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Meds Is Smoking Cannabis as Harmful as Tobacco?

momofthegoons

Vapor Accessory Addict
Staff member
Several studies have been done to ascertain the health risks of smoking our favorite herb. And while vaporizing is thought of as more healthful, it is encouraging to see that smoking (or combusting) marijuana is not as harmful as originally thought.

According to this article by NORML, " although tobacco smoke and marijuana smoke have some similar chemical properties, the two substances possess different pharmacological activities and are not equally carcinogenic." It explains that, "marijuana smoke contains multiple cannabinoids – many of which possess anti–cancer activity and therefore likely exerts a protective effect against pro-carcinogens that require activation. Components of cannabis smoke minimize some carcinogenic pathways whereas tobacco smoke enhances some.”

Another article I found, published by Scientific Reports, titled 'Comparative risk assessment of alcohol, tobacco, cannabis and other illicit drugs using the margin of exposure approach,' shows the risk as being 'deficient.'


It's somewhat reassuring to know that the years I spent smoking my medicine might not have done as much harm as I thought.
 

herbivore21

Well-Known Member
It is probably worth mentioning that tobacco contains compounds which are toxic/carcinogenic before it is combusted. It is incomparable to cannabis in terms of health risks. Cannabis is much safer, especially when not combusted since the harmful compounds are released as byproducts of combustion and are not present when we boil the resin and inhale it instead of burning.
 

momofthegoons

Vapor Accessory Addict
Staff member
Study Shows Medical Cannabis Helps Reverse Specific Harmful Effects of Tobacco
By Jason Sander - Dec 29, 2017

Most people who have used both cannabis and tobacco would tell you that tobacco is more harmful for the body, especially in the long run. Everyone knows that smoking cigarettes causes cancer, but there are also many other harmful side effects from tobacco use that you might not be aware of – yet another reason to stay away from it.

One of the lesser known issues that come with smoking tobacco is a disease called Thromboangiitis obliterans (TO). TO clots capillary blood vessels in the veins and arteries of the fingers and toes, due to the inflammation of surrounding tissue. Showing yet another way that cannabis plant medicine can heal, a new study indicates that medical marijuana reverses the effects of this disease.

The patient in this particular study was showing signs of what the researchers call Buerger disease, which is another name for TO. The patient was found showing signs of TO after it was discovered that they also showed signs of ischemia. Basically, ischemia is when muscle and skin tissue begins to die because they aren’t getting their proper nutrients. Usually, this is caused by poor circulation to the fingers and toes.

The study says that using tobacco products, either chewing or smoking them, directly causes ischemia. In the case of this patient, the blood clotting was caused by the TO, and the cycle continues itself. The degree to which tobacco use exacerbates the symptoms of ischemia and TO is currently unknown. However, the study indicates that every known case of TO was found in patients who have used tobacco in some form.

The study was initiated because a patient who had smoked two and a half packs a day was facing a possible amputation of his leg, because of severe symptoms of ischemia due to TO. The patient’s doctor, and author of the study, Dr. Robinson, recommended amputation right below the knee, but he refused. Instead, he started self-medicating with cannabis and wisely cut back on his tobacco use. After six months of self-medication, the patient was able to get a prescription for medical cannabis. The foot slowly regained circulation, the pain in his foot was reduced, and gradually continued to reduce over time.

After three years of medical cannabis treatments, quitting tobacco and taking antibiotics, the patient’s ischemia was reversed almost entirely. The scars on his foot were also greatly reduced, almost nonexistent. In the study, Dr. Robinson noted that the gradual return of blood flow to the patient’s limbs was likely due to the anti-inflammatory nature of CBD. As with so many other instances involving medical cannabis treatments, the study notes that more tests and research must be done to confirm that this anecdotal case study has statistical relevance and can be used to treat other patients suffering from TO and ischemia.
 

momofthegoons

Vapor Accessory Addict
Staff member
Medical Marijuana Reverses Tobacco Caused Ischemia
By B.G. Schmidt December 27, 2017

I don’t think I am making a controversial statement here by saying that weed is probably safer than tobacco. Sure, we are still producing minor carcinogens when combusting cannabis—but without all of the gross additives in cigarettes.

Aside from the big one (cancer), smoking cigarettes can cause a whole plethora of other problems, one being Thromboangiitis obliterans (TO), a disease that displays itself as the clotting of capillary blood vessels in the arteries/veins of our digits (fingers and toes) from inflammation of surrounding tissue. A case study out of Israel found that extensive use of cannabis reversed the effects of TO.

