In recent years, a significant amount of data has been generated showing that access to cannabis is associated with reduced use and abuse of opioids. But new data also indicate that many patients replace marijuana in the same way for a variety of other substances, including alcohol, tobacco and benzodiazepines.
Last month, a team of researchers from Canada and the United States questioned more than 2,000 federally registered medical cannabis patients about their use of cannabis and other substances. (Medical cannabis access has been legal in Canada for almost two decades).
Researchers reported that nearly 70 percent of respondents said they were replacing cannabis for prescription drugs, mainly opioids. Forty-five percent of respondents recognized the replacement of cannabis with alcohol and 31 percent of respondents said they used marijuana instead of tobacco.
Of the people who reported replacing alcohol with cannabis, 31 percent said they did not use alcohol at all, while 37 percent said they had to reduce their intake by at least 75 percent. Fifty-one percent of those who reported that they had to replace cannabis for tobacco said that they eventually completely ceased their use of tobacco.
This documentation about cannabis replacement is not unique. A 2017 study of medical cannabis patients also reported that 25 percent of the cohort reported that cannabis should be replaced with alcohol, while 12 percent replaced it with tobacco. A paper published in 2015, "Drug and Alcohol Review", also reported that more than half of the patients surveyed used marijuana instead of alcohol. A placebo-controlled clinical study conducted by researchers at London University College reported that the inhalation of CBD – a primary component in cannabis – is associated with a 40 percent reduction in cigarette consumption.
Numerous studies also indicate that legal access to cannabis is associated with a reduction in general expenditure on prescription drugs. Although much of this reduction is due to the reduced use of opioids, studies also report that consumption of other prescription drugs, such as sleeping pills, antidepressants and anti-anxiety drugs, is decreasing. A 2019 study by a team of Canadian researchers reported that the use of marijuana is associated with the discontinuation of benzodiazepines. (The popular anti-anxiety medication was responsible for more than 11,500 overdose deaths in the United States in 2017, according to the US Centers for Disease Control). In their study of 146 subjects, the initiation of medicinal cannabis resulted in significant and sustained reductions in the use of the drug by patients.
After the conclusion of the study, 45 percent of the participants had discontinued their use of benzodiazepines. In a separate study, also published this year, of more than 1,300 US medical cannabis patients suffering from chronic pain conditions, 22 percent reported having substituted marijuana for benzodiazepines.
These scientific findings are in conflict with the so-called "gateway theory" – the long-considered idea that exposure to marijuana encourages users to eventually use much more complicated and addictive substances. Cannabis, on the other hand, appears to act as an exit medicine for many people. away from potentially lethal medicines, liquor, cigarettes and even other illegal substances such as cocaine.
As more jurisdictions leave the ban on cannabis and move towards a system of regulated access, it will be important to examine to what extent these trends persist and to assess their long-term effects on public health and safety.
Paul Armentano is the deputy director of NORML – the national organization for the reform of marijuana laws. He is the co-author of the book, Marijuana Is safer: so why do we drive people to drink? and the author of the book, The Citizen's Guide to State-By-State Marijuana. Laws.