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Daily cannabis use during the novel coronavirus disease (COVID-19) pandemic in Canada: a repeated cross-sectional study from May 2020 to December 2020

Daily cannabis use during the novel coronavirus disease (COVID-19) pandemic in Canada: a repeated... Background: Daily cannabis use is most strongly implicated in the cannabis‑attributable burden of disease. In the context of the novel coronavirus disease (COVID‑19) pandemic in Canada, we characterized trends in daily cannabis use in the overall sample and various population subgroups, and examined risk characteristics associated with daily cannabis use. Methods: A cross‑sectional design was operationalized using data from six waves of a national, online survey of adults residing in Canada who spoke English (N = 6,021; May‑08 2020 to December ‑01 2020). Trends were character ‑ ized using the Cochran‑Armitage test and risk characteristics were identified using chi‑square test and logistic regres‑ sion analysis. Results: Daily cannabis use in the overall sample remained stable (5.34% – 6.10%; p = 0.30). This pattern of findings extended to various population subgroups as well. The odds of daily cannabis use were higher for those who: were males (Odds Ratio; 95% Confidence Interval: 1.46; 1.15 – 1.85), were between 18 – 29 years (2.36; 1.56 – 3.57), 30 – 39 years (2.65; 1.93 – 3.64) or 40–49 years (1.74; 1.19 – 2.54), self‑identified as white (1.97; 1.47 – 2.64), had less than col‑ lege or university completion (1.78; 1.39 – 2.28), engaged in heavy episodic drinking (2.05; 1.62 – 2.61), had a job that increased the risk of contracting COVID‑19 (1.38; 1.01 – 1.88), experienced loneliness 5–7 days in the past week (1.86; 1.26 – 2.73) and felt very worried (2.08; 1.21 – 3.58) or somewhat worried (1.83; 1.11 – 3.01) about the pandemic’s impact on their financial situation. Conclusions: Daily cannabis use did not change in the overall sample or various population subgroups during the pandemic. Pandemic‑related risks and impacts were associated with daily cannabis use. Keywords: Canada, SARS‑ CoV‑2, COVID ‑19, Coronavirus, Cannabis, Marijuana Introduction The novel coronavirus disease (COVID-19) pandemic has resulted in substantial burden of disease in Canada [1]. Government authorities have consequently enacted public health measures to contain the spread of the dis- *Correspondence: sameer.imtiaz@camh.ca; sameer.imtiaz@gmail.com Institute for Mental Health Policy Research, Centre for Addiction ease, most prominently physical distancing restrictions and Mental Health, 33 Russell Street, ON M5S 2S1 Toronto, Canada that involve closures of non-essential community and Full list of author information is available at the end of the article © The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http:// creat iveco mmons. org/ licen ses/ by/4. 0/. The Creative Commons Public Domain Dedication waiver (http:// creat iveco mmons. org/ publi cdoma in/ zero/1. 0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Imtiaz et al. Substance Abuse Treatment, Prevention, and Policy (2022) 17:14 Page 2 of 8 business institutions, limitations on in-person socializ- 1. Characterize trends in daily cannabis use in the over- ing and work from home mandates [2]. As these meas- all sample and various population subgroups. ures are associated with considerable economic and 2. Examine risk characteristics (including pandemic- social effects [3 ], they result in heightened stress, anxi- related risks and impacts) that are associated with ety and loneliness [4]. In addition, they disrupt daily daily cannabis use. routines by blurring the boundaries between work and leisure. As such, they may ultimately result in changes in cannabis use [5]. Indeed, increases in cannabis use Materials and methods during the pandemic have been documented in Canada Setting, design and data source [6, 7]. An online, cross-sectional survey of adults (≥ 18  years) Less is known about near daily or daily cannabis use residing in Canada was conducted by the Centre for (referred to here as daily cannabis use), the pattern of Addiction and Mental Health in collaboration with the consumption most strongly implicated in the cannabis- market research firm, Delvinia (see Table S1 in Additional attributable burden of disease [8, 9]. Indeed, a range of File 1 for the Checklist for Reporting Results of Internet adverse health outcomes have been documented with E-Surveys [CHERRIES]). The sampling frame was com - increasing frequency of cannabis use, including changes prised of a million plus members of an existing web panel in brain structure, neurocognitive effects, mental health called AskingCanadians (see http:// corpo rate. askin gcana problems, cardiovascular problems and motor vehicle dians. com/ for further details on the web panel). The injuries [10]. However, trends in daily cannabis use in sampling methodology entailed quota sampling by age, the overall population and various population subgroups gender and region (proportional to size of the population during the pandemic have not been characterized. Based that spoke English). The survey was repeated at six time on dollars of sale compiled by Statistics Canada, observed points since the pandemic began in 2020: Wave 1 (May cannabis retail sales compared with projected cannabis 8 – May 12: N = 1,005; Completion Rate [CR] = 15.93%), retail sales were 25% higher between March 2020 and Wave 2 (May 29 – June 01: N = 1,002; CR = 17.19%), June 2021, approximating an additional $811 million dur- Wave 3 (June 19 – June 23: N = 1,005; CR = 16.40%), ing the 16-month period [11]. Given the increases in can- Wave 4 (July 10 – July 14: N = 1,003; CR = 13.69%), nabis retail sales, it is important to understand if there Wave 5 (September 18 – September 22: N = 1,003; are corresponding changes in daily cannabis use as well. CR = 17.58%) and Wave 6 (November 27 – December 01: According to the National Cannabis Survey, daily can- N = 1,003; CR = 16.22%) (see Table S2 in Additional File 1 nabis use during the past three months increased among for age, sex and regional compositions of the samples, as those 15 years and older from 6% in the First Quarter of well as a comparison of the samples with the general pop- 2019 to 8% in the Fourth Quarter of 2020 [12, 13]. The ulation). Importantly, the sampling methodology ensured Canadian Cannabis Survey on the other hand indicated that participants were not included more than once in that daily cannabis use approximated one-fifth of those the survey (i.e. one-time inclusion in either of the six who used cannabis during the past 12  months in 2020, survey waves) due to the cross-sectional design. Further with no changes observed in this cannabis pattern of details regarding the survey methodology are described consumption from 2019 [14]. More importantly, the roles in the Supplementary Methods in Additional File 1. of the unique circumstances brought on by the pandemic in predicting daily cannabis use are yet to be examined. Measurements Such circumstances include employment-related risk of Daily cannabis use contracting COVID-19, feelings of loneliness, impacts Based on responses to the item “During the past seven on employment situation and impacts on financial situ - days, on how many days did you use cannabis (also ation, all of which may contribute to daily cannabis use known as marijuana, hash, pot)?”, daily cannabis use (yes, due to a combination of availability of leisure time, feel- no) was defined as cannabis use on at least five days dur - ings of boredom and heightened worries and anxieties. ing the past week. As the current lower-risk cannabis use guidelines rec- ommend cannabis use to not exceed occasional use [10], Demographics this knowledge may inform screening and targeted inter- Demographics included gender (male, female), age (18 – ventions at a time when cannabis is legal and available. 