. 54%), the medical condition for which cannabis use was being sought (52% vs. 43%) the potential side effects of cannabis (32% vs. 24%), and the potential of follow up appointments (30% vs. 18%).
A large majority (86%) of respondents who discussed the use of cannabis with a doctor or nurse practitioner reported going back to their health care provider for follow-up. Well over half (62%) reporting that they continue to be be followed while approximately one-quarter (24%) said they had one follow up.
Figure 18: Follow up with medical doctor or nurse practitioner
Patient continues to be followed = 62%
Patient had one follow up = 24%
Patient had no follow up = 14%
Q28. Have you gone back to the medical doctor or nurse practitioner for follow up? Base: n=779; respondents who discussed the use of cannabis for medical purposes with a medical doctor or nurse practitioner.
Just over half (53%) of the respondents who discussed the use of cannabis for medical purposes with a medical doctor or nurse practitioner said they received a medical document[5] authorizing a certain daily amount of cannabis to treat their condition. Most of the rest (38%) said they did not receive a medical document, while 9% could not recall the outcome of the discussions they had with their HCP about the use of cannabis for medical purposes.
Figure 19: Receipt of medical document authorizing daily amount of cannabis
Received medical document = 53%
Did NOT receive medical document = 38%
Cannot recall = 9%
Q29. Did you get a medical document from the medical doctor or nurse practitioner authorizing a certain daily amount of cannabis to treat your condition? Base: n=779; respondents who discussed the use of cannabis for medical purposes with a medical doctor or nurse practitioner.
Just over half (52%) of adult patients who consulted an HCP received a medical document, while more than two-thirds (68%) of children (as reported by their parent or guardian) who did the same received a document authorizing a certain daily amount of cannabis. Those living in Atlantic Canada (adult patients and children) (58%) and BC (48%) were more likely than respondents living elsewhere in the country to have not gotten a medical document. In addition, the likelihood of having obtained a medical document increased with education (from 42% of those with high school or less to 61% of those with at least a bachelor's degree).
The following types of respondents were more likely to have received a medical document:
Respondents who received a medical document authorizing the use of cannabis for medical purposes (n=418) most often reported having obtained this document once (29%) or twice (26%). The graph below identifies the proportions of respondents who reported receiving three medical documents or more. Nine percent could not recall the number of times they received a medical document authorizing the use of cannabis for medical purposes.
Figure 20: Number of times a medical document was obtained
Once = 29%
Twice = 26%
Three times = 14%
Four times = 6%
Five times = 3%
Six or more times = 12%
Cannot recall = 9%
Q30. How many times have you gotten a medical document for cannabis? Base: n=418; respondents who received a medical document authorizing their use of cannabis for medical purposes.
Those who did not use cannabis for medical purposes prior to legalization for non-medical purposes were more likely to have received a medical document for cannabis only once (37% vs. 23% of those who did so before the broader legalization of cannabis). Additionally, respondents without insurance coverage for cannabis for medical purposes were more likely to report receiving a medical document once (34% vs. 19% of those with full or partial coverage).
Nearly three-quarters (73%) of respondents who discussed the use of cannabis for medical purposes with a medical doctor or nurse practitioner, but who did not receive a medical document (n=298), reported that they did not ask for such a document. One in five reported asking for a medical document for cannabis from their doctor or nurse practitioner but being refused.
Figure 21: Reasons for not getting a medical document
Didn't ask for one = 73%
Asked for one, but they refused = 20%
Some other reason = 7%
Q31. Why didn't you get a medical document from the medical doctor or nurse practitioner? Base: n=298; respondents who discussed the use of cannabis for medical purposes with a medical doctor or nurse practitioner but did not receive a medical document.
Respondents living in the Prairies (93%) and Quebec (82%) were more likely than others to say they did not ask for a medical document.
Nearly two-thirds (65%) of those who did not ask for a medical document to authorize their use of cannabis (n=217) said they did not need one. The rest were mostly split between those who said they did not know what a medical document was (14%) and those who were uncomfortable requesting one from their doctor or nurse practitioner (13%). Three percent said they did not ask for a medical document because there was not enough time during the visit.
Figure 22: Reasons for not requesting a medical document
Didn't need one = 65%
Didn't know what a medical document was = 14%
Uncomfortable asking = 13%
There was not enough time during the visit = 3%
Some other reason = 5%
Q32. Why didn't you ask for a medical document from the medical doctor or nurse practitioner? Base: n=217; respondents did not ask for a medical document authorizing their use of cannabis for medical purposes.
Among the small proportion of patients who were refused a medical document by their doctor or nurse practitioner (n=60) most were told the reason for the refusal. Reasons mentioned with the greatest frequency included the following: the health care provider does not prescribe cannabis for patients (38%), there is a lack of evidence to support cannabis as a treatment option (31%), and the health care provider did not know enough about the use of cannabis for medical purposes (29%).
Other reasons were patient-specific and included the patient not being a good candidate for cannabis as a treatment option due to family history (16%), better treatment options being available for the condition (16%), and cannabis not being the best treatment option (16%). Two percent of respondents said that their doctor or nurse practitioner did not provide a reason for refusing to give them a medical document.
Figure 23: Reason medical doctor or nurse practitioner gave for refusal of medical document
Do not prescribe cannabis for any patients = 38%
Not enough evidence to support cannabis as a treatment option = 31%
Did not know enough about the use of cannabis for medical purposes = 29%
Not a good candidate for cannabis due to family history = 16%
Said other treatments were better for the condition = 16%
Said that cannabis is not the best treatment option = 16%
Didn't give a reason = 2%
Some other reason = 6%
Q33. What reason did the medical doctor or nurse practitioner give for refusing to give you a medical document? Multiple responses accepted. Base: n=60; respondents who were refused a medical document authorizing the use of Cannabis for medical purposes.
Those who received a medical document for cannabis (n=418) most often received it from their family doctor (40%), or another medical doctor (37%). Fewer (19%) received their medical document from a specialist (e.g., oncologist; neurologist; etc.) or a nurse practitioner (14%). Although not on the list of response options provided, one percent of respondents volunteered that they received their medical document from a clinic specializing in cannabis for medical purposes.
Figure 24: Source of medical document = 40%
Medical doctor (but not family doctor) = 38%
Specialist = 19%
Nurse practitioner = 14%
Cannabis Clinic = 1%
Other = 2%
Q34. From whom did you get your medical document for cannabis? Base: n=418; respondents who were given a medical document authorizing the use of cannabis for medical purposes.
Those who received their medical document from a medical doctor (but not their family doctor) were more likely to not have any insurance (44% vs. 30% of those partially or fully insured), while those who received their authorization from a specialist were more likely to have partial or full insurance (26% vs. 14% of those who are uninsured for the use of cannabis for medical purposes).
As the graph below indicates, the daily dosage of cannabis authorized by medical doctors and nurse practitioners varied considerably. Just over half the respondents said their HCP authorized less than 5 grams of dried cannabis per day: 15% are currently authorized to use 1 gram, 21% 2 grams, 15% 3 grams, and 7% 4 grams. Sixteen percent of respondents who received a medical document said they are authorized to use between 5 and 10 grams of cannabis a day, while 9% are authorized to use more than 10 grams daily. Fifteen percent did not know how much cannabis they are currently authorized to use per day.
Figure 25: Prescribed daily dosage
1 g = 15%
2 g = 21%
3 g = 15%
4 g = 7%
5 to 10g = 16%
More than 10g = 9%
I use another amount = 3%
Do not know = 15%
Q35. Your medical document includes the daily dosage prescribed by a medical doctor or nurse practitioner. How much cannabis are you currently authorized to use per day? Base: n=418; respondents who were given a medical document authorizing the use of cannabis for medical purposes.
Well over half the respondents (60%) who have a medical document for cannabis (n=418) said there has been no change in the amount of cannabis they have been authorized to use over time, while one-quarter have had their dosage increased and 13% have had it decreased.
Figure 26: Changes in the amount of cannabis authorized for use = 60%
Dosage has increased = 25%
Dosage has decreased = 13%
Don't know = 3%
Q36. Has the amount of cannabis you are authorized to use changed over time? Base: n=418; respondents who were given a medical document authorizing the use of cannabis for medical purposes.
Women were more likely to report an increase in the amount of cannabis they have been authorized to use (26% vs. 16% of men). So too were those who are partially or fully covered by their insurance for cannabis for medical purposes (36% vs. 19% of those who have no insurance coverage for this treatment). Those who did not use cannabis for medical purposes prior to the broader legalization of cannabis in Canada were more likely than those who did to say their dosage has remained the same over time (73% vs. 52%).
A majority of respondents who have a medical document for cannabis (61%) said they have never been charged a fee for their medical document, while 29% reported having been charged a fee for this, and 10% saying they cannot recall.
Figure 27: Fees charged for medical document authorizing use
NOT charged a fee for a medical document = 61%
Charged a fee for a medical document = 29%
Cannot recall = 10%
Q37. Were you ever charged a fee for your medical document for cannabis? Base: n=418; respondents who were given a medical document authorizing the use of cannabis for medical purposes.
Children (as reported by their parent or guardian) were significantly more likely to have been charged a fee for their medical document (63% vs. 24% of adult patients) as were those authorized to designate someone to produce cannabis for their medical purposes (59% compared to those using other methods of access via Health Canada's cannabis for medical purposes program)[6]. Those who use cannabis for only medical purposes were more likely to not have been charged a fee for their medical document (73% vs. 60% of those who also use cannabis for non-medical purposes).
Those who were charged a fee for their medical document for cannabis (n=123) were most often charged less than $100 (38%), or between $100 and $499 (43%) for the document. Thirteen percent were charged between $500 and $999, and 3% paid $1,000 or more for the medical document.
Figure 28: Amount charged for medical document authorizing use
Less than $100 = 38%
$100 to $499 = 43%
$500 to $999 = 13%
$1000 or more = 3%
Cannot recall = 3%
Q38. How much were you charged for the medical document? Base: n=123; respondents who were charged a fee for a medical document authorizing the use of cannabis for medical purposes.
Respondents who were given a medical document authorizing the use of cannabis for medical purposes (n=418) most often said they are registered with a licensed seller to obtain cannabis for their own medical use (37%) and/or are authorized by Health Canada to produce cannabis for their own medical use (33%).[7] Much smaller proportions said they are authorized by Health Canada to designate someone else to produce cannabis for them (13%) or have registered with Health Canada to possess cannabis in public above the limit of 30 gram (11%) (multiple responses accepted). Just over one-quarter (27%) indicated that none of these options apply to them.
Figure 29: Type of authorization
Registered with a licensed seller to obtain cannabis for medical use = 37%
Authorized by Health Canada to produce cannabis for medical use = 33%
Authorized by Health Canada to designate someone else to produce cannabis = 13%
Registered with Health Canada to possess cannabis in public above the 30 grams limit = 11%
None of these = 27%
Q39. Which of the following apply to you? Multiple responses accepted. Base: n=418; respondents who were given a medical document authorizing the use of cannabis for medical purposes.
Men were more likely to have an authorization to produce cannabis for their own medical use (36% vs. 23% of women).
Those authorized by Health Canada to produce cannabis for their own medical use (n=133) were asked what issues, if any, they encountered when applying for authorization and when growing their own cannabis. Over one-third (37%) said the application process took a long time while just under one-third (31%) said it was complicated. One in five identified difficulties growing enough cannabis for their medical needs, while 16% identified difficulty finding clones and seeds (multiple responses accepted). Just over one-quarter (26%) said they did not experience any issues seeking authorization from Health Canada and growing their own cannabis.
Figure 30: Issues growing cannabis for medical purposes
Application process took a long time = 37%
Application process was complicated = 31%
Difficult to grow enough cannabis for my medical purposes = 20%
Difficult to find clones and seeds = 16%
Other = 1%
Did not experience any issues = 26%
Q40. What issues, if any, did you encounter when applying to Health Canada for authorization and when growing your own cannabis for medical purposes? Multiple responses accepted. Base: n=133; respondents who are authorized to produce cannabis for their own medical use.
Those authorized by Health Canada to designate someone else to grow cannabis for them (n=57)[8] encountered some of the same type of issues as those authorized to produce cannabis for their own medical use. Specifically, 38% found the registration process with Health Canada took a long time, and 32% said the registration process was complicated. Additionally, one-third (33%) said that getting cannabis from a designated grower was more expensive than expected, and just over one-quarter (26%) found it difficult to find someone willing to be their designated grower. Relatively few (7%) said they did not experience any issues designating someone to grow cannabis for them for medical purposes.
Figure 31: Issues encountered designating someone to grow cannabis
Registration process took a long time = 38%
More expensive than expected = 33%
Registration process was complicated = 32%
Difficult to find someone to be the designated grower = 26%
Did not experience any issues = 7%
Q41. What issues, if any, did you encounter with designating someone to grow cannabis for you for medical purposes? Multiple responses accepted. Base: n=57; respondents who are authorized to designate someone else to produce cannabis for their medical use.
Those registered with a licensed seller to obtain cannabis for their own medical use (n=150) also encountered issues buying cannabis for medical purposes.
Cost led the way, with approximately one-third (34%) saying the cannabis available from a licensed seller is more expensive. Following this, approximately one-quarter of respondents identified the need to buy cannabis online/no physical store and an inability to always get their preferred products when buying cannabis from a licensed seller (27% each) and wait time for the cannabis to be delivered (24%) (multiple responses accepted). Approximately one in five (19%) pointed to cannabis only being shippable to a home address, while 16% said the registration process was complicated, and 13% said it took a long time. Over one-quarter (29%) said they did not experience any issues when buying cannabis from a licensed seller for medical purposes.
Figure 32: Issues encountered buying cannabis from a licensed seller
Cannabis was more expensive = 34%
Had to buy online; no physical store = 27%
Could not always get preferred cannabis products = 27%
Could not get the cannabis immediately = 24%
Cannabis could be shipped only to a home address = 19%
Registration process was complicated = 16%
Registration process took a long time = 13%
Other = 2%
Did not experience any issues = 29%
Q42. What issues, if any, did you encounter when buying cannabis from a licensed seller for medical purposes? Multiple responses accepted. Base: n=150; respondents who are registered with a licensed seller to obtain cannabis for their medical use.
Those who buy cannabis from a licensed seller (n=150) pointed to a variety of reasons for doing so, though they most often said they use a licensed seller because they want to buy cannabis for medical purposes (42%) and/or because their health care provider suggested it (41%). Nearly identical proportions attributed their use of a licensed seller to the compassionate pricing offered by the seller (33%), the seller having the type of product needed (32%), the perception that this was the only way to get cannabis for medical purposes (31%), and the convenience of buying from a licensed seller (31%) (multiple responses accepted). The full range of reasons offered can be found in the graph below.
Figure 33: Reasons for buying cannabis from a licensed seller
Want to buy cannabis for medical purposes = 42%
Health care provider suggested it = 41%
Seller offered compassion pricing = 33%
Seller has the type of cannabis product needed = 32%
Thought it was the only way to get cannabis for medical purposes = 31%
It was convenient = 31%
Thought it would be more official = 19%
Cannabis sold through legal storefront/provincially authorized retailer is for recreational purposes = 19%
Thought that it would improve chances of having insurance coverage = 10%
Know someone who gets cannabis from a licensed seller = 8%
Quality = 2%
Other = 7%
Don't know; just did = 3%
Q43. Why do you buy cannabis through a licensed seller for medical purposes? Multiple responses accepted. Base: n=150; respondents who buy cannabis through a licensed seller for medical purposes.
Approximately half (49%) of all patients surveyed access the cannabis they use for medical purposes from a legal storefront, sometimes also referred to as a provincially authorized retailer.[9] This was followed at a distance by legal websites for cannabis for medical purposes (21%) and non-medical cannabis (19%). Smaller proportions reported obtaining cannabis for medical purposes from a friend or family member (12%), growing their own, either with authorization from Health Canada (10%) or without it (12%), receiving authorization from Health Canada to designate someone to grow cannabis on their behalf (5%), and getting their cannabis from a hospital (2%) (multiple responses accepted).
Other sources included illicit ones such as dealers (7%), illegal online stores (4%) and illegal storefronts (4%), while some use online stores and storefronts without knowing whether they are legal or illegal.
Figure 34: Main source for acquiring cannabis for medical purposes
Legal storefront/provincially authorized retailer = 49%
Legal website for medical cannabis = 21%
Legal website for non-medical cannabis = 19%
Grow own (without authorization from Health Canada) = 12%
Family member or friend = 12%
Authorized by Health Canada to grow own = 10%
Dealer = 7%
Online source, don't know whether legal or illegal = 5%
Authorized by Health Canada to designate someone to grow = 5%
Illegal online source = 4%
Illegal storefront = 4%
Storefront, don't know whether legal or illegal = 3%
Hospital = 2%
Other = 1%
Prefer not to say = 3%
Q44. Where do you typically get the cannabis you use for medical purposes? Multiple responses accepted. Base: n=1,205; all respondents.
Gender differences were evident when it came to typical sources of cannabis for medical purposes. Women were more likely to purchase their cannabis from a legal storefront or provincially authorized retailer (55% vs. 46% of men), through a legal website for cannabis for medical purposes (24% vs. 17%), and from family and friends (14% vs. 9%). Men were more likely to turn to growing their own with authorization from Health Canada (12% vs. 6%) or without (14% vs. 8%).
The likelihood of growing one's own cannabis (without authorization) was higher among those living in rural (19%) and small population (18%) centres than in large urban areas (8%).
In addition, the following types of respondents were more likely to purchase cannabis for medical purposes from a legal storefront or provincially authorized retailer:
Those who use cannabis for medical purposes daily or nearly daily (30%) were more likely than those who do so monthly (17%) to get their cannabis from a legal website for cannabis for medical purposes (i.e., a licensed seller).
Among respondents who access cannabis for medical purposes from a provincially authorized retailer, a legal website for non-medical cannabis (provincially authorized retailer), an illegal storefront or online source, a family member or friend, and/or a 'dealer' (n=897), more than half do so because they are comfortable using this source (55%), or because it is easy and convenient to access through this source (54%) (multiple responses accepted). Approximately one-third each believe that the price (37%), the quality of products available (37%), and the variety of products from which to choose (32%) is better through these sources than from other sources (including growing or designating someone to grow for them, purchasing from a legal website for cannabis for medical purposes, and obtaining from a hospital).
Figure 35: Reasons for accessing medical cannabis from source identified
Comfortable using this source = 55%
Convenience/it's easy to access = 54%
Price/most economical = 37%
Better quality products available = 37%
More products to choose from = 32%
Other = 3%
I don't know = 1%
Q45. Why do you access cannabis for medical purposes from these sources? Multiple responses accepted. Base: n=897; respondents accessing cannabis for medical purposes from the following sources: a legal storefront/provincially authorized retailer; a legal website for non-medical cannabis (provincially authorized retailer); an illegal storefront or online source; a family member or friend; and a 'dealer'.
Women were more likely to say they access cannabis from their chosen source(s) because they are more comfortable using this source (61% vs. 51% of men) or because it is more convenient (59% vs. 49%). Men, on the other hand, were more likely to point to cost as the factor (42% vs. 34% of women).
Those who used cannabis for medical purposes prior to the broader legalization of cannabis in 2018 pointed to many of the reasons listed: comfort (59% vs. 51% who did not use cannabis for medical purposes prior to 2018), convenience (57% vs. 49%), cost (45% vs. 28%), quality of products (44% vs. 29%), and breadth of products (37% vs. 27%).
A large majority (84%) of those who access cannabis from sources[10] not authorized to sell cannabis for medical purposes, have not considered accessing cannabis through Health Canada's cannabis for medical purposes program. Among the few who have, 8% have considered registering with a licensed seller, 7% have considered applying to Health Canada to grow cannabis for medical purposes, and 4% have considered applying to designate someone to grow cannabis for medical purposes for them.
Figure 36: Alternative sources for cannabis for medical purposes
Registering with a licensed seller to obtain cannabis for medical use = 8%
Applying to Health Canada for authorization to grow cannabis for medical purposes = 7%
Applying to Health Canada to have a designated person grow cannabis for medical purposes = 4%
Have NOT considered any of those options = 84%
Q46. Have you considered any of the following: Multiple responses accepted. Base: n=751; respondents accessing cannabis for medical purposes from sources not licensed to sell medical grade cannabis.
Those who started using cannabis for medical purposes after it was legalized in Canada for non-medical purposes were more likely to say they have not considered accessing cannabis through Health Canada's cannabis for medical purposes program (90% vs. 79% of those who began use before the broader legalization of cannabis in Canada). Along similar lines, 89% of patients using cannabis for medical purposes who did not discuss this with a health care provider have not considered any of these options (compared to 80% who did discuss use with an HCP).
Those who have not applied to Health Canada for authorization to grow their own cannabis for medical purposes (n=957) were asked why. The two most frequently identified reasons were matters of choice: not wanting to apply to grow their own cannabis (33%) and preferring to purchase cannabis (27%). Following this, in declining order of frequency, were lack of growing space (25%), lack of time (18%), wanting to know exactly how much THC and CBD they are using (16%), and inability to grow cannabis (13%) (multiple responses accepted). One in 10 respondents identified the perceived complexity of the application process, thinking they were ineligible for the program, inability to make the types of cannabis needed, and not knowing one could obtain authorization. An additional one in 10 provided no reason.
Figure 37: Reasons for not applying to Health Canada to grow own cannabis
Did not want to = 33%
Prefer to purchase the cannabis = 27%
Don't have the space to grow my own cannabis = 25%
Don't have the time to grow my own cannabis = 18%
Want to know exactly how much THC and CBD I'm using = 16%
Not able to grow the cannabis = 13%
The application process seemed complicated = 11%
Did not think I was eligible for the program = 10%
Can't make the types of cannabis products that I need = 10%
Did not know you could get authorization = 10%
Only use oil products = 1%
Application was not approved by Health Canada = 1%
Other = 4%
No reason = 10%
Q47. Why did you not consider applying to Health Canada to grow your own cannabis for medical purposes? Multiple responses accepted. Base: n=957; respondents who have not applied to Health Canada for authorization to grow their own cannabis.
18–34-year-olds were more likely than those 55 and older to say they don't have time to grow their own cannabis (24% vs. 14%). On the other hand, those aged 55 and older were more likely to say they did not want to apply to grow their own cannabis (41% vs. 28% of 35-54-year-olds and 30% of 18-34-year-olds) or that they prefer buying the cannabis (35% vs. 22% of those 18-54 years of age). Women were more likely to attribute their lack of interest to not having time (21% vs. 15% of men).
Respondents who do not buy cannabis through a licensed seller of cannabis for medical purposes (n=858) most often said this is because it is more expensive (27%) to do so. As the graph below shows, a host of other reasons were identified by smaller proportions of respondents (14% or less), while just over one-quarter (27%) could not provide any explanation for not buying cannabis for medical purposes through a licensed seller.
Figure 38: Reasons for not accessing medical cannabis through a licensed seller
It is more expensive = 27%
Did not know about them = 14%
The registration process seemed complicated = 11%
It is difficult to = 11%
Did not think I could get the type of products = 10%
Would have to wait for it to be delivered = 10%
The cannabis can only be shipped to your home address = 7%
You can only order the cannabis on-line; there aren't any stores where cannabis can be bought for medical purposes = 6%
Buy from licensed seller/legal source = 1%
Quality concerns = 1%
Other = 4%
No reason = 27%
Q48. Why have you not considered buying cannabis for medical purposes from a licensed seller? Multiple responses accepted. Base: n=858; respondents who do not buy cannabis for medical purposes from a licensed seller.
Those who said they have used cannabis for non-medical purposes, in addition to their medical use, were more likely to list cost as a reason for not buying from a licensed seller(30%), as compared to those who only consume cannabis for medical purposes. Similarly, those who used cannabis for medical purposes prior to the legalization of cannabis for non-medical purposes were more likely (35%) to say that they haven't considered buying cannabis from a licensed seller because of cost than any other reason.
