By A.J. Hostetler 

Alcohol can cause serious harm to the liver, especially when consumed heavily or consistently over a long time. Alcohol-associated liver disease (ALD) is one of the leading causes of liver failure and liver-related deaths worldwide. 

Yet, doctors have few effective treatments for the disease other than reducing or stopping alcohol use. But for many people, that’s not easy. Researchers have been searching for new ways to protect the liver from alcohol’s harmful effects. 

Researchers from Virginia Commonwealth University and VCU Health now suggest that one possible clue may come from an unexpected source: cannabis. 

A new study of medical data on more than 66,000 adults nationwide showed that those with alcohol use disorder who also used cannabis were less likely to develop alcohol-associated liver disease than those who did not use products derived from the plant, which include hemp and marijuana. This suggests that certain compounds found in cannabis, especially its chemical compound known as CBD, might play a protective role in the liver. 

If confirmed by clinical trials, these findings, published by the journal Liver International and presented at the annual conference of the American Association for the Study of Liver Diseases, could lead to new treatments for alcohol-associated liver disease. 

Study authors Juan Pablo Arab, M.D., of VCU’s Stravitz-Sanyal Institute for Liver Disease and Metabolic Health (left), and Butros Fakhoury, M.D., VCU Health hospitalist (right), at the annual American Association for the Study of Liver Diseases conference in 2025. (Contributed photo)

What did the study show about this connection between liver disease and cannabis use? 

The research team identified adults diagnosed with alcohol use disorder between 2010 and 2022. They then divided participants into three groups: those diagnosed with cannabis use disorder, cannabis users without signs of dependence and those who did not use cannabis at all. 

The researchers followed these patients for three years after they were initially diagnosed to see who developed alcohol-associated liver disease, experienced liver failure or died from any cause. They also used a statistical method to make sure the groups were similar in age, gender and health conditions, so that differences in outcomes could be more clearly linked to cannabis use. 

The analysis showed a clear pattern:  

• Compared with those who did not use cannabis, patients with cannabis use disorder had a 40% lower risk of developing alcohol-related liver disease.  
• Patients with cannabis use disorder also had a 17% lower risk of serious liver complications and a 14% lower risk of death from any cause. 
• Even people who used cannabis only occasionally had a slightly lower risk of developing liver disease. 

How could cannabis protect the liver? 

This is not the first time that scientists have suspected that cannabinoids could influence liver health. Previous animal studies have shown that CBD may reduce inflammation and oxidative stress in the liver. It may also help liver cells process fat more efficiently, which could prevent fat buildup and inflammation – two early signs of liver injury. 

“CBD appears to calm inflammation and reduce some of the chemical signals that drive liver scarring,” said Juan Pablo Arab, M.D., director of alcohol sciences for VCU’s Stravitz-Sanyal Institute for Liver Disease and Metabolic Health and the study’s senior author. “Our findings show that real-world cannabis use may have some of these same protective effects in people who drink heavily.” 

CBD interacts with the body’s endocannabinoid system (a network of receptors that help regulate pain), metabolism and immune function. The endocannabinoid system also plays a role in liver health, influencing how the body processes fat and responds to injury.

What do these results mean for cannabis users? 

Researchers emphasize that the findings do not mean people should use cannabis to protect their liver. Cannabis use carries its own health risks, especially for young people and those with mental health conditions.  

“This study shows an association, not cause and effect,” said Butros Fakhoury, M.D., VCU Health hospitalist and study author. “Cannabis may have protective properties, but we still don’t know exactly how much, what form or what dose might be safe or effective. The goal isn’t to promote cannabis use, but to understand which parts of it might hold promise as medicine.” 

Fakhoury noted this analogy: Although smoking tobacco is associated with a lower risk of ulcerative colitis, clinicians would not recommend it. The key distinction in this case, he says, is that specific compounds such as CBD can be isolated and studied under controlled clinical conditions.  

“The main challenge lies in determining an appropriate and safe dose, as CBD undergoes metabolism in the liver, which is particularly important for patients with chronic liver disease,” Fakhoury said.

What’s next for research on liver disease and cannabis use? 

The research team hopes to build on these findings by studying specific cannabinoids, such as CBD, in controlled clinical trials. Because CBD does not cause intoxication and is already approved by the U.S. Food and Drug Administration to treat certain seizure disorders, it’s a promising candidate for further study in liver disease. 

Vinay Jahagirdar, M.D., of the VCU Gastroenterology Fellowship Training Program, and visiting medical school student Kaanthi Rama, M.D., were among the study authors. 

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