Age Demographics Influences Cannabis Use Pre and Post Federal Legalization in Canada and Implications for Clinical Trial Application in Healthy Populations

Introduction Cannabis has been used effectively as a medical drug for many years. With the recent federal legalization of cannabis in Canada and hemp in the United States, there is growing consumer interest in how cannabinoids can be efficacious in improving quality of life. The objective of this study was to examine how age influences cannabis use in Southwestern Ontario before and after federal legalization in Canada. Methods A 31 question, online survey was conducted from March 2018 to October 2019 and designed as a market research project to engage with Canadians on past and present medical and recreational cannabis use. The data were used to investigate how age influences self‐reported reasons for use, life stage when started, and method, frequency and component of cannabis most frequently used. Respondents were stratified into age groups (<19 (n=199), 19–24 (n=1182), 25–34 (n=1362), 35–44 (n=1166), 45–54 (n=569), 55–64 (n=537), 65+ (n=82)). Possible differences in cannabis consumption between groups pre and post federal legalization was assessed by the Chi Square test or Fisher’s Exact (2‐tail) test, as appropriate Results There were 2,667 and 2,430 survey respondents’ pre and post‐legalization, respectively. There were significant effects of age group on the cannabinoid consumed, the primary reason for using cannabis, the life stage when started using cannabis, and both the frequency and mode of consumption (p<0.01). There was a demographic shift in those who reported using cannabis for “social/relaxation” purposes following legalization. Prior to legalization, social/relaxation was the most frequently reported reason for use in those <19–24 years. Reducing anxiety was the most frequently reported reason for use for users aged 25–34 and controlling pain was most frequent amongst users aged 35–65+. Following legalization, social/relaxation became the most frequently reported reason for use across a greater age range of <19–45 years. Across all age groups, since legalization, 18–68% reported using cannabis to reduce anxiety, 23–60% to control pain, and 4–27% for digestion/ISB/IBD. These are important findings for consumers of translational research in these areas. Daily users across groups was similar before and after legalization. Prior to legalization, 40–73% reported daily use compared to 48–72% post‐legalization. There were significant differences in use of inhalation (vapor, smoke) and ingestion (oral, sublingual) routes of administration between age groups. Across groups, the most frequently reported route of administration was smoking. There were no differences in suppository (0–9%) and topical (0–18%) use. Conclusion Age influences how and why cannabis is consumed, both before and after federal legalization. Most clinical trials on cannabis have not been completed in healthy populations, which confounds the literature available to inform formulation of investigational products for trails in this population. Moving forward with effective clinical trial design for efficacious use in healthy populations requires an understanding of the needs, perceptions and barriers of consumers, making surveys such as this critical in advancing this choice of treatment modality.

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