29 years, 30 – 39 years, 40 – 49 years, ≥ 50  years), region We accordingly addressed these critical knowledge gaps (Western [British Columbia, Yukon, Northwest Terri- using repeated cross-sectional assessments conducted tories and Nunavut), Prairies [Alberta, Saskatchewan, online between May 2020 and December 2020 in Can- Manitoba], Central [Ontario] and Atlantic [Quebec, New ada. Our specific objectives were as follows: Brunswick, Newfoundland and Labrador, Nova Scotia, I mtiaz et al. Substance Abuse Treatment, Prevention, and Policy (2022) 17:14 Page 3 of 8 Prince Edward Island]), urbanicity (urban, suburban, Risk characteristics with p < 0.05 in these analyses were rural), marital status (married or living with a partner, subsequently entered in multivariable logistic regression widowed, divorced or separated, never married), size of analyses. Variance inflation factors were generated to household (1 person, 2 people, 3 people, ≥ 4 people), eth- assess multicollinearity and the Hosmer–Lemeshow test nicity (white, non-white) and education (less than univer- was used to assess the model fit. sity or college completion, at least university or college completion). Results Trends in daily cannabis use Heavy episodic drinking Daily cannabis use during the pandemic remained stable: Heavy episodic drinking (yes, no) was defined as con - 5.34% (N = 107) in Period 1, 5.24% (N = 105) in Period 2 sumption of at least five drinks for men and at least four and 6.10% (N = 122) in Period 3 (p = 0.2955). After the drinks for women in one drinking occasion during the adjustment for multiple comparisons, differential pat - past week. terns of change in daily cannabis use were not observed among the various population subgroups (Table 1). Pandemic‑related risks and impacts Employment-related risk of contracting COVID-19 was Risk characteristics associated with daily cannabis use determined by asking participants if they had a job that Gender, age, marital status, ethnicity, education, heavy exposed them to a high risk of contracting COVID-19 episodic drinking, employment-related risk of contract- (yes, no). Feelings of loneliness were measured by ask- ing COVID-19, feelings of loneliness, impacts on employ- ing participants about the frequency of loneliness during ment situation and impacts on financial situation were the past week [15]: < 1  day, 1 – 2  days, 3 – 4  days and 5 associated with daily cannabis use in chi-square analyses – 7 days. (Table  2). These risk characteristics were subsequently The impact of the pandemic on employment situation included in the logistic regression analyses. An adequate was determined by asking participants, “How have physi- model fit was achieved (p = 0.4053) and multicollinearity cal distancing measures due to the COVID-19 pandemic was not detected (Variance Inflation Factors < 10 for all affected your employment situation?”, with the responses risk characteristics). After the simultaneous adjustment coded into six categories: currently working from home, for these risk characteristics, higher odds of daily can- currently not working or loss of employment, previously nabis use were observed for participants who were males working from home during the pandemic, previously not (Odds Ratio [OR]; 95% Confidence Interval [CI]: 1.46; working or loss of employment during the pandemic, 1.15 – 1.85), between 18 – 29  years (2.36; 1.56 – 3.57), other and no change. The impact of the pandemic on 30 – 39  years (2.65; 1.93 – 3.64) or 40 – 49  years (1.74; financial situation was examined by asking participants, 1.19–2.54), self-identified as white (1.97; 1.47 – 2.64), had “How worried are you about the impact of COVID-19 on less than college or university completion (1.78; 1.39 – your personal financial situation”: not at all worried, not 2.28) and engaged in heavy episodic drinking (2.05; 1.62 very worried, somewhat worried and very worried. – 2.61). In terms of pandemic-related risks and impacts, increased odds of daily cannabis use were demonstrated Statistical analysis for participants who had a job that increased the risk of To maximize the sample size for the statistical analy- contracting COVID-19 (OR, 95% CI: 1.38; 1.01 – 1.88), ses, adjacent survey waves were collapsed into periods: experienced loneliness 5 to 7  days during the past week Period 1 (Waves 1 – 2), Period 2 (Waves 3 – 4) and Period (1.86; 1.26 – 2.73), and felt very worried (2.08; 1.21 – 3 (Waves 5 – 6). Trends in daily cannabis use in the over- 3.58) or somewhat worried (1.83; 1.11 – 3.01) about the all sample were examined using the Cochran-Armitage impact of the pandemic on financial situation. test. This analysis was then repeated among the various population subgroups to test for differential patterns of Discussion change. The examined population subgroups included We characterized trends in daily cannabis use and exam- categories of gender, age, region, urbanicity, marital ined risk characteristics associated with daily cannabis status, ethnicity, education and heavy episodic drink- use during the pandemic in Canada. Daily cannabis use ing. Given the number of simultaneous tests performed, in the overall sample and various population subgroups adjustments were made for multiple comparisons using did not change. Risk characteristics associated with daily the Bonferroni Correction, a conservative approach that cannabis use included gender, age, ethnicity, education, focuses on large and meaningful changes. Thereafter, risk heavy episodic drinking, employment-related risk of con- characteristics associated with daily cannabis use were tracting COVID-19, feelings of loneliness and impacts on identified using cross-tabulations with chi-square tests. financial situation. Imtiaz et al. Substance Abuse Treatment, Prevention, and Policy (2022) 17:14 Page 4 of 8 Table 1 Trends in Daily Cannabis Use Among Population Subgroups in Canada Period 1 (May 08 to Period 2 (June 19 to July Period 3 (September 18 to P-Value a a a June 1, 2020 [N = 107]) 14, 2020 [N = 105]) December 01, 2020 [N = 122]) % (N) % (N) % (N) Gender Male 32.98 (62) 30.32 (57) 36.70 (69) 0.4878 Female 30.94 (43) 33.81 (47) 35.25 (49) 0.5433 Age 18—29 Years 36.36 (20) 40.00 (22) 23.64 (13) 0.5223 30—39 Years 27.42 (34) 34.68 (43) 37.90 (47) 0.3080 40—49 Years 34.69 (17) 28.57 (14) 36.73 (18) 0.9181 ≥ 50 Years 33.96 (36) 24.53 (26) 41.51 (44) 0.2731 Region Western 19.61 (10) 31.37 (16) 49.02 (25) 0.0045 Prairies 34.78 (32) 41.30 (38) 23.91 (22) 0.2309 Central 33.61 (40) 26.05 (31) 40.34 (48) 0.3575 Atlantic 34.72 (25) 27.78 (20) 37.50 (27) 0.8158 Urbanicity Urban Area 30.34 (44) 35.17 (51) 34.48 (50) 0.5653 Suburban Area 34.62 (45) 26.15 (34) 39.23 (51) 0.4260 Rural Area 30.51 (18) 33.90 (20) 35.59 (21) 0.6795 Marital Status Married or Living with a Partner 29.17 (56) 31.25 (60) 39.58 (76) 0.1384 Widowed, Divorced or Separated 42.50 (17) 25.00 (10) 32.50 (13) 0.6241 Never Married 34.34 (34) 33.33 (33) 32.32 (32) 0.8748 Ethnicity White 33.86 (85) 29.08 (73) 37.05 (93) 0.4931 Non‑ white 28.00 (21) 36.00 (27) 36.00 (27) 0.3878 Education Less than College or University Completion 32.06 (42) 32.06 (42) 35.88 (47) 0.4328 At least College or University Completion 32.18 (65) 30.69 (62) 37.13 (75) 0.4184 Heavy Episodic Drinking Yes 33.77 (51) 31.79 (48) 34.44 (52) 0.8601 No 30.60 (56) 31.15 (57) 38.25 (70) 0.1597 The sum of individual cells may not equal the period totals due to missing data Differences are considered statistically significant at the p < 0.0023 level due to the Bonferroni Correction Trends in daily cannabis use during the pandemic on a representative sample of adults (≥ 25  years), canna- have not been previously characterized in Canada, lim- bis use during the pandemic increased in 5%, decreased iting direct comparisons with the present findings. The in 2% and remained stable in 93% of the population