Review paperAlcohol and cannabis: Comparing their adverse health effects and regulatory regimes
Section snippets
The adverse health effects of alcohol
Thanks to over half a century of epidemiological research, the adverse health effects of alcohol are reasonably well understood (Babor et al., 2010; Parry, Patra, & Rehm, 2011; Rehm & Shield, 2013; Shield, Parry, & Rehm, 2013). In large doses alcohol can cause fatal overdoses from respiratory depression and alcohol intoxication, is a major cause of road accidents, and contributes to assaults and suicide (Babor et al., 2010). When consumed heavily and regularly, alcohol can cause a dependence
The adverse health effects of cannabis: the standard account
The known adverse effects of using cannabis look very modest by comparison with the manifold and protean adverse health effects of alcohol (Hall, 2015, Hall and Degenhardt, 2009; Hall, Renström, & Poznyak, 2016). As advocates of more liberal cannabis policies stress, cannabis is not known to cause fatal overdoses (Gable, 2004) because it does not have respiratory depressant effects like the opioids or alcohol (Boffey, 2014). Cannabis intoxication only modestly increases road accident risk
Taking cannabis dependence seriously
Cannabis dependence is not an artefact of prohibition. This is clear from the increase in the numbers of persons seeking treatment for problem cannabis use in the Netherlands (EMCDDA, 2013) where cannabis use, possession and small scale retail sales were decriminalised over 40 years ago (Room et al., 2010). The health problems reported by cannabis dependent persons – e.g. bronchitis and impaired memory – are much less serious on average than those reported by persons who are alcohol dependent (
The long term health risks of regular cannabis use
The long term adverse health effects of sustained daily cannabis smoking are not as well understood as the risks of sustained heavy drinking. This is because there are many fewer daily cannabis smokers than daily drinkers, very few daily cannabis users have smoked for decades, and there have been very few studies of those who have used daily for decades.
It was a reasonable hypothesis in the 1980s that regular cannabis smoking would adversely affect the respiratory system because there were
Regular use and dependence
The most likely short term effect of cannabis legalisation will be a reduction in cannabis price, an effect which, in turn, will probably increase the frequency of use among current users (Hall & Lynskey, 2016a). This is what usually happens when alcohol availability increases or alcohol prices are reduced (Babor et al., 2010; Wagenaar, Tobler, & Komro, 2010). The effects of increased availability and reduced price will be amplified by reduced social disapproval of use, the removal of criminal
Regulating a legal cannabis market
The foregoing analysis indicates that cannabis is a dependence producing drug but it has fewer and generally more modest adverse health effects than alcohol. It is perhaps unsurprising then that those US states that have legalised cannabis have modelled their cannabis regulations on those of alcohol, rather than tobacco, which is subject to stronger regulatory controls. Given the recent history of alcohol regulation, it is unlikely that this approach will minimise the adverse public health
Acknowledgments
This paper was written in response to Jonathon Caulkins’ provocative paper on regulating cannabis as a dependence producing and performance degrading drug at the Marron Institute Cannabis Summit on Science and Policy in New York City in April 2016. I gratefully acknowledge Sarah Yeates’ assistance in preparing this paper for publication and Rachel Barry’s helpful comments on an earlier draft of the paper.
Conflict of interest
I have no competing or conflicting interests to declare that arise from
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2023, American Journal of Preventive MedicineCitation Excerpt :A clear understanding of whether adolescent cannabis use may increase after legalization is critical to inform policy and prevention. Although the use of nonmedical cannabis remains illegal for individuals aged <21 years in all states, legalization of adult use may lead to higher rates of, more frequent, or heavier cannabis use among adolescents through increased availability, removal of legal penalties, increasing potency, decreased perceptions of harm, and increased perceptions of acceptability.7–10 Factors such as removal of penalties and increasing acceptability may result, respectively, in immediate or delayed changes in use―or both.
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2022, International Journal of Drug PolicyCitation Excerpt :The population-based probabilities of PWUC experiencing many of the other identified cannabis-associated adverse health outcomes (e.g., cardio-vascular, reproductive, pulmonary problems) are even smaller. In addition, except for cannabis-related motor-vehicle-crash (MVC) fatalities, cannabis use makes virtually no direct contribution to mortality (especially when compared to the high mortality rates for alcohol and tobacco) (Calabria, Degenhardt, Hall, & Lynskey, 2010; Degenhardt et al., 2018; Drummer, Gerostamoulos, & Woodford, 2019; Hall, 2017). Recent national and global estimates have identified cannabis-impaired driving and related injuries/death – which may include non-using others - and CUD as leading contributors to the cannabis-related disease burden (Degenhardt et al., 2013; Degenhardt et al., 2017; Imtiaz et al., 2016).
Psychosocial and health problems associated with alcohol use disorder and cannabis use disorder in U.S. adults
2021, Drug and Alcohol DependenceCitation Excerpt :People with CUD had two to four times higher odds of interpersonal problems, financial, and legal problems compared with people who had no substance use disorder indicating that the problems associated with CUD are numerous and varied. CUD has been shown to influence multiple aspects of an individual’s life, and interferes with his or her ability to perform social roles in both interpersonal or professional life (Hall, 2017). These results are consistent with literature regarding adverse psychosocial and behavioral consequences of cannabis use among adolescents,(Volkow et al., 2014) which could suggest that these problems persist into adulthood or that adults with CUD experience similar psychosocial problems within their social networks.
Cannabis policies in Canada: How will we know which is best?
2021, International Journal of Drug PolicyCitation Excerpt :Aside from the potential of evidence of benefits from medicinal cannabis, there may be clear health and social benefits if alcohol consumption decreases (substitute) in those who have heavy and problematic alcohol consumption but there may be harms if cannabis consumption leads to increased consumption of tobacco (either on its own or through mixing). In addition to costs to government for the provision of health care, there may personal costs and/ or benefits (or losses) related to low birth weight newborns, anxiety, psychosis, dependence, exposure to second hand smoke, accidents (see, Hall, 2016) for an excellent discussion; also see (Caulkins et al., 2016; Fischer, Russell, Rehm & Leece, 2018; Liccardo Pacula et al., 2014; Shanahan & Ritter, 2014). The population-level administrative data (i.e., health care, education, social services) in many Canadian jurisdictions could be well utilised in combination with data from well-designed survey data monitoring changes in consumption patterns (age of uptake, frequency and quantity) and the impact on public health outcomes (Fischer et al., 2018).