Mental Health, Substance Use, and Polysubstance Use Study (2024)
Final Report

Prepared for Health Canada

Supplier name: Earnscliffe Strategy Group
Contract number: CW2346803
Contract value: $193,919.30
Award date: January 23, 2024
Delivery date: August 26, 2024

Registration number: POR 088-23
For more information on this report, please contact Health Canada at:
hc.cpab.por-rop.dgcap.sc@canada.ca

Ce rapport est aussi disponible en français.

Mental Health, Substance Use, and Polysubstance Use Study (2024)
Final Report

Prepared for Health Canada
Supplier name: Earnscliffe Strategy Group
August 2, 2024

This public opinion research report presents the results of an online survey conducted by Earnscliffe Strategy Group on behalf of Health Canada. The quantitative research was conducted from March 27 to April 30, 2024.

Cette publication est aussi disponible en français sous le titre: Étude sur la santé mentale, la consommation de substances et la polyconsommation (2024)

This publication may be reproduced for non-commercial purposes only. Prior written permission must be obtained from Health Canada. For more information on this report, please contact the Public Health Agency of Canada at: hc.cpab.por-rop.dgcap.sc@canada.ca or at:

Health Canada, CPAB
200 Eglantine Driveway, Tunney's Pasture
Jeanne Mance Building, AL 1915C
Ottawa, Ontario K1A 0K9

Catalogue Number: H14-642/2024E-PDF

International Standard Book Number (ISBN): 978-0-660-73872-7

Related publications (registration number): POR 088-23

Étude sur la santé mentale, la consommation de substances et la polyconsommation (2024) (Final Report, French)
Catalogue Number: H14-642/2024F-PDF
International Standard Book Number (ISBN): 978-0-660-73873-4

^©His Majesty the King in Right of Canada, as represented by the Minister of Health, 2024

Executive summary

Earnscliffe Strategy Group (Earnscliffe) is pleased to present this report to Health Canada summarizing the results of a quantitative research study on mental health, substance use, and polysubstance use.

Background and objectives

The goal of the renewed Canadian Drugs and Substances Strategy (CDSS) is to improve the health and safety of all Canadians by minimizing substance-related harms for individuals, families, and communities. As polysubstance use – the use of more than one substance at the same time or close in time where effects overlap – is on the rise and contributing to the increased severity of overdoses and the mental health crisis, there is a need to advance the public conversation and to raise awareness of its risks, harm reduction measures, and approaches to seeking help.

Health Canada commissioned this quantitative research to better understand the relationship between the prevalence of polysubstance use as well as substance use and mental health issues and/or emotional challenges, including the level of awareness and knowledge of these issues, as well as the attitudes, perceptions, and behaviours of Canadians.

These findings will help establish a contemporary view of the Canadian substance and polysubstance use landscape and inform the development of a public education strategy, help identify key issues and considerations and inform policy decisions and possible future public education requirements.

The primary objective of this study was to collect information about mental health, substance use, and polysubstance use. More specifically, the research objectives were to:

• Measure prevalence and patterns of polysubstance use (e.g., age of initiation, frequency of use over time, quantities used, and products used/mixed);
• Assess attitudes and perception of risk and normalization of polysubstance use;
• Measure patterns of substance(s) use in relation to mental health issues and/or emotional challenge and vice-versa (which substance(s) are used for which mental health issue/illness);
• Understand public knowledge and awareness about the relationship between mental health and substance use, including perception of risks and substance use normalization (e.g., do people even realize they are using a substance as a coping mechanism; do they know and realize they have or may be displaying higher-risk behaviours or have a substance use disorder);
• Measure level of awareness and knowledge of existing supports (e.g., people, programs) when experiencing with mental health and substance use challenges or co-occurring disorders, as well as barriers to seek help (e.g., lack of awareness, stigma).

Research design

To meet these objectives, Earnscliffe conducted a quantitative research study. It was conducted with Canadians aged 13 and over and was done so as to be reflective of the Canadian population based on age (youth 13-17 years old, young adults 18-24 years old, and adults 25 years old or older), region, gender, ethnicity and other key demographics. Within the general public sample, specific subgroups of interest included people who engage in polysubstance use and people with mental health concerns.

Throughout the report, people who use substances and people who engage in polysubstance use are the terms used as person-first language is preferred to minimize stigmatizing those who are using substances.

In total 10,012 respondents living in Canada over the age of 13 years old were surveyed. The survey was conducted in both English and French and was an average of 16 minutes in length. The survey was in field from March 27^th to April 30^th, 2024.

Additionally, minimum quotas were set for the following target audiences:

The final data of both the probability and non-probability samples were individually weighted using a target weighting scheme to replicate actual population distribution by region, age, and gender according to the 2021 census data available. As a result, the aggregate data is also weighted to be reflective of the same census datapoints. While no margin of error can be provided for the non-probability sample, the n=4,999 cases from the probability sample have a margin of error of +/- 1.4% at the 95% confidence interval.

The results of the combined samples are not statistically projectable to the target population because the inclusion of the non-probability sampling method used does not ensure that the sample represents the target population with a known margin of sampling error. Other than where the probability sample has been exclusively used (Section A), the reported percentages are not generalizable to any group other than the sample studied, and therefore no formal statistical inferences can be drawn between the combined sample results and the broader target population it may be intended to reflect.

The treatment here of both the non-probability and probability samples are aligned with the Standards for the Conduct of Government of Canada Public Opinion Research - Online Surveys. A more comprehensive discussion of research design, sampling, and data collection can be found in the quantitative methodology report in Appendix B.

An incredible wealth of data has been generated with this study. The questionnaire was designed specifically to ensure the ability to examine aggregate trends in behaviours and use across multiple substance groups and types as well as allow for analysis at the substance level, resulting in hundreds of variables to examine within the dataset. With a sample of just over 10,000 respondents and including stratified quotas to enable examination across a multitude of characteristics, the range of analysis enabled by this dataset is massive. Producing a summary report cannot do justice to the insights the data can yield and, as a result, this report has been designed with a limited scope in mind and by no means represents all the possible findings to be gleaned from the dataset. Data tables with the results are published alongside this report.

The key findings from the research are presented below.

Key findings

Section A: Profile of substance use and polysubstance use

• Demographically, nearly every subgroup has over 80% identifying at least one substance having been used in the past 12 months and, notably, little variance across nearly all subsets. With the exception of Canadians aged 13 to 17 years, who are less likely to have taken at least one substance (52%). The most commonly used substances overall are alcohol (70%), over-the-counter (OTC) medication (52%), and cannabis (31%).
• There appears to be a correlation between breadth of mental health challenges and the total number of substances used over the past 12 months. Those rating their own mental health as Fair/Poor have used, on average, more substances (3.0 on average) than those identifying their mental health as Very Good/Excellent (1.8).
• People who feel they are financially struggling or just keeping up financially have, on average, used a higher variety of substances in the past 12 months than people who report having no financial commitments.
• Canadians aged 18-24 are the segment most likely to indicate polysubstance use with 56% saying they have combined at least one pair of substances in the past year. Conversely, youth aged 13-17 are least likely to report polysubstance use with only 11% saying they have combined any two substances in the past year.
• Those who have been diagnosed with any mental health condition are more likely to indicate polysubstance use than those who have not (68% versus 45%). The highest prevalence of polysubstance use by self-identified mental health conditions are found among those who report having a personality disorder (75%); with a bipolar disorder (70%); and with depression (73%).

Section B: Polysubstance behaviours

After being asked which substances they consumed in the past 12-months, how frequently they consumed them in the past 30 days, and if they ever consumed them with other substances in the same 24-hour period, respondents were classified into different segment use categorizations which are used throughout the report:

• Those engaging in polysubstance use are those who took any two substances within the same 24-hour period. In order to focus on certain behaviours, the analysis throughout the report focuses on those who used at least one combination of substances excluding nicotine as one of the paired substances (referred to as "poly " in the tables included in this report). This segment represents 36% of respondents.
• Those not engaging in polysubstance use are those who took any substances but did not combine any within the same 24-hour period. The analysis throughout this report expands that definition to include the subset of people who paired substance(s) with nicotine only (referred to as "non-poly" in the tables included in this report). This segment represents 51% of respondents.
• Those who did not identify having used any of the 15 substances in the past 12 months are referred to as "No substances" in the tables included in this report. This segment represents 13% of respondents.
• Half (51%) of those engaging in polysubstance use, including those who use nicotine, say that they have combined three or more of the tested substances within a 24-hour period.
• Among those engaging in polysubstance use, the most common circumstances in which they consumed these substances were when at home (66%), when around friends (58%), and when around family (43%).
• When asked whether they had experienced any side effects from substance use, 46% of those engaging in polysubstance use selected "nothing specific". The most common side-effects they noted experiencing were feeling unwell after using, including nausea, headaches, or being tired (26%); being unable to stop or reduce the frequency of usage (14%); and having to lie or feeling guilty about the amount used or frequency (14%).

Section C: Mental health and wellbeing

• Those aged 13-17 (50%) and over the age of 25 (49%) are more likely to self-assess their mental health as excellent or very good, while those between the ages of 18-24 are significantly more likely than others to say that their mental health is fair or poor (38%).
• People who engage in polysubstance use are more likely to say that their mental health is fair or poor (32%) compared to those who do not engage in polysubstance use (19%) or those who do not use substances at all (16%).
• When asked if they had faced problems with work, school, or daily life within the last 30 days due to mental or emotional challenges, those aged 18-24 were the most likely to respond yes (at 50%).
• Across all the negative feelings listed, those aged 18-24 were the most likely to say that they experienced these most or all of the time. For every feeling, this was statistically significant when compared to those over the age of 25 and, for all of them except crying and feeling aggressive, it was significant relative to those aged 13-17.
• The most commonly self-reported mental illnesses were anxiety disorder (17%), depression (16%), and attention deficit hyperactivity disorder (9%). People who engage in polysubstance use are significantly more likely than others to say that they have any of the eight most reported mental illnesses.
• Almost three quarters (72%) of respondents who report having a mental illness say that they have received a diagnosis for this.

