I will. Thank you very much. I'll be speaking to it today. The notes will come to you shortly thereafter.
I'm here representing the Canadian Medical Cannabis Council today. I also want to share that I am a research affiliate with the Centre for Addictions Research of British Columbia, and vice-president of patient research and access at Tilray, one of the licensed producers here in Canada, located in Nanaimo, B.C. I've been working personally on medical cannabis for about 22 years now, so this is an area that's somewhat familiar to me. It's a pleasure to be here today, to be able to share some of our knowledge with you, as well as the work and research that we're doing.
I want to tell you a little bit about the Canadian Medical Cannabis Council. We're an industry association representing seven licensed producers and serving approximately about 40,000 patients from that group of producers. One distinguishing characteristic of the Canadian Medical Cannabis Council is putting a patient-centred lens on our policies and practices. We have a patient advisory committee made up of national organizations that include the Arthritis Society of Canada, the Canadian AIDS Society, Canadian Cancer Survivor Network, the GI Society of Canada, and a number of other organizations that help advise us when it comes to the policies that we put forward and our lobbying positions.
Some of the CMCC's priorities include lowering the cost of medical cannabis and improving access to patients. We've been urging the federal and provincial governments to maintain a clear separation between medical and recreational cannabis markets through differential taxation. We feel that medical cannabis should be treated like all other prescription drugs in Canada, and not be taxed. Certainly that's one thing I hope to be able to discuss as we take questions today, as to why medical cannabis should be zero-rated like other medications in Canada.
I'd also like to share that we're working with private insurers to help improve and increase the insurance coverage for medical cannabis patients as a precursor to getting provincial coverage for patients in Canada.
Today I'm going to share some results from a national patient survey that we conducted in January. It's the largest patient survey ever conducted in Canada, with 2,032 responses, and it will help illustrate some of the ways in which end-users are using medical cannabis in Canada, because there's a lot of overlap between the patient population and the recreational cannabis population.
The average age of this particular population is 40 years old. We see that it's actually middle-aged individuals, typically, who are seeking medical cannabis. A lot of the time they've had treatment failures and they're seeking alternatives to their current prescription drug use.
In terms of primary conditions, we find that mental health, which is a grouping of insomnia, mental health, and post-traumatic stress disorder, is actually the number one reason that patients are using medical cannabis. That covers 40% of all patients in Canada. That's closely followed by pain, which is a grouping of arthritis, chronic pain, and headache, which represents about 37.5%. What you see is that about 80% of patients in Canada are currently using cannabis as a treatment for pain or for mental health.
In terms of average use, we see that patients report using, on average, about 1.5 grams per day, and that 78% of patients use three grams or fewer per day. You're not seeing large patterns of use here. That data is consistent with research that's been done in Canada and the U.S., as well as in Europe over the last few years. It shows that most medical cannabis patients use between 0.5 and 1.5 grams per day.
In terms of primary method of use, I have good news to share. I've been doing this kind of research for the last 10 or 15 years. In this survey we find that the primary method of use reported is vaporization, at 31%. It actually beats out joints, pipes, and water bongs, which might have been more popular in the past. This is a really health-conscious shift that we're seeing from the medical cannabis population, but I also think it has policy implications as we move to regulate even the vaporization of products in Ontario and throughout Canada.
The key focus area of my research is cannabis substitution effect, which is the way that both patients and recreational users consciously and subconsciously use cannabis instead of other substances. I'll share a bit of data on that from this survey. In the survey—which as I said is by far the largest survey of Canadian cannabis users to date—69% of patients report substituting cannabis for prescription drugs, so they're using cannabis in order to reduce their dependence on prescription drugs. We also find ad hoc substitution for alcohol by 44%, substitution for tobacco by 31%, and substitution for illicit substances by 26% of the population that had previously used these substances.
I like to get a bit more granular with my data, so when patients say they substitute for prescription drugs, I ask them, “Well, can you name three prescription drugs you're substituting for, or up to three?”
It should be no surprise, knowing that patients are using cannabis for pain and mental health, that 35% of the substitution is for prescription opioids. That's closely followed by antidepressants at 21%, and then non-opioid pain medications at 10%. We also see very high rates of substitution for benzodiazepines, which are nearly as problematic in our society as opioids are in terms of dependence and public health impacts.
