Quality & Science

Is Marijuana Safer Than Alcohol?

by Richard G. Soper, MD, FASAM, DABAM | February 13, 2014

Are we talking about direct effects of alcohol vs. marijuana? Are we talking about alcohol-associated diseases vs. marijuana-associated disease? Are we talking about auto injuries and fatalities associated with driving under the influence of either drug? Are we talking about short-term or infrequent use relative to long-term use? Are we talking about how use of either drug leads to incarceration, and how race is superimposed by law enforcement?

Is marijuana safe? No, there’s no such thing as absolute safety. And we’ll definitely be learning more as Colorado and Washington conduct their experiments with lawful sales of recreational marijuana. NIH’s National Institute on Drug Abuse (NIDA) cites a published survey study that found that, “6.8 percent of drivers, mostly under age 35, who were involved in accidents tested positive for THC; alcohol levels above the legal limit were found in 21 percent of such drivers.”

Excessive alcohol use was responsible for 88,000 U.S. deaths every year between 2006 and 2010, costing the economy $224 billion according to a January 10, 2014 report in the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report (MMWR). That’s up from 75,766 alcohol-attributed deaths in 2001.  

Eighty. Eight. Thousand. People. That’s the equivalent of half of the citizens of Providence, Rhode Island being wiped out each year. That information was just from the first sentence of the MMWR report. The primary purpose of the study was to discuss the trends in health professional counseling of patients about their alcohol use. Nationwide, only 1 in 6 patients reported such an experience, even though Alcohol Screening and Brief Intervention (ASBI) had been recommended by public health officials since 2004. Increased application of this program, whose costs are now to be covered under the Affordable Care Act, is expected to improve treatment of alcohol-related illnesses.

Richard G. Soper,MD, FASAM

ASAM Weekly Editor-in-Chief


Leave a comment
  1. Jim Gibson May 24, 2018 - 08:37 PM
    Marijuana is safer than alcohol because there are no fatalities associated with cannabis use. I mean direct cause. I have been growing marijuana for personal use using what I learned through www.learngrowingmarijuana.com. You provided a very helpful info here!
  2. Doug Hanshaw Feb 26, 2014 - 11:43 AM
    Anyone who conflates the worst case scenario they see in treatment with the normal MJ experience must've been stoned for their statistics class as well as the one on research design.  Pointing to a few reefer madness outliers does nobody any good, except prohibitionists.  Intoxicants are with us to stay, and the sooner we admit the fact the sooner we can focus on helping the minority of cannabis users who actually need help.
  3. Peter Banys, MD, MSc Feb 21, 2014 - 08:34 PM
    Whether or not ASAM agrees with decriminalization or even legalization of marijuana, that train has left the station. The American public has grown fatigued with nearly a century of demonization of marijuana. More and more states will legalize. Countries in Europe, Latin, and South America are equally exhausted by the failed international War on Drugs; and, for them marijuana regulation/taxation is the beginning of a repudiation of a War on Drugs that has mostly devolved to a War on Users. And, in America it has fueled a massive incarceration industry. The next public policy discourse that is needed is not about marijuana, it is about making much-needed distinctions between soft and hard drugs.
  4. Tim Cermak Feb 20, 2014 - 07:37 PM

    ASAM's Natioinal Drug Policy states "ASAM supports public policies that would offer treatment and rehabilitation in place of criminal penalties for persons who are suffering from psychoactive substance dependence or abuse and whose only offense is possession of a dependence-producing drug for their own use."

    Does it make sense to support criminal penalties for people who use marijuana but do not satisfy the criteria for dependence or abuse? What sense does it make not to punish addiction, or even abuse, but to arrest and prosecute recreational / social use? 

    Marijuana has risks, not as great as alcohol for most people, but it does have substantial risks for a minority who use it. Do we have any hard evidence that adding the risk of an arrest record (with all the damage this can do to career, educational funding and access to other social services) reduces the rate of abuse and dependence?