A large majority (87%) of respondents who buy cannabis for medical purposes (n=1,033) spend less than $300 per month on this, and nearly two-thirds (64%) said they spend less than $100 a month. Conversely, approximately one in 10 (11%) spend $300 or more each month, in general, on cannabis for medical purposes.
Figure 39: Monthly amount spent on cannabis for medical purposes
Less than $50 = 35%
$50 to $99 = 29%
$100 to $299 = 23%
$300 to $499 = 8%
$500 to $699 = 2%
$700 to $1000 = 1%
More than $1,000 = <0.5%
Q49. In general, how much do you spend per month on cannabis for medical purposes? [NR: 2%]. Base: n=1,033; respondents who buy cannabis for medical purposes (excludes respondents who grow/designate an individual to grow cannabis on their behalf).
Those who grow their own cannabis or have designated someone to grow cannabis for their medical purposes (n=278) provided various reasons to explain why. Leading the way was cost (43% saying it's cheaper than purchasing it), ease and convenience (40%), guaranteed purity of the product and confidence in its quality (37% each), and obtaining the specific strain wanted (35%) (multiple responses accepted). One-quarter said they grow their own, or have some grow it for them, because they enjoy growing cannabis/find it fun and because this method provides them with enough cannabis to meet their medical needs.
Figure 40: Reasons for growing own cannabis
It is cheaper than buying cannabis = 43%
It's easy and convenient = 40%
Can guarantee the purity of the product = 37%
Can be confident of the quality of the product = 37%
Can get the specific strain wanted = 35%
Enjoy growing/it's fun = 26%
Can get enough cannabis to meet medical needs = 25%
Other = 1%
Don't know; just did = 3%
Q50. Why do you grow your own cannabis or designate someone to grow it for you? Multiple responses accepted. Base: n=278; respondents who grow their own cannabis or have designated someone to grow cannabis for their medical purposes.
Women were more likely to report that growing their own cannabis is cheaper (64% vs. 38% of men) and that they enjoy doing so (40% vs. 26%). Patients without insurance coverage were more likely to point to cost (66% vs. 21% of insured patients), purity of the product (50% vs. 26%), quality of the product (57% vs. 21%), and the ability to get the specific strain they want (43% vs. 30%).
Nearly half (47%) of those who grow their own cannabis (with and without authorization from Health Canada), or who have designated someone to do so, are currently growing between one and four cannabis plants for medical purposes. Following at a distance, 15% grow between five and 19 cannabis plants, while 20% grow between 20 and 59 cannabis plants. Thirteen percent reported having 60 or more cannabis plants currently growing for medical purposes.
Figure 41: Number of cannabis plants grown for medical purposes
1-4 plants = 47%
5-19 plants = 15%
20-39 plants = 10%
40-59 plants = 10%
60-99 plants = 3%
100-199 plants = 6%
200-299 plants = 2%
300-399 plants = 1%
400 or more plants = 1%
Q51. How many cannabis plants are you or your designated grower currently growing for your medical purposes? [NR: 5%] Base: n=278; respondents who grow their own cannabis or have designated someone to grow cannabis for their medical purposes.
The likelihood of growing one to four plants increased with age, from 43% of 18-34-year-olds to 68% of those aged 55 and older.
Nearly three-quarters (72%) of respondents are not currently covered by insurance for cannabis for medical purposes. Eleven percent are fully covered and 10% said they have partial coverage.
Figure 42: Insurance coverage of cannabis for medical purposes
Not covered by insurance = 72%
Yes, costs are fully covered = 11%
Yes, costs are partially covered = 10%
Don't know = 7%
Q52. Are you currently covered by insurance for cannabis for medical purposes? Base: n=1,205; all respondents.
Children (as reported by their parent or guardian) are significantly more likely than adults to have full insurance coverage for cannabis for medical purposes (39% vs. 9% of those aged 18 and older). In addition, men are more likely to have full coverage (13% vs. 5% of women) or partial coverage (12% vs. 7% of women).
Three-quarters of respondents said they have never been a beneficiary of compassionate pricing of cannabis for medical purposes. Twelve percent said they are currently the beneficiary of compassionate pricing, and 13% said they have been the beneficiary of compassionate pricing in the past.
Figure 43: Compassionate pricing of cannabis for medical purposes
Never been a beneficiary of compassionate pricing = 75%
Beneficiary in the past = 13%
Currently receive the discount = 12%
Q53. Have you ever been a beneficiary of compassionate pricing for cannabis? Base: n=1,205; all respondents.
Children (as reported by their parent or guardian) are significantly more likely than adults to have been a beneficiary of compassionate pricing for cannabis (43% vs. 10% of those aged 18 and older). In addition, men were more likely to report having been a beneficiary of compassionate pricing in the past (14% vs. 8% of women).
Patients who have a medical document authorizing their use of cannabis for medical purposes were more likely to report being a current beneficiary of compassionate pricing (25% vs. 10% of those without a medical document) as well as a past beneficiary (23% vs. 12%).
The largest proportion of respondents (39%) reported using cannabis daily or almost daily for medical purposes in a typical month, with an additional one in five (21%) reporting doing so several times a week. Nearly one-quarter reported doing so once a week (14%) or several times a month (10%), while 15% reported doing so once a month or less.
Figure 44: Frequency of use – monthly
Daily or almost daily = 39%
Several times a week = 21%
Once a week = 14%
Several times a month = 10%
Once a month = 5%
Less than once a month = 10%
Q54. In a typical month, how often do you use cannabis for medical purposes? Base: n=1,205; all respondents.
Women were more likely to report using cannabis for medical purposes daily or almost daily in a typical month (43% vs. 34% of men). So too were those with fair to poor mental health (47% vs. 36% of those with good to excellent health) and fair to poor physical health (48% vs. 35% of those with good to excellent health).
Those who had been using cannabis for medical purposes prior to the broader legalization of cannabis in 2018, who discussed using cannabis for medical purposes with a health care professional, and who have a medical document were more likely to report daily or almost daily use.
Patients who use cannabis more than once a month (n=1,023) were most likely to report doing so once (37%) or twice (22%) a day. Just over one-quarter (27%) use cannabis between three and five times a day while 14% do so six or more times in a typical day.
Figure 45: Frequency of use – daily
1 time = 37%
2 times = 22%
3 times = 12%
4 times = 8%
5 times = 7%
6 times = 3%
7 times = 2%
8 times = 2%
9 times = 0%
10 times = 1%
More than 10 times = 6%
Q55. In a typical month, how many times per day do you use cannabis for medical purposes? Base: n=1,023; respondents who use cannabis for medical purposes more than once a month.
Among patients who use cannabis for medical purposes more than once a month:
As the graph below shows, respondents' ways of consuming cannabis for medical purposes over the past year vary. That being said, the three methods of consumption identified most often were smoking it (44%), followed by eating it (34%), and ingesting cannabis extract (31%) (multiple responses accepted).
Figure 46: Methods of consumption
Smoked it = 44%
Eaten it = 34%
Ingested cannabis extract = 31%
Vaporized it with a vape pen or e-cigarette = 19%
Sublingually = 18%
Applied to skin = 15%
Drank it = 11%
Vaporized it with a vaporizer = 10%
Dabbing = 6%
Other = 2%
Q56. In the last 12 months, which of the following methods have you used to consume cannabis for medical purposes? Multiple responses accepted. Base: n=1,205; all respondents.
Those 18 to 34 years of age were more likely to report smoking cannabis (53%) compared to those 55 years and older (37%). Conversely, the likelihood of ingesting cannabis extracts increased with age (from 27% of 18-34-year-olds to 37% of those 55 and older), as did consuming cannabis sublingually (from 12% of 18-34-year-olds to 24% of those 55 and older). Women were more likely to report eating cannabis (38% vs. 31% of men) and ingesting cannabis extracts (37% vs. 24%).
Those who have also used cannabis for non-medical purposes were more likely than those who had not to report smoking it (57% vs. 17%). The same was true of those who had used cannabis for medical purposes prior to the broader legalization of cannabis for non-medical purposes in Canada in 2018 (56% reported smoking it compared to 30% of those who had not used cannabis prior to legalization) and those who do not have insurance coverage (47% reported smoking compared to 32% of those who are fully or partially covered).
Those who said they obtain cannabis for medical purposes from a dealer or a family member/friend were more likely than patients who obtain their cannabis from other sources to say they have consumed it by smoking (84% and 68%, respectively). Compared to respondents who grow their own cannabis with an authorization (31%), or who obtain it from a legal storefront/provincially authorized retailer (39%) or the website of a licensed seller for medical purposes (30%), those who get their cannabis from a friend or family (56%) were more likely to report consuming the cannabis by eating it. Those who obtain their cannabis online from a licensed seller for medical purposes were more likely to say they have ingested cannabis extracts (47%) than those who obtain their cannabis from other sources.
When using cannabis products for medical purposes, most respondents typically use products that include a blend of THC and CBD.[12] That said, the nature of the blend varies. Specifically, 30% typically use cannabis products with higher levels of CBD, 27% use ones with higher levels of THC, and 28% use ones with equal levels of CBD and THC. One in five (20%) typically use cannabis products for medical purposes with CBD only and 13% with THC only.
Figure 47: Preferred levels of THC and CBD
Higher CBD, lower THC = 30%
Equal levels of THC and CBD = 28%
Higher THC, lower CBD = 27%
CBD only = 20%
THC only = 13%
Other = 1%
Don't know = 9%
Q57. When choosing cannabis products for medical purposes, what levels of THC and CBD do you typically use? Multiple responses accepted. Base: n=1,205; all respondents.
The use of CBD only products is more common with older respondents (25% of those 55 and older and 22% of those 35-54 compared to 12% of those 18-34 years of age). Women were also more likely to report using CBD only products (24% vs. 16% of men).
Those who have used cannabis for non-medical purposes in the past three years were more likely than those who have used it only for medical purposes to opt for products with equal levels of THC and CBD (31% vs. 23%) as well as products with higher THC and lower CBD (33% vs. 14%). Those who used cannabis for medical purposes prior to the broader legalization of cannabis for non-medical purposes were more likely than those who did not to report using products with equal levels of THC and CBD (32% vs. 25%), higher THC, lower CBD (36% vs. 18%), and THC only (18% vs. 8%). Respondents with a medical document were more likely to opt for products with higher CBD, lower THC (39% vs. 30% of those without an authorization).
Patients who are authorized by Health Canada to designate someone to grow on their behalf (57%) were more likely to say they typically use higher CBD and lower THC levels than those who purchase from a legal storefront/provincially authorized retailer (29%) or from a family member or friend (29%).
Among those who smoke cannabis for medical purposes (n=555), the amount of dried flower/leaf smoked varied widely from a quarter of a gram, reported by 20% of respondents, to 10 or more grams, reported by 4% of these respondents.
With that said, well over half of respondents (62%) reported smoking amounts falling between a quarter of one gram and two grams. Notably, almost one in five (17%) did not know how much dried flower they typically use on the days that they smoked cannabis.
Figure 48: Typical amount of dried flower smoked
1/4g = 20%
1/2g = 11%
1 g = 17%
2 g = 14%
3 g = 7%
4 g = 4%
5-9 g = 6%
10-14 g = 2%
15-19 g = <0.5%
20-28 g = 1%
More than 28 g = <0.5%
Don't know = 17%
Q58. On the days that you smoked cannabis for medical purposes, how much dried flower/leaf did you typically use? Base: n=555; respondents who smoke cannabis for medical purposes.
The large majority (82%) of those who ate edible cannabis for medical purposes in the last 12 months (n=416) typically consumed amounts ranging from half a serving to two servings. The largest single proportion (42%) said they typically consumed one serving in a day, while one in five (21%) said they typically consumed half a serving and almost as many (19%) said they typically eat two servings in a day. Relatively few (12%) consume three or more servings of edible cannabis in a typical day of use.
Figure 49: Typical amount of edible cannabis consumed
1/2 serving = 21%
1 serving = 42%
2 servings = 19%
3 servings = 5%
4 servings = 5%
5 servings = 2%
6 servings = <0.5%
7 servings = <0.5%
8 servings = <0.5%
10 servings or more = <0.5%
Don't know = 6%
Q59. When you ate edible cannabis products for medical purposes, how much did you typically eat in a day? Base: n=416; respondents who ate edible cannabis for medical purposes.
Respondents who had consumed cannabis beverages for medical purposes in the last 12 months (n=132) were asked how much cannabis was typically consumed in a day. In response, the largest single proportions said they typically consumed one cup (22%) or one and a half cups (17%) in a typical day. Over one-third (38%) consumed amounts ranging from one-eighth of a cup to three-quarters of a cup, while relatively few (9%) consumed more than one and a half cups per day.
Figure 50: Typical amount of cannabis beverages consumed
30ml (1/8 cup) = 10%
62.5ml (1/4 cup) = 9%
125ml (1/2 cup) = 11%
187.5ml (3/4 cup) = 8%
250ml (1 cup) = 22%
375ml (1.5 cups) = 17%
500ml (2 cups) = 5%
625ml (2.5 cups) = 2%
750ml (3 cups) = 1%
1000ml (1 litre) (4 cups) or more = 1%
Don't know = 12%
Q60. In a typical month, on the days that you drank cannabis beverages for medical purposes, how much was typically consumed in a day? Base: n=132; respondents who drank cannabis beverages for medical purposes.
Respondents who vaped cannabis for medical purposes in the last 12 months (n=304) were asked how much cannabis was typically used in a day. As the graph below shows, responses varied widely. The largest single proportion (29%) indicated that a cartridge typically lasts 30 days, with most of the others (37%) saying it lasts somewhere between 7 and 21 days. Approximately one in five (22%) said they did not know.
Figure 51: Typical amount of cannabis vaped
A cartridge lasts 30 use days = 29%
A cartridge lasts 21 use days = 9%
A cartridge lasts 14 use days = 12%
A cartridge lasts 10 use days = 8%
A cartridge lasts 7 use days = 8%
A cartridge lasts 6 use days = 2%
A cartridge lasts 5 use days = 2%
A cartridge lasts 4 use days = 2%
A cartridge lasts 3 use days = 2%
A cartridge lasts 2 use days = 1%
A cartridge lasts 1 use day = 2%
Don't know = 22%
Q61. In a typical month, on the days that you vaped cannabis for medical purposes, how much was typically used in a day? Base: n=304; respondents who vape cannabis for medical purposes.
Respondents who dabbed cannabis for medical purposes in the last 12 months (n=73) were asked how much cannabis was typically used in a day. In response, the largest single proportion (20%) reported using one gram of cannabis in a typical day. Nearly half (48%) reported using somewhere between 50 and 500 milligrams, while nearly one in five (18%) reported using 2 grams or more. Thirteen percent said they did not know.
Figure 52: Typical amount of cannabis dabbed
50mg (1/20g) = 10%
100mg (1/10g) = 11%
125mg (1/8g) = 7%
250mg (1/4g) = 12%
500mg (1/2g) = 8%
1g = 20%
2g = 6%
3g = 3%
4g = 3%
5g = 1%
6g = 1%
7g (1/4oz) = 1%
10g or more = 3%
Don't know = 13%
Q62. In a typical month, on the days that you dabbed cannabis for medical purposes, how much was typically used in a day? Base: n=73; respondents who dab cannabis for medical purposes.
Respondents who applied cannabis topicals for medical purposes in the last 12 months (n=177) were asked how much cannabis was typically used in a day. In response, one-third reported using 50 milligrams, followed by smaller identical proportions (13% each) who reported using 100 and 125 milligrams respectively. Few (6%) reported using more than 125 milligrams. Notably, the single largest proportion (35%) said they did not know the quantity of topicals used in a typical day.
Figure 53: Typical amount of cannabis topicals applied
50mg (1/20g) = 33%
100mg (1/10g) = 13%
125mg (1/8g) = 13%
250mg (1/4g) = 1%
500mg (1/2g) = 3%
More than 500mg = 2%
Don't know = 35%
Q63. In a typical month, on the days that you applied cannabis topicals for medical purposes, how much was typically used in a day? Base: n=177; respondents who use cannabis topicals for medical purposes.
Respondents who consumed cannabis sublingually for medical purposes in the last 12 months (n=200) were asked how much cannabis was typically used in a day. As the graph below shows, the typical amount of cannabis consumed sublingually by patients for medical purposes varies greatly. One-third of respondents reported consuming 1 milliliter or less in a typical month, with most of the rest (28%) consuming somewhere between 2 milliliters or more. Approximately one in 10 ten respondents (11%) said that they did not know.
Figure 54: Typical amount of cannabis consumed sublingually
0.25ml (1/4ml) = 6%
0.5ml (1/2ml) = 12%
1ml = 15%
2ml = 6%
3ml = 3%
4ml = 2%
5ml = 8%
6ml = 4%
7ml = 1%
More than 7ml = 4%
1 spray/drop = 3%
2 sprays/drops = 6%
3 sprays/drops = 3%
4 sprays/drops = 2%
5 sprays/drops = 2%
6 sprays/drops = 1%
7 sprays/drops = <0.5%
10 sprays/drops = 3%
1 tablet/lozenge/pill = 4%
2 tablets/lozenges/pills = 2%
3 tablets/lozenges/pills = 1%
5 tablets/lozenges/pills = 1%
6 tablets/lozenges/pills = <0.5%
10 tablets/lozenges/pills = <0.5%
Don't know = 11%
Q64. In a typical month, on the days that you consumed cannabis sublingually (under the tongue) for medical purposes, how much was typically used in a day? Base: n=200; respondents who consume cannabis sublingually for medical purposes.
Respondents who ingested cannabis extracts for medical purposes (n=369) were asked how much cannabis was typically used in a day. As the graph below shows, the amounts of cannabis used in a typical day vary greatly among those who ingested cannabis extract for medical purposes.
Figure 55: Typical amount of cannabis extract ingested
0.25ml (1/4ml) = 5%
0.5ml (1/2ml) = 5%
1ml = 16%
2ml = 5%
3ml = 4%
4ml = 4%
5ml = 10%
6ml = 2%
7ml = 2%
More than 7ml = 3%
1 spray/drop = 2%
2 sprays/drops = 2%
3 sprays/drops = 2%
4 sprays/drops = 1%
5 sprays/drops = 1%
6 sprays/drops = <0.5%
10 sprays/drops = 1%
1 tablet/lozenge/pill = 11%
2 tablets/lozenges/pills = 6%
3 tablets/lozenges/pills = 1%
4 tablets/lozenges/pills = 1%
5 tablets/lozenges/pills = 1%
6 tablets/lozenges/pills = <0.5%
7 tablets/lozenges/pills = 1%
10 tablets/lozenges/pills = <0.5%
Don't know = 13%
Q65. In a typical month, on the days that you ingested cannabis extract for medical purposes, how much was typically used in a day? Base: n=369; respondents who ingest cannabis extract for medical purposes.
Just over half (53%) of respondents said the frequency with which they use cannabis for medical purposes has not changed in the past three years. Among those who reported changes, 22% said their frequency of using cannabis for medical purposes has increased while slightly fewer (19%) reported a decrease in their frequency of use.
Figure 56: Changes in frequency of using cannabis for medical purposes in the past 3 years
Frequency of use has remained the same = 53%
Frequency of use has increased = 22%
Frequency of use has decreased = 19%
Don't know = 6%
Q66. How, if at all, has your frequency of using cannabis for medical purposes changed in the past 3 years? Base: n=1,205; all respondents.
The likelihood of reporting greater use decreased with age (from 30% of those aged 18-34 to 16% of those 55 and older). Men were more likely to say there has been no change to the frequency with which they use cannabis for medical purposes (57% vs. 50% of women), while women were more apt to report an increased in their frequency of use (24% vs. 18% of men).
The frequency of using cannabis for medical purposes was more likely to have increased in the past three years among the following:
More than three-quarters (78%) of respondents reported a positive outcome of using cannabis for medical purposes. Positive outcomes included feeling better in general (45%), improvement in symptoms (33%), ability to function better in general (31%), improvement/resolution of condition (21%), a decrease in the use of other medications (19%), and improved sleep (2%) (multiple responses accepted).
Comparatively fewer patients (26% in total) identified negative outcomes from their cannabis use. These included feelings of intoxication (10%), feeling adverse or negative effects (9%), impacts on the ability to drive (8%) or work (6%), and a worsening of their medical issues (3%).
One in 10 (10%) said the use of cannabis had no impact on their symptoms or conditions. Others mentioned that they have not yet found the right dose or the right combination of THC and CBD levels (7% each), or the right product (6%).
Figure 57: Outcome of using cannabis for medical purposes
Feel better in general = 45%
Symptoms have improved = 33%
Able to function better in general = 31%
Condition has improved/resolved = 21%
Able to decrease the use of other medications = 19%
Makes me feel intoxicated = 10%
Didn't make any difference to symptom/condition = 10%
Experience = 9%
Affects ability to drive = 8%
Haven't found the right dose = 7%
Haven't found the right THC and/or CBD levels = 7%
Affects ability to work = 6%
Haven't found the right cannabis product = 6%
Worsening of medical issues = 3%
Improves sleep = 2%
Other = 3%
Q67. What has been the outcome of using cannabis for medical purposes? Multiple responses accepted. Base: n=1,205; all respondents.
Respondents between 35-54 years of age (23%) and those 55 and older (22%) were more likely to report being able to decrease the use of other medications than those aged 18-34 (14%). Respondents between 18-34 years of age were more likely than those 35 and older to say that using cannabis for medical purposes makes them feel intoxicated (15% vs. 8%).
Those who reported having used cannabis for medical and non-medical purposes in the past three years were more likely to say that they feel better in general (50% vs. 34% of those who have only used cannabis for medical purposes) and that their symptoms have improved (36% vs. 28%). Conversely, those who have only used cannabis for medical purposes in the last three years were more apt to report a decrease in the use of other medications (25% vs. 18% of those who used recreational cannabis), no difference (19% vs. 6%), and that they have not found the right dose (11% vs. 5%) or the right levels of THC/CBD levels (10% vs. 5%). Those who used cannabis for medical purposes prior to the broader legalization of cannabis in Canada were more likely to report feeling better (49% vs. 40% of those who had not), the ability to function better in general (37% vs. 24%), and the ability to decrease the use of other medications (25% vs. 13%).
Among those who experienced a negative reaction or side effect (that is, an adverse reaction) from using cannabis for medical purposes (n=115), just over two-thirds (68%) said the side effect was not serious and no medical attention was sought, while 41% said the side effect was due to an error in use, such as dosing errors or incorrect product use. Very few (n=8) described the negative reaction or side effect from using cannabis for medical purposes as serious. Those who did said the side effect resulted in hospitalization, disability, incapacity, or death (n=5) or said the side effect required medical attention (n=3).
Figure 58: Negative outcome of using cannabis for medical purposes
The side effect was not serious, and no medical attention was sought = 68%
The side effect was due to an error in use (overdosage, underdosage, use of wrong product) = 41%
The side effect resulted in hospitalization, disability, incapacity, or death = 4%
The side effect required medical attention = 4%
Q68. You answered that you experienced a negative reaction or side effect from using cannabis for medical purposes. Which of the following best describes this experience? Multiple responses accepted. Base: n=115; respondents who experienced negative side effects.
