The Relationship Between Rates of Cannabis Use and Covid-19 Infection Rates During the Pandemic: An Analysis of Canada's National Cannabis Survey.

Background: The well-documented relationship between mental health and substance use is corroborated by recent research on the impacts of the Covid-19 pandemic on cannabis use behavior. Social isolation, anxiety, depression, stress, and boredom are all linked to the greater prevalence of cannabis and other substance use. Objectives: To better understand the relationship between infection rates in Canada and cannabis use behavior, this research examines the prevalence and frequency of cannabis use across health regions in all 10 provinces at the height of the pandemic. Methods: Our analyses linked data from the National Cannabis Survey with Covid-19 case rates and cannabis availability through legal retail outlets at the end of 2020, 2 years after cannabis legalization came into effect. Hierarchical generalized linear models were employed, controlling for age, gender, SES, mental health, the number of cannabis stores per square kilometer, and prevalence of cannabis use in each health region prior to the pandemic. Results: Even after controlling for other predictors, our models show that those residing where infection rates are higher are more likely to use cannabis and use it more often. Conclusions: The findings of this study support investing in better-targeted harm reduction measures in areas hit hardest by the pandemic to address contributing societal conditions. The implications are noteworthy for drug policy observers in North America and other global jurisdictions pursuing evidence-based public health approaches to regulating cannabis and other substance use.