Since its legalization in 2017, cannabis use has been widely seen across Canada, with 50 per cent of people aged 20-24 reporting frequent use in the 2022 Canadian Cannabis Survey.

Despite the all-time high amount of cannabis users, many disregard or minimize the dangers presented by frequent use.

Cannabis use disorder affects nearly one-in-three cannabis users, according to Dr. Anees Bahji, MD, a PhD candidate in community health sciences at the Cumming School of Medicine.

The current lack of formal clinical guidelines or approved treatments for cannabis use disorder in Canada is partly cultural, according to Bahji.

“Cannabis is often seen as benign or even therapeutic, and that’s shaped public perception and research priorities. There hasn’t been strong pharmaceutical investment, likely due to limited perceived market opportunity,” he said.

“Legalization focused on regulation and supply, not treatment infrastructure.”

Cannabis use disorder, or CUD, currently has no medications approved by Health Canada. Bahji’s research aims to fill these current nationwide gaps while building a system of care for people living with the disorder.

His doctoral research involves analyzing large-scale provincial and national health and survey datasets, including efforts to validate a case definition for CUD.

As a psychiatrist, Bahji said that cannabis is woven into his clinical work and “everywhere.”

“What stood out to me early in my practice was how cannabis use could be profoundly disruptive for some patients, yet it was often dismissed or downplayed, both socially and within healthcare,” he said.

Bahji said that he wanted to explore it further and bring depth and evidence to a poorly understood space, rather than judgment.

Through his research, Bahji has found cannabis use to be a challenging issue. Firstly, researchers don’t have access to dispensary or sales data, meaning they often miss half the picture, Bahji said.

Secondly, Bahji noted that CUD is subjective and many people with milder forms of the disorder won’t seek care, meaning they are unaccounted for in health data.

“Even when people do present, whether they get diagnosed or coded with CUD can vary by provider and context. The end result is an under-identified, inconsistently tracked condition,” he said.

Bahji’s research includes a population-based laboratory, a model that allows researchers to test hypotheses and monitor trends using population-level data, he said.

“It’s about triangulating large, often disconnected data sources, health administrative data, national and provincial surveys, and clinical datasets to build a real-world lens on cannabis-related harms,” he said.

Bahji said that early lab insights indicate that cannabis use disorder is likely more common than surveys suggest and that it’s possible to build a viable research infrastructure around it.

“We’ve also found early signals suggesting people with CUD have an elevated risk of outcomes like cardiovascular disease, even after adjusting for other risk factors, which could be especially relevant for younger individuals,” Bahji said.

Progress coming, despite medical avoidance

Bahji said that some researchers have avoided CUD for fear of appearing anti-cannabis or out of touch with legalization movements.

Despite the current status quo, progress is happening.

Bahji said that he is currently involved in developing new national clinical guidelines for CUD.

“I hope they’ll provide much-needed clarity and support for both patients and providers,” he said.

Bahji has also contributed to national guidelines, partnered with provincial policy bodies and developed tools like an animated explainer video on YouTube to support public engagement and clinical education.

“Ultimately, data must inform action, or we’re just describing suffering without helping to alleviate it,” he said.