Among respondents who reported an improvement in symptoms (n=111), a majority of those experiencing nausea/vomiting (61%) and problems sleeping (53%) reported significant improvement since starting to use cannabis for medical purposes.[13] Smaller, and nearly identical proportions reported significant improvements in relation to headaches and migraines (42%), feelings of depression (42%), feelings of anxiety (41%), and chronic non-cancer pain symptoms (41%). The table below provides the proportions identifying various degrees of improvement in relation to specific symptoms. Caution should be exercised when interpreting results based on small numbers of respondents.[14]
Figure 59: Extent to which using cannabis improved symptoms
| Small | Moderate | Significant | Uncertain | Unweighted n | |
| Cancer pain | 35% | 33% | 20% | 11% | n=12*[15] |
| Headaches/migraines | 19% | 39% | 42% | 1% | n=114 |
| Opioid withdrawal symptoms | 17% | 52% | 20% | 11% | n=9* |
| Feelings of anxiety | 16% | 42% | 41% | 1% | n=219 |
| Chronic non-cancer pain | 15% | 42% | 41% | 2% | n=111 |
| Muscle spasms | 13% | 53% | 33% | 1% | n=74 |
| Feelings of depression | 13% | 44% | 42% | 1% | n=126 |
| Acute pain | 13% | 59% | 27% | 1% | n=95 |
| Alcohol withdrawal symptoms | 13% | 45% | 31% | 12% | n=9* |
| Problems sleeping | 12% | 34% | 53% | 1% | n=236 |
| Nausea/vomiting | 11% | 26% | 61% | 2% | n=45 |
| Wasting/weight loss/lack of appetite | 9% | 23% | 51% | 17% | n=13* |
| Seizures | 8% | 68% | 24% | -- | n=9* |
| Palliative care | -- | 80% | 20% | -- | n=5* |
Q69. You mentioned that your symptoms have improved since starting to use cannabis for medical purposes. Have you seen a small, moderate, or significant improvement in your symptoms? Base: respondents who experienced improved symptoms.
Those who used cannabis for medical purposes prior to the legalization of cannabis for non-medical purposes collectively identified a variety of sources from which they typically got the cannabis they used for medical purposes. They were most likely to have obtained cannabis from a family or family member (32%) or from a dealer (29%). A host of other sources were identified less frequently, including a licensed producer (17%), a designated producer with authorization from Health Canada (13%), online sources (11%), growing their own without authorization from Health Canada (10%), an illegal storefront (9%), an illegal online source (7%), growing their own with authorization from Health Canada (5%), and a hospital (5%) (multiple responses accepted).
Figure 60: Sources of cannabis for medical purposes prior to legalization
Family member or friend = 32%
Dealer = 29%
Licensed producer = 17%
Designated producer with authori = 13%
Online source, don't know whether legal or illegal = 11%
Grew own without authorization from Health Canada = 10%
From an illegal storefront = 9%
From an illegal online source = 7%
Grew own with authorization from Health Canada = 5%
Hospital = 5%
Other = 3%
Prefer not to say = 4%
Q70. Prior to the legalization of cannabis where did you typically get the cannabis you used for medical purposes? Multiple responses accepted. Base: n=660; respondents who used cannabis for medical purposes prior to legalization.
Women were more likely to report accessing cannabis for medical purposes before legalization for non-medical purposes in 2018 from a family member or friend (36% vs. 28% of men). Patients who did not discuss the use of cannabis with a health care provider were more likely to have obtained cannabis from a family member or friend (39% vs. 28% of those who discussed it with an HCP) or from a dealer (41% vs. 24%).
A majority (60%) said that the legalization of cannabis in Canada for non-medical purposes has improved their access to cannabis for medical purposes. Among the rest, 16% feel that the broader legalization of cannabis has had no impact on their access to cannabis for medical purposes and 10% believe legalization has negatively impacted acesss. Fourteen percent said they did not know how.
Figure 61: Impact of legalization on access to cannabis for medical purposes
Positive = 60%
No impact = 16%
Negative = 10%
I don't know = 14%
Q71. In your opinion, how has the legalization of cannabis affected access to cannabis for medical purposes? Base: n=1,205; all respondents.
Adult patients were more likely than patients who are minors (as reported by a parent or guardian) to feel that the broader legalization of cannabis has improved their access (61% vs. 48%). The following were also more likely to feel this way: women (65% vs. 56% of men), those who had not used cannabis for medical purposes prior to legalization (64% vs. 56% of those who had), and those who consume cannabis for medical purposes daily or near daily (64% vs. 43% of those who do so less than monthly).
Those who obtain their cannabis from a legal storefront/provincially authorized retailer (72%) were more likely than those who access cannabis from the website of a licensed seller of medical cannabis (61%) or from a friend/family member (59%) or who grow their own without authorization (54%) to say that the broader legalization of cannabis has positively affected access to cannabis for medical purposes.
Those who indicated that the broader legalization of cannabis in Canada has positively impacted access to cannabis for medical purposes (n=728) pointed to a number of different ways in which this has happened. Reasons provided included more products to choose from (52%), better quality products, and less stigma associated with the use of cannabis for medical purposes (50% each), more sources to purchase from (49%), and greater ease finding information on cannabis products (47%) (multiple responses accepted). Other positive impacts included reduction in the cost of cannabis (24%), the ability to grow one's own cannabis (18%),and the ability to get cannabis from a friend (12%).
Figure 62: Ways access has improved since legalization
More products to choose from = 52%
Better qualit = 50%
Less stigma = 50%
More sources to purchase from = 49%
Easier to find information on cannabis products = 47%
Cannabis is gotten cheaper = 24%
I can grow my own cannabis = 18%
I can get cannabis from a friend = 12%
Other = 2%
Don't know = 3%
Q72. How has the legalization of cannabis positively impacted access to cannabis for medical purposes? Multiple responses accepted. Base: n=728; respondents who say access has improved since legalization.
Those 55 and older were more likely than younger respondents to point to the following impacts: more products (63%), less stigma (65%), and more sources (59%). Women were more apt to mention the availability of more products (57%), less stigma (58%), and easier access to information about cannabis products (52%).
Those who used cannabis for medical purposes prior to the broader legalization of cannabis for non-medical purposes were more likely to point to cost—that cannabis has gotten cheaper since it was legalized in Canada (32% vs. 17% of those who had not). As well, they were more apt to mention that more products are available (57% vs. 46%) and that there are more sources to purchase from (54% vs. 45%).
Those who mentioned that there is less stigma associated with the use of cannabis for medical purposes (n=364) were asked in which situations they have noticed that it is more socially acceptable to use or talk about cannabis for medical purposes. Three situations were identified by a majority of respondents: with friends (72%), with family (69%), and within the medical system (60%) (multiple responses accepted). Just under half (46%) feel more at ease discussing the use of cannabis for medical purposes within social or community services, while over one-quarter (28%) find that the stigma surrounding these conversations has improved in work settings.
Figure 63: Situation in which stigma reduced
With friends = 72%
With family = 69%
With the medical system = 60%
With social or community services = 46%
At work = 28%
Other = 1%
Q73. You mentioned that there is less stigma associated with the use of cannabis for medical purposes. In which situations are you noticing that it is more socially acceptable to use or talk about cannabis for medical purposes? Multiple responses accepted. Base: n=364; respondents who say there is less stigma surrounding the use of cannabis for medical purposes.
Those who have found it more acceptable to talk about cannabis use for medical purposes within the medical system or with social or community services were more likely to have used cannabis for medical purposes prior to the broader legalization of cannabis in 2018.
Nearly two-thirds (64%) of respondents said that they have not faced any challenges or barriers to accessing cannabis for medical purposes since the broader legalization of cannabis in Canada in October 2018. Conversely, 17% said they have faced challenges or barriers to access since legalization. Nearly one in five (19%) said they did not know whether there are challenges or barriers.
Figure 64: Challenges accessing cannabis following legalization
Yes, I have faced challenges accessing cannabis for medical purposes following legalization = 17%
No, I have not faced any challenges accessing cannabis for medical purposes following legalization = 64%
I don't know = 19%
Q74. Since legalization (October 2018), are there any challenges or barriers to accessing cannabis for medical purposes? Base: n=1,205; all respondents.
Men were more likely to report no barriers or challenges to access following legalization (71% vs. 61% of women).
Respondents who mentioned that there are challenges or barriers to accessing cannabis for medical purposes since the broader legalization of cannabis (n=192) collectively identified a variety of them. Topping the list was the impression that cannabis is too expensive (40%). This was followed by difficulty finding a medical doctor or nurse practitioner willing to authorize cannabis for medical use (34%), health care providers not having enough information to advise on cannabis use for medical purposes (27%), having to figure out the use of cannabis for medical purposes on one's own (24%), complications purchasing cannabis for medical purposes from a licensed vendor (21%), complications applying to Health Canada to grow cannabis on one's own or to get someone else to grow it for them (17% each), lacking information to make informed choices (16%), mail being the only way to have cannabis sent to one's home address (15%), lack of anyone from whom to get information (12%), and the products needed not being available through legal sources (11%) (multiple responses accepted).
Figure 65: Top barriers to accessing cannabis for medical purposes following legalization
Cannabis is too expensive = 40%
It is difficult to find a HCP willing to authorize cannabis for medical use = 34%
HCPs don't have enough information to advise on cannabis = 27%
Have to figure out the use of cannabis for medical purposes on own = 24%
It is complicated to buy from a licensed seller for medical purposes = 21%
It is complicated to apply to Health Canada to have someone else grow it = 17%
It is complicated to apply to Health Canada to grow your own = 17%
Don't have the information needed to make informed choices = 16%
Cannabis can only be sent to your home address by mail = 15%
There is no one you can ask for information = 12%
The products needed are not available through legal sources = 11%
Other = 6%
I don't know = 3%
Q75/Q76. What are the challenges or barriers to accessing cannabis for medical purposes? Multiple responses accepted. Base: n=192; respondents who have faced challenges accessing cannabis for medical purposes since legalization.
The following tables present the characteristics of respondents (using weighted data).
| Type of respondents | Percent |
|---|---|
| Patients | 93% |
| Parents responding on behalf of their children | 7% |
| Province and territories | Percent |
|---|---|
| Ontario | 39% |
| Quebec | 23% |
| British Columbia | 14% |
| Alberta | 9% |
| Nova Scotia | 5% |
| Manitoba | 3% |
| New Brunswick | 3% |
| Saskatchewan | 2% |
| Newfoundland and Labrador | 1% |
| Prince Edward Island | 1% |
| Territories | <0.5% |
| Age | Percent |
|---|---|
| 16-24 | 13% |
| 25-34 | 19% |
| 35-49 | 25% |
| 50-54 | 8% |
| 55-64 | 17% |
| 65+ | 19% |
| No response | <0.5% |
| Gender | Percent |
|---|---|
| Woman | 53% |
| Man | 46% |
| Other gender | 1% |
| Education | Percent |
|---|---|
| Less than a High School diploma or equivalent | 3% |
| High School diploma or equivalent | 23% |
| Registered Apprenticeship or other trades certificate or diploma | 8% |
| College, CEGEP or other non-university certificate or diploma | 28% |
| University certificate or diploma below bachelor's level | 8% |
| Bachelor's degree | 22% |
| Post graduate degree above bachelor's level | 7% |
| Prefer not to respond | 1% |
| Household income | Percent |
|---|---|
| Under $20,000 | 10% |
| $20,000 to just under $40,000 | 20% |
| $40,000 to just under $60,000 | 16% |
| $60,000 to just under $80,000 | 14% |
| $80,000 to just under $100,000 | 12% |
| $100,000 to just under $150,000 | 15% |
| $150,000 and above | 6% |
| Prefer not to respond | 6% |
| Language | Percent |
|---|---|
| English | 81% |
| French | 18% |
| Other | 1% |
This section of the report presents the findings from an online survey of medical doctors and nurse practitioners[16] who have experience with cannabis for medical purposes since its legalization in Canada. Those eligible to complete the survey had done or experienced one or more of the following in the last three years: treated a patient who uses cannabis for medical purposes, given a patient a medical document to access cannabis, referred a patient to a colleague who is an expert on the use of cannabis for medical purposes, recommended to a patient that they use cannabis to treat their symptom/disease, or had been asked by patient for information about using cannabis for medical purposes.
Nearly all survey respondents (94%) identified themselves as physicians, with only 6% identifying themselves as nurse practitioners. Those who identified themselves as physicians (n=770) were almost equally divided between general practitioners (51%) and specialists (49%). This was consistent with the research design.
Figure 66: Type of practitioner
a physician = 94%
a nurse practitioner = 6%
General practitioner = 51%
Specialist = 49%
[Left] Q7. Are you a physician or a nurse practitioner? Base: n=823; all respondents.
[Right] Q7B. Are you a general practitioner or specialist? Base: n=770; those who are physicians.
The largest single proportion of health care providers (43%) indicated that they are licensed in Ontario. One in five said they were licensed in British Columbia, followed by almost equal proportions licensed in Quebec (14%) and Alberta (13%). Four percent or fewer are licensed in other provinces and the territories (multiple responses accepted).
67: Licensed location
Ontario = 43%
British Columbia = 20%
Quebec = 14%
Alberta = 13%
Manitoba = 4%
Saskatchewan = 3%
Nova Scotia = 3%
New Brunswick = 2%
Newfoundland and Labrador = 1%
Nunavut = <0.5%
Prince Edward Island = <0.5%
Northwest Territories = <0.5%
Q8. In which province(s) or territory(ies) are you licensed? [Multiple Responses Accepted] Base: n=823; all respondents.
Health care providers who are licensed in multiple locations (n=24) are most likely to be currently practicing in Ontario and Alberta.
As the graph below shows, a majority of the health care providers surveyed (57%) have been in practice for ten years or more, and the largest single proportion (41%) have been in practice for more than 15 years. Just over one-quarter have been in practice for between 6-10 years, and most of the rest (16%) have been in practice for between 1-5 years.
HCPs who have authorized the use of cannabis for medical purposes were more likely than those who have not done so to say they have been practicing for more than 15 years (48% vs. 38% of HCPs who have not issued a medical document).
Figure 68: Length of time practicing
Less than 1 year = <0.5%
1 to 5 years = 16%
6 to 10 years = 27%
11 to 15 years = 16%
More than 15 years = 41%
Q13. For how long have you been practicing as a [physician/nurse practitioner]? Base: n=823; all respondents.
The majority of health care providers' primary work setting is a family medicine clinic (33%) followed by a hospital setting other than emergency room or urgent care (26%). Most of the rest work in a solo practice (15%), a multi-disciplinary clinic (8%), or a specialized health centre (e.g., an oncology clinic or a mental health centre) (8%). Additional work settings were cited in small proportions (3% or less) and are identified in the graph below.
Figure 69: Primary work setting
Family medicine clinic = 33%
Hospital setting (other than ER/urgent care) = 26%
Solo practice = 15%
Multi-disciplinary clinic = 8%
Specialized health centre = 8%
Community health centre = 3%
Urgent care = 2%
Walk-in-clinic (other than ER/urgent care) = 1%
Long-term care residence = 1%
Cannabis clinic = <0.5%
Public Health clinic/setting = <0.5%
Other = 5%
Q14. What is your primary work setting? Base: n=823; all respondents.
HCPs who have authorized the use of cannabis for medical purposes were more likely than those who have not done so to say they are family physicians/practice family medicine (70% compared to 36% of HCPs who have not issued a medical document).
Of those who are physicians (n=770), nearly half (48%) said they are family physicians or in family medicine. All other types of physicians were mentioned in much smaller proportions (8% or less) and are identified in the graph below (multiple responses accepted).
Figure 70: Type of physician
Family physician/family medicine = 48%
Psychiatry = 8%
Internal medicine/internist = 7%
Pediatrics/pediatrician = 7%
Emergency medicine = 7%
Neurologist = 4%
Rheumatologist = 4%
Cardiologist = 3%
Gastroenterologist = 3%
Respiratory Medicine/respirology = 2%
Endocrinologist = 2%
Oncology/oncologist = 2%
Infectious diseases = 2%
Pain specialist = 2%
Obstetrician/Gynecologist = 2%
Geriatrics = 1%
Anesthesiologist = 1%
Ophthalmology = 1%
Otolaryngologist = <0.5%
Other = 7%
Q15. What type of physician are you? Multiple responses accepted. Base: n=770; respondents who are physicians.
Practitioners with a solo practice or who work in a family medicine clinic are more likely to be comfortable speaking with patients about cannabis for medical purposes. In contrast, those who work in a hospital setting are more likely to be not very or not at all comfortable speaking with patients.
Medical doctors and nurse practitioners were asked which, if any, of the following they have done in the past 3 years (since the legalization of cannabis):
Most of these health care providers have experience with patients who use, or would like to use, cannabis for medical purposes. The vast majority (92%) said they have been asked by patients for information about using cannabis for medical purposes. This was followed at a distance by nearly two-thirds (64%) who said they have treated a patient who uses cannabis for medical purposes without recommending it.
Figure 71: Behaviours of past three years
Been asked by a patient for information about using cannabis for medical purposes = 92%
Treated a patient who uses cannabis for medical purposes but you did not recommend it = 64%
Referred a patient to a colleague who is an expert on the use of cannabis for medical purposes = 55%
Recommended to a patient that they don't use cannabis to treat their symptom/disease = 54%
Recommended to a patient that they use cannabis to treat their symptom/disease = 53%
Given a patient a medical document to access cannabis to treat their symptom/disease = 35%
Refused to give a patient a medical document to access cannabis to treat their symptom/disease = 17%
Q3. In the past 3 years, which, if any, of the following have you done? [Multiple Responses Accepted] Base: n=823; all respondents.
Smaller majorities said they have referred a patient to a colleague who is an expert on the use of cannabis for medical purposes (55%), recommended a patient not use cannabis to treat their symptom or disease (54%), or recommended to a patient that they use cannabis to treat their symptom or disease (53%) (multiple responses accepted).
Just over one-third (35%) of the health care providers surveyed said they have given a patient a medical document to access cannabis to treat their symptom or disease, while fewer than one in five (17%) said they refused to do so.
Practitioners with high levels of comfort and knowledge in relation to cannabis for medical purposes were more likely than those who are not comfortable or who have poor knowledge to recommend cannabis to treat diseases/symptoms (78% and 72%, respectively, vs. 24% of those not comfortable and with poor knowledge) and to give a patient a medical document (59% of those comfortable and knowledgeable vs. 11% of those not comfortable and 13% of those with poor knowledge).
Medical doctors and nurse practitioners were then asked how often the interactions identified in figure 71 occurred in the past three years. As the graph below illustrates, with one exception practitioners who said they have engaged in these activities were much more likely to say they have 'sometimes' done them rather than 'often' or 'rarely'.
Indeed, half or more said they have 'sometimes' referred patients to a colleague who is an expert on the use of cannabis for medical purposes (58%), recommended to a patient that they use cannabis to treat their symptom or disease (57%), been asked by a patient for information about using cannabis for medical purposes (54%), recommended to a patient that they not use cannabis to treat their symptom or disease (54%), gave a patient a medical document to access cannabis to treat their symptom or disease (52%), and treated a patient who uses cannabis for medical purposes without recommending it (50%). The exception was refusing to give a patient a medical document to access cannabis to treat their symptom or disease, where practitioners were almost evenly divided between doing this 'sometimes' (47%) and doing it 'rarely' (46%).
The likelihood of doing these things 'often' varied from a low of 7% in the case of refusing to give a patient a medical document to access cannabis to treat their symptom or disease, to a high of 36% in the case of treating a patient who uses cannabis for medical purposes without recommending it. The likelihood of doing these things 'rarely' varied from a low of 11% in the case of being asked by a patient for information about using cannabis for medical purposes to a high of 46% in the case of refusing to give a patient a medical document to access cannabis to treat their symptom or disease.
Figure 72: Frequency of behaviours in past three years
Been asked by a patient for information about using cannabis for medical purposes (n=759).
Rarely = 11%
Sometimes = 54%
Often = 35%
Treated a patient who uses cannabis for medical purposes but you did not recommend it (n=525).
Rarely = 13%
Sometimes = 50%
Often = 36%
Don't know = 1%
Referred a patient to a colleague who is an expert on the use of cannabis for medical purposes (n=456).
Rarely = 22%
Sometimes = 58%
Often = 20%
Recommended to a patient that they don't use cannabis to treat their symptom/disease (n=445).
Rarely = 15%
Sometimes = 54%
Often = 30%
Recommended to a patient that they use cannabis to treat their symptom/disease (n=431).
Rarely = 30%
Sometimes = 57%
Often = 13%
Given a patient a medical document to access cannabis to treat their symptom/disease (n=283).
Rarely = 31%
Sometimes = 52%
Often = 17%
Refused to give a patient a medical document to access cannabis to treat their symptom/disease (n=138).
Rarely = 46%
Sometimes = 47%
Often = 7%
Q4. In the past 3 years, how often have you done the following…? Base: all respondents.
Health care providers who said in the past 3 years that they have not recommended to any patients that they use cannabis to treat their symptoms or diseases nor given a patient a medical document to access cannabis (n=392) most often pointed to a lack of evidence about the efficacy of cannabis (58%) or a lack of information about appropriate dosage (55%) to explain why (multiple responses accepted). Close to half of them said that they are not well enough informed about the uses of cannabis for medical purposes (48%) and that there are side-effects to using cannabis (47%) to explain why they do not recommend cannabis.
A host of other reasons were offered and included the following, in descending order of frequency: lack of familiarity with the process of providing a medical document to patients for the use of cannabis for medical purposes (38%), concern that patients will use cannabis for its psychoactive effects (29%), most of the cannabis available is not being regulated as a drug (27%), never being asked by a patient to provide them with a medical document for the use of cannabis to treat their symptoms or disease (16%), and lack of need/not seeing patients who would benefit from using cannabis (15%).
Figure 73: Reasons for not recommending patients use cannabis
There is a lack of evidence about the efficacy of cannabis = 58%
There is a lack of information about appropriate dosage = 55%
I am not well enough informed about the uses of cannabis for medical purposes = 48%
There are side-effects to using cannabis = 47%
I am not familiar with the process of providing a medical document to patients for the use of cannabis for medical purposes = 38%
I am concerned that patients will use cannabis for the psychoactive effects = 29%
Most of the cannabis that is available is not regulated as a drug = 27%
A patient has never asked me to provide them with a medical document for the use of cannabis to treat their symptoms or disease = 16%
Lack of need/I don't see patients who would benefit from using cannabis = 15%
No reason/I just have not = 1%
Other = 7%
Q5A. Why have you not recommended to a patient that they use cannabis to treat their symptom/disease? [Multiple Responses Accepted] Base: n=392; those who have not recommended patients to use cannabis to treat their symptom/disease.
Health care providers who reported never having given a patient a medical document to access cannabis to treat their symptom or disease (n=392) were asked to explain why this is the case. In response, nearly half (47%) said they are not familiar with the process of providing a medical document to patients for the use of cannabis for medical purposes. Identical proportions (40% in each case) cited lack of information about appropriate dosage and not being well enough informed about the uses of cannabis for medical purposes (multiple responses accepted).
One-third (34%) pointed to a lack of evidence about the efficacy of cannabis, while close to one in three said there are side-effects to using cannabis (29%) and that their patients have never asked them to provide a medical document for the use of cannabis to treat their symptoms or disease (28%). Approximately one in five said they are concerned that patients will use cannabis for the psychoactive effects (21%) and that most of the cannabis that is available is not regulated as a drug (19%). Nine percent pointed to lack of need/not seeing patients who would benefit from using cannabis while a few (4%) said that there was no reason except that they have not done it.
Figure 74: Reasons for not giving patients medical document to access cannabis
I am not familiar with the process of providing a medical document to patients for the use of cannabis for medical purposes = 47%
There is a lack of information about appropriate dosage = 40%
I am not well enough informed about the uses of cannabis for medical purposes = 40%
There is a lack of evidence about the efficacy of cannabis = 34%
There are side-effects to using cannabis = 29%
A patient has never asked me to provide them with a medical document for the use of cannabis to treat their symptoms or disease = 28%
I am concerned that patients will use cannabis for the psychoactive effects = 21%
Most of the cannabis that is available is not regulated as a drug = 19%
Lack of need/I don't see patients who would benefit from using cannabis = 9%
No reason/I just have not = 4%
Other = 6%
Q5B. Why have you not given a patient a medical document to access cannabis to treat their symptom or disease? [Multiple Responses Accepted] Base: n=392; those who have not given patients a medical document to access cannabis to treat their symptom or disease.
Health care providers who have ever recommended that patients not use cannabis to treat their symptom or disease (n=262) most often said they did so because cannabis is not an effective treatment for their patient's condition (61%). Other reasons identified by half or more of the health care providers in question included other treatment options having not been exhausted (53%), the patient's history of substance abuse (51%), and the patient's personal history of psychiatric disorders or a family history of schizophrenia (50%) (multiple responses accepted). The graph below includes the full set of reasons identified by these medical doctors and nurse practitioners.
