Pharmacopsychiatry 2024; 57(03): 141-151
DOI: 10.1055/a-2264-1047
Original Paper

Perceptions, Experiences, and Patterns of Cannabis Use in Individuals with Mood and Anxiety Disorders in the Context of Cannabis Legalization and Medical Cannabis Program in Canada – A Qualitative Study

Ankita Das
1   Institute of Medical Sciences, University of Toronto, Toronto, Canada
4   Centre for Addiction and Mental Health, Toronto, Canada
Christian S. Hendershot
2   Department of Psychiatry and Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill, NC, USA
M.Ishrat Husain
1   Institute of Medical Sciences, University of Toronto, Toronto, Canada
3   Department of Psychiatry, University of Toronto, Toronto, Canada
4   Centre for Addiction and Mental Health, Toronto, Canada
5   Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada
6   Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
Yuliya Knyahnytska
3   Department of Psychiatry, University of Toronto, Toronto, Canada
4   Centre for Addiction and Mental Health, Toronto, Canada
Sonja Elsaid
1   Institute of Medical Sciences, University of Toronto, Toronto, Canada
4   Centre for Addiction and Mental Health, Toronto, Canada
Bernard Le Foll
1   Institute of Medical Sciences, University of Toronto, Toronto, Canada
3   Department of Psychiatry, University of Toronto, Toronto, Canada
4   Centre for Addiction and Mental Health, Toronto, Canada
5   Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada
6   Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
7   Department of Family and Community Medicine, University of Toronto, Toronto, Canada
8   Waypoint Research Institute, Waypoint Centre for Mental Health Care, Penetanguishene, Canada
Stefan Kloiber
1   Institute of Medical Sciences, University of Toronto, Toronto, Canada
3   Department of Psychiatry, University of Toronto, Toronto, Canada
4   Centre for Addiction and Mental Health, Toronto, Canada
5   Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada
6   Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
› Author Affiliations
Funding Information Canadian Centre on Substance Use and Addiction and Toronto Cannabis and Cannabinoid Research Consortium (TC3) Fellowship Award.


Introduction Perceptions of cannabis as a potential medical treatment for mood and anxiety disorders have been increasing in the context of legalizations, availability, and medical cannabis programs, though current evidence predominately indicates risks and negative effects of cannabis use (CU) on mental health outcomes. This study aims to understand motivations, perceptions, effects, and patterns of CU in individuals with mood and anxiety disorders.

Methods Thirty-six adult patients diagnosed with mood or anxiety disorders, obsessive-compulsive disorder, or posttraumatic stress disorder who were currently using cannabis completed an in-depth qualitative interview on individual motivations, perceptions, experiences, effects, and patterns of their CU. The thematic analysis focused on phases of CU and sources of cannabis products and information.

Results Reported motivations for initiation of CU included curiosity, peer pressure, and dissatisfaction with conventional treatments. Factors such as psychotropic effects and coping with mental health symptoms and insomnia contributed to the continuation of CU. More negative effects, including cognitive dysfunction, worsening of mood, and anxiety symptoms, were acknowledged with ongoing CU. Concerning findings included common initiation of CU before age 18, combined medical and recreational CU, rare consultation of medical professionals on CU, and potential effects and harms.

Discussion Findings indicate individual complexity of motivations, perceptions, and patterns of CU in the study population. The reported potential beneficial effects of specific cannabis products should be further investigated. Findings emphasize patient-provider dialogue on both CU and conventional treatments. Information from this study can contribute to and inform the development of education, prevention, and intervention strategies.

Publication History

Received: 16 September 2023
Received: 16 January 2024

Accepted: 30 January 2024

Article published online:
11 March 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