Section D: Coping mechanisms for challenges with mental health and substance use

• More than half (59%) of respondents say they have never used substances to cope with mental illness or emotional challenges. Those engaging in polysubstance use are significantly more likely (64%) to say that they have ever used substances to cope with mental illness or emotional challenges than those not engaging in polysubstance use (30%) and those not using substances (12%).
• Among those who have used substances as a coping mechanism for mental illness or emotional challenges, two thirds (67%) say they have done so in the past 30 days.
• The most selected mechanisms for coping with mental or emotional challenges other than substances are connecting with family or friends (45%), being physically active (41%), and reading or listening to books (35%).
• When asked if respondents would know where to find mental health or substance use support service if needed, just under half (44%) say they would know where to find information on both.

Section E: Awareness, knowledge, and perception of risk and harms of substance and polysubstance use

• A majority (81%) of all respondents say that they are very (31%) or somewhat (50%) knowledgeable about the mental health-related risks and harms associated with substance use.
• Three quarters (77%) of all respondents say they are very (31%) or somewhat (45%) familiar with the risks associated with combining substances.
• When presented with a list of negative implications for mental health and asked which they believed to be side-effects of substance use, over half (56%) of all respondents correctly selected "all of the above".
• In order to evaluate their level of knowledge, respondents were presented with a series of statements relating to risk associated with substance use and asked if they believe each to be true or false. Respondents were graded on whether they got the responses right as per the guidelines stipulated by Health Canada. At an aggregate level, 43% of respondents got all the answers correctly, 46% got most (66%-99%) of the responses correctly, and 10% got less than 65% of the responses correctly.
• Those who use substances were asked what, if anything, would help lower their frequency of usage. The top answer was nothing, as respondents believed everything is good (37%). As for actual action items, the most selected were noticing a negative change in one's mental health (24%), sudden health issues or developing a mental illness (14%) or having an accident or sustaining an injury caused by substance use (12%).

Political neutrality statement

Research firm: Earnscliffe Strategy Group (Earnscliffe)
Contract number: CW2346803
Contract value: $193,919.30
Award date: January 23, 2024

I hereby certify as a representative of Earnscliffe Strategy Group that the final deliverables fully comply with the Government of Canada political neutrality requirements outlined in the Communications Policy of the Government of Canada and Procedures for Planning and Contracting Public Opinion Research. Specifically, the deliverables do not include information on electoral voting intentions, political party preferences, standings with the electorate or ratings of the performance of a political party or its leaders.

Signed:
Douglas Anderson
Principal, Earnscliffe

Date:
August 26, 2024

Introduction

Earnscliffe Strategy Group (Earnscliffe) is pleased to present this report to Health Canada summarizing the results of a quantitative research study on mental health, substance use, and polysubstance use.

Background and objectives

The goal of the renewed Canadian Drugs and Substances Strategy (CDSS) is to improve the health and safety of all Canadians by minimizing substance-related harms for individuals, families, and communities. As polysubstance use – the use of more than one substance at the same time or close in time where effects overlap – is on the rise and contributing to the increased severity of overdoses and the mental health crisis, there is a need to advance the public conversation and to raise awareness of its risks, harm reduction measures, and approaches to seeking help.

Health Canada commissioned this quantitative research to understand the prevalence rates of polysubstance use and substance use to cope with mental health issues and/or emotional challenges (and vice-versa), including the level of awareness and knowledge of these issues, as well as the attitudes, perceptions, and behaviours of Canadians.

These findings will help establish a contemporary view of the Canadian substance and polysubstance use landscape and inform the development of a comprehensive public education strategy, help identify key issues and considerations and inform policy decisions and possible requirements.

The primary objective of this study was to collect information about mental health, substance use, and polysubstance use. More specifically, the research objectives were to:

• Measure prevalence and patterns of polysubstance use (e.g., age of initiation, frequency of use over time, quantities used, and products used/mixed);
• Assess attitudes and perception of risk and normalization of polysubstance use;
• Measure patterns of substance(s) use in relation to mental health issues and/or emotional challenge and vice-versa (which substance(s) are used for which mental health issue/illness);
• Understand public knowledge and awareness about the relationship between mental health and substance use, including perception of risks and substance use normalization (e.g., do people even realize they are using substances as a coping mechanism; do they know and realize they have or may be displaying higher-risk behaviours or have a substance use disorder);
• Measure level of awareness and knowledge of existing supports (e.g., people, programs) when dealing with mental health and substance use challenges or co-occurring disorders, as well as barriers to seek help (e.g., lack of awareness, stigma).

Research design

To meet these objectives, Earnscliffe conducted a comprehensive quantitative research study. It was conducted with Canadians aged 13 and over and was done so as to be reflective of the Canadian population based on age (youth 13-17 years old, young adults 18-24 years old, and adults 25 years old or older), region, gender, ethnicity and other key demographics. With the general public sample, specific audiences included:

• People who engage in polysubstance use: people who use more than one substance at the same time or close in time where effects overlap; and,
• People with mental health concerns: people who are struggling with their mental health (self-reported or diagnosed) and who use at least one substance.

Throughout the report, people who use substances and people who engage in polysubstance use are the terms used as person-first language is preferred to minimize stigmatizing those who are using substances. Readers are encouraged to use non-stigmatising language when talking about substance use. For more information on changing how we talk about substance use, please see Communicating about Substance Use in Compassionate, Safe and Non-Stigmatizing Ways.

In total 10,012 respondents living in Canada over the age of 13 years old were surveyed. The survey was conducted in both English and French and was an average of 16 minutes in length. The survey was in field from March 27^th to April 30^th, 2024.

The sample was a hybrid with data collection using two separate sample sources: a probability and a non-probability sample. As the objective of the research is to understand prevalence rate calculations and establish a baseline for polysubstance use in Canada, the probability-based sampling was used for the estimates presented in Section A.

However, some of the oversampling (particularly youth) that was required could not be fully satisfied using a probability sample. As a result, an identically sized study with a non-probability sample was also completed.

Additionally, minimum quotas were set for the following target audiences:

The final data of both the probability and non-probability samples were individually weighted using a target weighting scheme to replicate actual population distribution by region, age, and gender according to the 2021 census data available. As a result, the aggregate data is also weighted to be reflective of same census datapoints.

While no margin of error can be provided for the non-probability sample, the n=4,999 cases from the probability sample have a margin of error of +/- 1.4% at the 95% confidence interval.

The results of the combined samples are not statistically projectable to the target population because the inclusion of the non-probability sampling method used does not ensure that the sample represents the target population with a known margin of sampling error. Other than where the probability sample has been exclusively used (Section A), the reported percentages are not generalizable to any group other than the sample studied, and therefore no formal statistical inferences can be drawn between the combined sample results and the broader target population it may be intended to reflect.

The treatment here of both the non-probability and probability samples are aligned with the Standards for the Conduct of Government of Canada Public Opinion Research - Online Surveys. A more comprehensive discussion of research design, sampling, and data collection inter alia, can be found in the quantitative methodology report in Appendix B.

Within the tables included in the body of the report, no statistical significance is included. In the tables provided under separate cover, letters beside percentages indicate results that are significantly different than those found in the specific comparison columns indicated by the letter. Within the tables provided under separate cover, unless otherwise noted, differences highlighted are statistically significant at the 95% confidence level. The statistical test used to determine the significance of the results was the Z-test.

Due to rounding, results may not add to 100%. Additionally, due to the way that the survey logic was constructed with parents handing the surveys off to their children, please note that the age groups add up to over 100%.

Detailed findings

An incredible wealth of data has been generated with this study. The questionnaire was designed specifically to ensure the ability to examine aggregate trends in behaviours and use across multiple substance groups and types as well as allow for analysis at the substance level, resulting in hundreds of variables to examine within the dataset. With a sample of just over 10,000 respondents and including stratified quotas to enable examination across a multitude of characteristics, the range of analysis enabled by this dataset is massive. Producing a summary report cannot do justice to the insights the data can yield and, as a result, this report has been designed with a limited scope in mind and by no means represents all the possible findings to be gleaned from the dataset.

The following report presents the analysis of the quantitative research.

It is divided into six main sections:

• Section A: Profile of substance use and polysubstance use;
• Section B: Polysubstance behaviours;
• Section C: Mental health and wellbeing;
• Section D: Coping mechanisms for challenges with mental health and substance use
• Section E: Awareness, knowledge, and perception of risks and harms of substance and polysubstance use
• Section F: Target subgroup analysis

Each section presents the findings of the quantitative survey and is guided by one of the research objectives of this study. Section A presents the findings in a primarily narrative format with only a few accompanying tables to help illustrate the data. It also only uses the data from the probability-based panel. The following sections, by contrast, use the combined dataset which includes both the probability-based panel as well as the non-probability panel.

Above each table, the titles provide a short description of the topic examined in each question as well as the crosstabs used to examine it. These are typically age, gender, region, mental health status, and the substance use segmentation (people who engage in polysubstance use excluding nicotine, people who do not engage in polysubstance use excluding nicotine, and those who do not engage in substance use at all). Which crosstabs are used to examine each question vary by section. As many of the questions were only asked of a specific target population, above each table there is a descriptive text of what the base for that particular question was. The weighted and unweighted sample sizes (n) can be found at the bottom of each table. Appended data tables provide the results across a much broader range of characteristics.

There are also visual dashboards providing information on individual substances and substance pairings that are provided under separate cover. Details about the survey design, methodology, sampling approach, and weighting of the results may be found in the Quantitative Methodology Report in Appendix A.

Unless otherwise noted the data points and demographic differences highlighted in the body of this report are statistically significant at the 95% confidence level. The statistical test used to determine the significance of the results was the Z-test. Hyphens (-) indicate that there is no data for that particular cell in a table. While inferential statistics were used to support the identification of these differences, they only serve to highlight trends within the existing data set as they cannot be extrapolated to a broader audience.

