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Alcohol and cannabis: Comparing their adverse health effects and regulatory regimes

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Abstract

The claim that the adverse health effects of cannabis are much less serious than those of alcohol has been central to the case for cannabis legalisation. Regulators in US states that have legalised cannabis have adopted regulatory models based on alcohol. This paper critically examines the claim about adverse health effects and the wisdom of regulating cannabis like alcohol. First, it compares what we know about the adverse health effects of alcohol and cannabis. Second, it discusses the uncertainties about the long term health effects of sustained daily cannabis use. Third, it speculates about how the adverse health effects of cannabis may change after legalisation. Fourth, it questions the assumption that alcohol provides the best regulatory model for a legal cannabis market. Fifth, it outlines the major challenges in regulating cannabis under the liberal alcohol-like regulatory regimes now being introduced.

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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