National Cannabis Survey most recently demonstrated between March 29, 2020 and April 03, 2020 in Canada that daily cannabis use during the past three months [16]. An earlier analysis of the first three waves of the approximated 8% among those 15 years and older in the present survey also demonstrated that cannabis use Fourth Quarter of 2020 [13]. Despite the differences in increased in 52% of those who use cannabis compared to the assessment time frame (past three months vs. past before the beginning of the pandemic between May 08, week), these findings are broadly similar to the estimate 2020 and June 23, 2020 in Canada [7]. These findings col - obtained hereunder for Period 3 (6%). On the other hand, lectively indicate increased cannabis use during the pan- changes in cannabis use since the onset of the pandemic demic. Coupled with the present null findings pertaining have been most frequently examined, with increases in to the trends in daily cannabis use, it is possible that the cannabis use documented in the overall population [16, frequency of cannabis use increased, but not to an extent 17] and among those who use cannabis [7, 18, 19]. Based of daily cannabis use. Indeed, median number of days of I mtiaz et al. Substance Abuse Treatment, Prevention, and Policy (2022) 17:14 Page 5 of 8 Table 2 Risk Characteristics Associated with Daily Cannabis Use in Canada a a b Daily Cannabis Use Unadjusted Odds Ratio Adjusted Odds Ratio , N % P-Value Estimate 95% CI Estimate 95% CI Gender Male 188 6.32 0.0115 1.38 1.10 – 1.73 1.46 1.15—1.85 Female 146 4.82 Reference Reference Age 18—29 years 55 7.47 < 0.0001 2.07 1.48 – 2.89 2.36 1.56—3.57 30—39 years 124 7.72 2.14 1.64 – 2.80 2.65 1.93—3.64 40—49 years 49 5.80 1.58 1.11 – 2.23 1.74 1.19—2.54 ≥ 50 years 106 3.76 Reference Reference Region Western 51 5.62 0.1080 Prairies 92 6.30 Central 119 4.75 Atlantic 72 6.37 Urbanicity Urban area 145 5.17 0.4387 Suburban area 130 5.82 Rural area 59 6.10 Marital Status Married or living with a partner 192 5.11 0.0456 0.73 0.57 – 0.94 0.96 0.71—1.29 Widowed, divorced or separated 40 5.48 0.79 0.54 – 1.15 1.14 0.74—1.77 Never married 99 6.88 Reference Reference Size of household 1 person 66 5.37 0.6592 2 people 134 5.34 3 people 67 6.36 ≥ 4 people 67 5.61 Ethnicity White 251 6.02 0.0199 1.37 1.05 – 1.78 1.97 1.47 – 2.64 Non‑ white 75 4.47 Reference Reference Education Less than college or university completion 131 8.13 < 0.0001 1.81 1.44 – 2.28 1.78 1.39—2.28 At least college or university completion 202 4.65 Reference Reference Heavy Episodic Drinking Yes 151 9.84 < 0.0001 2.42 1.93 – 3.04 2.05 1.62—2.61 No 183 4.11 Reference Reference Employment‑Related Health Risk Yes 60 8.04 0.0016 1.59 1.19 – 2.13 1.38 1.01 – 1.88 No 274 5.21 Reference Reference Feelings of Loneliness 5—7 Days 59 11.59 < 0.0001 2.77 2.01 – 3.82 1.86 1.26—2.73 3—4 Days 61 7.31 1.67 1.22 – 2.27 1.28 0.91—1.79 1—2 Days 74 4.73 1.05 0.79 – 1.40 0.91 0.67—1.23 < 1 Day 140 4.52 Reference Reference Impact of Pandemic on Financial Situation Very worried 88 7.46 0.0020 2.28 1.40 – 3.71 2.08 1.21—3.58 Somewhat worried 146 5.60 1.68 1.05 – 2.67 1.83 1.11 – 3.01 Not very worried 79 4.93 1.47 0.90 – 2.34 1.68 1.00—2.82 Not at all worried 21 3.41 Reference Reference Imtiaz et al. Substance Abuse Treatment, Prevention, and Policy (2022) 17:14 Page 6 of 8 Table 2 (continued) a a b Daily Cannabis Use Unadjusted Odds Ratio Adjusted Odds Ratio , N % P-Value Estimate 95% CI Estimate 95% CI Impact of Pandemic on Employment Situation Currently working from home 71 4.77 0.0233 0.92 0.69 – 1.23 0.81 0.59—1.12 Currently not working or loss of employment 49 7.35 1.46 1.05 – 2.03 1.01 0.70—1.46 Previously working from home 13 5.06 0.98 0.55 – 1.75 0.77 0.42—1.40 Previously not working or loss of employment 19 7.79 1.55 0.95 – 2.55 0.81 0.46—1.43 Other 26 8.05 1.61 1.05 – 2.48 1.52 0.96—2.42 No Impact 156 5.16 Reference Reference Note: Bolded interface denotes p < 0.05 Abbreviations: CI Confidence Interval The outcome reference category in all logistic regression models is no daily cannabis use The odds ratios are adjusted for gender, age, marital status, ethnicity, education, heavy episodic drinking, employment-related health risk, feelings of loneliness, impact of the pandemic on employment situation and impact of pandemic on financial situation cannabis use in the present survey were 4 days in Period associated with both an increase and decrease in canna- 1, 3 days in Period 2 and 4 days in Period 3. Alternatively, bis use among the general population [16]. However, in changes in daily cannabis use may have occurred that an earlier analysis of the first three waves of the present were not captured by the surveys, as the first survey wave survey, being “somewhat worried” about the impacts on was conducted well after the enactment of the initial pub- financial situation was associated with an increase in can - lic health measures in March 2020, or changes may have nabis use among those who use cannabis [7]. Although occurred in other cannabis patterns of consumption. these findings are not directly comparable due to a differ - In terms of risk characteristics associated with daily ent outcome, they are consistent with the positive asso- cannabis use during the pandemic, the observed effects ciation observed between impacts on financial situation of male gender [20], younger age [20] and lesser educa- and daily cannabis use. tion [21] are consistent with assessments of cannabis Further research is nonetheless needed to obtain a patterns of consumption that were conducted before the broader understanding of the changes in cannabis pat- pandemic. The same is also applicable to heavy episodic terns of consumption due to COVID-19. Daily cannabis drinking. In the context of co-occurring alcohol and can- use needs to be monitored among certain high-risk seg- nabis use, higher levels of consumption of one substance ments of the population. Indeed, increase in cannabis use are related to higher levels of consumption of the other and problematic cannabis use were elevated among those substance [22]. Importantly, co-occurring cannabis and with mental health concerns and substance use concerns alcohol use is associated with greater harms and con- (including histories of psychiatric disorders) in Canada sequences than either substance alone [22]. Pandemic- [18]. In addition, the intersection of coping motives with related risks and impacts in relation to daily cannabis pandemic-related risks and impacts in predicting daily use have been examined to a lesser extent. As many have cannabis use warrant further exploration. Furthermore, experienced employment-related risk of contracting the trajectory of cannabis patterns of consumption other COVID-19, feelings of loneliness and impacts on finan - than daily cannabis use need to be examined, such as fre- cial situation during the pandemic, some may engage quency per day, quantity per occasion, modes of admin- in substance use to avoid and cope with the resulting istration and types of products, all of which may impact negative affect, including stress, depression and anxiety. the resulting cannabis-attributable burden of disease. Indeed, self-isolation and coping with depression motives Unfortunately, such assessments were not included in were both associated with cannabis use levels during the the present surveys, but they represent important lines of pandemic when accounting for cannabis use levels before investigation for future studies. the pandemic [23]. Compared to their counterparts who There are some limitations that should be consid - did not engage in self-isolation, those who did engage ered. First, given the absence of a measurement before in self-isolation were using 20% more cannabis [23]. the pandemic began, it is not possible to determine if Impacts on financial situation have contrastingly yielded daily cannabis use changed due to the pandemic. Fur- mixed findings. Reporting “too soon to determine finan - thermore, the recent legalization of recreational can- cial impacts” and “experiencing financial impacts” were nabis consumption in October 2018 in Canada limits I mtiaz et al. Substance Abuse Treatment, Prevention, and Policy (2022) 17:14 Page 7 of 8 the comparison with historic data, and serves as a con- Supplementary Information founder because the expanding cannabis retail market The online version contains supplementary material available at https:// doi. org/ 10. 