Cannabis Use Among Sexual and Gender Minorities Across Canada - Perspectives and Experiences Following Legalization

Executive Summary

Prepared for Health Canada

Prepared by Narrative Research
Call-Up Number: CW2333025
Requisition Reference Number: HT372-234561
Contracted Value: $126,237.95
Contract Date: 2023-10-05
Delivery Date: 2023-12-14
POR number: 057-23

For more information, please contact: cpab_por-rop_dgcap@hc-sc.gc.ca

Ce rapport est aussi disponible en français

Cannabis Use Among Sexual and Gender Minorities Across Canada - Perspectives and Experiences Following Legalization - Executive Summary

Prepared for Health Canada

Supplier Name: Narrative Research
December 2023

This public opinion research report presents the results of 21 online focus groups with individuals who identify as a sexual or gender minority. A total of seven different groups were conducted in each of three regions, namely the East (Nunavut, Ontario, and the Atlantic provinces), West (Prairie provinces, Alberta, British Columbia, Yukon, and the Northwest Territories), and Quebec/New Brunswick (francophones). Within each region, groups were segmented by identity (gay, lesbian, bisexual or another identity), as well as by age (young adults 18-25 years old and adults 26 years and older). Participants had consumed cannabis at least once in the past year for non-medical and/or medical purposes. All sessions, except for the francophone ones, were conducted in English. The fieldwork was conducted from November 8^th to 16^th, 2023.

Cette publication est aussi disponible en français sous le titre :

Consommation de cannabis chez les minorités sexuelles et de genre au Canada - perspectives et expériences après la légalisation

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: cpab_por-rop_dgcap@hc-sc.gc.ca

Catalogue Number:
H14-596/2024E-PDF

International Standard Book Number (ISBN):
978-0-660-71134-8

Related publications (registration number: POR-057-23):
Catalogue Number: H14-596/2024F-PDF (Final Report, French)
ISBN 978-0-660-71135-5

^© His Majesty the King in Right of Canada, as represented by the Minister of Health, 2023

Executive Summary

Narrative Research Inc.
Call-Up Number: CW2333025
Requisition Reference Number: HT372-234561
POR Registration Number: 023-05
Contract Award Date: 2023-10-05
Contracted Value: $126,237.95

Background and Research Methodology

The prevalence of cannabis use among sexual and gender minorities (SGM) is higher compared to the general population. Intersecting with higher levels of cannabis use, the broader evidence base consistently highlights that SGM also have higher prevalence of poor mental health (e.g., anxiety/mood disorders) compared to the general population. Evidence suggests that higher frequency of cannabis use among SGM is a coping mechanism associated with the experience of minority stress (e.g., discrimination/abuse from others, internalized stigma, etc.). However, longitudinal evidence also suggests frequent cannabis use elevates the risk of experiencing persistent mental health problems over time.

Due to the high prevalence of cannabis use and poor mental health among SGM, Health Canada was interested in garnering insight into these populations. Thus, public opinion research was undertaken to qualitatively explore the range of cannabis-related opinions, knowledge, and behaviours among the SGM communities across Canadian provinces and territories. Research findings can help inform different elements of public health strategy (e.g., public education, data monitoring, Sex and Gender Based Analysis plus), and enhance the Cannabis Act's public health approach to protecting public health and public safety and minimizing harms from cannabis use.

More specifically, research objectives were to explore SGM:

• Perspectives and experiences surrounding cannabis use (e.g., reasons for use, use characteristics, sourcing cannabis, perceived benefits/risks, polysubstance use, cannabis-impaired driving)
• Perceived impact of cannabis legalization and regulation on various cannabis-related indicators (e.g., stigma, use patterns, access/source of cannabis, consumption methods, product preferences)
• Perspectives on cannabis public education (e.g., awareness and exposure, knowledge of risk, desired content, and delivery)

To achieve these objectives, a qualitative research approach was undertaken with the fieldwork conducted from November 8^th to 16^th, 2023. The research entailed a total of 21 online focus groups across three regions including the East (Nunavut, Ontario, and the Atlantic provinces), West (Prairie provinces, Alberta, British Columbia, Yukon, and the Northwest Territories), and Quebec/New Brunswick (francophones). Seven groups were conducted in each region, with groups segmented by identity (gay, lesbian, bisexual and identify not already listed) and by age (young adults 18-25 years old and adults 26 years and older).

All participants consumed cannabis at least once in the past year for non-medical and/or medical purposes. A mix of ages (within range), household situations and ethnic backgrounds were represented in each group. Those currently employed in, or retired from a sensitive occupation, or who have others in their household in this situation were excluded from the research. All participants had access to a computer or tablet with high-speed internet equipped with a webcam, or a smartphone, to take part in the session.

