Jason, 32, has never been a big fan of alcohol.
“I drank a couple times in my early 20s and it was not for me from the beginning,” he said. “It wasn’t very fun; it didn’t taste good at all.”
But Jason — who asked that we not use his last name — has Crohn’s disease. With that comes chronic pain, and there’s no cure.
About five years ago, he developed a resistance to his medicine and could no longer take it. That’s when he started self-medicating with cannabis.
Jason lives in Minnesota, where medical cannabis is legal for his condition. But it comes with an annual $200 registration fee, and isn’t covered by insurance.
“It is so much cheaper to buy off the street,” he said. “Since I’m such a lightweight that’s about every three months, and it’s about $40 to $80.”
Since he started regularly using the drug three years ago — which is illegal recreationally in his state — he says his symptoms have gone back into remission.
He smokes weed three or four nights a week. He still has no urge to drink. But he likes the way weed makes him feel. It’s much more relaxing, he says.
Just as young adults are drinking less alcohol than previous generations, they’re using more marijuana.
According to the National Institute on Drug Abuse’s 2018 Monitoring the Future survey, marijuana use is the highest it’s been in three decades. Eight percent of folks aged 19 to 28 use cannabis daily, more than triple the percentage in 1992.
Meanwhile, binge drinking in the same age group dropped nearly 4 percent over the past five years, a decrease the researchers called “significant.”
There are lots of reasons people choose to go Cali sober. Some can’t stand the hangovers they get and prefer the feeling of being high to the feeling of being drunk.
Others, like Jason, use it to self-medicate for chronic pain, or sleep disorders, or anxiety.
Cannabis is more legally accessible than it was in 1992. Since 2012, 11 states and the District of Columbia have legalized marijuana for recreational use.
Some believe cannabis to be a safe, “natural” alternative to other drugs.
But researchers like R. Lorraine Collins say it’s not that simple.
“People have embraced the use of cannabis because it’s got this reputation for being natural,” said Collins, associate dean for research at the University at Buffalo’s School of Public Health and Health Professions.
“But the fact that it’s natural doesn’t mean it would not produce harm if used in certain kinds of circumstances.”
Collins was part of a landmark report by the National Academies of Sciences, Engineering and Medicine on the health effects of cannabis.
“The key areas where the National Academies review of cannabis showed health benefits were related to reducing chronic pain, reducing nausea related to chemotherapy in cancer treatment, and helping with some forms of spasticity,” she said.
“The review found moderate benefits related to improving short-term sleep, for sleep apnea, fibromyalgia and some symptoms of multiple sclerosis.”
The medical conditions that qualify for medical marijuana are much broader than that list and vary state by state.
Of course, most people who use cannabis don’t do it for the health benefits. They do it for the high.
In 2013, just 17 percent of folks who used cannabis did it medically.
Eleanor, 27, is one of the 83 percent who use cannabis strictly for fun.
For the past year and a half, she’s been almost completely alcohol-free, save for a drink or two, like when her boss handed her a glass of wine at a social function without asking.
But she uses marijuana about once a month.
“For me, the feeling of being high and buzzed are sort of comparable, but with weed I don’t experience the nasty side effects that I get with alcohol,” she said.
Eleanor says she has a sensitivity to alcohol that causes painful stomach cramps and digestive issues. It’s only gotten worse as she’s gotten older.
“I tend to be an over-thinker, and weed helps me calm down and get out of my head, which is an effect that isn’t as present with alcohol,” she said.
Eleanor asked to use a pseudonym for this article. She’s an American living abroad, in a country where cannabis is not legal.
“I really don’t like to think that I’m self-medicating through substances, so I try to use only recreationally and not because I ‘need’ to,” she said.
“I do occasionally catch myself thinking ‘Oh man, I would really like a joint’ after a long week, but I don’t have my own supply or anything.”
That means she only uses it with friends, which isn’t often. She likes that it’s not attached to her mental, physical or emotional state.
For Eleanor, weed is a good alternative to alcohol at social gatherings.
But Collins says there are still health concerns that come with using the drug that folks might want to take into account.
Long-term, smoking weed is linked to breathing problems and, over time, lung damage. Pregnant folks who use cannabis are at risk of delivering a baby with a low birth weight.
And though cannabis overdoses aren’t fatal, too much can still send you to the emergency room — especially with the ascent of edibles, which can pack a punch. Sometimes, the serving size isn’t clear.
In adolescents and young adults, cannabis has been linked to poor memory and attention span. And for people who already have a history of psychosis, marijuana can trigger psychotic episodes.
Just as folks who overuse alcohol can develop alcohol use disorder, folks who use cannabis can develop marijuana use disorder, characterized by “craving, withdrawal, lack of control and negative effects on personal and professional responsibilities.”
The other challenge? We don’t know nearly as much about cannabis as we do about alcohol. While we focus on THC, which provides the high, and CBD, there are more than 100 other unique chemical compounds called cannabinoids in the plant.
CBD, the cannabinoid that exploded in popularity after the 2018 farm bill loosened restrictions on hemp, has been touted by sellers as a “miracle oil” for everything from chronic pain to acne to depression. But there isn’t research to back that all up.
“For many years there was little or no funding for cannabis research,” Collins said. “And I don’t know, maybe the feds thought, if we ignore it, it won’t happen.
“What it means is that we’re playing catch up. We have policies that have opened up medicinal and adult use of cannabis. And we don’t understand many facets of the drug.”
There’s no standard cannabis product. So when there is funding for cannabis research, the drug that is studied is different than many versions of the drug that might be on the street, or sold in stores. There might be a different ratio of THC to CBD. Or the studied drug might be less potent.
And, because recreational legalization of the drug is new, many folks don’t get the same education about dosage and serving size that they might get about alcohol. There’s no “one shot = one glass of wine = one glass of beer” equivalent in the cannabis world.
“Typically what is provided in a public health message is to start with lower THC and smaller amounts until you have a sense of how you react,” Collins said.
Despite all the unknowns, the stigma around cannabis use has toned down. Public opinion has turned.
In 1969, just 12 percent of folks believed marijuana should be broadly legalized. In 2019, that number is 67 percent, according to the Pew Research Center.
Jason and Eleanor say most of their friends don’t give their smoking a second thought.
“I’ve gotten more pushback for not drinking than for smoking weed,” Eleanor said. “I guess because the drinking culture is so ingrained.”