Figure 75: Reasons for recommending patients not use cannabis
Cannabis was not an effective treatment for the patient's condition = 61%
Other treatment options had not been exhausted = 53%
The patient had a history of substance abuse = 51%
The patient had a personal history of psychiatric disorders or a family history of schizophrenia = 50%
The patient had a mood or anxiety disorder = 45%
I did not have sufficient information to feel confident in recommending cannabis for medical purposes for the requested condition/s = 41%
The patient was taking sedatives or other psychoactive drugs = 41%
The patient was using other medications or substances that could pose a risk of drug interactions with cannabis = 40%
The patient was under the age or 18 = 38%
The patient/s required further assessment prior to the selection of a treatment option = 35%
The patient had a severe disease, or risk factors for severe disease (e.g., cardio-pulmonary, respiratory, liver, renal) = 30%
I referred the patient/s to a colleague who is an expert on using cannabis to treat medical conditions = 28%
The patient was planning on conceiving, was pregnant, or was breastfeeding = 26%
The patient had a history of hypersensitivity to cannabis = 17%
I am not familiar with the process of providing a patient with a medical document for the use of cannabis = 8%
Other = 4%
Q6A. Why have you recommended to a patient that they do not use cannabis to treat their symptom/disease? [Multiple Responses Accepted] Base: n=262; those who have recommended patients to not use cannabis to treat their symptom/disease.
Health care providers who refused to give a medical document to access cannabis for medical purposes to a patient (n=84) most often provided three reasons to explain why, with each one identified by a majority: cannabis not being an effective treatment for the patient's condition (60%), a patient's history of substance abuse (58%), and a patient's personal history of psychiatric disorders or family history of schizophrenia (53%) (multiple responses accepted). Note that these same reasons were among the reasons most frequently given to explain why health care providers recommended that patients not use cannabis to treat their symptom or disease. The graph below includes the full set of reasons identified by these practitioners.
Figure 76: Reasons for refusing to give patients medical document to access cannabis
Cannabis was not an effective treatment for the patient's condition = 60%
The patient had a history of substance abuse = 58%
The patient had a personal history of psychiatric disorders or a family history of schizophrenia = 53%
I did not have sufficient information to feel confident in recommending cannabis for medical purposes for the requested condition/s = 42%
The patient was taking sedatives or other psychoactive drugs = 41%
The patient was under the age or 18 = 40%
Other treatment options had not been exhausted = 39%
The patient had a mood or anxiety disorder = 38%
The patient had a severe disease, or risk factors for severe disease (e.g., cardio-pulmonary, respiratory, liver, renal) = 30%
The patient was using other medications or substances that could pose a risk of drug interactions with cannabis = 27%
The patient/s required further assessment prior to the selection of a treatment option = 26%
I referred the patient/s to a colleague who is an expert on using cannabis to treat medical conditions = 23%
The patient had a history of hypersensitivity to cannabis = 20%
The patient was planning on conceiving, was pregnant, or was breastfeeding = 19%
I am not familiar with the process of providing a patient with a medical document for the use of cannabis = 1%
No reason/I just have not = 1%
Other = 3%
Q6B. Why have you refused to give a patient a medical document for the use of cannabis for medical purposes? [Multiple Responses Accepted] Base: n=84; those who have refused to give a patient a medical document for the use of cannabis for medical purposes.
Asked if there is therapeutic value to the use of cannabis, nearly half the health care providers surveyed (49%) answered yes, with most of the rest (45%) answering 'sometimes'. A very small proportion (2%) said they thought there was no therapeutic value in it and 4% said they did not know.
Figure 77: Therapeutic value to use of cannabis
Yes = 49%
Sometimes = 45%
No = 2%
Don't Know = 4%
Q10. In your opinion, is there therapeutic value to the use of cannabis? Base: n=823; all respondents.
Nurse practitioners (84%) were more likely than medical doctors (48%) to hold the view that there is therapeutic value to the use of cannabis. So too were HCPs practicing in Quebec (56%) and Ontario (52%) compared to those practicing in British Columbia or the North (42%) as well as HCPs who are very (68%) or somewhat (51%) comfortable talking to patients about cannabis (vs. 34% of those who are not very or not at all comfortable) and those who view themselves as knowledgeable (65%) about cannabis for medical purposes (vs. 34% of those who said their knowledge is poor to very poor). Additionally, HCPs who have authorized cannabis through a medical document (61%) were more likely than those who have not authorized cannabis (43%) to say there is therapeutic value to the use of cannabis.
Three-quarters of those who said they believe there is at least some therapeutic value to the use of cannabis (n=774) pointed to clinical examples as the rationale for believing so.
Smaller and nearly identical majorities identified two other reasons to explain why: the intolerability or ineffectiveness of other treatments for some patients presents cannabis as a reasonable treatment option (59%), and the lack of other effective treatments which presents cannabis as a reasonable treatment option for certain diseases or symptoms (58%) (multiple responses accepted).
Nearly half (47%) pointed to existing evidence suggesting that cannabis for medical purposes has clinical utility, while 42% pointed to the experiences of other health care colleagues, and 38% pointed to their own experience with their patients.
Figure 78: Reasons why there is therapeutic value to use of cannabis
There are clinical examples that suggest that cannabis can have therapeutic value = 75%
Intolerability or ineffectiveness of other treatments for some patients presents cannabis as a reasonable treatment option = 59%
Lack of other effective treatments presents cannabis as a reasonable treatment option for certain diseases or symptoms = 58%
Existing evidence suggests that cannabis for medical purposes has clinical utility = 47%
Experiences of other healthcare colleagues suggest that cannabis has therapeutic value = 42%
I've used it with my patients and have seen positive results = 38%
Other = 3%
Don't know = <0.5%
Q11. You said there is therapeutic value to the use of cannabis. Will you please explain why? Base: n=774; those who said there was or sometimes was therapeutic value to cannabis.
Those who said that terpenes (87%) are the part of the cannabis plant with therapeutic value were more likely than those who pointed to CBD (77%) to say that there are clinical examples that suggest that cannabis can have therapeutic value. In contrast, those who said that other cannabinoids (61%) or THC (57%) are the parts with therapeutic value were more likely than those who pointed to CBD (50%) to say existing evidence suggests that cannabis for medical purposes has clinical utility. Compared to those who said that CBD (40%) is the part of the plant with therapeutic value, those who mentioned terpenes (61%) or THC (51%) were more likely to say that they have used cannabis with their patients and have seen positive results.
HCPs who have given a patient a medical document were more likely than those who have not authorized cannabis for medical purposes to attribute their view that there is therapeutic value to cannabis to the following reasons: they used it with their patients and have seen positive results (66% vs. 22%), there are clinical examples that suggest that cannabis can have therapeutic value (80% vs 72%), the lack of other effective treatments presents cannabis as a reasonable treatment option for certain diseases or symptoms (67% vs 53%), intolerability or ineffectiveness of other treatments for some patients presents cannabis as a reasonable treatment option (71% vs 53%), and existing evidence suggests that cannabis for medical purposes has clinical utility (57% vs 42%).
Practitioners who said there was no therapeutic value to cannabis, of which there were very few, (n=15) most often explained why by pointing to insufficient evidence to establish that cannabis has clinical utility, lack of standards for dosing, and lack of efficacy data or clinical trials.
As the graph below shows, the length of time health care providers have been seeing and/or treating patients who use cannabis for medical purposes varies. Relatively similar proportions said they have been doing so for one to three years (26%), four to five years (29%), and six to 10 years (27%). Fourteen percent have been doing so for more than 10 years, while very few (1%) have been doing so for less than one year. A small number (2%) said they do not typically see or treat patients who use cannabis for medical purposes.
Figure 79: Length of time treating patients who use cannabis for medical purposes
Less than 1 year = 1%
1 to 3 years = 26%
4 to 5 years = 29%
6 to 10 years = 27%
11 to 15 years = 6%
More than 15 years = 8%
I don't typically see or treat patients who use cannabis for medical purposes = 2%
Q16. How long have you been seeing and/or treating patients who use cannabis for medical purposes? Base: n=823; all respondents.
Those who are very comfortable talking to patients about cannabis were more likely to have been treating patients who use cannabis for medical purposes for more than 15 years (17% vs. 6% of those who are less comfortable doing this). The same is true about knowledge—those who rated their knowledge about cannabis for medical purposes as good or very good were more likely to have been treating patients for more than 15 years (12% vs.7% of those who are less knowledgeable about this).
The frequency with which medical doctors and nurse practitioners see patients who use cannabis for medical purposes varies widely. That said, a little more than half indicated that they see such patients rather frequently, i.e., at least once a week. This includes the largest single proportion (26%) who said they see such patients several times a week, 15% who said they see such patients about once a week, and 13% who said they see such patients at least once a day. The rest of the health care providers surveyed see such patients less frequently: 16% do so several times a month, 12% about once a month, and 17% less often than once a month. One percent said they never see such patients.
Figure 80: Frequency seeing patients who use cannabis for medical purposes
Multiple times a day = 8%
Once a day = 5%
Several times a week = 26%
About once a week = 15%
Several times a month = 16%
About once a month = 12%
Less often than once a month = 17%
Never = 1%
Q17. On average, how often do you see patients who use cannabis for medical purposes? Base: n=823; all respondents.
Health care providers who are very comfortable talking to patients about cannabis were more likely than those who are somewhat or not comfortable doing this to report seeing patients who use cannabis for medical purposes multiple times a day (18% vs. 6%).
Asked how comfortable they are talking to patients about using cannabis for medical purposes, close to three-quarters of health care providers (71%) characterized themselves as at least somewhat comfortable doing this (20% saying very comfortable). On the other hand, one-quarter said they are not very comfortable doing this, and 4% said they are not at all comfortable doing it.
Figure 81: Comfort level talking to patients about cannabis
Very comfortable = 20%
Somewhat comfortable = 51%
Not very comfortable = 25%
Not at all comfortable = 4%
Q18. How comfortable are you talking to patients about using cannabis for medical purposes? Base: n=823; all respondents.
The following groups of HCPs were more likely to be very comfortable talking to patients about using cannabis for medical purposes: practitioners aged 55 and older (31% vs. 17% of those 35 to 54 and 19% of those under 35); those who have been treating patients with cannabis for more than 15 years (42% vs. 19% of those who have been treating patients with cannabis for less than 15 years); and HCPs who are knowledgeable about cannabis for medical purposes (51% of those who have good or very good knowledge vs. 6% of those who are less knowledgeable).
Asked to rate their level of knowledge about cannabis for medical purposes, three-quarters of health care providers (76%) said they have at least a fair level of knowledge about this. The largest single proportion (44%) rated their level of knowledge as fair, while one-quarter (26%) rated their knowledge level as good and 6% as very good. Conversely, approximately one-quarter of respondents characterized their level of knowledge of cannabis for medical purposes as poor (20%) or very poor (4%).
Figure 82: Knowledge of cannabis for medical purposes
Very good = 6%
Good = 26%
Fair = 44%
Poor = 20%
Very poor = 4%
Q19. How would you rate your level of knowledge about cannabis for medical purposes? Base: n=823; all respondents.
Health care practitioners who said there is therapeutic value for cannabis were more likely to characterize their level of knowledge about cannabis for medical purposes as good or very good (42% vs. 23% of those who said there is sometimes therapeutic value) as were those who are very comfortable talking to patients about cannabis (80% vs. 30% of those who are only somewhat comfortable doing this).
Survey respondents were asked how confident they are in the following areas:
As the graph below shows, in only three areas did a majority of health care providers rate themselves as at least somewhat confident. This included answering patients' questions on the use of cannabis for medical purposes (61%), explaining contraindications and adverse effects (57%), and advising patients on how to access cannabis for medical purposes (52%). In the five other areas, the likelihood of health care providers rating themselves as at least somewhat confident ranged from 46% in the case of monitoring and evaluating patient status and progress to 28% in the case of advising patients under 18 years old on cannabis for medical purposes and providing advice on appropriate dosing.
In fact, in all five other areas, respondents were more likely to rate themselves as only slightly confident or not confident at all. The likelihood of doing so ranged from 53% in the case of monitoring and evaluating patient status and progress, to 72% in the case of providing advice on appropriate dosing. Moreover, regarding the latter and advising patients under 18 years old on cannabis for medical purposes, a majority of practitioners rated themselves as not confident at all (62% when it came to advising patients under 18 years old on cannabis for medical purposes, and 55% when it came to providing advice on appropriate dosing).
Figure 83: Confidence
Answering patients' questions on the use of cannabis for medical purposes.
Extremely confident = 4%
Quite confident = 23%
Somewhat confident = 34%
Slightly confident = 25%
Not at all confident = 14%
Explaining contraindications and adverse effects.
Extremely confident = 7%
Quite confident = 23%
Somewhat confident = 27%
Slightly confident = 27%
Not at all confident = 17%
Advising patients on how to access cannabis for medical purposes.
Extremely confident = 8%
Quite confident = 19%
Somewhat confident = 25%
Slightly confident = 24%
Not at all confident = 24%
Monitoring and evaluating patient status and progress.
Extremely confident = 5%
Quite confident = 17%
Somewhat confident = 24%
Slightly confident = 24%
Not at all confident = 29%
Advising patients on the types of cannabis to use for medical purposes.
Extremely confident = 2%
Quite confident = 13%
Somewhat confident = 24%
Slightly confident = 24%
Not at all confident = 37%
Discussing cannabinoid content.
Extremely confident = 3%
Quite confident = 13%
Somewhat confident = 23%
Slightly confident = 24%
Not at all confident = 37%
Providing advice on appropriate dosing.
Extremely confident = 3%
Quite confident = 8%
Somewhat confident = 17%
Slightly confident = 17%
Not at all confident = 55%
Advising patients under 18 years old on cannabis for medical purposes.
Extremely confident = 7%
Quite confident = 10%
Somewhat confident = 11%
Slightly confident = 9%
Not at all confident = 62%
Q20. How confident are you in the following areas….? Base: n=823; all respondents.
Practitioners with high levels of comfort and knowledge in relation to cannabis for medical purposes were more likely than those who are not comfortable or who have poor knowledge to say they are confident in all these areas. In contrast, HCPs who are not very or not all comfortable talking to patients about cannabis for medical purposes and/or who have poor or very poor knowledge about cannabis for medical purposes were more likely to rate themselves as not at all confident in all these areas.
HCPs who have authorized the use of cannabis with a medical document were more likely than their counterparts who have not done so to say they are at least quite confident with regards to:
Health care providers were asked how much they agree or disagree with the following statements about cannabis for medical purposes:
Half or more of the health care providers surveyed agreed with each of these statements, and with one exception, agreement was more likely to be moderate than strong.
Practitioners were most likely to agree that there needs to be more education about cannabis for medical purposes (83%) and that there are mental health risks associated with cannabis use for medical purposes (81%). Agreement that there needs to be more education about cannabis for medical purposes was the only instance where agreement was more likely to be strong than moderate.
Approximately three-quarters of respondents agreed that cannabis has therapeutic value for patients under medical supervision for treating diseases or disorders or the symptoms of diseases or disorders (76%), and that there are physical health risks associated with cannabis use for medical purposes (72%). Nearly two-thirds (65%) agreed that there are physical health benefits to using cannabis for medical purposes, while well over half (60%) agreed that there is sufficient evidence to support the use of cannabis for medical purposes for some conditions. A small majority (54%) agreed they know where to find information about cannabis for medical purposes if they need it, while exactly half agreed that there are mental health benefits to using cannabis for medical purposes.
In all but one instance, health care providers who did not agree with these statements were more likely to say that they did not know rather than to express disagreement. The exception concerned the statement 'I know where to find information about cannabis for medical purposes if I need it' (17% said they did not know and 27% expressed disagreement). Levels of disagreement with other statements ranged from 4% to 19%.
Figure 84: Agreement levels about cannabis for medical purposes
There needs to be more education about cannabis for medical purposes.
Strongly agree = 44%
Somewhat agree = 39%
Neither agree nor disagree = 12%
Somewhat disagree = 3%
Strongly disagree = 2%
Don't know = 1%
There are mental health risks associated with cannabis use for medical purposes.
Strongly agree = 36%
Somewhat agree = 45%
Neither agree nor disagree = 13%
Somewhat disagree = 4%
Strongly disagree = 0%
Don't know = 1%
Cannabis has therapeutic value for patients under medical supervision.
Strongly agree = 17%
Somewhat agree = 59%
Neither agree nor disagree = 14%
Somewhat disagree = 6%
Strongly disagree = 2%
Don't know = 3%
There are physical health risks associated with cannabis use for medical purposes.
Strongly agree = 23%
Somewhat agree = 49%
Neither agree nor disagree = 19%
Somewhat disagree = 6%
Strongly disagree = 0%
Don't know = 2%
There are physical health benefits to using cannabis for medical purposes.
Strongly agree = 12%
Somewhat agree = 53%
Neither agree nor disagree = 24%
Somewhat disagree = 6%
Strongly disagree = 2%
Don't know = 3%
There is sufficient evidence to support the use of cannabis for medical purposes for some conditions.
Strongly agree = 14%
Somewhat agree = 47%
Neither agree nor disagree = 21%
Somewhat disagree = 13%
Strongly disagree = 3%
Don't know = 3%
I know where to find information about cannabis for medical purposes.
Strongly agree = 13%
Somewhat agree = 41%
Neither agree nor disagree = 17%
Somewhat disagree = 18%
Strongly disagree = 9%
Don't know = 2%
There are mental health benefits to using cannabis for medical purposes.
Strongly agree = 9%
Somewhat agree = 41%
Neither agree nor disagree = 28%
Somewhat disagree = 13%
Strongly disagree = 6%
Don't know = 2%
Q21. How much do you agree or disagree with the following statements about cannabis for medical purposes….? Base: n=823; all respondents.
The following subgroup differences are noteworthy:
When those who said there was at least some therapeutic value to the use of cannabis (n=774) were asked what parts of the cannabis plant have therapeutic value, the vast majority (89%) identified CBD. Following this, 44% identified THC, 13% identified other cannabinoids, and 9% identified terpenes (multiple responses accepted).
Figure 85: Therapeutic parts of cannabis plant
CBD = 89%
THC = 44%
Terpenes = 9%
Other cannabinoids (besides CBD and THC) = 13%
Other = 1%
Don't know = 8%
Q22. What parts of the cannabis plant have therapeutic value? [Multiple Responses Accepted]
Base: n=774; those who said yes or sometimes to there being therapeutic value to the use of cannabis.
The following differences are noteworthy:
Health care providers were asked how much they agree or disagree with the following statements about THC and CBD:
The extent to which respondents agreed about the therapeutic value and risks of THC and CBD varied widely. There was widespread agreement that CBD has therapeutic value (90%), and that there are risks associated with the use of THC for medical purposes (85%), though in each case agreement was more likely to be moderate than strong. The only other statement with which a majority agreed was that there are risks associated with the use of CBD for medical purposes (55%), with agreement much more likely to be moderate than strong, and the rest divided between those neither agreeing or disagreeing (23%) and those expressing disagreement (20%).
Figure 86: Agreement level about THC and CBD
CBD has therapeutic value
Strongly agree = 31%
Somewhat agree = 59%
Neither agree nor disagree = 6%
Somewhat disagree = 2%
Strongly disagree = 0%
Don't know = 1%
There are risks associated with the use of THC for medical purposes
Strongly agree = 32%
Somewhat agree = 53%
Neither agree nor disagree = 10%
Somewhat disagree = 2%
Strongly disagree = 0%
Don't know = 3%
There are risks associated with the use of CBD for medical purposes
Strongly agree = 8%
Somewhat agree = 47%
Neither agree nor disagree = 23%
Somewhat disagree = 16%
Strongly disagree = 4%
Don't know = 2%
THC has therapeutic value
Strongly agree = 7%
Somewhat agree = 39%
Neither agree nor disagree = 23%
Somewhat disagree = 19%
Strongly disagree = 7%
Don't know = 6%
THC does not have therapeutic value
Strongly agree = 6%
Somewhat agree = 21%
Neither agree nor disagree = 27%
Somewhat disagree = 29%
Strongly disagree = 11%
Don't know = 6%
There are no risks associated with the use of CBD for medical purposes
Strongly agree = 3%
Somewhat agree = 13%
Neither agree nor disagree = 23%
Somewhat disagree = 39%
Strongly disagree = 19%
Don't know = 3%
CBD does not have therapeutic value
Strongly agree = 1%
Somewhat agree = 6%
Neither agree nor disagree = 14%
Somewhat disagree = 45%
Strongly disagree = 32%
Don't know = 2%
There are no risks associated with the use of THC for medical purposes
Strongly agree = 2%
Somewhat agree = 4%
Neither agree nor disagree = 11%
Somewhat disagree = 37%
Strongly disagree = 43%
Don't know = 3%
Q23. How much do you agree or disagree with the following statements about THC and CBD…? Base: n=823; all respondents.
Close to half (46%) agreed that THC has therapeutic value, with agreement much more likely to be moderate than strong, and the rest divided between those expressing disagreement (26%) and those neither agreeing nor disagreeing (23%). The statement 'THC does not have therapeutic value' was most likely to elicit mixed views: 27% agreeing, 40% disagreeing, and 27% neither agreeing nor disagreeing.
A majority of health care providers expressed disagreement with the three remaining statements. Strong majorities disagreed that there are no risks associated with the use of THC for medical purposes (80%) and that CBD does not have therapeutic value (77%), while a smaller majority (58%) disagreed that there are no risks associated with the use of CBD for medical purposes (16% agreeing and 23% neither agreeing nor disagreeing).
Health care providers were asked how helpful they think cannabis is for treating the following symptoms:
While a majority felt that cannabis is at least somewhat helpful in treating most of these symptoms, the size of the majority varied. Moreover, cannabis was much more likely to be considered somewhat helpful than very helpful for every one of these symptoms.
There was widespread agreement that cannabis is at least somewhat helpful in treating cancer pain (89%), palliative care (88%), and chronic non-cancer pain (86%). Just over three-quarters described it as at least somewhat helpful for wasting/weight loss and/or lack of appetite (78%), and nausea (77%), while two-thirds described it as at least somewhat helpful for problems sleeping. A small majority described it as at least somewhat helpful for anxiety.
Fewer than half considered cannabis at least somewhat helpful for treating the remaining conditions, with the proportion ranging from 43% in the case of acute pain to 17% in the case of alcohol withdrawal symptoms. Impressions that cannabis is not very/not at all helpful in treating symptoms were highest regarding feelings of depression (50%), acute pain (48%), alcohol withdrawal symptoms (42%), opioid withdrawal symptoms (40%), headaches (37%), and muscle spasms, feelings of anxiety, and seizures (33% each).
