Jason, 32, has never been a big fan of alcohol.
âI drank a couple times in my early 20s and it was not for me from the beginning,â he said. âIt wasnât very fun; it didnât taste good at all.â
But Jason â who asked that we not use his last name â has Crohnâs disease. With that comes chronic pain, and thereâs no cure.
About five years ago, he developed a resistance to his medicine and could no longer take it. Thatâs 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 isnât covered by insurance.
âIt is so much cheaper to buy off the street,â he said. âSince Iâm such a lightweight thatâs about every three months, and itâs about $40 to $80.â
Since he started regularly using the drug three years ago â which is illegal recreationally in his state â 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. Itâs much more relaxing, he says.
Just as young adults are drinking less alcohol than previous generations, theyâre using more marijuana.
According to the National Institute on Drug Abuseâs 2018 Monitoring the Future survey, marijuana use is the highest itâs 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 âsignificant.â
There are lots of reasons people choose to go Cali sober. SomeÂ canât stand the hangoversÂ 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, ânaturalâ alternative to other drugs.
But researchers like R. Lorraine Collins say itâs not that simple.
âPeople have embraced the use of cannabis because itâs got this reputation for being natural,â said Collins, associate dean for research at the University at Buffaloâs School of Public Health and Health Professions.
âBut the fact that itâs natural doesnât mean it would not produce harm if used in certain kinds of circumstances.â
Collins was part of a landmark report by the National Academies of Sciences, Engineering and Medicine on the health effects of cannabis.
âThe 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,â she said.
âThe review found moderate benefits related to improving short-term sleep, for sleep apnea, fibromyalgia and some symptoms of multiple sclerosis.â
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 donât 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, sheâs 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.
âFor me, the feeling of being high and buzzed are sort of comparable, but with weed I donât experience the nasty side effects that I get with alcohol,â she said.
Eleanor says she has a sensitivity to alcohol that causes painful stomach cramps and digestive issues. Itâs only gotten worse as sheâs gotten older.
âI tend to be an over-thinker, and weed helps me calm down and get out of my head, which is an effect that isnât as present with alcohol,â she said.
Eleanor asked to use a pseudonym for this article. Sheâs an American living abroad, in a country where cannabis is not legal.
âI really donât like to think that Iâm self-medicating through substances, so I try to use only recreationally and not because I âneedâ to,â she said.
âI do occasionally catch myself thinking âOh man, I would really like a jointâ after a long week, but I donât have my own supply or anything.â
That means she only uses it with friends, which isnât often. She likes that itâs 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 areÂ at risk of delivering a baby with a low birth weight.
And though cannabis overdoses arenât fatal, too much can still send you to the emergency room â especially with the ascent of edibles, which can pack a punch. Sometimes, the serving size isnât 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 âcraving, withdrawal, lack of control and negative effects on personal and professional responsibilities.â
The other challenge? We donât 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 âmiracle oilâ for everything from chronic pain to acne to depression. But there isnât research to back that all up.
âFor many years there was little or no funding for cannabis research,â Collins said. âAnd I donât know, maybe the feds thought, if we ignore it, it wonât happen.
âWhat it means is that weâre playing catch up. We have policies that have opened up medicinal and adult use of cannabis. And we donât understand many facets of the drug.â
Thereâs 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 donât get the same education about dosage and serving size that they might get about alcohol. Thereâs no âone shot = one glass of wine = one glass of beerâ equivalent in the cannabis world.
âTypically 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,â 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 donât give their smoking a second thought.
âIâve gotten more pushback for not drinking than for smoking weed,â Eleanor said. âI guess because the drinking culture is so ingrained.â
Gretchen is an editor for Rewire. With past stints in public radio and at a rural daily newspaper, sheâs passionate about public media as a public service. Sheâs also into music and really good coffee. Follow her on Twitter @gretch_brown.