Most high-risk drug users substituted their preferred drug with another, with synthetic cannabinoids replacing cannabis in 33% of cases
Among 592 high-risk drug users in treatment, 75.7% reported substituting their preferred drug, with 33.5% of cannabis users switching to synthetic cannabinoids and 35.9% of heroin users switching to street methadone.
Quick Facts
What This Study Found
448 of 592 high-risk drug users (75.7%) reported substituting their preferred drug. Cannabis users most commonly substituted synthetic cannabinoid receptor agonists (33.5%) followed by alcohol (16%). Heroin users most commonly substituted street methadone (35.9%) followed by prescription opioids (17.7%). Age at onset, education, and treatment setting predicted substitution patterns.
Key Numbers
592 users; 75.7% reported substitution; cannabis→synthetic cannabinoids 33.5%; cannabis→alcohol 16%; heroin→street methadone 35.9%; heroin→prescription opioids 17.7%.
How They Did This
Cross-sectional interviews with 592 high-risk drug users in pharmacological and psychosocial treatment, assessing lifetime substitution patterns for heroin and cannabis using descriptive statistics and multinomial logistic regression.
Why This Research Matters
Drug substitution is a clinical reality that treatment programs rarely address. When cannabis is unavailable, users may switch to more dangerous synthetic cannabinoids. Understanding these patterns helps predict risks when supply is disrupted.
The Bigger Picture
The high rate of cannabis-to-synthetic-cannabinoid substitution has direct policy implications: restricting cannabis access without addressing synthetic alternatives may push users toward more dangerous products.
What This Study Doesn't Tell Us
High-risk treatment population (may not represent casual users); Israeli sample (drug availability differs from US/Europe); self-report of substitution; retrospective; cannot determine health outcomes of substitution.
Questions This Raises
- ?Would cannabis legalization reduce synthetic cannabinoid use?
- ?Should treatment programs screen for substitution behavior to prevent escalation?
Trust & Context
- Key Stat:
- 75.7% substituted drugs; 33.5% of cannabis users switched to synthetic cannabinoids
- Evidence Grade:
- Moderate: reasonable sample with clinical population, but cross-sectional and self-report.
- Study Age:
- Published 2020.
- Original Title:
- The switch from one substance-of-abuse to another: illicit drug substitution behaviors in a sample of high-risk drug users.
- Published In:
- PeerJ, 8, e9461 (2020)
- Authors:
- Shapira, Barak(2), Rosca, Paola(4), Berkovitz, Ronny(2), Gorjaltsan, Igor, Neumark, Yehuda
- Database ID:
- RTHC-02838
Evidence Hierarchy
A snapshot of a population at one point in time.
What do these levels mean? →Frequently Asked Questions
What do cannabis users switch to when cannabis is unavailable?
In this high-risk population, 33.5% of cannabis users substituted synthetic cannabinoids (which are more potent and dangerous), followed by alcohol (16%). This suggests restricting cannabis access may inadvertently push users toward riskier substances.
Is drug substitution common?
Very. Over three-quarters (75.7%) of high-risk drug users reported substituting their preferred drug for another substance at some point, driven by cost, availability, safety perceptions, and legal concerns.
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Cite This Study
https://rethinkthc.com/research/RTHC-02838APA
Shapira, Barak; Rosca, Paola; Berkovitz, Ronny; Gorjaltsan, Igor; Neumark, Yehuda. (2020). The switch from one substance-of-abuse to another: illicit drug substitution behaviors in a sample of high-risk drug users.. PeerJ, 8, e9461. https://doi.org/10.7717/peerj.9461
MLA
Shapira, Barak, et al. "The switch from one substance-of-abuse to another: illicit drug substitution behaviors in a sample of high-risk drug users.." PeerJ, 2020. https://doi.org/10.7717/peerj.9461
RethinkTHC
RethinkTHC Research Database. "The switch from one substance-of-abuse to another: illicit d..." RTHC-02838. Retrieved from https://rethinkthc.com/research/shapira-2020-the-switch-from-one
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.