Figure 87: Helpfulness of cannabis – Symptoms
Cancer pain
Very helpful = 33%
Somewhat helpful = 56%
Not very helpful = 5%
Not at all helpful = 1%
Don't know = 4%
Palliative care
Very helpful = 35%
Somewhat helpful = 53%
Not very helpful = 5%
Not at all helpful = 1%
Don't know = 6%
Chronic non-cancer pain
Very helpful = 25%
Somewhat helpful = 61%
Not very helpful = 7%
Not at all helpful = 2%
Don't know = 4%
Nausea/vomiting
Very helpful = 23%
Somewhat helpful = 54%
Not very helpful = 12%
Not at all helpful = 5%
Don't know = 6%
Wasting/weight loss and/or lack of appetite
Very helpful = 24%
Somewhat helpful = 54%
Not very helpful = 10%
Not at all helpful = 3%
Don't know = 10%
Problems sleeping
Very helpful = 13%
Somewhat helpful = 53%
Not very helpful = 17%
Not at all helpful = 8%
Don't know = 9%
Feelings of anxiety
Very helpful = 9%
Somewhat helpful = 46%
Not very helpful = 19%
Not at all helpful = 14%
Don't know = 12%
Muscle spasms
Very helpful = 6%
Somewhat helpful = 36%
Not very helpful = 24%
Not at all helpful = 9%
Don't know = 24%
Acute pain
Very helpful = 7%
Somewhat helpful = 36%
Not very helpful = 32%
Not at all helpful = 16%
Don't know = 10%
Headaches/migraines
Very helpful = 4%
Somewhat helpful = 38%
Not very helpful = 25%
Not at all helpful = 12%
Don't know = 22%
Seizures
Very helpful = 9%
Somewhat helpful = 32%
Not very helpful = 20%
Not at all helpful = 13%
Don't know = 27%
Feelings of depression
Very helpful = 3%
Somewhat helpful = 25%
Not very helpful = 29%
Not at all helpful = 21%
Don't know = 22%
Opioid withdrawal symptoms
Very helpful = 2%
Somewhat helpful = 20%
Not very helpful = 24%
Not at all helpful = 16%
Don't know = 38%
Alcohol withdrawal symptoms
Very helpful = 1%
Somewhat helpful = 16%
Not very helpful = 25%
Not at all helpful = 17%
Don't know = 40%
Q24. How helpful do you think cannabis is for the following symptoms…? Base: n=823; all respondents.
Overall, those with good or very good knowledge about cannabis for medical purposes were more likely to say that cannabis is helpful for these symptoms as compared to those with less knowledge about cannabis for medical purposes.
Health care providers were asked if they thought cannabis was helpful for any other symptoms. In response, a large majority (81%) said no.
Figure 88: Other symptom cannabis is helpful for
Yes = 19%
No = 81%
Q24O. Are there any other symptoms you think cannabis is helpful for? Base: n=823; all respondents.
Among those who felt cannabis would be helpful for other symptoms (n=157), nearly all (98%) said they thought cannabis would be at least somewhat helpful (19% said it would be very helpful) for other symptoms. When asked to identify which other symptoms they believe cannabis is helpful for, most HCPs reiterated the symptoms they were already asked to assess (see Figure 87). Other symptoms commonly mentioned included pruritus, joint and muscle pain, spasticity, nightmares, stress, and mood swings.
Respondents were asked how helpful they think cannabis is for treating the following diseases or disorders:
As the graph below illustrates, impressions about how helpful cannabis is for treating these diseases or disorders varied and tended to be mixed.
Small majorities rated cannabis at least somewhat helpful for treating insomnia (55%) and arthritis (53%), while exactly half said they found it helpful for treating multiple sclerosis, ALS and spinal cord injury. In each of these cases (but also most others), health care providers were much more likely to rate cannabis as somewhat helpful than very helpful.
Conversely, there were diseases and disorders regarding which a majority rated cannabis as not very or not at all helpful. Nearly two-thirds (65%) indicated that cannabis is not very or not at all helpful in treating schizophrenia and psychosis, and well over half indicated the same regarding diabetes and obesity (61% each). Just over half (52%) felt that cannabis is not very or not at all helpful in treating ADHD and ADD, while exactly half said the same regarding skin disease and Alzheimer's disease/dementia. In each of these cases, respondents were much more likely to rate cannabis as not at all helpful than not very helpful.
In three instances, small majorities indicated that they did not know whether cannabis is helpful or not. This included Huntington's disease (56%), Tourette's syndrome (52%), and Parkinson's disease (51%).
Figure 89: Helpfulness of cannabis - Diseases or Disorders
Insomnia
Very helpful = 11%
Somewhat helpful = 44%
Not very helpful = 19%
Not at all helpful = 10%
Don't know = 16%
Arthritis
Very helpful = 6%
Somewhat helpful = 47%
Not very helpful = 19%
Not at all helpful = 8%
Don't know = 21%
MS, ALS, spinal cord injury
Very helpful = 9%
Somewhat helpful = 41%
Not very helpful = 11%
Not at all helpful = 6%
Don't know = 33%
Other anxiety disorders
Very helpful = 7%
Somewhat helpful = 40%
Not very helpful = 22%
Not at all helpful = 15%
Don't know = 16%
Cancer
Very helpful = 12%
Somewhat helpful = 33%
Not very helpful = 12%
Not at all helpful = 18%
Don't know = 25%
PTSD
Very helpful = 7%
Somewhat helpful = 37%
Not very helpful = 18%
Not at all helpful = 9%
Don't know = 28%
Epilepsy
Very helpful = 7%
Somewhat helpful = 33%
Not very helpful = 18%
Not at all helpful = 11%
Don't know = 31%
Dystonia
Very helpful = 4%
Somewhat helpful = 30%
Not very helpful = 17%
Not at all helpful = 8%
Don't know = 41%
Depression
Very helpful = 3%
Somewhat helpful = 23%
Not very helpful = 29%
Not at all helpful = 20%
Don't know = 24%
Glaucoma
Very helpful = 4%
Somewhat helpful = 22%
Not very helpful = 13%
Not at all helpful = 13%
Don't know = 47%
Irritable bowel syndrome
Very helpful = 2%
Somewhat helpful = 21%
Not very helpful = 19%
Not at all helpful = 18%
Don't know = 40%
HIV/AIDS
Very helpful = 4%
Somewhat helpful = 19%
Not very helpful = 15%
Not at all helpful = 22%
Don't know = 40%
Parkinson's disease
Very helpful = 2%
Somewhat helpful = 17%
Not very helpful = 18%
Not at all helpful = 12%
Don't know = 51%
Huntington's disease
Very helpful = 3%
Somewhat helpful = 16%
Not very helpful = 16%
Not at all helpful = 9%
Don't know = 56%
Tourette's syndrome
Very helpful = 2%
Somewhat helpful = 16%
Not very helpful = 19%
Not at all helpful = 11%
Don't know = 52%
Inflammatory bowel diseases
Very helpful = 2%
Somewhat helpful = 15%
Not very helpful = 18%
Not at all helpful = 25%
Don't know = 41%
ADHD/ADD
Very helpful = 2%
Somewhat helpful = 9%
Not very helpful = 17%
Not at all helpful = 35%
Don't know = 36%
Autism
Very helpful = 1%
Somewhat helpful = 8%
Not very helpful = 16%
Not at all helpful = 28%
Don't know = 46%
Alzheimer's disease/dementia
Very helpful = 1%
Somewhat helpful = 8%
Not very helpful = 17%
Not at all helpful = 33%
Don't know = 41%
Skin diseases
Very helpful = 0%
Somewhat helpful = 6%
Not very helpful = 16%
Not at all helpful = 34%
Don't know = 44%
Schizophrenia/psychosis
Very helpful = 1%
Somewhat helpful = 5%
Not very helpful = 15%
Not at all helpful = 50%
Don't know = 29%
Liver disease
Very helpful = 1%
Somewhat helpful = 4%
Not very helpful = 16%
Not at all helpful = 33%
Don't know = 47%
Diabetes
Very helpful = 1%
Somewhat helpful = 3%
Not very helpful = 15%
Not at all helpful = 46%
Don't know = 35%
Obesity
Very helpful = 1%
Somewhat helpful = 3%
Not very helpful = 16%
Not at all helpful = 45%
35%
Q25. How helpful do you think cannabis is for the following diseases or disorders…? Base: n=823; all respondents.
Those who are comfortable discussing cannabis for medical purposes with patients and those who are knowledgeable about cannabis for medical purposes were more likely to say that cannabis is helpful for many of these diseases or disorders as compared to those with poor knowledge about cannabis for medical purposes and lack of comfort discussing it with patients.
When asked if there were other diseases or disorders they thought cannabis would be helpful for, nearly all (96%) said it was not helpful for treating other diseases or disorders. Among the few (n=33) who said cannabis would be helpful in treating other diseases or disorders, roughly three-quarters (72%) believe it is somewhat helpful while 22% believe it is very helpful. Caution should be exercised when interpreting these results due to the very small sample size.
Health care providers were asked to what extent they think using cannabis for medical purposes will increase the following diseases, disorders and symptoms.
Nearly two-thirds (65%) said they thought that the use of cannabis would at least somewhat increase the risk of psychotic symptoms, followed by well over half (60%) who said they thought it would at least somewhat increase the risk of cannabis use disorder. Slightly more than half (53%) said they thought it would at least somewhat increase the risk of memory problems. Impressions that the use of cannabis would at least somewhat increase other diseases, disorders and symptoms varied widely, ranging from 49% in the case of depression to only 7% in the case of diabetes.
Figure 90: Cannabis' potential for increasing risks
Psychotic symptoms
A lot = 28%
Somewhat = 37%
A little = 19%
Not at all = 6%
Don't know = 10%
Cannabis use disorder
A lot = 22%
Somewhat = 38%
A little = 23%
Not at all = 5%
Don't know = 11%
Memory problems
A lot = 15%
Somewhat = 38%
A little = 27%
Not at all = 8%
Don't know = 13%
Depression
A lot = 8%
Somewhat = 41%
A little = 27%
Not at all = 9%
Don't know = 15%
Accidents
A lot = 11%
Somewhat = 36%
A little = 31%
Not at all = 9%
Don't know = 13%
GI symptoms
A lot = 15%
Somewhat = 30%
A little = 25%
Not at all = 8%
Don't know = 21%
Low birth weight if used during pregnancy
A lot = 16%
Somewhat = 28%
A little = 13%
Not at all = 9%
Don't know = 34%
Anxiety
A lot = 12%
Somewhat = 33%
A little = 27%
Not at all = 12%
Don't know = 17%
Substance (other than cannabis) use disorder
A lot = 11%
Somewhat = 33%
A little = 27%
Not at all = 11%
Don't know = 19%
Respiratory symptoms
A lot = 11%
Somewhat = 28%
A little = 26%
Not at all = 18%
Don't know = 17%
Drug interactions
A lot = 4%
Somewhat = 26%
A little = 31%
Not at all = 10%
Don't know = 28%
Cancer
A lot = 3%
Somewhat = 13%
A little = 18%
Not at all = 26%
Don't know = 40%
Stroke
A lot = 2%
Somewhat = 10%
A little = 14%
Not at all = 27%
Don't know = 47%
Heart attack
A lot = 2%
Somewhat = 10%
A little = 16%
Not at all = 28%
44%
Don't know = Diabetes
A lot = 1%
Somewhat = 6%
A little = 12%
Not at all = 34%
Don't know = 48%
Q26. To what extent do you think using cannabis for medical purposes increases the risk of…? Base: n=823; all respondents.
The proportion of respondents who thought that the use of cannabis would pose little to no risk in terms of increasing these diseases ranged from 22% in the case of low birth weight to almost half (46%) in the case of diabetes. The likelihood of practitioners saying they did not know what the effect of cannabis would be was highest regarding diabetes (48%), stroke (47%), heart attack (44%), and cancer (40%).
A small majority of medical doctors and nurse practitioners (54%) said that they have had patients report a negative reaction or side effect from using cannabis, while 32% said they have not had patients report negative reactions or side effects, and 14% said they did not know.
Health care providers practicing in Quebec were less likely than their colleagues practicing in other regions of the country to have had patients report a negative reaction or side effect (39% compared to 51% to 63% elsewhere in the country). Compared to HCPs working in large urban centres (52%), those working in smaller population centres or rural areas were more likely to have had a patient report a negative reaction or side effect (60%). In addition, HCPs who say they are very comfortable talking to patients about cannabis (61%) and who have a good or very good level of knowledge about cannabis for medical purposes (62%) were more likely than HCPs who are less comfortable and less knowledgeable (41% and 43%, respectively) to say they have had a patient report a negative reaction or side effect.
Of those health care providers who said they had patients report negative reactions or side effects from the use of cannabis for medical purposes (n=438), just over two-thirds (68%) said the side effects were not serious and no medical attention was sought. On the other hand, 42% said the side effects required medical attention. Approximately one in five (21%) respondents reported that the side effects were due to an error in use (e.g., overdosage, under dosage, use of wrong product) and/or that the side effects resulted in hospitalization, disability, incapacity, or death (multiple responses accepted).
Figure 91: Negative reactions or side effects
The side effect was not serious = 68%
The side effect required medical attention = 42%
The side effect was due to an error in use = 21%
The side effect was serious = 21%
Other = 2%
Q28. Thinking of the range of reactions and side effects among those patients, please indicate which of the following have been reported to you? [Multiple Responses Accepted] Base: n=438; those who said patients reported negative reactions or side effects.
Practitioners who recommend that patients grow their own cannabis with authorization from Health Canada were more likely to report that the side effect was due to an error in use (34% vs. 23% of HCPS who recommend sourcing cannabis from a legal storefront and 24% of those who recommend a legal website). Those who have good or very good knowledge about cannabis for medical purposes were more likely to say that the side effect was not serious (78% vs. 62% of those with fair or poor knowledge), as were HCPs who are much more supportive of the use of cannabis for medical purposes following the broader legalization of cannabis (78% vs. 56% of those who are less supportive and 64% of those who report no change in their view).
Asked where they recommend that their patients access cannabis for medical purposes, health care providers were most likely to say they recommend legal storefronts or provincially authorized retailers and legal websites at least some of the time. Specifically, 70% said they recommend legal storefronts at least sometimes while 60% said this about legal website for cannabis for medical purposes. Fewer HCPs recommend that patients access cannabis for medical purposes from the hospital or via Health Canada.
Figure 92: Recommendations to access cannabis for medical purposes
From the hospital
Never = 86%
Sometimes = 11%
Often = 2%
Always = 1%
Apply to Health Canada to designate someone to grow
Never = 83%
Sometimes = 14%
Often = 2%
Always = 1%
Apply to Health Canada to grow their own
Never = 73%
Sometimes = 23%
Often = 2%
Always = 1%
From a legal website for medical cannabis
Never = 40%
Sometimes = 35%
Often = 17%
Always = 8%
From a legal storefront/provincially authorized retailer
Never = 30%
Sometimes = 35%
Often = 24%
Always = 11%
Q29. Where do you recommend that your patients access cannabis for medical purposes…? Base: n=823; all respondents.
Practitioners who are not comfortable discussing cannabis with patients and who have poor or very poor knowledge in this area were more likely to say they never recommend that patients access cannabis for medical purposes from a licensed seller for medical purposes, from a provincially authorized retailer, by designating someone to grow it for them, and by growing it themselves with authorization from Health Canada.
Of those who said they recommend patients access cannabis for medical purposes from select sources (n=646), two-thirds (66%) said they recommend the sources because of the safety of cannabis products, while slightly less (62%) said they recommend sources because of the consistent quality of cannabis products. Smaller majorities identified ease of access (55%) and trust in the sources (52%) as reasons for recommending sources. These reasons were followed at a distance by cost effectiveness (22%).
Figure 93: Reasons for recommending patients access cannabis for medical purposes from sources
Safety of cannabis products = 66%
Consistent quality of cannabis products = 62%
Ease of access = 55%
Trust this/these source(s) = 52%
Cost effectiveness = 22%
Other = 4%
Q30. Why do you recommend that your patients access cannabis for medical purposes from…? [Multiple Responses Accepted] Base: n=646; those who said they sometimes, often or always recommend patients access to cannabis from select sources.
A majority (60%) of respondents who have recommended the use of cannabis or provided medical documents to access cannabis (n=494) indicated that they have been doing so for between two and five years. Within this group, almost identical proportions said they have been doing this for two to three years (31%) and four to five years (30%). Nearly one in five (18%) said they have been doing so for six years or more, while just over one in 10 (12%) said they have been doing so for less than two years.
Figure 94: Length of time recommending cannabis for medical purposes
Less than 12 months = 2%
1 year to less than 2 years = 10%
2 to 3 years = 31%
4 to 5 years = 30%
6 or more years = 18%
Prefer not to respond = 8%
Q31. How long have you been recommending cannabis for medical purposes? Base: n=494; those who have recommended the use of cannabis or provided medical documents to access cannabis.
Just over half (53%) of the health care providers who have recommended the use of cannabis or provided medical documents to access cannabis (n=494) said they have not prescribed pharmaceutical medications containing cannabinoids (e.g., Sativex). Conversely, 43% said they have prescribed such pharmaceutical medications (4% preferred not to respond to this question).
Figure 95: Prescribed medications containing cannabinoids
Yes = 43%
No = 53%
Prefer not to respond = 4%
Q32. Have you ever prescribed pharmaceutical medications containing cannabinoids (e.g., Sativex)? Base: n=494; those who have recommended the use of cannabis or provided medical documents to access cannabis.
Those who have been practicing for more than 15 years were more likely to report having prescribed pharmaceutical medications containing cannabinoids (52% vs. 32% to 37% of those who have been practicing for less than 15 years). So too were those who said they are very comfortable talking to patients about cannabis for medical purposes (59% vs. 41% of those who are only somewhat comfortable doing this) and those who have good to very good knowledge in this area (57% vs. 36% of those with fair knowledge).
Practitioners who authorize a maximum daily amount of cannabis of 3 or more grams (61%) are more likely to have prescribed pharmaceutical medications containing cannabinoids than those whose maximum amount authorized is 1 or 2 grams (45%). HCPs also more likely to have prescribed medications containing cannabinoids are those who always follow up with their patients (56% vs. 26% of HCPs who sometimes or never follow up with patients).
Nabilone is by far the most frequently prescribed pharmaceutical medication containing cannabis. Among practitioners who have prescribed pharmaceutical medications containing cannabinoids (n=208), the vast majority (91%) said they have prescribed Nabilone. This was followed at a distance by Nabiximols 1:1-9-THC and CBD (28%), Dronabinol (20%), and CBD (9%) (multiple responses accepted).
Figure 96: Types of pharmaceutical medications prescribed
Nabilone (Cesamet®) = 91%
Nabiximols 1:1 9-THC and CBD (Sativex®) = 28%
Dronabinol (Marinol®and Syndros®) = 20%
CBD (Epidiolex®) = 9%
Other = <0.5%
Q33. Which pharmaceutical medications containing cannabis have you prescribed? [Multiple Responses Accepted] Base: n=208; those who have pharmaceutical medications containing cannabinoids.
Those who have recommended the use of cannabis or provided medical documents to access cannabis (n=494) most often suggest higher CBD, lower THC or only CBD when doing so. Specifically, just over half (53%) said that they typically suggest higher CBD, lower THC, while over one-third (38%) said they typically suggest only CBD. Approximately one-quarter suggest either a mix of THC and CBD (14%) or equals levels (12%). A relatively small number typically suggest THC only or higher THC, lower CBD (4% each), while 14% said they are unsure or do not know (multiple responses accepted).
Figure 97: Suggested levels of THC and CBD
Higher CBD, lower THC = 53%
CBD only = 38%
A mix of products = 14%
Equal levels of THC and CBD = 12%
THC only = 4%
Higher THC, lower CBD = 4%
Other = 5%
Don't know/Not sure = 14%
Q34. When recommending cannabis for medical purposes, what level of THC and CBD do you typically suggest? [Multiple Responses Accepted] Base: n=494; those who have recommended the use of cannabis or provided medical documents to access cannabis.
Those who have authorized the use of cannabis for medical purposes were more likely than HCPs who have not to say they recommend higher CBD, lower THC (58% vs. 48%) or equal levels of THC and CBD (14% vs 8%).
A majority (57%) of health care providers who have recommended the use of cannabis or provided medical documents to access cannabis (n=494) said that they do not have a daily amount of THC or CBD that they typically recommend. On the other hand, just over one-third (35%) said that they do have a daily maximum amount of THC that they typically recommend, while approximately one-quarter (24%) said this about CBD (multiple responses were accepted).
Figure 98: Daily maximum amount of THC or CBD
Yes, for THC = 35%
Yes, for CBD = 24%
No = 57%
Q35. Is there a daily maximum amount of THC or CBD that you typically recommend? [Multiple Responses Accepted] Base: n=494; those who have recommended the use of cannabis or provided medical documents to access cannabis.
HCPs who have authorized the use of cannabis for medical purposes were more likely than HCPs who have not to say there is a daily maximum about of THC (45% vs. 22% of those who have not issued a medical document) and CBD (28% vs. 18% of those who have not issued a medical document) that they typically recommend to patients.
Additionally, HCPs who are comfortable talking to patients about cannabis for medical purposes (46%), as well as those who have good or very good knowledge about cannabis for medical purposes (46%) were more likely to report having a daily maximum amount of THC that they typically recommend (compared to their counterparts who are somewhat or not comfortable and who have fair to poor knowledge). Practitioners who always follow up with their patients were more likely than those who sometimes or never do to have a maximum daily amount for both THC and CBD. Those who recognize the therapeutic value of terpenes were more likely than those who recognize THC and CBD as therapeutic parts of the cannabis plant to say there is a maximum daily amount of THC that they typically recommend.
As the two accompanying graphs show, recommended daily maximum amounts of THC and CBD vary. That being said, most practitioners do not recommend daily amounts exceeding 10 milligrams (mgs).
Among those who said they recommend a daily maximum amount of THC (n=175), close to three-quarters said they typically recommend daily amounts of 10 mgs. or less. The largest single proportion (29%) said they typically recommend up to 2.5. mgs. daily, followed by almost identical proportions saying they typically recommend between 2.6 and 5 mgs (22%) and between 5.1 and 10 mgs. (21%). The proportion of respondents who typically recommend a daily amount of more than 10 mgs. declines as the dose amount increases (from 15% who typically recommend between 10.1 and 15 mgs. to 1% who typically recommend more than 25 mgs.).
Figure 99: Daily maximum amount of THC recommended
Up to 2.5 mg = 29%
2.6 mg to 5 mg = 22%
5.1 mg to 10 mg = 21%
10. 1 mg to 15 mg = 15%
More than 15 mg = 13%
Q36. What is the daily maximum amount of THC that you typically recommend? Base: n=175; those who say there is a daily maximum of THC.
Among those who said they typically recommend a daily maximum amount of CBD (n=117), nearly two-thirds (64%) said they typically recommend daily amounts of 10 mgs. or less, with the largest single proportion (27%) recommending between 5.1 and 10 mgs. The proportion of practitioners who typically recommend a daily amount of more than 10 mgs. includes 13% who typically recommend between 10.1 and 15 mgs., 4% who typically recommend between 15.1 and 20 mgs., 13% who typically recommend between 20.1 and 25 mgs, and 7% who typically recommend more than 25 mgs.
Figure 100: Daily maximum amount of CBD recommended
Up to 2.5 mg = 15%
2.6 mg to 5 mg = 22%
5.1 mg to 10 mg = 27%
10. 1 mg to 15 mg = 13%
More than 15 mg = 24%
Q37. What is the daily maximum amount of CBD that you typically recommend? Base: n=117; those who say there's a daily maximum of CBD.
Those who have recommended the use of cannabis or provided medical documents to access cannabis (n=494) identified a variety of ways by which they determine what dose to recommend. The most frequently mentioned way, identified by nearly half of these health care providers, was titration (i.e., starting low and increasing as needed).
Figure 101: Method to determine dose
Titration = 49%
Colleagues = 35%
Scientific literature = 31%
Based on patient's experience = 30%
My experience with other patients = 29%
Health Canada = 25%
Licensing college recommendations = 20%
Based on patient's request = 9%
Popular literature = 6%
Refer to specialist/others = 3%
Other = 8%
Q38. How do you determine what dose to recommend? [Multiple Responses Accepted] Base: n=494; those who have recommended the use of cannabis or provided medical documents to access cannabis.
A number of other ways were identified by at least one in five respondents. In descending order of frequency these include, colleagues (35%), scientific literature (31%), the patient's experience (30%), the practitioner's experience with other patients (29%), Health Canada (25%), and licensing college recommendations (20%) (multiple responses accepted). Ways identified less frequently included basing the dosage on the patient's request (9%), popular literature (6%), and referring to a specialist/others (3%).
The following types of HCPs were more likely to say they use titration to determine what dose they will recommend: those who are very comfortable talking to patients about cannabis for medical purposes (62%), those who have good or very good knowledge of cannabis (58%), those who recommend sources through which to access cannabis for medical purposes (52%), those who always follow up with their patients (63%), and those who have prescribed medication with cannabinoids (64%).