Before we get into the nuts and bolts of how cannabis may be doing this, let’s quickly go over some of the medical terms we will be seeing. Though the patient exhibited signs of Buerger disease (another name for TO), it was found because of what is called ischemia.

Ischemia is essentially the dying of tissue (skin/muscle) due to lack of nutrients (i.e. glucose, oxygen, etc.) from poor blood circulation. This lack of blood flow was caused by the clotting from T.O. The disease is a direct result of tobacco use, whether it is smoking or chewing. While the mechanism by which tobacco produces these symptoms is unknown, the only people who have Buerger’s disease smoke tobacco. Interestingly, it appears as though men have a greater likelihood of acquiring Buerger’s disease, though this could be attributed to a higher rate of tobacco usage with men.

OK, let’s now get into the story. How did the doctor know to prescribe cannabis, especially when this relationship between medical marijuana and TO had never before been looked at before? The truth of the matter is that the doctor did not initially prescribe pot.

The patient, who we will refer to as Bob, was a heavy smoker, nearly 2.5 packs of cigarettes per day. Bob came into the hospital with severe pain in his foot; he had a massive infection and ischemia due to T.O. It had progressed so bad that Dr. Robinson recommended an amputation below the knee. Bob refused and opted to self-medicate with marijuana, twice daily. After the first six months, his pain had reduced, and it continued to reduce for the next two and a half years. During this time, he also cut back on his cigarette smoking.

With the first six months down, Dr. Robinson was able to prescribe Bob medical cannabis in the form of what is called MCT (medical cannabis treatment), and Bob’s MCT dosage steadily increased over the course of a few years. After three years of MCT, and antibiotics for the initial infection, Bob’s ischemia had almost completely reversed—leaving minimal scarring.

Dr. Robinson attributed the cannabis’ action to the anti-inflammatory effects of CBD, gradually returning blood flow to the ischemic limbs. He did note, however, that this is a case study, and no statistical significance can be attributed to cannabis’ effects on ischemic-reversal until further research is done. Until then, I think this is a beautiful study further showing the potential for cannabis in modern medicine and society!
 

deep_meditation

Well-Known Member
Nicotine is bad news - especially with regards to bones healing. Cannabis? I'm not sure but I do know that nicotine is just bad news all together with regards to fractures and spinal fusions and other bone related surgeries. There are some doctors who actually test patients for nicotine prior to surgery.

Who knows, maybe CBD helps with bone healing too, lol. Just Googled it.... of course some Israeli studies popped up.
 

momofthegoons

Vapor Accessory Addict
Staff member
New Study: Marijuana Smoke Exposure Not Linked To Poor Lung Health
FEBRUARY 5, 2018


COLORADO: Long-term exposure to cannabis smoke is not associated with significant adverse effects on pulmonary function, according to clinical data published in the journal Chronic Obstructive Pulmonary Diseases.

A team of investigators led by researchers at the Colorado School of Public Health assessed the relationship between marijuana use and respiratory function in a cohort of 2,300 subjects ages 40 to 80, many of whom also smoked tobacco.

Authors reported, “Neither current nor former marijuana use was associated with increased risk of cough, wheeze, or chronic bronchitis when compared to never marijuana users. … Current and former marijuana smokers had significantly higher FEV1 (forced expiratory volume) … when compared to never users. … Both current and former marijuana use was associated with significantly less quantitative emphysema … when compared to never users, even after adjusting for age, … current tobacco smoking pack years, and BMI. … In agreement with other published studies, we also did not find that marijuana use was associated with more obstructive lung disease.”

Researchers also reported that the long-term combined use of tobacco and cannabis was not associated with any additive adverse effects on the lungs. They concluded, “Among older adults with a history of tobacco use, marijuana use does not appear to increase risk for adverse lung function. … There may be no to little increased risk of marijuana use for a further increase in respiratory symptoms or adverse effects … among those with a history of concomitant tobacco use.”

Prior longitudinal studies assessing the effects of long-term cannabis smoke exposure on lung function have similarly reported that subjects’ marijuana use history is not positively associated with increased incidences of chronic obstructive pulmonary disease (COPD), lung cancer, or with other significant detrimental effects on pulmonary function.
 

momofthegoons

Vapor Accessory Addict
Staff member
Study Shows Medical Cannabis Helps Reverse Specific Harmful Effects of Tobacco

Most people who have used both cannabis and tobacco would tell you that tobacco is more harmful for the body, especially in the long run. Everyone knows that smoking cigarettes causes cancer, but there are also many other harmful side effects from tobacco use that you might not be aware of – yet another reason to stay away from it.

