An online survey of cannabis users and ex-users in Ireland

Background
Cannabis is the most widely used illicit drug in Europe. Among Irish adults, 27.9% report lifetime, 7.7% last year and 4.4% last month use. Cannabis use is associated with various harms and from 2015-19 cannabis was the main problem drug among new cases presenting for treatment in Ireland. Despite the relatively high number of people who use cannabis presenting to treatment, the vast majority of those who have used cannabis never access treatment. Most research has been carried out with clinical populations and so this study aimed to explore the experiences and wellbeing of adults who currently or previously used cannabis. In light of recent paradigm shifts in cannabis legislation worldwide, cannabis use is of considerable interest to policy makers. 

Methods
The target population was adults, living in Ireland, who have used cannabis. An online survey was distributed on social media, obtaining 732 responses. Quantitative data was analysed using SPSS (Version 24) while Qualyzer was used to analyse qualitative data. The questionnaire gathered information on demographics, attitudes towards cannabis and drug use. Additionally, two validated questionnaires were included; the Severity of Dependence Scale (SDS) which measures substance dependency and the World Health Organisation Wellbeing Index (WHO-5) which measures wellbeing. The study received ethical approval from the Faculty of Medicine in Trinity College Dublin.

Results
Respondents were primarily male (61.6%) and 76.4% aged under 30. They report considerable experience of cannabis, three-quarters smoked cannabis on more than 100 occasions, and 48% on more than 400 occasions. Mean age of first use was 15 and 78% used cannabis in the last month. Three-quaters reported their heaviest use of cannabis was between 16 and 21 years old. The most common reasons for no longer using were losing interest (68%) and concerns for mental health (30%). They were positively disposed towards cannabis and were in favour of more liberal policies but were divided on decriminalisation of all drugs. Cannabis dependence is possibly present in 14-30% of current users depending on cut-off used. While wellbeing was overall good, women report significantly poorer wellbeing. Tobacco use was twice as high among current users and four times as high as the general population. Only 3.2% of the sample reported that they regretted using cannabis. 

Conclusion
Harm reduction is needed as many cannabis users do not regret their use and do not appear to be looking to quit. Advice in relation to tobacco use is also indicated as tobacco use is approximately four times as high as the general population. Cannabis use among women may also be indicative of poorer wellbeing. Policy is needed which can deliver harm reduction to a group who largely do not present to services.