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Harm Reduct J. 2019 Jan 28;16(1):9. doi: 10.1186/s12954-019-0278-6.

Medical cannabis patterns of use and substitution for opioids & other pharmaceutical drugs, alcohol, tobacco, and illicit substances; results from a cross-sectional survey of authorized patients.

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Social Dimensions of Health, University of Victoria, 3800 Finnerty Rd., Victoria, BC, V8P 5C2, Canada.
, Tilray, 1100 Maughan Rd, Nanaimo, BC, V9X1J2, Canada.
Canadian Institute for Substance Use Research, 2300 McKenzie Ave, Victoria, BC, V8N 5M8, Canada.
Cleveland Clinic Neurological Institute, Department of Neurology, Center for Neurological Restoration - Headache and Chronic Pain Medicine , 10524 Euclid Avenue, C21, Cleveland, OH, 44195, USA.
Principal Research Scientist; Division of Data Science, Leafly, 71 Columbia Street, Suite 200, Seattle, WA, 98104, USA.



A 239-question cross-sectional survey was sent out via email in January 2017 to gather comprehensive information on cannabis use from Canadian medical cannabis patients registered with a federally authorized licensed cannabis producer, resulting in 2032 complete surveys.


The survey gathered detailed demographic data and comprehensive information on patient patterns of medical cannabis use, including questions assessing the self-reported impact of cannabis on the use of prescription drugs, illicit substances, alcohol, and tobacco.


Participants were 62.6% male (n = 1271) and 91% Caucasian (n = 1839). The mean age was 40 years old, and pain and mental health conditions accounted for 83.7% of all respondents (n = 1700). Then, 74.6% of respondents reported daily cannabis use (n = 1515) and mean amount used per day was 1.5 g. The most commonly cited substitution was for prescription drugs (69.1%, n = 953), followed by alcohol (44.5%, n = 515), tobacco (31.1%, n = 406), and illicit substances (26.6%, n = 136). Opioid medications accounted for 35.3% of all prescription drug substitution (n = 610), followed by antidepressants (21.5%, n = 371). Of the 610 mentions of specific opioid medications, patients report total cessation of use of 59.3% (n = 362).


This study offers a unique perspective by focusing on the use of a standardized, government-regulated source of medical cannabis by patients registered in Canada's federal medical cannabis program. The findings provide a granular view of patient patterns of medical cannabis use, and the subsequent self-reported impacts on the use of opioids, alcohol, and other substances, adding to a growing body of academic research suggesting that increased regulated access to medical and recreational cannabis can result in a reduction in the use of and subsequent harms associated with opioids, alcohol, tobacco, and other substances.


Addiction; Cannabis; Harm reduction; Marijuana; Opioids; Substitution

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