Between April 2014 and January 2019, 65245 adult patients were authorized for medical cannabis use following clinic-based medical assessments. Of these patients, 61835 (94.8%) were from ON and 3410 (5.2%) were from AB. Across both Provinces, the mean age of the patients was 52.8 ± 15.4 years and 53.9% of patients were female. The patients resided in neighborhoods distributed across all income quintiles - with the highest income quintile having the lowest proportion of patients (13.9%) (Table 1). The demographics of patients in ON and AB were very similar with respect to age (52.9 ± 15.4 vs. 51.8 ± 15.7 years) and sex (53.8% vs. 55.7% female) in ON and AB, respectively (Table 1). Both provinces also had similar distributions of self-reported questionnaire scores in the GAD-7, PHQ-9, and CAGE-AID assessments - with the majority of patients in both provinces self-reporting no or only mild issues with respect to anxiety (54.5%), depression (49.7%), or addiction (89.1%) (Table 1). Conversely, severe issues were reported by 25.7% of patients for anxiety and 12.5% for depression, and 110.9% reported problems with drugs and alcohol addiction.
Table 1
Characteristics of patients authorized medical cannabis in Ontario and Alberta, Canada (n = 65245)
Characteristic | All Patients | Ontario Patients | Alberta Patients |
| (N = 65245) | (N = 61835) | (N = 3410) |
Age (years) | | | |
< 21 | 576 (0.9) | 531 (0.9) | 45 (1.3) |
21–30 | 4732 (7.3) | 4451 (7.2) | 281 (8.2) |
31–40 | 9814 (15.0) | 9269 (15.0) | 545 (16.0) |
41–50 | 11492 (17.6) | 10904 (17.6) | 588 (17.2) |
51–60 | 15653 (24.0) | 14873 (24.1) | 780 (22.9) |
61–70 | 12599 (19.3) | 11948 (19.3) | 651 (19.1) |
71–80 | 7012 (10.8) | 6656 (10.8) | 356 (10.4) |
81–90 | 2960 (4.5) | 2806 (4.5) | 154 (4.5) |
> 90 | 406 (0.6) | 396 (0.6) | 10 (0.3) |
Sex | | | |
Female | 35135 (53.9) | 33236 (53.8) | 1899 (55.7) |
Male | 30109 (46.1) | 28598 (46.2) | 1511 (44.3) |
Other | 1 (0.0) | 1 (0.0) | - |
Neighbourhood Income Quintile | | | |
1 | 12814 (19.6) | 11880 (19.2) | 934 (27.4) |
2 | 14565 (22.3) | 13628 (22.0) | 937 (27.5) |
3 | 13420 (20.6) | 12894 (20.9) | 526 (15.4) |
4 | 15068 (23.1) | 14470 (23.4) | 598 (17.5) |
5 | 9063 (13.9) | 8672 (14.0) | 391 (11.5) |
Missing | 315 (0.5) | 291 (0.5) | 24 (0.7) |
GAD-7 | N = 37303 | N = 36962 | N = 341 |
None | 11809 (31.7) | 11701 (31.7) | 108 (31.67) |
Mild | 8496 (22.8) | 8419 (22.8) | 77 (22.6) |
Moderate | 7400 (19.8) | 7319 (19.8) | 81 (23.8) |
Severe | 9598 (25.7) | 9523 (25.8) | 75 (22.0) |
PHQ-9 | N = 37338 | N = 36995 | N = 343 |
None | 8777 (23.5) | 8689 (23.5) | 88 (25.7) |
Mild | 9769 (26.2) | 9686 (26.2) | 83 (24.2) |
Moderate | 8005 (21.4) | 7912 (21.4) | 93 (27.1) |
Moderately Severe | 6106 (16.4) | 6057 (16.4) | 49 (14.3) |
Severe | 4681 (12.5) | 4651 (12.6) | 30 (8.8) |
CAGE | N = 34534 | N = 34316 | N = 218 |
Negative | 30758 (89.1) | 30565 (89.1) | 193 (88.5) |
Positive | 3776 (10.9) | 3751 (10.9) | 25 (11.5) |
Method of Use | | | |
Smoking | 33024 (50.6) | 31301 (50.6) | 1723 (50.5) |
Vaping | 30044 (46.1) | 29536 (47.8) | 508 (14.9) |
Ingesting | 42366 (64.9) | 40448 (65.4) | 1918 (56.3) |
