Comparative harms assessments for cannabis, alcohol, and tobacco: Risk for psychosis, cognitive impairment, and traffic accident
Drug Science, Policy and Law 2022 DOI: 10.1177/20503245221095228 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Review Peer reviewed |
|---|---|
| Topics | Cannabis |
| Key findings | Argues that the risks of psychosis, cognitive impairment, and traffic accidents associated with moderate cannabis use are generally comparable to those from tobacco use, and that the harms of cannabis and other criminalized drugs are probably exaggerated due to confounding by underlying dysfunction and the composition of the user population under criminalization. |
Abstract
Researchers have associated cannabis use with risk for psychosis, cognitive impairment, and traffic accident. However, this review shows that the association between moderate cannabis use and psychosis is no stronger, and often considerably weaker, than the corresponding association for moderate tobacco use. The same holds for associations with cognitive impairment. For the risk of traffic accident, the review confirms that the risk from alcohol use is substantially stronger than the risk from cannabis use, while the corresponding risk from tobacco use appears to be almost as strong as that from cannabis use. It thus appears that the risk for psychosis, cognitive impairment, and traffic accident associated with cannabis use is generally comparable to that from tobacco use. The article discusses different interpretations of these comparative harms assessments and presents two points of methodological critique to argue that the risks associated with cannabis and other generally criminalized drugs are probably exaggerated. First, any measurement of harms associated with high escapist activities such as drug abuse will be affected by the general dysfunction associated with the underlying reason why a person settles for frequent escapism. From this perspective, cannabis and tobacco use disorder are probably both associated with underlying problems and life issues that are, in and of themselves, associated with psychopathology, and researchers should be careful not to conflate the selection effect from belonging to the population segment that opts for high escapist lifestyles with any (putative) harmful effect from drug use itself. Second, criminalization probably shifts the composition of the user population in the direction of more dysfunctional users. From this perspective, the association between substance use disorder and underlying problems and life issues is stronger for criminalized substances, since people who live troubled lives are less likely to be deterred by the prospect of legal problems.
Comparable studies
Other narrative reviews on cannabis, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Causal association between cannabis and psychosis: examination of the evidence | 2004 | Review | |
| Cannabis sativa: A comprehensive ethnopharmacological review of a medicinal plant with a long history. General (historical and pharmacological review) | 2018 | Review | |
| Psychiatric effects of cannabis | 2001 | Review | |
| Beyond THC: The New Generation of Cannabinoid Designer Drugs | 2011 | Review | |
| Cannabidiol, a Cannabis sativa constituent, as an antipsychotic drug | 2006 | Review |
Citations in the library
Cites 28
- High-potency cannabis and the risk of psychosis The British Journal of Psychiatry November 30, 2009
- Continued cannabis use and risk of incidence and persistence of psychotic symptoms: 10 year follow-up cohort study BMJ March 1, 2011
- Effects of cannabis use on outcomes of psychotic disorders: systematic review The British Journal of Psychiatry October 31, 2008
- Smoked Cannabis' Psychomotor and Neurocognitive Effects in Occasional and Frequent Smokers Journal of Analytical Toxicology March 4, 2015
- Who is ‘Molly’? MDMA adulterants by product name and the impact of harm-reduction services at raves Journal of Psychopharmacology July 10, 2017
and 23 more in the library