A total of 5433 participants reported currently taking medical cannabis. Nearly 62% identified as a woman, with most respondents reporting their ethnicity as White (81.3%), with 5.7% identifying as Indigenous, and 5.8% reporting mixed ethnicity. Participants ranged in age from 16 to 89 years (mean = 49.5 years (SD = 14.4 years)). Almost 93% reported achieving a high school education or higher, whereas close to 30% reported a before-tax household income of < $35,000 CAD/year (Table 1).

Of the total sample, 54.1% reported holding current medical cannabis authorization. Close to three-quarters of individuals with current authorization (73.8%) reported first obtaining authorization more than 3 years ago. The most prevalent health conditions for which medical cannabis was taken were chronic pain (67.0%), anxiety (63.6%), and sleep issues (61.8%) (Additional file 1: Table S1). The average number of health indications for which medical cannabis was taken was five (SD = 3.4).

Participants who were older were more likely to report holding authorization (≥ 70 years vs. < 30 years: odds ratio (OR), 4.85 (95% confidence intervals (CI), 3.49–6.76), p-trend < 0.001), as were participants who identified as a man (man vs. woman: OR, 1.53 (1.34–1.74)). Further, those who reported having undergraduate (OR, 1.62 (1.33–1.98)) or graduate education (OR, 1.56 (1.19–2.04)) in comparison with high school education were more likely to report holding medical cannabis authorization, as were individuals who received a household income higher than $75,000 CAD (OR, 1.40 (1.16–1.70)) and $100,000 CAD (OR, 1.55 (1.30–1.84)) in comparison with those whose household income was less than $50,000 CAD (Table 2). In addition, participants who identified as being members of the Canadian Armed Forces, including Veterans, were three times as likely to report being authorized to take medical cannabis versus no military affiliation (OR 3.06 (2.19–4.27)). With regard to ethnicity, individuals who identified as Indigenous were half as likely to report holding authorization (OR, 0.49 (0.38–0.64) in comparison with individuals who identified as White. Individuals living in small, rural towns were also less likely to report holding medical cannabis authorization (OR, 0.69 (0.59–0.81)) than those living in large cities.

In terms of health- and medical cannabis-related factors, individuals who reported taking medical cannabis to manage depression were less likely to report holding current authorization (OR, 0.78 (0.67–0.90)) whereas participants who reported taking medical cannabis to address chronic pain (OR, 1.74 (1.50–2.01)), seizures (OR, 1.88 (1.19–2.98)), and traumatic brain injury (TBI) (OR, 2.12; CI, 1.50–3.02) were more likely to report holding authorization (Table 3). In addition, participants who reported taking medical cannabis for 3–10 years were more likely to report holding authorization (OR, 1.56 (1.07–2.27)) than those who were within the first 6 months of taking medical cannabis (Table 3). However, participants who had the lengthiest experience with medical cannabis (over 10 years) were found to be half as likely to report holding current authorization compared to the most recent consumers of medical cannabis (< 6 months; OR, 0.54, 0.37–0.79) (Table 3).

Numerous reasons for taking medical cannabis were found to be associated with holding current authorization, such as perceiving cannabis to be effective, including more so than other medications, and potentiating the effect of existing medications (Table 3). In contrast, participants were found to be less likely to hold current authorization if they reported taking cannabis, at times, for recreational purposes, perceived medical cannabis to be less expensive than other medications, and the fact they could purchase cannabis for therapeutic purposes from a recreational store (Table 3).

Individuals with authorization were significantly more likely (p < 0.001) to report taking oils and capsules while those without authorization were more likely to report using dried flower, edibles, and concentrates (p < 0.001) (Table 4). Participants generally struggled to estimate the amount of medical cannabis they utilized; however, participants with authorization were more likely to be able to report the amount of cannabis they took daily, including THC and CBD content, compared to individuals without authorization (32.1% vs. 17.7%; p < 0.001) (data not shown).

Participants with authorization were more likely to report that they had not experienced any side effects associated with cannabis use compared to those without authorization (29.9% vs. 23.4%; p < 0.001). The latter were more likely to report experiencing cough (35.1% vs. 23.7%; p < 0.001), dependency/addiction (10.8% vs. 3.6%; p < 0.001), dry mouth (47.6% vs. 42.8%; p < 0.001), and feeling paranoid (8.5% vs. 5.9%; p < 0.001) (Table 4).

With regard to the source of medical cannabis, a total of 3395 individuals (62.5%) reported obtaining cannabis from the legal recreational market. Those with authorization were significantly more likely to get cannabis from only legal or regulated sources (including medical and recreational) than those without authorization (74.1% vs. 47.5%; p < 0.001); however, only 1040 individuals (35.4%) with authorization reported obtaining cannabis exclusively from their authorized sources. Individuals without authorization were significantly more likely (p < 0.001) to access the non-legal market or other unregulated sources, such as family and friends, dealers, and online unregulated sellers than those without authorization (Fig. 1).

Sources of medical cannabis in the past 12 months separated by authorization status. *p < 0.001

Participants with authorization were significantly more likely to get information from the following sources: a specialist doctor, a nurse practitioner, a medical cannabis clinic, or an online support group than those without authorization (p < 0.001). In contrast, participants without authorization were more likely to receive information from family or friends, a dealer, Google, recreational cannabis stores, or the media compared to those with authorization (p < 0.001) (Fig. 2).

Sources of information on medical cannabis separated by medical authorization status. *p < 0.001