Topical Use | 2026 (3.1) | 1980 (3.2) | 46 (1.4) |
Unknown | 22249 (34.1) | 20757 (33.6) | 1492 (43.8) |
Overall, 45,660 (70%) of the patients were categorized into more than one high-level condition (pain, mental health, autoimmune, cancer, sleep problems, neurological, gastrointestinal, other, or uncategorized). 19,585 patients (30.0%) were in one category, 20,843 (32.0%) in two categories, 15,434 (23.7%) in three categories, and 9,383 (14.4%) in four to eight categories. Both ON and AB patient demographics reflected the same top reasons for cannabis authorization: 1) pain (AB = 77%, ON = 76%), 2) mental health (AB = 32.9%, ON = 38,7%), and 3) sleep problems (AB = 28%, ON = 25%) (Table 2). Within the pain category the primary complaints were due to chronic pain conditions resulting in musculoskeletal pain (25% of all patients, 33% of pain patients), arthritic pain (22.7% of all patients, 29.3% of pain patients), and neurologic pain (18.0% of all patients, 23.7% of pain patients). Patients seeking medical cannabis for mental health were mainly concerned with anxiety (24.7% of all patients, 64.1% of mental health patients) and depression (15.7% of all patients, 40.8% of mental health patients). Patients’ sleep problems were primarily insomnia (10.3% of all patients, 42.6% of sleep problem patients). Multiple sclerosis was another condition that was commonly cited (18.5% of all patients) as a reason for obtaining cannabis authorization; however, it is unclear if the underlying reason may have been related to pain or spasticity concerns or both.
Table 2
Reason for Medical Cannabis Authorization in Ontario and Alberta Adult Patients (n = 65245)
Disorder | All (N = 65245) | Ontario (N = 61835) | Alberta (N = 3410) |
Pain | 49621 (76.0) | 46987 (76.0) | 2634 (77.2) |
Endometriosis | 444 (0.7) | 416 (0.7) | 28 (0.8) |
Cancer Pain | 4933 (7.6) | 4744 (7.7) | 189 (5.5) |
Arthritic Pain | 14547 (22.7) | 13730 (22.2) | 817 (24.0) |
Neurologic Pain | 11772 (18.0) | 11173 (18.1) | 599 (17.6) |
Musculoskeletal Pain | 16451 (25.2) | 15607 (25.2) | 1832 (53.7) |
Mental Health | 25081 (38.4) | 23960 (38.7) | 1121 (32.9) |
Anxiety | 16088 (24.7) | 15272 (24.7) | 816 (23.9) |
Depression | 10236 (15.7) | 9727 (15.7) | 509 (14.9) |
PTSD | 2581 (4.0) | 2463 (4.0) | 118 (3.5) |
Bipolar | 1340 (2.0) | 1300 (2.1) | 40 (1.2) |
ADHD | 984 (1.5) | 935 (1.5) | 49 (1.4) |
Panic Disorder | 2331 (3.6) | 2272 (3.7) | 59 (1.7) |
ADD | 4854 (7.4) | 4774 (7.7) | 80 (2.4) |
Mood Disorder | 2542 (3.9) | 2457 (4.0) | 85 (2.5) |
Stress | 2370 (3.6) | 2285 (3.7) | 85 (2.5) |
OCD | 424 (0.6) | 398 (0.6) | 26 (0.8) |
Schizophrenia | 325 (0.5) | 319 (0.5) | 6 (0.2) |
Autoimmune | 13729 (21.0) | 13243 (21.4) | 486 (14.2) |
Multiple Sclerosis | 12084 (18.5) | 11666 (18.9) | 418 (12.3) |
IBS | 1741 (2.7) | 1686 (2.7) | 55 (1.6) |
Lupus | 301 (0.5) | 285 (0.5) | 16 (0.5) |
Sjogren’s | 97 (0.1) | 90 (0.2) | 7 (0.2) |
Sleep problems | 16122 (24.7) | 15159 (24.5) | 963 (28.2) |
Insomnia | 6706 (10.3) | 6003 (9.7) | 703 (20.6) |
Fatigue | 1835 (2.8) | 1787 (2.9) | 48 (1.4) |
Sleep Apnea | 904 (1.4) | 879 (1.4) | 25 (0.7) |
Neurological | 5052 (7.7) | 4829 (7.8) | 223 (6.5) |
