Drugs

Nicotine

We all know that smoking is bad for us, especially wreaking havoc on our respiratory system. Even so, 2017 statistics reveal that 15% of Canadians smoke an average of 13.9 cigarettes per day.^[1]

Nicotine is directly related to lung disease, cancer, mouth/gum disease and heart issues.^[2] In addition to the carcinogenic chemicals present in cigarettes, recent research has found that it harms our immune system as well. Nicotine has been found to have immunosuppressive effects on the body, for example, suppressing or decreasing neutrophils phagocytic activity.^[3] Nicotine also produces a decrease in inflammation, a decreased antibody response, and a decrease in T-cell functioning.^[4] Chemical compounds in cigarette smoke also lowers the amount of protective antioxidants in our blood, increasing our risk of oxidative damage via free radicals throughout the body.^[5]  Not only do free radicals accelerate aging, they also damage or mutate cells, activate harmful genes within our DNA, and overload our immune system.^[6]

Electronic Cigarettes (e-cigarettes) or vaping deserves special mention as many people think these are a safe alterative to smoking cigarettes and have no idea of their potential health risks. In 2017, past 30-day use of e-cigarettes was reported by 3% of Canadians over 15 years old and increases to 6% of young adults (age 20-24).^[7] A large proportion (64%) of e-cigarette users admit that their e-cigarette contains nicotine.^[8]

As vaping is a fairly recent phenomenon, many long-term health effects have yet to be determined. However, research has shown evidence of some health risks thus far. Of course, those that use nicotine in their e-cigarettes have the previously mentioned ramifications of nicotine. Additional issues related to vape oils are the numerous chemicals they contain that are directly harmful to the lungs. A new term has been applied by the CDC – EVALI – which stands for ‘E-cigarette, or Vaping, product use-Associated Lung Injury’. One of the ingredients used in some e-cigarettes, vitamin E acetate, is a honey-like substance that has been shown to stick to the lungs, causing injury, resulting in numerous hospitalizations and many deaths. ^[9]

Cannabis

In October of 2018, Canada became the second country in the world to legalize cannabis (marijuana) use for non-medical purposes.^[10] Cannabis use includes using cannabis in its dry form or when mixed or processed into another product, such as an edible or a concentrate.

Results from a 2021 Canadian Cannabis survey showed that people between the ages of 20-24 years of age reported nearly double the cannabis use (49%) versus those 25 years and older (22%).^[11] Overall, 25% of Canadians reported using cannabis within the last 12 months, an increase from 2017’s pre-legalization statistics of 15%.^[12]

Canadians were asked in the survey if they knew about the harms related to cannabis. A large majority indicated that they were aware that cannabis smoke can be harmful, daily use increases risk of mental health issues, and that teenagers are at greater risk of harm from using cannabis than adults.^[13] The following table shows the percentages:

Why do people use cannabis? While the historical portrayal of cannabis users has been likened to unmotivated “stoners”, much research of late has shown a very different story. People across the world have used cannabis for thousands of years for many different reasons, but generally for social, spiritual and medical purposes.

14% of Canadians aged 16 and older indicate that they use cannabis for medical purposes, with 22% of these having a health care professionals document or prescription. ^[14] 52% of the people surveyed stated that they were able to decrease their use of other pharmaceutical medications due to using cannabis.^[15]

The Canadian Cannabis survey did not specify what medical conditions people used cannabis for. However, in 2018, researchers studied self-reported cannabis use for medical purposes across both the USA and Canada via online surveys.

The researchers found that amongst those who had self-reported using cannabis for medical purposes, the most frequently reported physical reasons were to “manage pain (53%), problems sleeping (46%), headaches or migraines (35%), lack of appetite (22%), and nausea or vomiting (21%)”. ^[16] For those that reported mental health reasons, the most common uses were “anxiety (52%), depression (40%), post-traumatic stress disorder (PTSD), or trauma (17%)”.^[17] Physical and mental issues were also interrelated, such as depression and anxiety was often associated with problems sleeping. The following table depicts the breakdown of data :

While many individuals believe that cannabis use is not habit forming, it’s not as benign as many people think. Teens who begin using cannabis before the age of 18 are four to seven times more likely to develop a marijuana use disorder.^[18] Marijuana use disorder is often associated with dependence, where a person experiences withdrawal symptoms such as mood and sleep issues, cravings and other forms of discomfort when not taking the drug. We know the brain has its own endocannabinoid neurotransmitters, and when it adapts to large amounts of the drug over time, it can experience tolerance by reducing production and sensitivity to these receptors.^{[19] [20]} Marijuana use disorder can take the form of addiction in severe cases, where being unable to stop using interferes in many aspects of the persons life.

Opioid Crisis

Canadian statistics show increasingly elevated numbers of opioid-related overdose and deaths since surveillance began in 2016, with an exacerbation since the pandemic began.^[21]  Opioids are a class of psychoactive drugs that are often used for pain management, including fentanyl, morphine, heroin, and oxycodone.^[22] Many individuals can use opioids for pain relief for short periods of time without concern.  However, illegal use of these drugs has led to significant harm across Canada in recent years, including deaths due to overdose.

In the first half of 2022 (January to July), 20 opioid deaths per day were recorded in Canada, compared to 8 in 2016, and the majority of these deaths occurred in British Columbia (BC), Alberta and Ontario.^[23]  In October 2022 in BC alone, there were an average of 6 deaths per day from opioid use.^[24] Statistics on the polysubstance nature of this crisis reveal that 47% of deaths across Canada in the same time period (January to July 2022), also involved a stimulant such as cocaine and methamphetamines.^[25]

The Canadian Centre on Substance Use and Addiction states that the opioid crisis is a consequence of numerous complex factors that include:

• “A misunderstanding of the addictive risk of prescription opioids;
• Psychological, social and biological risk factors like genetics, mental health, early life experiences, trauma, poverty, lack of secure housing and other social determinants of health;
• Stigma towards substance use disorders;
• Frequent opioid prescribing and high amounts being prescribed for pain relief;
• Lack of awareness or access to alternative treatments for pain;
• Use of prescription opioids by individuals to whom they are not prescribed, such as friends and family members;
• Lack of access to prescription opioids leading to illicit opioid use;
• Illegal drugs that are laced with fentanyl and its analogues; and
• A lack of comprehensive care to respond to all the mental and physical health needs of an individual.”^[26]

The opioid crisis is widespread and clearly has complex health and societal implications that affects not only individuals, but families, communities and society as a whole. Opioid awareness, education, prevention, and stigma reduction is imperative in the fight against opioid overdose. The Government of Canada offers multiple opioid education resources here.

In addition, the Government of British Columbia outlines various routes of recovery services and treatment support here.

Watch this 30 second End the Stigma message from the Government of Canada: