Melissa Egan and her wife, Kasha, enjoy kicking back with some craft beverages and tasty appetizers on the weekend. But forget wine and cheese—this Toronto couple prefers cannabis drinks and edibles.
“I’ve found cannabis to be very useful, particularly this year, because it’s a relaxing experience; it’s a unifying experience rather than something that makes me feel aggressive or overly emotional,” says Egan.
That “something” is booze, which Egan rarely touches.
The 45-year-old used to reach for sangria or a gin and tonic after work, but when she hit her mid-30s, and perimenopause, she started to really feel it—in a bad way. Alcohol exacerbated her hot flashes, insomnia, night sweats, nausea, dizziness and stomach issues. And then there were the hangovers.
“If I had three drinks on a Friday night, I wouldn’t feel like myself until Sunday afternoon. That’s a waste of a weekend,” says Egan. “I thought, ‘Why am I drinking? I’m not actually getting what I want from it in the moment. And in the aftermath, it feels pretty bad.’”
Around the same time, she started seeing Kasha, who introduced her to a medical cannabis grower and high-quality product. Egan realized that cannabis, just like alcohol, helped her relax, socialize and have a giggle, but without the negative side effects. In fact, she says, cannabis has eased many of her perimenopause symptoms, particularly nausea and insomnia. Today, she uses cannabis daily, both recreationally and therapeutically.
Now that recreational cannabis is legal in Canada, more people have the option to go “California sober” by trading booze for weed. The percentage of women who use cannabis recreationally at least once a month has been inching up since legalization in 2018, according to federal government stats. Meanwhile, the portion of women who drink alcohol at the same frequency dipped for the first time in several years. Today, about 58 percent of women drink alcohol and 15 percent use cannabis on a monthly basis or more frequently.
Statistics Canada has said that the increase in cannabis consumption is likely because the drug has become more socially acceptable, and the number of retail outlets and products has been growing. Another reason could be that many women, like Egan, think that cannabis is better for their physical and mental health. But is cannabis really a healthier choice than alcohol? The answer seems to be yes, but with plenty of caveats.
Rebecca Jesseman is director of policy at the Canadian Centre on Substance Use and Addiction (CCSA), an NGO that aims to reduce the harms of substance use. She finds it difficult to say whether cannabis is less harmful than alcohol, in part because there is much more research about the clear harms of alcohol use.
It’s also because the substances are so different: “[It’s] like comparing apples and oranges,” says Jesseman. “I think it’s really important to start by recognizing that both substances pose health risks and can be used in unhealthy ways that can lead to dependence.”
Individual factors, such as how often you consume your drug of choice and in what strength and quantity, are all relevant. There’s a big difference between having a couple of glasses of wine on Saturday night and a few martinis every evening; similarly, certain strains and forms of cannabis are stronger than others (say, high-THC hash compared with CBD oil), and certain consumption methods (think smoking rather than eating) are more harmful to your health. Genetics and any underlying health issues can also play a role.
Jesseman also cautions that it was difficult to study cannabis before it was legal. “We’ve had decades and generations to look at the health impacts of alcohol use, whereas we’re just starting to scratch the surface on that evidence for cannabis use,” she says.
Despite that, some experts have made up their minds. “Cannabis isn’t a harmless herb, but alcohol is far more dangerous, and the harms it causes are far more prevalent and costly,” says Tim Stockwell, a scientist at the Canadian Institute for Substance Use Research (CISUR) at the University of Victoria. Stockwell co-leads the Canadian Substance Use Costs and Harms project, a collaboration between CCSA and CISUR that estimates the social, health and economic costs of substance use in Canada. The researchers found that, in 2017, the most recent year for which data is available, about four times as many women used alcohol than used cannabis, but booze caused 15 times as many deaths and hospitalizations.
While Stockwell acknowledges that more research is needed into the health effects of cannabis, he points out that there have been many longitudinal studies of people who use it. “If there was a huge problem, we’d likely know about it,” he says.
The highs and the lows
Alcohol and cannabis deliver many of the same desired effects: They can help you unwind, relax, socialize and have fun. They can also have some of the same immediate health harm; most notably, impairing you physically and mentally.
“When you’re impaired, you’re not making decisions in the same way that you usually would,” says Jesseman. “So, doing something that is safety-sensitive, whether that’s driving or even recreational activities, could result in injury.”
If you consume too much cannabis, you may become anxious or paranoid, whereas too much booze may make you irritable or aggressive. Both can cause nausea and vomiting. But while you can’t die from a cannabis overdose, alcohol poisoning can be fatal. Stockwell adds that consuming alcohol and cannabis at the same time can intensify the negative effects. “The combined effects are worse than the sum of the parts,” he says. “There seem to be some nasty interactions.”
Too much booze can lead to a hangover, whereas too much cannabis can make you feel burnt-out. Both can affect your sleep. Research shows that alcohol at any dose can help you fall asleep faster, but it can also disturb your sleep later in the night. Again, research into cannabis and sleep is in its infancy, but a 2017 review of studies by researchers at the VA Palo Alto Health Care System in California found that CBD may help treat insomnia, while THC, like booze, may help you fall asleep faster but can lead to disturbances later on.