One of the lesser known issues that come with smoking tobacco is a disease called Thromboangiitis obliterans (TO). TO clots capillary blood vessels in the veins and arteries of the fingers and toes, due to the inflammation of surrounding tissue. Showing yet another way that cannabis plant medicine can heal, a new study indicates that medical marijuana reverses the effects of this disease.

The patient in this particular study was showing signs of what the researchers call Buerger disease, which is another name for TO. The patient was found showing signs of TO after it was discovered that they also showed signs of ischemia. Basically, ischemia is when muscle and skin tissue begins to die because they aren’t getting their proper nutrients. Usually, this is caused by poor circulation to the fingers and toes.

The study says that using tobacco products, either chewing or smoking them, directly causes ischemia. In the case of this patient, the blood clotting was caused by the TO, and the cycle continues itself. The degree to which tobacco use exacerbates the symptoms of ischemia and TO is currently unknown. However, the study indicates that every known case of TO was found in patients who have used tobacco in some form.

The study was initiated because a patient who had smoked two and a half packs a day was facing a possible amputation of his leg, because of severe symptoms of ischemia due to TO. The patient’s doctor, and author of the study, Dr. Robinson, recommended amputation right below the knee, but he refused. Instead, he started self-medicating with cannabis and wisely cut back on his tobacco use. After six months of self-medication, the patient was able to get a prescription for medical cannabis. The foot slowly regained circulation, the pain in his foot was reduced, and gradually continued to reduce over time.

After three years of medical cannabis treatments, quitting tobacco and taking antibiotics, the patient’s ischemia was reversed almost entirely. The scars on his foot were also greatly reduced, almost nonexistent. In the study, Dr. Robinson noted that the gradual return of blood flow to the patient’s limbs was likely due to the anti-inflammatory nature of CBD. As with so many other instances involving medical cannabis treatments, the study notes that more tests and research must be done to confirm that this anecdotal case study has statistical relevance and can be used to treat other patients suffering from TO and ischemia.

 

momofthegoons

Vapor Accessory Addict
Staff member
Study: Cannabis Inhalation Not Associated With COPD, Other Tobacco-Related Harms

London, United Kingdom: Cannabis smoke exposure, even long-term, is not positively associated with chronic obstructive pulmonary disease (COPD), lung cancer, or irreversible airway damage, according to a literature review published in the journal Breathe.

British researchers reviewed nearly 20 observational studies assessing cannabis inhalation and lung health, involving over 25,000 subjects.

Investigators reported that the available literature fails to support an association between cannabis smoke exposure and the onset of COPD, emphysema, lung cancer, shortness of breath, or irreversible airway damage. "The long-term respiratory effects of cannabis differ from traditional smoking," authors concluded. "[C]annabis smoking does not appear to be carcinogenic."

Researchers did identify a link between marijuana inhalation and more frequent cough, sputum production, wheezing, and chronic bronchitis - though they acknowledged that these symptoms largely cease upon quitting. Authors also acknowledged that vaporizing cannabis - a process which activates cannabinoids, but does not heat them to the point of combustion - reduces many of these symptoms.

The study's findings are similar to those of others reporting that cannabis smoke and tobacco smoke differ significantly in their health effects, and that long-term marijuana smoke exposure is not associatedwith poor lung health.
 

momofthegoons

Vapor Accessory Addict
Staff member
What effects does smoking cannabis have on the respiratory system?

**Publication Note: In the text below if you see words that look like this you can hover your mouse over the word to view a definition. This hover function only works on desktop computers therefore, a full glossary is also available at the end of the article.**

The most common form of administration of cannabis (either recreational or medicinal) is through inhalation (smoking or vaporizing).[ 1 ][ 2 ] A 2016 survey of 364 Canadian medicinal cannabis users found that 52.7% vaporized cannabis, whereas 58.8% also smoked cannabis in some form.[ 2 ] As cannabis contains many compounds with a similar profile to tobacco, heating and combustion of these chemicals may result in short- and long-term respiratory effects.[ 3 ] This Evidence Brief will summarize what is known about smoking cannabis and its acute and chronic effects on the respiratory system.