Percentages may not add up to 100% due to rounding. The response metrics "don't know" and "no response" are denoted by "DK" and "NR" respectively.

Section A: Profile of substance use and polysubstance use

This initial section of the report provides a very basic overview of trends seen in the data as they relate to substance and polysubstance use.

Throughout the report, substances tested are referenced, often in an abbreviated form to make reading easier. The full description of the 15 specific substances as tested is below:

Cannabis in any form (smoked, vaped, edible, etc.)

Opioids (e.g., oxycodone (OxyContin^®), morphine (APO^®), or fentanyl, hydromorphone, buprenorphine, Suboxone^®, methadone, diacetylmorphine, oxy, OC, percs, roxies, heroin, H, Smack)

Anti-anxiety drugs (e.g. venlafaxine (Effexor^®XR), pregabalin (Lyrica^®), sertraline (Zoloft^®), citalopram (Celexa^®), benzos, tranks, K)

Sedatives or sleeping aid (e.g. trazodone (Desyrel^®, Trazorel^®), lorazepam (Ativan^®), zopiclone (Imovane^®), clonazepam (Klonopin^®, Rivotril^®), downers, jellies)

Anti-depressants (e.g. venlafaxine (Effexor^®XR), citalopram (Celexa^®), escitalopram (Cipralex^®), bupropion (Wellbutrin^®))

Stimulants (e.g., methylphenidate, Ritalin^®, Concerta^®, Biphentin^®, beenies, ritz)

Over the counter medication (e.g., cough syrup, decongestants)

Cocaine (e.g., coke, snow, powder) or crack cocaine (e.g., rock, freebase, angie)

MDMA or Ecstasy (e.g., E, X, Molly)

Hallucinogens (e.g., Psilocybin, magic mushrooms/shrooms, LSD, Acid, blotters)

Methamphetamine (e.g., crystal meth, crank, speed)

Bath salts (e.g., drone, MCAT, vanilla sky, blue magic) – This does not include salts used in a bath

Inhalants (e.g., glue, gasoline, other solvents)

Alcohol (e.g., beer, wines, spirits)

Nicotine in any form (e.g., cigarettes, vaped)

Numerous data tables are appended under separate cover providing many more results than can be highlighted in the body of this report.

Substance use

The data show that substance use amongst Canadians is widespread when considering the 15 specific substances tested in this study. While some substances are clearly used more than others and some are used by very few, the vast majority of Canadians (87%) indicate using one or more of these 15 substances in the past 12 months.

The most commonly used substances are alcohol (70%), over-the-counter (OTC) medication (52%), and cannabis (31%). For six specific substances (cannabis, anti-depressants, sedatives or sleeping aids, anti-anxiety drugs, opioids, and stimulants), those who had taken that substance were asked whether they had taken that substance with their own prescription or ever taken it after accessing it through another source (someone else's prescription or another source altogether). Since people may have taken a substance multiple times in the past year, this was a multiple response question.

Figure 1 - Substance use prevalence (probability sample)

Q7: Please indicate which, if any, of the substances listed below you have used in the past 12 months for any reason at all?

Base: Respondents from the probability-based panel only (n=4999)

Among the substances that could be obtained through a prescription, most were only sourced as prescription medication. Cannabis was the only substance where the tendency was to obtain it through another source, resulting in 27% of Canadians having used this substance in the past year through some other source than their own prescription and only 3% of Canadians indicating having used cannabis in the past year exclusively with their own prescription.

Figure 2 - Substance use with/without a prescription*

Q8: You indicated having used the substance or substances below in the past 12 months. For each, please indicate whether the times you took it, it was always prescribed to you personally or not always prescribed to you personally. Which of the following best describes the source or sources? Please select all that apply.

Q9: You indicated having used over the counter medication in the past 12 months. Did you always use it to treat related symptoms as indicated on the package?

Base: Respondents from the probability-based panel only (n=varies by substance; percentages are for the total base and not for the row)

Demographically, nearly every subgroup (80%) have used at least one substance and, notably, little variance across nearly all subsets, except for Canadians aged 13 to 17 years, of whom, only roughly half (52%) say they have taken one of these substances in the past year.

The most commonly used substances are quite similar across most demographic categories with alcohol (70%), over-the-counter (OTC) medication (52%), and cannabis (31%). The most commonly used substances by youth 13-17 are the same but vary in order: OTC medication (36%), followed by alcohol (25%) and cannabis (14%).

Most Canadians (64%) indicate having used more than one substance in the past year.

Table 3 - Prevalence rate of substance use by age and gender

Q7: Please indicate which, if any, of the substances listed below you have used in the past 12 months for any reason at all?

Base: Respondents from the probability-based panel only (n=4999)

Regionally, results on substance use show little variance, however, nearly all respondents from the territories identify having used at least one substance and the single biggest explanator is the fact that they are twice as likely as the national average to have said they used nicotine (36% compared to 17% nationally).

Table 4 - Prevalence rate of substance use by region

Exhibit A2 – Q7: Please indicate which, if any, of the substances listed below you have used in the past 12 months for any reason at all?

Base: Respondents from the probability-based panel only

How people feel about their financial situation also seems to relate to their substance use. People who feel they are financially struggling (86% any substances, 2.6 mean substances) or just keeping up financially have (87%, 2.4), on average, used substances more than people who have no financial commitments (63%, 1.4).

Table 5 - Prevalence rate of substance use by self-assessed financial wellbeing

Exhibit A3 – Q7: Please indicate which, if any, of the substances listed below you have used in the past 12 months for any reason at all?

Base: Respondents from the probability-based panel only

In terms of occupation, the top three most commonly used substances (alcohol, OTC and cannabis) are the same as found overall and are the same across all occupations. However, there are some differences in terms of the less common substances. As examples, among the occupations of interest for this analysis, there is a higher prevalence of sleeping aids taken among those who work in law (21%) or healthcare (19%) compared to the national average (9%); and people who work in healthcare (12%), are more than twice as likely to use stimulants as the national average (5%).

Table 6 - Prevalence rate of substance use by occupation

Exhibit A4 – Q7: Please indicate which, if any, of the substances listed below you have used in the past 12 months for any reason at all?

Base: Respondents from the probability-based panel only

Polysubstance use

After being asked which substances they consumed in the past 12-months, how frequently they consumed them in the past 30 days, and if they ever consumed them with other substances in the same 24-hour period, respondents were classified into different segment categorizations which are used throughout the report:

• Those engaging in polysubstance use are those who took any two substances within the same 24-hour period. In order to focus on certain behaviours, the analysis throughout the report focuses on those engaging in polysubstance use with at least one combination of substances (referred to as "poly" in the tables included in this report). This segment represents 36% of respondents. Pairs of substances that included nicotine were excluded from the definition of polysubstance use for the purpose of this report.
• Those not engaging in polysubstance use are those who took any substances but did not combine any within the same 24-hour period. The analysis throughout this report expands that definition to include the people who paired any substance(s) with nicotine only (referred to as "non-poly" in the tables included in this report). This segment represents 51% of respondents.
• Those who did not identify having used any of the 15 substances in the past 12 months are referred to as "No substances" in the tables included in this report. This segment represents 13% of respondents.

This report focuses on substance pairings that exclude nicotine in order to focus on the project objectives. While nicotine is included in measuring the prevalence of polysubstance use and co-use with other substances, pairing specific questions were not asked of those including nicotine. Please note that not all possible substance pairings were able to be tested with every respondent who took them due to interview length limitations. For more details on how these pairings were tested, please see the methodology report in Appendix B and the questionnaire in Appendix C.

In total, after accounting for sources of opioids among those who have taken an opioid, a total of 29 different pairs of substances were identified in terms of prevalence and a total of 23 pairings were included in the study for further examination. Medications included did not differentiate between prescription and non-prescription versions, however those only using prescribed medications and no other substances were excluded from the polysubstance use questions. The text included in the questionnaire is provided in Table 8 for each of these 29 pairings, with respective short forms used in charts or tables of this report.

The reference to taking OTC medication includes people who took it as directed and those who say they ever took OTC medication not as directed.

[Footnote 1] Denotes pairings that were excluded from any follow-up questions.

As can be seen in the chart below, the prevalence of use of these 29 possible pairings varies widely. Overall, 40% reported using two of the substances from these groupings together in the same 24-hour period in the last 12 months. The highest prevalence of a substance pairing was cannabis with alcohol (18%). The next most commonly used pairings were alcohol with medication (14%); alcohol with OTC medication (13%); and alcohol with nicotine (13%).

Figure 3 – Polysubstance use

Exhibit A6 – Q12a to Q17b: Thinking of all the times in the past 12 months that you have used [substance taken], have you also used any of the following within the same 24-hour period? [Pairs only included those that were possible based upon the substances identified as having been taken in the past 12 months]

Base: Respondents from the probability-based panel only (n=4999)

Only 11% of youth aged 13-17 have combined any two substances in the past year, whereas far more of those aged 18-24 (56%) and adults 25+ (41%) have done so. Among youth aged 13-17, the most common pairings indicated are alcohol and cannabis (6%), alcohol and nicotine (6%) and cannabis and nicotine (5%).

Among young adults aged 18-24, the most common pairings indicated are cannabis with alcohol (28%); alcohol with nicotine (28%) and alcohol with "at least one of anti-anxiety drugs; sedatives or sleeping aid; anti-depressants; prescription stimulants" (20%). Among those aged 25+, the three most common pairings all involve alcohol: cannabis with alcohol (18%); alcohol with "at least one of anti-anxiety drugs; sedatives or sleeping aid; anti-depressants; prescription stimulants" (14%); and alcohol with OTC medication (13%).

