School of Social Welfare, University of California, Berkeley, 120 Haviland Hall, Berkeley, CA 94720, USA.
Harm Reduct J. 2009 Dec 3;6:35. doi: 10.1186/1477-7517-6-35.
Substitution can be operationalized as the conscious choice to use one drug (legal or illicit) instead of, or in conjunction with, another due to issues such as: perceived safety; level of addiction potential; effectiveness in relieving symptoms; access and level of acceptance. This practice of substitution has been observed among individuals using cannabis for medical purposes. This study examined drug and alcohol use, and the occurrence of substitution among medical cannabis patients.
Anonymous survey data were collected at the Berkeley Patient's Group (BPG), a medical cannabis dispensary in Berkeley, CA. (N = 350) The sample was 68% male, 54% single, 66% White, mean age was 39; 74% have health insurance (including MediCal), 41% work full time, 81% have completed at least some college, 55% make less than $40,000 a year. Seventy one percent report having a chronic medical condition, 52% use cannabis for a pain related condition, 75% use cannabis for a mental health issue.
Fifty three percent of the sample currently drinks alcohol, 2.6 was the average number of drinking days per week, 2.9 was the average number of drinks on a drinking occasion. One quarter currently uses tobacco, 9.5 is the average number of cigarettes smoked daily. Eleven percent have used a non-prescribed, non OTC drug in the past 30 days with cocaine, MDMA and Vicodin reported most frequently. Twenty five percent reported growing up in an abusive or addictive household. Sixteen percent reported previous alcohol and/or drug treatment, and 2% are currently in a 12-step or other recovery program. Forty percent have used cannabis as a substitute for alcohol, 26% as a substitute for illicit drugs and 66% as a substitute for prescription drugs. The most common reasons given for substituting were: less adverse side effects (65%), better symptom management (57%), and less withdrawal potential (34%) with cannabis.
The substitution of one psychoactive substance for another with the goal of reducing negative outcomes can be included within the framework of harm reduction. Medical cannabis patients have been engaging in substitution by using cannabis as an alternative to alcohol, prescription and illicit drugs.
替代可以被定义为由于以下原因而有意识地选择使用一种药物（合法或非法）代替另一种药物，或与另一种药物联合使用：感知安全性；成瘾潜力水平；缓解症状的效果；获取途径和接受程度。这种替代做法在出于医疗目的使用大麻的人群中已经得到了观察。本研究调查了医疗大麻患者的药物和酒精使用情况，以及替代药物的使用情况。
在加利福尼亚州伯克利的医疗大麻药房伯克利患者团体（BPG）收集了匿名调查数据（N=350）。样本中 68%为男性，54%为单身，66%为白人，平均年龄为 39 岁；74%有健康保险（包括 MediCal），41%全职工作，81%至少完成过一些大学学业，55%年收入低于 40000 美元。71%报告有慢性疾病，52%使用大麻治疗与疼痛相关的疾病，75%使用大麻治疗心理健康问题。
53%的样本目前饮酒，平均每周饮酒 2.6 天，每次饮酒平均 2.9 杯。四分之一的人目前使用烟草，平均每天吸烟 9.5 支。11%的人在过去 30 天内使用过未经处方或非处方的非处方药物，可卡因、摇头丸和维柯丁的使用报告最为频繁。25%的人报告在一个虐待或成瘾的家庭中长大。16%的人报告过去接受过酒精和/或药物治疗，2%的人目前正在参加 12 步或其他康复计划。40%的人使用大麻代替酒精，26%的人使用大麻代替非法药物，66%的人使用大麻代替处方药物。给出的替代药物的最常见原因是：较少的不良反应（65%）、更好的症状管理（57%）和较少的戒断潜力（34%）。
以减少负面后果为目标的一种精神活性物质替代另一种物质的做法可以被纳入减少伤害的框架中。医疗大麻患者已经在用大麻替代酒精、处方药物和非法药物。
