Academic Studies
Cannabis Substitution as Harm Reduction
Scientific Support for “California Sober” Movement
Most of this author’s previous articles have been in the sobriety tradition of sharing “experience, strength, and hope” with the intent that people in my audience struggling with alcohol, mental illness, and hard drugs will benefit. Some readers (and authors of other Medium.com articles) think that using Cannabis as harm reduction simply does not work. They cite older studies that argue that Cannabis is more harmful than the data supports. One author said that people suffering from marijuana psychosis commit most crimes.
As a retired lawyer, the best way to convince people is to lay out the evidence, brick-by-brick simply, and then look at the building and let the facts fall where they may. It is time to look at all the scientific evidence.
A few months ago, Sinikka L Kvamme, Michael M Pedersen, Kristine Rømer Thomsen, and Birgitte Thylstrup published “Exploring the use of cannabis as a substitute for prescription drugs in a convenience sample,” Harm Reduct J. 2021 Jul 10;18(1):72. doi: 10.1186/s12954–021–00520–5. The study participants were self-selected through an anonymous online survey of people aged 18 years or older who use Cannabis (prescribed or non-prescribed) for medical purposes. The study concluded that Cannabis as medicine “is frequently used as a substitute for prescription drugs, particularly opioids.”
In 2019, Philippe Lucas, Eric P Baron, and Nick Jikomes published “Medical cannabis patterns of use and substitution for opioids & other pharmaceutical drugs, alcohol, tobacco, and illicit substances; results from a cross-sectional survey of authorized patients,” Harm Reduct J. 2019 Jan 28;16(1):9. doi: 10.1186/s12954–019–0278–6. Canadian medical cannabis patients registered with a federally authorized licensed cannabis producer completed a 239-question cross-sectional survey in January 2017, resulting in 2032 complete surveys. The results were consistent with all the studies discussed in this article. The most common Marijuana substitution “was for prescription drugs (69.1%, n = 953), followed by alcohol (44.5%, n = 515), tobacco (31.1%, n = 406), and illicit substances (26.6%, n = 136). Opioid medications accounted for 35.3% of all prescription drug substitution (n =
610), followed by antidepressants (21.5%, n = 371). Of the 610 mentions of specific opioid medications, patients report total cessation of use of 59.3% (n = 362).” The findings provide “self-reported impacts on the use of opioids, alcohol, and other substances, adding to a growing body of academic research suggesting that increased regulated access to medical and recreational cannabis can result in a reduction in the use of and subsequent harms associated with opioids, alcohol, tobacco, and other substances.”
In 2017, James M Corroon Jr, Laurie K Mischley, and Michelle Sexton published “Cannabis as a substitute for prescription drugs — a cross-sectional study,” J Pain Res. 2017 May 2;10:989–998. doi: 10.2147/JPR.S134330. eCollection 2017. The study participants were 2,774 individuals, self-selected, who reported having used Cannabis at least once in the previous 90 days and were solicited either online or at Washington State cannabis dispensaries. “A total of 1,248 (46%) respondents reported using Cannabis as a substitute for prescription drugs. The most common classes of drugs substituted were narcotics/opioids (35.8%), anxiolytics/benzodiazepines (13.6%) and antidepressants (12.7%).” The study concluded that the results of this study “support prior research that individuals are using cannabis as a substitute for prescription drugs, particularly, narcotics/opioids.”
Also, in 2017, Philippe Lucas and Zach Walsh wrote: “Medical cannabis access, use, and substitution for prescription opioids and other substances: A survey of authorized medical cannabis patients,” Int J Drug Policy. 2017 Apr;42:30–35. doi: 10.1016/j.drugpo.2017.01.011. Epub 2017 Feb 9. 271 patients registered to purchase Cannabis from Tilray, a federally authorized Licenced Producer (LP) within the Health Canada Marihuana for Medical Purposes Regulations (MMPR). The study results are: “Cannabis is perceived to be an effective treatment for diverse conditions, with pain and mental health the most prominent. Findings include high self-reported use of Cannabis as a substitute for prescription drugs (63%), particularly pharmaceutical opioids (30%), benzodiazepines (16%), and antidepressants (12%). Patients also reported substituting cannabis for alcohol (25%), cigarettes/tobacco (12%), and illicit drugs (3%).” The authors commented that this study confirmed other studies of medical marijuana users.
In 2016, Philippe Lucas and Zach Walsh, joined by Crosby K, Callaway R, Belle-Isle L, Kay R, Capler R, and Holtzman S., published “Substituting cannabis for prescription drugs, alcohol and other substances among medical cannabis patients: The impact of contextual factors,” Drug Alcohol Rev. 2016 May;35(3):326–33. doi: 10.1111/dar.12323. Epub 2015 Sep 14. In Canada, 473 adults who use medical Cannabis responded to an extensive survey. “Substituting cannabis for one or more of alcohol, illicit drugs or prescription drugs was reported by 87% (n = 410) of respondents, with 80.3% reporting substitution for prescription drugs, 51.7% for alcohol, and 32.6% for illicit substances.”
In 2015, Nicholas Lau, Paloma Sales, Sheigla Averill, Fiona Murphy, Sye-Ok Sato, and Sheigla Murphy published “Responsible and controlled use: Older cannabis users and harm reduction,” Int J Drug Policy. 2015 Aug;26(8):709–18. doi: 10.1016/j.drugpo.2015.03.008. Epub 2015 Mar 30. The study participants were Baby Boomer (born 1946–1964) marijuana users in the San Francisco Bay Area. The authors concluded that cultural norms among these marijuana users defined “normal” or “acceptable” use. The study also concluded: “Findings also suggest that users with access to a regulated market (medical cannabis dispensaries) were better equipped to practice harm reduction.”
Later that year, the same authors published: “A safer alternative: Cannabis substitution as harm reduction,” Drug Alcohol Rev. 2015 Nov;34(6):654–9. doi:10.1111/dar.12275. Epub 2015 Apr 28. The study participants were the same cohort of San Francisco Boomers from the above study. “Study participants described using cannabis as a safer alternative for alcohol, illicit drugs and pharmaceuticals based on their perceptions of less adverse side effects, low-risk for addiction and greater effectiveness at relieving symptoms, such as chronic pain.” The study concluded that marijuana substitution could be an effective harm reduction method for those unable or unwilling to stop using drugs completely.
The above is not a comprehensive survey of the academic literature. However, given the evidence above, a comprehensive survey is no longer necessary. The movement for California Sober — using marijuana for opioids, benzodiazepine, and alcohol and tobacco substitutes is a valid, proven path for many people.
Do not continue “contempt prior to investigation” regarding medical marijuana and its ability to help keep people sober. Stay open-minded as the research unfolds. The facts should dictate the appropriate directions for society.
