Almost half of respondents substituted prescription medications with cannabis, particularly opioids, regardless of the legal status of medical cannabis.
Summary
n=2.774 cannabis users; 1.248 (46%) reported using cannabis as a substitute for prescription medications. Most common substitutions: narcotics/opioids (35,8%), anxiolytics/benzodiazepines (13,6%), antidepressants (12,7%). Medical cannabis users had 4,59× higher odds of substitution vs. recreational users (95% CI 3.87–5.43). Self-selected convenience sample, no evidence of actual opioid dose reduction; real-world indication of substitution behaviour.
P
PopulationCannabis users (≥1× in the last 90 days), self-selected convenience sample from Washington State and social media, n=2.774
I
InterventionSelf-reported intentional substitution of prescription medications with cannabis
O
Outcome46% (n=1.248) reported cannabis substitution; most common drug classes: opioids/narcotics (35,8%), benzodiazepines/anxiolytics (13,6%), antidepressants (12,7%); OR for substitution in medical vs. non-medical users 4,59 (95% CI 3,87–5,43)
Confidence in the evidence
Very lowLowModerateHigh
Low
The second of four GRADE levels, the effect estimate is of limited reliability.
<h4>Background</h4>The use of medical cannabis is increasing, most commonly for pain, anxiety and depression. Emerging data suggest that use and abuse of prescription drugs may be decreasing in states where medical cannabis is legal. The aim of this study was to survey cannabis users to determine whether they had intentionally substituted cannabis for prescription drugs.<h4>Methods</h4>A total of 2,774 individuals were a self-selected convenience sample who reported having used cannabis at least once in the previous 90 days. Subjects were surveyed via an online anonymous questionnaire on cannabis substitution effects. Participants were recruited through social media and cannabis dispensaries in Washington State.<h4>Results</h4>A total of 1,248 (46%) respondents reported using cannabis as a substitute for prescription drugs. The most common classes of drugs substituted were narcotics/opioids (35.8%), anxiolytics/benzodiazepines (13.6%) and antidepressants (12.7%). A total of 2,473 substitutions were reported or approximately two drug substitutions per affirmative respondent. The odds of reporting substituting were 4.59 (95% confidence interval [CI], 3.87-5.43) greater among medical cannabis users compared with non-medical users and 1.66 (95% CI, 1.27-2.16) greater among those reporting use for managing the comorbidities of pain, anxiety and depression. A slightly higher percentage of those who reported substituting resided in states where medical cannabis was legal at the time of the survey (47% vs. 45%, <i>p</i>=0.58), but this difference was not statistically significant.<h4>Discussion</h4>These patient-reported outcomes support prior research that individuals are using cannabis as a substitute for prescription drugs, particularly, narcotics/opioids, and independent of whether they identify themselves as medical or non-medical users. This is especially true if they suffer from pain, anxiety and depression. Additionally, this study suggests that state laws allowing access to, and use of, medical cannabis may not be influencing individual decision-making in this area.