From 210 recruited individuals, 184 took part across all sessions. Each group discussion lasted between 90 minutes and two hours. In total, 186 individual incentives of $125 were distributed, including two for people who were unable to participate due to technical difficulties. All discussions were held in English except in Quebec/New Brunswick where the sessions were conducted in French. All participants were recruited per the specifications for the Government of Canada. Recruitment was conducted through qualitative panels stored on Canadian servers, with follow up calls to confirm the details provided and to ensure quotas were met. A referral recruitment approach was also accepted for harder-to-reach populations, following industry guidelines to ensure no participant from the same household took part in the study, and to ensure no participants knew each other in the same group.

This report presents the findings from the study. Caution must be exercised when interpreting the results from this study, as qualitative research is exploratory and cannot infer causality.

Political Neutrality Certification

I hereby certify as a Representative of Narrative Research that the deliverables fully comply with the Government of Canada political neutrality requirements outlined in the Directive on the Management of Communications. Specifically, the deliverables do not include information on electoral voting intentions, political party preferences, standings with the electorate or ratings of the performance of a political party or its leaders.

Margaret Brigley, CEO & Partner | Narrative Research
Date: December 14, 2023

Key Findings

The following provides key highlights from the research:

Commonality / Normality

• Legalization has normalized the use of cannabis, made it easier to obtain, and contributed to a perception that it is of lesser harm, with notable diminished negative stigma. The fact that cannabis production, sales and possession is now condoned by the government, and is sold in regulated stores, legitimizes it as a substance that is perceived to be relatively safe to consume. Moreover, legalization provides consumers with a means to access cannabis from a safe and reliable source (e.g., knowing exactly what is in the product, and being assured it is not laced with other drugs).
• Among sexual and gender minority groups, cannabis was considered common practice, primarily to cope with societal stressors, as well as the openness and shared ideologies within the communities. Hearing of higher cannabis consumption among sexual and gender minority groups compared to the general population was not surprising to most and was attributed to two key factors. To begin, higher cannabis usage is attributed to members of SGM communities having unique experiences and stresses, because of having to deal with unacceptance, criticism or hate within society. It was felt that many regularly turn to cannabis and other substances to cope with increased stressors. Another factor was the openness of the communities in their ideologies and behaviours, and a greater inclination to be liberal, open-minded and exploratory in nature.

Reasons for Use

• Cannabis use was considered a pleasurable and habitual experience for most and one that provides a variety of benefits, including being a coping mechanism for anxiety / stress, as a sleep aid, for socialization, managing eating disorders, and pain management. Among sexual and gender minority groups, cannabis is used both for non-medical and medical purposes. Participants attributed a wide range of benefits to cannabis usage, most notably as a coping mechanism for anxiety / stress, as a sleep aid, for socialization, managing eating disorders, and pain management. For some, cannabis has become their drug of choice, resulting in reduced alcohol intake, reduced usage of harder drugs, and/or decreased reliance on pharmaceuticals. While some felt that cannabis use helps them become more focused or improves their overall concentration, others described it as providing a sense of euphoria and escapism. Depending on the strain used, cannabis could either elevate an evening or add a sense of calmness or relaxation.
• While some professed to use cannabis socially on a weekly or less frequent basis, many reportedly use cannabis daily. For many, cannabis is considered habitual as a regular coping mechanism for life's various challenges. Across locations, several participants cited that their cannabis use increased notably following the onset of the COVID pandemic as they struggled to cope with isolation and changing social realities.

Medical Use

• Few use cannabis for medical purposes only and there is limited reliance on health practitioners' counsel relating to cannabis usage. Many use cannabis for both non-medical purposes and health-related reasons. That said, very few are authorized by a health care practitioner to use cannabis for medical purposes. Rather, they self-medicate to address a range of different diagnosed conditions, after experiencing considerable success using cannabis compared to more traditional pharmaceutical options.
• It was generally felt that physicians have limited knowledge of cannabis or other natural remedies and they prefer to rely on pharmaceuticals over cannabis. While a few participants had spoken with their family doctor about their usage, many rely on the advice of others who have used cannabis, or their own personal experience, to direct their cannabis use when dealing with symptoms. Doctors were generally considered not fully informed about cannabis use and its benefits, and often perceived as being judgemental towards its use. Many felt that physicians generally do not consider cannabis a viable substitute for prescription medications, which proved problematic to many, given the high cost of prescription drugs. Further, some do not have a family doctor, or commented that they feel uncomfortable or stigmatized around health care professionals because of their sexual orientation or gender identity.

