Cannabis effects and dependency concerns in long-term frequent users: A missing piece of the public health puzzle

Based on structured interviews with 104 experienced users in Toronto, Canada, this article examines the perceived costs and benefits of cannabis consumption. A pretested questionnaire that was developed by Cohen and Sas (1998 ) in the Netherlands, and later translated for use in the U.S. and Germany as part of a three-city cross-national comparative study [(Reinarman et al . (2000 ). Is availability destiny? Drug use prevalence and discontinuance in Amsterdam, San Francisco and Bremen. Paper presented at the 11th International Conference on the Reduction of Drug-Related Harm, St. Helier, Jersey, Channel Islands, April 9-13, 2000; Cohen and Kaal (2001 ). The Irrelevance of Drug Policy: Patterns and Careers of Experienced Cannabis Use in the Populations of Amsterdam, San Francisco and Bremen. Centre for Drug Research, University of Amsterdam)] guided data collection on a range of drug effects, including measures of dependence inspired by DSM-IV criteria. The findings support a rational choice view of cannabis use insofar as reported advantages outweigh negative use outcomes. Top reasons for use pertain to relaxation and enhancement of recreational activities followed by coping with stress and anxiety. The frequency of respiratory and throat problems attributed to using cannabis underscores the perceived risk of pulmonary damage due to long-term heavy use. Whereas concerns about use levels nonetheless overshadowed other dependency indicators, including concern for personal health, however, no association was found between amounts nor frequency of use and the number of DSM-IV items reported by respondents. Users acknowledged and accepted the potential for dependence, adapting use levels accordingly when seen as problematic.