Beyond the SmokeScreen: Dr Frank Compares the Dangers Posed by Alcohol and Cannabis

CANNABIS CULTURE- With all the evidence we have so far, marijuana, cannabis, pot, weed, tea or whatever you want to call it, is orders of magnitude safer than alcohol on pretty much every metric, from health harms to social harms.

The above chart, courtesy of David J. Nutt at Dagga magazine, illustrates the harm trends experienced in the UK. However, we can easily apply this graph to the United States to some extent. When first seen, this graph is both surprising and unsurprising. Heroin, crack cocaine, methamphetamine, powder cocaine and tobacco are near the top of the list.
The surprises? Alcohol more dangerous than heroin, crack cocaine and crystal meth? Cannabis
more dangerous than benzodiazepines, methadone and ketamine? There are things both adding up and not adding up here. Here’s a bit of explanation as to why David Nutt’s graph shows what it shows, and how we can apply this to the age-old question of “Which is worse for your health: cannabis or alcohol?”

We are going to focus mostly on cannabis vs. alcohol, but it is worth noting that just looking at these two substances in isolation and without regard to other drugs and medications – prescribed or not – means that we are looking at only one part of the jigsaw of the personal, social and environmental effects of drug use and addiction. Different drugs also have different biological effects, which has an impact on how rapidly one can build tolerance and develop an addiction. This can explain why some psychedelic drugs are so low on David Nutt’s graph.

The Numbers of People Taking Each Substance & Biology

Alcohol is a hugely popular substance worldwide. If heroin, crack cocaine and methamphetamine as popular as alcohol – and therefore easier to study – we can be sure that the harm they cause would surpass the harm alcohol causes. The reason for this is down to biology. Alcohol, though addictive, doesn’t lead to addiction as rapidly as heroin or crystal meth does. Of those who try cannabis, 9% develop dependence, in comparison to 18% for cocaine and 24% for heroin. As for alcohol, in the U.S., there are approximately 15.1 million people aged 18 or over with alcohol use disorder (AUD). This is about 6.2% of the U.S. population.

When it comes to alcohol, there’s a big difference between having a glass of wine with your dinner a few nights a week and having a bottle or two of wine every night for weeks on end. The first scenario will probably not lead to addiction; the second scenario is pretty much alcoholism.
If we were to schedule alcohol as a drug, a single, occasional glass of beer or wine would be somewhere around schedule 3, whereas drinking a bottle of spirit would be schedule 1 in terms of harm caused. There are several other factors that certainly merit seeing alcohol as essentially a legal schedule 1 substance. To use the National Institute of Alcohol Abuse and Alcoholism as a main reference point again:

• An estimated 88,000 people die annually from alcohol-related causes in the U.S. – the fourth leading cause of preventable death in the U.S.
• 37,000 adolescents received treatment for an alcohol-related problem in 2015
• 1.3 million adults received treatment for AUD in 2015
• Alcohol misuse cost the U.S. $249 billion in 2010
• The amount of motor vehicle accidents, assault and school-/work- time missed related to alcohol use is not to be baulked at
• Could alcohol be the real “gateway drug”? After all, a drunk person is prone to reckless behavior and could well be easily convinced to “give something a go”, even if that something might kill them …
• You don’t need to be an alcoholic to die from an alcohol overdose
• Though physical dependence to alcohol takes a while, psychological dependence is much easier to fall into – alcohol dependence needn’t always require excessive drinking, and even a few drinks after work could be harmful to long-term health if done regularly enough
So, how harmful is alcohol, overall? It’s a complex question, but it can be said to be both “devastating” and “not too bad in moderation”. When Homer Simpson eloquently oded, “To alcohol: the cause of – and solution to – all of life’s problems,” he was being at least partially accurate!

Though there has been a leap in marijuana-related hospitalizations in the U.S., it is safe to say that very few of these end up costing people’s lives. It’s essentially stomach pumps and saline drips for alcohol overdose, or a bit of hand-holding and talk therapy for a cannabis “overdose”. Alcohol overdoses occur with greater frequency. Considering that approximately 13% of U.S. adults use marijuana – just over 40 million people – having under 10,000 people per year hospitalized for it (and no deaths) shows how safe it generally is.

Moreover, many of these hospitalizations are due to the combination of cannabis with central nervous system depressants (alcohol, opioids, barbiturates), rare adverse reactions when combined with other medications and psychiatric problems that may have been “triggered” (but not necessarily directly caused) by cannabis use.

