Consumer perceptions of legal cannabis products in Canada, 2019-2021: a repeat cross-sectional study.

BACKGROUND: Consumer perceptions of legal cannabis products may drive willingness to purchase from the illegal or legal market; however, little is known on this topic. The current study examined perceptions of legal products among Canadian cannabis consumers over a 3-year period following federal legalization of non-medical cannabis in 2018. METHODS: Data were analyzed from Canadian respondents in the International Cannabis Policy Study, a repeat cross-sectional survey conducted in 2019-2021. Respondents were 15,311 past 12-month cannabis consumers of legal age to purchase cannabis. Weighted logistic regression models examined the association between perceptions of legal cannabis and province of residence, and frequency of cannabis use over time. RESULTS: In 2021, cannabis consumers perceived legal cannabis to be safer to buy (54.0%), more convenient to buy (47.8%), more expensive (47.2%), safer to use (46.8%) and higher quality (29.3%) than illegal cannabis. Except for safety of purchasing, consumers had more favourable perceptions of legal cannabis in 2021 than 2019 across all outcomes. For example, consumers had higher odds of perceiving legal cannabis as more convenient to buy in 2021 than 2019 (AOR = 3.09, 95%CI: 2.65,3.60). More frequent consumers had less favourable perceptions of legal cannabis than less frequent consumers. CONCLUSIONS: Three years since legalization, Canadian cannabis consumers generally had increasingly favourable perceptions of legal vs. illegal products - except for price - with variation across the provinces and frequency of cannabis use. To achieve public health objectives of legalization, federal and provincial governments must ensure that legal cannabis products are preferred to illegal, without appealing to non-consumers.

Changes in the dollar value of per capita alcohol, essential, and non-essential retail sales in Canada during COVID-19.

BACKGROUND: Multiple survey reports suggest that alcohol use has increased in Canada during the COVID-19 pandemic. However, less is known about how per capita alcohol sales, which predict population-level alcohol use, have changed and whether changes in alcohol sales differ from changes in sales of other products due to pandemic factors. METHODS: We obtained monthly retail sales data by industry from Statistics Canada, for the six largest provinces in Canada (containing 93% of the national population), between January 2010 and November 2020, representing time before and 9 months after the start of the pandemic in Canada. We used an interrupted time series analysis to estimate pandemic impacts on the dollar value of monthly per capita (per individuals 15+ years) alcohol, essential and non-essential retail sales. We adjusted our analyses for pre-pandemic sales trends, inflation, seasonality and changing population demographics over time. RESULTS: During the first 9 months of the pandemic, the values of per capita alcohol, essential and non-essential sales were, respectively, 13.2% higher, 3.6% higher and 13.1% lower than the average values during the same period in the prior 3 years. Interrupted time series models showed significant level change for the value of monthly per capita alcohol sales (+$4.86, 95% CIs: 2.88, 6.83), essential sales (-$59.80, 95% CIs: - 78.47, - 41.03) and non-essential sales (-$308.70, 95% CIs: - $326.60, - 290.79) during the pandemic. Alcohol sales were consistently elevated during the pandemic, and the pre- and post-pandemic slopes were comparable. In contrast, essential and non-essential retail sales declined in the early months of the pandemic before returning to regular spending levels. CONCLUSION: During the first 9 months of the pandemic, per capita alcohol sales were moderately elevated in Canada. In contrast, non-essential sales were lower than prior years, driven by large decreases during the initial months of the pandemic. These findings suggest that the pandemic was associated with increased population-level alcohol consumption, which may lead to increased alcohol-related harms. Ongoing research is needed to examine how factors, including pandemic-related stressors and specific alcohol sales-related policies, may have influenced changes in alcohol use and harms.

Proximity to Legal Cannabis Stores in Canada and Use of Cannabis Sources in the First Three Years of Legalization, 2019-2021.