  • References

  • 1 Guardian T. Canada becomes second country to legalise Cannabis. 2018
  • 2 Kourgiantakis T, Lee E, Kosar AKT. et al. Youth cannabis use in Canada post-legalization: service providers’ perceptions, practices, and recommendations. Subst Abuse Treat Prev Policy 2023; 18: 36
  • 3 Statistics C. Looking back from 2020, how cannabis use and related behaviours changed in Canada. 2021
  • 4 Canadian Cannabis Survey 2017. Summary, 2017
  • 5 Shim M, Nguyen H, Grootendorst P. Lessons from 20 years of medical cannabis use in Canada. PLoS One 2023; 18: e0271079
  • 6 Curran HV, Freeman TP, Mokrysz C. et al. Keep off the grass? Cannabis, cognition and addiction. Nat Rev Neurosci 2016; 17: 293-306
  • 7 Bloomfield MA, Morgan CJ, Egerton A. et al. Dopaminergic function in cannabis users and its relationship to cannabis-induced psychotic symptoms. Biol Psychiatry 2014; 75: 470-478
  • 8 Connor JP, Stjepanović D, Le Foll B. et al. Cannabis use and cannabis use disorder. Nat Rev Dis Primers 2021; 7: 16
  • 9 Lowe DJE, Sasiadek JD, Coles AS. et al. Cannabis and mental illness: A review. Eur Arch Psychiatry Clin Neurosci 2019; 269: 107-120
  • 10 Marconi A, Di Forti M, Lewis CM. et al. Meta-analysis of the association between the level of cannabis use and risk of psychosis. Schizophr Bull 2016; 42: 1262-1269
  • 11 Tervo-Clemmens B, Simmonds D, Calabro FJ. et al. Adolescent cannabis use and brain systems supporting adult working memory encoding, maintenance, and retrieval. Neuroimage 2018; 169: 496-509
  • 12 Becker B, Wagner D, Gouzoulis-Mayfrank E. et al. Altered parahippocampal functioning in cannabis users is related to the frequency of use. Psychopharmacology (Berl) 2010; 209: 361-374
  • 13 Bossong MG, Jager G, van Hell HH. et al. Effects of Δ9-tetrahydrocannabinol administration on human encoding and recall memory function: A pharmacological FMRI study. J Cogn Neurosci 2012; 24: 588-599
  • 14 Bossong MG, Jager G, Bhattacharyya S. et al. Acute and non-acute effects of cannabis on human memory function: A critical review of neuroimaging studies. Curr Pharm Des 2014; 20: 2114-2125
  • 15 Xue S, Husain MI, Zhao H. et al. Cannabis use and prospective long-term association with anxiety: A systematic review and meta-analysis of longitudinal studies. Can J Psychiatry 2012; 66: 126-138
  • 16 Abrams DI, Guzman M. Cannabis in cancer care. Clin Pharmacol Ther 2015; 97: 575-586
  • 17 Boehnke KF, Litinas E, Clauw DJ. Medical cannabis use is associated with decreased opiate medication use in a retrospective cross-sectional survey of patients with chronic pain. J Pain 2016; 17: 739-744
  • 18 Rog DJ, Nurmikko TJ, Friede T. et al. Randomized, controlled trial of cannabis-based medicine in central pain in multiple sclerosis. Neurology 2005; 65: 812-819
  • 19 Smith LA, Azariah F, Lavender VT. et al. Cannabinoids for nausea and vomiting in adults with cancer receiving chemotherapy. Cochrane Database Syst Rev 2015; 2015: Cd009464
  • 20 Wade DT, Makela P, Robson P. et al. Do cannabis-based medicinal extracts have general or specific effects on symptoms in multiple sclerosis? A double-blind, randomized, placebo-controlled study on 160 patients. Mult Scler 2004; 10: 434-441
  • 21 Lucatch AM, Coles AS, Hill KP. et al. Cannabis and mood disorders. Curr Addict Rep 2018; 5: 336-345
  • 22 Schoeler T, Theobald D, Pingault JB. et al. Developmental sensitivity to cannabis use patterns and risk for major depressive disorder in mid-life: Findings from 40 years of follow-up. Psychol Med 2018; 48: 2169-2176
  • 23 Lev-Ran S, Le Foll B, McKenzie K. et al. Bipolar disorder and co-occurring cannabis use disorders: characteristics, co-morbidities and clinical correlates. Psychiatry Res 2013; 209: 459-465
  • 24 Feingold D, Rehm J, Lev-Ran S. Cannabis use and the course and outcome of major depressive disorder: A population based longitudinal study. Psychiatry Res 2017; 251: 225-234
  • 25 Grant BF, Chou SP, Goldstein RB. et al. Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: Results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry 2008; 69: 533-545
