Out of 1451 participants who interacted with the survey, a total of 660 participants completed the questionnaire. From this group, 489 were included for analysis after the exclusion of 1 participant who was under 21 years old, 98 subjects who reported recreational cannabis use only, and 72 subjects who did not use cannabis products bought at SQDC (from illegal sources or licensed producers). The mean age of the 489 participants was 36 years (age range: 21-77 years), 48,67% were women, 48.06% men, and 3.27% reported other gender (Table 1). About 25% (n=122) reported using cannabis only for medical purposes while the other 75% declared using cannabis for both recreational and medical purposes. Almost half of respondents who use cannabis for both purposes were under 30 years (47.54%) while this proportion was 26,23% among the exclusive medical users. Women reported exclusive medical use more frequently compared to men (59.84 % vs 37.70 %). Participants were distributed in all the regions of Quebec. The quasi-totality of respondents were Caucasians (93.57%).
Reasons for self-medication with cannabis
The main reasons reported for not consulting cannabis clinics were the lack of information on the medical access of cannabis (52.85%), the perceived complexity of the process (39.86%), the difficulty accessing a cannabis clinic (23.23%), the inconvenience of the follow-up with a physician for cannabis (20.27%), the inability to choose the cannabis products (18.91%), the delay to obtain cannabis in the medical circuit (16,17%) and the price (12,07%) (Table 2). In general, men and participants under 34 years were more likely to report a reason limiting their access to a cannabis clinic (Table 2).
Treated health conditions
The number of treated conditions per participant varied from 1 to 13. Only 13% reported using cannabis to treat a single health condition or symptom. About two thirds (65.64%) of respondents were using cannabis for 2 to 5 concomitant conditions or symptoms while 20.99% treated 6 or more simultaneously. Cannabis was more frequently used to treat psychological conditions than physical conditions (85.57% vs 74.43%). Anxiety (70.93%), insomnia (56.49%), depression (37.94%) and attention deficit hyperactivity disorder (ADHD) (25.57%) were the most frequently reported psychological conditions. Chronic non-cancer pain (53.40%), headache/migraine (28.45%), muscle spasticity (16,70%) and bowel disease (11.34%) were the most reported physical conditions. While men mostly treat ADHD, shyness or depression, women more frequently treat anxiety, nausea, headaches or bowel disease (Table 3). However, use of cannabis for chronic pain was similar between men and women (54.08% vs. 53.16%, p = 0.84).
Conditions treated also slightly varied by age as presented in Table 3. Participants under 34 years treat psychological conditions more than older patients (90.04% vs 80.77%, p = 0.004) (Table 3).
Patterns of cannabis use
Table 4 displays reported patterns of cannabis use, with stratification for the type of use (exclusively medical or mixed). Regarding THC and CBD ratio, 35% used products with higher THC than CBD and 13% used products with only THC. Regarding potency, about two thirds reported they mostly used products with THC concentration > 10% while 45% used product with CBD concentration > 10%. Differences were notable according to the type of cannabis use. Namely, exclusive medical users were more likely to use products stronger in CBD than THC (27.50% vs 17.70%), or products containing only CBD (22.50% vs 8.99%).
Regarding modes of use, more than one mode of use was reported by some participants. Smoking was reported by the majority of participants (81.19%) followed by ingestion (48.26%) (Table 4). Smoking was less preferred by exclusive medical users compared to mixed users (Table 4).
For frequency of use, 45.71% of respondents reported daily cannabis use while 32.53% reported weekly to near-daily use.
The majority of participants reported treating a health conditions with cannabis for ≥ 1 year.
Concurrent use of other medications
A total of 276 (56.44%) participants reported having other prescribed drugs. Among them, 223 reported using their prescribed drugs while 53 mentioned not using their drugs. Drugs’ names were provided by 247 participants. The most mentioned drugs were for pain and for psychiatric disorders (Table 5).
Healthcare resources and other resources utilization
About 46% of study participants reported that all their treated conditions were diagnosed by a physician, with a higher representation of exclusive medical cannabis users in this category (60.83% versus 41.16% for mixed users) (Table 6).
For information on cannabis, participants reported having consulted SQDC retailers (36.81%), physicians (29.24%), illegal sellers (9.20%) and pharmacists (7.36%). However, 39% of all participants reported that they had never consulted a resource about their self-medication with cannabis (Table 6).
Specifically focusing on the 36 participants who reported having consulted a pharmacist, the main reason was to ask for the safety to combine cannabis with other medications (29/36). 19/36 reported being satisfied with the pharmacist advice (Supplemental Table 1).
The three questions added after the launch of the survey were completed by 351 participants. About 15% of them reported that they never declared their self-medication with cannabis to healthcare professionals (Table 6). Exclusive medical users were more likely to never report their cannabis use to healthcare professionals compared to medical and recreational users (21% vs 13%). The proportion of women who reported that they never declared their cannabis use was similar to men (17% vs 12%).
Interestingly, 80.47% of all respondents answered that they were willing to have easier access to health professionals for advice related to their medical use of cannabis.
Impact of COVID-19 on cannabis consumption
From the 357 participants who completed the three questions added after the launch of the survey, 18 indicated that the question on the pandemic effect was not applicable to them (Please note that the question was addressed to participants who were self-medicating with cannabis before the pandemic). From the remaining 339 participants, 139 (41.00%), 185 (54.57%) and 15 (4.43%) reported an increase, no change, and a decrease in their use of cannabis, respectively.