We recently discussed a study in which we found smoking cannabis was popular within a sample of medical cannabis dispensary users. We found smoking cannabis was associated with greater cannabis use and preference for THC-dominant chemovars and was associated with concurrent alcohol use disorder. These findings provided several key insights into risks and harm reduction strategies for people smoking cannabis with a medical intent.

Our takeaways included:

1. Cannabis smokers are at a greater risk for adverse outcomes:

– Smoking poses a respiratory risk

– More frequent use of THC may lead to a higher chance of side effects such as impairment or sedation

2. A key harm reduction strategy may be educating on how to better control symptoms with the least amount of harm:

– This includes better utilizing CBD

– Vaporization as an alternative inhalation method

3. The benefits of dried product vaporization should be more widely available:

– Vaporization of dried cannabis flower has a lower respiratory risk compared to smoking

– Dried flower is cheaper than cannabis oils or edibles, which may be useful for individuals with alcohol use disorder and may need to afford both substances

– It is important to use a dried product vaporizer compared to an electronic cigarette, which uses concentrated product, as concentrates may also contain harmful toxins

– Regulated product should always be used when possible to ensure the product being consumed does not contain contaminants or toxins

What this might mean for you:

1. If you want to inhale your cannabis, use dried-product vaporization from a regulated source (a licensed dispensary, medical treatment center, or caregiver).

2. Remember that one of the goals of medical cannabis use is to use the lowest doses possible that allow for adequate symptom control, especially for THC. This can be done by first trying CBD-dominant or 1:1 CBD:THC strains. If greater symptom relief is needed, slowly increase the amount of THC you use.

Dr. Caroline MacCallum is a specialist in internal medicine with expertise in complex pain and cannabinoid medicine. In addition to serving as an advisor to EO Care, she is a clinical instructor in the Department of Medicine; Adjunct Professor in the Faculty of Pharmaceutical Sciences program; and associate member in the Dept. of Palliative Care at the University of British Columbia. An avid researcher, Dr. MacCallum is primary author of Practical Considerations for Medical Cannabis Administration and Dosing, and assistant editor for Cannabinoids and Pain.

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