Cannabis vs. Alcohol, Tobacco & Opioids: Are We Comparing the Risks Fairly?

Beyond the Headlines: Cannabis, Science & Public Health | Part 1

By Jesse Christianson, DNP, AGPCNP-BCFounder, Dr. Murse / CannabisDNP

Are We Asking the Right Questions?

We hear plenty about the dangers of cannabis.

Addiction. Impairment. Overdose. Long-term health consequences. These are legitimate public health concerns, and they deserve serious discussion. But here's something I've been thinking about as a healthcare professional:

Are we evaluating cannabis using the same scientific standards we apply to alcohol, tobacco, opioids, and other commonly used substances?

Or are we comparing completely different types of risk and treating them as though they tell us the same thing?

As a Doctor of Nursing Practice and board-certified Nurse Practitioner, I believe meaningful education begins with asking better questions.

So, let's examine what U.S. public health research actually tells us.

What Does the CDC Tell Us?

The Centers for Disease Control and Prevention (CDC) tracks the health consequences associated with substance use throughout the United States.

And some of those numbers deserve a closer look.

🚬 Tobacco: More Than 480,000 Deaths Annually

According to the CDC, cigarette smoking and secondhand smoke exposure cause more than 480,000 deaths annually in the United States (Centers for Disease Control and Prevention [CDC], 2024).

These deaths are largely associated with long-term consequences, including cardiovascular disease, chronic respiratory illness, and cancer.

Tobacco's greatest public health burden isn't typically acute poisoning. It's what repeated exposure can do to the body over years or decades.

🍺 Alcohol: Approximately 178,000 Deaths Annually

Research published in the CDC's Morbidity and Mortality Weekly Report estimated that excessive alcohol consumption contributed to approximately 178,307 deaths annually during 2020–2021 (Esser et al., 2024). Those deaths included both acute and chronic consequences. Alcohol can contribute to liver disease, cardiovascular complications, certain cancers, injuries, and fatal alcohol poisoning. And unlike withdrawal from many other substances, severe alcohol withdrawal can itself become life-threatening. Yet alcohol remains a widely accepted part of American social culture.

That contrast is worth examining.

💊 Opioids: Tens of Thousands of Fatal Overdoses

Opioids present another substantial public health concern. According to provisional CDC data, approximately 44,564 opioid-involved overdose deaths occurred in the United States during 2025 (National Center for Health Statistics [NCHS], 2026). That's a decline from the preceding year, but it remains a significant loss of life. We also have the challenge of newer and stronger synthesized opiates becoming available in unlicensed markets.

Opioids can suppress respiratory drive, causing potentially fatal respiratory depression.

It's also important to recognize that prescription opioids, heroin, and illicitly manufactured fentanyl do not have identical risk profiles.

The substance, dose, tolerance, and presence of other drugs all influence the likelihood of harm.

🌿 Cannabis: A Different Acute Toxicity Profile

Cannabis presents a different picture. Fatal poisoning attributable to cannabis alone is exceptionally rare compared with fatal opioid overdose. However, that does not mean cannabis is harmless. Cannabis exposure can produce significant adverse effects, including severe intoxication, anxiety, confusion, impaired coordination, and cardiovascular symptoms.

Cannabis use can also contribute to injuries, impaired driving, and accidental pediatric exposures.

Dose, THC concentration, route of administration, frequency of use, and individual susceptibility all matter.

Lower fatal overdose risk does not automatically mean lower risk in every other category.

And that's where scientific comparisons become particularly important.

Here's Where the Numbers Can Become Misleading

Look at the statistics we just discussed.

• Tobacco mortality estimates largely reflect chronic disease and long-term exposure.

• Alcohol-attributable mortality includes both acute and chronic consequences.

• Opioid overdose statistics primarily measure fatal acute drug toxicity.

• Cannabis-related harms include intoxication, impairment, dependence, and other outcomes that are not adequately captured by a single fatal-overdose figure.

  
  

These are not identical measurements.

And we shouldn't pretend they are. A substance may carry a substantial risk of dependence without having the same fatal overdose potential as opioids. Another may have a relatively low acute overdose risk but contribute to chronic disease after years of repeated exposure.

Still another may create significant risks through impaired judgment, hazardous use, or interactions with other substances. So when someone asks, "Which substance is safer?", my response is another question:

Safer in what way?

Are we discussing addiction? Fatal overdose? Long-term organ damage? Mental health?Impaired driving? Or the effects of repeated exposure?

Until we define what we're measuring, a simple ranking can tell us very little.

Three Questions We Should Be Asking

If we want a meaningful comparison of cannabis, alcohol, tobacco, and opioids, I believe we need to examine three separate areas.

1. Addiction and Dependence

How frequently do problematic patterns of use develop? How severe can they become? And are we appropriately distinguishing physiological dependence from a clinically significant substance use disorder?

2. Acute Toxicity and Fatal Overdose

What happens when someone consumes too much? What mechanisms produce serious injury or death? And how often do those outcomes occur?

3. Long-Term Health Consequences

How do age, frequency, dose, route of administration, and individual susceptibility influence health outcomes over time?

These questions require different types of research. They also require us to acknowledge the limitations of the available evidence.

The Dr. Murse Perspective

For me, this discussion isn't about defending cannabis or pretending it doesn't carry risks.

It's about scientific consistency.

If we're going to educate consumers, inform healthcare decisions, or develop public health policies, we should be willing to examine all substances through a balanced, evidence-informed lens.

That means recognizing established harms, questioning assumptions, and acknowledging where research remains incomplete.

At Dr. Murse / CannabisDNP, that philosophy extends into our approach to cannabinoid education and intentional formulation.

Every ingredient should have a purpose. Every formulation should have a scientific rationale. And every consumer deserves information that helps them make informed decisions.

Because stronger isn't necessarily smarter.

Not Stronger. Smarter.

Doctor-Formulated. Nurse Practitioner-Owned.

🔬 Coming Next: Is Cannabis Use Disorder Really the Same as Addiction?

Here's something to consider before our next discussion.

If someone uses cannabis regularly for a medical purpose, develops tolerance, or experiences withdrawal when stopping, does that automatically mean they're addicted?

Not necessarily.

Yet the distinction between tolerance, physiological dependence, and cannabis use disorder is frequently overlooked.

In Part 2 of Beyond the Headlines: Cannabis, Science & Public Health, we'll examine how cannabis use disorder is diagnosed, what U.S. prevalence statistics actually measure, and why medical cannabis use introduces important clinical considerations.

Are we accurately identifying problematic cannabis use, or are we sometimes confusing expected physiological adaptations with addiction?

Let's examine the evidence.

🌐 Continue exploring cannabinoid science, educational articles, and our intentionally formulated products at www.cannabisdnp.com.

References

Centers for Disease Control and Prevention. (2024, September 17). Cigarette smoking. https://www.cdc.gov/tobacco/about/

Esser, M. B., Sherk, A., Liu, Y., & Naimi, T. S. (2024). Deaths from excessive alcohol use—United States, 2016–2021. Morbidity and Mortality Weekly Report, 73(8), 154–161. https://doi.org/10.15585/mmwr.mm7308a1

National Center for Health Statistics. (2026, May 13). U.S. overdose deaths decrease for third consecutive year in 2025. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/pressroom/releases/20260513.html

Disclaimer: This article is provided for educational purposes and does not constitute individualized medical advice. Comparative substance-related mortality statistics measure different health outcomes and should not be interpreted as a direct ranking of overall substance safety.