Table 8 – Prevalence rate of polysubstance use by age

Exhibit A6 – Q12a to Q17b: Thinking of all the times in the past 12 months that you have used [substance taken], have you also used any of the following within the same 24-hour period? [Pairs only included those that were possible based upon the substances identified as having been taken in the past 12 months]

Base: Respondents from the probability-based panel only

Combining three or more substances

This section expands on the behaviour of those engaging in polysubstance use who had identified at least one 'pair' of substances used together in the span of 24-hours and used in total at least 3 substances. Those who had taken substances from at least three of the groups listed and had paired at least one pair of substances were asked "At any time in the past 12 months, did you ever take or combine substances from three or more of these groups within the same 24-hour period". The seven groups of substances used for this investigation were:

• Alcohol - Alcohol (e.g., beer, wines, spirits)
• Cannabis - Cannabis in any form (smoked, vaped, edible, etc.)
• Nicotine - Nicotine in any form (e.g., cigarettes, vaped)
• Opioids - (e.g., oxycodone (OxyContin^®), morphine (APO^®), or fentanyl, hydromorphone, buprenorphine, Suboxone^®, methadone, diacetylmorphine, oxy, OC, percs, roxies, heroin, H, Smack)
• Over the Counter Medications - (e.g. cough syrup, decongestants)
• Other Medications - At least one of anti-anxiety drugs; sedatives or sleeping aid; anti-depressants; prescription stimulants
• Other Controlled Substances - At least one of cocaine, ecstasy, hallucinogens, methamphetamine, bath salts, inhalants

Half of those who had used at least one pair of substances together had also used three or more substances from these groups together within a 24-hour period (51%). Out of the (40%) of Canadians who engage in polysubstance use, 42% indicated that they were also engaging in multi-polysubstance use. In total, this represents 16% of Canadians aged 13 or older who are engaging in multi-polysubstance use.

Table 9 - Use of three or more substances within 24-hours by age and polysubstance segment

Exhibit A7 – Q18: You've indicated that in the past 12 months you have taken or combined substances from at least two of the groups below. At any time in the past 12 months, did you ever take or combine substances from three or more of these groups within the same 24-hour period?

Base: Respondents from the probability-based panel only

Section B: Polysubstance behaviours

This section examines the circumstance surrounding polysubstance use among people who engage in polysubstance use other than pairs that involve nicotine. Questions were asked to determine the frequency and the timing of taking substances relative to each other, the reasons behind polysubstance use, and the feelings that were sought. The tables below tell the aggregated story of all responses across all pairs for the total population, as well as by age group 13-17, 18-24, and those aged 25 or older).

To respect the time commitment required by any survey respondent, questions were asked for up to three pairings. Respondents who had indicated having taken four or more pairs of substances in the past year were shown the list of pairs they had indicated and asked to identify the three they had taken most often in the past 12 months and were asked questions related to those specific pairs. As a result, the sample sizes for all pairs tested is not exactly the same as the total number of respondents who had taken that pair. Pair-specific data is available in the data tables provided under separate cover and in the dataset.

Across all people who engage in polysubstance use, there is a fairly even distribution in terms of how often they are doing that and relatively little variation by age. While 21% are taking substances in pairs daily, a quarter (24%) are taking them weekly, another quarter are taking them monthly, and 30% say they are not even taking them as often as monthly. In terms of the differences by ages, those aged 13-17 are more likely to be saying they took multiple substances weekly (30%), those aged 18-24 skew a bit higher in saying monthly (29%) or less often (30%) and those aged 25 and older have a nearly identical tendency as is found overall.

Table 10 - Frequency of using paired substances by age

Exhibit B1 – Q20/Q23/Q26: In the past 12 months, how frequently you have taken [PAIR 1 / PAIR 2 / PAIR 3] within the same 24-hour period?

Base: People who engage in polysubstance use

For each of the top three pairs of substances used by respondents within a 24-hour period, they were asked to indicate if they took them together, one after the other or when they no longer feel the effects. At the aggregate across all evaluated pairs, most appear to be taking one substance after the other when it suits them (52%), rather than together simultaneously (27%). In just over one quarter (28%) of the cases studied, the second substance was taken once the effects of the previous substance had worn off.

Table 11 - Chronological timing of pairing substances

Exhibit B2 – Q21/Q24/Q27: When you have taken [PAIR 1 / PAIR 2 / PAIR 3] within the same 24-hour period, did you take them at the same time, or one after the other close enough in time so that the effects may have overlapped? Please select all that apply.

Base: Total number of pair tests for people who engage in polysubstance use

Substances the most often taken together or when it suits them included two other controlled substances (90%), cannabis and other controlled substances (85%), alcohol and other controlled substances (86%), and cannabis with alcohol (82%). Those taken after the effects of the other had worn off included pairs that mixed medicines with other substances such as alcohol and prescription opioids (36%), medications and other controlled substances (34%) and prescription opioids and over the counter medication (31%).

Provided with a list of 16 possible reasons for taking the two specific substances within the same 24-hour period, the most common reasons offered were to help ease pain (27%) or to help cope with poor mental health or a mental illness (26%). Almost as many said it was to prolong a high (24%) and 19% said it was because their friends of family were doing it.

Figure 4 – Reasons for combining substances

Q22: - When you have taken... within the same 24-hour period, please indicate all of the reasons you were taking those substances together?

Base: Total number of pair tests for people who engage in polysubstance use (Unweighted n=2011; weighted n=2066)

Respondents were asked what feelings they were seeking when they took the specific pairs and were shown a list of nine possible feelings to choose from with the opportunity to specify another feeling. The question was also multiple response, allowing respondents to offer up to three different feelings sought. The most common feeling sought was to be less stressed, relaxed or at peace which was identified by nearly half (49%) of all people who engage in polysubstance use. The next most common reasons were for pain relief (35%) and to be less anxious (31%).

Although the most common reason is the same across all three age groups, there are some interesting differences among the other answers offered.

For youth aged 13-17, the most common feeling sought was to feel less stressed, relaxed or at peace (59%), to happy, euphoric or on top of their game (53%), and to more social, less shy or brave (52%). Just over half (51%) say they do it to be less anxious. Also, although not as common as other feelings sought, youth aged 13-17 who engage in polysubstance use are five times as likely as the national average to say they do it to feel included or accepted by others (35% compared to a national average of 6%).

Among young adults aged 18-24, the most common reasons are very similar to those indicated by youth, but smaller proportions identify each. Half (53%) do it to be less stressed, relaxed or at peace, 44% to be less anxious, 41% to be happy, euphoric or on top of their game and the same proportion (40%) to be more social, less shy, or brave.

People who engage in polysubstance use aged 25 or older most often pair substances to be less stressed, relaxed or at peace (48%), for pain relief (36%) or to feel less anxious (29%).

Table 12 - Feelings sought when pairing substances by age

Exhibit B3 – Q29a/Q29b/Q29c: For each of the combinations you have identified taking in the past 12 months, please indicate which feeling(s) you were seeking when using that combination substances when you did. Select all that apply.

Base: People who engage in polysubstance use

Circumstances of Substance Use

Respondents were asked to name the kinds of circumstances they were in when using any substances. They were shown a list of possible circumstances to choose from and could select as many as applied. Overall, the three most commonly cited answers were when at home (59%), when around friends (57%), and when around family (46%). There are significant differences when looked at by age. Those over the age of 25 are the most likely to say that they consumed these substances at home (62%) or when around family (48%). However, those aged 18-24 are the most likely to say they consume these substances when around friends (74%) rather than at home (43%) or when around family (34%). This age group is also the most likely to say that they consume substances when they are alone (30%), when at a party (42%), or when bored (22%).

People who engage in polysubstance use are significantly more likely to say that they consume substances when they are at home (66%) than those only engaging in non-polysubstance use (54%). Those who do not engage in polysubstance use, for their part, are significantly more likely to say that they consume them around family than people who engage in polysubstance use (50% versus 43%).

Table 13 - Circumstances in which substances are used by age and polysubstance use

Exhibit B4 – Q31: For the substances you identified having taken in the past 12 months, what kinds of circumstances were you in when you used any of them? Select all that apply. *mentions <1% hidden.

Base: People who engage in substance use excluding those with prescriptions

Respondents were asked if they have felt any of a list of adverse or dangerous effects as a result of taking any of the substances they have taken in the past 12 months. A majority (61%) of respondents indicated experiencing "nothing specific", very similar to the proportions measured among those aged 13-17 (56%) and those 25 or older (63%).

Those engaging in polysubstance use were significantly more likely than those engaging in non-polysubstance use only to say that they had felt or experienced at least one of the effects tested. While 70% of those who do not engage in polysubstance use indicated experiencing nothing specific, this proportion is only 46% among people who engage in polysubstance use.

Table 14 - Situations or feelings experienced while using substances by age and polysubstance use

Exhibit B5 – Q32: For any of the substances you identified having taken in the past 12 months, have you ever experienced any of these situations and/or feelings? Select all that apply. *mentions <1% hidden.

Base: People who engage in substance use

Section C: Mental health and wellbeing

This study included a variety of questions relating to mental health in order to investigate the prevalence of mental health challenges and associated coping mechanisms, including substance and polysubstance use. The first question in this section asked respondents to self-assess their mental health on a scale from "excellent" to "poor".

Those aged 13-17 (50%) and over the age of 25 (49%) are more likely to rate their own mental health as excellent or very good, than those between the ages of 18-24 (30%). Those between the ages of 18-24 are significantly more likely to say that their mental health is fair or poor (38%) than adults over 25 (21%).

Table 15 - Self-assessed mental health by age

Exhibit C1 – Q34: How would you rate your overall mental health?

Base: All respondents

When broken out by the substance use segmentation, people who engage in polysubstance use are more likely to say that their mental health is fair or poor (32%) than those who do not engage in polysubstance use (19%) or those who do not use substances at all (16%). Similarly, people who use multiple substances are less likely to report very good or excellent mental health (36%) than people who only use one substance (52%), or people who do not use any substances (53%).

Table 16 - Self-assessed mental health by substance use segmentation

Exhibit C2 – Q34: How would you rate your overall mental health?

Base: All respondents

When asked if they had faced problems with work, school, or daily life within the last 30 days due to mental or emotional challenges, nearly a third of respondents (31%) said they had. Those aged 18-24 were the most likely to respond yes (at 50%).