More on Biology: Cannabis Science & Its Effects

If we want to be scientific about all of this (and we do), it is not fair to say that “cannabis has no potential to cause harm whatsoever.” Granted, you can’t overdose on it, but it can react with other medications in a dangerous way. There is some evidence that marijuana may react negatively with certain antidepressants, benzodiazepines (both CBD and benzos work on cytochrome P450 enzymes in the liver) and, as already mentioned, alcohol.

As for mental health and the risks of developing a psychotic disorder, there is a lot of debate, but so far most longitudinal studies say “the link between schizophrenia development and cannabis use is weak at best”. This is a clear “chicken-or-egg?” scenario. Also, why is the relationship between alcohol use and schizophrenia not looked at more often?

As for the effects of smoking cannabis purely and without tobacco, it is nowhere near as harmful as tobacco smoke. In other words, tobacco smoke has a causal link to lung, colon or rectal cancers; a connection between marijuana smoking and lung or colorectal cancer was not observed (though there was some cannabis smoke-induced cellular damage).

Another thing to remember in all of this is the aforementioned ECS. For those of you who don’t know what this is, it is the series of endogenous cannabinoid receptors throughout the human body that plays a massive part in homeostasis – that is, the “balance” of the body and its physiological processes. This includes sleep, appetite, pain-sensation, body temperature, mood, memory, reward & motivation, and even the body’s immune system.

The body creates its own cannabinoids (endocannabinoids), whereas cannabinoids from plants are called “phytocannabinoids”. The endocannabinoid anandamide is analogous to tetrahydrocannabinol (THC), and can cause euphoria as well as repress nausea. The endocannabinoid 2-Arachidonoylglycerol (2-AG) is analogous to cannabidiol (CBD), and has anti-inflammatory purposes. Some even speculate – convincingly so – that conditions like irritable bowel syndrome (IBS), fibromyalgia and migraine are a symptom of Clinical Endocannabinoid Deficiency (CECD)!

As everyone has a different ECS, it wouldn’t be theoretically impossible to suggest that some people may actually have an abundance of endocannabinoids, or even an abundance of some but a deficiency of others! This could explain why some people have adverse reactions (paranoia, confusion) to even small intakes of marijuana regardless of strain, or why certain strains work very well for their condition whilst other strains have little-to-no positive or even negative effects on their condition.

Some people may also be allergic to marijuana, though in most cases this is likely to be pollen or mold rather than the cannabinoids themselves. However, we can imagine someone who might be allergic to terpenoids like lavender having adverse reactions to lavender-heavy cannabis strains.

Cannabis for Alcoholism?

Those of you reading closely enough will have noticed a few things mentioned already, and why these things could mean cannabis being of immense use for the treatment of drug addiction of all kinds, including alcohol. To refresh your memory and to elucidate upon them further, they are …
1. The “harshing of the buzz” – mixing cannabis with other substances can turn a positive into a negative. Marijuana users tend to be averse to things that could ruin a pleasant experience, which leads to another interesting supposition: could marijuana’s cannabinoids make a person “hypersensitive” to other drugs? Could this be a fundamental part of why marijuana could be an “exit drug/medicine”?
2. The range of effects – there isn’t much out there that’s like cannabis. If you want to feel happy, chatty and social, go for a sativa; if you want to relax and settle down on the couch with a loved one, go for an indica. This could be one reason why cannabis works as an “exit medicine” for so many different types of drug addiction – it “replicates” or “approximates” the effects of other drugs quite well.
3. You’re still in control – it is still possible to remain conscious and make decisions whilst under the influence of cannabis. This is not so much the case if you are drunk, and we know there are people out there who have done things whilst drinking they wouldn’t have done otherwise.

Yes, if you’re looking to find a way out of alcohol, opiate/opioid, amphetamine, benzodiazepine and/or barbiturate addiction, it may very well be worth getting yourself a medical marijuana card! The other advantage of using marijuana as a replacement for alcohol and other addictive substances is that it has cannabinoids and terpenoids that are beneficial to health.

So, if you are taking CBD for your arthritis, it is also working as a neuroprotectant, even if that wasn’t your intention! Then there’s other cannabinoids like cannabichromene (CBC), cannabigerol (CBG) and cannabinol (CBN), all of which have health properties of their own and also work together with THC and CBD in order to improve their efficacy – the “Entourage Effect”. Alcohol certainly can’t claim that it has the medical applications and health benefits cannabis has.