Many Medical Cannabis Patients Used It as a Substitute for Alcohol, Prescription Drugs, or Illicit Drugs | Research

The takeaway

Among 350 medical cannabis dispensary patients, 40% used cannabis as a substitute for alcohol, 26% for illicit drugs, and 66% for prescription drugs, citing fewer side effects, better symptom management, and less withdrawal potential.

Read this if you are interested in whether medical cannabis patients use it to replace other substances.

66% used cannabis to substitute for prescription drugs; 40% for alcohol

What the researchers found

Researchers surveyed 350 patients at a Berkeley, California medical cannabis dispensary about their substance use patterns and substitution behaviors.

Substitution was common: 40% had used cannabis as a substitute for alcohol, 26% for illicit drugs, and 66% for prescription drugs.

The most frequently cited reasons for substituting cannabis were fewer adverse side effects (65%), better symptom management (57%), and less withdrawal potential (34%).

The sample was predominantly male (68%), with a mean age of 39. Most (71%) reported a chronic medical condition, 52% used cannabis for pain, and 75% for a mental health issue. Just 16% had previous substance abuse treatment.

Why it matters

The finding that two-thirds of patients used cannabis as a substitute for prescription drugs challenges the narrative that cannabis is purely an additional substance of abuse and supports its consideration within a harm reduction framework.

The numbers in context

350 patients surveyed. 40% substituted for alcohol. 26% for illicit drugs. 66% for prescription drugs. Top reasons: fewer side effects (65%), better symptom management (57%), less withdrawal potential (34%).

How the study worked

Anonymous cross-sectional survey of 350 patients at a single medical cannabis dispensary in Berkeley, California. Data collected on demographics, substance use patterns, and substitution behaviors.

What this study cannot tell us

Self-selected sample from a single dispensary. No verification of medical conditions or prescription histories. Self-report of substitution behavior may not reflect actual outcomes. Berkeley, California population may not be representative.

How to read the evidence

Cross-sectional survey from a single dispensary with self-selected participants. Provides descriptive data but cannot establish whether substitution improves outcomes.

When this study was published

Published in 2009. Cannabis substitution research has expanded substantially since then, particularly regarding opioid substitution, with mixed but generally supportive findings.

The bigger picture

This study was among the early research documenting cannabis substitution patterns in medical patients. The findings anticipated what would become a major research theme: cannabis as a potential harm reduction tool for more dangerous substances, particularly opioids.

Questions still open

Does cannabis substitution lead to measurably better health outcomes? Are patients reducing prescription use safely or prematurely? Would controlled studies confirm the self-reported benefits of substitution?

Common questions

Is using cannabis instead of prescription drugs safe?

This study documented that patients report doing so and cite fewer side effects. However, switching from prescribed medications to cannabis should involve medical guidance, as stopping certain medications abruptly can be dangerous.

Does this support cannabis as harm reduction?

The authors framed substitution within a harm reduction framework, arguing that choosing a less harmful substance over a more harmful one can reduce negative outcomes. Whether cannabis is actually less harmful depends on the specific substance being replaced and individual circumstances.

Read the original research

Cannabis as a substitute for alcohol and other drugs.

Harm reduction journal, 6, 35

View on PubMed ↗Publisher’s paper ↗

Citation

Reiman, Amanda. (2009). Cannabis as a substitute for alcohol and other drugs.. Harm reduction journal, 6, 35. https://doi.org/10.1186/1477-7517-6-35