Neuropathy | 2079 (3.2) | 1992 (3.2) | 87 (2.6) |
Parkinson’s | 678 (1.0) | 642 (1.0) | 36 (1.1) |
Seizure | 1150 (1.8) | 1111 (1.8) | 39 (1.1) |
Epilepsy | 606 (0.9) | 576 (0.9) | 30 (0.9) |
Restless Leg Syndrome | 406 (0.6) | 384 (0.6) | 22 (0.7) |
Tremor | 894 (1.4) | 850 (1.4) | 44 (1.3) |
ALS | 108 (0.2) | 107 (0.2) | 1 (0.03) |
Cerebral Palsy | 107 (0.2) | 106 (0.2) | 1 (0.03) |
Gastrointestinal | 2818 (4.3) | 2710 (4.4) | 108 (3.2) |
Crohn’s | 764 (1.2) | 731 (1.2) | 33 (1.0) |
Colitis | 469 (0.7) | 444 (0.7) | 25 (0.7) |
Other | 10517 (16.1) | 10081 (16.3) | 436 (12.8) |
Osteoporosis | 3274 (5.0) | 3110 (5.0) | 164 (4.8) |
Nausea | 2938 (4.5) | 2855 (4.6) | 83 (2.4) |
Cancer Related Nausea | 1049 (1.6) | 1025 (1.7) | 24 (0.7) |
Diabetes | 1348 (2.1) | 1251 (2.0) | 97 (2.8) |
Appetite | 2307 (3.5) | 2250 (3.6) | 57 (1.7) |
Cancer Related Appetite | 975 (1.5) | 954 (1.5) | 21 (0.6) |
COPD | 936 (1.4) | 907 (1.5) | 29 (0.8) |
Concussion | 524 (0.8) | 501 (0.8) | 23 (0.7) |
Autism | 198 (0.3) | 188 (0.3) | 10 (0.3) |
Glaucoma | 295 (0.4) | 287 (0.5) | 8 (0.2) |
Huntington’s | 17 (0.03) | 16 (0.03) | 1 (0.03) |
Uncategorized | 5796 (8.9) | 5729 (9.3) | 67 (2.0) |
PTSD: Post-traumatic stress disorder ADHD: Attention deficit hyperactivity disorder ADD: Attention deficit disorder OCD: Obsessive compulsive disorder IBS: Irritable bowel syndrome ALS: Amyotrophic lateral sclerosis COPD: Chronic obstructive pulmonary disease |
Of the conditions reported, those with substantive or conclusive evidence to support use include refractory pain related to cancer (7.6% of patients), chronic neuropathic pain (18.0% of patients), refractory spasticity conditions (7.7% of patients), short-term sleep improvement (24.7% of patients), and cancer-related nausea (1.6% of patients)5, 23, 30. While there is evidence to support the use for these conditions, it was noted as being weak to moderate evidence in the guidelines, so cannabis is not recommended as a first-line form of therapy. Glaucoma (0.4% of patients) was the only condition examined that had limited evidence and reviews or guidelines suggested that cannabis should be recommended against30. There was no specific evidence to support or refute the use of medical cannabis for Attention Deficit Disorder, Obsessive Compulsive Disorder, Lupus, Sjogren’s, or Osteoporosis. The remaining conditions examined (8.9%) had either limited or insufficient evidence available so recommendations could not be made.
In all, roughly 16483 (25.3%) patients are seeking medical cannabis for reasons with limited or insufficient evidence to support the therapeutic benefits of medical cannabis for their condition based on currently available evidence (Appendix A). This includes some of the conditions most frequently cited as reasons for prescription such as non-neuropathic musculoskeletal pain (25.2% of patients), arthritic pain (22.7% of patients), anxiety (24.7% of patients), and depression (15.7% of patients). The majority of the remaining conditions, as mentioned, have either no available evidence or show weak evidence in showing an association with its use for that particular condition.