Clearing the Air about Cannabis: Consider the Continuum of Use

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Introduction

We know that 22% of Ontario students between Grades 7-12 have used cannabis in the past year1. Some of those students used cannabis only once, whereas others used it daily. The potential risks associated with these different levels of use can vary greatly, and therefore, different messages may be helpful when engaging with students on the topic of cannabis.

In this column, we’ll explore the continuum of use, and how it can offer a helpful framework for educators. We’ll highlight the key ideas to keep in mind about each segment, so that you can support your students in making lower-risk choices.

‘Just Say No’ to Dichotomies

Cannabis education has traditionally framed use in very narrow ways and ignored the diverse spectrum of use patterns between “abstinent” and “problematic.” 2

Even though cannabis remains an illegal substance for the majority of elementary and secondary students, it’s crucial that we move away from dichotomous ways of viewing substance use. When we view cannabis use through the lens of use or non-use – all or nothing, bad or good – we miss out on opportunities to support students in thinking critically about healthy choices.

Abstinence-based drug education flows from this use and non-use perspective, presenting the idea that avoiding cannabis is the only acceptable option2. This approach ignores the diversity in how young people use cannabis, which can fall anywhere along a spectrum from no use at all to a substance use disorder. This spectrum or continuum of use offers a more nuanced framework to understand how young people may be using cannabis, and to help inform your conversations with your students.

“Moving away from the use and non-use dichotomy is a big help to young people” – Heather D’Alessio, Canadian Student for Sensible Drug Policy3

The Continuum of Use

You may have seen images of the continuum labelled in different ways. For example, the School Mental Health Ontario continuum contains the categories: no use, beneficial use, non-problematic use, problematic use, potentially harmful use, and substance use disorder. The Canadian Centre on Substance Use and Addiction, in their communication guide Talking Pot with Youth, instead refers to categories based on amount and frequency of use. We’ll draw on this guide to explore the different segments of the continuum and key messages to keep in mind when talking with students about different levels of use.

No Use

The majority of students do not use cannabis1. As we explored in our blog post, To use or not to use? Youth share their perspectives, this may be for a wide variety of reasons. Although students at this segment of the continuum are not using cannabis, they may be researching it or thinking about trying it. Having conversations about substance use with these students is just as important as with those in other segments of the continuum.

Harm Reduction Key Messages

“Your brain is still developing and the earlier you begin to use cannabis, the more likely you are to experience health harms or, in more serious cases, develop an addiction to cannabis.”4

“Using cannabis when you’re younger can increase the risk of problems with your health, education and social life… Try to delay using cannabis until you’re older to lower the risks.”5

“No matter how you use cannabis, there are some short and long-term health risks. The only way to completely avoid all of the risks is to not use cannabis.”5

Experimental or Low Use

In this segment of the continuum, young people may be trying cannabis for the first time or experimenting with different methods of consumption. Their use is low, but risks could still be present. The key messages below offer suggestions for lower risk experimentation.

Harm Reduction Key Messages

“Delay cannabis use as long as possible. Your brain is still developing and early cannabis use can affect cognition, memory and attention.”4

“Avoid combining cannabis with alcohol and other substances.”4

“Don’t drive after using cannabis. Plan alternative options to get home or sleep at a friend’s house.”4

“Make sure you are in a safe environment if you are planning to use cannabis. To ensure you are safe, consider who you are with and what hazards may be around you.”4

Social or Intermittent Use

In this segment, youth may use cannabis primarily in social situations and no more than once a week. The same key messages from the first two segments apply here as well. In addition, the messages below can help guide students who are using cannabis socially or intermittently to make choices to lower the potential risks.

Harm Reduction Key Messages

“Try to avoid daily or near-daily cannabis use.”4

If you smoke cannabis…

“Consider vaping rather than smoking cannabis.”4

“Stopping cannabis smoking can reverse the harms to your lungs.”4

“Refrain from deep inhalation and holding your breath after inhaling.”4

“If you eat cannabis, “start low and go slow” with small amounts and wait at least two hours before eating more to avoid accidental overconsumption.”4

“Try to choose products with low THC content, or higher CBD compared to THC content.”5

“If you or your family has a history of psychosis or substance use disorder, your chances of experiencing cannabis-related psychosis, dependence and/or other mental health problems are higher. It’s safest to avoid using cannabis if you or your family has a history of psychosis or substance use disorder.”5

Regular or Heavy Use

Regular or heavy cannabis use can be quantified as nearly daily use. About 2% of students in grades 7-12 use cannabis daily. Grade 12 students have the highest rate of daily cannabis use at 5%1.

Those using cannabis at this level are more likely to experience negative health and social consequences4. It’s helpful to keep in mind that they may be using cannabis as a means to cope with other challenges, although it’s best not to make assumptions about students’ reasons for use. As educators, our role is to promote resilience, notice when students may be struggling, and provide ongoing support at school6.

