Demographics and clinical characteristics
Of the 136 individuals who were screened for participation and emailed the survey link, 80 (58.8%) completed it and were included in the analysis. Two participants were removed from the analysis due to incomplete surveys. The demographic and injury/clinical characteristics of these participants are provided in Table 1. The mean age was 57.74 years (SD 13.2), age range 27–81 years, and 61.2 % were men. The number of years since injury onset was 42.79 years (range 4-77 years) (SD 17.8). Most of the participants (57.5%) had a post-secondary degree and (43.7%) were retired. Cervical (C1 - C8) injuries were the most common level of injury (42.5%), while completeness of injury based on AIS score was primarily unknown by participants (80 %).
Table 1: Demographic and injury characteristics
Variable
|
Mean (SD) [Min-Max]
|
current age
Missing
|
57.74 (13.243) [27-81]
6
|
Age at injury
Missing
|
42.79 (17.831) [4-77]
1
|
|
Count (%)
|
Gender
Male
Female
Missing
|
49(61.2)
30(37.5)
1(1.3)
|
Level of education
Advanced degree
Less than secondary school graduation
Post-secondary degree
Secondary school graduation
Missing
|
7(8.7)
3(3.8)
46(57.5)
23(28.7)
1(1.3)
|
Employment
Currently employed – Full time
Currently employed - Part time
Not currently employed
Retired
Missing
|
11(13.8)
8(10.0)
26(32.5)
35(43.7)
0
|
Level and completeness of injury
Cervical (C1 - C8)
Lumbar (L1 - L5)
Thoracic (T1 - T12)
Unknown
Missing
|
34(42.5)
16(20.0)
24(30.0)
5(6.2)
1 (1.3)
|
AIS Score
AIS A (complete)
AIS B
AIS C
AIS D
Unknown
Missing
|
6(7.5)
4(5.0)
2(2.5)
0 (0.0)
64 (80)
4 (5.0)
|
Cannabis use before and after injury
Cannabis use before and after injury is cross tabulated in Table 2. Of the 80 participants included in this survey, the majority (n=41 [51.2%]), indicated that they had tried cannabis in their lifetime, while 30 (37.5%) were current users.
When considering changes in cannabis use pre and post injury, there was a non-significant increase (p=0.13) in cannabis use from pre (n=26, 32.5%) to post-injury (n=34, 42.5%). This change was driven by 19 (23.75%) pre-injury cannabis users continuing to use cannabis post-injury, 15 (18.75%) new cannabis users’ post-injury, and only 7 (8.7%) pre-injury cannabis users choosing to stop using cannabis following their injury.
Table 2: Cannabis use before versus after injury
|
Cannabis Use After Injury
|
Cannabis use before injury
No, n (%)
Yes, n (%)
Total, n (%)
|
No, n (%)
39(48.8)
7(8.7)
46(57.5)
|
Yes, n (%)
15(18.75)
19(23.75)
34(42.5)
|
Total, n (%)
54(67.5)
26(32.5)
80(100)
|
Frequency, reasons, and methods of cannabis use before and after injury
The frequency, reasons, and methods for cannabis use before and after injury are summarized in Table 3. Sixteen percent of participants (16.3%) indicated that they used cannabis rarely (less than once per month) before the injury, whereas (22.5%) of participants reported daily use since the injury. Participants were read a list of reasons for cannabis use and asked to endorse all that applied to them or to list other reasons for use before and after injury. Before the injury, the highest response was for enjoyment (25.0%), while the most common reasons for using cannabis after injury were reducing pain (36.3 %) and improving sleep (30.0%). Among participants who did not use cannabis prior to their injury, the primary reason was that it was illegal at the time (31.3%). The most frequently reported reasons for not using cannabis after injury were negative health implications (13.8%), social stigma or fear of judgment (12.5%), and other reasons (25%) (table 5). Smoking was the most common method of cannabis use before injury (27.5%), whereas most participants (26.3%) preferred edibles after injury. In addition, most of the participants did not report any side effects of cannabis use before or after injury (18.8%). However, fatigue was indicated by some participants as a negative side effect before (7.5%) and after the injury (11.3%).