    Let's begin to put the emphasis where it should be. Marijuana is a health problem for many, but not for most. Making it a potential legal problem for all has bred more contempt for the law, racial disparities in enforcement and distrust of the government than necessary.

    Treatment, not incarceration, has been the guiding light for ASAM for years. It is time to follow this principle to its logical conclusion - the decriminalization of marijuana.

  5. Bill Carrick Feb 20, 2014 - 04:50 PM

    I am glad to see so many lucid comments about this editorial and the use and misuse of Cannabis / MJ. MJ has been acculturated in the US over the past 100 years. Like Alcohol, MJ is widely used by many, and like Alcohol misused by some. The eventual decriminalization and legalization of MJ by all states is a fait accompli. It's time the addiction industry recognizes this fact and prepares for it pro-actively rather than pretending it still may not happen. 

  6. David Cooke Feb 20, 2014 - 04:38 PM

    I don't think anyone can rationally argue that marijuana is more dangerous than tobacco or alcohol.  That is not the same as saying that marijuana is safe, however, or that legalization is a good idea.

    While certainly more harmful than marijuana, outlawing tobacco or alcohol is unlikely to ever work (and didn't work with alcohol) because both are ubiquitous and deeply entwined in American culture.  Marijuana does not have this degree of cultural tradition, and I think that measures to prevent this are wise.  Our drug wars have not had the degree of success that was hoped for, and have had many unintended consequences, but I'm not sure that unrestricted access is the solution, either.

  7. Sarz Maxwell Feb 19, 2014 - 01:21 PM

    Thank you Richard, and all the rest who recognize the insane injustice of our drug use mores and laws.  Carnage?  Carnage isn't done by marijuana but by Marlboros!  Yet you can still buy tobacco products at any pharmacy (though thankfully CVS is planning to stop).

    As long as marijuana (and all other intoxicating drugs, from Xtasy to cocaine to prescription opiates) are illegal to imbibe, we have NO WAY to control their sale to and use by youngsters, who definitely can be harmed by early chronic use of marijuana (or tobacco, or alcohol, or high-fructose corn syrup).  If 10% of the budget for incarcerating marijuana users alone were available for addictions treatment ... well, that would be a good start, yes?

    The law has persecuted people with primary psychiatric disorders since the Spanish Inquisition.  Can't we try to be just a bit more enlightened than they were?

  8. Marcey Shapiro Feb 19, 2014 - 11:42 AM

    As a physician in a state (California) where medical cannabis has been available for many years, I am pleased to see ACAM taking a more level headed look at this important medicinal plant and its social and addictive ramifications. I offer a few reality check observations: 1. There is currently NO blood test for active THC in the blood. Finding it indicates use within 7 days, in regular users, and within 24 hours in occasional users. The presence of THC in blood is not a test of intoxication. Presumably, many of those positive for THC were not actually "high."  2. The study does not mention how what percentage of those who  tested positive for THC were also drunk. There has been no clear link established between cannabis consumption and hazardous driving, other than mildly impaired reaction times. However many law enforcement officials have noted that cannabis consumption before driving (which I am, of course, NOT advising!) may lead people to drive more slowly and carefully. 3. Much of the suffering and jail time from cannabis has been from incarceration of users and small time truncations. This has been an enormous burden on our justice system, taking time away from investigation and prosecution of more serious crimes. Selective prosecution has also been widely documented, not only among African Americans, but also among cannabis advocates and social dissidents. I look forward to the continued discussion, but support full legalization, and hope there are many medical studies of the potential benefits of responsible use of cannabis. 

  9. Andrea Barthwell Feb 19, 2014 - 10:51 AM

    The miscarriage of justice in the black community is due to a lot of factors, never have I once considered that out was due to the legal status of marijuana.

  10. Christian ONeil Feb 19, 2014 - 10:45 AM
    Having someone in the field who believes that cannabis is CAUSING "absolute carnage" is actually quite frightening to me.  There is carnage in our culture allright, though excessive cannabis use is a symptom of it, an attempt to alieviate it, not the cause of it. 
  11. Lee H, Beecher, MD, FASAM Feb 19, 2014 - 03:53 AM

    Minnesota, along with other states, is considering legislation legalizing "medical marijuana" during its coming 2014 legislative session. We're in the process of examining the wisdom or folly of expanding access to marijuana by claiming medical indications or simply nixing prohibition.

