To smoke or not to smoke? If you want to reap the potential therapeutic benefits of cannabis while protecting your health, you've probably pondered the safety of smoking. Although a joint has long been the quickest and most convenient method of ingesting cannabis, mounting evidence suggests that regularly smoking weed is linked to many undesirable effects on the respiratory system.
When it comes to health, knowledge is power. Becoming informed about the pros and cons of smoking cannabis empowers you to determine whether smoking is the right choice for your body or not.
The benefits of smoking as a delivery method
In a 2016-2017 JAMA survey of 169,036 patients who used cannabis for medical conditions, 77.5% reported that they favored smoking as their preferred delivery method. In a 2019 survey published in Gerontology and Geriatric Medicine, both medical and recreational users identified smoking as their favorite way of ingesting the plant.
It's no coincidence that diverse cannabis users choose to smoke weed; it boasts several benefits over other delivery routes. However, it's vital to acknowledge that most data exploring the benefits of smoking is based on subjective evaluations from cannabis users, rather than clinical studies.
Rapid onset of effects
Smoking cannabis results in near-instantaneous effects on the body. When marijuana is inhaled, the smoke travels down into the lungs, through the alveoli (air sacs), and directly into the bloodstream where it is carried to the brain, organs, and body tissue. THC becomes detectable in plasma seconds after the first inhalation and absorption peaks within approximately five minutes. The psychoactive effects of cannabis can be felt in mere minutes, peak after about thirty minutes, and last up to three hours.
For medical cannabis users looking to alleviate their symptoms rapidly, smoking provides more rapid relief than other administration methods. In a 2013 international survey of almost 1000 participants published in the Journal of Psychoactive Drugs, individuals reported the most satisfaction with smoking as providing the fastest onset of action.
Ease of managing and titrating
Cannabis is notorious for being tricky to dose. Different cultivars vary in the cannabinoid concentration. It can affect individuals distinctively depending on factors such as tolerance and body weight. Like a lot of medications, THC has a definitive therapeutic window where it can achieve the desired outcome before adverse effects start kicking in. Smoking can make it easier to manage dosing with greater predictability because smoking provides more rapid feedback to the user than other ingestion methods.
The same Journal of Psychoactive Drugs survey mentioned above found that smoking scored the highest for ease of dose titration, while orally-administered cannabis scored the lowest. When cannabis is ingested orally, THC is converted into a metabolite called 11-hydroxy-THC, which can produce a more enduring, intense high. Homemade edibles can be particularly volatile with respect to delivering consistent, predictable doses. Experienced cannabis smokers can regulate their dose to maximize the desired effects and minimize the less desirable ones, although newbie smokers may find this more challenging.
Bioavailability refers to the actual percentage of the active ingredient that reaches its target destination. Smoking offers between two and 56% bioavailability. In comparison, the bioavailability of oral THC is estimated to be between 10 and 20%.
Cannabis users consistently identify enjoyment, relaxation, and euphoria as critical motivations for favoring smoking over other delivery routes. A 2016 Harm Reduction Journal study exploring medical cannabis use in Canada found that users associated smoking with greater enjoyment and the experience of whole-body euphoria.
The downsides of smoking as a delivery method
Despite the benefits that are associated with smoking, there are numerous risks and downsides that must also be acknowledged.
Respiratory illnesses and compromised respiratory function
The risk of lung inflammation and respiratory illness constitutes a real health risk for smokers, especially those who smoke regularly. Cannabis smoke contains some of the same chemicals found in cigarette smoke, such as carcinogens, tar, bronchial irritants, and carbon monoxide. The tar in cannabis joints contains higher concentrations of benzanthracene and benzopyrenes, which are both known carcinogens, than what is found in tobacco.
Cannabis smokers often face more significant risks than tobacco smokers as they typically inhale more deeply, for a longer duration, and at higher temperatures. Smoking cannabis is associated with at least a threefold increase in the amount of tar inhaled, with one third more tar retained in the respiratory tract.
Studies show that smoking cannabis can compromise pulmonary function and increase respiratory symptoms. Chronic cannabis smoking has been linked to coughing, wheezing, shortness of breath, sputum production, chest tightness, exacerbated asthma, and the development of chronic bronchitis. There's also evidence suggesting that regular cannabis smokers are at a heightened risk of airway infections, COPD, reduced lung function, and lung cancer (though the evidence for lung cancer has been inconsistent).
In the 2016-2017 study of 169,036 medical cannabis users mentioned above, participants with respiratory conditions indicated a higher prevalence of marijuana use. For example, adults between the ages of 18 and 34 with COPD were almost three times more likely to report using marijuana than their peers without COPD. The authors suggested that chronic marijuana use could possibly contribute to this and other respiratory comorbidities.
However, some detrimental effects associated with smoking may be reversible. Those who quit smoking cannabis reported rates of chronic bronchitis symptoms similar to those who had never smoked.
Duration of effects
Another downside associated with smoking cannabis is that the effects don't last as long as other delivery routes. Edible highs last anywhere from four to eight hours on average. According to a 2016 study, not only does oral ingestion offer significantly longer-lasting analgesic effects, it may also be less intoxicating than smoking when delivered in safe, consistent doses.
Loss of THC in side-stream smoke
One's toking technique strongly influences the quantity of cannabis that is actually inhaled. As much as 80% of THC can be lost in side-stream smoke. Inexperienced users are likely to receive less potential benefits.
Questions to ask yourself and your doctor before starting a cannabis regimen
If you're thinking of smoking cannabis for pain relief, to manage symptoms related to autoimmune disorders, or as a treatment for other conditions, consider talking to a doctor experienced in cannabis medicine. There are a number of factors to take into consideration when deciding on whether to smoke cannabis, opt for another delivery method, or rule out cannabis entirely (for example, if it dangerously interferes with your other medications).
First, how often will you be using cannabis? Patients who frequently use cannabis might benefit from considering other administration routes due to the dangers associated with regular smoking. Patients with existing respiratory illnesses may require a safer delivery method.
While we still need long-term research into the effects of vaping, research suggests it offers comparable benefits to smoking and may be safer. Oil-based vaping is a delivery method that heats cannabis oil that the user inhales. Following the outbreak of vaping-associated respiratory illness in 2019, however, it's essential to be discerning and stick to purchasing vapes and vaping paraphernalia from licensed retailers or medical dispensaries.
One of the most underutilized and potentially beneficial administration routes is whole-plant vaporization using a handheld or desk-top device. Today there are many options when it comes to purchasing a whole-flower vaporizer, and whole-flower vaporization is unlike smoking in that it contains far fewer toxic and carcinogenic compounds. Vaporized flower is also more economical and environmentally friendly than vaping cannabis oils, which often come in single-use, non-recyclable devices. Although more research is needed, whole-plant vaporizing appears to deliver all the benefits of inhaling cannabis with the fewest health risks (compared to either vaping oil or smoking).
Other issues, such as cost, convenience, and ease of dosing, should also figure in your conversation with a medical professional.
Major contributions from Dr. Adie Rae.