Healthcare providers at a Canadian psychiatric hospital reported that cannabis legalization improved product safety and clinical conversations but increased use, complicated mental health treatment, and left providers with inadequate training.
Mental health clinicians and administrators; policymakers in jurisdictions considering or implementing cannabis legalization.
20 providers across multiple disciplines identified persistent gaps in cannabis education and clinical guidelines
What the researchers found
Providers reported legalization had some positive impacts (improved product safety, more open clinical conversations) but also raised concerns about increased cannabis use rates, risks to mental health, and ongoing challenges engaging patients about cannabis. Providers recommended updated curricula, clinical guidelines, standardized screening, and public health campaigns.
Why it matters
Mental health settings are at the front line of potential cannabis-related harms. This study provides the first systematic look at how legalization has affected clinical practice in a major psychiatric hospital, revealing a gap between the evolving cannabis landscape and provider preparedness.
The numbers in context
20 healthcare providers interviewed across multiple roles (physicians, pharmacists, nurses). Interviews conducted June 1 to July 2, 2021 (about 2.5 years post-legalization). Multiple recommendation themes identified across five domains: medical education, mental health care, government, medical cannabis access, and legal cannabis system.
How the study worked
Qualitative study with semi-structured interviews of 20 healthcare providers (physicians, pharmacists, nurses) at a tertiary psychiatric hospital in Ontario, Canada, conducted June-July 2021. Thematic analysis of responses about legalization impacts on patient health, clinical practice, and the cannabis access system.
What this study cannot tell us
Single psychiatric hospital in Ontario limits generalizability. Provider perspectives may not reflect patient experiences. The 2021 data collection occurred during COVID-19, which may have independently affected both cannabis use and mental health care delivery.
How to read the evidence
Preliminary: rigorous qualitative methodology at a major psychiatric hospital, but limited to a single site with a small sample of providers.
When this study was published
2024 publication using 2021 interview data.
The bigger picture
Cannabis legalization is being adopted in more jurisdictions, but mental healthcare infrastructure has been slow to adapt. These provider perspectives highlight specific, actionable gaps -- from training to screening to clinical guidelines -- that other jurisdictions can address proactively rather than reactively.
Questions still open
- Have the provider concerns identified in 2021 been addressed three years later? Do providers at non-psychiatric facilities have different perspectives on legalization impacts?
Common questions
What positive changes did legalization bring?
What were the main concerns?
Read the original research
"Like the Wild West": Health care provider perspectives on impacts of recreational cannabis legalization on patients and providers at a tertiary psychiatric hospital in Ontario, Canada.
Journal of substance use and addiction treatment, 167, 209487
Citation
Wiese, Jessica L; Watson, Tara Marie; Bozinoff, Nikki; Rush, Brian; Stergiopoulos, Vicky; Le Foll, Bernard; Rueda, Sergio. (2024). "Like the Wild West": Health care provider perspectives on impacts of recreational cannabis legalization on patients and providers at a tertiary psychiatric hospital in Ontario, Canada.. Journal of substance use and addiction treatment, 167, 209487. https://doi.org/10.1016/j.josat.2024.209487