1186/ s13011‑ 022‑ 00441‑x. may have also affected the trends in daily cannabis use. Second, although the effects are expected to be minimal Additional file 1. since the surveys were conducted online rather than in- person or over the telephone, the self-reported nature of the data may have resulted in social desirability and recall Acknowledgements Not applicable. biases. As such, daily cannabis use may have been under- reported. However, self-reports of alcohol and drug use Authors’ contributions have been shown to be valid [24]. Third, causal inferences SI and JR conceived the research question and outlined the study design. SW, HH, Y TN, DJ and TE‑M managed the data acquisition. SI conducted the between the risk characteristics and daily cannabis use data analyses, with input from CW and TE‑M. SI drafted the manuscript and cannot be made due to a cross-sectional design that does all other authors critically revised the manuscript for important intellectual not account for temporality. Fourth, certain geographic content. All authors have read and approved the final manuscript. segments may not have been adequately represented, as Funding the survey was restricted to the population that spoke Delvinia provided in‑kind support for the data collection. SI, SW, HH and TE‑M English. Fifth, owing to a sampling frame comprised of acknowledge funding from the Canadian Institutes of Health Research and Canadian Centre on Substance Use and Addiction (Partnerships for Cannabis an existing web panel, sampling strategy lacking random Policy Evaluation Team Grant), and SI, JR and TE‑M acknowledge funding from selection procedures, recruitment of a modest number the Canadian Institutes of Health Research’s Institute of Neurosciences, Mental of participants and an average survey completion rate Health and Addiction (Canadian Research Initiative on Substance Misuse Ontario Node Grant [SMN‑13950]). The funders had no role in study design, of 16%, the generalizability of the findings may be lim - data collection, analysis and interpretation, decision to publish, or preparation ited. These concerns about limited generalizability may of the manuscript. be especially pertinent to those without internet access. Availability of data and materials However, the effects are expected to be minimal, as quota Survey data are publicly available from the Methodify Platform by Delvinia sampling in online surveys is an established method (https:// www. delvi nia. com/ camh‑ coron avirus‑ mental‑ health/). to rapidly collect data concerning sensitive subjects [25–27], and only about 6% of the population reports a Declarations lack of home internet access [28]. Sixth, a distinction Ethics approval and consent to participate between non-medicinal and medicinal cannabis use was Research protocols were approved by the Research Ethics Board at the Centre not made, which would affect rates of daily cannabis use. for Addiction and Mental Health. All participants provided informed consent Finally, feelings of loneliness captured by the surveys may before the administration of the surveys. or may not have been precipitated due to the pandemic, Consent for publication as it was not specified in the assessment measure. Not applicable. Competing interests The authors declare that they have no competing interests. Conclusions Daily cannabis use in the overall sample and various Author details Institute for Mental Health Policy Research, Centre for Addiction and Mental population subgroups remained stable during the pan- Health, 33 Russell Street, ON M5S 2S1 Toronto, Canada. Campbell F amily demic in Canada. Pandemic-related risks and impacts Mental Health Research Institute, Centre for Addiction and Mental Health, 250 were associated with daily cannabis use. As increased College Street, Toronto, ON M5T 1R8, Canada. Dalla Lana School of Public Health, University of Toronto, 6th Floor, 155 College Street, Toronto, ON M5T frequency of cannabis use is linked to acute and chronic 3M7, Canada. Department of Epidemiology and Biostatistics, Schulich School adverse health outcomes [29, 30] and the current lower- of Medicine and Dentistry, Western University, Kresge Building, London, ON risk guidelines recommend no more than occasional use N6A 5C1, Canada. Institute of Medical Science, University of Toronto, Room 2374, 1 King’s College Circle, Toronto, ON M5S 1A8, Canada. Depar tment for those who use cannabis [10], it is imperative for gov- of Psychiatry, University of Toronto, 8th Floor, 250 College Street, Toronto, ON ernment authorities to ensure non-medicinal daily can- 7 M5T 1R8, Canada. Institute for Clinical Psychology and Psychotherapy, TU nabis use remains limited, especially as multiple lines of Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany. Department of Inter‑ national Health Projects, Institute for Leadership and Health Management, inquiries suggest an increase in cannabis use. These find - I.M. Sechenov First Moscow State Medical University, Trubetskaya Str., 8, B. 2, ings can inform screening and targeted interventions to 9 119992 Moscow, Russian Federation. Institute of Health Policy, Management reduce daily cannabis use in Canada. and Evaluation, University of Toronto, 425‑155 College Street, Toronto, ON M5T 1P8, Canada. Department of Pharmacology & Toxicology, University of Toronto, 1 King’s College Circle, Toronto, ON M5S 1A8, Canada. I nforma‑ tion Management, Centre for Addiction and Mental Health, 1001 Queen Street Abbreviations West, Toronto, ON M6J 1H4, Canada. Department of Health Sciences, Lake‑ CHERRIES: Checklist for the Checklist for Reporting Results of Internet head University, SN 1006, 955 Oliver Road, Thunder Bay, ON P7B 5E1, Canada. 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Mental health and substance use during COVID‑19. Ottawa: Mental Health Commission of Canada; 2021. fast, convenient online submission 19. Robillard R, Daros AR, Phillips JL, Porteous M, Saad M, Pennestri MH, Quilty thorough peer review by experienced researchers in your field LC. Emerging New Psychiatric Symptoms and the Worsening of Pre‑ existing Mental Disorders during the COVID‑19 Pandemic: A Canadian rapid publication on acceptance Multisite Study: Nouveaux symptômes psychiatriques émergents et support for research data, including large and complex data types détérioration des troubles mentaux préexistants durant la pandémie • gold Open Access which fosters wider collaboration and increased citations de la COVID‑19: une étude canadienne multisite. Can J Psychiatry. maximum visibility for your research: over 100M website views per year 2021;66(9):815‑826. • 20. Leos‑ Toro C, Rynard V, Hammond D. Prevalence of problematic cannabis use in Canada: Cross‑sectional findings from the 2013 Canadian tobacco, At BMC, research is always in progress. alcohol and drugs survey. Can J Public Health. 2018;108(5–6):e516–22. Learn more biomedcentral.com/submissions 21. Legleye S, Khlat M, Mayet A, Beck F, Falissard B, Chau N, et al. From cannabis initiation to daily use: educational inequalities in http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png "Substance Abuse Treatment, Prevention, and Policy" Springer Journals

Daily cannabis use during the novel coronavirus disease (COVID-19) pandemic in Canada: a repeated cross-sectional study from May 2020 to December 2020

