Understanding youth and young adult cannabis use in Canada post-legalization: a scoping review on a public health issue.

BACKGROUND: Canada legalized recreational cannabis in 2018, and one of the primary objectives of the Cannabis Act was to protect youth by reducing their access to cannabis and providing public education. Canada has the highest prevalence of cannabis use worldwide, particularly among youth and young adults under the age of 25. Cannabis use is linked with many adverse effects for youth and young adults including psychosis, anxiety, depression, respiratory distress, cannabinoid hyperemesis syndrome, and impaired cognitive performance. Despite the high prevalence of cannabis use and the evolution of policies in Canada and globally, significant knowledge and research gaps remain regarding youth and young adult cannabis use. The aim of this scoping review is to map the extent, nature, and range of evidence available on youth and young adult cannabis use in Canada since its legalization, in order to strengthen policies, services, treatments, training, and public education strategies. METHODS: Using a scoping review framework developed by Arksey and O'Malley, along with the PRISMA-ScR guidelines, we conducted a rigorous search in five academic databases: MEDLINE, Embase, APA PsycINFO, CINAHL and Web of Science Core Collection. We included empirical studies that collected data in Canada after the legalization of recreational cannabis (October 2018) and focused on youth or young adults < 30. Two reviewers independently screened articles in two stages and extracted relevant information from articles meeting the inclusion criteria. RESULTS: Of the 47 articles meeting our inclusion criteria, 92% used quantitative methods, 6% were qualitative, and 2% used a mixed-methods approach. Over two-thirds (68%) used secondary data. These studies were categorized into six focus areas: (1) prevalence, patterns, and trends, (2) cannabis-related injuries and emergency department (ED) visits, (3) rates and patterns during the pandemic, (4) perceptions of cannabis use, (5) prevention tools, and (6) cannabis-related offenses. Key findings from the studies reviewed include an increase in cannabis use among 18-24-year-olds post-legalization, with mixed results for youth under 18. ED visits for intentional and unintentional cannabis-related injuries have increased in young children and teens. Perception studies show a mix of concern and normalization of cannabis use. Though limited, prevention studies are promising in raising awareness. A decline in cannabis-related offenses was noted by one study. The review highlights several research gaps, including the need for more qualitative data, disaggregation of demographic data, intervention research, and comprehensive studies on the physical and mental health impacts of cannabis use among youth and young adults. CONCLUSION: Maintaining a public health approach is critical, with a focus on reducing the high prevalence of cannabis use among youth and young adults. This involves implementing prevention strategies to minimize harms, enhancing public education, minimizing commercialization, reducing youth access to cannabis, promoting guidelines for lower-risk cannabis use and harm reduction strategies, and increasing training for healthcare providers.

Cannabis use among youth in Canada: a scoping review protocol.

INTRODUCTION: Canadian youth (aged 15-24) have the highest rates of cannabis use globally. There are increasing concerns about the adverse effects of cannabis use on youth physical and mental health. However, there are gaps in our understanding of risks and harms to youth. This scoping review will synthesise the literature related to youth cannabis use in Canada. We will examine the relationship between youth cannabis use and physical and mental health, and the relationship with use of other substances. We will also examine prevention strategies for youth cannabis use in Canada and how the literature addresses social determinants of health. METHODS AND ANALYSIS: Using a scoping review framework developed by Arksey and O'Malley, we will conduct our search in five academic databases: MEDLINE, Embase, APA PsycInfo, CINAHL and Web of Science's Core Collection. We will include articles published between 2000 and 2021, and articles meeting the inclusion criteria will be charted to extract relevant themes and analysed using a qualitative thematic analysis approach. ETHICS AND DISSEMINATION: This review will provide relevant information about youth cannabis use and generate recommendations and gaps in the literature. Updated research will inform policies, public education strategies and evidence-based programming. Results will be disseminated through an infographic, peer-reviewed publication and presentation at a mental health and addiction conference. Ethics approval is not required for this scoping review.