A safer alternative: Cannabis substitution as harm reduction

Drug Alcohol Rev. 2015 Nov;34(6):654-9. doi: 10.1111/dar.12275. Epub 2015 Apr 28.


Introduction and aims: Substitution is operationalised as a conscious choice made by users to use one drug instead of, or in conjunction with another based on: perceived safety, level of addiction potential, effectiveness in relieving symptoms, access and level of acceptance. Harm reduction is a set of strategies that aim to minimise problems associated with drug use while recognising that for some users, abstinence may be neither a realistic nor a desirable goal. In this paper, we aim for deeper understandings of older adult cannabis users' beliefs and substitution practices as part of the harm reduction framework.

Design and methods: We present selected findings from our qualitative study of Baby Boomer (born 1946-1964) marijuana users in the San Francisco Bay Area. Although the sample consisted of primary cannabis users, many had personal experience with other drugs throughout their lifetimes. Data collection consisted of an audio-recorded, semi-structured in-depth life history interview followed by a questionnaire and health survey. Qualitative interviews were analysed to discover users' harm reduction beliefs and cannabis substitution practices.

Results: Study participants described using cannabis as a safer alternative for alcohol, illicit drugs and pharmaceuticals based on their perceptions of less adverse side effects, low-risk for addiction and greater effectiveness at relieving symptoms, such as chronic pain.

Discussion and conclusions: Cannabis substitution can be an effective harm reduction method for those who are unable or unwilling to stop using drugs completely. More research is needed on cannabis as a safer alternative.

Keywords: cannabis; drug substitution; drug user; harm reduction; marijuana.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Attitude to Health
  • Cannabis / adverse effects
  • Chronic Pain / drug therapy
  • Female
  • Humans
  • Interviews as Topic
  • Male
  • Marijuana Abuse / complications
  • Marijuana Abuse / psychology*
  • Middle Aged
  • Qualitative Research
  • San Francisco

Associated data

  • GENBANK/DA033841