Cannabis Treatment Demand
in Canada
Dr. Brian Rush
Dr. Carol Strike
Karen Urbanoski
Marion Mueller
Health Systems Research and Consulting Unit
Centre for Addiction and Mental Health
Toronto, Ontario, Canada
In support of the Canadian Centre on Substance Abuse
Cannabis Treatment Demand in
Canada
• Health care services are administered by provinces
• No centralized national reporting system for
substance abuse treatment
• Existence of provincial reporting systems for
substance abuse treatment is variable
• No standardized definitions, standard set of criteria
collected
Cannabis Use in the General
Population
In 1994:
• 29% of Canadian adults reported lifetime
cannabis use
• 7% reported past-year use
• 2% reported using at least weekly in the past year
Source: Canada’s Alcohol and Other Drug Survey (CADS)
conducted by Statistics Canada
Cannabis Use in the General
Population
In 2000:
• 35% of Ontario adults reported lifetime cannabis use
• 11% reported past-year use
• 68% of lifetime users reported no past-year use
• 0.5% met ICD-10 criteria for cannabis dependence
Source: CAMH Monitor 2000, conducted by the Centre for
Addiction and Mental Health
ONTARIO
Prevalence of Cannabis Problems
in the Ontario Treatment System
Of all clients entering substance abuse treatment in
Ontario in fiscal 2000 (Apr-1-00 to Mar-31-01;
N=47995)
• 30.5% (N=14633) identified cannabis as a
problem substance
• 13.0% (N=6219) identified cannabis as the
primary problem substance
Prevalence of Cannabis Problems
in the Ontario Treatment System
Cannabis was identified as a problem substance by:
• 32% of men; 27% of women
• 69% of clients under age 20
• 41% of those with less than a high school education
• 67% of students
• 44% of single clients
Clients with Primary Cannabis
Problems (N=6219)
Average Frequency of Cannabis Use in Past Month
• 17% no use
• 21% less than twice weekly
• 16% 3 to 6 times weekly
• 45% daily
• 1.3% binge only
Distinctiveness of Clients with
Primary Cannabis Problems
Cannabis
Clients
(N=6219)
Total
Population
(N=47995)
Men
74%
70%
Under age 20
56%
15%
Less than high school
75%
52%
Student
43%
13%
Single
79%
50%
Distinctiveness of Clients with
Primary Cannabis Problems
Cannabis
Clients
(N=6219)
Total
Population
(N=47995)
Legal problems
39%
32%
External pressure to enter treatment
38%
28%
Parole or probation
17%
13%
School
5%
1%
Family
5%
2%
Distinctiveness of Clients with
Primary Cannabis Problems
Past-year use of:
Alcohol
Cocaine
Hallucinogens
Heroin
Amphetamines
3+ Psychoactive Substances
5+ Psychoactive Substances
Cannabis
Clients
(N=6219)
Total
Population
(N=47995)
72%
20%
30%
3%
12%
44%
5%
77%
26%
10%
5%
7%
30%
5%
Sources of Referral
Primary Referral Source:
Family or friends
Medical or psychiatric service
Police or legal system
School
Self
Withdrawal management service
Cannabis
Clients
(N=6219)
Total
Population
(N=47995)
16%
8%
17%
13%
24%
3%
9%
12%
13%
3%
35%
6%
Is the distinct referral pattern of
cannabis clients a factor of age?
50
40
< 2 0 y e a r s ; me n
30
%
< 2 0 y e a r s ; w o me n
2 0 + y e a r s ; me n
20
2 0 + y e a r s ; w o me n
10
el
f
S
l
ch
oo
S
ys
te
m
ia
n
ic
hy
s
P
Le
ga
ls
Fa
m
i ly
/fr
ie
nd
s
0
Prevalence of Cannabis Problems
in a Large Treatment Facility
Of clients assessed at the Centre for Addiction and
Mental Health (CAMH) in Toronto, Ontario
between Dec-1-96 and Mar-31-99 (n=4895):
• 9% identified cannabis as the primary problem
substance (n=426)
• Demographic profile: 80% male, 61% under age
30, 77% single
CAMH Cannabis Client Profile
at Treatment Entry
Cannabis-related adverse consequences experienced
in the 90 days prior to admission (n=426):
•
•
•
•
•
•
•
Cognitive impairment……….
Psychological problems……..
Vocational problems…………
Interpersonal problems………
Financial problems…………..
Physical health problems…….
Legal problems………………
50%
68%
53%
62%
60%
40%
18%
CAMH Cannabis Client Profile
at Treatment Entry
Also in the past 90 days:
• 27% had been physically or verbally abusive after
using cannabis
• 35% had sought help for psychological problems
• 16% had been charged with a criminal offense
CAMH Cannabis Client Profile
at Treatment Entry
In addition, primary problem cannabis clients
self-reported history included:
• Suicidal ideation………….
