Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, ON M5S 2S1, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON M5T 1R8, Canada.
Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, ON M5G 1V7, Canada.
J Subst Use Addict Treat. 2024 Dec;167:209487. doi: 10.1016/j.josat.2024.209487. Epub 2024 Aug 15.
Legalization has increased cannabis availability in Canada. Research shows complex relationships between cannabis use and mental health, and a need for health care providers to engage with patients about cannabis use. Providers have noted gaps in knowledge and research on the medical effects of cannabis as barriers to service delivery. It is unclear how providers and patients in mental health care settings have been impacted by legalization.
From June 1 to July 2, 2021, we conducted a qualitative study involving semi-structured interviews with 20 health care providers in a range of roles (e.g., physicians, pharmacists, nurses) within a psychiatric hospital setting. Participants responded to open-ended questions with follow-up probes on various topics related to cannabis legalization. Topics included impacts on patient mental and physical health, clinical impacts, education and training, legal cannabis retail system and the medical cannabis access system.
Thematic analysis identified several themes in the data. Participants reported that legalization has had some positive impacts relating to clinical care and cannabis safety. They also expressed concerns with increased rates of cannabis use, risks to mental health and ongoing challenges engaging with patients about cannabis. Participants made recommendations for medical educators and regulators (e.g., updated curriculums, clinical guidelines), the mental health care sector (e.g., implementation of standardized screening), government (e.g., public health campaigns, safe use guidelines), the medical cannabis access system (e.g., increased regulation, research), and the legal cannabis system (e.g., zoning changes, point-of-sale information).
This study begins to address the paucity of data on impacts of legalization from mental health service delivery settings. Findings show that although legalization has had some positive impacts, there are ongoing patient concerns and unmet provider needs. More research is needed to understand the experiences of providers delivering care to populations experiencing mental health and/or substance use concerns who use cannabis in the post-legalization era.
在加拿大，大麻合法化增加了大麻的可获得性。研究表明，大麻使用与心理健康之间存在复杂的关系，需要医疗保健提供者与患者就大麻使用问题进行沟通。提供者注意到，他们在大麻的医学效应方面的知识和研究存在差距，这成为提供服务的障碍。目前尚不清楚心理健康护理环境中的提供者和患者是如何受到合法化影响的。
2021 年 6 月 1 日至 7 月 2 日，我们开展了一项定性研究，在一家精神病院环境中，我们对 20 名不同角色的医疗保健提供者（如医生、药剂师、护士）进行了半结构式访谈。参与者对与大麻合法化相关的各种主题的开放性问题进行了回复，并进行了后续的探究。主题包括对患者身心健康的影响、临床影响、教育和培训、合法大麻零售系统和医用大麻准入系统。
主题分析确定了数据中的几个主题。参与者报告说，合法化在临床护理和大麻安全方面产生了一些积极影响。他们还对大麻使用率的上升、对心理健康的风险以及与患者就大麻问题进行接触的持续挑战表示关注。参与者就医学教育者和监管机构（例如，更新课程、临床指南）、心理健康护理部门（例如，实施标准化筛查）、政府（例如，公共卫生运动、安全使用指南）、医用大麻准入系统（例如，增加监管、研究）和合法大麻系统（例如，分区变化、销售点信息）提出了建议。
这项研究开始解决从心理健康服务提供环境中获取的合法化影响数据不足的问题。研究结果表明，尽管合法化产生了一些积极影响，但患者的担忧仍在继续，提供者的需求仍未得到满足。需要开展更多的研究，以了解在合法化后时代为患有心理健康和/或物质使用问题且使用大麻的人群提供护理的提供者的经验。