Among respondents who have recommended the use of cannabis or provided medical documents to access cannabis (n=494), a majority (58%) said that they do not suggest ways to consume cannabis.
Figure 102: Suggested methods to consume cannabis
Yes = 58%
No = 42%
Q39. When recommending cannabis for medical purposes, do you suggest methods to consume cannabis? Base: n=494; those who have recommended the use of cannabis or provided medical documents to access cannabis.
Practitioners who are very comfortable talking to patients about cannabis for medical purposes (69% vs. 43% of those not very or not at all comfortable) and those who have good or very good knowledge of cannabis (68% vs. 34% of those with poor or very poor knowledge) were more likely to say they suggest methods for consuming cannabis. In addition, health care providers who have authorized the use of cannabis for medical purposes were more likely to say they do suggest methods to consume cannabis (65%) compared to those who have not issued a medical document (49%).
As the accompanying graph shows, the typical daily amount of dried cannabis authorized on a medical document by health care providers who have provided such documents to access cannabis (n=283) varies. The largest single proportion (35%) indicated that there is no typical amount or that it varies too much to say. Half (51%) identified the typical daily amount that they authorize as three grams or less (24% identifying one gram per day, 16% identifying two grams, and 11% identifying 3 grams). Fourteen percent identified typically authorized amounts of four grams or more.
Figure 103: Daily amount of dried cannabis authorized on medical document
1 g per day = 24%
2 = 16%
3 = 11%
4 = 4%
5 = 6%
6-10 = 3%
11-20 = 1%
There is not a typical amount/It varies too much to say = 35%
Q40. What is the typical daily amount of dried cannabis that you authorize on a medical document (in grams per day)? Base: n=283; those who have provided medical documents to access cannabis.
The maximum daily amount of dried cannabis that this same group of health care providers is comfortable authorizing on a medical document also varies. Just over two-thirds placed themselves in a comfort zone ranging from one to five grams per day (18% identifying one gram per day, 14% identifying two grams, 15% identifying 3 grams, 5% identifying 4 grams, and 16% identifying 5 grams). Twelve percent placed themselves in a comfort zone exceeding 5 grams per day, while one in five indicated that there is no maximum amount of cannabis they are comfortable authorizing.
Figure 104: Maximum daily amount of dried cannabis authorized on medical document
1 g per day = 18%
2 = 14%
3 = 15%
4 = 5%
5 = 16%
6-10 = 7%
11-20 = 3%
21-30 = 1%
More than 30 g per day = 1%
There is not a maximum amount = 20%
Q41. What's the maximum daily amount of dried cannabis that you're comfortable authorizing on a medical document? Base: n=283; those who have provided medical documents to access cannabis.
Those who identified a maximum daily amount of dried cannabis that they are comfortable authorizing on a medical document (n=225) provided various reasons to explain why. The most frequently given reason, identified by over half (57%) was the patient's health and safety. This was followed by a desire to limit/minimize the risk of a patient's dependence on or abuse of cannabis (46%), and a decision based on professional experience (43%) (multiple responses accepted).
Reasons identified less often, but still relatively frequently, included lack of evidence that more cannabis would be beneficial (27%), available guidelines (24%), and feedback from other health care providers (23%). The only other reason given with any frequency was because there is credible evidence to support the maximum amount in question (12%).
Figure 105: Reasons for maximum daily amount of dried cannabis authorized on medical document
For patient health and safety = 57%
To limit/minimize risk of patient dependence or abuse of cannabis = 46%
Because of my professional experience = 43%
Because of lack of evidence that more cannabis would be beneficial = 27%
Available guidelines = 24%
Because of feedback from other health care providers = 23%
Because there is credible evidence to support the amount = 12%
Other = 5%
Q42. Why is [Q41] the maximum daily amount of dried cannabis that you're comfortable authorizing on a medical document? [Multiple Responses Accepted] Base: n=225; those who say there is a maximum daily amount of dried cannabis they are comfortable authorizing.
Nearly one-third (32%) of these same practitioners (n=225) indicated that they have patients who have asked them to authorize more dried cannabis than they are comfortable authorizing. Nearly half (48%) said this is not the case and one in five (20%) said they cannot recall.
Figure 106: Patients request more cannabis than comfort levels
Yes = 32%
No = 48%
Can't recall = 20%
Q43. Have patients ever asked you to authorize more dried cannabis than you're comfortable with? Base: n=225; those who say there is a maximum daily amount of dried cannabis they are comfortable authorizing.
Practitioners who said that there is no maximum daily amount of dried cannabis that they are comfortable authorizing on a medical document (n=58) provided various reasons to explain why. Caution should be exercised when interpreting these results though due to the small sample size. Reasons identified most often, in descending order of frequency, included the following: limits should be case dependent, as they would depend on symptoms or disease (34%), the use of titration by patients, resulting in their not always knowing how much they need (30%), and the impression that limits should depend on method of use, some methods requiring higher amounts of cannabis (27%) (multiple responses accepted).
Nearly one in five (19%) said that there is too little evidence to support limits, while 14% pointed to their professional experience to explain why. Small numbers identified feedback from other health care providers (5%) and lack of adverse effects (3%). Nearly one-third of these practitioners (31%) said that they did not know but that there should not be a daily limit.
Figure 107: Reasons for no maximum daily amount of dried cannabis authorized on medical document
Limits should be case dependent, as they would depend on symptom or disease = 34%
I don't know/there just shouldn't be a daily limit = 31%
My patients titrate cannabis for medical purposes, so don't always know how much they need = 30%
Limits would depend on method of use, some methods require higher amounts of cannabis = 27%
There is too little evidence to support limits = 19%
Because of my professional experience = 14%
Because of feedback from other health care providers = 5%
Lack of adverse effects = 3%
Other = 14%
Q44. Why do you not have a daily limit of dried cannabis that you would authorize for patients for medical purposes? [Multiple Responses Accepted] Base: n=58; those who say there is no maximum daily amount of dried cannabis they are comfortable authorizing.
Among practitioners who said they recommend methods to consume cannabis (n=288), the vast majority (90%) said they recommend ingesting it (i.e., oils, extracts). This was followed at a distance by eating it (49%), applying it to one's skin (34%), sublingual consumption (27%), vaporizing it with a non-portable vaporizer (25%), vaporizing it with a vape pen or e-cigarette (18%), drinking it (12%), and smoking it (10%) (multiple responses accepted). Only a few recommended dabbing.
Figure 108: Recommended methods to consume cannabis
Ingest it (oil capsules, extracts) = 90%
Eat it (e.g., brownies, cakes, cookies or candy) = 49%
Applying to the skin (e.g., topicals) = 34%
Sublingual (under the tongue) = 27%
Vaporize it with a vaporizer (non-portable) = 25%
Vaporize it with a vape pen or e-cigarette (portable) = 18%
Drink it (Cannabis beverages) = 12%
Smoke it (e.g., a joint, bong, pipe or blunt) = 10%
Dabbing (e.g., including hot knife/nail) = 1%
Other = 1%
Q45. Which of the following methods do you most often recommend? [Multiple Responses Accepted] Base: n=288; those who recommend methods to consume cannabis.
Health care providers who have recommended the use of cannabis or provided medical documents to access cannabis (n=494) were asked if they typically follow-up with patients after they have recommended that their patients start using cannabis for medical reasons. In response, the largest single proportion (37%) said they always do so and over one-quarter (28%) said they often do so. An almost identical proportion (29%) said they sometimes do so, while 6% said they never do.
Figure 109: Follow up with patients
Never = 6%
Sometimes = 29%
Often = 28%
Always = 37%
Q46. Do you typically follow up with patients after you have recommended that they start using cannabis for medical purposes? Base: n=494; those who have recommended the use of cannabis or provided medical documents to access cannabis.
Those who have authorized the use of cannabis with a medical document were more likely to always (43%) and often (31%) follow up with patients compared to those who have recommended cannabis for medical purposes but who have not provided a medical document (28%, always and 23%, often).
All respondents were asked to assess the usefulness of Health Canada's medical access program. In response, nearly half (49%) assessed it as useful, though they were much more likely to rate it as 'somewhat useful' (38%) than 'very useful' (11%). Conversely, 12% rated it as 'not very useful' and 5% as 'not useful at all'. One-third of respondents (34%) said they did not know.
Figure 110: Health Canada medical access program usefulness
Very useful = 11%
Somewhat useful = 38%
Not very useful = 12%
Not at all useful = 5%
Don't know = 34%
Q47. In your view, how useful is the Health Canada medical access program? Base: n=823; all respondents.
Practitioners who have authorized the use of cannabis for medical were more likely than those who have not done so to say they find Health Canada's medical access program very (21%) or somewhat (45%) useful.
Health care providers who have recommended the use of cannabis or provided medical documents to access cannabis (n=494) were provided with a list of diseases or disorders and asked for which ones they have recommended the use of cannabis. Leading the way was palliative care (56%) followed by cancer (45%), arthritis (40%), insomnia (39%), anxiety disorders (28%), MS, ALS, and spinal cord injury (25%), and PTSD (24%) (multiple responses accepted).
Other diseases or disorders identified with some frequency included irritable bowel syndrome and depression (14% each), epilepsy (12%), inflammatory bowel disease (9%), Parkinson's disease (8%), HIV/AIDS and dystonia (7% each), and Alzheimer's disease/dementia (6%). A host of other diseases/disorders were identified infrequently (5% or less).
Figure 111: Use of cannabis for medical purposes - Disorders and Diseases
Palliative Care = 56%
Cancer = 45%
Arthritis = 40%
Insomnia = 39%
Other anxiety disorders = 28%
MS, ALS, spinal cord injury = 25%
Post-Traumatic Stress Disorder = 24%
Irritable bowel syndrome = 14%
Depression = 14%
Epilepsy = 12%
Inflammatory bowel diseases = 9%
Parkinson's disease = 8%
HIV/AIDS = 7%
Dystonia = 7%
Alzheimer's disease/dementia = 6%
ADHD/ADD = 5%
Glaucoma = 4%
Autism = 4%
Skin diseases = 4%
Tourette's syndrome = 3%
Huntington's disease = 3%
Diabetes = 2%
Neuropathy/ Neuropathic pain = 2%
Obesity = 2%
Schizophrenia/psychosis = 1%
Liver disease = 1%
Other = 6%
Prefer not to say = 3%
Q48. For which of the following diseases or disorders have you recommended the use of cannabis? [Multiple Responses Accepted] Base: n=494; those who have recommended the use of cannabis or provided medical documents to access cannabis.
Asked how frequently they recommend the use of cannabis for these diseases and disorders, respondents were much more likely to say they do so 'sometimes' than 'often' or 'always'. As the accompanying graph shows, though the size of the majority varied, over half the respondents said they 'sometimes' recommend the use of cannabis for the disease or disorder in question. Caution should be exercised when interpreting results in cases where the sample size is small.
Figure 112: Frequency recommending use of cannabis for diseases or disorders
Palliative Care (n=275)
Sometimes = 61%
Often = 33%
Always = 6%
Cancer (n=220)
Sometimes = 68%
Often = 28%
Always = 5%
Arthritis (n=197)
Sometimes = 75%
Often = 23%
Always = 3%
Insomnia (n=191)
Sometimes = 69%
Often = 27%
Always = 4%
Other anxiety disorders (n=140)
Sometimes = 74%
Often = 23%
Always = 3%
MS, ALS, spinal cord injury (n=125)
Sometimes = 75%
Often = 23%
Always = 2%
PTSD (n=120)
Sometimes = 67%
Often = 27%
Always = 6%
Irritable bowel syndrome (n=69)
Sometimes = 76%
Often = 19%
Always = 4%
Depression (n=68)
Sometimes = 69%
Often = 26%
Always = 4%
Epilepsy (n=62)
Sometimes = 85%
Often = 14%
Always = 2%
Inflammatory bowel diseases (n=45)
Sometimes = 78%
Often = 18%
Always = 4%
Parkinson's disease (n=37)
Sometimes = 65%
Often = 29%
Always = 5%
HIV/AIDS (n=35)
Sometimes = 63%
Often = 31%
Always = 6%
Dystonia (n=35)
Sometimes = 66%
Often = 29%
Always = 6%
Alzheimer's disease/dementia (n=26)
Sometimes = 73%
Often = 23%
Always = 4%
ADHD/ADD (n=24)
Sometimes = 61%
Often = 34%
Always = 4%
Glaucoma (n=21)
Sometimes = 81%
Often = 10%
Always = 9%
Autism (n=17)
Sometimes = 88%
Often = 6%
Always = 6%
Skin diseases (n=18)
Sometimes = 66%
Often = 29%
Always = 6%
Tourette's syndrome (n=17)
Sometimes = 76%
Often = 13%
Always = 12%
Huntington's disease (n=15)
Sometimes = 52%
Often = 34%
Always = 13%
Diabetes (n=12)
Sometimes = 67%
Often = 17%
Always = 17%
Obesity (n=8)
Sometimes = 89%
Often = 11%
Always = 0%
Schizophrenia/psychosis (n=7)
Sometimes = 73%
Often = 14%
Always = 13%
Liver disease (n=6)
Sometimes = 100%
Often = 0%
Always = 0%
Q49. How frequently do you recommend the use of cannabis for the following diseases or disorders…? Base: those who have recommended the use of cannabis or provided medical documents to access cannabis.
This same group of respondents was then provided with a list of symptoms and asked for which ones they have recommended the use of cannabis. Three symptoms were identified by a majority as ones for which they have recommended the use of cannabis, though the size of the majority varied. Over three-quarters (78%) said they recommended the use of cannabis for chronic non-cancer pain, over two-thirds (68%) for cancer pain, and just over half for nausea/vomiting (multiple responses accepted).
Following this, in descending order of frequency were problems sleeping (41%), wasting/weight loss/lack of appetite (36%), feelings of anxiety (31%), muscle spasms (23%), headaches/migraines (20%), acute pain (16%), seizures (12%), and feelings of depression (11%). Small numbers recommended cannabis use for opioid withdrawal symptoms (6%) and alcohol withdrawal symptoms (4%).
Figure 113: Use of cannabis for medical purposes – Symptoms
Chronic non-cancer pain = 78%
Cancer pain = 68%
Nausea/vomiting = 52%
Problems sleeping = 41%
Wasting/weight loss and/or lack of appetite = 36%
Feelings of anxiety = 31%
Muscle spasms = 23%
Headaches/migraines = 20%
Acute pain = 16%
Seizures = 12%
Feelings of depression = 11%
Opioid withdrawal symptoms = 6%
Alcohol withdrawal symptoms = 4%
Other = 2%
Prefer not to say = 3%
Q50. For which of the following symptoms have you recommended the use of cannabis? [Multiple Responses Accepted] Base: n=494; those who have recommended the use of cannabis or provided medical documents to access cannabis.
As was the case for diseases and disorders, respondents were much more likely to say they recommend the use of cannabis 'sometimes' than 'often' or 'always' in relation to these symptoms. As the accompanying graph shows, majorities ranging from 62% to 76% said they 'sometimes' recommend the use of cannabis for the symptom in question. The proportion of respondents saying they 'often' do this ranges from 22% to 33%, while the proportion saying they 'always' do this ranges from 2% to 8%.
Caution should be exercised when interpreting results in cases where the sample size is small.
Figure 114: Frequency recommending use of cannabis for symptoms
Chronic non-cancer pain (n=384)
Sometimes = 71%
Often = 26%
Always = 4%
Cancer pain (n=337)
Sometimes = 65%
Often = 30%
Always = 5%
Nausea/vomiting (n=258)
Sometimes = 75%
Often = 23%
Always = 2%
Problems sleeping (n=200)
Sometimes = 68%
Often = 28%
Always = 3%
Wasting/weight loss and/or lack of appetite (n=178)
Sometimes = 67%
Often = 31%
Always = 2%
Feelings of anxiety (n=152)
Sometimes = 76%
Often = 22%
Always = 3%
Muscle spasms (n=111)
Sometimes = 67%
Often = 31%
Always = 3%
Headaches/migraines (n=101)
Sometimes = 68%
Often = 30%
Always = 2%
Acute pain (n=78)
Sometimes = 67%
Often = 26%
Always = 8%
Seizures (n=61)
Sometimes = 72%
Often = 23%
Always = 5%
Feelings of depression (n=53)
Sometimes = 73%
Often = 23%
Always = 4%
Opioid withdrawal symptoms (n=29)
Sometimes = 62%
Often = 31%
Always = 7%
Alcohol withdrawal symptoms (n=19)
Sometimes = 62%
Often = 33%
Always = 5%
Q51. How frequently do you recommend the use of cannabis for the following symptoms? Base: those who have recommended the use of cannabis or provided medical documents to access cannabis.
All respondents were asked how often, on average, they would have patients enquiring about cannabis for medical purposes prior to its legalization. Perhaps not surprisingly, the frequency with which this happened varied. As the accompanying graph shows, 16% of respondents indicated that this occurred once a week or more, with a similar proportion (15%) saying it occurred several times a month. In short, nearly one-third of respondents indicated this happened relatively frequently. Just over one in ten (12%) indicated that this occurred once a month, while just over one-quarter (28%) said it occurred once every few months. Eight percent said it happened once a year, and nearly one in five (19%) said they could not recall.
Figure 115: Frequency of patients inquiring about cannabis before legalization
Daily = 1%
Several times a week = 8%
Once a week = 7%
Several times a month = 15%
Once a month = 12%
Once every few months = 28%
Once a year = 8%
Can't recall = 19%
Q52. Prior to the legalization of cannabis, on average, how often would you have patients inquiring about cannabis for medical purposes? Base: n=823; all respondents.
Nearly two-thirds of respondents (64%) indicated that since the legalization of cannabis, patients ask questions more often about using cannabis for medical purposes. By contrast, just over one in ten (12%) said patients ask questions about this less often. Nearly one in five (18%) said that the frequency with which patients ask about this is about the same as it was prior to the legalization of cannabis.
Figure 116: Frequency of patients asking about use of cannabis since legalization
More often = 64%
Less often = 12%
About the same = 18%
Don't know = 4%
Does not apply = 3%
Q53. Since the legalization of cannabis, do patients ask questions about using cannabis for medical purposes…? Base: n=823; all respondents.
Those practicing in British Columbia, or the North were less likely than their counterparts elsewhere in the country to say that patients are asking questions about cannabis for medical purposes more often since the broader legalization of cannabis in 2018: 48% vs. 80% of HCPs in Atlantic Canada, 68% in Quebec, and 66% each in Ontario and the Prairies.
Practitioners who indicated that their patients ask questions about using cannabis for medical purposes more often or less often since its legalization (n=624) were asked how often, on average, they have patients enquiring about this since its legalization. As was the case prior to legalization, the frequency with which this happens since legalization varies. That being said, well over half (62%) indicated that this occurs relatively frequently. This includes over one-third (37%) who said that this occurs once a week or more, and one-quarter who said it occurs several times a month. Over one-third (36%) said that this occurs once a month or less often.
Figure 117: Frequency of patients inquiring about cannabis since legalization
Daily = 4%
Several times a week = 18%
Once a week = 15%
Several times a month = 25%
Once a month = 16%
Once every few months = 17%
Once a year = 3%
Can't recall = 1%
Q54. Since the legalization of cannabis, on average, how often do you have patients inquiring about cannabis for medical purposes? Base: n=624; those who said patients more or less often ask questions about using cannabis for medical purposes since legalization.
A majority of respondents (60%) said that since its legalization they have noticed changes in the way in which patients are accessing cannabis for medical purposes. Fourteen percent said they have seen no change while just over one-quarter (26%) said they do not know.
Figure 118: Changes in way patients access cannabis since legalization
Yes = 60%
No = 14%
Don't know = 26%
Q55. Since the legalization of cannabis, have you noticed any changes in the way in which patients are accessing cannabis for medical purposes? Base: n=823; all respondents.
Practitioners who are not comfortable talking to patients about cannabis (48%) and those with poor to very poor knowledge of cannabis for medical purposes (also 48%) were less likely than their counterparts to have noticed changes in the way in which patients are accessing cannabis for medical purposes. In addition, HCPs who have authorized the use of cannabis for medical purposes were more likely than those who have not to say they have noticed a change in how patients are accessing cannabis for medical purposes (66% vs. 57%).
Health care providers who indicated that they have noticed changes in how patients access cannabis since its legalization (n=494) were asked what change(s) they have noticed. Perhaps not surprisingly, the most frequently identified change was the increased number of patients who appear to be acquiring cannabis legally. Nearly all the respondents (94%) said they have noticed that more patients appear to be accessing cannabis from a provincially authorized retailer, while 43% said that fewer patients appear to be using illicit sources. While this is the predominant view, some respondents (8%) said that more patients appear to be using illicit sources since the legalization of cannabis (multiple responses accepted).
Figure 119: Noticed changes – Patients
More patients appear to be accessing cannabis from a provincially authorized retailer (storefront or online) = 94%
Fewer patients appear to be using illicit sources = 43%
Patients are accessing cannabis through more than one source = 34%
More patients appear to be growing their own cannabis or designating someone to do it for them = 23%
More patients appear to be accessing cannabis from 'informal' sources (e.g., friends) = 20%
Fewer patients appear to be growing their own cannabis or designating someone to grow it for them = 14%
More patients appear to be using illicit sources = 8%
Other = 1%
Q56. What changes have you noticed? [Multiple Responses Accepted] Base: n=494; those who noticed changes in how patients access cannabis since legalization.
Just over one-third (34%) indicated that patients are accessing cannabis through more than one source, and one in five (20%) think that more patients appear to be accessing cannabis from informal sources. While nearly one-quarter (23%) think that more patients appear to be growing their own cannabis or designating someone to do it for them, 14% think that fewer of their patients are doing this.
All respondents were asked if they have noticed any changes in their health care colleagues' attitudes towards authorizing cannabis for medical purposes since the legalization of cannabis. As the accompanying graph shows, respondents were divided about this. Just over half (52%) said they have noticed no changes in this regard while 48% said they have noticed changes.
Figure 120: Changes in colleagues' attitudes towards authorizing cannabis since legalization
Yes = 48%
No = 52%
Q57. Have you noticed any changes in your health care colleagues' attitudes towards authorizing cannabis for medical purposes since the legalization of cannabis? Base: n=823; all respondents.
HCPs who are much more supportive of the use of cannabis for medical purposes following its broader legalization in Canada were more likely to report noticing a change in their colleagues' attitudes (77% vs. 35% of those who are less supportive and 24% of those whose view has not changed).
Those who said they have noticed changes in their colleagues' attitudes towards authorizing cannabis since its legalization (n=399) were asked what changes they have noticed. The most frequently noticed change, identified by 71% of these practitioners, was greater willingness to authorize cannabis for medical purposes, while a smaller majority (54%) said that colleagues are more likely to refer patients who want such authorization. Nearly two-thirds (64%) said colleagues are more interested in education and training opportunities about cannabis for medical purposes, and 59% said their colleagues are more prepared to discussing cannabis for medical purposes with their patients (multiple responses accepted).
By contrast, few practitioners (6% or less) said they have noticed less willingness or less interest among their colleagues regarding these same things.
Figure 121: Noticed changes – Colleagues
They are more willing to authorize cannabis for medical purposes = 71%
They are more interested in education and training opportunities about cannabis for medical purposes = 64%
They are more prepared to discuss using cannabis for medical purposes with patients = 59%
They are more likely to refer patients who want an authorization to use cannabis for medical purposes = 54%
They are less willing to authorize cannabis for medical purposes = 6%
They are less interested in education and training opportunities about cannabis for medical purposes = 3%
They are less prepared to discuss using cannabis for medical purposes with patients = 2%
They are less likely to refer patients who want an authorization to use cannabis for medical purposes = 2%
Other = 1%
Q58. What changes have you noticed? [Multiple Responses Accepted] Base: n=399; those who noticed changes in colleagues' attitudes towards authorizing cannabis since legalization.