Table 17 - Problems faced within last 30 days due to mental or emotional challenges by age

Exhibit C3 – Q35: During the last 30 days, have you had any problems with school, your work or daily life due to your mental health or emotional challenges, like feeling depressed, sad, overwhelmed, unmotivated, anxious, or distressed?

Base: All respondents

Those engaging in polysubstance use are more likely to report having problems with school, work, or daily life due to mental or emotional challenges in the last 30 days (40%) compared to either those engaging only in non-polysubstance use (27%) or people who use no substances (26%).

Table 18 - Problems faced within last 30 days due to mental or emotional challenges by substance use segmentation

Exhibit C4 – Q35: During the last 30 days, have you had any problems with school, your work or daily life due to your mental health or emotional challenges, like feeling depressed, sad, overwhelmed, unmotivated, anxious, or distressed?

Base: All respondents

All respondents were also asked how often, if at all, they had felt or experienced any of the following mental health or emotional challenges in the past 30 days. The responses reported here show only those who selected "all of the time" or "most of the time" whereas a full breakdown by each response metric can be found in the appended data tables.

Across all the feelings tested, those aged 18-24 were the more likely than all other respondents to say that they experienced any of these most or all of the time. For every feeling, this was statistically significant when compared to those over the age of 25 and, for all of them except crying and feeling aggressive, it was also significant relative to those aged 13-17.

Table 19 - Those saying they have mental or emotional challenges all or most of the time within last 30 days by age

Exhibit C5 – Q36: Thinking of the past 30 days, how often, if at all, have you felt or experienced any of the following mental health or emotional challenges. (% saying all of the time or most of the time)

Base: All respondents

When compared with those engaging in only non-polysubstance use and those who use no substances, those engaging in polysubstance use are significantly more likely to say that they experience any of the challenges tested all or most of the time (52% versus 34% and 31% respectively).

Table 20 - Those saying they have mental or emotional challenges all or most of the time within last 30 days by substance use segmentation

Exhibit C6 – Q36: Thinking of the past 30 days, how often, if at all, have you felt or experienced any of the following mental health or emotional challenges. (% saying all of the time or most of the time)

Base: All respondents

The most commonly reported mental illnesses were anxiety disorder (17%), depression (16%), and attention deficit hyperactivity disorder (9%). Those aged 18-24 are the most likely to cite having one of these mental illnesses.

Table 21 - Mental disorders by age

Exhibit C7 – Q37: Do you have any of the following mental illness(es)? Please select all that apply. *mentions <1% hidden.

Base: All respondents

For the eight most cited mental illnesses – that is, from anxiety disorder to bipolar disorder – those engaging in polysubstance use are significantly more likely to say that they have said illness than those engaging only in non-polysubstance use or not using substances. The prevalence rates for the top three most cited mental illnesses among those who engage in polysubstance are 31% for depression, 29% for anxiety disorders, and 16% for attention deficit hyperactivity disorder.

Table 22 - Mental disorders by substance use segmentation

Exhibit C8 – Q37: Do you have any of the following mental illness(es)? Please select all that apply. *mentions <1% hidden.

Base: All respondents

Overall, almost three quarters (72%) of respondents who report having a mental illness say that they have received a diagnosis.

Table 23 - Mental disorder diagnosis by age

Exhibit C9 – Q38: Have you received a diagnosis from a mental health professional for any of these mental illness(es)?

Base: Respondents who report having a mental illness

Not only are those engaging in polysubstance use more likely to report having a mental illness, they are significantly more likely to say that they have received a diagnosis from a mental health professional for it at 80% saying so (this compared with 66% of those who do not engage in polysubstance use or 60% of those who do not engage in substance use at all).

Table 24 - Mental disorder diagnosis by substance use segmentation

Exhibit C10 – Q38: Have you received a diagnosis from a mental health professional for any of these mental illness(es)?

Base: Respondents who report having a mental illness

The data above demonstrate that there is a correlation between substance or polysubstance use and mental illness, and that mental health varies across the age groups. In terms of the likelihood to have used at least one of the 15 substances listed in the past 12 months, there is no real correlation between having mental health challenges and the prevalence of having used substances, with all groups having a strong tendency to have identified at least one substance taken. However, there does appear to be a correlation between breadth of mental health challenges and the total number of substances used over the past 12 months.

Those who self-assess their mental health as fair or poor are more likely to say that they use any of the substances tested with the exception of alcohol (68% versus 71-72% among those who self-assess their mental health as in better condition) and over the counter medication (56% – the same rate as those who self-assess their mental health as good).

Table 25 - Prevalence rate of substance use by mental health

Exhibit C11 – Q7: Please indicate which, if any, of the substances listed below you have used in the past 12 months for any reason at all?

Base: Respondents from the probability-based panel only

Those who have been diagnosed with any mental health condition are more likely to indicate any polysubstance use than those who have not (68% versus 45%). The highest prevalence of polysubstance use by mental health conditions are found among those who have been diagnosed with a personality disorder (75%); with depression (73%); or with a bipolar disorder (70%).

Those who self-assess their mental health as fair or poor are more likely to say that they use any of the substance pairings tested than those who self-assess their mental health as good, very good or excellent. They are also the more likely to indicate having taken a higher mean number of substance pairs (2.9) than those who say that their mental health is good (1.9) or excellent or very good (1.2).

Table 26 – Prevalence rate of polysubstance use by mental health

Exhibit C12 – Q12a to Q17b: Thinking of all the times in the past 12 months that you have used [substance taken], have you also used any of the following within the same 24-hour period? [Pairs only included those that were possible based upon the substances identified as having been taken in the past 12 months]

Base: Respondents from the probability-based panel only

The top circumstances identified where people who use substances engage in substance use include when at home (59%), when around friends (57%), and when around family (46%). Those who assess their mental health as fair or poor are more likely to say they consume substances at home (67% compared to 59%), when alone (41% compared to 26% overall), and when bored (22%, compared to 14% overall).

Table 27 - Circumstances in which substances are used by mental health

Exhibit C13 – Q31: For the substances you identified having taken in the past 12 months, what kinds of circumstances were you in when you used any of them? Select all that apply. *mentions <1% hidden.

Base: People who engage in substance use excluding those with prescriptions

Those who self-assessed their mental health as fair or poor were significantly more likely to say that they had experienced any of the adverse or dangerous effects listed – i.e., from feeling unwell (25% compared with 13% of those who describe their mental health as excellent or very good) all the way down to frequently getting into fights (1% compared with less than 1% of those who describe their mental health as excellent or very good.

Table 28 - Situations or feelings experienced while using substances by mental health

Exhibit C14 – Q32: For any of the substances you identified having taken in the past 12 months, have you ever experienced any of these situations and/or feelings? Select all that apply. *mentions <1% hidden.

Base: People who engage in substance use

Section D: Coping mechanisms for challenges with mental health and substance use

This section looks at how respondents are coping with mental health and/or substance use challenges. Asked if they have ever used substances to cope with mental illness or emotional challenges, the majority (59%) respondents say they never have, but well over a third of Canadians (38%) have, including one in ten (11%) who say they often or always do this. Those between the ages of 18-24 (46%), and those who assess their own mental health as fair or poor (62%), are the most likely to say that they have used a substance as a coping mechanism. Indeed, those who self-assess their mental health as poor or only fair are more than twice as likely (24%) as the national average to say this is something they do often or always.

Table 29 - Use of substances to cope with mental or emotional challenges by age and mental health

Exhibit D1 – Q39: How often, if ever, have you used a substance to help cope with your mental illness or emotional challenges?

Base: All respondents

People who engage in polysubstance use are also significantly more likely (64%) than those who do not engage in polysubstance use (31%) and people who do not engage in substance use at all (12%) to say that they have used substances to cope with mental illness or emotional challenges.

Please note that the following question was asked of all respondents as it deals with if respondents have ever taken a substance as a coping mechanism. Those in the no substance segment are respondents who say they have not used anything in the past 12 months, but their responses demonstrate that some have used substances as a coping mechanism at some earlier point in their lives.

Table 30 - Use of substances to cope with mental or emotional challenges by substance use segmentation

Exhibit D2 – Q39: How often, if ever, have you used a substance to help cope with your mental illness or emotional challenges?

Base: All respondents

Among those who said they had used substances to cope with mental health issues at some point in time, there is a tendency to have done this in the past 30 days, specifically. Fully two thirds (67%) of those who have ever done so, say they have in the past 30 days.

People who have ever used a substance to cope and who self-assessed as having fair or poor mental health are a lot more likely than everyone else to have used a substance to cope within the past 30 days specifically. The vast majority (80%) of this segment have used a substance to cope in the past month compared to 68% among those with good mental health who have used substances to cope and 50% among those who feel they have very good or excellent mental health and have used substances to cope at some point.

Table 31 - Frequency of substances use to cope with mental or emotional challenges by age and mental health

Exhibit D3 – Q40: How often, if ever, do you think you have used one or more substances to help cope with your mental illness or emotional challenges in the past 30 days?

Base: Those who have used substances to cope with mental or emotional challenges

People who engage in polysubstance use who have previously used a substance to cope are significantly more likely to say that they have done so in the past 30 days (75% saying so compared with 58% and 52% among those who do not engage in polysubstance use or who do not engage in substance use at all respectively). They also say that they use substances to cope more frequently than these other audiences with 20% of those who engage in polysubstance use saying they always use substances to cope (compared with 11% of those who do not engage in polysubstance use or 5% of those who do not engage in substance use at all).

Table 32 - Frequency of substances use to cope with mental or emotional challenges by substance use segmentation

Exhibit D4 – Q40: How often, if ever, do you think you have used one or more substances to help cope with your mental illness or emotional challenges in the past 30 days?

