Transcript Marijuana - The Lung Association

Respiratory Health Effects
Heather Giroux RRT, CRE
Myth vs Reality

Smoking Marijuana is much better for me
than smoking cigarettes right??
……Inhaling smoke from any burning material is
hazardous to your health!!
Aside from being an illegal substance, people who smoke Marijuana
once or more per week:



Experience more chest colds, bronchitis, emphysema and Asthmatic episodes
Issues with organization, motivation, short-term memory and compromised
decision making
People build up a tolerance to marijuana requiring them to smoke more to feel
the same effects and look to smoke more often
Definition:
n.1.A strong-smelling Asian plant (Cannabis
sativa), also called hemp, from which a number of
euphorogenic and hallucinogenic drugs are
prepared. The euphoric effect is predominantly
due to tetrahydrocannabinol (THC).

Thought by many to be safe because it grows naturally:



Many drugs originate from plants but that doesn’t make
them safe
THC, found in Marijuana is a powerful hallucinogen that can
impair judgment
The 400 other chemicals found in Marijuana can put you at
risk for mouth, esophageal and lung Cancers, COPD and
Immunosuppression
Marijuana vs Cigarettes








Pot, Grass, Weed, Hashish, Hash oil
(eat, smoke or drink)
Originates from the Cannabis plant
Smoke contains more than 400
Chemicals
The main psychoactive ingredient
is Tetrahydrocannabinol (THC)
Illegal uncontrolled substance
Heavy users can become
dependent (less addictive than
tobacco)
Impairs decision making ability,
reaction time, and concentration
Usually unfiltered

Cigarette, Pipe, Cigar, Chew

Originates from the tobacco plant
Smoke contains more than 4000
Chemicals
Nicotine is the addictive ingredient
Legal controlled substance
Addiction can occur after using a
Nicotine product only a few times
(can be more addictive than
Heroin)
Does not impair judgment. Often
used to cope with stress.
Usually filtered






Smoking Marijuana or Smoking Cigarettes
releases dangerous TAR into the Lungs!!!

Smoking: Self-prepared hand-rolled cigarette (called a joint), as a cigar where tobacco
is removed and replaced with Marijuana (called a blunt) or as a water pipe (called a
bong).

Oral Ingestion: Mixed in food, baked in cookies or brownies, cannabis tea or tablet
form for therapeutic purposes (Marinol)
**http://www.bbc.co.uk/news/world-us-canada-14770359

When Smoking from a Joint, Blunt or Bong: The effects appear within a
few minutes and can last up to three hours.

When eating or drinking Cannabis-Containing Substances: At oral
ingestion, the effects are felt approximately within the first hour, but last longer (for more
than 4 hours).
The “High” feeling can be decreased long before THC has been eliminated from the
users body, due to storage in the fatty tissues . After 5-7 days half of the original
dosage remains in the body and it can take weeks or as long as a month for THC to
leave the body completely.

Tolerance: Depends on dose, duration, exposure and metabolism.

Dependence: Developed by regular users.
In comparison
with other psychoactive drugs, the tolerance from Marijuana is milder. The mechanism of
Marijuana’s tolerance is directly related to the receptor regulation process.
Can lead to difficulties stopping usage,
cravings and withdrawal symptoms.

Withdrawal: Symptoms consist of restlessness, irritability, sleep disturbances,
decreased appetite, depression and tremors (heavy users of drug).
Medicinal Use

Medical Uses: Currently the medical use of marijuana is limited, mainly
due to the cannabinoid potency. However, Marinol (dronabinol) is approved
and being used in treating nausea and vomiting after chemotherapy among
patients with cancer, improving appetite of AIDS’s patients who have
developed the “wasting syndrome”, or in treating other disorders, such as:
spinal cord disease/injury, multiple sclerosis, chronic pain, etc.