Risk Perception

• Cannabis use was viewed as having minimal risks or harms, although several key risks were identified, most notably those associated with lung damage, potential dependency, memory loss, and negative financial implications. Participants perceived minimal risks or harms with cannabis use and considered the benefits of usage to outweigh the risks. That said, a number of risks were consistently identified, including lung damage / breathing problems from smoking cannabis, potential addiction, memory loss or difficulty concentrating, elevated heart rate, cost implications, increased anxiety, insomnia, and sluggish or unproductive behaviour. Participants professed to have only moderate knowledge of the risks associated with cannabis use.
• Risk perception of cannabis dependency was generally low and attributed to the perceived benefits cannabis provides. Overall, those who use cannabis as more of a coping mechanism for mental health conditions or other health conditions were generally more inclined to express some level of dependency, albeit moderate in most cases. When considering how their life would be different if they did not use cannabis, responses reflected perceptions of personal dependency. Most felt that their life would be much the same with little change, although they recognized that on the positive side, they would likely have more money and potentially more energy. While other participants did not consider themselves addicted to cannabis, many felt it would be challenging to cease use of cannabis altogether. Some anticipated that without cannabis they would experience negative health-related consequences and would likely resort to using other aids, substances or prescription drugs to cope. Such consequences primarily related to stress management, sleep and appetite.

Driving and Cannabis Usage

• There were mixed opinions on the impact of cannabis on driving. While most believed using cannabis and driving is risky and not a good idea, there was a perception that cannabis can enhance driving abilities. While most professed that using cannabis and driving poses a risk and is not a good idea, some indicated they know people who consider themselves to be more conscientious and safer drivers after using cannabis. Unlike alcohol consumption, there was a perception that moderate cannabis use enhances driving capabilities rather than inhibiting them. Overall, most felt that usage of cannabis while driving is a relatively common occurrence, particularly in smaller communities. It was generally felt that the risks associated with driving after using cannabis depends on what type of cannabis product is consumed, when it was used, and an individual's tolerance level. Further, it was felt that because there is no easy measure or indicator of cannabis consumption, it is easy to avoid getting caught by the authorities for driving under the influence.

Access & Sourcing

• Cannabis is generally purchased through a variety of sources, namely regulated stores, online 'unregulated' stores, and on First Nations reserves. A variety of sources are relied upon for obtaining cannabis, with cannabis generally purchased in regulated stores, online (through unregulated businesses), on First Nations reserves, or from individuals they know.
• There were clear perceived advantages in purchasing from 'unregulated' stores. Despite being a common source of cannabis because of its convenient access and safe supply, there was criticism that regulated stores offer products that are 'lower quality', overpriced, and with limited selection of product types and potency levels. While it was appreciated that products available in a regulated store are perceived as safer compared to products sold through dealers, it was considered a premium priced source. Online stores (unregulated) were clearly differentiated from regulated stores in a perceived superior product selection, product strength, convenience, and cost-effective pricing.
• There was confusion as to whether unregulated stores are illegal. There was a general perception that there is nothing wrong with purchasing product from unregulated online retailers. Such businesses were considered to be registered, legitimate businesses, with a professional online presence, professionally looking packages, safe point of sale practices, and legitimate delivery, often via Canada Post. Further, past purchase and product experiences have been positive and reflective of what they would expect from a legitimate and professional business.

Poly-substance use

• Use of cannabis and alcohol was common, as was usage with prescription drugs and other substances. Cannabis was considered a natural, cost-effective and less addictive alternative to other substances, as well as a way to supplement the overall experience. For some, cannabis has replaced the use of harder drugs, minimized alcohol usage, and eliminated some reliance on prescription medications. Many cited that alcohol had typically resulted in stronger and more negative side effects, so they intentionally replaced alcohol consumption with cannabis. For many, however, combining cannabis with other substances enhances the overall desired experience.

Public Education

• There was limited to no recall of recent public education about cannabis, especially any messaging that presents the risks and harms of cannabis use. Top of mind information or advertisements were generally limited to campaigns related to the risk of drinking and consuming cannabis while driving a vehicle. No participants recalled seeing or hearing any public education campaign specifically targeting SGM.
• Those with direct lived experience with cannabis were considered the most trusted source for information on the topic, although budtenders and governments were also respected by most. Information on cannabis was deemed most trustworthy coming from other people who use cannabis, (e.g., through lived experience, product reviews, testimonials), and governments (if referencing current, legitimate research studies). Those working in cannabis retail stores (budtenders) were also trusted for their input and are relied upon for information related to dosage, strains and consumption method.
• There was broad support for a public education campaign. Topics of interest include long-term effects, dosages and better understanding the differences between indica versus sativa. It was perceived that an effective public education campaign should be non-judgemental, fact-based, visually impactful, and will guide safe cannabis use in an unbiased, personally relevant, and balanced approach. In addition, information should explain the positive and negative health effects of cannabis consumption. A multi-mode approach to communicating information about the risks and potential harms associated with cannabis consumption was recommended by participants, with priority given to social media channels, traditional media, as well as point of sale.