Base: Those who have used substances to cope with mental or emotional challenges

Respondents were also asked about other mechanisms they use to cope with their mental illness or emotional challenges. The top five selected by respondents are connecting with family or friends (45%), being physically active (41%), reading or listening to books (35%), watching a lot of TV or playing video games (33%), or eating healthy (28%). Those with worse self-assessed mental health gravitate more towards watching TV or playing video games (50%) than those with better mental health, whereas respondents whose assessed their mental health as excellent or very good are the most likely to say that they do nothing (23%) to cope.

Table 33 - Other mechanisms to cope with mental or emotional challenges by age and mental health

Exhibit D5 – Q41: What actions, if any, do you take that help you cope with your mental illness or emotional challenges? Please select all that apply.

Base: All respondents

People who engage in polysubstance use are more likely to say that they use any of the coping mechanisms tested, whereas those who do not engage in polysubstance use and people who do not engage in substance use at all are more likely to say that they do nothing. The top three methods selected overall were connecting with friends or family (45%), being physically active (41%), or reading and listening to books (35%). These rates rise to 50%, 44%, and 41% among those who engage in polysubstance use respectively.

Table 34 - Other mechanisms to cope with mental or emotional challenges by substance use segmentation

Exhibit D6 – Q41: What actions, if any, do you take that help you cope with your mental illness or emotional challenges? Please select all that apply.

Base: All respondents

Respondents were also asked if they had received any type of support for mental health or substance use in the past 12 months. Mental health support was the most frequently used (16%), rather than substance use supports (1%) or both mental and substance use support (2%). Those aged 18-24 and those with poor self-assessed mental health are the most likely to say that they have sought support for mental health, but regardless of the segment, the majority say they have not done this.

Table 35 - Support received for mental health or substance use by age and mental health

Exhibit D7 – Q48: In the past 12 months, have you received any type of support for mental health and/or substance use?

Base: All respondents

People who engage in polysubstance use are more likely to have sought support for mental health issues (26%) than those who do not engage in polysubstance use (12%) and people who do not engage in substance use at all (8%). They are also slightly more likely to have sought support for substance use (3%) than those who do not engage in polysubstance use (1% and less than 1% respectively).

Table 36 - Support received for mental health or substance use by substance use segmentation

Exhibit D8 – Q48: In the past 12 months, have you received any type of support for mental health and/or substance use?

Base: All respondents

When asked if respondents would know where to find mental health or substance use support services if needed, just under half (44%) say they would know where to find information on both. Very few say they would only know where to access substance use resources (1%) while more say they know where to access only resources for mental health (12%).

Table 37 - Knowledge of where to access support by age and mental health

Exhibit D9 – Q49: Would you know where to access both mental health and substance use support services if you needed them?

Base: Those who have not already received support for both mental health and substance use in the past 12 months

People who engage in polysubstance use are more likely to say that they would know where to access supports for both mental health and substance use challenges (56%) if need be, than those who do not engage in substance use at all (27%).

Table 38 - Knowledge of where to access support by substance use segmentation

Exhibit D10 – Q49: Would you know where to access both mental health and substance use support services if you needed them?

Base: Those who have not already received support for both mental health and substance use

Section E: Awareness, knowledge, and perception of risks and harms of substance and polysubstance use

This section covers the levels of awareness and knowledge of the risks and harms of substance and polysubstance use, including the perceived risks and existing supports.

When asked how knowledgeable they are about the mental health-related risks and harms associated with substance use, four-in-five (81%) say that they are very (31%) or somewhat (50%) knowledgeable about the mental health-related risks and harms associated with substance use.

Table 39 - Knowledge of mental health-related risks associated with substance use by age and mental health

Exhibit E1 – Q42: How knowledgeable would you say you are about mental health-related risks and harms associated with substance use?

Base: All respondents

People who engage in polysubstance use are significantly more likely to indicate that they are very knowledgeable (38%) about the mental health-related risks and harms associated with substance use than those who do not engage in polysubstance use and those who do not use any substances.

Table 40 - Knowledge of mental health-related risks associated with substance use by substance use segmentation

Exhibit E2 – Q42: How knowledgeable would you say you are about mental health-related risks and harms associated with substance use?

Base: All respondents

When asked specifically about the risks of combining substances, most (77%) feel they are either very (31%) or somewhat (45%) familiar with the health risks and harms associated with combining substances. Although the degree of familiarity varies, this proportion is relatively the same across age groups and based upon self-assessed mental health.

Table 41 - Knowledge of health risks associated with combining substances by age and mental health

Exhibit E3 – Q43: How familiar would you say you are with the health risks and harms associated with combining substances?

Base: All respondents

Similarly, 81% of Canadians feel they are either somewhat (50%) or very knowledgeable (31%) about mental health-related risks and harms associated with substance use. The proportion who are very or somewhat familiar with the risk and harms associated with combining substances is higher among people who engage in polysubstance use (85%) or people who do not engage in polysubstance use (77%) than among those who did not indicate using any substance (59%).

Table 42 - Knowledge of health risks associated with combining substances by substance use segmentation

Exhibit E4 – Q43: How familiar would you say you are with the health risks and harms associated with combining substances?

Base: All respondents

From an accurate list of known impacts, respondents were asked to identify which, if any, possible long-term effects of using substances on mental health they believed were accurate. Over half (56%) feel that all are potential effects. Notably, those who self-assessed as having excellent or very good mental health were more likely (61%) to correctly select "all of the above'' than those who rated their mental health as good (53%), fair, or poor (50%).

Table 43 - Knowledge of possible long-term side effects of using substances on mental health by age and mental health

Exhibit E5 – Q47: Which of the following do you believe are possible long-term effects of using substances on mental health? Select all that apply.

Base: All respondents

Among the substance use segmentations, nearly two thirds of those who do not engage in polysubstance use (62%) correctly indicated ''all of the above'', compared to people who engage in polysubstance use (46%).

Table 44 - Knowledge of possible long-term side effects of using substances on mental health by substance use segmentation

Exhibit E6 – Q47: Which of the following do you believe are possible long-term effects of using substances on mental health? Select all that apply.

Base: All respondents

In order to investigate knowledge of potential effects of substance use, respondents were presented with a series of accurate and inaccurate statements and asked if they believe them to be true or false. The table below summarizes the proportions that correctly identified each statement as either true or false. For each statement, a strong majority of respondents offered the correct assessment of any statement. While there is little difference on the basis of self-assessed mental health, there are some noteworthy differences by age and by substance use segments.

Respondents were graded on whether they got the responses right as per the guidelines stipulated by Health Canada. At an aggregate level, 43% of respondents got all of the answers correct, 46% got most (66%-99%) of the responses correct, and 10% got less then 65% of the responses correct. For a full breakdown of the scores, please see the appended data tables.

Youth aged 13-17 are less likely than others to correctly identify two statements as false: substances like alcohol, tobacco and cannabis are less harmful than other drugs because they are legal (59% correctly identify it as false, compared to 79% overall); and substance addiction is a choice, anyone can stop (58% correctly identify it as false, compared to 70% overall).

Table 45 - Those who correctly identify each statement is either true or false by age and mental health

Exhibit E7 – Q50: For each of the following statements, please indicate whether you feel it is true or false. [Respondents randomly shown half of statements]

Base: All respondents (n=4829 to 5,165 per statement); Ages 13-17 (n=269 to 308); Ages 18-24 (n=295 to 325); Ages 25+(n=4265 to 4552); Excellent/very good (n=2429 to 2549); Good (n=1392 to 1521); Fair/Poor (n=974 to 1093);

In terms of the substance use segments, those who use no substances are less likely than others to accurately identify substance addiction is a choice, anyone can stop as false (56%).

Table 46 - Those who correctly identify each statement is either true or false by substance use segmentation

Exhibit E8 – Q50: For each of the following statements, please indicate whether you feel it is true or false. [Respondents randomly shown two of options A through D – available in the questionnaire in the Appendix – and randomly shown four of the rest]

Base: All respondents (n=4829 to 5,165 per statement); Polysubstance (excl Nicotine) (n=1495 to 1647); Non-Poly excl Nicotine (n=2569 to 2742); No substances (n=717 to 807);

Respondents who indicated that they had consumed substances were asked what, if anything, would help them consider lowering the number of substances they consume. The most common answer was nothing, as respondents believed everything is good (37%). As for actual action items, the most selected were noticing a negative change in one's mental health (24%), sudden health issues or developing a mental illness (14%) or having an accident or sustaining an injury caused by substance use (12%).

People engaging in substance use who assessed their own mental health as excellent or very good are most likely to say that nothing needs to change as the situation is currently all good (44%), whereas those with fair or poor mental health are most likely to say that not having enough money (11%) or having access to free mental health and/or substance use support (6%) would catalyze a change in consumption patterns.

Table 47 - Methods for lowering frequency of substance use by age and mental health

Exhibit E9 – Q51: What would help, if anything, for you to consider lowering the amount or frequency of the substances you use? You can select up to two responses. *mentions <1% hidden.

Base: People who engage in substance use

People who engage in polysubstance use offer answers in line with the national results, whereas people who engage in non-polysubstance use are more likely to say there's nothing to change as their situation is all good (42%).

Table 48 - Methods for lowering frequency of substance use by substance use segmentation

Exhibit E10 – Q51: What would help, if anything, for you to consider lowering the amount or frequency of the substances you use? You can select up to two responses. *mentions <1% hidden.

Base: People who engage in substance use

Section F: Audience specific analysis

This chapter provides additional analysis on the following audiences: those who identify as Indigenous respondents, those from ethno-cultural groups and visible minorities, those who identify as 2SLGBTQI+, those aged 13-17 years old, and those aged 18-24 years old.

The data show that polysubstance use is more prevalent than the total sample (40%) among those who identify as 2SLGBTQI+ (62%), among those who identify as Indigenous (53%) and among respondents in the 18-24-year-old segment (56%). Polysubstance use is slightly less prevalent than the total sample (40%) among those who identify as ethno-cultural or visible minorities (33%) and respondents in the 13-17-year-old segment (11%).

