Madeleine R. Kelly is a writer, poet and journalist residing in Toronto, Ontario. 

Many people suffer from the invisible illness of substance abuse and addiction, and alcohol is the most common culprit. In the year 2000, 3.5% of all deaths in the United States could be attributed to alcohol. Do you know how many deaths have been attributed to cannabis? Zero.

If you’re not familiar with the profiteering motives of the pharmaceutical industry, you may be surprised that cannabis hasn’t yet been fully embraced by the medical community for its many therapeutic uses. Meanwhile, highly addictive substances like benzodiazepines and opiates are welcomed with open arms, even sometimes pushed onto patients who are already struggling with drug abuse and addiction problems.

benzodiazepines and alcohol withdrawal

In fact, benzodiazepines are commonly prescribed to treat symptoms of alcohol withdrawal, even though mixing them with alcohol is dangerous and possibly lethal. Doctors are happily prescribing a substance which they know could kill their alcohol-dependent patient if they were to relapse, despite the well-established fact that cannabis can relieve the same symptoms without any of the physical health risks. However, some experts continue to claim there simply isn’t enough research available to justify using cannabis as a substitute for benzodiazepines when treating people suffering from alcohol addiction.

Well, the research that we do have is very promising, and common sense tells us that it’s probably better to give someone a substance that ​cannot​ kill them, over prescribing a medication that ​could ​kill them should they relapse, if there is evidence that it would have similar benefits.

Not only could prescribing benzodiazepines kill a patient if they relapse, it could also add to their existing dependency issues by causing an addiction to benzodiazepines in addition to alcohol. Withdrawal symptoms stemming from alcohol or benzodiazepines can lead to seizures, coma, or death. The withdrawal symptoms related to cannabis consist of trouble sleeping, strange dreams and angry outbursts. So, cannabis is incontestably less harmful than benzodiazepines ​and alcohol.

Despite echoed claims bemoaning lack of data, there is a significant amount of evidence dating back to 1970 that cannabis can be used to relieve symptoms of alcohol withdrawal. In fact, it may even help users in treatment to complete their programs, or help users to wean themselves off, compared to those who did not use medical cannabis.

Cannabis as a substitution

Studies show that medical cannabis users frequently substitute the plant in exchange for a drug they feel would be more harmful to them. Substitution means that an individual chooses to use one drug instead of another drug due to reasons like perceived safety, addiction potential, symptom relief, level of social acceptance and access.

Substitution therapies for tobacco and heroin dependence have been available for decades, namely nicotine replacement therapy and methadone, respectively. Right now, there is no similar substitution therapy for those suffering from alcohol dependence and addiction.

If cannabis is a viable substitution for alcohol, should people have the right to choose it instead of another, potentially more harmful, prescription alternative?

Weighing Harms

The majority of studies I reviewed determined that cannabis use actually reduces alcohol use and related harms. None of the studies suggested that cannabis was more harmful than alcohol. A growing number of studies suggest that people tend to use cannabis ​in place​ of alcohol, although some studies suggest that using alcohol and cannabis together may lead to more substance abuse overall compared to the use of either one alone.

But, unlike with alcohol and benzodiazepines, cannabis cannot cause an individual to overdose. Plus, combining cannabis with alcohol does not lead to higher blood or breath alcohol levels, so it can’t increase the risk of alcohol overdose, either. In contrast, we know that mixing alcohol and benzodiazepines, which are routinely prescribed to treat symptoms of alcohol addiction, can be lethal.

While researchers remain skeptical, existing research is generally optimistic that in the (hopefully near) future, cannabis can be used as a form of substitution therapy for patients struggling with alcohol abuse and addiction. Certainly, cannabis provides a less harmful option for patients, when compared to highly addictive prescription alternatives such as benzodiazepines.

References

Benzodiazepines for Alcohol Withdrawal. Addiction Center. https://www.addictioncenter.com/alcohol/benzodiazepines-alcohol-withdrawal/. Accessed January 15, 2019.

Chick J, Nutt DJ. Substitution therapy for alcoholism: time for a reappraisal? J Psychopharmacol. 2012;26:205–12.

Poulos CX, Zack M. Low-dose diazepam primes motivation for alcohol and alcohol-related semantic networks in problem drinkers. Behav Pharmacol. 2004;15:503–12.

Reiman A. Cannabis as a substitute for alcohol and other drugs. Harm Reduct J. 2009;6:35.

Subbaraman MS. Can cannabis be considered a substitute medication for alcohol?. Alcohol Alcohol. 2014;49(3):292-8.

Swartz R. Medical marijuana users in substance abuse treatment. Harm Reduction Journal. 2010;7:9.

US Food and Drug Administration. FDA Drug Safety Communication: Warning against use of Xyrem (sodium oxybate) with Alcohol or Drugs Causing Respiratory Depression. 2013. http://www.fda.gov/Drugs/DrugSafety/ucm332029.htm​.