Issue #25  July 2023

[This is a modified and updated excerpt from “Buzz Kill: The Corporatization of Cannabis”.]

Statistics on the prevalence of drug use are just that – reflecting only use and not necessarily harm. At an individual level, most people who use drugs do not experience serious harm. However, at the population level, the prevalence of drug use is often directly correlated with the prevalence of drug problems.

In statistical reports of drug use in the general population, you will often come across this word “prevalence’. Prevalence is a measure of the percentage of the general population that uses a drug within a given period – usually within the past year. Other common time frames used in surveys include the past 30 days, the past 3 months, or over the person’s lifetime. The measure of prevalence also stipulates the age range of those surveyed (eg. 15 years and older) and the geographic jurisdiction (eg. nation, province, state).

If aggregate use of a drug increases in the general population, use will also likely increase in that segment of the population that is vulnerable to drug problems. Thus, there is likely to be an increase in the overall prevalence of problems. Accordingly, one can encounter reports that use measures of drug use as a proxy for drug problems at the population level. At the very least, an increase in use can provide a yellow flag for a need for continued surveillance.

The Canadian Alcohol and Drugs Survey (CADS) is a general population survey of drug use by non-institutionalized Canadians aged fifteen and older. As of July 2023, the most recent data available from this survey were collected in 2019.

I should note that these surveys do not include caffeine use – the most popular drug in Canada and elsewhere, and not likely to be associated with problems.

Of the drugs covered in the survey, alcohol was by far the most popular among Canadians with 76% having used it at least once in the past year. Alcohol was followed distantly by cannabis which had been used by 21%. This was a significant increase from the 2017 (pre-legalization) prevalence of 15%. Past-year use of at least one of six illegal drugs (cocaine/crack, speed/methamphetamine, ecstasy, hallucinogens, heroin, salvia,) was 3% in 2019.

CADS also reports on the prevalence of use of prescribed medications in the past year. Use of pain relievers (e.g., oxycodone) was reported by 14% of respondents, followed by 11% for sedatives (e.g., diazepam), and 2% for stimulants (e.g., methylphenidate).

The greatest change in prevalence of drug use in Canada from the previous data collected in 2017 was the substantial increase in reported cannabis use. Some may argue that the observed change does not reflect an actual change in use, but a change in comfort to report use given that cannabis had become a legal drug in 2018. That may account for some of the observed change, but I would argue that it is not a major factor. The surveys are completed anonymously, and any stigma (certainly among users) had been substantially reduced by 2017, given the prominent attention to legalization in the media, and just about everywhere. (The number of requests I received for presentations was greater than at any other time of my career.)

It is likely that the greatest proportion of the increase arose from legalization. As I explore elsewhere, the literature tells us that for other recreational drugs such as alcohol and tobacco, increased access is a major predictor of increased use. Add legal permission and a significant amount of media attention and stealth product promotion, and it seems that legalization would be the major driver of an actual increase in use.

Beginning in 2019, tobacco use is reported separately in The Canadian Tobacco and Nicotine Survey (CTANS). Consistent with past tobacco surveys, CTANS uses a past 30 days time frame instead of use in the past year as does CADS for the other drug types. The prevalence for use of any tobacco product in the past 30 days is reported by CTANS as 14% for 2019. Unfortunately, the survey was designed such that e-cigarettes or vaping devices were excluded from this indicator and are reported with separate indicators. My use of some possibly precarious arithmetic produces an approximate estimate of nicotine use at 17%, which would include people who vape and were not included in the 14%.

The inconsistency of period prevents an easy comparison with the other drug types. However, we can be confident that the prevalence of tobacco use in the past year would be higher than the past 30-day prevalence of 17%, but still far below the past year prevalence for alcohol use of 76%.

Self-report surveys tend to underestimate people’s use of drugs. We can expect that the true extent of use is probably higher than estimated by these surveys. Nonetheless, we can safely conclude that legal alcohol, tobacco, cannabis, and prescribed pain relief medications appear to be the most popular drugs among Canadians. The predominance of legal drug products has been the case for alcohol and tobacco for the past half century. Interestingly, two recently introduced legal drugs – cannabis and oxycodone pain relievers – are closing in on tobacco. An increase in prevalence is exactly what we would expect with the legalization of cannabis. It is also what we would expect when pharmaceutical companies engage in aggressive, illegal marketing of a new, highly addictive product – as they have with oxycodone products. I will provide more on all these topics in future issues.

For previous issues of this newsletter related to the pharmaceutical industry see:
and .

Mike DeVillaer
Hamilton Ontario Canada
July 23 2023