Substitution of Cannabis for Prescribed Medications in the Management of Anxiety and Depression Among Midlife Women: A Cross‐Sectional Study

ABSTRACT Background and Aims Given the rising prevalence of cannabis use as an alternative strategy for managing mental health symptoms, there is a crucial need to understand the determinants of substitution behavior, particularly among midlife women who may experience distinct psychosocial and clinical profiles. This study examined the predictors of cannabis substitution among midlife women by comparing profiles of women who substituted cannabis for antidepressant medications versus those who substituted for anxiolytic medications. Methods A cross‐sectional survey of 172 women who reported substituting cannabis for either anxiety or depression medications was conducted. Measures included the PHQ‐8, OASIS, AUDIT, and ACEs. Logistic regression was used to identify predictors of substitution behavior. Results Among participants, 88 (51%) substituted cannabis for antidepressants and 84 (49%) for anxiolytics. Clinically significant anxiety ( M = 12.5, SD = 4.3) and depression ( M = 11.6, SD = 5.3) were observed. Average ACE scores exceeded four in both groups. In multivariate models, sleep difficulties (OR = 4.2, 95% CI: 2.1–8.0) and alcohol use (OR = 1.1, 95% CI: 1.01–1.09) predicted substitution for anxiety. For depression, predictors included sleep difficulties (OR = 6.6, 95% CI: 3.1–14.1), alcohol use (OR = 1.1, 95% CI: 1.1–1.2), lower education (OR = 0.71, 95% CI: 0.53–0.95), and loneliness (OR = 2.0, 95% CI: 1.2–3.8). Conclusion Sleep difficulties and alcohol use were found to be strong predictors for substituting cannabis for anxiety and depression medications among middle‐aged women. These findings highlight the need for clinical awareness of symptom‐specific substitution patterns and emphasize the importance of addressing co‐occurring sleep and substance use problems.