For a description of which respondents are reported in each table, please refer to the base description provided above each table. Please also note that many sample sizes reported here are below n=100 when reporting on substance pairing specific responses and these results should be interpreted with caution. Any questions or substance pairings where the sample size is below n=30 have not been included in this report.

For the questions on reported use of substances or prevalence among the target audience – either on their own or two substances taken within a 24-hour period – only responses from the probability sample were used. While a margin of error was calculated for the total probability sample, each of these tables in this section focuses on target audience subgroups. Due to their smaller sample sizes the precision of these tables has not been calculated. For all other results, the full aggregated sample of all respondents from the target audience is used.

As such, the results highlighted in this section are to be considered directional as they cannot be said to be representative of the population.

Indigenous respondents

This section focuses on the subset of the sample that identified as Indigenous. For the questions on reported use of substances – on their own or two substances taken within a 24-hour period – only responses from the probability sample of n=188 are used. For all other results, the full aggregated sample of all n=399 Indigenous respondents are used.

Substance use

Compared to the national averages, Indigenous respondents report a similar tendency to use each substance. There is one exception, nicotine (in any form), where reported use is significantly higher with 26% of Indigenous respondents saying they have used it in the past 30 days – this compared with 14% of the total sample saying the same.

Table 49 - Frequency of substance use

Exhibit F1 – Q7: Please indicate which, if any, of the substances listed below you have used in the past 12 months for any reason at all?

Q11: For each of the substances you identified as having used in the past 12 months, how often have you used the substance in the past 30 days, if at all? [Rebased to total respondents]

Base: Respondents from the probability-based panel only

Substance pair use

Compared to the national averages, Indigenous respondents report a similar tendency to use any of the specific combinations of substance pairs, although the total proportion of Indigenous who report using at least one pair of substances (53%) was significantly higher than the national average (40%). The largest difference measured is the higher propensity among Indigenous respondents to combine alcohol with nicotine, with 19% reporting having done this compared to a national average of 13%.

Among Indigenous people who engage in polysubstance use, the most common pairings are alcohol with nicotine (19%); cannabis with alcohol (17%); and alcohol with "at least one of anti-anxiety drugs; sedatives or sleeping aid; anti-depressants; prescription stimulants" (14%).

Table 50 – The percentage of those using in the past 12 months

Exhibit F2 - Q12a - Q17b: Thinking of all the times in the past 12 months that you have used [SUBSTANCE], have you also used any of the following [SUBSTANCES] within the same 24-hour period?

Base: Respondents from the probability-based panel only

When asked about their reasons for taking substances together within the span of 24 hours, Indigenous respondents are more likely than the general population to select a majority of the responses. The top three responses selected by Indigenous respondents overall were: to manage physical pain (34%), to help cope with emotional challenges (33%), and because their friends or family were doing it (32%).

Table 51 - Reasons for taking substances together within a 24-hour period (Top 5)

Exhibit F3 – Q22/Q25/Q28: When you have taken [PAIR 1/2/3] within the same 24-hour period, please indicate all of the reasons you were taking those substances together.

Base: Total number of pair tests for people who engage in polysubstance use

This section looks at the reasons for consuming specific pairings, beginning with the most common set identified within the target audience of Indigenous respondents. Please also note that many sample sizes reported here are below n=100 when reporting on substance pairing specific responses and these results should be interpreted with caution. One pair had a sufficient sample size above the reporting threshold of n=30 and is, as such, the only one reported on.

Focusing specifically now on those respondents who consumed cannabis and alcohol within the same 24-hour period, a similar percentage of Indigenous respondents (32%) say they are doing so to enhance or prolong a high as the general population (33%).

Indigenous respondents are more likely than the total sample to consume alcohol and cannabis together in order to cope with emotional challenges or mental illness (22% versus 15%) or to manage physical pain (22% versus 10%).

Table 52 - Reasons for taking cannabis and alcohol together within a 24-hour period (Top 5)

Exhibit F4 - Q22/Q25/Q28: When you have taken [MOST COMMON PAIR AMONG SEGMENT] within the same 24-hour period, please indicate all of the reasons you were taking those substances together.

Base: Indigenous who had taken cannabis with alcohol

The perceived personal health risks noted by Indigenous respondents for cannabis and alcohol tracks closely with that noted in the total sample (6% versus 7%).

Table 53 - Summary of those saying each substance pairing they have taken poses a high health risk

Exhibit F5 – Q44a/Q44b/Q44c: Going back to each combination of substances you identified as having taken in the past 12 months, what health risk do you believe exists for you personally when using that particular combination of substances? (% saying high risk)

Base: Those who had taken the specified substance

Mental health profile

The table below combines three different questions relating to mental health. It is notable that across all three measures, Indigenous respondents are more likely to report negative outcomes with 31% rating their overall mental health as fair or poor, with 45% saying they have experienced problems due to their mental health in the last 30 days, and 52% saying they have used substances to cope with mental illness at least one in the last 30 days compared to the general population (22%, 31% and 52% respectively).

Table 54 - Combined measures of mental health

Exhibit F6 – Q34: How would you rate your overall mental health? (% saying fair/poor)

Q35: During the last 30 days, have you had any problems with school, your work or daily life due to your mental health or emotional challenges, like feeling depressed, sad, overwhelmed, unmotivated, anxious, or distressed? (% saying yes)

Q39: How often, if ever, have you used a substance to help cope with your mental illness or emotional challenges? (% saying at least once)

Base: ALL

Familiarity with risks of combining substances

When asked about the familiarity of the health risks and harms associated with combining substances, Indigenous respondents are as likely to say they are very or somewhat familiar as the general population (78% versus 77%).

Table 55 - Those very or somewhat familiar with the risk and harms of combining substances

Exhibit F7 – Q43: How familiar would you say you are with the health risks and harms associated with combining substances? (% saying very/somewhat familiar)

Base: ALL

Ethno-cultural or visible minority focus

This sub-section focuses on the subset of the sample that identified as being an ethno-cultural or visible minority. For the questions on reported use of substances – on their own or two substances taken within a 24-hour period – only responses from the probability sample of n=449 are used. For all other results, the full aggregated sample of all n=998 ethno-cultural or visible minority respondents are used.

Substance use

Compared to the national averages, ethno-cultural and visible minorities report a similar tendency to use each substance. The one exception is alcohol, where respondents from ethnocultural or visible minority groups report lower levels of consumption in both the past 12 months (64% versus 70%) and the past 30 days (52% versus 62%) than the general population.

Table 56 - Frequency of substance use

Exhibit F8 – Q7: Please indicate which, if any, of the substances listed below you have used in the past 12 months for any reason at all?

Q11: For each of the substances you identified as having used in the past 12 months, how often have you used the substance in the past 30 days, if at all? [Rebased to total respondents]

Base: Respondents from the probability-based panel only

Substance pair use

When looking at the rates at which ethno-cultural and visible minorities report using any of the specific combinations of substances, they report a similar tendency as that found in the general population.

Table 57 - The percentage of those using in the past 12 months

Exhibit F9 – Q12a - Q17b: Thinking of all the times in the past 12 months that you have used [SUBSTANCE], have you also used any of the following [SUBSTANCES] within the same 24-hour period?

Base: Respondents from the probability-based panel only

At the aggregate level of all pairs, the primary reasons cited by ethno-cultural and visible minorities for combining substances within a 24-hour period are to enhance or prolong a high (33%); manage physical pain (30%); because friends or family were doing it (30%); and to help cope with emotional challenges (26%). For all except coping with emotional challenges (where both are 26%), ethno-cultural and visible minority respondents are more likely than the national average to say the same.

Table 58 - Reasons for taking substances together within a 24-hour period

Exhibit F10 – Q22/Q25/Q28: When you have taken [PAIR 1/2/3] within the same 24-hour period, please indicate all of the reasons you were taking those substances together.

Base: People who engage in polysubstance use (summarized across pairs evaluated)

This section looks at the reasons for consuming specific pairings, beginning with the most common set identified within the target audience of ethno-cultural and visible minority respondents. Please also note that many sample sizes reported here are below n=100 when reporting on substance pairing specific responses and these results should be interpreted with caution. The two pairs presented in this section are the only ones where the sample sizes are above the reporting threshold of n=30.

The most common substance pairing among ethno-cultural and visible minorities is cannabis and alcohol. As with the total sample, these respondents are most likely to say that they combine these two substances to enhance or prolong a high (37%). Unlike the total sample, however, ethno-cultural and visible minorities are significantly more likely to say that they are using this substance combination as their friends and families are also doing so (36% versus 25%).

Table 59 - Reasons for taking cannabis and alcohol together within a 24-hour period (Top 5)

Exhibit F11 – Q22/Q25/Q28: When you have taken [MOST COMMON PAIR AMONG SEGMENT] within the same 24-hour period, please indicate all of the reasons you were taking those substances together.

Base: Ethno-cultural or visible minorities who had taken cannabis + alcohol

Respondents from ethno-cultural or visible minority groups are more likely to say that they combine over the counter medications with alcohol in order to manage physical pain (44%) or emotional challenges (22%) than the general population (37% and 11% respectively). Respondents in this group are also more likely to say that they are combining these substances to offset each other (14%) than the total sample (7%).

Table 60 - Reasons for taking over the counter medication and alcohol together within a 24-hour period (Top 5)

Exhibit F12 – Q22/Q25/Q28: When you have taken [SECOND MOST COMMON PAIR AMONG SEGMENT] within the same 24-hour period, please indicate all of the reasons you were taking those substances together.

Base: Ethno-cultural or visible minorities who had taken alcohol + over-the-counter medication

When asked about the perceived personal health risks of consuming various substance pairs, respondents from ethno-cultural or visible minority groups are more likely to see them as high risk than the general population across the two pairings reported here.

