Posted: 22 May 2017

High in the USA

Americans can teach the rest of the world how to use cannabis more safely and other reflections on cannabis use based on data from the 69,000 cannabis users who took part in GDS2017

Dr Adam R Winstock

Founder and Managing Director Global Drug Survey

Consultant Psychiatrist and Addiction Medicine Specialist


The good

Congratulations America. Don’t worry about your leader, fake news and the endless incredulous headlines that will no doubt follow in the coming months, it’s time to celebrate your position as the world’s most enlightened and healthy users of cannabis. While 65% of world’s cannabis users mix tobacco when they smoke cannabis – in the USA that figure is just 8% (Mexico is right behind you at 9% and Canada is not that far behind at 17%). Part of the reason might be your preference for using pipes, preferred by 34% of US cannabis users and bongs (26%), compared to joints which was the most common way of using for only 15% of US respondents compared to over 70% for the rest of the world. Your preferred routes of smoking cannabis might also be linked to your preference for higher potency cannabis products. Sixty percent of American users cited a preference for high potency herbal cannabis, compared to a global average of 45% and the US reported the highest preference rate for concentrates (15%) compared to 2% elsewhere (largely because it’s not that widely available in other countries. Yet.   And you are up there with the leading cannabis vaping countries with 13% reporting vaping as their preferred method (second only to Finland – where we only 350 users but they got gold with 19%, and a global average of 6%).  That vaping is still a minority sport even in the US and Canada says the world has a long way to go before vaping consigns smoking cannabis to the ashtray of history.


The less good?

So far so good. On other metrics, you came first but perhaps for not the right reasons. Over one third of US respondents to GDS2017 reported use on 300 or more days in the last year, with only 25% reporting use on 10 or less days in the last year, compared to the rest of the world where the figures were 19% and 42% respectively. On average US respondents were stoned on more days in the last 365 that any other country (207 days compared to a global mean of 130). The US also had the highest percentage of respondents reporting being stoned for 12 or more a day (13%) compared to the Dutch (2%) and the highest percentage reporting having their first joint within an hour of waking (22%), compared global average of 10%. 31% reported having their last joint just before bed, coming third to the Irish and British.


The question?

In summary, American cannabis users choose the safest way of using tobacco among any country in the world. They avoid tobacco and rates of vaping are very high compared to the rest of the world. But respondents from the US were more stoned, more often than any other country. Now that is not necessarily problem. But it might be since, as a rule the more of a drug you use and the more often you use it the more likely you are to run into health-related harms. At least in terms of acute risk of harm this statement is not borne out by GDS2017 data on people seeking emergency medical treatment following the use of cannabis. Across the world 0.6% of last year user of cannabis sought EMT (down from 1% last year). In the US that figure was 0.4%. This low rate might be explained by US health care costs, insurance premiums and issues of confidentially that make it less likely for people to seek treatment in the US if they run into health problems related to drugs. It might be a sampling issue, where US respondents to the GDS2017 were very experienced users and knew how to avoid harm. I don’t know. But what strikes me as weird and I would love some feedback (nice or not!) is why relatively so few US cannabis users indicated they wanted to use less cannabis in the coming year.  You would expect that given the very high rates of heavy use in our study, that as a population US cannabis users might be more likely to want to cut down. Not a bit of it. While across the world an average of 36% of all cannabis users said that they wanted to use less (with 9% wanting help to do so), in the US that figure was 22%, with 12% wanting help to do so. That’s less than the Dutch, pretty much the least stoned nation we looked at and the least of all the English-speaking countries that we looked at including Canada.

The question is whether not this is an issue or not. Are US cannabis users just happy being stoned and don’t see a problem because there is none. Any concerns of health risk are mitigated by relative safe methods of using and good levels of functioning and joy at the drug law reforms wafting across the US. Is it because the idea of waking up and seeing Donald in the White House means not being stoned is just too scary? I don’t know but it struck me as something worth asking and mirrors the very high levels of problematic drinking among the Dutch respondents to GDS2017 but very low levels of interest in using less. Ambivalence about our behaviours can be a troublesome thing. Sometimes not thinking about change and defending the place we are is the safest and most comfortable place to be.  If are you one of the 25% of US cannabis users who would like to use less check out a new video we’ll launch in early June on how to cut down, use more safely or stop available at Or if you just want some quick feedback on your level of use check out the world’s first safer use guidelines at

I wish the rest of world would learn how to use cannabis like Americans. But maybe just a little less.


If you want to test your knowledge about drug sue around the world – take 4 minutes and do the GDS2017 quiz (some of the answers are in this piece so don’t feel so clever!) at

Until GDS2018 launching in October 2017 – good luck