, Volume 235, Issue 2, pp 409–417 | Cite as

A prospective observational study of problematic oral cannabinoid use

  • Mark A. WareEmail author
  • Marc O. Martel
  • Roman Jovey
  • Mary E. Lynch
  • Joel Singer
Original Investigation



Despite evidence supporting the benefits of cannabinoids for symptom control across a wide range of medical conditions, concerns have been raised regarding the potential misuse and/or problematic use of cannabinoids (CBs).


The first objective of this study was to examine the incidence of problematic prescription cannabinoid use (PPCBU) over a 12-month period among patients initiating cannabinoid therapy. The second objective was to examine the factors associated with PPCBU. A total of 265 patients who were prescribed oral cannabinoid therapy as part of usual medical practice were enrolled into this prospective observational study. Patients first completed a series of baseline questionnaires assessing demographic, clinical, and substance use variables. Three measures designed to assess PPCBU were then administered at 3, 6, and 12 months after initiation of cannabinoid therapy.


At each of the follow-up assessment time points, a significantly greater number of patients scored below (vs above) cutoff scores on the three main PPCBU outcomes (all p’s < .001). At any follow-up time point, a maximum of roughly 25% of patients demonstrated PPCBU. Heightened odds of PPCBU were observed among patients with a history of psychiatric problems, tobacco smokers, and recreational cannabis users (all p’s < .05). Results indicated that past-year substance abuse, assessed using the DAST-20, was the strongest predictor of PPCBU (p < .005).


Findings from the present study could have implications for clinicians considering the use of cannabinoids for the management of patients with medical conditions. Although results indicated that the majority of patients included in this study did not reach cutoff scores on the three main PPCBU outcomes, our findings suggest that PPCBU should be routinely assessed and monitored over the course of cannabinoid therapy, particularly among patients with a history of psychiatric or substance use problems.


Cannabinoids Problematic cannabinoid use Incidence Risk factors 



The authors wish to acknowledge all the additional clinical site investigators who enrolled subjects for the study, including Dr. Gordon Ko, Dr. Peter Blecher, Dr. Aline Boulanger, and Dr. May Ong-Lam. We also wish to acknowledge the advice of Dr. Kenneth Kirsch, the study management team at AXON for study coordination and data management, and medical writer Mark E. Rose, MA, for putting together the early draft of the paper.


The study was supported by an unrestricted educational grant from Valeant Pharmaceuticals (Canada). Valeant markets nabilone under the brand name Cesamet®.

Compliance with ethical standards

Conflict of interest

MAW discloses the following relationships: CanniMed, Green Sky Labs (grant to institution), CHI Inc., Zynerba, and CannaRoyalty (consultant). RJ discloses the following relationships: Astra Zeneca, Knight, Paladin, and Purdue Pharma (speakers’ bureau, consultant). MM and JS declare that they have no conflict of interest.

Supplementary material

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Supplementary Table 1 (DOCX 17 kb)
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Supplementary Table 6 (DOCX 15 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2017

Authors and Affiliations

  • Mark A. Ware
    • 1
    • 2
    • 3
    • 4
    Email author
  • Marc O. Martel
    • 1
    • 3
    • 5
  • Roman Jovey
    • 6
  • Mary E. Lynch
    • 7
  • Joel Singer
    • 8
  1. 1.Department of Anesthesia, Faculty of MedicineMcGill UniversityMontrealCanada
  2. 2.Department of Family MedicineMcGill UniversityMontrealCanada
  3. 3.Alan Edwards Pain Management UnitMcGill University Health CentreMontrealCanada
  4. 4.Montreal General HospitalMontrealCanada
  5. 5.Faculty of DentistryMcGill UniversityMontrealCanada
  6. 6.CPM Centres for Pain ManagementMississaugaCanada
  7. 7.Department of Anesthesia, Pain Medicine, and Perioperative CareDalhousie UniversityHalifaxCanada
  8. 8.School of Population and Public HealthUniversity of British ColumbiaVancouverCanada

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