Could cannabis replace some alcohol in programs for people with severe alcohol use disorder?

63% of MAP participants reported already substituting cannabis for alcohol, most often weekly (42%), primarily for alcohol cravings (79%) and withdrawal (53%). 84% expressed willingness to join a formal cannabis substitution program. Participants preferred staff-administered dry smoked cannabis with partial (not complete) replacement of alcohol doses.

Pre-implementation mixed-methods study using structured surveys and open-ended interviews with MAP organizational leaders (n=7), program participants (n=19), and staff/managers (n=17) across six MAPs in Canada. Organized using the Consolidated Framework for Implementation Research.

Managed alcohol programs serve people with severe alcohol use disorder who are often experiencing homelessness. Finding that most participants already use cannabis as an informal substitute, and want formal programs, suggests cannabis substitution could be integrated into existing harm reduction infrastructure.

Cannabis substitution for alcohol is controversial, but this study reveals it is already happening informally. Formalizing the practice within supervised programs could improve safety and consistency. The preference for partial rather than complete substitution suggests a pragmatic, incremental approach.

Very small sample (19 participants). Pre-implementation study without outcome data. Self-selected participants in a specific harm reduction setting. Cannot generalize to broader alcohol use disorder populations.