Interaction of Alcohol and Marijuana

With the recent legalization of recreational marijuana in Colorado and

Washington, there have been many questions regarding the harmful
consequences we may expect to see in coming years as well as how it will
affect our pharmacy profession. Although the main active ingredient, -9tetrahydrocannabinol (THC), has been the focus of a decent number of
research papers, there is still a lot more information that needs to be
researched about its psychoactive and pharmacological effects as both a
medicinal and recreational drug. The greatest challenge of dealing with
marijuana as a future pharmacist is that there has not been nearly enough
research conducted on marijuana and its short and long term psychological
and physiological effects. However, one particularly concerning aspect of
the legalization and increasing use of marijuana is its interaction with alcohol
as well as the consequences of acute and chronic use.
Marijuana and alcohol users are known to exhibit both decreased
inhibition and motor control. Although many studies have researched the
actions of chronic alcohol users, a study by Moreno, et al., investigated the
behavior and actions of binge drinkers and recreational marijuana users.
They found that recreational marijuana users had similar increases in
impulsivity and sensation-seeking behaviors as binge drinkers but neither
group displayed any psychopathological symptoms. When posed with a
problem, a significant number of users in both groups chose to make
disadvantageous choices compared to the non-drug group. Thus, it could be

concluded that the degree of risky behavior will greatly increase with the
legalization of recreational and medicinal marijuana. If and when medical
marijuana is legalized in Maryland, it will be crucial for pharmacists to
educate patients on what precautions to take and what they need to be
aware of.
Since the risk-taking driving behavior under the influence of alcohol
has been a very big issue in todays society, a study by Downey, et al.,
investigated the combined effects of marijuana and alcohol on a persons
driving ability. While marijuana and alcohol use both impair driving, they
showed that there was an additive impairment effect of alcohol and
marijuana when used together. Additionally, chronic cannabis users under
the influence of alcohol alone were shown to have significantly more
compromised driving than non-chronic users.
While sensation-seeking was increased in both binge drinkers and
cannabis users, those in the marijuana group had a significantly increase in
acting upon these drives, or experience-seeking. Furthermore, cannabis
users had a significantly higher number of errors while performing tasks and
additional impaired behavioral inhibition. The Moreno et al study concluded
that increased impulsivity lends itself to a greater risk of chronic drug abuse
because these marijuana users will have developed a pre-existing
vulnerability to drug abuse and eventually dependence. In addition,
marijuana use, especially during a time of physical and psychological
maturation, has been linked to future unstable and psychotic symptoms.

While it is important to be aware of the consequences of the drug,

pharmacists first need to stay up-to-date on the local, state, and federal laws
regarding medical (and recreational) marijuana. An article in AJHP by
Seamon et al. commented on how the role of pharmacists will need to adapt
to the changing legislation regarding marijuana, particularly if it has been
legalized in ones practicing state. Patients will need to be screened for
potential drug interactions including alcohol, as mentioned earlier in the
paper. They also need to be informed of side effects such as motor
impairment, reduced inhibition, psychological effects, weight gain,
respiratory problems, and possibility of addiction.
References
1. Bostwick JM. Blurred boundaries: the therapeutics and politics of
medical marijuana. Mayo Clin Proc. 2012;87(2):172-86.
2. Downey LA, King R, Papafotiou K, et al. The effects of cannabis and
alcohol on simulated driving: Influences of dose and experience. Accid
Anal Prev. 2013;50:879-86.
3. Moreno M, Estevez AF, Zaldivar F, et al. Impulsivity differences in
recreational cannabis users and binge drinkers in a university
population. Drug Alcohol Depend. 2012;124(3):355-62.
4. Seamon MJ, Fass JA, Maniscalco-feichtl M, Abu-shraie NA. Medical
marijuana and the developing role of the pharmacist. Am J Health Syst
Pharm. 2007;64(10):1037-44.