Differences in higher-risk cannabis use outcomes across Canadian provinces and territories: A cross-sectional study

In 2018, Canada legalized and regulated the production and sale of cannabis for non-medical purposes. This paper examined the prevalence of 'higher risk' cannabis use outcomes across Canadian provinces and territories (PTs), with rates hypothesized to be lower in Quebec and higher in the territories.

Past 12-month cannabis consumers from the 2023 and 2024 cycles of the Canadian Cannabis Survey were included (n = 7238). A previous study identified 16 higher risk cannabis use outcomes. Logistic regression models tested differences in each outcome by PT (10 provinces; three territories combined) or region (Western Canada, Ontario, Quebec, Atlantic Canada, territories).

Newfoundland and the territories had the highest rates of frequent cannabis use, and Alberta had the highest rate of inhalable cannabis extract use. Consumers in Quebec reported among the lowest rates of five 'higher risk' outcomes (including frequent cannabis use, past 12-month use of inhalable cannabis extracts, and use of extracts containing > 30% THC). In contrast, they reported among the highest rates of several other outcomes, including consuming edibles/beverages with > 10 mg THC/unit (despite a provincial limit of 5 mg/unit) and obtaining cannabis from illicit sources. The territories had high rates of frequent cannabis use; however, they did not differ significantly from the provinces on most outcomes.

Quebec continues to differ from other PTs in several domains. Differences are likely due to historically lower rates of cannabis use in Quebec, including lower use of extracts, combined with the province's restrictions on product sales, including cannabis products with > 30% THC.