I fell in love with the cannabis plant in my early 20’s. We just “get” each other. She knows what I need to feel better and I trust her as a medicine and as a wellness companion. When I first started consuming cannabis, there was really just one way to do that, smoking. Sure, pot brownies would pop up every so often, but during prohibition, there was no standardized edible product and many times you were left feeling nothing, or too high to function. Smoking was easy, convenient, and although it was smelly, it was the way cannabis was consumed back then. This relic of prohibition persists even in light of the bevy of products available in the legal marketplace. According to the 2023 Consumer Survey from New Frontier Data, 60% of current consumers say that smoking flower is their most frequent method of consumption and 21% said edibles. Old habits die hard. People who grew into cannabis by smoking it are likely to continue that route because they feel comfortable with it and know what to expect. Not to mention the fact that the act of smoking in and of itself can become a habit, whether it is cannabis or tobacco. But, what is interesting is that, according to the survey, when likely consumers are asked about what method they would choose if they decided to use cannabis (these are folks who have never consumed but are open to it), 71% said they would choose edibles and only 22% say they would choose flower. This is almost the exact opposite of how current consumers are using cannabis. This tells me that there is at least some lasting impact of prohibition on how current consumers use cannabis, and for those coming into the regulated market as first timers, smoking is not as appealing. Maybe they are onto something.
After 27 years of being a several times a day cannabis consumer, at the beginning of 2023 I stopped smoking completely. I made this decision for a few reasons. One, I didn’t like the lingering smell after I smoked a joint, which was reminding me more and more of a post cigarette aroma that clung to my hair, clothes and fingers. I didn’t like the resinous tar that I saw build up on my pipe that I knew was making its way into my lungs. My voice, a huge asset in my role as a public speaker and educator, was becoming raspy and throat clearing was a common part of any talk I was giving. My teeth, something I painfully went through years of orthodontia to straighten, were yellowing, and my gums had become red and sensitive. I had been a part of several research studies looking at the health risks of secondhand cannabis smoke, and the results gave me pause about smoking in an environment with my beloved pets. All of these experiences culminated in the decision to take 28 days away from cannabis completely, and then to come back to it as a non-smoker. Because I really like the immediate effect of inhaling cannabis and enjoy the ritual of hand to mouth consumption, I chose to use a dry flower vaporizer. At first, I felt like maybe I wasn’t getting as high as I did from smoking. I realized that was likely because I was missing my usual cue of coughing as a way to initiate intoxication. Once my brain got over that, I have never looked back, and the results have been pretty amazing. After 6 months of not smoking, my voice is clear, my teeth and gums are bright, I no longer have the lingering smell of burnt plant matter following me around, and instead of seeking a place to clandestinely smoke cannabis when I am out and about, I can whip out my Pax pretty much anywhere for a quick hit and no one is the wiser. Interestingly, after almost 3 decades of smoking, being away from it for 6 months has completely taken away its appeal. That’s my personal experience. But if you want to know more about what the science says, keep reading.
Cannabis smoke may impact oral health in a few ways. First, the smoke itself contains toxins that can permeate the gum tissue making it more susceptible to bacteria. Also, the side effect of dry mouth can exacerbate this effect. A 2020 study reviewed 23 papers on the relationship between cannabis smoking and oral health and found a significant relationship between cannabis smoking and the health of the periodontium, which is the supporting structure for the teeth. The review also suggests that smoking cannabis is an underlying risk factor for other oral diseases, but the research in that area is not as robust. A 2008 study of 903 adults looked at the relationship between cannabis smoking and periodontal disease. The researchers found that the “high cannabis exposure group” (defined as having 41 or more cannabis smoking sessions in the previous year), had a significantly elevated occurrence of periodontal disease, even after controlling for tobacco use, gender, socioeconomic status and other related factors.
Now thankfully, research seems to support that smoking cannabis does not hold the same risks for lung cancer and COPD as smoking tobacco. However, one reason for this is that cannabis smokers do not smoke as much as tobacco smokers and these diseases take time to manifest in the body. However, smoking cannabis has been linked to lung inflammation and respiratory issues. A 2002 study developed a cannabis smoke extract that could be administered in vitro (into the lungs) and found that the extract induced an inflammatory response in human lungs. A 2022 study looked at the small airway function of 895 participants. Participants’ cannabis use was assessed between the ages of 18-45 and small airway function was measured between the ages of 38-45. Researchers found that small airway dysfunction was associated with joint years among participants at age 45. This effect was stronger for women than for men. The researchers also concluded that this effect was potentially reversible as use of a bronchodilator weakened the association between cannabis smoking and small airway dysfunction.
With the discussion of cannabis consumption lounges (which I completely support), it is important to address the public health risks of secondhand cannabis smoke exposure. While exposure may not be an issue for patrons of a lounge since they are there for a short time, workers who may be in the lounge for several hours at a time may be at risk. A 2021 study measured the PM2.5 emissions from joints, glass pipes and bongs in a residential setting. PM2.5 emissions are made up of very tiny particles that cannot usually be seen, but can embed themselves deep into the lungs. The researchers found that joints produced the largest levels of PM2.5 which was 3.5 times the average emission rates for the same quantity of Marlboro cigarettes. The emission rate for the bong was 67% that of the joint, and the pipe was 44% that of the joint. A PM2.5 rating of over 500 is considered more than hazardous. The researchers in this study found that joints had a mean rating of 540, bongs were 361 (in the hazardous range) and pipes were 294 (on the lower end of the hazardous range). While all methods presented a hazard from the secondhand smoke, not all were created equal. Choosing to use a glass pipe rather than a joint may reduce exposure to PM2.5.
I know that this is not what a lot of folks want to hear. But, as you know, I am a harm reductionist. If giving up your bong or joint completely is a non-starter, there are things you can do to reduce the potential harms of smoking your cannabis.
I’m not here to harsh your buzz. I understand why smoking flower is the preferred method for so many people, as it was for me for nearly three decades. But, we have other options now, and we have research informing us on the risks of smoking cannabis. It is up to us to decide what to do with that information. It is all part of developing a healthy relationship with the beautiful plant cannabis.