  • 26 Weinstock LM, Gaudiano BA, Wenze SJ. et al. Demographic and clinical characteristics associated with comorbid cannabis use disorders (CUDs) in hospitalized patients with bipolar I disorder. Compr Psychiatry 2016; 65: 57-62
  • 27 Spradlin A, Mauzay D, Cuttler C. Symptoms of obsessive-compulsive disorder predict cannabis misuse. Addict Behav 2017; 72: 159-164
  • 28 Cooper ML, Frone MR, Russell M. et al. Drinking to regulate positive and negative emotions: a motivational model of alcohol use. J Pers Soc Psychol 1995; 69: 990-1005
  • 29 Cox WM, Klinger E. A motivational model of alcohol use. J Abnorm Psychol 1988; 97: 168-180
  • 30 Ikard FF, Green DE, Horn D. A scale to differentiate between types of smoking as related to the management of affect. Int J Addict 1969; 4: 649-659
  • 31 Russell MAH, Peto J, Patel UA. The classification of smoking by factorial structure of motives. J R Stat Soc Ser A 1974; 137: 313-346
  • 32 Stewart SH, Zeitlin SB, Samoluk SB. Examination of a three-dimensional drinking motives questionnaire in a young adult university student sample. Behav Res Ther 1996; 34: 61-71
  • 33 Stewart SH, Zvolensky MJ, Eifert GH. Negative-reinforcement drinking motives mediate the relation between anxiety sensitivity and increased drinking behavior. Pers Individ Dif 2001; 31: 157-171
  • 34 Zvolensky MJ, Feldner MT, Leen-Feldner E. et al. Evaluating the role of anxiety sensitivity in smoking outcome expectancies among regular smokers. Cognit Ther Res 2004; 28: 473-486
  • 35 Walsh Z, Callaway R, Belle-Isle L. et al. Cannabis for therapeutic purposes: Patient characteristics, access, and reasons for use. Int J Drug Policy 2013; 24: 511-516
  • 36 Earleywine M, Bolles JR. Marijuana, expectancies, and post-traumatic stress symptoms: A preliminary investigation. J Psychoactive Drugs 2014; 46: 171-177
  • 37 Elliott L, Golub A, Bennett A. et al. PTSD and cannabis-related coping among recent veterans in New York city. Contemp Drug Probl 2015; 42: 60-76
  • 38 Guillem E, Notides C, Vorspan F. et al. Cannabis expectancies in substance misusers: French validation of the Marijuana Effect Expectancy Questionnaire. Am J Addict 2011; 20: 543-554
  • 39 Metrik J, Jackson K, Bassett SS. et al. The mediating roles of coping, sleep, and anxiety motives in cannabis use and problems among returning veterans with PTSD and MDD. Psychol Addict Behav 2016; 30: 743-754
  • 40 Bonn-Miller MO, Boden MT, Bucossi MM. et al. Self-reported cannabis use characteristics, patterns and helpfulness among medical cannabis users. Am J Drug Alcohol Abuse 2014; 40: 23-30
  • 41 Lankenau SE, Ataiants J, Mohanty S. et al. Health conditions and motivations for marijuana use among young adult medical marijuana patients and non-patient marijuana users. Drug Alcohol Rev 2018; 37: 237-246
  • 42 Turna J, Balodis I, Munn C. et al. Overlapping patterns of recreational and medical cannabis use in a large community sample of cannabis users. Compr Psychiatry 2020; 102: 152188
  • 43 Reynolds IR, Fixen DR, Parnes BL. et al. Characteristics and patterns of marijuana use in community-dwelling older adults. J Am Geriatr Soc 2018; 66: 2167-2171
  • 44 Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. Int J Qual Health Care 2007; 19: 349-357
  • 45 Cuttler C, Spradlin A, McLaughlin RJ. A naturalistic examination of the perceived effects of cannabis on negative affect. J Affect Disord 2018; 235: 198-205
  • 46 Sexton M, Cuttler C, Finnell JS. et al. A cross-sectional survey of medical cannabis users: Patterns of use and perceived efficacy. Cannabis Cannabinoid Res 2016; 1: 131-138
  • 47 Leung J, Chan G, Stjepanović D. et al. Prevalence and self-reported reasons of cannabis use for medical purposes in USA and Canada. Psychopharmacology 2022; 239: 1509-1519
  • 48 Lee CM, Neighbors C, Hendershot CS. et al. Development and preliminary validation of a comprehensive marijuana motives questionnaire. J Stud Alcohol Drugs 2009; 70: 279-287