I wanted to get even more granular than that, so when patients cite that they substitute for opioids, I ask them, “Are you substituting at 25%, 50%, 75%, or are you giving up opioids altogether?” What we found is, of the 458 patients who cite substitution for 610 total opioids, understanding some patients use more than one type of opioid, a full 60% were given up altogether at 100%, and a further 18% were self-reported to be given up by 75% or more.
In terms of alcohol we get similar data. There were 513 respondents who substituted for alcohol, and 31% of those said they gave up alcohol altogether just as a kind of ad hoc effect of introducing medical cannabis into their course of care.
Now, I want to use that as the segue to look at some of the research that we've seen coming out of the U.S., both in terms of the medical cannabis states and the recreational cannabis states, because I think it can help inform what we can expect here in Canada. Over the past 20 years, over 20 states, as you know, have legalized access to medical cannabis. Right now, eight states have also legalized recreational adult use of cannabis. This has led to significant impacts on public health and safety. That includes a reduction in opioid overdose deaths. In fact, there's a study published in the Journal of the American Medical Association that showed a 25% reduction in opioid overdose deaths in medical cannabis states compared to the neighbouring states. The longer the medical marijuana program was in place in the state, the greater the effect. We also see reductions in alcohol-related automobile fatalities, reductions in violent crimes and homicides, and reductions in suicides. This answers one of the questions we heard today.
We also see a decline in teen use of cannabis. In fact, there was a report that came out from a national survey just last week that reported that teen use of cannabis has now declined to a rate that hasn't been lower since 2002. We're seeing a significant decline in the teen use of cannabis.
We are seeing a slight increase in the adult use of cannabis, but interestingly enough, it's also accompanied by a subsequent decrease in the use of alcohol and associated harms. The researchers suggest that all of the harms that I've mentioned that are reducing right now, whether they be violent crime, homicide, suicides, or otherwise, are being reduced because of that substitution of cannabis for alcohol.
Other impacts include great impacts on taxation. Colorado now makes more money on the sale and taxation of cannabis than they do on alcohol. This in the home, of course. Also, on job creation, in 2015 Colorado created 18,000 jobs and generated $2.4 billion in economic activity through their cannabis policies.
That leads me to a discussion that I think is important for this committee to consider, which is the importance of brands when it comes to defeating the black market. We heard today previous speakers talk about the fact that right now, if you go online, you can order cannabis from 20-plus different sources online across Canada. None of those are legitimate sources of cannabis, and it will be incredibly important to allow Canadian consumers to differentiate between the illicit market and the new and emerging licit market. One of the ways they can do that is through the importance of brands. The rationale for responsible branding directed to adults includes eliminating the confusion between the illegal and legal markets, allowing professional companies to separate themselves from less scrupulous competitors, differentiating high-quality products from low-quality products, and providing an opportunity to educate consumers about responsible consumption.
Now, this has started an initiative that's taking place right now between a number of the licensed producers in Canada—in fact, 16 licensed producers representing 90% of the medical market right now—and both industry associations, the Cannabis Canada Association as well as the Canadian Medical Cannabis Council. This is an initiative we're doing with Advertising Standards Canada to develop a self-regulatory regime to allow responsible branding to adults when it comes to the recreational access to cannabis.
The principles of this initiative are that marketing by licensed producers will only promote brand preference and will not attempt to influence adult non-consumers.
Marketing by licensed producers will not be directed to persons under the age of 18, or whatever the limit is in the individual provinces, be it 19 or higher. All advertising messages will contain responsible use statements, which goes much further than what we see from the current alcohol industry. Licensed producers may voluntarily obtain pre-clearance of advertising campaigns to ensure that they meet these guidelines, and licensed producers will agree to adhere to provisions of the Canadian Code of Advertising Standards.
In conclusion, I would like to say that medical cannabis, as I've reported, is primarily being used in the treatment of chronic pain and mental health, that medical cannabis patients commonly self-report substitution for pharmaceutical opioids and alcohol, often leading to complete abstinence from the substances identified, and that branding can not only reduce the harms associated with the legalization and regulation of adult use of cannabis but can also maximize the potential public health and safety benefits.
Thank you very much for your time today. I really appreciate it.