    I think most ASAM members support decriminalizing citizen use and possession of marijuana, want the devepoment of and access to better tools to assess functional and psychiatric impairments caused by THC, want the technical ability to monitor the effect of THC on driving, pilot readiness, etc., and want payment reforms to improve access to physician addiction specilialists. We also strongly support educational efforts in schools and general society much as we favor education about alcohol misuse because marijuana use can be dangerous and cause profound harm as we who treat patients know so well. 

  12. John Alves MD Feb 18, 2014 - 06:54 PM
    I am a Family Physician that has been treating Opioid Dependency for the past 8 years. I agree with Dr. Bunt's opinions. I have also worked in the Prison System for 20 years and have seen first hand the destruction of 'productivity, creativity, enthusiasm, and attachment to others' in many individuals. And yes, mostly black and Hispanic people. In light of the clear and objective facts that Cannabis, in comparison to other mind altering substances, is RELATIVELY safe, social justice cries for decriminalization of marijuana. We do have a lot to learn from WA and CO and must remain objective and politically unbiased in looking at future data, and if needed, social policy can be tweaked.
  13. Richard Bunt, M.D. Feb 18, 2014 - 01:30 PM

    As a Psychiatrist who actually subspecializes in treatment of substance use disorders (currently serving as Medical Director at a rehab facility), I have to say that in my years of outpatient, inpatient, and Psych ER practice I have seen - quite literally - THOUSANDS of patients with primary and secondary alcohol use disorders (not to mention thousands of patients with iatrogenic problems created by long term use of prescription benzodiazepines - mentioned here due to the cross reactivity with alcohol, and certain subsequently shared consequences of long term use) whereas I have encountered less than a dozen or so patients with primary THC use disorders.  With due acknowledgment to Dr. Robbins for what is surely a valid - if, in my opinion, just a bit overstated - point, I would also have to say that I've really not seen a huge number of secondary THC use disorders which were of a clinically significant degree of intensity.  I'm CERTAINLY NOT saying that THC or ANY recreational drug us is without negative consequences.  All that being said, I do believe that in a society where we are willing to accept alcohol use, we are simply being inconsistent and hypocritical to legislatively demonize THC.

  14. Joe Troncale Feb 18, 2014 - 11:43 AM

    Facts are generally the first casualty of war.

    Working with addicts on a daily basis and seeing the absolute carnage caused by marijuana on the current 18-25 year old generation makes "rational" an absurdity.


  15. Arnold Robbins Feb 18, 2014 - 09:15 AM
    In my busy psychiatric practice I find the chronic use of Marijuana having exceedingly negative effects on the lives of paients, to the point where they become almost untreatable.  A knowledge of developmental psychodynamics is crucial to seeing the emptiness and aimlessnes that habitual use of marijuana can lead to.  Comparisons with  chronic alcohol use are apt.  But chronic use of alcohol more often comes with crises, that often lead to change through treatment.  With chronic marijuana use there are no such crises, just a quiet decline and withdrawl from productivity, creativity, enthusiasm, and attachments to others which is most destructive in my eperience.
  16. Alan Wartenberg Feb 18, 2014 - 08:51 AM

    I am pleased to (finally) see a rational piece about cannabis in an ASAM publication.  I would remind Dr. Soper, however, that President Obama did not say that marijuana was "safer" than alcohol, but that it was certainly no more dangerous than the already-legal alcohol (as well as tobacco).  The continued prohibitionist views, as well as the near-hysterical tone taken by the ASAM white paper on cannabis, continue to promote a policy which has led to the squandering of our resources, as well as a large proportion of our population, and particularly those of color, into the criminal justice system.  We must be part of the solution in ending this madness, not a continuing part of the problem.

    Leave a comment