Harm Reduction Key Messages

“Using cannabis often (daily or almost every day) can affect your health and social life. It can increase your risk of cannabis dependence, changes in brain development and mental health challenges. If you use often, try to limit your use, such as using only on weekends or once a week.”5

“Re-evaluate your goals. Cannabis use can affect your physical health and hobbies, such as your ability to play sports.”4

“Understand the underlying reasons for use.”4

“Consider consulting with a healthcare practitioner if:

  • you are using cannabis to cope or self-medicate;
  • cannabis use is affecting your ability to meet your major life obligations;
  • you are missing or reducing important activities because of your cannabis use;
  • you continue to use cannabis even though you are experiencing physical or psychological problems; or
  • you have any other questions or concerns about cannabis use.”4

Cannabis Use Disorder

This segment of the continuum corresponds to a disorder defined in the Diagnostic and Statistics Manual of Mental Disorders (DSM). It refers to a problematic pattern of cannabis use associated with negative consequences such as a persistent desire to use cannabis, using more than intended, or spending an excessive amount of time obtaining and using cannabis7.

Only designated professionals should screen for cannabis use disorder.

Harm Reduction Key Messages

“If you are experiencing symptoms of cannabis use disorder or addiction, consult with a healthcare professional.”4

How to Use this Information

The segment descriptions and key messages above are not intended to serve as a script. Instead, they are meant to be a guide to help you feel more informed before engaging in discussions with youth. Using the continuum of use as a framework, educators have an additional tool in their toolkit for facilitating open conversations about substance use with students.

“It opens us up to being able to talk about substance use with a young person, with any person, in a way that helps us understand where is it, and how long has it been there, and where do they want it to be? I think it’s really helpful to understand that we can have these conversations and not presuppose what the goal is supposed to be.” – Allison Potts, School Mental Health Ontario.3

“It’s meant to help support in empowering young people to talk through and critically think about their motivators and their reasons for use, while we listen as youth allies and support their informed decision making.” – Kiran Somjee, Canadian Centre on Substance Use and Addiction.8

Learn More

Join our Facebook Live chat with Canadian Students for Sensible Drug Policy (@CSSDP) to get your harm reduction questions answered! Use the hashtag #Cannabis101Chat on Twitter, Facebook, or Instagram to follow along!

For more on this topic, check out the following resources:

To access our full selection of Cannabis Education Resources visit: Ophea's Cannabis Education Resources (Aussi disponible en français: Ressources d’éducation sur le cannabis).

Sign up for Ophea’s eConnection e-newsletter to read future issues of our Q&A column and to stay up to date with the latest resources and events!

Thank you!

Ophea and the Provincial System Support Program at CAMH

References

1. Boak, A., Elton-Marshall, T., Mann, R. E., & Hamilton, H. A. (2020). Drug use among Ontario students, 1977-2019: Detailed findings from the Ontario Student Drug Use and Health Survey (OSDUHS). Toronto, ON: Centre for Addiction and Mental Health. Retrieved from https://www.camh.ca/en/science-and-research/institutes-and-centres/institute-for-mental-health-policy-research/ontario-student-drug-use-and-health-survey---osduhs

2. Valleriani, J., Maghsoudi, N., Nguyen-Dang, M., Lake, S., Thiessen, M., Robinson, J., & Pavlova, D. (2018). Sensible cannabis education: a toolkit for educating youth. Canadian students for sensible drug policy. Retrieved from https://cssdp.org/youthtoolkit/

3. Potts, A. & D’Alessio, H. (2020). How to engage youth in a conversation about cannabis [webinar recording]. Cannabis Knowledge Exchange Hub. Retrieved from http://cannabisknowledgehub.ca/resources/how-to-engage-youth-in-a-conversation-about-cannabis.html

4. Canadian Centre on Substance Use and Addiction. (2020). Talking Pot with Youth: A Cannabis Communication Guide for Allies. Retrieved from https://www.ccsa.ca/talking-pot-youth-cannabis-communication-guide-youth-allies

5. Centre for Addictions and Mental Health. (2018). The Blunt Truth: Useful Tips about Safer Ways to Use Cannabis. Retrieved from https://www.camh.ca/-/media/images/all-other-images/research-lrcug-for-youth/lrcug_for_youth-eng-pdf.pdf?la=en&hash=15D9E4FBB8DBA73B665C3267E64FE233F937A298

6. School Mental Health Ontario. (n.d.). Substance Use and Addiction. Retrieved from https://smho-smso.ca/educators/learn-more/explore-by-topic/substance-use-and-addiction/

7. Patel, J., & Marwaha, R. (2019). Cannabis use disorder. In StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK538131/

8. Somjee, K., London-Nadeau, K., & Burgess, J. (2019). Supporting youth in making informed decisions about cannabis [webinar recording]. Cannabis Knowledge Exchange Hub. Retrieved from http://cannabisknowledgehub.ca/resources/supporting-youth-in-making-informed-decisions-about-cannabis.html