All respondents were asked if they are more or less supportive of the use of cannabis for medical purposes since its legalization. A majority (58%) said they are more supportive of this, though respondents were much more likely to describe themselves as 'somewhat more supportive' (45%) than 'much more supportive' (13%). Relatively few (6%) described themselves as less supportive, while just over one-third (35%) said there has been no change in their views on the use of cannabis for medical purposes.
Since the broader legalization of cannabis, HCPs who have authorized cannabis with a medical document were more likely than those who have not done so to say they are much more supportive (19% vs. 10%) and somewhat more supportive (50% vs. 43%) of the use of cannabis for medical purposes.
Figure 122: Support of cannabis for medical purposes since legalization
Much more supportive = 13%
Somewhat more supportive = 45%
Somewhat less supportive = 5%
Much less supportive = 1%
There has been no change in my views on the use of cannabis for medical purposes = 35%
Q59. Since the legalization of cannabis, are your more, or less supportive of the use of cannabis for medical purposes? Base: n=823; all respondents.
Health care providers who have recommended the use of cannabis or provided medical documents to access cannabis (n=494) were equally divided when asked if their practices for recommending cannabis for medical use has changed since the legalization of cannabis.
Figure 123: Changes in practices for recommending cannabis since legalization
Yes = 50%
No = 50%
Q60. Since the legalization of cannabis, have your practices for recommending cannabis for medical use changed? Base: n=494; those who have recommended the use of cannabis or provided medical documents to access cannabis.
Practitioners who said they have changed their practices for recommending cannabis for medical use since the legalization of cannabis (n=248) most often explained that they refer more patients to specialists to access cannabis for medical purposes (51%) and regularly consider cannabis for medical purposes as a treatment option for certain conditions (48%). Fewer, approximately one in five, said they refer fewer patients to specialists because they are more comfortable authorizing cannabis (multiple responses accepted).
Figure 124: Changes in practice
I refer more patients to specialists to access cannabis for medical purposes = 51%
I regularly consider cannabis for medical purposes as a treatment option for certain conditions = 48%
I refer fewer patients to specialists because I am more comfortable authorizing cannabis = 19%
Other = 5%
Q61. How have your practices changed? [Multiple Responses Accepted] Base: n=248; those who have changed their practices for recommending cannabis since legalization.
Responses were mixed when respondents were asked how supportive their licensing college is regarding the use of cannabis for medical purposes. While nearly half (47%) described their licensing college as supportive, respondents were much more likely to describe their college as 'somewhat supportive' (39%) than 'very supportive' (7%). By contrast, fifteen percent described their college as 'somewhat' or 'very' unsupportive, while well over one-third (39%) said they did not know how supportive their licensing college is regarding the use of cannabis for medical purposes.
HCPs who have authorized cannabis with a medical document were more likely than those who have not done so to say their licensing college is very supportive (10% vs. 5%) and somewhat supportive (50% vs. 33%) of the use of cannabis for medical purposes.
Figure 125: Support of licensing college
Very supportive = 7%
Somewhat supportive = 39%
Somewhat unsupportive = 11%
Very unsupportive = 4%
Don't know = 39%
Q62. How supportive is your licensing college regarding the use of cannabis for medical purposes?
Base: n=823; all respondents.
Nearly half of all survey respondents said they do not know if their licensing college offers courses or guidance on authorizing the use of cannabis for medical purposes. Over one-third answered affirmatively, specifying that their college offers both courses and guidance (15%), only guidance (16%), and only courses (6%). Seventeen percent said their licensing college offers no courses or guidance on authorizing the use of cannabis for medical purposes.
Figure 126: Licensing college courses or guidance on authorizing use of cannabis for medical purposes
Yes, courses and guidance = 15%
Yes, courses only = 6%
Yes, guidance only = 16%
No = 17%
Other = <0.5%
Don't know = 46%
Q63. Does your licensing college offer courses or guidance on authorizing the use of cannabis for medical purposes? Base: n=823; all respondents.
Those who have authorized the use of cannabis for medical purposes were more likely than HCPs who have not done so to say their licensing college offers courses and guidance (23% vs. 11%) and guidance only (20% vs 13%).
Respondents collectively identified a variety of sources they typically access to look for information on the use of cannabis for medical purposes. Sources identified most frequently, and the only ones identified by a majority of respondents, included continuing medical education programs (57%), and medical journals (52%) (multiple responses accepted). These were followed by Health Canada (39%), conferences (36%), and Colleagues or co-workers (32%). Between one-fifth and one-quarter of respondents identified sources that included webinars, professional associations, regulatory bodies or licensing colleges, and general internet searches. The only other source identified with any frequency was the Public Health Agency of Canada (16%). Smaller proportions (7% or less) identified Centers for Disease control and Prevention, the Canadian consortium for the investigation of Cannabinoids, social media, and professional insurers.
Some respondents (8%) said that they do not look for information on the use of cannabis for medical purposes.
Figure 127: Sources of information about use of cannabis for medical purposes
CME programs = 57%
Medical journals = 52%
Health Canada = 39%
Conferences = 36%
Colleague or co-worker = 32%
Webinars = 24%
Professional association = 24%
Regulatory body or licensing college = 23%
General internet search = 21%
Public Health Agency of Canada = 16%
CDC = 7%
CCIC = 5%
Social media = 3%
Professional insurer = 1%
Other = 3%
Do not look for this information = 8%
Q64. Where do you typically look for information on the use of cannabis for medical purposes? [Multiple Responses Accepted] Base: n=823; all respondents.
The following tables present the characteristics of respondents (using weighted data).
| Province and territories | Percent |
|---|---|
| Ontario | 43% |
| Quebec | 14% |
| British Columbia | 20% |
| Alberta | 13% |
| Nova Scotia | 3% |
| Manitoba | 4% |
| New Brunswick | 2% |
| Saskatchewan | 3% |
| Newfoundland and Labrador | 1% |
| Prince Edward Island | <0.5% |
| Territories | <0.5% |
| Age | Percent |
|---|---|
| Under 35 years | 13% |
| 35-44 | 35% |
| 45-54 | 24% |
| 55-64 | 16% |
| 65+ | 7% |
| No response | 4% |
| Gender | Percent |
|---|---|
Woman |
38% |
Man |
57% |
Other gender |
<1% |
No response |
5% |
| Type of Practitioner | Percent |
|---|---|
| Physician | 94% |
| Nurse Practitioner | 6% |
| Type of Physician | Percent |
|---|---|
| General Practitioner | 51% |
| Specialist | 49% |
| Area | Percent |
|---|---|
| Large urban population centre (more than 100,000 individuals) | 73% |
| Medium population centre (between 30,000 and 100,000 individuals) | 16% |
| Small population (between 1,000 and 29,000 individuals) | 6% |
| Rural location | 3% |
| No response | <1% |
What follows in this section is a comparison of the experiences of patients and health care providers. While the differences reported should be interpreted with caution due to sample composition, they provide some high-level insights.
Approximately half (53%) of the patients surveyed who discussed the use of cannabis for medical purposes with their HCP received a medical document authorizing them to use cannabis for medical purposes. In contrast, roughly one-third (35%) of the HCPs surveyed said they have given a patient a medical document to access cannabis to treat their symptoms and/or diseases or disorders.[17] Moreover, one in 10 patients who discussed the use of cannabis with a health care provider reported that the HCP was not supportive of the use of cannabis for medical purposes, and 8% found that some HCPs consulted where supportive and others were not. Among HCPs, 17% have refused to give a patient a medical document to access cannabis, and 54% have recommended that a patient not use cannabis for medical purposes. As noted above, these comparisons should be treated with caution.
Patients were asked if they have gone back to their HCP for a follow-up regarding the use of cannabis for medical purposes. Sixty-two percent said they continue to be followed by their HCP, one-quarter (24%) reported having one follow-up only, and 14% said they never followed up with their HCP. Health care providers were asked if they typically follow up with patients after recommending the use of cannabis for medical purposes. Thirty-seven percent said they always follow up, 28% do so often, and 29% sometimes follow up with these patients. Taken together, 94% follow up at least some of the time compared to 86% of patients who reported at least one follow up. Few HCPs (6%) say they never follow up with these patients—more than twice as many patients said the same.[18]
Patients who have been authorized to use cannabis for medical purposes by their HCP were asked what levels of THC and CBD were recommended. Similarly, HCPs were asked what levels of THC and CBD they typically suggest to patients when recommending cannabis for medical purposes.
In response, 53% of HCPs said they typically recommend products higher in CBD and lower in THC (compared to 31% of patients). Moreover, 38% of HCPs recommend CBD only compared to 19% of patients who said their HCP recommended CBD only. Compared to HCPs, more patients said their medical doctor or nurse practitioner recommended equal levels of THC and CBD, THC only, or high THC and lower CBD. Again, there is a difference evident between the experiences of patients and the practices of HCPs, but these differences should be treated with caution given the sample compositions.
![Figure 128: THC, CBD levels [HCPs vs. patients]. Text version below.](images/Slide127.JPG)
Figure 128: THC, CBD levels [HCPs vs. patients]
Higher CBD, lower THC
HCPs = 53%
Patients = 31%
CBD only
HCPs = 38%
Patients = 19%
Equal levels of THC and CBD
HCPs = 12%
Patients = 24%
THC only
HCPs = 4%
Patients = 8%
Higher THC, lower CBD
HCPs = 4%
Patients = 17%
Q34. HCPs: When recommending cannabis for medical purposes, what level of THC and CBD do you typically suggest
Q24. Patients: What levels of THC and CBD did your medical doctor or nurse practitioner recommend?
As figure 129 illustrates, there are differences between the methods of consuming cannabis HCPs reported recommending to their patients and the methods patients reported using to consume cannabis for medical purposes. The most common type of cannabis recommended by HCPs are cannabis oils and extracts (90%). In contrast, the single largest proportion of patients said they consumed cannabis for medical purposes by smoking it (44%).
![Figure 129: Type of cannabis [HCPs vs. patients]. Text version below.](images/Slide128.JPG)
Figure 129: Type of cannabis [HCPs vs. patients]
Ingest it (oil capsules, extracts)
HCPs = 90%
Patients = 31%
Eat it (e.g., brownies, cakes, cookies or candy)
HCPs = 49%
Patients = 34%
Applying to the skin (e.g., topicals)
HCPs = 34%
Patients = 15%
Sublingual (under the tongue)
HCPs = 27%
Patients = 18%
Vaporize it with a vaporizer (non-portable)
HCPs = 25%
Patients = 10%
Vaporize it with a vape pen or e-cigarette (portable)
HCPs = 18%
Patients = 19%
Drink it (Cannabis beverages)
HCPs = 12%
Patients = 11%
Smoke it (e.g., a joint, bong, pipe or blunt)
HCPs = 10%
Patients = 44%
Dabbing (e.g., including hot knife/nail)
HCPs = 1%
Patients = 6%
Q45. HCPs: Which of the following methods do you most often recommend?
Q56. Patients: In the last 12 months, which of the following methods have you used to consume cannabis for medical purposes?
When asked what amount of dried cannabis they typically authorize, HCPs most frequently reported that there is not a typical amount they would recommend (35%). Among the rest, 24% typically recommend 1 gram of dried cannabis, 16% recommend 2 grams, and 11% recommend 3 grams. The patients surveyed, in contrast, were more likely to report being authorized on their medical document by their HCP to use larger amounts of cannabis: 21% said they are authorized to use 2 grams per day (vs. 16% of HCPs), 22% said 3 to 4 grams (vs. 13% of HCPs), and 25% said 5 grams or more per day (vs. 10% of HCPs).
![Figure 130: Amount of cannabis [HCPs vs. patients]. Text version below.](images/Slide129.JPG)
Figure 130: Amount of cannabis [HCPs vs. patients]
1 g per day
HCPs = 24%
Patients = 15%
2
HCPs = 16%
Patients = 21%
3
HCPs = 11%
Patients = 15%
4
HCPs = 4%
Patients = 7%
5 to 10
HCPs = 9%
Patients = 16%
More than 10 g per day
HCPs = 1%
Patients = 9%
Q40. HCPs: What is the typical daily amount of dried cannabis that you authorize on a medical document?
Q35. Patients: How much cannabis are you currently authorized to use per day?
Few patients (9%) reported experiencing adverse or negative effects from the use of cannabis for medical purposes. When HCPs were asked if any patients had reported a negative reaction or side effect, however, more than half (54%) have had patients report a negative reaction.[19]
Among patients who experienced an adverse effect, 68% said the side effect was not serious, 41% reported an error in use, while 8% were hospitalized and/or required medical attention. Among HCPs, 68% said their patients' side effect was not serious, and 21% said the side effect was due to an error in use. HCPs were much more likely to report that the side effect required hospitalization and/or medical attention (63%).
![Figure 131: Adverse reactions [HCPs vs. patients]. Text version below.](images/Slide130.JPG)
Figure 131: Adverse reactions [HCPs vs. patients]
The side effect was not serious
HCPs = 68%
Patients = 68%
The side effect required medical attention
HCPs = 42%
Patients = 4%
The side effect was due to an error in use
HCPs = 21%
Patients = 41%
The side effect was serious
HCPs = 21%
Patients = 4%
Q28. HCPs: Thinking of the range of reactions and side effects among those patients, please indicate which of the following have been reported to you?
Q68. Patients: You answered that you experienced a negative reaction or side effect from using cannabis for medical purposes. Which of the following best describes this experience?
Below is a description of the research methodologies. All steps of the project complied with market research industry standards and the Standards for the Conduct of Government of Canada Public Opinion Research.
The following specifications applied to this survey:
| Participation Rate = R/(U+IS+R) | |
|---|---|
| Total Sample Used | 15,032 |
| Unresolved (U) | 10,748 |
| In-scope non-responding units (IS) | 154 |
| Respondent break-off/did not complete the survey | 154 |
| Responding units (R) | 4,130 |
| Completed survey | 1,205 |
| Disqualified | 2,799 |
| Over quota | 126 |
| Participation Rate = R/(U+IS+R) | 27% |
The following specifications applied to this survey:
| Participation Rate = R/(U+IS+R) | |
|---|---|
| Total Sample Used | 10,802 |
| Unresolved (U) | 9,489 |
| In-scope non-responding units (IS) | 166 |
| Respondent break-off/did not complete the survey | 166 |
| Responding units (R) | 1,147 |
| Completed survey | 823 |
| Disqualified – No experience with cannabis for medical purposes | 179 |
| Disqualified – Participated in a GC survey in the previous 30 days | 1 |
| Over quota | 144 |
| Participation Rate = R/(U+IS+R) | 11% |
Thank you for agreeing to take part in this survey. We anticipate that the survey will take up to 20 minutes to complete.
This research is being conducted by Phoenix Strategic Perspectives (Phoenix SPI), a Canadian public opinion research firm, on behalf of Health Canada.
The purpose of this survey is to gather evidence on the state of access to cannabis for medical purposes in Canada.
Your participation in the survey is completely voluntary and confidential. Your decision on whether or not to participate will not affect any dealings you may have with the Government of Canada, now or in future.
The final report written by Phoenix SPI will be available to the public through Library and Archives Canada (www.bac-lac.gc.ca/).
If you have any questions about the survey, you may contact Phoenix SPI at research@phoenixspi.ca.
Your help is greatly appreciated, and we look forward to receiving your feedback.
As a parent of or legal guardian to a youth living in your household, we are requesting your permission for your teenager to participate in an important survey being conducted for Health Canada.
This research is being conducted by Phoenix Strategic Perspectives (Phoenix SPI), a Canadian public opinion research firm, on behalf of Health Canada.
The purpose of this survey is to gather evidence on the state of access to cannabis for medical purposes in Canada.
Your participation in the survey is completely voluntary and confidential. Your decision on whether or not to participate will not affect any dealings you may have with the Government of Canada, now or in future.
The final report written by Phoenix SPI will be available to the public through Library and Archives Canada (www.bac-lac.gc.ca/).
If you have any questions about the survey, you may contact Phoenix SPI at research@phoenixspi.ca.
Would you allow your teen continue?
Thank you for your support of this important research. Before hitting the start button, please have your teen available to begin answering the following questions.
1a. Would you be willing to indicate in which of the following age categories you belong?
2. In which province or territory do you currently live?
What was your sex at birth?
What is your gender? This refers to current gender which may be different from sex assigned at birth.
[SKIP IF Q1=<18] Are you the guardian and/or parent of any of the person(s) under the age of 18 in your household?
For the purposes of this survey:
*[HYPERLINK/MOUSEOVER: Synthetic cannabinoids are human-made chemicals, often referred to as "herbal incense" under names such as K2 and spice.]
6. In the past 3 years (e.g., since the legalization* of cannabis) have you used cannabis for medical purposes?
*[HYPERLINK/MOUSEOVER: Recreational, or non-medical, use of cannabis became legal for adults on October 17, 2018, in all provinces and territories. PLACE A MOUSEOVER FOR ALL OCCURRENCES OF THE WORD 'LEGALIZATION' OR VARIATIONS WHERE THE TERM IS MARKED BY AN ASTERISK.]
Q6A. [IF Q5=01] Does your child use cannabis for medical purposes?
Q6B. [IF Q6A=01] Would you be willing to answer questions about your child's use of cannabis for medical purposes?
[DO NOT ASK THIS SECTION OF PARENTS: Q6B=01]
Before we ask about your use of cannabis for medical purposes, we have a few questions about cannabis use for non-medical purposes. By non-medical, we mean recreational, social, spiritual, lifestyle and other similar non-medical uses.
7. In the past 3 years, have you used cannabis for non-medical purposes?
8. [IF Q7=01] In a typical month, how often do you use cannabis for non-medical purposes?
[SHOW FOR PARENTS OF A CHILD WHO USES CANNABIS FOR MEDICAL PURPOSES: The questions in the survey focus on your child's use of cannabis for medical purposes. Please answer the questions to the best of your ability.]
These next questions focus on why you have [IF Q6B=01: REPLACE 'you have' WITH 'your child has'] used cannabis for medical purposes.
9. For which of the following symptoms have you [IF Q6B=01: REPLACE 'have you' WITH 'has your child'] used cannabis for medical purposes?
[ROTATE ITEMS]
10. For which of the following diseases or disorders have you [IF Q6B=01: REPLACE 'have you' WITH 'has your child'] used cannabis for medical purposes?
[ROTATE ITEMS]
11. Did you [IF Q6B=01: REPLACE 'you' WITH 'your child'] use cannabis for medical purposes before cannabis was legalized* (before October 17, 2018)?
12. How long have you [IF Q6B=01: REPLACE 'have you' WITH 'has your child'] been using cannabis for medical purposes?
13. Which, if any, of the following factors contributed to your decision, or motivated you, to start [IF Q6B=01: ADD 'your child'] using cannabis for medical purposes?
[ROTATE ITEMS]
14. [IF Q16=05] You said that the legalization* of cannabis in Canada was a factor that motivated you to start [IF Q6B=01: ADD 'your child'] using cannabis for medical purposes. Why is that?
[ROTATE ITEMS]
15. Excluding cannabis, do you [IF Q6B=01: REPLACE 'do you' WITH 'does your child'] use other medications, therapies, or substances to:
[GRID FORMAT]
[ROWS]
[RESPONSE OPTIONS; COLUMNS]
These next questions focus on how you access cannabis for medical purposes.
To start,
16. Did you [IF Q6B=01: REPLACE 'you' with 'your child'] discuss using cannabis for medical purposes with a medical doctor or nurse practitioner?
17. [IF Q16=04] Why did you [IF Q6B=01: REPLACE 'you' with 'your child'] not discuss using cannabis for medical purposes with a medical doctor or nurse practitioner?
[ROTATE ITEMS]
18. [IF Q16=04] Did you [IF Q6B=01: REPLACE 'you' with 'your child'] discuss using cannabis for medical purposes with another health care provider?
19. [IF Q18=01] Was the health care provider you [IF Q6B=01: REPLACE 'you' with 'your child'] discussed this with a…
[CONTINUE IF RESPONDENT DISCUSSED USING CANNABIS FOR MEDICAL PURPOSES AT Q16 (I.E., Q16=01,02,03); IF THEY DID NOT, (I.E., IF Q16=04), GO TO Q44]
20. [IF Q16=01,02,03] How many medical doctors or nurse practitioners did you [IF Q6B=01: REPLACE 'you' with 'your child'] consult on the use of cannabis for medical purposes?
21. [IF Q20=01,06] Was your medical doctor or nurse practitioner supportive of using cannabis to treat your [IF Q6B=01: ADD 'child's'] condition?
22. [IF Q20=02,03,04,05] Were the medical doctors or nurse practitioners you consulted supportive of using cannabis to treat your [IF Q6B=01: ADD 'child's'] condition?
23. [IF Q21=02 OR Q22=02,03] Why do you think the medical doctor(s) or nurse practitioner(s) you consulted was/were not supportive of using cannabis to treat your [IF Q6B=01: ADD 'child's'] condition?
[ROTATE ITEMS]
24. [IF Q21=01 OR Q22=01,03] What levels of THC and CBD did your [IF Q6B=01: ADD 'child's'] medical doctor or nurse practitioner recommend?
25. [IF Q21=01 OR Q22=01,03] What type(s) of cannabis did your medical doctor or nurse practitioner recommend you [IF Q6B=01: REPLACE 'you' with 'your child'] take?
26. [IF Q21=01 OR Q22=01,03] How often did your medical doctor or nurse practitioner recommend that you [IF Q6B=01: REPLACE 'you' with 'your child'] use cannabis to treat the medical condition?
27. [IF Q16=01,02,03] Did the medical doctor or nurse practitioner discuss your [IF Q6B=01: ADD 'child's'] medical needs?
28. [IF Q16=01,02,03] Have you [IF Q6B=01: REPLACE 'you' WITH 'your child'] gone back to the medical doctor or nurse practitioner for follow up?
29. [IF Q16=01,02,03] Did you get a medical document* from the medical doctor or nurse practitioner authorizing a certain daily amount of cannabis to treat your [IF Q6B=01: ADD 'child's'] condition?
*[HYPERLINK/MOUSEOVER: A medical document authorizing the use of cannabis for medical purposes typically contains information about the doctor or nurse practitioner and you, the daily quantity (grams) of dried cannabis that you are authorized to use for medical purposes, and the length of time that you are authorized to do so. They are like prescriptions.]
30. [IF Q29=01: AUTHORIZED USER] How many times have you [IF Q6B=01: REPLACE 'you' WITH 'your child'] gotten a medical document for cannabis?
31. [IF Q29=02] Why didn't you [IF Q6B=01: REPLACE 'you' WITH 'your child'] get a medical document from the medical doctor or nurse practitioner?
32. [IF Q31=01] Why didn't you [IF Q6B=01: REPLACE 'you' WITH 'your child'] ask for a medical document from the medical doctor or nurse practitioner?
33. [IF Q31=02] What reason did the medical doctor or nurse practitioner give for refusing to give you [IF Q6B=01: REPLACE 'you' WITH 'your child'] a medical document?
[ROTATE ITEMS]
[THOSE WITHOUT A MEDICAL DOCUMENT OR WHO CAN'T RECALL [I.E., Q29=02,03, SKIP TO Q44]
34. [IF Q29=01: AUTHORIZED USER] From whom did you get your [IF Q6B=01: ADD 'child'] medical document for cannabis?
[ROTATE ITEMS]
35. [IF Q29=01: AUTHORIZED USER] Your medical document includes the daily dosage prescribed by a medical doctor or nurse practitioner. How much cannabis are you [IF Q6B=01: REPLACE 'are you' WITH 'is your child'] currently authorized to use per day? Please indicate the amount in grams (g) of dried cannabis found on your current medical document.
36. [IF 29=01: AUTHORIZED USER] Has the amount of cannabis you are [IF Q6B=01: REPLACE 'you are' WITH 'your child is'] authorized to use changed over time?
37. [IF 29=01: AUTHORIZED USER] Were you ever charged a fee for your [IF Q6B=01: ADD 'child's'] medical document for cannabis (e.g., consultation fee)?