When Egan drank, she’d conk out, no problem, but wake up in the middle of the night and not be able to get back to sleep, making the next day that much worse. “If you’re hungover, only having two or three hours of sleep isn’t very helpful,” she says, adding that she got “killer” hangovers but hasn’t experienced cannabis burnout. Today, she has a THC-dominant vape pen by her bed, which she reaches for if she can’t sleep. “Having a few little puffs on that will relax my body and my mind enough to lead me to sleep” for the rest of the night, she says.
Chronic use and chronic conditions
The latest Canadian Substance Use Costs and Harms report lists health conditions that can be wholly or partially attributed to substance use. While alcohol is implicated in dozens of chronic conditions, including many that are fatal, the research, so far, indicates that cannabis only plays a role in a handful. Most notably, alcohol increases your risk of more than half a dozen types of cancer, including breast cancer.
“There’s a slight increase in risk of cancer at even one drink of alcohol a day,” says Stockwell, adding that the evidence that occasional cannabis users are at a higher risk of cancer “isn’t very convincing,” but “there’s definitely a reason for concern and caution.”
Smoking cannabis does make you more likely to get lung and tracheal cancer. Stockwell says cannabis smokers can reduce their risk by consuming the drug in another way, such as vaping. While there was an outbreak of lung injuries and deaths associated with vaping in 2019, the U.S. Centers for Disease Control and Prevention has linked the outbreak to vitamin E acetate, an additive in some illegal vapes. Stockwell encourages people to get their supplies from legal retailers to ensure they’re safe.
Alcohol can also cause several heart, digestive and endocrine conditions, while cannabis hasn’t been definitively linked to any—yet. Jennifer Brasch, lead of addiction psychiatry for the mental health and addictions program at St. Joseph’s Healthcare in Hamilton, Ont., says alcohol can induce or exacerbate mood and anxiety disorders and contribute to dementia.
Cannabis also increases the risk of developing psychotic disorders, such as schizophrenia, and leads to earlier onset, although Brasch says there is debate around whether the drug causes psychosis, or the people who would develop psychosis anyway are more likely to use it. Still, she encourages women with a family history of such disorders to be cautious about using cannabis. “Whether it’s a chicken or an egg, certainly avoiding a psychotic disorder should be a priority,” she says.
Brasch adds that both alcohol and cannabis should be avoided during pregnancy and breastfeeding. It has been well-established that drinking during pregnancy can lead to a long list of physical, behavioural and intellectual issues, and some research suggests that using cannabis can lead to low birth weight and learning challenges in childhood.
A drink or toke a day keeps the doctor away?
If you’ve been holding out hope that red wine is good for your heart, Stockwell has some bad news: “There are like 20 different reasons and types of scientific analysis that say that rather lovely idea is a false one,” he says. Moderate drinkers are healthier than abstainers in many ways—they’re more likely to exercise, eat well and not have any disabilities—and so their good health outcomes likely have “nothing to do with the alcohol.”
While scientists have been looking into whether cannabis can help treat a wide range of health issues—such as alcohol-use disorder, perimenopause symptoms and even COVID-19—they typically conclude that more research is needed. Still, people in the cannabis industry often jump on early positive results to push their products and services.
“Cannabis is being promoted for lots of health conditions, but the evidence is pretty skimpy,” says Brasch, who is also co-chair of the medical advisory board of the Michael G. DeGroote Centre for Medicinal Cannabis Research. “There’s no ‘Well, there’s no evidence, so don’t use it.’ It’s ‘There’s no evidence, so give it a try. Maybe it will help!’ ”
Randomized controlled trials, the gold standard in medical research, are needed to accurately determine the potential benefits and harms of cannabis. Brasch is one of more than 220 people from the scientific community who recently sent an open letter to Health Canada asking that permissions to do such studies become easier to obtain, noting that Canada’s estimated million-plus medical cannabis users aren’t being served well by “major gaps in evidence.”
Medical cannabis patients most commonly use the drug to treat chronic pain and mental illness, and randomized controlled trials on people with these conditions have been done in other countries. So far, the research suggests that while a lot of people think cannabis is helping, the scientific evidence doesn’t always back them up. One of Brasch’s colleagues recently did a review of trials on cannabis use for chronic pain and found that while 62 percent of people who received cannabis reported relief, so too did 52 percent of those who received a placebo. It’s likely that only about 10 percent of people truly experienced reduced pain thanks to cannabis.
If you’re thinking of trying cannabis to treat a health condition, Jesseman urges you to consult a health care practitioner and not the internet. “Google is not a doctor,” she says.
And whatever you kick back with this weekend, all of the experts recommend sticking to Canada’s low-risk guidelines: Women and men should have no more than two alcoholic drinks a week. Everyone should limit their cannabis consumption to occasional use, such as one day a week or on weekends, avoid smoking and use products with low THC content.
“Make sure you use restraint in the use of both,” says Stockwell. “A little bit of either is probably okay. Neither is entirely risk-free, but a lot of things in life aren’t.”
This article was originally published online in August 2021.