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Published: March 22, 2004
Newshawk: Rick Bayer
Pubdate: Fall 2004, Issue 31, September 1, 2004
Source: Alternatives Magazine (Eugene, OR)
Author: Rick Bayer, MD
Contact: mailto:editor@alternativesmagazine.com
Website: www.alternativesmagazine.com
Article: www.alternativesmagazine.com/31/bayer.html
Physicians' Perspective
Medical Cannabis Update: Smokeless Marijuana
By Dr. Rick Bayer
Oregonians passed the Oregon Medical Marijuana Act (OMMA) in 1998 and will
vote this fall to upgrade the OMMA. [Vote Yes on Measure 33, discussed
elsewhere this issue.]
Most Americans support medical cannabis (marijuana) and agree patients
should not be arrested for using marijuana under medical supervision.
Nevertheless, the most criticized aspect of medical marijuana is the smoke.
The question is, can patients benefit from cannabis without inhaling smoke
and the cancer-causing agents (carcinogens) created when plants combust?
Th ere are no studies showing cannabis smoking causes cancer or emphysema,
but cannabis smoke contains measurable carcinogens. We know smoking
marijuana can cause irritated airways (bronchitis) with cough and chest
pain. The prestigious Institute of Medicine issued a report in 1999 agreeing
cannabis is medicine but expressing concern about smoke. The highest risks
for long-term cannabis smoking are seen in regular users, including
patients.
In the past, if one needed immediate benefit from cannabis to control
vomiting, one had to smoke it. Eating cannabis or swallowing FDA-approved
Marinol (synthetic THC) requires an hour to work. Smoking works almost
immediately and so is attractive to those seeking immediate relief from
pain, spasm, nausea, etc.
Fortunately, there is an alternative to smoking cannabis called vaporizing
that avoids nearly all carcinogens but offers the rapid relief previously
found only by smoking. Cannabis releases medicinal vapors above 140°C
(284°F) but doesn't release benzene and other carcinogens until it reaches
200°C (392°F) and will not combust (release smoke) until it reaches 230°C
(446°F).
This means if a device gently cooks cannabis at 140° to 190°C (284° to
374°F), one can inhale the herbal medicine in the smokeless vapor without
inhaling the carcinogens found in smoke.
Fortunately, smokeless cannabis inhalers are available now. If you know
patients who smoke cannabis, make sure they know about vaporizers. At my
website www.omma1998.org, link to the medical cannabis bibliography and look
under scientific articles online for a detailed discussion of vaporization
and vaporizers.
Why don't all patients use them? The primary obstacle is cost, with the best
vaporizer being over $500. Hopefully, as medical cannabis becomes more
accepted, relaxation of paraphernalia laws will combine with product demand
to make vaporizers affordable.
Another obstacle is some persons do not tolerate inhaling any medicine. Even
asthma inhalers irritate our airways, taste bad, and take practice to use
correctly. The vapors from standard medical cannabis are almost entirely
botanical/natural THC, which does not cause cancer or emphysema but can
irritate airways.
One way to minimize risk of irritation to airways is to ingest cannabis by
mouth to control predictable symptoms and inhale vaporized cannabis to
control unpredictable symptoms. This would include “breakthrough pain” or
pain that occurs in spite of the regular dosing of oral pain medicine. This
type of protocol would be consistent with modern pain treatment standards.
Like other dried powdered herbal medicines, one can easily make capsules
from cannabis after heating 10 or more minutes at about 100° C or 212° F.
The mild heating activates raw cannabis by removing a carbon dioxide
molecule. But if one uses too much heat, the medicinal components vaporize.
Heat activation occurs during the process of vaporizing, smoking, or cooking
cannabis, but for capsules, it's useful to activate the cannabis before
ingestion to make it more potent and digestible.
Even on an empty stomach, oral cannabis takes an hour to work but lasts 4 to
6 hours. The cost of cannabis capsules for most OMMA patients is pennies
compared to synthetic pharmaceutical THC (Marinol) that can cost more than
$20/pill and is without biologically active compounds naturally found in
botanical cannabis. One can only hope the ability to grow one's own medicine
will increase access to medicine for Oregonians as the Oregon Health Plan
shrinks and drug costs continue to skyrocket.
Treatment of pain or other symptoms in any patient routinely requires
adjustments or titration of dose. Cannabis offers an advantage because no
lethal overdose exists, which makes it safer than standard pain treatment
medicine offered by the pharmaceutical industry. Cannabis represents a
legitimate alternative in many treatment situations. If risks of smoking are
removed, the risk of cannabis is the same as THC described at
www.marinol.com
With harm reduction technology like vaporization, economy of growing one's
own medicine, and no lethal overdose from cannabis; patients and doctors
have another tool to ease human suffering.
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Rick Bayer, MD is board-certified in internal medicine and a fellow in the
American College of Physicians. His is co-author of Is Marijuana the Right
Medicine For You? A Factual Guide to Medical Uses of Marijuana.
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