title: Medical cannabis access, use, and substitution for prescription opioids and other substances: A survey of authorized medical cannabis patients.
abstract: In 2014 Health Canada replaced the Marihuana for Medical Access Regulations (MMAR) with the Marihuana for Medical Purposes Regulations (MMPR). One of the primary changes in the new program has been to move from a single Licensed Producer (LP) of cannabis to multiple Licensed Producers. This is the first comprehensive survey of patients enrolled in the MMPR.
  
  
  
  Patients registered to purchase cannabis from Tilray, a federally authorized Licenced Producer (LP) within the MMPR, were invited to complete an online survey consisting of 107 questions on demographics, patterns of use, and cannabis substitution effect. The survey was completed by 271 respondents.
  
  
  
  Cannabis is perceived to be an effective treatment for diverse conditions, with pain and mental health the most prominent. Findings include high self-reported use of cannabis as a substitute for prescription drugs (63%), particularly pharmaceutical opioids (30%), benzodiazepines (16%), and antidepressants (12%). Patients also reported substituting cannabis for alcohol (25%), cigarettes/tobacco (12%), and illicit drugs (3%). A significant percentage of patients (42%) reported accessing cannabis from illegal/unregulated sources in addition to access via LPs, and over half (55%) were charged to receive a medical recommendation to use cannabis, with nearly 25% paying $300 or more.
  
  
  
  The finding that patients report its use as a substitute for prescription drugs supports prior research on medical cannabis users; however, this study is the first to specify the classes of prescription drugs for which cannabis it is used as a substitute, and to match this substitution to specific diagnostic categories. The findings that some authorized patients purchase cannabis from unregulated sources and that a significant percentage of patients were charged for medical cannabis recommendations highlight ongoing policy challenges for this federal program.
authors.affiliation: Tilray, 1100 Maughan Rd., Nanaimo, BC V9X1J2, Canada; Social Dimensions of Health, University of Victoria, 3800 Finnerty Rd., Victoria, BC V8P 5C2, Canada; Centre for Addictions Research of British Columbia, 2300 McKenzie Ave, Victoria, BC V8N 5M8, Canada. Electronic address: plucas@uvic.ca.
authors.forename: Philippe
authors.initials: P
authors.lastname: Lucas
authors.affiliation: Department of Psychology, University of British Columbia, Okanagan, 3333 University Way, Kelowna, BC V1V 1V7, Canada; Centre for the Advancement of Psychological Science and Law, University of British Columbia, Okanagan, 3333 University Way, Kelowna, BC V1V 1V7, Canada.
authors.forename: Zach
authors.initials: Z
authors.lastname: Walsh
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D011307:Drug Prescriptions; D005260:Female; D006801:Humans; D008004:Licensure; D008297:Male; D064086:Medical Marijuana / Q000191:economics / Q000600:supply & distribution* / Q000627:therapeutic use; D008875:Middle Aged; D011795:Surveys and Questionnaires
chemical_list: D000701:Analgesics, Opioid; D064086:Medical Marijuana
keywords: Addiction; Cannabis; Marijuana; Mental health; Opioids; Pain; Substitution