Marinol:

Health Canada:
It takes over one hour for Marinol to reach full systemic effect,
compared to minutes for smoked or vaporized cannabis. Some patients
accustomed to inhaling just enough cannabis smoke to manage symptoms
have complained of too-intense intoxication from Marinol's predetermined
dosages.
8-10 week processing time to authorize applications for
medical marijuana possession and/or license to produce drug for medical
purposes. NB ranks fourth per capita in the number of people authorized to
possess medical marijuana (as of June 2009)
~ High concentrations of Cannabinoid receptors exist in the Basal Ganglia, Hippocampus and
Cerebellum.
~The Basal Ganglia controls unconscious muscle movements, which impairs motor
coordination when bound to THC.
~ The hippocampus is located within the temporal lobe and is important for short-term
memory. When THC binds with the Cannabinoid receptors inside the hippocampus, it
interferes with the recollection of recent events.
~ Coordination is further impaired when THC binds with Cannabinoid receptors in the
cerebellum.
National Geographic Video: How Marijuana Works
Pulmonary Effects of Marijuana
Inhalation: Lung Function

Studies examining the effect of marijuana smoking on lung function have produced
somewhat variable results. This is likely to be related to the difficulty in obtaining
random samples of smokers and the potential for under-reporting of marijuana use
due to its illegal status.

Overall, the majority of studies suggest that marijuana smoking may be associated
with elevated lung volumes and slightly greater airway resistance but no change,
or an increase, in spirometry values (FEV1 and FVC normal or elevated)

This suggests that hyperinflation may be one of the primary physiological
abnormalities in marijuana smokers. The increased airway resistance and reduced
conductance is consistent with mucosal edema and inflammation, which has been
observed in the large airways of marijuana smokers. The bronchodilating effect of
THC is far outweighed by the irritative effects of marijuana on the airways.

Diffusion capacity does not appear to be effected by solely smoking marijuana but
when marijuana in combination with tobacco are smoked further impairment of
gas transfer has been noted (DLCO normal according to single study). Nitrogen
washout also normal.
Tissue Damage

Smoking 1 or more joints/day has been shown to cause damage to the cells in
bronchial passages (cilia) and to pulmonary macrophages, which protect the
body from inhaled microorganisms. This decreases the lungs ability to fight off
fungi, bacteria and tumor cells.

Reduced lung density noted on high resolution CT.

Video-assisted Thoracic Surgery of 10 marijuana smokers exposed a
predominance of intra-alveolar pigmented histiocytes, interstitial scarring and
irregular bullae and blebs. The tobacco smokers had a relatively minor
accumulation of pigmented histiocytes.
Pneumothorax Risk

Several cases of collapsed lung have been reported among
marijuana smokers. Those at risk tend to have existing
congenital blebs on their lungs, a condition that would remain
otherwise silent (inhaling deeply with breath hold poses risk).

Smoking marijuana produces a 5-fold greater increase in blood
carboxyhemoglobin compared to smoking tobacco, which results
in decreased blood oxygen levels.
Malignancy

One joint has 4 times the amount of the known cancer causing agent,
tar, than a cigarette.

Several reports indicate an unexpectedly large proportion of marijuana
users among cases of lung cancer and cancers of the oral cavity,
pharynx, and larynx.

Marijuana smoke contains a higher concentration of polynuclear
aromatic hydrocarbons than a cigarette, including 50% more of the
carcinogens benzypyrene and benzanthracene, which are known to
produce tumors in certain animal species.

N-nitrosamines, which have carcinogenic potential, are present in both
marijuana and tobacco smoke (roughly equal amounts).
Marijuana Smoking Is Associated with a
Spectrum of Respiratory Disorders:

Two NIDA-funded studies identify health risks that
underscore the importance of curbing marijuana abuse.
Research Findings: National Institute on Drug Abuse Vol. 21, No. 1 (October 2006)
“ Although far fewer marijuana than tobacco cigarettes are generally smoked
on a daily basis, the pulmonary consequences of marijuana smoking may be
magnified by the greater deposition of smoke particulates in the lung due to
the differing manner in which marijuana is smoked. Whereas THC causes
modest short-term bronchodilation, regular marijuana smoking produces a
number of long-term pulmonary consequences, including chronic cough and
sputum, histopathologic evidence of widespread airway inflammation and
injury and immunohistochemical evidence of dysregulated growth of
respiratory epithelial cells, that may be precursors to lung cancer. “
The Journal of American Chemical Society:
Chemical Research in Toxicology

OTTAWA, Dec. 20 (UPI) -- A 2007 Canadian report says
marijuana smoke contains more toxic compounds, including
ammonia and hydrogen cyanide, than tobacco smoke.