Similarities and differences between smoking cannabis and tobacco

When comparing cannabis and tobacco smoke, the exposures are different based on chemical constituents and smoking topography. Cannabis smokers typically inhale more deeply and for a longer duration.[ 5 ] Cannabis is also smoked at higher temperatures (leading to greater combustion) and, in cigarette (“joint”) form, smoked to a shorter butt length.[ 5 ] Furthermore, it has been demonstrated that the net respiratory burden of particulates is four times greater with cannabis than tobacco smoking. [ 5 ] As cannabis possesses many of the same harmful and carcinogenic chemicals as tobacco smoke (Table 1), it is theorized that acute and chronic smoking may lead to similar harm with respect to the respiratory system such as bronchitis, COPD and lung cancer.
Table 1 – Cannabis Smoke Vs. Tobacco Smoke. Values presented reflect the difference in cannabis smoke.
Carbon Monoxide-16%
Level of Tar+30%
Ammonia+1900%
Nitrogen Oxides+450%
Hydrogen Cyanide+500%
Aromatic Amines+500-600%
Adapted from Moir et al. 2008[ 4 ]

Acute Effects on Lung Function

Upon initial use, inhaling cannabis (in particular, via THC) may dilate the airways of healthy and asthmatic individuals from several minutes to hours and might be dose related. [ 6 ][ 7 ] Anandamide, an endocannabinoid, is known to bind to CB1 receptors in the lung, serving to relax bronchial muscles.[ 6 ] However, when bronchial muscles are already relaxed, anandamide will cause the opposite effect and produce bronchospasms, therefore restricting airways. [ 6 ] It is thought that chronic administration of THC, a phytocannabinoid, may also result in relaxing bronchial muscles acutely, but result in bronchoconstriction with chronic administration.[ 3 ][ 6 ]

Chronic Effects on Lung Function

With chronic (habitual) smoking of cannabis, users often cite symptoms such as coughing, wheezing, shortness of breath, excess sputum production, chest tightness, pharyngitis, hoarse voice, worsening asthma symptoms and the development of chronic bronchitis.[ 3 ] The odds of developing such symptoms as a result of chronic cannabis use (controlling for tobacco use), are 2-3 times greater when compared to individuals who have never smoked cannabis. [ 3 ] One interesting finding is that when comparing tobacco and cannabis smokers, the chronic respiratory symptoms of a cannabis smoker were similar to a tobacco smoker who had smoked for an additional 10 years. [ 3 ]
Chronic smoking results in physical changes to the respiratory system. When looking at biopsy specimens, researchers have noted that chronic cannabis smoking results in extensive histopathologic abnormalities in the trachea-bronchial mucosae similar to tobacco use.[ 3 ] These findings have also been confirmed upon visual inspection with video bronchoscopy, where smoked cannabis use results in large airway inflammation and injury. [ 3 ]

Infection Risk

In addition to airway injury, cannabis smoke may increase the risk of airway infections such as pneumonia. Cannabinoids are known to modulate, and possibly blunt immune cells such as B/T lymphocytes, natural killer cells, suppressing phagocytosis by macrophages and altering the presence of cytokines [ 6 ]. Airway infection rates among HIV-positive cannabis smokers are increased compared to non-users. [ 6 ] In addition, as the cannabis plant can harbor fungal and bacterial pathogens, there have been reports of allergic bronchopulmonary aspergillosis due to Aspergillus fumigatus in cannabis-users with asthma and cystic fibrosis. [ 6 ] Individuals sharing devices, such as pipes and bongs, have also been found to be at increased risk of tuberculosis (~2 to 6 fold risk).[ 7 ]


Chronic Obstructive Pulmonary Disease (COPD) Risk

When reviewing epidemiological studies, occasional use of marijuana with low cumulative use has not been established as a risk factor for the development of COPD (based on measuring spirometry).[ 3 ] However, heavy use may increase risk of COPD, particularly amongst individuals who smoke both cannabis and tobacco. [ 3 ] It should be noted that the available evidence to inform this issue is limited by the small number of cannabis users studied, and the variability in use from 50 joints to greater than 10,000 joints per lifetime. [ 3 ] Hence the association between chronic cannabis smoking and the development COPD remains to be established.