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Springer Journals
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Copyright © The Author(s) 2022
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1747-597X
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10.1186/s13011-022-00441-x
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Abstract

Background: Daily cannabis use is most strongly implicated in the cannabis‑attributable burden of disease. In the context of the novel coronavirus disease (COVID‑19) pandemic in Canada, we characterized trends in daily cannabis use in the overall sample and various population subgroups, and examined risk characteristics associated with daily cannabis use. Methods: A cross‑sectional design was operationalized using data from six waves of a national, online survey of adults residing in Canada who spoke English (N = 6,021; May‑08 2020 to December ‑01 2020). Trends were character ‑ ized using the Cochran‑Armitage test and risk characteristics were identified using chi‑square test and logistic regres‑ sion analysis. Results: Daily cannabis use in the overall sample remained stable (5.34% – 6.10%; p = 0.30). This pattern of findings extended to various population subgroups as well. The odds of daily cannabis use were higher for those who: were males (Odds Ratio; 95% Confidence Interval: 1.46; 1.15 – 1.85), were between 18 – 29 years (2.36; 1.56 – 3.57), 30 – 39 years (2.65; 1.93 – 3.64) or 40–49 years (1.74; 1.19 – 2.54), self‑identified as white (1.97; 1.47 – 2.64), had less than col‑ lege or university completion (1.78; 1.39 – 2.28), engaged in heavy episodic drinking (2.05; 1.62 – 2.61), had a job that increased the risk of contracting COVID‑19 (1.38; 1.01 – 1.88), experienced loneliness 5–7 days in the past week (1.86; 1.26 – 2.73) and felt very worried (2.08; 1.21 – 3.58) or somewhat worried (1.83; 1.11 – 3.01) about the pandemic’s impact on their financial situation. Conclusions: Daily cannabis use did not change in the overall sample or various population subgroups during the pandemic. Pandemic‑related risks and impacts were associated with daily cannabis use. Keywords: Canada, SARS‑ CoV‑2, COVID ‑19, Coronavirus, Cannabis, Marijuana Introduction The novel coronavirus disease (COVID-19) pandemic has resulted in substantial burden of disease in Canada [1]. Government authorities have consequently enacted public health measures to contain the spread of the dis- *Correspondence: sameer.imtiaz@camh.ca; sameer.imtiaz@gmail.com Institute for Mental Health Policy Research, Centre for Addiction ease, most prominently physical distancing restrictions and Mental Health, 33 Russell Street, ON M5S 2S1 Toronto, Canada that involve closures of non-essential community and Full list of author information is available at the end of the article © The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http:// creat iveco mmons. org/ licen ses/ by/4. 0/. The Creative Commons Public Domain Dedication waiver (http:// creat iveco mmons. org/ publi cdoma in/ zero/1. 0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Imtiaz et al. Substance Abuse Treatment, Prevention, and Policy (2022) 17:14 Page 2 of 8 business institutions, limitations on in-person socializ- 1. Characterize trends in daily cannabis use in the over- ing and work from home mandates [2]. As these meas- all sample and various population subgroups. ures are associated with considerable economic and 2. Examine risk characteristics (including pandemic- social effects [3 ], they result in heightened stress, anxi- related risks and impacts) that are associated with ety and loneliness [4]. In addition, they disrupt daily daily cannabis use. routines by blurring the boundaries between work and leisure. As such, they may ultimately result in changes in cannabis use [5]. Indeed, increases in cannabis use Materials and methods during the pandemic have been documented in Canada Setting, design and data source [6, 7]. An online, cross-sectional survey of adults (≥ 18  years) Less is known about near daily or daily cannabis use residing in Canada was conducted by the Centre for (referred to here as daily cannabis use), the pattern of Addiction and Mental Health in collaboration with the consumption most strongly implicated in the cannabis- market research firm, Delvinia (see Table S1 in Additional attributable burden of disease [8, 9]. Indeed, a range of File 1 for the Checklist for Reporting Results of Internet adverse health outcomes have been documented with E-Surveys [CHERRIES]). The sampling frame was com - increasing frequency of cannabis use, including changes prised of a million plus members of an existing web panel in brain structure, neurocognitive effects, mental health called AskingCanadians (see http:// corpo rate. askin gcana problems, cardiovascular problems and motor vehicle dians. com/ for further details on the web panel). The injuries [10]. However, trends in daily cannabis use in sampling methodology entailed quota sampling by age, the overall population and various population subgroups gender and region (proportional to size of the population during the pandemic have not been characterized. Based that spoke English). The survey was repeated at six time on dollars of sale compiled by Statistics Canada, observed points since the pandemic began in 2020: Wave 1 (May cannabis retail sales compared with projected cannabis 8 – May 12: N = 1,005; Completion Rate [CR] = 15.93%), retail sales were 25% higher between March 2020 and Wave 2 (May 29 – June 01: N = 1,002; CR = 17.19%), June 2021, approximating an additional $811 million dur- Wave 3 (June 19 – June 23: N = 1,005; CR = 16.40%), ing the 16-month period [11]. Given the increases in can- Wave 4 (July 10 – July 14: N = 1,003; CR = 13.69%), nabis retail sales, it is important to understand if there Wave 5 (September 18 – September 22: N = 1,003; are corresponding changes in daily cannabis use as well. CR = 17.58%) and Wave 6 (November 27 – December 01: According to the National Cannabis Survey, daily can- N = 1,003; CR = 16.22%) (see Table S2 in Additional File 1 nabis use during the past three months increased among for age, sex and regional compositions of the samples, as those 15 years and older from 6% in the First Quarter of well as a comparison of the samples with the general pop- 2019 to 8% in the Fourth Quarter of 2020 [12, 13]. The ulation). Importantly, the sampling methodology ensured Canadian Cannabis Survey on the other hand indicated that participants were not included more than once in that daily cannabis use approximated one-fifth of those the survey (i.e. one-time inclusion in either of the six who used cannabis during the past 12  months in 2020, survey waves) due to the cross-sectional design. Further with no changes observed in this cannabis pattern of details regarding the survey methodology are described consumption from 2019 [14]. More importantly, the roles in the Supplementary Methods in Additional File 1. of the unique circumstances brought on by the pandemic in predicting daily cannabis use are yet to be examined. Measurements Such circumstances include employment-related risk of Daily cannabis use contracting COVID-19, feelings of loneliness, impacts Based on responses to the item “During the past seven on employment situation and impacts on financial situ - days, on how many days did you use cannabis (also ation, all of which may contribute to daily cannabis use known as marijuana, hash, pot)?”, daily cannabis use (yes, due to a combination of availability of leisure time, feel- no) was defined as cannabis use on at least five days dur - ings of boredom and heightened worries and anxieties. ing the past week. As the current lower-risk cannabis use guidelines rec- ommend cannabis use to not exceed occasional use [10], Demographics this knowledge may inform screening and targeted inter- Demographics included gender (male, female), age (18 – ventions at a time when cannabis is legal and available. 