Read more: http://www.upi.com/Science_News/2007/12/20/Toxicchemicals-found-in-marijuana/UPI-63301198127783/#ixzz1LDtJavQY

Researchers, including David Moir of the Safe Environments
Program in Kitchener, Ontario, determined ammonia levels
were 20 times higher in marijuana smoke than in tobacco
smoke, while hydrogen cyanide, nitric oxide and certain
aromatic amines occurred at 3-5 times higher in marijuana
smoke.

Ammonia fumes are very irritating and corrosive to the eyes, nose and
airways. Fumes may cause a burning sensation, coughing, wheezing, shortness
of breath, laryngitis, rhinitis and watery eyes, even at low levels.

Breathing highly concentrated ammonia fumes may cause headache, loss of
sense of smell, nausea, vomiting, increased heart rate, and high blood pressure.
Breathing in very high levels may cause pulmonary edema.

Repeated or prolonged exposure to high levels may damage the eyes, liver,
kidneys, and lungs, and may cause bronchitis to develop, with cough, phlegm
and shortness of breath.
http://healthychild.org/issues/chemical-pop/ammonia/
(Chemical Encyclopedia ~ Healthy Child Healthy World)

Frequent exposure of low concentrations have been associated with weakness,
headache, nausea, vomiting, respiratory tract irritation, difficulty breathing,
confusion eye and skin irritation.

Hydrogen cyanide (AC) is a systemic chemical asphyxiate. It interferes with the
normal use of oxygen by nearly every organ of the body.

Breathing highly concentrated hydrogen cyanide fumes may cause seizures,
temporary blindness, shock, arrhythmias, low BP, pulmonary edema and
cardiac or respiratory arrest.
http://www.cdc.gov/niosh/ershdb/EmergencyResponseCard_29750038.html
(National Institute for Occupational Safety and Health)
CONCLUSION

Unfortunately, a large majority of marijuana smokers also smoke cigarettes
so it is difficult to accurately conclude the respiratory effects of smoking
marijuana alone. The illegal nature of Cannabis also makes obtaining data
much more complicated.

Despite this, there is evidence to suggest that regular marijuana smoking is
associated with slightly increased airway resistance, hyperinflation, large
airway edema, chronic cough, sputum production and frequent wheezing.

Numerous studies have also suggested a correlation between marijuana
usage and significant bullous disease in relatively young subjects due to
chemical composition and technique of smoking (ie: breath hold)

Some studies have also suggested an association between lung cancer and
Cannabis smoking.

Inhaling smoke from any burning material is hazardous to your health!!
References:

“For Every High There’s a Low. Be Drug Wise. Straight talk About Marijuana”. Health Canada
Publication, 2005. www.hc-sc.gc.ca.

“Pulmonary Effects of Marijuana Inhalation: Literature Review”.
www.medscape.com/viewarticle/738255_3

http://healthychild.org/issues/chemical-pop/ammonia/

National Geographic Channel “How Marijuana Works” video. www.video.nationalgeographic.com.

http://cyber.law.harvard.edu/evidence99/marijuana/Health_1.html

https://www.achievesolutions.net/achievesolutions/en/Content.do?contentId=454

http://www.cdc.gov/niosh/ershdb/EmergencyResponseCard_29750038.html

Effects of Marijuana Smoking on Pulmonary Function and Respiratory Complications: A Systematic
Review. Arch Intern Med. 2007 Feb. 12; 167(3): 221-228.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2720277/
•
http://www.medicalmarihuana.ca/for-patients/who-is-eligible
•
http://dailygleaner.canadaeast.com/cityregion/article/1053900