Lung Cancer Risk

As cannabis smoke contains carcinogens, there is a concern that cannabis smoking may lead to the development of lung cancer. With chronic cannabis use, histological changes have been noted in biopsies pointing to pre-cancerous states.[ 6 ] There have been approximately 12 studies to date reporting on the risk of cannabis smoking and lung cancer.[ 8 ] These studies were conducted in the US, Europe and North Africa and most involved both men and women. [ 8 ] Eight studies noted an increase in lung cancer risk from cannabis use and four studies found either no significant association or a lower risk for lung cancer. [ 8 ]In those studies that noted an increased risk, these ranged from 2 to 4-fold increased risk of lung cancer in cannabis smokers, but were not methodologically as strong as those studies finding no increases in cancer risk.[ 6 ][ 8 ] In conclusion, cannabis use is plausibly relevant to lung cancer risk but the evidence has been inconsistent.

Reversal of Adverse Effects via Cannabis Smoking Cessation

It is unknown whether cannabis smoking cessation reduces the observed histological changes in airways.[ 3 ] However, there are benefits to cannabis smoking cessation. A longitudinal study of 299 young adults over 10 years found that those who smoked either cannabis or tobacco were at increased risk of symptoms of chronic bronchitis at follow-up. [ 9 ] In comparison, those individuals who quit smoking either cannabis or tobacco had a similar risk of chronic bronchitis symptoms as those who never smoked. [ 9 ] These findings were also noted in a cohort study of 1000 subjects over 38 years, that found stopping cannabis, tobacco or cannabis/tobacco smoking significantly reduced the amount of coughing, sputum secretion and wheeze, and that reported rates of these events that were similar to those who never smoked. [ 10 ]

Conclusion and Key Takeaways
  • Inhaling cannabis, particularly smoking, remains one of the most common methods of administration of medicinal cannabis
  • Cannabis possesses many of the same harmful chemicals as tobacco smoke, either in similar or greater quantities (Table 1)
  • Cannabis can lead to similar risk of harm to the respiratory system (Table 2)
  • Methods other than smoking or vaporizing should be emphasized, such as oral administration of cannabis, due to potential risks of chronic bronchitis, infection, COPD and lung cancer

Table 2 – Summary of Acute and Chronic Effects of Cannabis Smoking on the Respiratory System
ConditionFindings
Acute Use (infrequent)Short term (15-60 minutes) bronchodilator effects. More frequent use noted to produce bronchospasm.
Chronic UseDevelopment of chronic bronchitis and symptoms of coughing, wheezing, shortness of breath, excess sputum production, chest tightness, pharyngitis, hoarse voice, worsening asthma symptoms.
Infection RiskPotential increased risk of respiratory infections, especially in immunosuppressed individuals or sharing administration devices to smoke/vaporize cannabis.
COPD RiskLow, cumulative use not associated with increased COPD risk.
Risk is uncertain with high, cumulative use – likely to increase COPD risk.
Lung Cancer Risk

Histological biopsies show evidence of pre-cancerous airway changes among cannabis smokers.