29 years, 30 – 39 years, 40 – 49 years, ≥ 50  years), region We accordingly addressed these critical knowledge gaps (Western [British Columbia, Yukon, Northwest Terri- using repeated cross-sectional assessments conducted tories and Nunavut), Prairies [Alberta, Saskatchewan, online between May 2020 and December 2020 in Can- Manitoba], Central [Ontario] and Atlantic [Quebec, New ada. Our specific objectives were as follows: Brunswick, Newfoundland and Labrador, Nova Scotia, I mtiaz et al. Substance Abuse Treatment, Prevention, and Policy (2022) 17:14 Page 3 of 8 Prince Edward Island]), urbanicity (urban, suburban, Risk characteristics with p < 0.05 in these analyses were rural), marital status (married or living with a partner, subsequently entered in multivariable logistic regression widowed, divorced or separated, never married), size of analyses. Variance inflation factors were generated to household (1 person, 2 people, 3 people, ≥ 4 people), eth- assess multicollinearity and the Hosmer–Lemeshow test nicity (white, non-white) and education (less than univer- was used to assess the model fit. sity or college completion, at least university or college completion). Results Trends in daily cannabis use Heavy episodic drinking Daily cannabis use during the pandemic remained stable: Heavy episodic drinking (yes, no) was defined as con - 5.34% (N = 107) in Period 1, 5.24% (N = 105) in Period 2 sumption of at least five drinks for men and at least four and 6.10% (N = 122) in Period 3 (p = 0.2955). After the drinks for women in one drinking occasion during the adjustment for multiple comparisons, differential pat - past week. terns of change in daily cannabis use were not observed among the various population subgroups (Table 1). Pandemic‑related risks and impacts Employment-related risk of contracting COVID-19 was Risk characteristics associated with daily cannabis use determined by asking participants if they had a job that Gender, age, marital status, ethnicity, education, heavy exposed them to a high risk of contracting COVID-19 episodic drinking, employment-related risk of contract- (yes, no). Feelings of loneliness were measured by ask- ing COVID-19, feelings of loneliness, impacts on employ- ing participants about the frequency of loneliness during ment situation and impacts on financial situation were the past week [15]: < 1  day, 1 – 2  days, 3 – 4  days and 5 associated with daily cannabis use in chi-square analyses – 7 days. (Table  2). These risk characteristics were subsequently The impact of the pandemic on employment situation included in the logistic regression analyses. An adequate was determined by asking participants, “How have physi- model fit was achieved (p = 0.4053) and multicollinearity cal distancing measures due to the COVID-19 pandemic was not detected (Variance Inflation Factors < 10 for all affected your employment situation?”, with the responses risk characteristics). After the simultaneous adjustment coded into six categories: currently working from home, for these risk characteristics, higher odds of daily can- currently not working or loss of employment, previously nabis use were observed for participants who were males working from home during the pandemic, previously not (Odds Ratio [OR]; 95% Confidence Interval [CI]: 1.46; working or loss of employment during the pandemic, 1.15 – 1.85), between 18 – 29  years (2.36; 1.56 – 3.57), other and no change. The impact of the pandemic on 30 – 39  years (2.65; 1.93 – 3.64) or 40 – 49  years (1.74; financial situation was examined by asking participants, 1.19–2.54), self-identified as white (1.97; 1.47 – 2.64), had “How worried are you about the impact of COVID-19 on less than college or university completion (1.78; 1.39 – your personal financial situation”: not at all worried, not 2.28) and engaged in heavy episodic drinking (2.05; 1.62 very worried, somewhat worried and very worried. – 2.61). In terms of pandemic-related risks and impacts, increased odds of daily cannabis use were demonstrated Statistical analysis for participants who had a job that increased the risk of To maximize the sample size for the statistical analy- contracting COVID-19 (OR, 95% CI: 1.38; 1.01 – 1.88), ses, adjacent survey waves were collapsed into periods: experienced loneliness 5 to 7  days during the past week Period 1 (Waves 1 – 2), Period 2 (Waves 3 – 4) and Period (1.86; 1.26 – 2.73), and felt very worried (2.08; 1.21 – 3 (Waves 5 – 6). Trends in daily cannabis use in the over- 3.58) or somewhat worried (1.83; 1.11 – 3.01) about the all sample were examined using the Cochran-Armitage impact of the pandemic on financial situation. test. This analysis was then repeated among the various population subgroups to test for differential patterns of Discussion change. The examined population subgroups included We characterized trends in daily cannabis use and exam- categories of gender, age, region, urbanicity, marital ined risk characteristics associated with daily cannabis status, ethnicity, education and heavy episodic drink- use during the pandemic in Canada. Daily cannabis use ing. Given the number of simultaneous tests performed, in the overall sample and various population subgroups adjustments were made for multiple comparisons using did not change. Risk characteristics associated with daily the Bonferroni Correction, a conservative approach that cannabis use included gender, age, ethnicity, education, focuses on large and meaningful changes. Thereafter, risk heavy episodic drinking, employment-related risk of con- characteristics associated with daily cannabis use were tracting COVID-19, feelings of loneliness and impacts on identified using cross-tabulations with chi-square tests. financial situation. Imtiaz et al. Substance Abuse Treatment, Prevention, and Policy (2022) 17:14 Page 4 of 8 Table 1 Trends in Daily Cannabis Use Among Population Subgroups in Canada Period 1 (May 08 to Period 2 (June 19 to July Period 3 (September 18 to P-Value a a a June 1, 2020 [N = 107]) 14, 2020 [N = 105]) December 01, 2020 [N = 122]) % (N) % (N) % (N) Gender Male 32.98 (62) 30.32 (57) 36.70 (69) 0.4878 Female 30.94 (43) 33.81 (47) 35.25 (49) 0.5433 Age 18—29 Years 36.36 (20) 40.00 (22) 23.64 (13) 0.5223 30—39 Years 27.42 (34) 34.68 (43) 37.90 (47) 0.3080 40—49 Years 34.69 (17) 28.57 (14) 36.73 (18) 0.9181 ≥ 50 Years 33.96 (36) 24.53 (26) 41.51 (44) 0.2731 Region Western 19.61 (10) 31.37 (16) 49.02 (25) 0.0045 Prairies 34.78 (32) 41.30 (38) 23.91 (22) 0.2309 Central 33.61 (40) 26.05 (31) 40.34 (48) 0.3575 Atlantic 34.72 (25) 27.78 (20) 37.50 (27) 0.8158 Urbanicity Urban Area 30.34 (44) 35.17 (51) 34.48 (50) 0.5653 Suburban Area 34.62 (45) 26.15 (34) 39.23 (51) 0.4260 Rural Area 30.51 (18) 33.90 (20) 35.59 (21) 0.6795 Marital Status Married or Living with a Partner 29.17 (56) 31.25 (60) 39.58 (76) 0.1384 Widowed, Divorced or Separated 42.50 (17) 25.00 (10) 32.50 (13) 0.6241 Never Married 34.34 (34) 33.33 (33) 32.32 (32) 0.8748 Ethnicity White 33.86 (85) 29.08 (73) 37.05 (93) 0.4931 Non‑ white 28.00 (21) 36.00 (27) 36.00 (27) 0.3878 Education Less than College or University Completion 32.06 (42) 32.06 (42) 35.88 (47) 0.4328 At least College or University Completion 32.18 (65) 30.69 (62) 37.13 (75) 0.4184 Heavy Episodic Drinking Yes 33.77 (51) 31.79 (48) 34.44 (52) 0.8601 No 30.60 (56) 31.15 (57) 38.25 (70) 0.1597 The sum of individual cells may not equal the period totals due to missing data Differences are considered statistically significant at the p < 0.0023 level due to the Bonferroni Correction Trends in daily cannabis use during the pandemic on a representative sample of adults (≥ 25  years), canna- have not been previously characterized in Canada, lim- bis use during the pandemic increased in 5%, decreased iting direct comparisons with the present findings. The