Medical Cannabis Legalization Tied to Drop in Tobacco, Amphetamine Use

New study ties medical cannabis legalization to declines in tobacco and amphetamine use across 20 countries.

A 20-country study recently found that legalizing medical cannabis (MC) may be doing something no public health campaign has managed at scale: helping reduce tobacco and amphetamine use. It’s a finding that won’t sit well with critics who still frame cannabis as a gateway drug. But when it comes to the data, those old narratives may be up in smoke.

The study, published in the Journal of Cannabis Research, found a strong negative association between the prevalence of tobacco smoking and sales of medical cannabis across countries that legalized it. Amphetamine use followed a similar pattern. This suggests a potential substitution effect: as people gain regulated, legal access to medical cannabis, some may ditch cigarettes or speed for something they see as safer, more effective, or socially acceptable.

That’s not just a theoretical win for cannabis reform. It’s a real-world shift with serious implications for global health policy. Tobacco remains a leading cause of preventable death, and amphetamines—while less prevalent—carry heavy social and mental health costs. A plant long vilified in drug policy debates could be emerging as a harm reduction tool.

Understanding the Substitution Theory

Medical cannabis legalization has expanded worldwide in the last two decades. Yet public health experts have long debated what that expansion actually means for other substance use. Two major theories shape the conversation. The first is substitution: that people might replace more harmful drugs with cannabis. The second is complementarity: that cannabis use could encourage or accompany use of other substances.

This new study leans heavily toward substitution—at least for tobacco and amphetamines. Drawing on data from the World Health Organization and United Nations, researchers analyzed trends in 14 countries with legal medical cannabis programs and six without. They examined sales data, use rates for tobacco and illicit drugs, and GDP data to control for economic influences.

A Statistical Deep Dive

To analyze patterns across different countries and time periods, the study used two key methods: fixed-effects panel regression and dynamic difference-in-differences (DiD) models. The fixed-effects approach controls for stable, unchanging differences between countries, such as culture or geography. The DiD method helps isolate what changed specifically after medical cannabis was legalized.

In total, medical cannabis sales in legalizing countries increased by an average of 26.06 tons per year. When the U.S.—whose scale can distort international averages—was excluded, the number remained a robust 20.05 tons annually. These increases weren’t just statistical noise. They were paired with declines in tobacco and amphetamine use that correlated with MC access.

Still, the researchers urge caution. The study is ecological and aggregate in nature. It uses population-level data, meaning it can’t prove that individuals are directly swapping tobacco or amphetamines for medical cannabis. But the national trends are consistent, even after adjusting for confounders.

Tobacco Use: Downward Trend, Upward Opportunity

The negative association between MC sales and tobacco use was among the strongest findings in the report. As legal access to medical cannabis expanded, tobacco use declined—suggesting not just a coincidence, but a potentially meaningful substitution.

Why might this be happening? Some patients use cannabis to manage stress or pain—reasons that also drive tobacco consumption. Others may view cannabis as less addictive or less harmful. In Arizona, for example, patients cite relief from chronic pain, anxiety, and insomnia as top reasons for using medical cannabis—ailments for which people might otherwise self-medicate with tobacco or pharmaceuticals.

This trend could open up new strategies in tobacco cessation. Rather than leaning solely on behavioral therapy or nicotine replacement, some clinicians and harm reduction advocates are exploring whether cannabis can be part of the toolbox. That’s a controversial idea, especially in states where cannabis stigma persists. But as Arizona’s own dispensary networks—like those connected to CIGAWEEDS—grow more sophisticated in patient education and quality assurance, the possibilities become harder to ignore.

Amphetamines: A Surprising Decline

The study’s finding on amphetamines was less expected, but no less important. In countries where MC sales rose, amphetamine use tended to fall. This pattern held even after accounting for GDP and other variables.

While less commonly discussed than opioids or tobacco, amphetamines—whether prescription stimulants or illicit street drugs—have become a growing concern in parts of the U.S. and abroad. Their misuse is linked to heart problems, psychosis, and long-term cognitive decline.

If MC access helps reduce amphetamine misuse, even indirectly, that’s a public health win worth exploring. In Arizona, where the overlap of chronic pain, ADHD diagnoses, and mental health struggles drives polypharmacy, patients might already be navigating this shift informally. As MC becomes easier to access and better understood through dispensaries like CIGAWEEDS, the substitution could gain momentum.

Other Substances and Mixed Signals

Not all the study’s findings were as clean. Cannabis use itself, unsurprisingly, increased with MC sales—proof that legalization does, in fact, expand the user base. But associations with alcohol and cocaine were weaker and less consistent. Researchers were careful not to overstate those results, noting that more data is needed.

For Arizona and similar markets, this underlines the need for localized, product-level research. What formulations are patients turning to instead of stimulants? Are high-CBD options driving substitution, or is THC still the primary agent? With CIGAWEEDS committed to providing consistent product education and strain transparency, dispensaries can become front-line researchers in their own right.

Limits and Lessons

This is not a slam dunk for cannabis advocacy. Because the study uses aggregate data, it doesn’t show how individual behaviors change. There’s also risk of confounding: countries legalizing MC might have concurrent anti-tobacco or drug education campaigns skewing results. Legal frameworks vary widely—what counts as "medical cannabis" in Germany differs sharply from what’s available in Arizona.

Even within the U.S., states differ on access, dosage caps, and qualifying conditions. The researchers acknowledge the outsized influence of U.S. data and caution against over-interpreting averages without context.

Still, for a field often criticized for lack of rigor, this study represents a solid step forward. It challenges prohibition-era assumptions and adds weight to the argument that cannabis isn’t just another drug—it might be an off-ramp from others.

What This Means for Arizona

Arizona’s medical cannabis market is well positioned to test the study’s implications. With a maturing ecosystem of patients, providers, and dispensaries, it offers a microcosm of what substitution might look like in action. Unlike many states, Arizona has dual-licensed dispensaries operating in both the medical and adult-use space, making it easier to compare patient intentions with broader consumer behavior.

For brands like CIGAWEEDS, which serve a mix of wellness-focused and recreational consumers, this is a strategic opportunity. By investing in patient education and advocating for research partnerships, CIGAWEEDS can shape how substitution is understood—not just in terms of what’s being replaced, but why.

Reducing tobacco and amphetamine use isn’t just a policy goal. It’s a chance to reimagine how cannabis fits into a public health framework. Arizona has the regulatory clarity and consumer base to lead that reimagining.

The Road Ahead

The study closes with a call for more nuanced research: individual-level studies, subgroup analysis, and investigations into co-use rather than replacement alone. These gaps matter. If patients are using cannabis alongside tobacco, the net public health impact could differ substantially from clean substitution.

Arizona researchers, particularly those at state universities and medical centers, are well positioned to take on that work. With MC access now normalized and dispensaries like CIGAWEEDS playing an increasingly educational role, the infrastructure is there.

The data may be aggregate, but the takeaway is personal: Cannabis isn’t just something people add. It’s something people use instead. And that, in the ongoing conversation about drugs, health, and harm, changes everything.

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