Most veterans with free cannabis access used it to substitute for prescription drugs, alcohol, tobacco, or illicit substances, but primarily selected higher-risk formulations (high THC, low CBD, smoked).
Veterans, VA clinicians, medical cannabis program designers, and policymakers.
High THC/low CBD preferred
What the researchers found
The majority of veterans reported using cannabis as a substitute for prescription medications, alcohol, tobacco, or illicit substances. However, they predominantly chose high-THC/low-CBD products and smoked them frequently (modal use >4x/day, 5-8 grams/week). Most used cannabis to self-treat multiple physical and mental health conditions.
Why it matters
As veteran access to cannabis expands, this study reveals a concerning pattern: while substitution away from opioids and alcohol may be beneficial, veterans are gravitating toward the highest-risk cannabis products without clinical guidance.
The numbers in context
93 veterans surveyed; 84.9% male; modal use >4x/day; 5-8 grams/week typical; majority selected high THC/low CBD formulations; most used smoked route of administration.
How the study worked
Cross-sectional self-report survey of 93 US military veterans (84.9% male) with access to free cannabis through a veterans' collective, assessing formulation choices, routes of administration, and substitution practices.
What this study cannot tell us
Small, self-selected sample (93 veterans). Cross-sectional design cannot establish substitution as causal. No objective verification of substitution claims. Free access may not reflect typical use patterns.
How to read the evidence
Preliminary: small cross-sectional survey with self-reported data.
When this study was published
Published in 2019.
The bigger picture
Veterans are a population with high rates of chronic pain, PTSD, and substance use issues. Removing cost barriers to cannabis access shows they will use it heavily, raising questions about whether unguided access serves their health interests.
Questions still open
- Would clinical guidance shift veterans toward lower-risk CBD-rich products? Does heavy, unguided cannabis use actually improve veterans' health outcomes compared to conventional treatments?
Common questions
What did veterans substitute cannabis for?
What cannabis products did veterans choose?
Read the original research
A cross-sectional examination of choice and behavior of veterans with access to free medicinal cannabis.
The American journal of drug and alcohol abuse, 45(5), 506-513
Citation
Loflin, Mallory J E; Babson, Kimberly; Sottile, James; Norman, Sonya B; Gruber, Staci; Bonn-Miller, Marcel O. (2019). A cross-sectional examination of choice and behavior of veterans with access to free medicinal cannabis.. The American journal of drug and alcohol abuse, 45(5), 506-513. https://doi.org/10.1080/00952990.2019.1604722
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