Would you smoke cannabis if it meant you might consume less alcohol, tobacco, or prescription drugs? A recent study examining a group of patients adds more convincing evidence to the idea that marijuana is an “exit” drug rather than a gateway drug
Published in the International Journal of Drug Policy, the study compared survey results of 973 patients who answered questions about how they used alcohol before and after receiving medical cannabis authorizations from their doctors. Among them, 44 percent reported drinking less frequently on a monthly basis, 34 percent consumed fewer standard drinks per week, and eight percent said they drank no alcohol at all in the 30 days prior to completing the survey.
The study’s data is derived from the Canadian Cannabis Patient Survey 2019, a survey of patients registered with licensed producer Tilray, and led by the company’s VP of patient research and access and University of Victoria researcher Philippe Lucas.
Lucas says the study’s most interesting finding was that when patients had a deliberate intention to use medical cannabis to reduce their alcohol consumption, their odds of drinking less or ceasing drinking altogether were significantly higher
“About 13 percent of participants cited that they deliberately used medical cannabis to reduce the use of alcohol. Conversely, fewer than one percent worked with their physician to do so,” Lucas says.
This points to “both a gap and an opportunity” for a public health campaign aimed at physicians and medical cannabis patients, he says, that highlights this common but often unintended benefit of consuming cannabis: a patient may begin using cannabis to treat their chronic pain or anxiety and find themselves unexpectedly inclined to consume less of society’s favourite liquid carcinogen.
“If there was an overwhelming awareness on both sides of that equation, I think we’d see the harm reduction aspects and substitution effects be even more significant,” he says.
And it isn’t just alcohol consumption that can be reduced. Many patients also reduce their use of prescription opioids, tobacco and illicit substances when they incorporate medical cannabis into their treatment regime, he says.
“For those who are affected by problematic substance use, more and more research is suggesting that whether your dependence is on alcohol or tobacco, on prescription opioids or illicit opioids, that it may be helpful, either as a standalone or as an adjunct treatment to either reduce or cease the use of these substances.”
A Safer Option
But is it really any good if a patient is simply swapping one substance for another? Lucas and others in the field agree that it’s not that simple, especially given the mountains of existing evidence that show that our vice of choice, alcohol, is in fact the most dangerous.
“While cannabis carries with it a small chance of dependence, it is far lower than the risk of addiction and associated morbidity and mortality than alcohol,” he says.
Worldwide, alcohol use is a leading risk factor for disease, and accounts for nearly 10 percent of global deaths in people aged 15 to 49. According to the World Health Organization, nearly three million deaths a year—five percent of annual deaths worldwide—are related to booze.
Let’s not forget alcohol’s link to cancer, which is estimated to kill more than 605,000 Americans in 2020. Risks of colorectal and breast cancers increase by 50 percent in people who drink excessively, with research showing even one drink a day can increase a woman’s risk of developing breast cancer.
“While I would be the last person to suggest that cannabis is completely safe, or the right drug for all patients under any circumstance—there are some populations that are going to be more vulnerable when it comes to using cannabis—for some patients as well as non-medical users, it’s not a gateway but rather an exit drug to problematic substance use,” Lucas says.
Flipping the Script
The Canadian researcher has studied cannabis as a substitution for other substances for several years, and was first introduced to the concept 20 years ago when he opened up the Vancouver Island Compassion Society in 1999.
“Patients would share with me that when they smoked a joint or ate a cannabis cookie, they wouldn’t have an urge to go out and look for heroin or crystal meth,” he says. “That really flipped the script for me because up until that point, we had our governments and our public health and education systems calling cannabis a gateway drug.”
Now that there is robust evidence to support this, federal agencies north of the border are starting to pay attention. Lucas has been invited to present data to Health Canada, Veteran Affairs, Senate special committees and the House of Commons.
Since alcohol is the most harmful psychoactive substance used in the world and has far greater impacts to individual and public health than cannabis, he says, a shift from the former to the latter could significantly improve public health and safety.
“In U.S. states that have legalized the medical and non-medical use of cannabis, research has found associated reductions in alcohol-related automobile fatalities, violent crimes, homicides, and even suicides, as all of these are associated with alcohol use—but not with cannabis consumption.”
Lucas is currently working on follow-up studies that take a closer look at how cannabis affects patients’ opioid and tobacco consumption.