Table 3: Frequency, reasons, and method of cannabis use before and after injury
|
Before
Count (%)
|
After
Count (%)
|
Frequency of cannabis use
Daily
Weekly
Monthly
Rarely (less than once per month)
I have used cannabis since my injury but no longer use it
Never
|
7(8.8)
1(1.3)
5(6.3)
13(16.3)
--------
54(67.5)
|
18(22.5)
5(6.3)
2(2.5)
5(6.3)
4(5.0)
46(57.5)
|
Reasons for cannabis use
Recreation / Enjoyment
Reducing Pain
Reducing Spasticity
Reducing Nausea
Reducing Stress / Anxiety
Reducing Depression
Improving Sleep
Improving Appetite
Reducing the need for other medications
Other
Unknown
|
20(25.0)
5(6.3)
0
0
5(6.3)
3(3.8)
5(6.3)
0
4(5.0)
3(3.8)
0
|
8(10.0)
29(36.3)
16(20)
4(5.0)
12(15)
11(13.8)
24 (30.0)
5(6.3)
13(16.3)
3(3.8)
0
|
Reasons for not using cannabis
Cost / Too expensive
Negative health implications
Social stigma / Fear of judgement
Dislike taste / smell
Illegal (at the time
Unsure how to obtain cannabis
Other
Unknown
|
1(1.3)
11(13.8)
13(16.3)
6(7.5)
25(31.3)
7(8.8)
17(21.3)
0
|
1(1.3)
11(13.8)
10(12.5)
5(6.3)
8(10.0)
4(5.0)
20(25.0)
0
|
Method of cannabinoid use
Smoking
Vaping
Edibles
applied to skin
liquid spray
Nabilone
Other
Unknown
|
22(27.5)
3(3.8)
5(6.3)
2(2.5)
0
0
3(3.8)
0
|
13(16.3)
13(16.3)
21(26.3)
5(6.3)
7(8.8)
10(12.5)
8(10.0)
0
|
Negative side effects with cannabinoid use
None
Fatigue
Weight Gain
Heart Palpitations
Nausea
Low Blood Pressure
Paranoia
Reduced Motivation
Reduced Physical Capabilities
Other
Unknown
|
15(18.8)
6(7.5)
0
0
1(1.3)
0
2(2.5)
3(3.8)
2(2.5)
3(3.8)
0
|
15(18.8)
9(11.3)
1(1.3)
0
2(2.5)
2 (2.5)
2(2.5)
5(6.3)
4(5.0)
3(3.8)
0
|
Effectiveness of cannabis before and after injury
Participants were asked to rate the effectiveness of cannabis before and after their injury on a scale from 1 to 100 for their intended purpose (table 4). Most participants used cannabis for recreation pre-injury. Prior to their injury, participants reported that cannabis was most effective at reducing the need for other medications, the mean (SD) was 89.25 (10.751), and improving symptoms of depression, the mean (SD) was 75.00 (10.000). Post-injury, participants most commonly used cannabis for reducing pain and improving sleep. After injury, participants indicated that cannabis was moderately to highly effective for improving all outcomes. Cannabis was reported to be most beneficial for improving appetite, the mean (SD) was 75.75 (17.821), enjoyment, the mean (SD) was 71.38 (15.287), and stress/anxiety, the mean (SD) was 70.83 (18.693) post-injury.
Cannabis had similar reported effects on reducing pain (Pre-injury, the mean (SD) was 53.80 (26.87)), (Post-injury, the mean (SD) was 53.10 (27.64)), reducing stress/anxiety (Pre-injury, the mean (SD) was 68.80 (13.6)), (Post-injury, the mean (SD) was 70.83 (18.693)) and improving sleep (Pre-injury, the mean (SD) was 72.40 (8.08)), (Post-injury, the mean (SD) was 68.38 (25.65)) in the pre and post injury timeframes.
When asked whether they felt cannabis was more effective than other medications for their purposes approximately 14% of participants indicated that cannabis was more effective than other medications before their injury, while 20% stated that it was more effective than other medications after their injury.
Table 4: Effectiveness of cannabis use before and after the injury (a scale from 0-100)
Variables
|
Pre- injury
Mean (SD) [Range]
|
Post- injury
Mean (SD) [range]
|
providing recreation/enjoyment
N
Reducing pain
N
Reducing spasticity
N
Reducing nausea
N
Reducing stress/ anxiety
N
Reducing depression
N
Improving sleep
N
Improving appetite
N
Reducing the need for other medications
N
Other
N
|
46.50 (33.843) [0-100]
18
53.80 (26.874) [10-80]
5
0
0
0
0
68.80 (13.590) [50-80]
5
75.00 (10.000) [65-80]
3
72.40 (8.081) [64-85]
5
0
0
89.25 (10.751) [80-100]
4
50.00 (43.301) [0-75]
3
|
71.38 (15.287) [50-90]
8
53.10 (27.642) [0-100]
29
60.56 (24.424) [6-100]
16
58.75 (17.500) [50-85]
4
70.83 (18.693) [25-100]
12
68.00 (21.840) [25-100]
11
68.38 (25.649) [5-100]
24
75.75 (17.821) [50-91]
4
69.77 (24.297) [8-100]
13
85.00 (7.071) [80-90]
2
|
Relationships between demographic characteristics and cannabis use after injury
The distributions of cannabis use and frequency of use (for those reporting use) are summarized by gender, education, and employment. Among post-injury cannabis users, approximately 65% were male and 32% were female. Among these participants, 66.7% of males and 27.7% of females reported using cannabis daily. In addition, participants with post-secondary degrees had a higher rate of cannabis use after injury (58.9%). The rate of daily use ranged from 5.6% to 50% among the education subgroups. The rate of cannabis use after injury was higher for those retired (44.1%); while the rate of daily use was higher for those unemployed (38.9%). Among those post-injury who did not use cannabis, 58.7% were male and 41.3% were female. Those with post-secondary degrees (56.5%) and those who were retired (43.5%), represented a higher proportion of respondents who did not use cannabis post-injury (56.5%). A Chi-Square analysis was conducted to test the relationship between cannabis use since injury and sex, education, and employment. No significant differences were shown. Sex, X2= 1.886, df=2, p=0.389, Education, X2= 2.039, df=4, p=0.729, Employment, X2= 4.677, df=3, p=0.197. For additional information, refer to the supplementary material Table 1.