• Sexual abuse……………..
• Physical abuse……………
• Depressive symptoms……
• Anxiety symptoms……….
39%
24%
33%
36%
13%
CAMH Cannabis Client Profile
at Treatment Entry
Other psychoactive substances used in the 90
days prior to the assessment interviews:
• Alcohol…………..
• Hallucinogens……
• Cocaine…………..
• Opiates……………
• Benzodiazepines….
79%
18%
18%
17%
14%
Despite the high rate of
poly-drug use…
• 64% of primary problem cannabis users reported no
secondary or tertiary problem substances
• 22% reported alcohol as a secondary problem
substance; however:
• Only 10% reported drinking on >45 of the last 90 days
• 50% reported drinking on 5 or fewer days
• Unlikely that clients were attributing problem related
to alcohol and other drug use to their cannabis use
SASKATCHEWAN
Prevalence of Cannabis Problems in
the Saskatchewan Treatment System
Trend in % of admissions reporting cannabis-related problems:
35
30
25
%
20
15
10
5
0
1992-
1993-
1994-
1995-
1996-
1997-
1998-
1999-
2000-
2001-
93
94
95
96
97
98
99
00
01
02
F isca l Ye a r
Prevalence of Cannabis Problems in
the Saskatchewan Treatment System
Of all admissions to substance abuse treatment in
Saskatchewan in Fiscal 2000 (Apr-1-00 to Mar31-01; N=18832)
• 25% (n=4672) reported that their use of cannabis
was creating problems
• Second most prevalent problem substance after
alcohol (reported by 10355 clients, 55%)
Prevalence of Cannabis Problems:
Fiscal 2000 (N=4672)
• Men
• Women
24%
28%
• < 20 years
• 20-29 years
• 30-39 years
• 40-49 years
• 50 + years
47%
29%
23%
13%
3%
Distinctiveness of Clients with
Primary Cannabis Problems
Cannabis
Clients
(N=4672)
Total
Population
(N=18832)
Men
67%
70%
< 20 years
31%
16%
20-29 years
34%
29%
30-39 years
24%
26%
40-49 years
10%
19%
50 + years
1%
10%
ALBERTA
Prevalence of Frequent Cannabis Use
in the Alberta Treatment System
Trend in % of admissions reporting cannabis as the most
frequently used substance in the past year:
14
12
10
%
8
6
4
2
0
1 9 9 3 -9 4
1 9 9 4 -9 5
1 9 9 5 -9 6
1 9 9 6 -9 7
F i sc a l Ye a r
1 9 9 7 -9 8
1 9 9 8 -9 9
Prevalence of Cannabis Problems in
the Alberta Treatment System
Of all admissions to substance abuse treatment in
Alberta in Fiscal 2002 (Apr-1-02 to Mar-31-03;
N=31863)
• 22% (n=5437) reported cannabis as a substance of
concern in the past year
• In comparison, 54% reported concerns with
alcohol, 33% with cocaine, 14% with opiates
Distinctiveness of Clients with
Primary Cannabis Problems
Cannabis
Clients
(N=5437)
Total
Population
(N=31863)
Men
73%
69%
< 20 years
25%
19%
20-29 years
29%
22%
30-39 years
28%
28%
40-49 years
15%
22%
50 + years
2%
10%
Qualitative Study of Therapists:
Initial Impressions
• Guidelines
• What is a safe level?
• Relative to other drugs and tobacco
• Considerable variation in what is considered
harmful (daily use; consequences)
• Self-report during assessment perhaps more
accurate
• Cannabis
Mental health? But who cares?
Conclusions
• Clients with cannabis-related problems constitute
a non-trivial proportion of clients many Canadian
substance abuse treatment systems
• Rates of cannabis-related problems are stable in
at least some jurisdictions
• Have a baseline to monitor impact of anticipated
change in legislation
Conclusions
• Clients who seek help with cannabis-related
problems may be a demographically distinct
sub-population within the larger substance
abuse treatment population
• Unique social position of the young, single,
male, with low educational attainment may
affect treatment needs/outcomes
Conclusions
• Those who seek treatment for cannabisrelated problems may present with a host of
issues that could potentially affect treatment
needs/outcomes
• High rates of legal system involvement,
psychiatric symptoms, external pressure to
treatment, cannabis-related psychosocial
problems
Future Areas of Research
• Need outcome studies (e.g., comparing
cannabis-specific and non-specific
treatment interventions)
• Need training and information for harm
reduction approaches
Descargar

Cannabis Treatment Demand in a Canadian Treatment …