Canadian Medical Association

Note: When this survey was conducted in 2016, the CMA used the term marijuana when referring to this issue. Since this survey, the CMA has updated its terminology to cannabis be more inclusive and align with federal and provincial governments terminology. The word marijuana is used throughout this summary to reflect survey questions posed to respondents.

As the federal government prepared to legalize and regulate marijuana for non-medical use in Canada, we surveyed e-Panel members to ensure the physician perspective would be reflected in our advocacy work. We asked members about their concerns and opinions on marijuana distribution, consumption, regulation and the supports they would need as frontline practitioners.

Completed:
July 2016

Distributed to:
4,244 e-Panel members

Responses:
788

Response rate:
18.57%

Want to share your perspective? Visit the CMA Member Voice e-Panel page for more information on  how to participate in future surveys.

CMA must lead on making the risks of marijuana use well known to physicians, public and politicians. We must insist on national surveillance data on the impacts marijuana use is having on our citizens and society. We must NOT relive the tobacco tragedy.

- Member Voice e-Panel respondent

What members said

Federal regulatory regime

We asked survey participants what regulatory regime the federal government should implement for recreational (non-medical) marijuana use. 43% supported a single system for regulating marijuana for both medical and recreational uses. About the same proportion (39%) supported creating a second regulatory system solely for non-medical use.

The regulatory framework needs to be able to be adjusted based on the research of the impact, so the law can be more generic and the regulations more specific. There should be a lot of funds allocated to education, de-normalization in youth especially, and to research. Clear regulation will help enforcement, and mechanisms to facilitate citizen's participation in the information needed for enforcement will be helpful.

Changes to the regulation of marijuana for medical use

Respondents suggested several changes to the regulation of marijuana for medical use, including:

  • Regulating and standardizing dosages, strains and THC/CBD concentrations
  • Funding research focused on other marijuana intake methods
  • Increasing government-funded research on the benefits and harms associated with marijuana
  • Giving physicians the choice to authorize marijuana or not
  • Providing physicians with guidelines for authorizing marijuana for cases they deem necessary (minimum age of patient, evidence-based resources)
  • Improving the availability of marijuana to patients while restricting accessibility to youth
  • Having insurance coverage for marijuana for medical purposes

Marijuana distribution for non-medical use

We asked participants about their preferred distribution models for marijuana intended for recreational use. Respondents felt it should be distributed through:

  • Existing non-health care structures (e.g., liquor stores or similar) (56% agreed or strongly agreed)
  • Storefronts intended specifically for the sale of marijuana (e.g., independent dispensaries) (47% agreed or strongly agreed)
  • Healthcare settings (e.g., pharmacies) (29% agreed or strongly agreed)
  • Mail, as is currently done with marijuana for medical purposes (16% agreed or strongly agreed)

There was no clear consensus on whether provincial and territorial governments should be left to decide appropriate distribution mechanisms (35% agreed or strongly agreed; 40% disagreed or strongly disagreed).

Respondents also offered several considerations for distribution:

  • Supporting distribution models through effective staff training, offering education and counselling support for users
  • Providing ease of access, regulating sales, impromptu inspections
  • Restricting access to minors and other vulnerable populations
  • Treating distribution of marijuana for recreational use similar to the alcohol distribution system
  • Implementing government-controlled prices and taxes for licensed dispensaries

Personal growth of marijuana plants for non-medical use

About 40% of respondents agreed or strongly agreed that Canadians should be able to grow their own marijuana plants.

Respondents identified several parameters related to this, including:

  • Allowing growth for personal use but not commercial
  • Allowing just small/limited amounts to be grown at home
  • Enforcing certain parameters, housing codes and hazard protocols
  • Preventing young children, minors and pets from accessing home-grown marijuana plants
  • Considering the lack of product control and regulation, pesticide use

Locations for consumption of marijuana for non-medical use

We asked participants where people should be allowed to consume marijuana for recreational use. Nearly 80% preferred consumption in private homes. Only 36% agreed with marijuana consumption in designated public places.

Concerns about second-hand smoking in open public places and exposing minors to marijuana smoke emerged as major themes in respondents’ comments about consumption locations.

Respondents were divided on whether marijuana and tobacco should share the same consumption locations, with 43.0% agreeing and 43.2% disagreeing.

Minimum age for purchasing and possessing marijuana for non-medical use

When asked about the minimum age for purchasing and possessing marijuana for recreational use, 25% of respondents recommended 21 years old.

Chart showing members' recommended age for purchase & possession of marijuana for recreational purposes

When asked for the thinking behind their answer, respondents most often cited:

  • Decreased likelihood for psychosis to emerge
  • Adverse effects on the developing/adolescent brain
  • Societal views of being mature and responsible for one’s actions at that age
  • Same age as alcohol and tobacco use
  • Age of majority according to the province/territory

Regulation of THC levels in marijuana for non-medical use

72% of respondents agreed or strongly agreed that the federal government should regulate the potency of THC in marijuana for recreational use.

Patient interactions and resources

Excluding those not in clinical practice, 60% of respondents always or often ask patients about their recreational marijuana use.

Excluding those not in clinical practice, 47% of respondents felt they had the information they needed to advise patients on the risks associated with recreational marijuana use. Almost 40% of respondents said they lacked this information.

We asked what other tools would support discussions with patients about recreational marijuana use. Respondents said they could benefit from:

  • Updated information on the research associated with the harms of marijuana (87%)
  • Guidelines to counsel patients on marijuana use and driving/operating dangerous equipment (80%)
  • Access to data on the surveillance of the harms of marijuana use (e.g., emergency room cases, deaths, hospitalizations) (72%)
  • Clinical guidelines for the screening and monitoring of chronic users of marijuana (71%)

18% of respondents said they had authorized marijuana for medical purposes to their patients at least once within the past year.

I think marijuana will find its place in society just like other prescription drugs and alcohol. I think it has potential harms and benefits, and those should be weighed on a case-by-case basis, rather than blanket bans or completely unrestricted use. More research would definitely be helpful in determining its clinical applications.

What’s next

The findings from this survey directly informed our submission to the government’s Task Force on Marijuana Legalization and Regulation, where we called for a broad public health policy approach for cannabis legalization and regulation in Canada. We’ll continue to represent physicians’ views as Canadian policy on marijuana for non-medical use develops.

Other e-Panel survey summaries

See what CMA members had to say about other health topics: