In this scoping review, we identified 21 records that addressed the impact of the pandemic on patterns of use and cannabis-related health and safety in Canada. Our findings suggest that the impact of the pandemic on cannabis consumption in Canada is more complex than simplistic assumptions of increase or decrease. The association appears to be based on the characteristics of the consumers such as age, gender, type of user (occasional/frequent), reasons for use, and accentuated health impacts.

Our findings match those of other countries and portray a mixed picture with respect to cannabis use during the pandemic (Farhoudian et al. 2020; Turna 2021; Manthey et al. 2021; Vanderbruggen et al. 2020; van Laar et al. 2020; European 2021). An online survey of 21 European countries found that the pattern of change in cannabis consumption across Europe during the pandemic was not clear; however, on average, consumers reported an increase in use (Manthey et al. 2021). Similarly, a global survey found that approximately 42% of participating countries reported that cannabis consumption increased, whereas 26% and 22% reported a decrease and no change in cannabis use pattern, respectively (Farhoudian et al. 2020). Interestingly, a survey in Belgium found there were no significant changes in cannabis consumption noted in the period before and during the COVID-19 lockdown suggesting social isolation did not influence cannabis consumption (Vanderbruggen et al. 2020).

Similar to findings in Canada, cannabis consumption patterns in the Netherlands may have changed more among regular consumers during the pandemic (van Laar et al. 2020). In addition, data available from the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) suggests that some occasional users may have stopped using or reduced their cannabis use during the lockdown period, while those who had more frequent or intensive patterns of use may have increased their consumption (European 2021). These findings are similar to patterns seen in Canada (Imtiaz et al. 2021).

Motives that drove the increased consumption of cannabis during the pandemic appear to be similar around the globe. Top reasons reported for consuming cannabis more during the pandemic included boredom and loneliness (Vanderbruggen et al. 2020; van Laar et al. 2020). However, an interesting difference was noted when comparing healthcare practitioners in Italy, Brazil, and the USA to those in Canada where Canadian practitioners reported increasing their cannabis consumption during the pandemic to cope with stress and anxiety (Turna 2021).

Gender-specific considerations influencing cannabis consumption are important to consider for prevention and public education as the pandemic evolves. While the CCSA’s 2021 report “Differences in Cannabis Perceptions among Canadian Adolescent Boys and Girls’’ reported that boys and young men reportedly use cannabis more frequently and heavily than girls and young women (Goodman 2021), our scoping review found that in the context of COVID-19, cannabis use among female youth increased during the COVID-19 pandemic compared to male youth. Furthermore, there was a greater reduction in the expected escalation of cannabis use among males compared to females, suggesting cannabis consumption among males may be more socially driven than among females (Dumas et al. 2020; Leatherdale et al. 2021). As the effects of the pandemic extend beyond the disease itself, it has become imperative to understand the short and long-term consequences of the pandemic and understand the impacts for specific segments of the population, including variation between genders. Informing mitigation strategies with ​​a gender-specific understanding of patterns of use is important.

Smoking cannabis continued to be the most common method of consumption at the end of 2020. Evidence supports the concern that cannabis smoke can negatively affect heart and lung health (Canadian 2020). The extent to which cannabis smoke impacts respiratory and immune health in humans is not well-known and further studies are needed to confirm these relationships (Canadian 2020). This is concerning in the context of the pandemic as smoking cannabis has been linked to increased risk for COVID-19 complications and related death (Canadian 2020). In light of the ongoing pandemic, behaviors that might put an individual’s health at risk should be carefully considered. Furthermore, given smoking continues to be the most common method of consumption, it highlights a need for evidence-informed cannabis education, and in particular, with regards to Canada’s lower-risk cannabis use guidelines (Fischer et al. 2017).

Despite the effect of above factors on cannabis consumption during the pandemic, there are methodological issues that needs to be considered for interpretation and that are not explored in this study. The heterogeneity of findings could be due to difference in study designs and qualities. Due to the short timeframe between the pandemic and this study, follow-up length and baseline cannabis use could impact the consumption patterns that are captures in studies reviewed in this manuscript.

This scoping review identified several implications for future research and practice. Frequent cannabis consumers who are adolescents, young adults, mothers, and frontline workers require more attention for further research. The COVID-19 pandemic and measures to control it have caused a range of mental health issues leading to increased consumption to address those issues; however, this review did not find evidence of the benefits from consuming cannabis. Understanding the cycle of mental health and substance use is important to inform decisions and policies to facilitate greater availability of, and accessibility to, mental health and substance use services as the COVID-19 pandemic evolves and for future public health crises. In particular, further research is needed to understand the changes in cannabis consumption during the pandemic and how these changes have impacted health and safety that will be relevant post-pandemic. It would also be interesting to investigate the role of therapeutic cannabis use among regular cannabis users, during an unprecedented pandemic.

This scoping review includes a number of limitations. Many of the included studies were conducted relatively close to the beginning of the pandemic, therefore, routines may have not been established and the possible full impact of the pandemic not captured. Many of the studies reviewed used self-reported cannabis use and self-perceived changes during the pandemic. Subjectivity can be both a strength and a limitation, depending on different epistemological perspectives. In addition, the review is dependent on information on the review question being available and since the pandemic is ongoing there may be gaps in evidence. It is also possible that relevant sources of information may have been omitted. Finally, as is the case for all scoping reviews, no rating of quality or level of evidence is provided; therefore, practice recommendations cannot be graded.