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Cannabis versus alcohol: A head to head competition!

Let’s compare alcohol and cannabis across five dimensions from safety to cost, and examine which comes out on top, and more importantly, the role that prohibition and lack of regulation play.
Written by
Dr. Amanda Reiman
February 20, 2024

Now that Dry January has come to a close for many, it's a good time to create a discussion about two commonly used drugs: cannabis and alcohol. They have a lot in common in addition to their place at the top of the list of the most widely used psychoactive substances. Both experienced a period of prohibition, and both are plant based. The cannabis plant has been transformed into gummies, tinctures, brownies and more, while one of the closest plant cousins to cannabis, hops, is made into beer. Grapes become wine, and blue agave, tequila. And even though the raw versions of the alcohol bases are not often consumed for psychoactive effects, manufactured cannabis products, including beverages, are a fast growing sector of the market. So, let’s compare alcohol and cannabis across five dimensions from safety to cost, and examine which comes out on top, and more importantly, the role that prohibition and lack of regulation play. 

Product Safety: Winner Alcohol

During alcohol prohibition, fewer people drank, but more people died from drinking tainted alcohol. And while cannabis available in the regulated market is tested for safety and potency, the products that are bought and sold in the unregulated market, including hemp derived products, are largely not. A few years ago, EVALI, a lung disease caused by unregulated cannabis and tobacco vape products, claimed nearly 3000 lives. Delta 8 THC, synthesized from CBD harvested from hemp, is largely unregulated, and a cannabis lab in MA that tested 5000 Delta 8 samples found a contamination rate of 100%. So while natural cannabis, tested for safety, is no more risky to consume than a beer bought at the grocery store, the continued prohibition of cannabis and the existence of unregulated products makes alcohol the winner here.

Lack of addiction potential: Winner Cannabis

According to the 2022 National Household Survey on Drug Use and Health, 10.5% of those 12 and older experienced alcohol use disorder in the past year. And while the number 9% has been thrown around as the rate of cannabis addiction, it is suggested that this number is inflated due to the way cannabis use disorder is defined, often conflating dependence with valid medical consumption. Even if the 9% holds true, it is still a lower rate than alcohol. Furthermore, withdrawals from physical dependence on alcohol can be fatal, while THC withdrawals are often mild and short lived. Because cannabis dependence does not present with the same physical symptoms as other substances, it is important to practice mindful consumption and maintain a healthy relationship with the plant. But, overall, cannabis wins the “less addictive” category. 

Price: Winner Alcohol

Cannabis is expensive. And even though the wholesale price of flower has dropped considerably in the past few years, the excise and additional cannabis taxes still price it higher per unit than alcohol. CANORML did a comparison of excise tax price per unit for alcohol and cannabis in California, and found that 5 oz of wine is assigned a penny in excise taxes, 12 oz of beer costs 2 pennies, 1.5 oz of liquor adds 4-8 pennies in tax, and a .5 gram cannabis joint boasts 80-90 cents in excise taxes. Excise taxes are designed to pay for the societal costs of personal consumption of a certain item. The societal costs associated with alcohol (DUI, assault, domestic violence, long term health problems, overdoses and more) outweigh those caused by cannabis (eating too much pizza?), and yet, by looking at the excise taxes, cannabis is viewed as having nearly 100x the societal harm. This makes alcohol the winner in the price category.

Health Benefits vs. Risks: Winner Cannabis

Last year, the federal government finally confirmed what societies across the globe have known for thousands of years, that cannabis has medical benefits. There was also a time when alcohol, especially red wine, was touted as having medical benefits. However, last year the Mayo Clinic released a statement that no amount of alcohol consumption was without health risk, even though the risks associated with low to moderate drinking are low. And even though claims of cardiovascular benefits from low to moderate drinking still exist, cannabis holds promise as a medicine to treat chronic pain, nausea, insomnia, PTSD, arthritis, epilepsy, MS and a host of other illnesses and symptoms. The secret to cannabis as a medicine lies in our own Endocannabinoid Systems, which release chemicals just like those in the plant. As a result we have receptors throughout the body primed to accept the cannabinoids delivered by the cannabis plant. No such system exists for alcohol. And while cannabis is not without risk, fatal overdose is not one of them, something that cannot be said for alcohol. So, cannabis is the clear winner here.

Social acceptability: Winner Alcohol

As meetings are being held about whether to allow social consumption centers for cannabis, many meeting attendees will rehash their arguments at a local bar. The social consumption of alcohol has been woven into the fabric of American living. Whether at the bar, a ball game, a winery, concert or restaurant, we have festivals and events that celebrate our right to get together in a group and drink alcohol. Early medical cannabis dispensaries included lounges as a crucial component of their operations as the use of cannabis was accepted in very few places. And while that has changed, partly due to more discreet options like gummies and vapes, there still exists very few opportunities to truly use cannabis openly in a social situation outside of a private event. Some localities in legal states have started to embrace the idea of social consumption by allowing and in some cases sponsoring cannabis centric social events. But they still pale in comparison to the Oktoberfests, wine tastings, pub crawls, and other alcohol based social opportunities. The reason seems to mimic that of why we have higher excise taxes on cannabis, which is the perception of public harm. Hopefully, as cannabis continues to become less stigmatized, we will see more options for social consumption. But, for now, alcohol wins this one.

Whether you choose to use cannabis, alcohol, both or neither, it is important to be aware that safety, price, availability and other factors are not always tied to the substance itself. Regulations vs. prohibition play a role in how these substances are used by individuals and their level of acceptance in greater society.

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