As more states legalize marijuana , a new study shows that many patients are choosing medical cannabis to supplement or even replace pharmaceutical drugs.

The study comes from the University of Michigan Institute for Social Research, which surveyed 450 adults who identified as current cannabis users. Among those surveyed, 78 percent said they used cannabis to treat a medical or health condition.

As the study notes, people use medical weed for a wide variety of health issues, including chronic pain, depression, anxiety, post-traumatic stress disorder, menstrual cramps, and headaches. It’s also used to mitigate the adverse effects of chemotherapy, and to alleviate nausea in HIV-AIDS patients.

Nearly half of those users—42 percent—said they’d completely stopped taking a pharmaceutical drug, while 38 percent cut back their use of one because of using medical marijuana. Users reported trusting medical cannabis more than mainstream health care, rating weed better than pharmaceuticals on effectiveness, side effects, availability, and cost. Also, nearly a third of respondents (30 percent) said their doctor or healthcare provider didn’t know they were using medical marijuana.

The authors note how little was previously known about the mindsets of medical marijuana users, writing that, “Given the state of the science of medicinal cannabis, even basic information about users’ attitudes and behaviors would be helpful.” The results suggest that medical cannabis users trust the plant more than they do pharmaceuticals, and are finding enough relief using it that many have moved away from other drugs. At the same time, many are not sharing that decision with their healthcare providers.

Understanding these attitudes, the authors say, will be essential to shaping policy. As more states legalize (while marijuana remains prohibited at the federal level), the questions around medical marijuana will only get more tangled.

“Given the growing use of cannabis for medical purposes and the widespread use for recreation purposes despite criminalization,” Daniel Kruger, a study co-author, said in a statement , “the current public health framework focusing primarily on cannabis abstinence appears obsolete.” With people using weed to improve their health—even as they turn away from pharmaceuticals, “just say no” is no longer useful advice.

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