In a matched cohort of over 33,000 people with alcohol use disorder, those with cannabis use disorder had a 40% lower risk of developing alcohol-associated liver disease and lower mortality.
Hepatologists, addiction medicine specialists, ALD treatment researchers.
40% lower risk of alcohol-related liver disease with cannabis use disorder (HR 0.60)
What the researchers found
Compared to non-cannabis users, those with CUD had a 40% lower ALD risk (HR 0.60), 17% lower decompensation risk (HR 0.83), and 14% lower mortality (HR 0.86). Cannabis users without CUD had lower ALD risk but similar decompensation and mortality.
Why it matters
Alcohol-associated liver disease is a leading cause of liver death with limited treatments. The dose-response pattern suggests cannabinoid system modulation may genuinely protect against alcohol liver injury.
The numbers in context
33,114 matched per group. CUD vs non-CU: ALD HR 0.60, decompensation HR 0.83, mortality HR 0.86. CU vs non-CU: ALD risk lower but decompensation and mortality similar.
How the study worked
Propensity-matched cohort using TriNetX (2010-2022). Adults with AUD categorized into CUD, cannabis use, and non-cannabis use. Outcomes over 3 years via Cox regression.
What this study cannot tell us
Observational; cannot prove causation. Healthy user bias possible. CUD based on ICD coding. Concurrent factors not captured.
How to read the evidence
Large propensity-matched cohort with dose-response pattern, but observational design and potential healthy user bias limit causal conclusions.
When this study was published
Published in 2025, data 2010-2022.
The bigger picture
Preclinical data suggest CBD reduces alcohol-induced liver injury. This large clinical dataset supports the hypothesis that the cannabinoid system could be a therapeutic target for ALD.
Questions still open
- Which cannabinoid drives the protective effect? Would targeted cannabinoid drugs replicate this without cannabis-related harms?
Common questions
Can cannabis protect the liver from alcohol damage?
Should people with alcohol problems use cannabis?
Read the original research
The Cannabinoid System as a Potential Novel Target for Alcohol-Associated Liver Disease: A Propensity-Matched Cohort Study.
Liver international : official journal of the International Association for the Study of the Liver, 45(11), e70401
Citation
Fakhoury, Butros; Jahagirdar, Vinay; Rama, Kaanthi; Hudson, David; Wang, Wei; Díaz, Luis Antonio; Arab, Juan Pablo. (2025). The Cannabinoid System as a Potential Novel Target for Alcohol-Associated Liver Disease: A Propensity-Matched Cohort Study.. Liver international : official journal of the International Association for the Study of the Liver, 45(11), e70401. https://doi.org/10.1111/liv.70401
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