38. [IF Q37=01] How much were charged for the medical document?
[NOTE: ONLY ASK Q39-43 IF Q29=01; USERS HAVE A MEDICAL DOCUMENT, INCLUDING PARENTS, I.E., AUTHORIZED USERS]
These next questions focus on where you access cannabis for medical purposes.
To start,
39. [IF Q29=01; AUTHORIZED USER] Which of the following apply to you [IF Q6B=01, REPLACE 'you' WITH 'your child']?
Through the Health Canada cannabis for medical purposes program, if you have a medical document you can register to buy cannabis directly from 1) a licensed seller for medical purposes who ships it to your home, or 2) apply to Health Canada for authorization to grow your own, or designate someone else to grow it for you.
*IF Q6B=01, USE THESE RESPONSE OPTIONS:
40. [IF Q39=01; AUTHORIZED USER] What issues, if any, did you [IF Q6B=01, ADD '/your child'] encounter when applying to Health Canada for authorization and when growing your own [IF Q6B=01, DELETE 'your own'] cannabis for medical purposes?
[ROTATE ITEMS]
41. [IF Q39=02; AUTHORIZED USER] What issues, if any, did you [IF Q6B=01, ADD '/your child'] encounter with designating someone to grow cannabis for you [IF Q6B=01, DELETE 'for you'] for medical purposes?
[ROTATE ITEMS]
42. [IF Q39=03; AUTHORIZED USER] What issues, if any, did you [IF Q6B=01, ADD '/your child'] encounter when buying cannabis from a licensed seller for medical purposes?
[ROTATE ITEMS]
43. [IF Q39=03; AUTHORIZED USER] Why do you [IF Q6B=01, ADD '/your child'] buy cannabis through a licensed seller for medical purposes?
[ROTATE ITEMS]
44. [ASK EVERYONE] Where do you typically get the cannabis you use [IF Q6B=01: REPLACE 'you use' WITH 'your child uses'] for medical purposes?
Through the Health Canada cannabis for medical purposes program, if you have a medical document you can register to buy cannabis directly from 1) a licensed seller for medical purposes who ships it to your home, or 2) apply to Health Canada for authorization to grow your own, or designate someone else to grow it for you.
45. [IF Q44=04,05,08,09,10,11,12,13] Why do you [IF Q6B=01: REPLACE 'you' WITH 'your child'] access cannabis for medical purposes from these sources?
[ROTATE ITEMS]
46. [IF Q44≠02,03 or 06 AND Q39≠01,02,03] Have you [IF Q6B=01: REPLACE 'you' WITH 'your child'] considered any of the following:
47. [IF Q46≠01 AND Q44≠02 AND Q39≠01] Why did you [IF Q6B=01: REPLACE 'you' WITH 'your child'] not consider applying to Health Canada to grow your [IF Q6B=01: REPLACE 'your' WITH 'their'] own cannabis for medical purposes?
[ROTATE ITEMS]
48. [IF Q46≠03 AND Q44≠06 AND Q39≠03] Why have you [IF Q6B=01: REPLACE 'you' WITH 'your child'] not considered buying cannabis for medical purposes from a licensed seller?
[ROTATE ITEMS]
49. [IF Q44=04,05,06,08,09,10,11,12,13] In general, how much do you [IF Q6B=01: REPLACE 'do you' WITH 'does your child'] spend per month on cannabis for medical purposes?
50. [If Q44=01,02,03] Why do you grow your own cannabis or designate someone to grow it for you [IF Q6B=01: 'Why does your child grow their own cannabis or designate someone to grow it for them']?
51. [IF Q44=01,02,03] How many cannabis plants are you or your designated grower currently growing for your medical purposes [IF Q6B=01: How many cannabis plants is your child or their designated grower currently growing for their medical purposes]?
52. Are you [IF Q6B=01: REPLACE 'you' WITH 'your child'] currently covered by insurance for cannabis for medical purposes?
53. Have you [IF Q6B=01: REPLACE 'you' WITH 'your child'] ever been a beneficiary of compassionate pricing for cannabis?
[ASK EVERYONE]
These next questions focus on how you use [IF Q6B=01: REPLACE 'you use' WITH 'your child uses'] cannabis for medical purposes.
54. In a typical month, how often do you use [IF Q6B=01: REPLACE 'do you use' WITH 'does your child uses'] cannabis for medical purposes?
55. [IF Q54≠05,06] In a typical month, how many times per day do you use [IF Q6B=01: REPLACE 'do you use' WITH 'does your child uses'] cannabis for medical purposes?
56. In the last 12 months, which of the following methods have you [IF Q6B=01: REPLACE 'have you' WITH 'has your child'] used to consume cannabis for medical purposes?
[ROTATE ITEMS]
57. When choosing cannabis products for medical purposes, what levels of THC and CBD do you [IF Q6B=01: REPLACE 'do you' WITH 'does your child'] typically use?
58. [IF Q56=01] On the days that you [IF Q6B=01: REPLACE 'you' WITH 'your child'] smoked cannabis for medical purposes, how much dried flower/leaf did you typically use?
59. [IF Q57=02] When you [IF Q6B=01: REPLACE 'you' WITH 'your child'] ate edible cannabis products (e.g. cookies or gummies) for medical purposes, how much did you typically eat in a day?
60. [IF Q57=03] In a typical month, on the days that you [IF Q6B=01: REPLACE 'you' WITH 'your child'] drank cannabis beverages for medical purposes, how much was typically consumed in a day?
61. [IF Q57=04,05] In a typical month, on the days that you [IF Q6B=01: REPLACE 'you' WITH 'your child'] vaped cannabis for medical purposes, how much was typically used in a day?
62. [IF Q57=06] In a typical month, on the days that you [IF Q6B=01: REPLACE 'you' WITH 'your child'] dabbed cannabis for medical purposes, how much was typically used in a day?
63. [IF Q57=07] In a typical month, on the days that you [IF Q6B=01: REPLACE 'you' WITH 'your child'] applied cannabis topicals for medical purposes, how much was typically used in a day?
64. [IF Q57=08] In a typical month, on the days that you [IF Q6B=01: REPLACE 'you' WITH 'your child'] consumed cannabis sublingually (under the tongue) for medical purposes, how much was typically used in a day?
65. [IF Q57=09] In a typical month, on the days that you [IF Q6B=01: REPLACE 'you' WITH 'your child'] ingested cannabis extract (e.g., oil capsules) for medical purposes, how much was typically used in a day?
66. How, if at all, has your [IF Q6B=01: ADD 'child's'] frequency of using cannabis for medical purposes changed in the past 3 years?
[ASK EVERYONE]
These next questions focus on the outcome of using cannabis for medical purposes.
67. What has been the outcome of using cannabis for medical purposes [IF Q6B=01: ADD 'for your child']?
[ROTATE ITEMS]
68. [IF Q67=12] You answered that you [IF Q6B=01: REPLACE 'you' WITH 'your child'] experienced a negative reaction or side effect from using cannabis for medical purposes. Which of the following best describes this experience?
69. [ASK IF 67=01] You mentioned that your [IF Q6B=01: REPLACE 'your' WITH 'your child's'] symptoms have improved since starting to use cannabis for medical purposes. Have you seen a small, moderate, or significant improvement in your [IF Q6B=01: ADD 'child's'] symptoms?
[GRID FORMAT]
[INSERT SELECTED ITEMS FROM Q9; ROWS]
[RESPONSE OPTIONS; COLUMNS]
[ASK EVERYONE]
70. [IF Q11=01] Prior to the legalization* of cannabis where did you typically get the cannabis you [IF Q6B=01: REPLACE 'you' WITH 'your child'] used for medical purposes?
Select all that apply
[ROTATE ITEMS]
71. In your opinion, how has the legalization* of cannabis affected access to cannabis for medical purposes?
72. [ASK IF Q71=01] How has the legalization* of cannabis positively impacted access to cannabis for medical purposes?
[ROTATE ITEMS]
73. [IF Q72=08] You mentioned that there is less stigma associated with the use of cannabis for medical purposes. In which situations are you noticing that it is more socially acceptable to use or talk about cannabis for medical purposes?
Select all that apply
[ROTATE ITEMS]
74. Since legalization* (October 2018), are there any challenges or barriers to accessing cannabis for medical purposes?
75. [ASK IF Q74=01] What are the challenges or barriers to accessing cannabis for medical purposes?
[ROTATE ITEMS]
76. [IF Q75=2+ ITEMS] You identified the following challenges or barriers to accessing cannabis for medical purposes. Please rank them in order, using "1" to indicate the most important challenge, "2" the second most important challenge, etc.
[INSERT ITEMS FROM Q75]
These last questions will help us group your answers with others that we will receive in this survey.
77. In general, how is your [IF Q6B=01: ADD 'child's'] physical health?
78. In general, how is your [IF Q6B=01: ADD 'child's'] mental health?
79. What is the highest level of formal education that you have completed?
80. What language do you speak most often at home?
81. Which of the following best describes your total household income last year, before taxes, from all sources for all household members?
82. Were you born in Canada?
83. [IF Q82=02] In what year did you first come to Canada?
84. We know that people of different races do not have significantly different genetics. But our race still has important consequences, including how we are treated by different individuals and institutions. Which race category best describes you?
Select all that apply.
85. [IF Q84=03] Which Indigenous group(s) do you identify as? Please select all that apply.
86. [IF Q6B=01: DO NOT ASK] What is your sexual orientation? Would you say you are:
87. Which of the following best describes the size of your community?
Finally,
88. Were you able to provide 'honest' answers about your cannabis use during the survey?
That concludes the survey. This survey was conducted on behalf of Health Canada. In the coming months the report will be available from Library and Archives Canada. We thank you very much for taking the time to answer this survey. Your help is greatly appreciated.
Thank you for agreeing to take part in this survey. We anticipate that the survey will take up to 15 minutes to complete.
This research is being conducted by Phoenix Strategic Perspectives (Phoenix SPI), a Canadian public opinion research firm, on behalf of Health Canada.
The purpose of this survey is to gather evidence on the state of access to cannabis for medical purposes in Canada.
Your participation in the survey is completely voluntary and confidential. Your decision on whether or not to participate will not affect any dealings you may have with the Government of Canada, now or in future.
The final report written by Phoenix SPI will be available to the public through Library and Archives Canada (www.bac-lac.gc.ca/).
If you have any questions about the survey, you may contact Phoenix SPI at research@phoenixspi.ca.
Your help is greatly appreciated, and we look forward to receiving your feedback.
TERMINATION MESSAGES:
INCLUDE MOUSEOVERS AS FOLLOWS:
1. In the previous 30 days, in which, if any, of the following have you participated?
2. Do you, or any member of your immediate family, work for…?
Recreational, or non-medical, use of cannabis became legal for adults on October 17, 2018, in all provinces and territories. For the purposes of this survey, 'cannabis' is used to refer to marijuana (e.g., weed, pot), hashish, THC, CBD or any other products made from the cannabis plant. It does not include pharmaceutical medications that contain cannabinoids.
3. In the past 3 years (e.g., since the legalization* of cannabis), which, if any, of the following have you done? For this survey, 'medical purposes' means to treat a disease/disorder or to improve symptoms associated with a disease/disorder.
4. [IF Q3 ≠ 8] In the past 3 years, how often have you done the following… [WATCH QUOTAS/INCIDENCE RATE]
[GRID]
[ROW = ANSWERS FROM Q3]
[RESPONSES]
[COLUMN ITEMS]
5. [IF Q3 does not equal 02 OR 04; *EXCEPTION: IF Q3 does not equal 02 but equals 04, SKIP] Why have you not done the following:
INSERT RESPONSES MENTIONED AT Q3:
Recommended to a patient that they use cannabis to treat their symptom/disease?
Given a patient a medical document* to access cannabis to treat their symptom or disease?
[ROTATE ITEMS]
6. [IF Q3=03 OR 05 AND Q5 WAS NOT ASKED] Why have you done the following:
INSERT RESPONSES MENTIONED AT Q3:
Recommended to a patient that they do not use cannabis to treat their symptom or disease?
Refused to give a patient a medical document* for the use of cannabis for medical purposes?
Select all that apply
[ROTATE ITEMS]
[CONTINUE IF Q3=02,04,06]
[IF Q3=01 OR 07 EXCLUSIVELY, ALLOW N=200 TO PROCEED; TERMINATE WHEN QUOTA REACHES N=200]
[IF Q3=03 OR 05 EXCLUSIVELY, TERMINATE]
7. Are you…? [WATCH QUOTAS/INCIDENCE]
8. In which province(s) or territory(ies) are you licensed?
9. [IF Q8=MORE THAN ONE] In which province or territory do you currently practice?
10. In your opinion, is there therapeutic value to the use of cannabis?
11.[IF Q10=01,03] You said there is [ADD 'sometimes' IF Q10=03] therapeutic value to the use of cannabis. Will you please explain why?
12. [IF Q10=02] You said there is no therapeutic value to the use of cannabis. Will you please explain why?
[ASK EVERYONE]
These next few questions are about your work environment.
13. For how long have you been practicing as a [INSERT Q8 RESPONSE]?
14. What is your primary work setting?
15. [IF Q7=01] What type of physician are you?
[ASK EVERYONE]
These next questions are about your general experience with patients who use cannabis for medical purposes.
16. How long have you been seeing and/or treating patients who use cannabis for medical purposes?
17. On average, how often do you see patients who use cannabis for medical purposes?
18. How comfortable are you talking to patients about using cannabis for medical purposes?
[ASK EVERYONE]
These next questions are about your knowledge and perceptions about cannabis for medical purposes.
To start,
19. How would you rate your level of knowledge about cannabis for medical purposes?
20How confident are you in the following areas:
[GRID FORMAT]
[ROWS]
[RESPONSE OPTIONS; COLUMNS]
21. How much do you agree or disagree with the following statements about cannabis for medical purposes?
[GRID]
[ROW ITEMS]
[COLUMNS; RESPONSE OPTIONS]
22. [ASK IF Q11=01 OR 03] In your opinion, what parts of the cannabis plant have therapeutic value:
[MOUSEOVERS:
THC stands for delta-9-tetrahydrocannabinol. It is the main psychoactive component of cannabis.
CBD stands for cannabidiol. It is a non-psychoactive component of cannabis.]
23. [ASK IF Q23=01 OR 02] How much do you agree or disagree with the following statements about THC* and CBD*?
[MOUSEOVERS:
THC stands for delta-9-tetrahydrocannabinol. It is the main psychoactive component of cannabis.
CBD stands for cannabidiol. It is a non-psychoactive component of cannabis.]
[GRID]
[ROW ITEMS]
[COLUMNS; RESPONSE OPTIONS]
24. How helpful do you think cannabis is for the following symptoms:
[GRID]
[ROW ITEMS]
[COLUMNS; RESPONSE OPTIONS]
25. How helpful do you think cannabis is for treating the following diseases or disorders:
[GRID]
[ROW ITEMS]
[COLUMNS; RESPONSE OPTIONS]
26. To what extent do you think using cannabis for medical purposes increases the risk for the following:
[GRID]
[ROW ITEMS]
[COLUMNS; RESPONSE OPTIONS]
27. Have you had any patients report a negative reaction or side effect from using cannabis for medical purposes?
28. [IF Q27=01] Thinking of the range of reactions and side effects among those patients, please indicate which of the following have been reported to you?
Select all that apply
29. Where do you recommend that your patients access cannabis for medical purposes?
[GRID FORMAT]
[ROWS]
[RESPONSE OPTIONS; COLUMNS]
30. [IF Q30a,b,c,d,e=02,03,04] Why do you recommend that your patients access cannabis for medical purposes from [ADJUST BASED ON Q29: these sources/this source]?
[ROTATE ITEMS]
[ASK IF Q3=02,04, EXCEPT WHERE NOTED]
31. How long have you been recommending cannabis for medical purposes?
32. [IF Q33=01] Which pharmaceutical medications containing cannabis have you prescribed?
[ROTATE ITEMS]
These next questions focus on recommending the use of cannabis for medical purposes in the past 3 years (i.e., since the legalization* of cannabis).
34. When recommending cannabis for medical purposes, what level of THC and CBD do you typically suggest? [SAME LIST AS USER SURVEY]
35. Is there a daily maximum amount of THC or CBD that you typically recommend?
36. [If Q36=01, ask] What is the daily maximum amount of THC that you typically recommend?
37. [If Q36=02, ask] What is the daily maximum amount of CBD that you typically recommend?
38. How do you determine what dose to recommend?
[ROTATE ITEMS]
39.When recommending cannabis for medical purposes, do you suggest methods to consume cannabis?
40. [IF Q3=04] What is the typical daily amount of dried cannabis that you authorize on a medical document (in grams per day)?
41. [IF Q3=04] What's the maximum daily amount of dried cannabis that you're comfortable authorizing on a medical document?
42. [IF Q42=01-10] Why is [INSERT Q42 RESPONSE] the maximum daily amount of dried cannabis that you're comfortable authorizing on a medical document?
[ROTATE ITEMS]
43. [If Q42=01-10, ask] Have patients ever asked you to authorize more dried cannabis than you're comfortable with?
44. [IF Q42=11] Why do you not have a daily limit of dried cannabis that you would authorize for patients for medical purposes?
[ROTATE ITEMS]
45. [IF Q40=01] Which of the following methods do you most often recommend?
46. Do you typically follow up with patients after you have recommended that they start using cannabis for medical purposes?
47. [ASK EVERYONE] In your view, how useful is the Health Canada medical access program?
Through the Health Canada cannabis for medical purposes program, a patient with a medical document from a physician or nurse practitioner can buy cannabis directly from a licensed seller for medical purposes who ships it to their home or apply to Health Canada to grow their own or designate someone else to grow it for them.
[ASK IF Q3=02, 04]
These next questions focus on why you have recommended the use of cannabis for medical purposes in the past three years.
48. For which of the following diseases or disorders have you recommended the use of cannabis [SAME LIST AS USER SURVEY]
[ROTATE ITEMS]
49. How frequently do you recommend the use of cannabis for the following diseases or disorders…
[GRID FORMAT]
[ROWS—ITEMS FROM Q49]
[RESPONSE OPTIONS; COLUMNS]
50. For which of the following symptoms have you recommended the use of cannabis? [SAME LIST AS USER SURVEY]
[ROTATE ITEMS]
[GRID FORMAT]
[ROWS—ITEMS FROM Q51]
[RESPONSE OPTIONS; COLUMNS]
[ASK EVERYONE]
These next questions focus on changes in patient behaviour and health care provider practices since the legalization of cannabis for non-medical purposes. Recreational, or non-medical, use of cannabis became legal for adults on October 17, 2018, in all provinces and territories.
52. Prior to the legalization* of cannabis, on average, how often would you have patients inquiring about cannabis for medical purposes?
53. Since the legalization* of cannabis, do patients ask questions about using cannabis for medical purposes…
54. [IF Q54=01,02] Since the legalization* of cannabis, on average, how often do you have patients inquiring about cannabis for medical purposes?
55. Since the legalization* of cannabis, have you noticed any changes in the way in which patients are accessing cannabis for medical purposes?
56. [IF Q56=1] What changes have you noticed?
57. Have you noticed any changes in your health care colleagues' attitudes towards authorizing cannabis for medical purposes since the legalization* of cannabis?
58. [IF Q58=01] What changes have you noticed?
59. Since the legalization* of cannabis, are you more, or less supportive of the use of cannabis for medical purposes?
60. [IF Q3=02,04] Since the legalization* of cannabis, have your practices for recommending cannabis for medical use changed?
61. How have your practices changed?
62. How supportive is your licensing college regarding the use of cannabis for medical purposes?
63. To the best of your knowledge, does your licensing college offer courses or guidance on authorizing the use of cannabis for medical purposes?
[EVERYONE]
You're almost finished the survey. We appreciate your feedback.
64. Where do you typically look for information on the use of cannabis for medical purposes?
[ROTATE ITEMS]
The following are questions to help us to group the results. Your responses will be anonymous and kept strictly confidential.
65. As a health care provider, are you…?
66. Which of the following best describes the area where your primary place of work is located?
67. What is your gender? This refers to current gender which may be different from sex assigned at birth.
Finally,
68. In which of the following age categories do you belong?
That concludes the survey. Thank you very much for your thoughtful feedback. It is much appreciated. The results will be available at the Library and Archives Canada website in the coming months.
[1] This includes adults and guardians who are responsible for a person under the age of 18 who uses cannabis for medical purposes
[2] This includes adults/guardians who are responsible for a person under the age of 18 who uses cannabis for medical purposes.
[3] Q19. Was the health care provider you discussed this with a… Multiple responses accepted. Base: n=46; respondents who discussed the use of cannabis for medical purposes with another health care provider, excluding medical doctors and nurse practitioners.
[4] CBD (or cannabidiol) is a non-psychoactive component of cannabis. THC (delta-9-tetrahydrocannabinol) is the main psychoactive component of cannabis.
[5] The following description of a medical document was available to respondents: "A medical document authorizing the use of cannabis for medical purposes typically contains information about the doctor or nurse practitioner and you, the daily quantity (grams) of dried cannabis that you are authorized to use for medical purposes, and the length of time that you are authorized to do so. They are like prescriptions."
[6] Through the Health Canada cannabis for medical purposes program, those with a medical document you can register to buy cannabis directly from 1) a licensed seller for medical purposes who ships it to their home, or 2) apply to Health Canada for authorization to grow their own, or designate someone else to grow it for them.
[7] The following description of the Health Canada cannabis for medical purposes program was available to respondents: "Through the Health Canada cannabis for medical purposes program, if you have a medical document you can register to buy cannabis directly from 1) a licensed seller for medical purposes who ships it to your home, or 2) apply to Health Canada for authorization to grow your own, or designate someone else to grow it for you."
[8] Caution should be exercised when interpreting this data due to the small sample size.
[9] The following description of the Health Canada cannabis for medical purposes program was available to respondents: "Through the Health Canada cannabis for medical purposes program, if you have a medical document you can register to buy cannabis directly from 1) a licensed seller for medical purposes who ships it to your home, or 2) apply to Health Canada for authorization to grow your own, or designate someone else to grow it for you."
[10] This includes those who grow their own without authorization from Health Canada and those who access cannabis for medical purposes from the following sources: a legal storefront/provincially authorized retailer; a legal website for non-medical cannabis (provincially authorized retailer); an illegal storefront or online source; a family member or friend; and a 'dealer'.
[11] Refers to a licensed seller of cannabis for medical purposes.
[12] THC (delta-9-tetrahydrocannabinol) is the main psychoactive component of cannabis. CBD (or cannabidiol) is a non-psychoactive component of cannabis.
[13] The response categories 'small', 'moderate' and 'significant' were not defined in the questionnaire. Responses are based on patients' interpretation of each category.
[14] In Figure 59, an asterisk is used to denote small sample sizes.
[15] Exercise caution when interpreting this data due to the small sample size.
[16] Health care 'providers' and 'practitioners' are used interchangeably to refer to medical doctors and nurse practitioners.
[17] Q3. HCPs: In the past 3 years, which, if any, of the following have you done? / Q21/Q22. Patients: Was your medical doctor or nurse practitioner supportive of using cannabis to treat your condition? / Q29. Patients: Did you get a medical document from the medical doctor or nurse practitioner authorizing a certain daily amount of cannabis to treat your condition?
[18] Q46. HCPs: Do you typically follow up with patients after you have recommended that they start using cannabis for medical purposes? / Q28. Patients: Have you gone back to the medical doctor or nurse practitioner for follow up?
[19] Q27. HCPs: Have you had any patients report a negative reaction or side effect from using cannabis for medical purposes? / Q67. Patients: What has been the outcome of using cannabis for medical purposes?
[20] Because this was a small population with a low incidence, the full pre-test was not completed to ensure the availability of adequate amounts of sample for the full launch.
[21] Canadian Institute for Health Information. Canada's Health Care Providers, 2015 to 2019 — Data Tables. Ottawa, ON: CIHI; 2020.