Table 61 - Summary of those saying each substance pairing they have taken poses a high health risk

Exhibit F13 – Q44a/Q44b/Q44c: Going back to each combination of substances you identified as having taken in the past 12 months, what health risk do you believe exists for you personally when using that particular combination of substances? (% saying high risk)

Base: Those who had taken the specified substance

Mental health profile

The table below combines three different questions relating to mental health. While respondents from ethno-cultural or visible minority groups are slightly more likely to assess their mental health as fair or poor (27% versus total sample 22%), for the other two measures reported here – problems in the past 30 days and using substances to cope – the rates indicated align with those noted in the general population sample.

Table 62 - Combined measures of mental health

Exhibit F14 – Q34: How would you rate your overall mental health? (% saying fair/poor)

Q35: During the last 30 days, have you had any problems with school, your work or daily life due to your mental health or emotional challenges, like feeling depressed, sad, overwhelmed, unmotivated, anxious, or distressed? (% saying yes)

Q39: How often, if ever, have you used a substance to help cope with your mental illness or emotional challenges? (% saying at least once)

Base: ALL

Familiarity with risks of combining substances

Respondents from ethno-cultural or visible minority groups are slightly less likely (70% versus 77%) than the general population sample to say that they are very or somewhat familiar with the risks or harms associated with combining substances.

Table 63 - Those very or somewhat familiar with the risk and harms of combining substances

Exhibit F15 – Q43: How familiar would you say you are with the health risks and harms associated with combining substances? (% saying very/somewhat familiar)

Base: ALL

2SLGBTQi+ focus

This sub-section focuses on the subset of the sample that identified as being a 2SLGBTQi+. For the questions on reported use of substances – on their own or two substances taken within a 24-hour period – only responses from the probability sample of n=351 are used. For all other results, the full aggregated sample of all n=688 2SLGBTQi+ respondents are used.

Substance use

Compared to the national averages, 2SLGBTQi+ respondents report significantly higher use of over-the-counter medication, cannabis, anti-depressants, anti-anxiety drugs, hallucinogens, and stimulants than other respondents.

Table 64 - Frequency of substance use

Exhibit F16 – Q7: Please indicate which, if any, of the substances listed below you have used in the past 12 months for any reason at all?

Q11: For each of the substances you identified as having used in the past 12 months, how often have you used the substance in the past 30 days, if at all? [Rebased to total respondents]

Base: Respondents from the probability-based panel only

Substance pair use

Respondents who identify as 2SLGBTQi+ are more likely to report using almost all substances pairings tested. Compared to the general population, the different levels of use are especially notable when looking at the cannabis and alcohol pairing (32% versus 18%); the alcohol and medication pairing (35% versus 14%); the medication and over the counter medication pairing (27% versus 10%); and the cannabis and anti-anxiety pairing (24% versus 8%).

Among 2SLGBTQI+ people who engage in polysubstance use, the most common pairings are alcohol with "at least one of anti-anxiety drugs; sedatives or sleeping aid; anti-depressants; prescription stimulants" (35%); cannabis with alcohol (32%); and "at least one of anti-anxiety drugs; sedatives or sleeping aid; anti-depressants; prescription stimulants" with OTC medication (27%).

Table 65 - The percentage of those using in the past 12 months

Exhibit F17 – Q12a - Q17b: Thinking of all the times in the past 12 months that you have used [SUBSTANCE], have you also used any of the following [SUBSTANCES] within the same 24-hour period?

Base: Respondents from the probability-based panel only

When asked about their reasons for taking substances together within the span of 24 hours, 2SLGBTQi+ respondents are more likely than the total sample to cite managing physical pain (32%) or emotional challenges or mental illness (35%). Again, across almost all response metrics, 2SLGBTQi+ respondents are more likely to select each than the general population.

Table 66 - Reasons for taking substances together within a 24-hour period

Exhibit F18 – Q22/Q25/Q28: When you have taken [PAIR 1/2/3] within the same 24-hour period, please indicate all of the reasons you were taking those substances together.

Base: Total number of pair tests for people who engage in polysubstance use

This section looks at the reasons for consuming specific pairings, beginning with the most common set identified within the target audience of 2SLGBTQi+ respondents. Please note that many sample sizes reported here are below n=100 when reporting on substance pairing specific responses and these results should be interpreted with caution. As the sample sizes are sufficiently large to include in this section, the top five pairs are presented.

For cannabis and alcohol, the most common pairing among this audience, the rates are similar with those noted in the general population sample with the most commonly cited reason being to enhance or prolong a high (35%).

Table 67 - Reasons for taking cannabis and alcohol together within a 24-hour period (Top 5)

Exhibit F19 – Q22/Q25/Q28: When you have taken [MOST COMMON PAIR AMONG SEGMENT] within the same 24-hour period, please indicate all of the reasons you were taking those substances together.

Base: 2SLGBTQi+ who had taken cannabis + alcohol

The second most common substance pairing among 2SLGBTQi+ respondents is medications and over the counter medications. Here the top two reasons for consuming this pairing selected by 2SLGBTQi+ respondents – both at rates higher than the general population – are to manage emotional challenges or mental illness (47%) or to manage physical pain (43%). Of note, 2SLGBTQi+ respondents are also significantly more likely to say that this combination is for medical purposes or for daily prescriptions (20% versus 9%).

Table 68 - Reasons for taking medications and over the counter medications within a 24-hour period (Top 5)

Exhibit F20 – Q22/Q25/Q28: When you have [2ND MOST COMMON PAIR AMONG SEGMENT] within the same 24-hour period, please indicate all of the reasons you were taking those substances together.

Base: 2SLGBTQi+ who had taken medications + OTC

The third most common pairing among this target audience is cannabis and medications. As with the previous pairing, the top two reasons for consuming this pairing within a 24-hour period is to cope with emotional challenges or mental illness (44%) or to manage physical pain (27%). With this pairing, however, the reasons reported by 2SLGBTQi+ respondents are similar to those witnessed in the general population.

Table 69 - Reasons for taking cannabis and medications within a 24-hour period (Top 5)

Exhibit F6 – Q22/Q25/Q28: When you have taken [3RD MOST COMMON PAIR AMONG SEGMENT] within the same 24-hour period, please indicate all of the reasons you were taking those substances together.

Base: 2SLGBTQi+ who had taken cannabis + medications

The combination of alcohol and medications is the fourth most common pair in this audience. Here again the reasons selected by 2SLGBTQi+ respondents track closely with the general population sample, with coping with emotional challenges or mental illness being the most selected at 41%.

Table 70 - Reasons for taking alcohol and medications within a 24-hour period (Top 5)

Exhibit F21 – Q22/Q25/Q28: When you have taken [4TH MOST COMMON PAIR AMONG SEGMENT] within the same 24-hour period, please indicate all of the reasons you were taking those substances together.

Base: 2SLGBTQi+ who had taken alcohol + medications

The final pairing included here is alcohol and over the counter medications. Here 2SLGBTQi+ respondents are significantly more likely to use this pairing to manage physical pain (47% versus 37%) and to cope with mental challenges (22% versus 11%) than the general population.

Table 71 - Reasons for taking alcohol and over the counter medication within a 24-hour period (Top 5)

Exhibit F22 – Q22/Q25/Q28: When you have taken [5TH MOST COMMON PAIR AMONG SEGMENT] within the same 24-hour period, please indicate all of the reasons you were taking those substances together.

Base: 2SLGBTQi+ who had taken alcohol + over-the-counter medication

Respondents were asked what they thought the risk levels were to them personally of consuming each of the substance pairings they identified as having taken at least once in the past 12 months. Across the five pairings included here the rates of 2SLGBTQi+ respondents say that each poses a high risk to them align with those of the general population.

Table 72 - Summary of those saying each substance pairing they have taken poses a high health risk

Exhibit F23 – Q44a/Q44b/Q44c: Going back to each combination of substances you identified as having taken in the past 12 months, what health risk do you believe exists for you personally when using that particular combination of substances? (% saying high risk)

Base: Those who had taken the specified substance

Mental health profile

The table below combines three different questions relating to mental health. It is notable that across all three measures, 2SLGBTQi+ respondents are significantly more likely to report negative outcomes than the general population, with 40% rating their overall mental health as fair or poor, with 55% saying they have experienced problems due to their mental health in the last 30 days, and 59% saying they have used substances to cope with mental illness at least once in the last 30 days. These are the highest rates seen among any of the target audiences examined in this chapter.

Table 73 - Combined measures of mental health

Exhibit F24 – Q34: How would you rate your overall mental health? (% saying fair/poor)

Q35: During the last 30 days, have you had any problems with school, your work or daily life due to your mental health or emotional challenges, like feeling depressed, sad, overwhelmed, unmotivated, anxious, or distressed? (% saying yes)

Q39: How often, if ever, have you used a substance to help cope with your mental illness or emotional challenges? (% saying at least once)

Base: ALL

Familiarity with risks of combining substances

At 84% saying so, 2SLGBTQi+ respondents are slightly more likely to say that they are very or somewhat familiar with the risks and harms of combining substances than the general population sample (77%).

Table 74 - Those very or somewhat familiar with the risk and harms of combining substances

Exhibit F25 – Q43: How familiar would you say you are with the health risks and harms associated with combining substances? (% saying very/somewhat familiar)

Base: ALL

Ages 13-17 focus

This sub-section focuses on the subset of the sample that identified as being between the ages 13-17. For the questions on reported use of substances – on their own or two substances taken within a 24-hour period – only responses from the probability sample of n=240 are used. For all other results, the full aggregated sample of all n=573 respondents aged 13-17 are used.

Substance use

Compared to the national averages, respondents ages 13-17 are less likely to say that they have used any of the substances tested in the past 12 months than the general population – a pattern which holds when looking at use in the past 30 days as well. This is particularly noticeable with consumption of alcohol where a quarter (25%) of those aged 13-17 say they have consumed it in the past 12 months, compared to 70% of the general population.

Table 75 - Frequency of substance use

Exhibit F26 – Q7: Please indicate which, if any, of the substances listed below you have used in the past 12 months for any reason at all?

Q11: For each of the substances you identified as having used in the past 12 months, how often have you used the substance in the past 30 days, if at all?

Base: Respondents from the probability-based panel only