November 2013 – Matters of Substance

Cannabis is neither completely harmless, nor is it a cure-all, but with polls showing that Canadians overwhelmingly support cannabis policy reform, it’s fair to assume that most people no longer believe that legalization would lead to the end of the world. Yet, some who support reform nonetheless have concerns that adding yet another legal drug (alongside alcohol, tobacco and pharmaceuticals) for society to struggle with might result in an increase in use.

But what if the legalization of adult access to cannabis also resulted in a reduction in the use of alcohol and other drugs? What if rather than being a gateway drug, cannabis actually proved to be an exit drug from problematic substance use? A growing body of research on a theory called cannabis substitution effect suggests just that.

In a nutshell, substitution effect is an economic theory that suggests that variations in the availability of one product may affect the use of another. Perhaps the best example of deliberate drug substitution is the common prescription use of methadone as a substitute for heroin, or e-cigarettes or nicotine patches rather than tobacco smoking.

However, substitution effect can be also be the unintended result of public policy shifts or other social changes, such as changes in the cost, legal status or availability of a substance. For example, in 13 U.S. states that decriminalized the personal recreational use of cannabis in the 1970s, research found that users shifted from using harder drugs to marijuana after its legal risks were decreased (Model, 1993).

Findings from Australia’s 2001 National Drug Strategy Household Survey specifically identify cannabis substitution effect, indicating 56.6% of people who used heroin substituted cannabis when their substance of choice was unavailable. The survey also found that 31.8% of people who use pharmaceutical analgesics for nonmedical purposes reported using cannabis when painkillers weren’t available (Aharonovich et al., 2002).

Additionally, a 2011 survey of 404 medical cannabis patients in Canada that colleagues and I conducted found that over 75% of respondents reported they substitute cannabis for another substance, with over 67% using cannabis as a substitute for prescription drugs, 41% as a substitute for alcohol, and 36% as a substitute for illicit substances (Lucas et al., 2012).

This and other evidence that cannabis can be a substitute for pharmaceutical opiates, alcohol and other drugs – and thereby reduce alcohol-related automobile accidents, violence and property crime, as well as disease transmission associated with injection drug use – could inform an evidence-based, public health-centered drug policy. Given the potential to decrease personal suffering and the social costs associated with addiction, further research on cannabis substitution effect appears to be justified on both economic and ethical grounds.

Maximizing the public health benefits of cannabis substitution effect could require the legalization of adult cannabis use, as currently being implemented in Colorado and Washington State. So the question is: do we have the courage to abandon long-standing drug policies based on fear, prejudice and misinformation, and instead develop strategies informed by science, reason and compassion?

*Please note that the material presented here does not necessarily imply endorsement or agreement by individuals at the Centre for Addictions Research of BC

Philippe Lucas is a Graduate Researcher with the Centre for Addictions Research of BC, President of the Multidisciplinary Association of Psychedelic Studies Canada, and a founding Board member of the Canadian Drug Policy Coalition. In 2012 he was awarded the Queen Elizabeth II Diamond Jubilee Medal for his work on medical cannabis.

I am 33 years old, married, a university graduate, and a business professional. I also have Crohn’s Disease, and I have used marijuana to treat ongoing symptoms such as pain, nausea, lack of appetite, and low energy. I do not use “medical” marijuana, but rather the dispensaries that currently fall under a grey area of legality in BC. I take no other pharmaceuticals for my Crohn’s Disease, and am able to control it with diet and a healthy lifestyle. I have chosen to write this blog as anonymous because unfortunately, there is still a fair amount of stigma, stereotypes and misinformation surrounding the “typical” marijuana user (and I think my parents would kill me).

I started using marijuana as part of my treatment when I was 26. My doctor informed me I was underweight and needed to gain about 15 lbs. The problem was, I couldn’t eat. My stomach would turn at the thought of eating, and I would often throw up after meals. I started smoking a very minuscule amount of weed before dinner so that I could not only eat, but enjoy eating again. It worked like a charm.

However, I struggled to find a reliable source of marijuana. I did not like the idea of going to a dealer. It was shady and illegal and I was never quite comfortable with it (though it was never very difficult to come by). My GP at the time was not open to prescribing medical marijuana to me, and I felt extremely judged! She was very closed minded about the medical benefits of marijuana despite the living proof standing right in front of her, 15 lbs heavier and healthier than before.

In 2011, a friend took me to a medical marijuana dispensary in downtown Victoria. She was a member there due to ongoing and severe debilitating back pain, which would put her on the floor for days at a time. To become a member at the dispensary, I simply needed proof of my condition and photo ID. Crohn’s is classified as Category 2 symptom on the Health Canada info page on medical marijuana. I brought in proof of my condition, sat through a 45-minute orientation and happily became a full-fledged member of the Victoria Cannabis Buyers Club. The role of the dispensary is to serve those who have legitimate conditions that can be treated by marijuana, but whose doctors will not prescribe it. They offer an incredible selection of products, including dried smokeables, edibles, oils, creams, compresses, and capsules. I tend to favour their Cannoil, which is made specifically to treat upper gastrointestinal disorders, and has provided me relief from not only nausea, but also severe cramping and bouts of diarrhea. The staff is friendly and knowledgeable on recommending the different strains to best suit your specific needs. As for the clientele, you’d perhaps be surprised to know that more often than not, it’s other “normal” people, business professionals, moms and grandparents seeking relief from what ails them.

Will I seek eligibility for medical marijuana? Perhaps one day, though I feel less inclined to now. I am a light user, and I like the convenience and selection of products that are on offer at the dispensary. I will probably also start growing my own, when I have suitable space to do so, so that I may control exactly what is in my medicine.

Though currently not using, marijuana will always be a part of my wider treatment plan. It’s enabled me to avoid harsh pharmaceuticals that are, in my opinion, far worse for me than something that has been grown naturally from the earth.

Further information on Crohn’s and Marijuana can be found here:

Treatment of Crohn’s Disease with Cannabis: An Observational Study

Cannabis Alleviates Symptoms of Crohn’s Disease

Medical Marijuana for Crohn’s Disease

Medical Marijuan & Crohn’s Disease—Getting your Doctor to Sign Health Canada’s Paperwork

*Please note that the material presented here does not necessarily imply endorsement or agreement by individuals at the Centre for Addictions Research of BC

Author: Anony Mous

Month: November 2013

Cannabis: the Exit Drug

Marijuana, a Friend to Crohn’s Patients Everywhere