CANNABIS CULTURE – Last week, I wrote an article on Smart Approaches to Marijuana’s approach to cannabis legalization. One of the things that really stood out for me was the the motto “Preventing another big tobacco’. So, I thought to do a bit of a side-by-side comparison, and see if cannabis really is another big tobacco …

Toxicity

As I’ve written in ‘Busting the Overdose Myth’, cannabis is pretty much one of the least lethal plants on this planet. Even raw potatoes are more toxic! Nicotine, on the other hand, is possibly as toxic as cyanide (with some caveats). The median lethal dose of nicotine is 0.5 to 1.0 mg/kg, or 40 to 60 mg in an average human being. There is essentially no comparison between the two in terms of toxicity. There are also a huge number of other chemicals in tobacco that are poisonous, such as arsenic, benzene, cadmium, methanol, toluene and many more.

Cannabis smoke vs. tobacco smoke

There’s a lot of literature out there saying things like ‘one joint is equal to 5/10/20/insert whatever number of cigarettes per day’. This is pretty much a myth. Yes, burning plant matter and inhaling smoke can lead to health problems (e.g. bronchial epithelial ciliary loss, bronchitis), but it seems that there is a lot of conflicting evidence on how carcinogenic cannabis is. Why is this? One simple answer is nicotine. Not only is it addictive, but to quote Robert Melamede’s ‘Cannabis and tobacco smoke are not equally carcinogenic’:

“ … [D]espite potentially higher levels of polycyclic aromatic hydrocarbons found in cannabis smoke compared to tobacco smoke (dependent on what part of the plant is smoked), the THC present in cannabis smoke should exert a protective effect against pro-carcinogens that require activation. In contrast, nicotine activates some CYP1A1 [cytochrome P1A1]activities, thus potentially increasing the carcinogenic effects of tobacco smoke.”

Essentially, this means that the cannabinoids in cannabis smoke may protect against carcinogens, perhaps by inhibiting some of the activity of the liver enzyme CYP1A1. Tobacco, meanwhile, activates some activities in this liver enzyme and increases the carcinogenic effect of the smoke.

Now, there are some studies that suggest that inhaling cannabis smoke may increase the chances of developing lung cancer. Whether such studies control for tobacco smoking as well (remember: many people mix the two, especially outside of North America) as well as other factors (e.g. diet, exercise) depends upon how well the study was carried out and its methodology. Some studies are good, some are not. There is one particularly interesting study that rarely gets mentioned, and that is Donald P. Tashkin’s ‘Effects of Marijuana Smoking on the Lung’, where he states:

“Several case reports have implicated marijuana smoking as an etiologic factor in pneumothorax/pneumomediastinum and bullous lung disease, although evidence of a possible causal link from epidemiologic studies is lacking. In summary, the accumulated weight of evidence implies far lower risks for pulmonary complications of even regular heavy use of marijuana compared with the grave pulmonary consequences of tobacco.”

Tashkin’s work is very good, and he does a great job of assessing the harms of cannabis smoke vis-a-vis tobacco smoke. At this point in time, it’s also worth remembering that there are all sorts of alternative ingestion methods that can get rid of the need to smoke cannabis as well. Vaporizers are one, and there’s also tinctures, sprays, topicals, transdermals and microdosing edibles as well. There is a lack of data on the long-term health effects of these ingestion methods but, assuming they’re well-made, it would seem that they’re generally not likely to be as harmful as smoking. The extremely low toxicity of cannabis would also suggest that alternative ingestion methods are unlikely to cause any major harm for most people.

Deaths

There are no cases of death via cannabis overdose alone. According to the CDC, cigarette smoking is responsible for more than 480,000 deaths per year in the U.S., with around 16 million Americans living with a disease caused by smoking. Usually, the main problem comes when a person under the influence of cannabis decides to take control of a car or another piece of heavy machinery, and even in quite a few of these cases, there’s usually more than just cannabis in their blood – alcohol, benzodiazepines and many prescription medications are usually involved as well, and it’s important to remember that, just because cannabinoid metabolites were found in the body, this doesn’t mean that the person was using cannabis at the time of the accident.

Addiction

Cannabis does not contain nicotine, and it is the nicotine in tobacco that is highly addictive. On its own, cannabis is not very addictive, and has low abuse potential. `The lifetime risk of dependence (“cannabis use disorder”) amongst all cannabis users is 9%. For those who experiment with cigarettes, 20% to 30% will meet the criteria for tobacco use disorder in their lifetime, with 60% to 80% of current smokers fulfilling the classic criteria for drug dependence. Much of the “addiction” to cannabis may be due to tobacco for those who mix the two substances, rather than the cannabis itself. For many people, withdrawing from cannabis use is not too uncomfortable, and it should come as no surprise that at least some (and probably not insignificant number) non-medical cannabis enthusiasts tend to stop once they reach their mid-20s (marriage and life tends to take over).

The business side

If there’s one thing I and many other people in the cannabis industry are afraid of, it’s cannabis going down the same route as tobacco, alcohol and big pharma. However, one of the cornerstones of these industries are “repeat customers”. Cannabis’s addiction potential is quite low, meaning the chance of going to the same provider over-and-over again is quite low. Moreover, cannabis is a hardy plant that can be grown almost anywhere and cannot really be patented. The only way cannabis can become big business is by severely restricting growers’ rights – something which many states throughout the U.S. are doing, sadly, which in my mind is a severe curtailment of citizens’ freedoms as well as patient rights.

How possible it is to enforce this in the long-term, I do not know, but all such restrictions will lead to us back to a black market, and is a step back for legalization. Allow people to grow their own, and monopolies become much harder to form. Plus, there are many people in the cannabis industry who are very much suspicious of any monopolistic activity, and will campaign to stop it. This is rarely found in the tobacco and pharmaceutical industries.

Are there things to worry about with cannabis legalization? Sure.

For example, ensuring safe, standardized products, having “joined up” interstate and intrastate regulations, keeping cannabis out of the hands of minors and so on. Scaremongering with bad or incomplete data will only keep our focus off these issues, and ultimately will more likely lead to irrational policies that are more harmful than beneficial. Oh, and if we want to prevent cannabis from becoming another big tobacco, all we have to do is give people the right to grow their own!