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The other substitution effect is worth some study. 

One of the most important questions about legal marijuana is this: Will it be a substitute for booze, or a complement?

Typically, marijuana users are less dangerous than their boozy counterparts. While neither the heavily stoned nor the drunk are safe drivers, the latter is more prone to violence. (Criminologist Mark Kleiman calls alcohol "the #1 date-rape drug.") We should want people who are of legal age and sound mind to choose marijuana over alcohol; and we should want them to never mix the two.

And that's not the only thing we should be rooting for. Prescription painkillers, while helpful when taken correctly, are incredibly dangerous when not. If it's reasonable to want people to use marijuana at the expense of alcohol, it's fair to say that, when and where feasible, we should want them to do the same with prescription opioids. (There's also a case for using marijuana and MDMA, rather than pills, to treat PTSD; but that's for another post.) 

The logic of medical substitution, at least, appeals to West Virginians. Today, the Marijuana Policy Project released poll results [PDF] showing 56 percent of West Virginians support legalizing medical marijuana. That's an increase of three percentage points over a January 2013 poll [PDF] asking the same question. At the same time, opposition to medical marijuana in West Virginia has fallen six percentage points, from 40 percent in January 2013 down to 34 percent today. 

West Virginians—currently experiencing the highest drug overdose mortality rate in the U.S.—are also convinced by a huge margin that marijuana is safer than the prescription painkiller Oxycontin. The below map explains why West Virginians might feel that way:

Drug Overdose Rates by State, 2008. Courtesy of the CDC


 

Here are the top line results for the Oxy versus Marijuana question in 2013: 

Which do you believe is a safer treatment for debilitating pain: the medical use of marijuana or Oxycontin?
 
Marijuana: 63%
 
Oxycontin: 22%
 
No opinion/Don't know: 15% 
And here are the responses from January 2014: 
Which do you believe is a safer treatment for debilitating pain: the medical use of marijuana or OxyContin?
 
Medical use of marijuana:  57% 
 
OxyContin: 16%
 
Equally safe: 6%
 
Not sure: 21% 

The second poll offers respondents the chance to select "equally safe," which may explain why slightly fewer people saw marijuana as safer than Oxy the second time around.

I hadn't seen the Oxy question on any other state MPP poll, so I emailed Mason Tvert ("the Don Draper of pot") to ask if contrasting marijuana and Oxy was integral to advancing medical marijuana laws.

"At this point, three out of four Americans recognize that marijuana has legitimate medical benefits," Tvert writes back. "Whether people recognize that marijuana is safer than Oxycontin is not critical to the advancement of sensible medical marijuana policies. It is just one reason among many to support them."

I have no idea for how many ailments marijuana would be a better treatment than prescription opioids, and hoping for a substitution effect is nowhere near as effective as making life-saving drugs like Naloxone (the overdoser's equivalent to the EpiPen) available over the counter.

But at the very least, it would be great if we saw more people substituting marijuana for recreational opioid use. Hopefully the reforms in Colorado and Washington will prove valuable for that reason as well.

Top image: Some pills. Shutterstock.com/Brian Goodman

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