Since 2008, Veterans Affairs Canada (VAC) has reimbursed Veterans for the use of cannabis for medical purposes (CMP) providing they have a medical authorization and purchase the CMP from a federally licensed seller. To date, little is known about this group of Veterans, nor is there strong evidence related to the impacts and efficacy of CMP. This research project was supported by VAC as part of its broader CMP research strategy to address these knowledge gaps.

What is this Research About?

This research examined current scientific knowledge on factors related to veterans’ use of medicinal cannabis. It also explored factors associated with cannabis for medical purposes authorizations and dosage amounts among VAC clients.

What did the Researchers Do?

This research is divided into three parts:

1. a literature review that summarizes the current scientific evidence on factors associated with medicinal cannabis use among military Veterans;
2. a feasibility study demonstrating the utility of the linkage of VAC data and the procedures for using these data for research purposes, including a descriptive study that investigates the use of VAC data to summarize the population of Canadian Veterans who receive CMP; and
3. an epidemiological study to examine the complex profile of sociodemographic/ economic, health-related and military service characteristics associated with VAC medicinal cannabis authorization dosage prescribed for Canadian Regular Force Veterans (4 to 10 grams versus 3 grams or less).

To ensure privacy, only anonymized data files from VAC was used, (meaning no personal or identifying information was shared).

What did the Researchers Find?

Part 1:

The review of existing research indicates that the majority of studies have been conducted in the United States. There is evidence to suggest that Veterans’ use of cannabis for medical purposes is associated with factors such as:

• marital status (both single status and poor marital relationships);
• lower education;
• economic status (lower status, financial difficulties and unemployed); and
• race/ethnicity or minority status.

Part 2:

Overall, during the study period (from 2007 to 2020):

• the average daily authorization amount was 3.6 grams;
• average daily authorization amounts generally decreased over time, with a peak of 6 grams/day in 2014 and a low of 2.7 grams/day in 2020*
• the percentage of Veterans with authorizations for higher daily amounts also decreased over time*:
  • 30.2% authorized for 4-9 grams/day in 2014 vs. 4.4% in 2020;
  • 29.1% authorized for 10 grams/day in 2014 vs 0.6% in 2020

*This decreasing trend aligns with the 2017 revision to the VAC policy which required additional specialist medical approval for authorizations over 3 grams/day

The analysis of CMP authorized Veterans found that of the 13,173 Regular Force Canadian Veterans with an active CMP authorization on December 31, 2020:

• ages ranged from under 30 to over 65, with the greatest numbers in their 40s (22.4%) and 50s (37.6%)
• over half were married or in common law relationships (54.8%)
• most had authorizations for 3 grams/day or less (79.8%)
• 5.4% were authorized for the maximum amount of 10 grams/day

Part 3:

Among 9,104 Regular Force Canadian Veterans released since 1998, with an active CMP authorization on December 31, 2020 , higher authorized daily amounts (defined as 4-10 grams per day) of CMP were significantly more likely to be observed among Veterans who were:

• male
• of younger age
• receiving benefits for mental health conditions (alone or in combination with musculoskeletal (MSK) or hearing conditions), or receiving benefits for both MSK and hearing loss conditions
• currently participating in VAC rehabilitation services
• released from military service involuntarily
• serving in the Army (i.e., land military) at the time of their release
• of lower rank at release

Sources

Mejia, A. C. (2022). Investigating factors associated with medicinal cannabis use among military veterans (T). University of British olumbia. https://open.library.ubc.ca/collections/ubctheses/24/items/1.0412788

Mejia A. C., Koehoorn M, Hall A, Davies H, Van Til L. Investigating factors associated with medicinal cannabis authorization dosage among military Veterans in Canada. Journal of Military, Veteran and Family Health 2023 9:5, 56-70. https://jmvfh.utpjournals.press/doi/full/10.3138/jmvfh-2022-0080