OBJECTIVE: The accessibility of legal cannabis in Canada may influence how consumers source their cannabis. The aims of this study were to examine (a) the distance between respondents' homes and legal retail stores, (b) the cannabis sources used in the past 12 months, and (c) the association between cannabis sources used and distance to legal retail stores. METHOD: Data were analyzed from Canadian respondents participating in the International Cannabis Policy Study from 2019 to 2021. Respondents were 15,311 past-12-month cannabis consumers of legal age to purchase cannabis. Weighted logistic regression models examined cannabis sources used and their association with the Euclidean distance to the nearest legal store, province of residence, and year (n = 12,928). RESULTS: Respondents lived closer to a legal retail store in 2021 (1.5 km) versus 2019 (6.8 km) as the number of retail stores increased. Respondents in 2020 and 2021 had higher odds of obtaining cannabis from legal sources (e.g., legal stores: 47.9% and 60.0% vs. 38.6%, respectively, adjusted odds ratio [AOR] range: 1.41-2.42) and lower odds of obtaining cannabis from illegal sources versus 2019 (e.g., dealers: 22.6% and 19.9% vs. 29.1%, respectively, AOR range: 0.65-0.54). Respondents who lived closest to legal stores had higher odds of sourcing from legal stores and lower odds of sourcing from legal websites or growing their own cannabis. CONCLUSIONS: Legal cannabis stores are increasingly accessible to people living in Canada 3 years after legalization. Household proximity to a legal cannabis store was associated with sourcing cannabis from legal retail stores, but only among those who live very close (<3 km). Findings suggest that proximity to legal cannabis stores may aid uptake of the legal market, yet there may be diminishing returns after a certain point.

Home cultivation across Canadian provinces after cannabis legalization.

Aims: Little research exists on home cultivation in Canada after non-medical cannabis legalization in 2018. The aims of the study were to: (1) estimate the percentage of home cultivation before and after legalization; (2) estimate the quantity and expenditure of cannabis plants; and (3) examine the association between provincial policies and home cultivation after legalization. Methods: Repeat cross-sectional survey data come from Canadian respondents in the International Cannabis Policy Study in 2018, 2019, and 2020. Respondents aged 16-65 were recruited through online commercial panels. Home cultivation rates were estimated among all respondents in 2019 and 2020 (n = 26,304) and among a sub-sample of past 12-month cannabis consumers in 2018-2020 (n = 12,493). Weighted multivariable logistic regression models examined the association between home cultivation and provincial policies among all respondents, 2019-2020. Results: Cannabis consumers in 2019 (7.9%; AOR = 1.47, 95% CI: 1.07,2.01) and 2020 (8.8%; AOR = 1.62, 95 %CI: 1.18,2.23) had higher odds of reporting home cultivation in the past 12 months than pre-legalization (5.8%). Post-legalization, past 12-month home cultivation was lower in Quebec and Manitoba, the two provinces that prohibited home cultivation (3.2%), than in provinces where home cultivation was permitted (6.8%; AOR = 0.48, 95 %CI: 0.39, 0.59). The median number of plants grown across all provinces was between 3.1 and 3.5 in all years. Conclusions: Almost one in ten Canadian cannabis consumers reported home cultivation of cannabis in 2020, with modest increases following legalization and most growing within the non-medical limit of four plants. Home cultivation was less common in provinces where home cultivation was prohibited.

Interrupted time series analysis of Canadian legal cannabis sales during the COVID-19 pandemic.

INTRODUCTION: There were repeated reports of increased cannabis sales, use and health impacts in Canada during the COVID-19 pandemic. However, it was unclear whether the increases were due to pandemic effects or industry expansion. METHODS: We performed interrupted time series regressions of monthly per capita legal cannabis sales from March 2019 to February 2021, first with national averages, then with provincial/territorial data after adjusting for store density. We considered two interruption alternatives: January 2020, when product variety increased; and March 2020, when pandemic restrictions began. RESULTS: The provincial/territorial regression with the January interruption explained R2  = 69.6% of within-jurisdiction variation: baseline monthly per capita sales growth averaged $0.21 (95% confidence interval [CI] 0.15, 0.26), sales immediately dropped in January by $1.02 (95% CI -1.67, -0.37), and monthly growth thereafter increased by $0.16 (95% CI 0.06, 0.25). With the March interruption, the regression instead explained 68.7% of variation: baseline sales growth averaged $0.14 (95% CI 0.06, 0.22), there was no immediate drop and growth thereafter increased by $0.22 per month (95% CI 0.08, 0.35). DISCUSSION AND CONCLUSIONS: Increasing cannabis sales during the pandemic was consistent with pre-existing trends and increasing store numbers. The extra increased growth was more aligned with January's new product arrivals than with March's pandemic measures, though the latter cannot be ruled out. We found little evidence of pandemic impacts on Canada's aggregate legal cannabis sales. We therefore caution against attributing increased population-level cannabis use or health impacts primarily to the pandemic.

Examining Barriers as Risk Factors for Relapse: A focus on the Canadian Treatment and Recovery System of Care.

