Alcoholism is a devastating disease that is responsible for the deaths of roughly 88,000 people a year, not to mention the 9,967 deaths due to alcohol-impaired driving. Alcoholism, or alcohol use disorder (AUD), is diagnosed by several symptoms, including, to name a few: drinking more than intended; inability to quit despite the desire to do so; craving; and, perhaps the most dangerous (if you are a heavy drinker) is potentially deadly withdrawal effects. There are several pharmaceutical treatments designed to treat alcoholism, such as naltrexone, acamprosate, disulfiram, and topiramate. However, only about 9% of AUD patients receive pharmacological treatment, according to a 2018 review published in JAMA, and rates of recidivism have not been adequately studied.
Medical marijuana has a lot of anecdotal evidence suggesting it helps everything from glaucoma, inflammation, rheumatoid arthritis, to cancer, to name a few. However, the scientific-based evidence is slowly coming together to divide the real medicinal effects versus hearsay. For example, according to a post in this newsletter, scientists have demonstrated a role for medical marijuana in treating opioid addiction. On the other hand, medical marijuana has called into question its claims to aid in autism; whether it can lead to addiction; and whether it can cure cancer (although its use as a palliative has been documented). Based on the evidence showing how medical marijuana can help keep opiate addicts in treatment, is their evidence that it could help patients with AUD stay off the wagon?
Much like methadone substitution-treatment for heroin, a few studies on the usefulness of medical marijuana have focused on its use as a drug substitute. In a clinical review published in 2014 which compared whether medical marijuana made a better substitute than alcohol found that it does seem to reduce harm (a critical component for a substitute drug) when substituted completely for alcohol. The caveat is that, if these two substances are consumed together, this can lead to greater adverse consequences than if either is taken alone.
Another study looking at a clinical population of patients with comorbid depression and AUD found that marijuana did not have any beneficial effects, and may have even worsened patients' depression. This study concluded that marijuana would not be a good treatment for this particular population. What seems even more dismal for the potential of medical marijuana is the finding that patients who are in treatment for alcoholism, and who also used marijuana, had worse treatment outcomes (as measured by the number of days to relapse) than those patients who did not use marijuana.
While the evidence-based research is mixed, it appears, at least for now, that the best way to use marijuana to treat AUD is to substitute the former for alcohol. Although it is important to remember, many people with AUD already smoke marijuana. Furthermore, they may be suffering from comorbid disorders such as depression or schizophrenia. This comorbidity only muddies the waters for research on medical marijuana for AUD treatment. Thus, even if marijuana has been touted as "safer" than alcohol, it may not be the best idea to try to wean alcoholics off the bottle by handing them a joint.
Sources: LabRoots.com, Journal of Developmental and Behavioral Pediatrics, National Institute on Drug Addiction, sciencebasedmedicine.org, National Institue on Alcoholism and Alcohol Abuse, www.pgdf.org, www.aafp.org, JAMA, Alcohol and Alcoholism, Psychiatry Research, Addiction, BusinessInsider.com