Cannabis substitution for opioids was common but not affected by legalization status
Among 44,119 cannabis consumers in the US and Canada, 79-84% of those using cannabis for pain reported substituting it for opioids or prescription pain medication, regardless of whether cannabis was legally available.
Quick Facts
What This Study Found
Between 14-33% of cannabis consumers used it for pain. Of those, 78-84% reported substituting cannabis for opioids or prescription pain medication. There was no significant association between recreational cannabis legalization and the rate of substitution.
Key Numbers
44,119 total respondents. 14-33% used cannabis for pain. Substitution rates: Canada 78-79%, US illegal states 80-83%, US legal states 83-84%. No significant legal status effect (Canada AOR 0.98, US AOR 1.11).
How They Did This
Repeat cross-sectional survey from the International Cannabis Policy Study (2018-2019) in Canada and the US. 44,119 respondents aged 16-65 who had ever tried cannabis. 15,092 analyzed for substitution outcomes. Weighted binary logistic regression compared legal versus illegal jurisdictions.
Why This Research Matters
The finding that opioid substitution rates are similarly high regardless of legal status challenges the argument that legalization will drive a public health benefit through opioid replacement.
The Bigger Picture
While cannabis-opioid substitution is widespread among pain patients who use cannabis, this behavior appears to be driven by individual decision-making rather than legal access, suggesting policy alone may not shift opioid use patterns.
What This Study Doesn't Tell Us
Cross-sectional design cannot establish causation. Self-reported substitution may not reflect actual opioid reduction. Two-year window may be too short to capture legalization effects. Online panel recruitment may introduce bias.
Questions This Raises
- ?Does self-reported substitution translate to actual reductions in opioid prescriptions or overdoses?
- ?Would longer post-legalization timeframes show different patterns?
- ?Are certain pain conditions more amenable to cannabis substitution?
Trust & Context
- Key Stat:
- 79-84% substitution rate regardless of legal status
- Evidence Grade:
- Strong: very large cross-national sample with repeat waves and weighted regression analysis.
- Study Age:
- Published in 2022.
- Original Title:
- Legal status of recreational cannabis and self-reported substitution of cannabis for opioids or prescription pain medication in Canada and the United States.
- Published In:
- Substance abuse, 43(1), 943-948 (2022)
- Authors:
- Wadsworth, Elle(11), Hines, Lindsey A(7), Hammond, David(36)
- Database ID:
- RTHC-04285
Evidence Hierarchy
A snapshot of a population at one point in time.
What do these levels mean? →Frequently Asked Questions
Does cannabis legalization reduce opioid use?
This study found no significant association between recreational cannabis legalization and the rate at which people substitute cannabis for opioids. Substitution was equally common in legal and illegal jurisdictions.
How many cannabis users substitute it for opioids?
Among those who use cannabis for pain (14-33% of all consumers), approximately 79-84% reported substituting it for opioids or prescription pain medication.
Why does legalization not affect substitution rates?
People appear to make substitution decisions based on personal experience with cannabis for pain, regardless of its legal status. Those who find it helpful substitute regardless of legality.
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Cite This Study
https://rethinkthc.com/research/RTHC-04285APA
Wadsworth, Elle; Hines, Lindsey A; Hammond, David. (2022). Legal status of recreational cannabis and self-reported substitution of cannabis for opioids or prescription pain medication in Canada and the United States.. Substance abuse, 43(1), 943-948. https://doi.org/10.1080/08897077.2022.2060431
MLA
Wadsworth, Elle, et al. "Legal status of recreational cannabis and self-reported substitution of cannabis for opioids or prescription pain medication in Canada and the United States.." Substance abuse, 2022. https://doi.org/10.1080/08897077.2022.2060431
RethinkTHC
RethinkTHC Research Database. "Legal status of recreational cannabis and self-reported subs..." RTHC-04285. Retrieved from https://rethinkthc.com/research/wadsworth-2022-legal-status-of-recreational
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.