Legalization of Marijuana and How it Affects Respiratory Health

 Updated: April 29, 2020

young person with e-cig

by Mary Martinasek, PhD, RRT, and Angelica Deleon

What is Marijuana?

Marijuana is one of the most used illegal drugs in the United States with an increasing popularity due to state legalization. Marijuana is a psychoactive drug derived from the Cannabis plant. Marijuana contains hundreds of cannabinoids including tetrahydrocannabinol (THC), the primary component of the mind-altering effects equated with use. In the world of “ganja,” it is very well known that the higher concentration of THC in what is being ingested or inhaled, the stronger and longer the effects will last.

There are three basic classifications of marijuana called strains, these include Sativa, Indica and Hybrid. Sativa is known for making the user feel focused and creative with a “head high,” while Indica is known for bringing serenity, calmness, and relaxation through a “body high.” Lastly, a hybrid is a mixture of both strains producing an “uplifting” effect from both mental and physical stimulation, but the feeling mainly depends on which strain is more dominant.

Types of Inhalational Marijuana

New ways of smoking marijuana have developed over the years causing uncertainty of safety. Inhalational marijuana is a much faster route of uptake as compared to edibles and topicals. Marijuana can be inhaled in several ways, including rolling it with tobacco or cigarette paper (blunt), using a bong or a bowl, heating concentrated THC wax in a water pipe type device (dabbing), or smoking liquified THC wax from a cartridge like a vape device (vaping). Marijuana strength is measured by the body’s uptake. Inhalational marijuana is the easiest method of consumption to control as the desired effects are more immediate.

Cannabidiol or CBD is another cannabinoid. CBD does not cause the psychoactive effects like THC. CBD oil-based vapes are a common source of inhalation. Vapes or pens are electronic cigarette-like devices with a heating element that produces an aerosol or vapor from the liquid. Dabbing is a more contemporary method of consuming high amounts of concentrated THC. Dab, also known as butane hash oil (BHO) is concentrated THC made by pouring a solvent-like butane on the marijuana that allows the THC to leave the plant and dissolve into the butane that after a filtering process, results in a sticky oily substance referred to as wax. Dabs are typically heated on a very hot surface to temperatures as high as 400 degrees Celsius and are used with water pipes, oil pipes or glass bongs. Torches are used to heat the object the user will smoke from, torch-less methods of dabbing include electronic nails (e-nails) to provide temperature control.

Short Term Side Effects of Marijuana

Marijuana use carries with it known short term and long terms effects. Marijuana smoke contains many of the same carcinogens and chemicals found in tobacco smoke and can lead to similar negative cardiorespiratory compromise including airway inflammation. Cannabis is associated with bronchodilation, cough, wheeze and phlegm production.

Exposure to secondhand marijuana smoke can impair endothelial function. There have been reported cases of acute eosinophilic pneumonia associated with marijuana smoking. BAL procedures have been used as the confirmation of elevated counts of eosinophils. Marijuana smoke is an irritant to the lungs and throat. With the current coronavirus and Covid-19 pandemic, early reports from China indicate that individuals who smoke have a 14.3 times greater odds of disease progression than individuals who do not smoke.

Respiratory and general health complications caused by dabbing are related to the residual solvents and pesticides that can be present in different batches of wax depending on how it was made. “Dirty oil” or a bad batch of wax can contain chemical contaminants or too many residual solvents that may present health hazards to users via inhalation. Some cartridges used for vape pens contain toxic chemicals such as vitamin E acetate, derived from vitamin E which is good for skin and oral consumption, but not safe to inhale. Vitamin E acetate is strongly associated with E-cigarette, or vaping, product use-associated lung injury (EVALI). Cases ending in hospitalization or death currently exceed 2,800 in the U.S. alone there have been 68 confirmed deaths. Other constituents in dabbing have been associated with acute hypersensitivity pneumonitis.

The risks of vaping CBD oil are unsettling because of the lack of regulation and little testing into the exact constituents. Many extracts sold in vape pens and cartridges are diluted with other substances, such as medium-chain-triglyceride, or MCT, oils (fats that are frequently derived from natural sources such as coconut oil). While these are known to be safe to eat, there’s little if any evidence that it’s safe to vape them, despite some manufacturers touting them as an all-natural ingredient and including them in the product.

Long-Term Side Effects of Marijuana

Long-term respiratory effects of marijuana are centered around decreased lung function, an increased risk of bullous emphysema and an increased odds of lung cancer. Marijuana-only smokers had greater associations for basal cell hyperplasia than tobacco-only smokers. Cannabis use has been associated with hyperinflation and increased large airway resistance.

Because cannabis smokers may be cigarette smokers also, studies have made efforts to control or hold constant cigarette smoke to evaluate the direct long-term effects of marijuana. In one study, heavy cannabis use was associated with a 2.12 association of lung cancer risk after adjusting for tobacco use and respiratory conditions. In another study, using marijuana for greater than 30 joint-years was positively associated with oral, lung and esophageal cancer but no positive association after controlling for cigarette smoking. One joint-year is equivalent to smoking 365 joints. Other studies have found no associations with lung cancer. More research is needed in this area.

Although the verbiage is different, marijuana smokers can become addicted, however the terminology used is “dependence” as a substance use disorder. In 2018, nearly 4.4 million people aged 12 years or older had a marijuana use disorder in the past year.

Legalization of Recreational Marijuana

Currently there are 11 states that have legalized recreational marijuana use for individuals over the age of 21 years and older (Washington, Oregon, Nevada, California, Colorado, Illinois, Michigan, Vermont, Maine, Massachusetts and Alaska) and 33 states that have legalized medical marijuana.

Despite individual states legalizing marijuana, the federal laws continue to prohibit the use of marijuana and have since 1937. The United States Drug Enforcement Agency labels Marijuana (Cannabis) as a Schedule 1 drug through the Controlled Substance Act of 1970.

Schedule 1 drugs are defined as “drugs with no currently accepted medical use and a high potential for abuse.” The U.S. Food and Drug Administration (FDA) does not recognize nor approve marijuana as a medicine.

References

  1. United States Drug Enforcement Administration. Drug Scheduling. https://www.dea.gov/drug-scheduling
  2. National Institute on Drug Abuse. https://www.drugabuse.gov/publications/drugfacts/marijuana-medicine
  3. National Institute on Drug Abuse for Teens. https://teens.drugabuse.gov/blog/post/how-legal-marijuana
  4. Centers for Disease Control and Prevention. Smoking and Tobacco use. https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html
  5. Richman, L. S., Whitaker, J., & Kinnard, W. V. (2018). A Case of Acute Hypersensitivity Pneumonitis Due to Cannabis Dabbing. In D35. Drug Induced Lung Disease: Case Reports (pp. A6636-A6636). American Thoracic Society.
  6. Oleson, E. B., & Cheer, J. F. (2012). A brain on cannabinoids: the role of dopamine release in reward seeking. Cold Spring Harbor perspectives in medicine, 2(8), a012229.
  7. Martinasek, M. P., McGrogan, J. B., & Maysonet, A. (2016). A systematic review of the respiratory effects of inhalational marijuana. Respiratory care, 61(11), 1543-1551.
  8. Substance Use and Mental Health Services Administration. https://www.samhsa.gov/find-help/atod
  9. Wang, X., R. Derakhshandeh, J. Liu, S. Narayan, P. Nabavizadeh, S. Le, O. M. Danforth, K. Pinnamaneni, H. J. Rodriguez, E. Luu, R. E. Sievers, S. F. Schick, S. A. Glantz and M. L. Springer (2016). “One Minute of Marijuana Secondhand Smoke