Marijuana vs. alcohol — is cannabis healthier than drinking alcohol?


Q: I constantly hear about people giving up alcohol and switching to cannabis because they think it’s better for them. Is it true?

A: We have decades of research on the effects of alcohol consumption on health. But cannabis research continues to evolve, and the public health consequences of its commercial use – in new products and doses – will take years to understand.

From a medical perspective, no level of alcohol consumption is completely safe, as studies have shown harm even with light consumption.

If my patient drinks daily, I advise him to reduce his consumption. If they can’t cut down on alcohol despite their best efforts, I suggest treatments to help them cut down or quit: Many people are surprised to learn that there are three FDA-approved drugs (naltrexone, acamprosate and disulfiram) that help reduce their alcohol consumption, and that behavioral treatments – individual or group therapy – are equally effective.

When it comes to cannabis, I tell my patients that we still don’t know if there is a safe level of consumption, but in general scientists consider frequent, high-THC consumption to be more risky.

If my patients use cannabis, I ask them if they use it for a medical reason and offer them alternatives that have more rigorous scientific support. If they still plan to use it, I advise against smoking and vaping to protect their lungs, and I suggest using low tetrahydrocannabinol (THC) products or trying cannabidiol (CBD) in square.

THC and cannabidiol (CBD) are two of the active ingredients in cannabis: THC, the psychoactive component that makes people feel high, has been linked to more health risks. I suggest they try CBD edibles with less than 5% THC content – with the caveat that edibles may enter the system more slowly and unpredictably, so patients should start low and slow down if they plan to increase the dose.

One of the reasons we know less about the harms of cannabis compared to alcohol is that until recently, cannabis use was illegal in many states. Now, as the number of people who use cannabis increases, we will have a better understanding of potential risks through studies in which we follow large groups of people who use cannabis and those who do not over time. .

Similar observational studies over decades have been essential to our current alcohol knowledge base. We also need randomized controlled trials to understand the potential benefits of different cannabinoid compounds.

If you are considering consuming alcohol or cannabis, here are some things to keep in mind:

Alcohol is linked to adverse health effects

Some of my patients believe that drinking wine is beneficial and reduces their risk of heart attack. But new search challenged the idea that there is a cardiovascular benefit to drinking moderately.

It is clear that excessive alcohol consumption is associated with multiple cardiovascular risks, including hypertension, stroke and heart failure. Long-term heavy drinking is also linked to other serious health problems, such as depression and dementia. In addition, alcohol is a carcinogenic, and moderate alcohol consumption is associated with an increased risk of several types of cancer. Even light consumption – half a glass a day – is associated with a slight increase in the incidence of breast cancer in women and colorectal cancer in men.

Alcohol can cause road accidents and contribute to assaults and suicide. In large doses, it can even cause respiratory depression and death.

Cannabis can also cause harm

Cannabis does not cause respiratory depression, so it does not cause what we consider an “overdose”. But high-potency cannabis use has been associated with acute psychosis, and in some cases it has resulted in death or suicide.

Contrary to popular belief, it is possible to become physically dependent on cannabis or to develop a cannabis use disorder. People who use cannabis frequently can become dependent and experience withdrawal symptoms when they reduce or stop their use. People who use cannabis in a way that causes significant impairment may have cannabis use disorder. These people may need treatment to help them cut down or stop drinking.

Most Cannabis Health Claims Are Not Supported by Science

Only three cannabinoid-containing drugs have been approved by the FDA: dronabinol and nabilone contain synthetic THC and can be used to treat nausea and vomiting from chemotherapy in patients who have not responded to other drugs; CBD is used to treat rare forms of childhood epilepsy; and dronabinol is also approved to treat anorexia due to AIDS. Studies suggest that cannabis extracts may be helpful in managing the pain and spasticity of multiple sclerosis, and that cannabinoids may be effective in the management of neuropathic pain.

Although common marketing practices – and countless anecdotal reports – present cannabis as a proven treatment for anxiety, pain, insomnia and more, all of these claims require further research until we can make firm recommendations. Cannabis use can actually make depression treatment More difficult.

But the potential therapeutic uses of pharmaceutical-grade cannabis should not be confused with products sold in dispensaries. Many products in dispensaries may have contaminants, may not actually contain CBD and can be high in THC concentration.

Smoking and vaping cannabis carries risks

A few years ago, my patient had a heart attack. It was somewhat unexpected because he was healthy and physically active. While I had documented that he was not a tobacco smoker, given the recent heart attack, I asked him again, “Do you smoke?” »

He said no. Then he stopped and clarified that he didn’t smoke tobacco. But he had been smoking cannabis every day after work for years. Although the available evidence is limited, some studies suggest that cannabis use, like tobacco use, is associated with heart attacks.

We need studies that examine the health effects of daily cannabis use, as daily cannabis use is becoming increasingly common in young adults and several studies have reported that people who use it daily are at a higher risk of adverse health effects.

Our research group conducted several systematic reviews of the literature. We found that smoking cannabis was associated with cough, wheeze and testicular cancer.

Concerns about THC use and mental health

Cannabis use during adolescence has been linked to development of depression and suicide attempts during young adulthood. It is also associated with psychosisa potentially devastating disease in this age group.

According national institutes of healthcannabis use among young adults hit an all-time high in 2021.

I’m also concerned about older patients taking multiple medications and using cannabis, given the limited data on how the two interact. Cannabis use is increasing among older people, but there is very little data on its effects in this group.

Given the available evidence, I do not recommend the use of alcohol or cannabis to my patients for medical or psychiatric conditions.

Cannabis proponents like to say it’s “natural”, so it can’t be bad for us. Remember that tobacco is also a “natural” leafy green plant. It had been used for thousands of years. Yet, in the 20th century, the tobacco industry designed highly addictive products and caused a global epidemic of tobacco addiction and cancer, cardiovascular and lung disease.

It’s clear what excessive alcohol consumption can do to our body and mind. It’s too early to tell what effect commercial cannabis – and its ubiquitous use – will have on our health.

Salome Keyhani is a professor of medicine at the University of California, San Francisco.

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