OBJECTIVES: In 2016, the Canadian Centre on Substance Use and Addiction (CCSA) conducted the first survey of individuals in recovery from addiction in Canada. The findings revealed that many individuals in recovery lead meaningful lives, contributing to their families and society. However, participants also identified a number of barriers to starting and maintaining recovery. The current study examined the relationship between the barriers experienced and relapse during recovery. METHODS: Data from the 2016 Life in Recovery (LIR) from Addiction in Canada survey were analyzed using descriptive and logistic regression analyses. Participants comprised 855 individuals (Mage = 47.3 years), all of whom self-reported being in recovery from addiction. RESULTS: Logistic regressions revealed that upon starting recovery, long delays for treatment, odds ratio (OR) = 1.77, 95% confidence interval (CI) = 1.21-2.60, P < 0.01, and not having stable housing, OR = 1.83, 95% CI = 1.14-2.95, P < 0.05, were associated with increased risk of relapse. Moreover, upon examining barriers to maintaining recovery, a lack of supportive social networks, OR = 2.10, 95% CI = 1.26-3.48, p < 0.01, a lack of programs or supports, OR = 1.75, 95% CI = 1.03-2.98, P < 0.05, and the costs of recovery services OR = 1.73, 95% CI = 1.02-2.91, P < 0.05 were associated with increased risk of relapse. CONCLUSIONS: Targeted investments to address the treatment-related barriers that most strongly relate to relapse, could significantly improve the lives of individuals struggling with addiction and those beginning and maintaining their recovery journey. OBJECTIFS: En 2016, le Centre canadien de lutte contre l'alcoolisme et les toxicomanies (CCLAT) a mené un premier sondage auprès des personnes en rétablissement à la suite d'une dépendance au Canada. Les résultats ont révélé que de nombreuses personnes en rétablissement mènent des vies significatives, contribuant ainsi à leur famille et à la société. Cependant, les participants ont également identifié un certain nombre d'obstacles au démarrage et au maintien du rétablissement. La présente étude a examiné la relation entre les obstacles rencontrés et la rechute pendant le rétablissement. MÉTHODES: Les données de l'enquête Life in Recovery (LIR) de l'Enquête sur la toxicomanie au Canada de 2016 ont été analysées à l'aide d'analyses de régression descriptives et logistiques. Les participants comprenaient 855 individus (Moyenne d'âge = 47,3 ans), qui ont tous déclaré être en rétablissement après une dépendance. RÉSULTATS: Les régressions logistiques ont révélé qu'au début du rétablissement, de longs délais de traitement, chance de réussite (CR) = 1,77, intervalle de confiance à 95% (IC) = 1,21-2,60, p < 0,01, et n'ayant pas de logement stable, CR = 1,83, IC 95% = 1,14-2,95, p < 0,05, étaient associés à un risque accru de rechute. De plus, en examinant les obstacles au maintien du rétablissement, un manque de réseaux sociaux de soutien, CR = 2.10, IC à 95% = 1.26-3.48, p < 0.01, manque de programmes ou de soutien, CR = 1.75, IC à 95% = 1.03-2,98, p < 0,05, et les coÛts des services de récupération CR = 1,73, IC 95% = 1,02-2,91, p < 0,05 étaient associés à un risque accru de rechute. CONCLUSIONS: Des investissements ciblés visant à surmonter les obstacles liés au traitement les plus étroitement liés à la rechute pourraient améliorer considérablement la vie des personnes aux prises avec une dépendance et de celles qui amorcent et poursuivent leur chemin vers le rétablissement.

A common public health-oriented policy framework for cannabis, alcohol and tobacco in Canada?

Support for a public health approach to cannabis policy as an alternative to prohibition and criminalization is gaining momentum. Recent drug policy changes in the United States suggest growing political feasibility for legal regulation of cannabis in other North American jurisdictions. This commentary discusses the outcomes of an interdisciplinary policy meeting with Canadian experts and knowledge users in the area of substance use interventions. The meeting explored possibilities for applying cross-substance learning on policy interventions for alcohol, tobacco and cannabis, towards the goal of advancing a public health framework for reducing harms associated with substance use in Canada. The meeting also explored how the shift in approach to cannabis policy can provide an opportunity to explore potential changes in substance use policy more generally, especially in relation to tobacco and alcohol as legally regulated substances associated with a heavy burden of illness. Drawing from the contributions and debates arising from the policy meeting, this commentary identifies underlying principles and opportunities for learning from policy interventions across tobacco, alcohol and cannabis, as well as research gaps that need to be addressed before a public health framework can be effectively pursued across these substances.