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Cannabis is one of the most commonly used recreational substances globally and the second-most used in Canada (Canadian Centre on Substance Abuse, 2007). Since its legalization in 2018, which permitted the sale (from government sanctioned locations), growth and recreational use for citizens of legal age (Cannabis Act, 2018), its recreational and therapeutic usage has increased (Statistics Canada, 2019). Pain, anxiety, and depression are the most common indications for the therapeutic use of cannabis (Sexton et al., 2016). However, the existing body of literature only supports cannabis’s efficacy in alleviating pain – not symptoms of anxiety and depression (Kosiba et al., 2019). The majority of existing literature discusses increased risks associated with the development or potential exacerbation of existing mental health disorders (Buckner et al., 2007; de Graaf et al., 2010; Fairman & Anthony, 2012), including social anxiety (Feingold et al., 2016), depression (Lev-Ran et al., 2013; Rasic et al., 2013), and psychosis (Maloney-Hall et al., 2020). Data regarding cannabis-related hospitalizations post-legalization is not yet available. However, cannabis use has been associated with increased hospitalizations for mental health reasons, especially psychosis (Galvez-Buccolini et al., 2012; Maloney-Hall et al., 2020). In fact, cannabis-related hospitalizations doubled in Canada and hospitalizations with primary diagnoses related to mental health and behavioural disorders tripled between 2006 and 2015 (Maloney-Hall et al., 2020).
While evidence points to the contrary, there is a strong belief amongst young adults that cannabis is effective in treating anxiety and depression symptoms (Buckner et al., 2007; Wallis et al., 2019). It is important to understand the perspectives and experiences of individuals that use cannabis therapeutically for anxiety and depression symptoms. This provides insight into areas such as perceived efficacy and risks, and sources of cannabis-related information. There is an existing body of literature examining various topics involving international and Canadian young adults that use cannabis therapeutically, such as reduced accessibility to healthcare (Belle-Isle et al., 2014), perceived risks of cannabis use (Popova et al., 2017), and reasons for use compared to prescribed medication (Bottorf et al., 2013; Seaman et al., 2019). While many of these studies are more recent than others, most – if not all – pertain to study periods that pre-date legalization in both Canada and the United States of America.
In recent years, and even prior to the legalization of cannabis, there has been increased awareness of mental health, stigma reduction strategies, and various mental health initiatives, such as the Bell Let’s Talk campaign. These developments, along with the decriminalization of cannabis and an increased acceptance of cannabis use in society, suggest a potential paradigm shift from the existing body of literature. Corey Hanson, a BScN candidate (Class of 2021) from Cape Breton University (Sydney, Nova Scotia) believes that this topic should be revisited, and a more local scope (Atlantic Canada) should be applied. At the time of writing, wait times for mental health services in Cape Breton and Halifax (Nova Scotia) are as high as 92 days and 70 days respectively (Nova Scotia, 2021). Also, a single Cape Breton cannabis outlet averaged annual sales of $9.6 million and a daily average of $26,000 per day (Jala, 2021). It was recently reported that there are increases in cannabis-related hospitalizations (Maloney-Hall et al., 2020), which are likely to increase further.
Legalized cannabis is still in its infancy. As a result, we do not have the same awareness, knowledge, or informative advertisements available as we do with tobacco and alcohol. Hanson believes that an initiative should be developed to increase awareness and available knowledge surrounding cannabis, identify and address barriers to mental health services, and the role of cannabis regarding anxiety and depression symptoms. Specifically, is there a therapeutic role or does it increase the risk of symptom exacerbation? This question needs to be addressed due to the belief amongst young adults that cannabis is effective in alleviating symptoms of anxiety and depression (Buckner et al., 2007; Wallis et al., 2019). Under the supervision of Dr. Janet L. Kuhnke (Cape Breton University), Hanson designed and executed a qualitative study that he hopes and believes to be the first of many to address barriers to mental health services and explore the relationship between therapeutic cannabis and symptoms of anxiety and depression. The study was an interview-based exploration of the experiences of young adults that use cannabis therapeutically and its perceived effects on their anxiety and depression symptoms, such as anxiousness, nervousness, fear, feeling inadequate, persistent sadness, hopelessness, decreased energy and constantly feeling tired, feelings of guilt, self-criticism and worthlessness, irritability, inability to concentrate, reduced appetite, and insomnia (Hanson & Kuhnke, 2021). Participants were asked about their experiences with therapeutic cannabis, its perceived effects and risks, reasons for use compared to prescription medication, and whether cannabis use was disclosed to their physician.
It is believed that this study improves the understanding of researchers and health educators surrounding knowledge sources, sources of stigma and barriers to access. This study serves as the foundation for further research focusing on identifying ways to reduce stigma associated with cannabis use and mental health to encourage individuals to seek medical care for mental health symptoms, identify how and where individuals find information on the benefits and risks of cannabis use, and further investigate perceived risk of cannabis use and its natural and non harmful perception. Further improving upon our understanding of how cannabis users perceive risks, how this risk is assessed, and the information available to the public regarding cannabis risk would assist public health education interventions and harm reduction strategies. It would give individuals a better understanding of the risks associated with cannabis use, would better inform their use, and improve their knowledge of the relationship between mental health, specifically anxiety and depression, and cannabis use.
References
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de Graaf, R., Radovanovic, M., van Laar, M., Fairman, B., Degenhardt, L., Aguilar-Gaxiola, S., Bruffaerts, R., de Girolamo, G., Fayyad, J., Gureje, O., Haro, J. M., Huang, Y., Kostychenko, S., Lépine, J.-P., Matschinger, H., Mora, M. E., Neumark, Y., Ormel, J., Posada-Villa, J., Stein, D. J., Tachimori, H., Wells, J. E., & Anthony, J. C. (2010). Early cannabis use and estimated risk of later onset of depression spells: Epidemiologic evidence from the population-based World Health Organization World Mental Health Survey Initiative. American Journal of Epidemiology, 172(2), 149-159. https://dx.doi.org/10.1093%2Faje%2Fkwq096
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Hanson C. C., & Kuhnke, J. L. (2021). Exploration of Young Adults’ Experiences With Cannabis and Its Effects on Anxiety and Depression Symptoms: A Qualitative Interview-Based Inquiry [Manuscript submitted for publication]. School of Nursing, Cape Breton University.
Jala, D. (2021). Cape Breton NSLC store sold $23 million in alcohol, cannabis products during last fiscal year. Cape Breton Post. https://www.saltwire.com/atlantic-canada/business/cape-breton-nslc-store-sold-23-million-in-alcohol-cannabis-products-during-last-fiscal-year-100602464/
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Maloney-Hall, B., Wallingford, S. C., Konefalm S., & Young, M. M. (2020). Psychotic disorder and cannabis use: Canadian hospitalization trends, 2006-2015. Health Promotion and Chronic Disease Prevention in Canada: Research, Policy, and Practice, 40(5/6), 176-183. https://doi.org/10.24095/hpcdp.40.5/6.06
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Sexton, M., Cutler, C., Finnell, J. S., & Mischley, L. K. (2016). A cross-sectional survey of medical cannabis users: Patterns of use and perceived efficacy. Cannabis and Cannabinoid Research, 1(1), 131-138. https://doi.org/10.1089/can.2016.0007
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Wallis, A. L., Gretz, D. P., Rings, J. A., & Eberle, K. M. (2019). Assessing marijuana use, anxiety, and academic performance among college students. Journal of College Counseling, 22(2), 125-137. https://doi.org/10.1002/.jocc.12125
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