  • 49 Lee CM, Neighbors C, Woods BA. Marijuana motives: Young adults’ reasons for using marijuana. Addict Behav 2007; 32: 1384-1394
  • 50 Ahmadi J, Fakoor A, Pezeshkian P. et al. Substance use among Iranian psychiatric inpatients. Psychol Rep 2001; 89: 363-365
  • 51 Winters KC, Lee CY. Likelihood of developing an alcohol and cannabis use disorder during youth: Association with recent use and age. Drug Alcohol Depend 2008; 92: 239-247
  • 52 Arseneault L, Cannon M, Poulton R. et al. Cannabis use in adolescence and risk for adult psychosis: Longitudinal prospective study. BMJ 2002; 325: 1212-1213
  • 53 Cyrus E, Coudray MS, Kiplagat S. et al. A review investigating the relationship between cannabis use and adolescent cognitive functioning. Curr Opin Psychol 2021; 38: 38-48
  • 54 Fontes MA, Bolla KI, Cunha PJ. et al. Cannabis use before age 15 and subsequent executive functioning. Br J Psychiatry 2011; 198: 442-447
  • 55 Gobbi G, Atkin T, Zytynski T. et al. Association of cannabis use in adolescence and risk of depression, anxiety, and suicidality in young adulthood: A systematic review and meta-analysis. JAMA Psychiatry 2019; 76: 426-434
  • 56 Moore TH, Zammit S, Lingford-Hughes A. et al. Cannabis use and risk of psychotic or affective mental health outcomes: A systematic review. Lancet 2007; 370: 319-328
  • 57 Silins E, Horwood LJ, Patton GC. et al. Young adult sequelae of adolescent cannabis use: An integrative analysis. Lancet Psychiatry 2014; 1: 286-293
  • 58 Lubman DI, Cheetham A, Yücel M. Cannabis and adolescent brain development. Pharmacol Ther 2015; 148: 1-16
  • 59 Scott JC, Slomiak ST, Jones JD. et al. Association of cannabis with cognitive functioning in adolescents and young adults: A systematic review and meta-analysis. JAMA Psychiatry 2018; 75: 585-595
  • 60 Clark HK, Ringwalt CL, Shamblen SR. Predicting adolescent substance use: The effects of depressed mood and positive expectancies. Addict Behav 2011; 36: 488-493
  • 61 Farris SG, Zvolensky MJ, Boden MT. et al. Cannabis use expectancies mediate the relation between depressive symptoms and cannabis use among cannabis-dependent veterans. J Addict Med 2014; 8: 130-136
  • 62 Hasin DS, Saha TD, Kerridge BT. et al. Prevalence of marijuana use disorders in the United States between 2001-2002 and 2012-2013. JAMA Psychiatry 2015; 72: 1235-1242
  • 63 Volkow ND, Baler RD, Compton WM. et al. Adverse health effects of marijuana use. N Engl J Med 2014; 370: 2219-2227
  • 64 Lopez-Quintero C. Pérez de los Cobos J, Hasin DS et al. Probability and predictors of transition from first use to dependence on nicotine, alcohol, cannabis, and cocaine: results of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Drug Alcohol Depend 2011; 115: 120-130
  • 65 Gates PJ, Albertella L, Copeland J. The effects of cannabinoid administration on sleep: A systematic review of human studies. Sleep Med Rev 2014; 18: 477-487
  • 66 Pinto JV, Saraf G, Frysch C. et al. Cannabidiol as a treatment for mood disorders: A systematic review. Can J Psychiatry 6 2020; 5: 213-227
  • 67 Linares IM, Zuardi AW, Pereira LC. et al. Cannabidiol presents an inverted U-shaped dose-response curve in a simulated public speaking test. Braz J Psychiatry 2019; 41: 9-14
  • 68 Zuardi AW. Cannabidiol: From an inactive cannabinoid to a drug with wide spectrum of action. Braz J Psychiatry 2008; 30: 271-280
  • 69 Morgan CJ, Gardener C, Schafer G. et al. Sub-chronic impact of cannabinoids in street cannabis on cognition, psychotic-like symptoms and psychological well-being. Psychol Med 2012; 42: 391-400
  • 70 Schubart CD, Sommer IE, van Gastel WA. et al. Cannabis with high cannabidiol content is associated with fewer psychotic experiences. Schizophr Res 2011; 130: 216-221
  • 71 Hazekamp A, Ruhaak R, Zuurman L. et al. Evaluation of a vaporizing device (Volcano) for the pulmonary administration of tetrahydrocannabinol. J Pharm Sci 2006; 95: 1308-1317
  • 72 Merlin JS, Althouse A, Feldman R. et al. Analysis of state cannabis laws and dispensary staff recommendations to adults purchasing medical cannabis. JAMA Netw Open 2021; 4: e2124511