Story time. When I became a medical cannabis patient in 2003, my doctor, Frank Lucido, had an extensive intake form. Different from the pot doc shops that seemed to churn out hundreds of patients per hour, Dr. Lucido, one of the pioneers of cannabis medicine, wanted to collect information about his patients and their relationship with cannabis. Deep into the intake form was a question about whether I was using cannabis as a substitute for alcohol or prescription drugs. It was the first time I had considered cannabis from a harm reduction perspective. That not only could it provide medical and other benefits, but in doing so, it might reduce or eliminate the use of potentially more harmful substances.
Two years later, I was designing the survey for my doctoral dissertation on medical cannabis patients and dispensaries, and the question about substitution was still in my head. With Dr. Lucido’s permission, I adapted his intake form and included the question about the use of cannabis as a substitute. In my sample of 130 patients, over half said they were using cannabis as a substitute for alcohol and nearly two thirds said they were using cannabis instead of a prescription drug. This was the first study of the use of cannabis as a substitute. I replicated that study with a sample twice as big in 2008 and it was replicated again in Canada. Every time we got the same results. This was a phenomenon that was occurring among cannabis consumers. The reasons for substitution were also the same across studies: fewer negative side effects from cannabis, less chance of dependence with cannabis, and better outcomes with cannabis.
Today, the concept of using cannabis as a substitute has been firmly adopted by the messaging of the industry. Cannabis beverage companies especially have embraced the concept of using cannabis in lieu of alcohol, and cannabis products like tablets and pills mimic the form factor of prescription drugs. Indeed, in the wake of legalization and increased disinterest among Gen Z’s, alcohol sales have been declining and there is a growing wariness of pharmaceutical interventions.
While the behavior of using cannabis as a substitute is real and valuable for countless people, there is a lack of instruction on when and how cannabis harm reduction can be deployed. So, for part 3 of the mindful consumption series, here is a guide for several points where cannabis can be used as a substitute.
This is probably the most well known way that cannabis substitution can happen. Simply, this means eating an edible instead of having a drink. Or taking some tincture for sleep instead of Ambien. This type of substitution is deeply rooted in harm reduction and a recognition that some remedies may pose higher risk than others. Here are some tips that can help ensure success.
For alcohol substitution, know the set and setting you are engaging with when planning your method of consumption. Inhaling cannabis is closest to drinking alcohol in terms of onset. The caveat being that some cannabis beverages and edibles have been formulated to be faster acting. If you are heading to a party that lasts 2 hours, taking a traditional edible right before you arrive might give an onset that doesn’t match the environment. Also, if you plan to take an edible as a substitute, know that it is a stronger experience than smoking or vaping, so start low and go slow. Finally, know what kind of cannabis consumption is allowed if you are attending something outside of the home. Don’t count on being able to smoke a joint instead of having a cocktail unless you know smoking will be allowed.
For prescription drug substitution, consult with a physician before stopping any prescription medication, especially psychotropic medications. There could be interactions with cannabis or withdrawal concerns that need to be addressed before substitution can take place. Like alcohol, decide which method of consumption works best for your needs. It should be noted that for some people, cannabis + their prescription medication gives them the best outcomes. Research has shown that the use of cannabis plus opiates allowed patients to use less opiates less often, reducing the likelihood of dependence and accidental overdose. Recently, I wrote about the idea of "plant + pills" in Rolling Stone. Finally, keep a journal or use a cannabis use tracking app like Tetragram to monitor the effects of different strains and products and which ones are helping you achieve your desired outcome.
For both alcohol and prescription drugs, cannabis can be used as a medication to treat withdrawal symptoms. Some more outdated models of drug treatment view the misery of withdrawals as a way to prevent relapse. However, we have no evidence that leaving withdrawals untreated encourages abstinence. I believe that another reason some programs discourage withdrawal medications is because of beliefs about drug users and getting what they deserve. But, people who have dependence on substances are still people, and deserve comfort when available. Withdrawal symptoms from alcohol and prescription drugs can include symptoms like insomnia, lack of appetite, irritability, muscle spasms, and nausea. Cannabis can be effective at treating all of these symptoms. One note, withdrawals from alcohol and certain prescription drugs like Benzodiazepines can be fatal. If you are looking to wean yourself off of these substances and you have physical dependence on them, consult a physician.
In practice, "harm reduction" measures progress through multiple dimensions of functioning outside of substance use itself. Better hygiene, personal relationships, employment status, improved mood, can all be signs of creating a healthier lifestyle, even if some kind of substance use persists. Unfortunately, programs like 12 Step programs, view any kind of substance use during recovery as relapse, making them rigid and not beneficial for many people. Medication assisted treatment or MAT, recognizes that, for some people, medication can help them reduce or eliminate the substance(s) that are causing harm in their lives. Cannabis used in this way can be considered a medication that is helping someone stay away from hazardous substance use. Of course, like any medication, cannabis is not for everyone. If you find that using cannabis puts you at risk for hazardous substance use, it might not be an appropriate treatment for you.
Mindful consumption = awareness without judgment. However cannabis interacts with your life, be aware of what it is adding or detracting from where you want to go and who you want to be. Cannabis is safer than many other choices for therapy and recreation, but only through paying attention to our intentions and outcomes with cannabis can we develop a beneficial life-long relationship with this plant.