Youth cannabis use in Canada post-legalization: service providers’ perceptions, practices, and recommendations

Kourgiantakis et al. Substance Abuse Treatment, Prevention, and Policy https://doi.org/10.1186/s13011-023-00550-1 (2023) 18:36 Substance Abuse Treatment, Prevention, and Policy Open Access RESEARCH Youth cannabis use in Canada postlegalization: service providers’ perceptions, practices, and recommendations Toula Kourgiantakis1* , Eunjung Lee1 , A. Kumsal Tekirdag Kosar1 , Christine Tait1 , Carrie K.Y. Lau1 , Sandra McNeil1, Shelley Craig1 , Rachelle Ashcroft1 , Charmaine C. Williams1 , Abby L. Goldstein2, Uppala Chandrasekera1, Deepy Sur3 and J. L. Henderson4 Abstract Background In 2018, Canada legalized recreational cannabis use with the purpose of protecting youth and restricting access. However, concerns have been raised that this objective has not been met as rates of cannabis use among youth aged 16–24 have not declined. Youth cannabis use is associated with various adverse effects including psychosis, anxiety, depression, suicidality, respiratory distress, cannabinoid hyperemesis syndrome, and intoxications. Service providers play a crucial role in addressing youth cannabis use. This study aimed to understand Ontario service providers’ perceptions, practices, and recommendations on youth cannabis use. Methods This mixed method study included a survey and two focus groups. The survey was distributed to mental health service providers serving youth aged 16–24 across Ontario who were given the option to participate in a focus group. The survey included closed and open-ended questions regarding perceptions, practices, and recommendations, while the focus groups explored these categories in greater depth. Descriptive statistics were used to analyze close-ended questions and interpretative content analysis was applied for open-ended questions. Focus group data were analyzed using thematic analysis. Results The survey was completed by 160 service providers and 12 participated in two focus groups. Regarding perceptions, 60% of survey participants agreed with legalization, 26% had a strong understanding of medical versus recreational cannabis, 84% believed that cannabis has physical and mental health risks, and 49% perceived stigmatization. Less than half of the survey participants reported screening or assessing cannabis use, 16% stated they are highly familiar with treating cannabis use, and 67% reported that they rarely work with families. Subthemes identified in the focus groups under perceptions included normalization and stigmatization, harms for youth, and stigma, racism, and discrimination. Subthemes under practice included cannabis not being the primary focus, challenges with screening, assessment, and intervention, and referral to specialized services. Both the survey and focus group participants recommended increasing public education, enhancing service provider training, improving *Correspondence: Toula Kourgiantakis Full list of author information is available at the end of the article © Crown 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Kourgiantakis et al. Substance Abuse Treatment, Prevention, and Policy (2023) 18:36 Page 2 of 18 regulation and policies, reducing stigma and minimization, improving service access, and providing more culturally responsive services. Conclusion Youth cannabis use in Canada remains a significant public health concern, necessitating a more comprehensive plan to protect Ontario youth and reduce associated harms. Key words Youth, Cannabis, Legalization, Canada, Service providers, Mixed methods Canada has one of the highest prevalence rates of cannabis use in the world [1], and cannabis use is highest among young adults aged 20–24 (50%) followed by 16–19-yearolds (37%) [2]. In 2018, Canada legalized recreational cannabis use with the implementation of the Cannabis Act – a national policy intended to guide the selling and distribution of cannabis across the country [3]. The purpose of the Cannabis Act is to protect public health and safety, with a specific focus on a few key areas, including to “protect the health of young persons by restricting their access to cannabis” [3]. However, researchers report that to date, the objective of protecting youth has not been met since the Cannabis Act has not led to a reduction in youth cannabis use, and youth cannabis use remains a serious public health concern [4]. Since legalization came into effect, the rates of cannabis use in Canadian youth have increased [4–9] and there are increased rates of cannabis use disorder diagnoses in 18–24 -year-olds since legalization [10]. The cannabis market has expanded considerably since legalization, although there is large variation in cannabis access across the provinces. Ontario uses a private retail model and has 1,552 cannabis stores, compared to the neighbouring province of Quebec which uses a public model and has 91 cannabis stores [11]. Youth report easier access to cannabis [8, 12], with 41% of Ontario students in grades 7–12 reporting through the Ontario Student Drug and Health Survey (OSDUHS) that it is easy to obtain cannabis [13]. A study examining patterns of cannabis use among Canadian youth found that there is a high propensity for youth using cannabis at baseline to switch to multimode use (smoking, eating/drinking, vaping) or increase their use if already engaged in multimode use [5]. Some studies also report increased rates of initiation of cannabis use post-legalization among youth who did not use cannabis pre-legalization [8, 9]. There are also reports of increased use of cannabis among youth during the COVID-19 pandemic [2, 6, 14, 15], attributed to stress, anxiety, boredom, loneliness, and lack of a regular schedule [2]. One study found increased rates of cannabis use among 14–18-year-olds during the pandemic [6] and another reported that emerging adults who were self isolating used 20% more cannabis [14]. Several studies have reported that one of the most frequently reported motives for cannabis use by youth is cop (...truncated)