in 2% and remained stable in 93% of the population National Cannabis Survey most recently demonstrated between March 29, 2020 and April 03, 2020 in Canada that daily cannabis use during the past three months [16]. An earlier analysis of the first three waves of the approximated 8% among those 15 years and older in the present survey also demonstrated that cannabis use Fourth Quarter of 2020 [13]. Despite the differences in increased in 52% of those who use cannabis compared to the assessment time frame (past three months vs. past before the beginning of the pandemic between May 08, week), these findings are broadly similar to the estimate 2020 and June 23, 2020 in Canada [7]. These findings col - obtained hereunder for Period 3 (6%). On the other hand, lectively indicate increased cannabis use during the pan- changes in cannabis use since the onset of the pandemic demic. Coupled with the present null findings pertaining have been most frequently examined, with increases in to the trends in daily cannabis use, it is possible that the cannabis use documented in the overall population [16, frequency of cannabis use increased, but not to an extent 17] and among those who use cannabis [7, 18, 19]. Based of daily cannabis use. Indeed, median number of days of I mtiaz et al. Substance Abuse Treatment, Prevention, and Policy (2022) 17:14 Page 5 of 8 Table 2 Risk Characteristics Associated with Daily Cannabis Use in Canada a a b Daily Cannabis Use Unadjusted Odds Ratio Adjusted Odds Ratio , N % P-Value Estimate 95% CI Estimate 95% CI Gender Male 188 6.32 0.0115 1.38 1.10 – 1.73 1.46 1.15—1.85 Female 146 4.82 Reference Reference Age 18—29 years 55 7.47 < 0.0001 2.07 1.48 – 2.89 2.36 1.56—3.57 30—39 years 124 7.72 2.14 1.64 – 2.80 2.65 1.93—3.64 40—49 years 49 5.80 1.58 1.11 – 2.23 1.74 1.19—2.54 ≥ 50 years 106 3.76 Reference Reference Region Western 51 5.62 0.1080 Prairies 92 6.30 Central 119 4.75 Atlantic 72 6.37 Urbanicity Urban area 145 5.17 0.4387 Suburban area 130 5.82 Rural area 59 6.10 Marital Status Married or living with a partner 192 5.11 0.0456 0.73 0.57 – 0.94 0.96 0.71—1.29 Widowed, divorced or separated 40 5.48 0.79 0.54 – 1.15 1.14 0.74—1.77 Never married 99 6.88 Reference Reference Size of household 1 person 66 5.37 0.6592 2 people 134 5.34 3 people 67 6.36 ≥ 4 people 67 5.61 Ethnicity White 251 6.02 0.0199 1.37 1.05 – 1.78 1.97 1.47 – 2.64 Non‑ white 75 4.47 Reference Reference Education Less than college or university completion 131 8.13 < 0.0001 1.81 1.44 – 2.28 1.78 1.39—2.28 At least college or university completion 202 4.65 Reference Reference Heavy Episodic Drinking Yes 151 9.84 < 0.0001 2.42 1.93 – 3.04 2.05 1.62—2.61 No 183 4.11 Reference Reference Employment‑Related Health Risk Yes 60 8.04 0.0016 1.59 1.19 – 2.13 1.38 1.01 – 1.88 No 274 5.21 Reference Reference Feelings of Loneliness 5—7 Days 59 11.59 < 0.0001 2.77 2.01 – 3.82 1.86 1.26—2.73 3—4 Days 61 7.31 1.67 1.22 – 2.27 1.28 0.91—1.79 1—2 Days 74 4.73 1.05 0.79 – 1.40 0.91 0.67—1.23 < 1 Day 140 4.52 Reference Reference Impact of Pandemic on Financial Situation Very worried 88 7.46 0.0020 2.28 1.40 – 3.71 2.08 1.21—3.58 Somewhat worried 146 5.60 1.68 1.05 – 2.67 1.83 1.11 – 3.01 Not very worried 79 4.93 1.47 0.90 – 2.34 1.68 1.00—2.82 Not at all worried 21 3.41 Reference Reference Imtiaz et al. Substance Abuse Treatment, Prevention, and Policy (2022) 17:14 Page 6 of 8 Table 2 (continued) a a b Daily Cannabis Use Unadjusted Odds Ratio Adjusted Odds Ratio , N % P-Value Estimate 95% CI Estimate 95% CI Impact of Pandemic on Employment Situation Currently working from home 71 4.77 0.0233 0.92 0.69 – 1.23 0.81 0.59—1.12 Currently not working or loss of employment 49 7.35 1.46 1.05 – 2.03 1.01 0.70—1.46 Previously working from home 13 5.06 0.98 0.55 – 1.75 0.77 0.42—1.40 Previously not working or loss of employment 19 7.79 1.55 0.95 – 2.55 0.81 0.46—1.43 Other 26 8.05 1.61 1.05 – 2.48 1.52 0.96—2.42 No Impact 156 5.16 Reference Reference Note: Bolded interface denotes p < 0.05 Abbreviations: CI Confidence Interval The outcome reference category in all logistic regression models is no daily cannabis use The odds ratios are adjusted for gender, age, marital status, ethnicity, education, heavy episodic drinking, employment-related health risk, feelings of loneliness, impact of the pandemic on employment situation and impact of pandemic on financial situation cannabis use in the present survey were 4 days in Period associated with both an increase and decrease in canna- 1, 3 days in Period 2 and 4 days in Period 3. Alternatively, bis use among the general population [16]. However, in changes in daily cannabis use may have occurred that an earlier analysis of the first three waves of the present were not captured by the surveys, as the first survey wave survey, being “somewhat worried” about the impacts on was conducted well after the enactment of the initial pub- financial situation was associated with an increase in can - lic health measures in March 2020, or changes may have nabis use among those who use cannabis [7]. Although occurred in other cannabis patterns of consumption. these findings are not directly comparable due to a differ - In terms of risk characteristics associated with daily ent outcome, they are consistent with the positive asso- cannabis use during the pandemic, the observed effects ciation observed between impacts on financial situation of male gender [20], younger age [20] and lesser educa- and daily cannabis use. tion [21] are consistent with assessments of cannabis Further research is nonetheless needed to obtain a patterns of consumption that were conducted before the broader understanding of the changes in cannabis pat- pandemic. The same is also applicable to heavy episodic terns of consumption due to COVID-19. Daily cannabis drinking. In the context of co-occurring alcohol and can- use needs to be monitored among certain high-risk seg- nabis use, higher levels of consumption of one substance ments of the population. Indeed, increase in cannabis use are related to higher levels of consumption of the other and problematic cannabis use were elevated among those substance [22]. Importantly, co-occurring cannabis and with mental health concerns and substance use concerns alcohol use is associated with greater harms and con- (including histories of psychiatric disorders) in Canada sequences than either substance alone [22]. Pandemic- [18]. In addition, the intersection of coping motives with related risks and impacts in relation to daily cannabis pandemic-related risks and impacts in predicting daily use have been examined to a lesser extent. As many have cannabis use warrant further exploration. Furthermore, experienced employment-related risk of contracting the trajectory of cannabis patterns of consumption other COVID-19, feelings of loneliness and impacts on finan - than daily cannabis use need to be examined, such as fre- cial situation during the pandemic, some may engage quency per day, quantity per occasion, modes of admin- in substance use to avoid and cope with the resulting istration and types of products, all of which may impact negative affect, including stress, depression and anxiety. the resulting cannabis-attributable burden of disease. Indeed, self-isolation and coping with depression motives Unfortunately, such assessments were not included in were both associated with cannabis use levels during the the present surveys, but they represent important lines of pandemic when accounting for cannabis use levels before investigation for future studies. the pandemic [23]. Compared to their counterparts who There are some limitations that should be consid - did not engage in self-isolation, those who did engage ered. First, given the absence of a measurement before in self-isolation were using 20% more cannabis [23]. the pandemic began, it is not possible to determine if Impacts on financial situation have contrastingly yielded daily cannabis use changed due to the pandemic. Fur- mixed findings. Reporting “too soon to determine finan - thermore, the recent legalization of recreational can- cial impacts” and “experiencing financial impacts” were nabis consumption in October 2018 in Canada limits I mtiaz et al. Substance Abuse Treatment, Prevention, and Policy (2022) 17:14 Page 7 of 8 the comparison with historic data, and serves as a con- Supplementary Information founder because the expanding cannabis retail market The online version contains supplementary material available at https:// doi. org/ 10. 