3. Understanding Substance Use

Cannabis and other drugs such as alcohol and tobacco are psychoactive substances which, when taken into the body, alter mental processes such as cognition.^[1]Canadian Public Health Association. (2014). Canadian Public Health Association discussion paper. A new approach to managing illegal psychoactive substances in Canada. Retrieved from: https://www.cpha.ca/sites/default/files/assets/policy/ips_2014-05-15_e.pdf Psychoactive substance use falls on a spectrum. Movement along the spectrum is not necessarily linear; that is, a person may use substances differently at different points in their life. It is possible to introduce interventions to minimize risks and harms when problematic use occurs. Problematic use means use of substances in ways that are associated with physical, psychological, economic or social problems or use pose health or security risks to the person, and those around them.^[2]Canadian Public Health Association. (2014). Canadian Public Health Association discussion paper. A new approach to managing illegal psychoactive substances in Canada. Retrieved from: https://www.cpha.ca/sites/default/files/assets/policy/ips_2014-05-15_e.pdf

It is important to recognize that use of substances such as cannabis is not the same as being dependent or addicted. Rather, substance use can range from beneficial to problematic, as shown below:

• Abstinence: No use.
• Beneficial: Use resulting in more positive than negative effects.
• Non-problematic: Use resulting in few health or social effects.
• Problematic use: Use resulting in potentially negative effects for the person, their friends, or family.
• Substance use disorder: Use that is compulsive or difficult to stop despite negative health and social effects.

Figure 1: Substance Use Continuum (adapted from A path forward: A provincial approach to facilitate regional and local planning and action.)^[3]First Nations Health Authority, British Columbia Ministry of Health & Health Canada. (2013). A path forward: A provincial approach to facilitate regional and local planning and action. Retrieved from: http://www.fnha.ca/documents/fnha_mwsu.pdf

Some people use cannabis for medical purposes. Cannabis has been endorsed for a broad range of medical conditions but evidence of its effectiveness to treat all these conditions is incomplete.^[4]Perry, D., Ton. J., Beahm, N.P., Crisp, N.,…Lindblad.A.J.(2018). Simplified guideline for prescribing medical cannabinoids in primary care.Canadian Family Physician, 64. Sufficient evidence exists on the use of cannabis to treat end-of-life pain, chemotherapy-induced nausea and vomiting, and spasticity due to multiple sclerosis or spinal cord injury.^[5]Perry, D., Ton. J., Beahm, N.P., Crisp, N.,…Lindblad.A.J.(2018). Simplified guideline for prescribing medical cannabinoids in primary care.Canadian Family Physician, 64.

In Canada, regulations governing access to medical cannabis have been in place since 2001. Since then, these regulations have changed numerous times. In their most recent version, introduced by the federal government in 2016, the Access to Cannabis for Medical Purposes Regulations allow medical use of cannabis when authorized and prescribed by a health care provider. Medical cannabis can be purchased from a producer that is licensed by Health Canada, or a person can produce their own cannabis based on the daily amount prescribed by their health care provider.^[6]Government of Canada. (2016). Medical use of marijuana. Retrieved from https://www.canada.ca/en/health-canada/services/drugs-health-products/medical-use-marijuana/medical-use-marijuana.html

Purchases from a licensed producer can be made online, by a written order, or through telephone, and are delivered by mail. Until legalization, only licensed producers are authorized to produce, sell, and mail cannabis to the public. “Dispensaries” or “compassion clubs” are not allowed to sell cannabis for medical or non-medical purposes.^[7]Government of Canada. (2018). Statement from Health Canada concerning access to cannabis for medical purposes. Retrieved from: https://www.canada.ca/en/health-canada/news/2016/08/statement-from-health-canada-concerning-access-to-cannabis-for-medical-purposes.html

The legalization of cannabis will not change the rules and processes for accessing cannabis for medical purposes.^[8]Government of Ontario. (2018). Cannabis legalization. Retrieved from: https://www.ontario.ca/page/cannabis-legalization