Inconsistent evidence. Some studies report increased risk of cancer while others do not. Difficult to control for the influence of tobacco use.
Smoking Cessation of CannabisSmoking cessation shown to reduce acute and chronic bronchitis symptoms. Unknown if any reversal in histologic changes occur.
Limitations of Research
Due to the concurrent use of cannabis and tobacco smoking, research obtained on acute and chronic use, infection risk, COPD risk and lung cancer risk is confounded to various degrees and therefore not as robust in comparison to the literature on tobacco use and respiratory harms. In an attempt to limit the degree of confounding, most studies attempted to control for factors such as age, social factors and tobacco use.
Glossary of Terms
Aspergillosis - is the name given to a wide variety of diseases caused by infection by fungi of the genus Aspergillus.
Asthma - a chronic lung disorder that is marked by recurring episodes of airway obstruction.
B/T lymphocytes - a form of small leukocyte (white blood cell) with a single round nucleus, occurring especially in the lymphatic system.
Bronchial, Bronchi - is a passage of airway in the respiratory system that conducts air into the lungs after branching from the trachea.
Bronchitis - is an inflammation of the lining of the bronchial tubes.
Bronchopulmonary - Pertaining to both the air passages (bronchi) leading to the lungs and the lungs (pulmonary) themselves.
Bronchoscopy - Bronchoscopy is an endoscopic technique of visualizing the inside of the airways for diagnostic and therapeutic purposes.
Bronchospasm - spasm of bronchial smooth muscle producing narrowing of the bronchi.
Confounding - A situation in which the effect or association between an exposure and outcome is distorted by the presence of another variable.
Cytokines - any of a number of substances, such as interferon, interleukin, and growth factors that are secreted by certain cells of the immune system and have an effect on other cells.
Endocannabinoid - cannabinoids produced endogenously (for example in humans) and not from plant sources.
Epidemiological - relating to the branch of medicine which deals with the incidence, distribution, and control of diseases.
Histopathologic - refers to the microscopic examination of tissue in order to study the manifestations of disease.
Macrophages - a large phagocytic cell found in stationary form in the tissues or as a mobile white blood cell, especially at sites of infection.
Mucosae - is a membrane that lines various cavities in the body and covers the surface of internal organs.
Natural killer cells - are a type of lymphocyte (a white blood cell) and a component of innate immune system.
Particulates - matter in particulate form that can cause harm to human health.
Pathogens - a bacterium, virus, or other microorganism that can cause disease.
Phagocytosis - the ingestion of bacteria or other material by phagocytes.
Pharyngitis – is caused by swelling in the back of the throat (pharynx) between the tonsils and the voice box (larynx).
Phytocannabinoid - naturally occurring cannabinoids found in the cannabis plant.
Pre-cancerous - (of a cell or medical condition) likely to develop into cancer if untreated.
Spirometry - measures lung function, specifically the amount (volume) and/or speed (flow) of air that can be inhaled and exhaled.
Sputum - a mixture of saliva and mucus coughed up from the respiratory tract.
Trachea - colloquially called the windpipe, is a cartilaginous tube that connects the pharynx and larynx to the lungs, allowing the passage of air, and so is present in almost all air-breathing animals with lungs.
Tuberculosis - is a lung disease caused by bacteria called Mycobacterium Tuberculosis.


Author Details
The latest scientific evidence on this topic was reviewed by the Centre's leadership team. This evidence brief is written by Vikas Parihar, assessed for accuracy by the Directors of CMCR. There are no conflicts of interest. Questions regarding this piece should be directed to cmcr@mcmaster.ca.

References
  1. Russell C, Rueda S, Room R, Tyndall M, Fischer B. Routes of administration for cannabis use – basic prevalence and related health outcomes: A scoping review and synthesis. Int J Drug Policy. 2018;52:87-96. doi:10.1016/j.drugpo.2017.11.008.
  2. Shiplo S, Asbridge M, Leatherdale ST, Hammond D. Medical cannabis use in Canada: Vapourization and modes of delivery. Harm Reduct J. 2016;13(1):1-10. doi:10.1186/s12954-016-0119-9.
  3. Joshi M, Joshi A, Bartter T. Marijuana and lung diseases. Curr Opin Pulm Med. 2014;20(2):173-179. doi:10.1097/MCP.0000000000000026.
  4. Moir D, Rickert WS, Levasseur G, et al. A comparison of mainstream and sidestream marijuana and tobacco cigarette smoke produced under two machine smoking conditions. Chem Res Toxicol. 2008;21(2):494-502. doi:10.1021/tx700275p.
  5. Wu, Tzu-Chin; Tashkin, Donald P.; Djahed, Behnam; Rose JE. Pulmonary Hazards of Smoking Marijuana as Compared with Tobacco. N Engl J Med. 1988;318(6):347-351. doi:10.1056/NEJM198802113180603.
  6. Gates P, Jaffe A, Copeland J. Cannabis smoking and respiratory health: Consideration of the literature. Respirology. 2014;19(5):655-662. doi:10.1111/resp.12298.
  7. Lutchmansingh D, Pawar L, Savici D. Legalizing Cannabis: A physician’s primer on the pulmonary effects of marijuana. Curr Respir Care Rep. 2014;3(4):200-205. doi:10.1007/s13665-014-0093-1.
  8. Martinasek MP, McGrogan JB, Maysonet A. A Systematic Review of the Respiratory Effects of Inhalational Marijuana. Respir Care. 2016;61(11):1543-1551. doi:10.4187/respcare.04846.
  9. Tashkin DP. The respiratory health benefits of quitting cannabis use. Eur Respir J. 2015;46(1):1-4. doi:10.1183/09031936.00034515.
  10. Hancox RJ, Shin HH, Gray AR, Poulton R, Sears MR. Effects of quitting cannabis on respiratory symptoms. Eur Respir J. 2015;46(1):80-87. doi:10.1183/09031936.00228914.
 

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