1186/ s13011‑ 022‑ 00441‑x. may have also affected the trends in daily cannabis use. Second, although the effects are expected to be minimal Additional file 1. since the surveys were conducted online rather than in- person or over the telephone, the self-reported nature of the data may have resulted in social desirability and recall Acknowledgements Not applicable. biases. As such, daily cannabis use may have been under- reported. However, self-reports of alcohol and drug use Authors’ contributions have been shown to be valid [24]. Third, causal inferences SI and JR conceived the research question and outlined the study design. SW, HH, Y TN, DJ and TE‑M managed the data acquisition. SI conducted the between the risk characteristics and daily cannabis use data analyses, with input from CW and TE‑M. SI drafted the manuscript and cannot be made due to a cross-sectional design that does all other authors critically revised the manuscript for important intellectual not account for temporality. Fourth, certain geographic content. All authors have read and approved the final manuscript. segments may not have been adequately represented, as Funding the survey was restricted to the population that spoke Delvinia provided in‑kind support for the data collection. SI, SW, HH and TE‑M English. Fifth, owing to a sampling frame comprised of acknowledge funding from the Canadian Institutes of Health Research and Canadian Centre on Substance Use and Addiction (Partnerships for Cannabis an existing web panel, sampling strategy lacking random Policy Evaluation Team Grant), and SI, JR and TE‑M acknowledge funding from selection procedures, recruitment of a modest number the Canadian Institutes of Health Research’s Institute of Neurosciences, Mental of participants and an average survey completion rate Health and Addiction (Canadian Research Initiative on Substance Misuse Ontario Node Grant [SMN‑13950]). The funders had no role in study design, of 16%, the generalizability of the findings may be lim - data collection, analysis and interpretation, decision to publish, or preparation ited. These concerns about limited generalizability may of the manuscript. be especially pertinent to those without internet access. Availability of data and materials However, the effects are expected to be minimal, as quota Survey data are publicly available from the Methodify Platform by Delvinia sampling in online surveys is an established method (https:// www. delvi nia. com/ camh‑ coron avirus‑ mental‑ health/). to rapidly collect data concerning sensitive subjects [25–27], and only about 6% of the population reports a Declarations lack of home internet access [28]. Sixth, a distinction Ethics approval and consent to participate between non-medicinal and medicinal cannabis use was Research protocols were approved by the Research Ethics Board at the Centre not made, which would affect rates of daily cannabis use. for Addiction and Mental Health. All participants provided informed consent Finally, feelings of loneliness captured by the surveys may before the administration of the surveys. or may not have been precipitated due to the pandemic, Consent for publication as it was not specified in the assessment measure. Not applicable. Competing interests The authors declare that they have no competing interests. Conclusions Daily cannabis use in the overall sample and various Author details Institute for Mental Health Policy Research, Centre for Addiction and Mental population subgroups remained stable during the pan- Health, 33 Russell Street, ON M5S 2S1 Toronto, Canada. Campbell F amily demic in Canada. Pandemic-related risks and impacts Mental Health Research Institute, Centre for Addiction and Mental Health, 250 were associated with daily cannabis use. As increased College Street, Toronto, ON M5T 1R8, Canada. Dalla Lana School of Public Health, University of Toronto, 6th Floor, 155 College Street, Toronto, ON M5T frequency of cannabis use is linked to acute and chronic 3M7, Canada. Department of Epidemiology and Biostatistics, Schulich School adverse health outcomes [29, 30] and the current lower- of Medicine and Dentistry, Western University, Kresge Building, London, ON risk guidelines recommend no more than occasional use N6A 5C1, Canada. Institute of Medical Science, University of Toronto, Room 2374, 1 King’s College Circle, Toronto, ON M5S 1A8, Canada. Depar tment for those who use cannabis [10], it is imperative for gov- of Psychiatry, University of Toronto, 8th Floor, 250 College Street, Toronto, ON ernment authorities to ensure non-medicinal daily can- 7 M5T 1R8, Canada. Institute for Clinical Psychology and Psychotherapy, TU nabis use remains limited, especially as multiple lines of Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany. Department of Inter‑ national Health Projects, Institute for Leadership and Health Management, inquiries suggest an increase in cannabis use. These find - I.M. Sechenov First Moscow State Medical University, Trubetskaya Str., 8, B. 2, ings can inform screening and targeted interventions to 9 119992 Moscow, Russian Federation. Institute of Health Policy, Management reduce daily cannabis use in Canada. and Evaluation, University of Toronto, 425‑155 College Street, Toronto, ON M5T 1P8, Canada. Department of Pharmacology & Toxicology, University of Toronto, 1 King’s College Circle, Toronto, ON M5S 1A8, Canada. I nforma‑ tion Management, Centre for Addiction and Mental Health, 1001 Queen Street Abbreviations West, Toronto, ON M6J 1H4, Canada. Department of Health Sciences, Lake‑ CHERRIES: Checklist for the Checklist for Reporting Results of Internet head University, SN 1006, 955 Oliver Road, Thunder Bay, ON P7B 5E1, Canada. 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Mental health and substance use during COVID‑19. Ottawa: Mental Health Commission of Canada; 2021. fast, convenient online submission 19. Robillard R, Daros AR, Phillips JL, Porteous M, Saad M, Pennestri MH, Quilty thorough peer review by experienced researchers in your field LC. Emerging New Psychiatric Symptoms and the Worsening of Pre‑ existing Mental Disorders during the COVID‑19 Pandemic: A Canadian rapid publication on acceptance Multisite Study: Nouveaux symptômes psychiatriques émergents et support for research data, including large and complex data types détérioration des troubles mentaux préexistants durant la pandémie • gold Open Access which fosters wider collaboration and increased citations de la COVID‑19: une étude canadienne multisite. Can J Psychiatry. maximum visibility for your research: over 100M website views per year 2021;66(9):815‑826. • 20. Leos‑ Toro C, Rynard V, Hammond D. Prevalence of problematic cannabis use in Canada: Cross‑sectional findings from the 2013 Canadian tobacco, At BMC, research is always in progress. alcohol and drugs survey. Can J Public Health. 2018;108(5–6):e516–22. Learn more biomedcentral.com/submissions 21. Legleye S, Khlat M, Mayet A, Beck F, Falissard B, Chau N, et al. From cannabis initiation to daily use: educational inequalities in

Journal

"Substance Abuse Treatment, Prevention, and Policy"Springer Journals

Published: Feb 21, 2022

Keywords: Canada; SARS-CoV-2; COVID-19; Coronavirus; Cannabis; Marijuana

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