Healthier Alternatives to Smoking Medical Marijuana
Angela Morrow, RN, BSN, CHPN, is a certified hospice and palliative care nurse.
Anita Chandrasekaran, MD, MPH, is board-certified in internal medicine and rheumatology and currently works as a rheumatologist at Hartford Healthcare Medical Group in Connecticut.
The medicinal use of marijuana is legal in a growing number of U.S. states, and other states might eventually join this list. Some patients, however, might be unable to smoke medical marijuana because of their illness, disease, symptoms, treatments and/or other factors. This article explores the alternatives to smoking marijuana that might prove healthier or more viable for patients who’ve received a prescription for medical marijuana.
Marijuana Use for Medicinal Purposes
Requiring a doctor’s “recommendation” or referral and secured from legal vendors, medical marijuana can help relieve numerous symptoms, such as pain, glaucoma, migraine headaches, nausea, and weight loss.
While there are various pros and cons of using medical marijuana, it’s important to understand that the use of marijuana is not without potential side effects. For example, conventional or “street” marijuana might contain harmful fungus and/or pesticides, which can prove especially dangerous for patients with a compromised immune system.
Moreover, the fact that marijuana is usually smoked—either in cigarette form or through the use of tobacco or water pipes—introduces additional concerns. Patients who have never smoked before, or those receiving other treatments that can interfere with their ability to smoke, might find smoking marijuana difficult or simply impossible.
I found that to be a case with a patient with lung cancer and COPD. He suffered from chronic bone pain, nausea, and severe weight loss. He asked his doctor about medical marijuana and received the necessary prescription. When I came to see him, he held a joint but didn’t know how to use it. It was immediately clear that because of his inexperience and because he was using oxygen and was already suffering from a forceful cough, smoking a marijuana cigarette would not be the best method for him.
It’s important to again stress that medical marijuana is a physician-referred treatment and should only be used according to a doctor’s instructions. If you or someone you care for receives a prescription for medical marijuana use but cannot smoke marijuana, non-smoking options might include:
Edible Marijuana: Medical cannabis can be heated and made into oils, butters, and tinctures. Many “cannabis clubs” sell pre-made cookies, brownies, lollipops, and teas. Savvy patients—those willing to take the time to empower themselves through research and knowledge—can also find recipes to make their own marijuana tincture, oil, or butter.
Eating or drinking marijuana’s main or active ingredient tetrahydrocannabinol (THC) is certainly preferable for many patients rather than smoking it, but these alternative methods can also create problems. When consumed via food or drink, THC does not absorb into the bloodstream as quickly as when it is smoked. This can make it more difficult to control the effectiveness of the drug or how much is consumed. In addition, patients who suffer from decreased appetite or nausea might not tolerate eating or drinking marijuana.
Vaporizers: Another option is to inhale marijuana using a vaporizer. This method involves heating the marijuana to a high enough temperature to vaporize the THC but not burn the plant. Patients can then breathe in the vapor from a bag without inhaling the harsh and potentially toxic smoke.
Vaping as it is commonly known, can cause serious lung injury. In 2019, a series of outbreaks across the country of what is called product use associated lung injury (EVALI), have resulted in over 2,291 hospitalizations and caused a reported 48 deaths (as of December 3, 2019). The Centers for Disease Control and Prevention are conducting studies to analyze the components of the TCH from the vaping products. They recommend that people do not use THC vaporizers and to watch carefully for any symptoms if they continue to vape.
Finding the Solution That Works for You
Ultimately, it is possible to find healthier or more suitable alternatives to smoking marijuana, as my aforementioned patient did. He experimented with edible marijuana and found that he enjoyed the marijuana brownies he was able to get at a cannabis club, but as his appetite waned, he found it difficult to stomach the rich chocolate taste. He didn’t want to invest in a vaporizer because his life expectancy was short. However, through the people he met at the cannabis club, he was able to strike a deal with another medical marijuana patient and split the cost of a vaporizer—with the agreement that the other patient would inherit the device after his death. It was an unusual arrangement, to be sure, but it allowed him to continue using medical marijuana for several more weeks.
The alternatives to smoking marijuana that might prove healthier or more viable for patients who've received a prescription for medical marijuana.
Legal marijuana alternatives
Alternative Responses to the Drug Problem
There seems to be an amusing idea among the Drug Warriors that there are only two possible ways a society can deal with the problems of drug use: Either we give people longer prison sentences for growing pot than for rape, or we hand out heroin and needles to kids on the schoolyard. There are, of course, a thousand shades of gray in between these two equally ridiculous ideas. What America needs is true drug control, not a continuation of the failure of Prohibition.
The most popular of the alternative approaches to dealing with the public health problems of drug use is ‘harm reduction’, a philosophy that tries to stay neutral about drug use itself, declining to take a moral stance for or against drug use while trying to protect those who do choose to use drugs by educating them about the risks and, in some cases, by providing health services such as clean needles to addicts who inject drugs.
The advantage of harm reduction is that it’s relatively easy to implement (often requiring no new legislation) and provides a high return on investment; drug users are generally actually perfectly willing to moderate or change their drug use habits if a credible source tells them how and why it’s in their own interests to do so. The government has absolutely zero credibility among drug users, having too dramatically oversold the risks for decades. Although harm reduction has made great strides in recent years, it remains hampered in the US by the hard-line Prohibitionists, who are angered by what they perceive as a ‘soft on drugs’ attitude inherent in the admission that many of the dangers of drugs can be greatly reduced or eliminated.
The disadvantage of harm reduction is that it does nothing to disrupt the current black-market drug trade; users are still forced to deal with criminals to get drugs, placing them at risk of theft, fraud, violence and contaminated/inconsistent drugs while empowering and enriching some of the worst elements of our society. Although harm reduction can do a great deal of good, it remains only a partial solution.
Under decriminalization, drugs remain illegal. However, instead of facing arrest and a criminal record, people who are caught with small amounts of drugs for personal use would have their drugs confiscated and would be given a fine (rather like a traffic ticket.) Decriminalization has gained considerable momentum world-wide, most famously in the Netherlands (where even confiscation/fines are not enforced for simple possession of marijuana.) The United Kingdom has also recently decriminalized marijuana, with Canada likely to follow suit. A number of states within the US have also decriminalized marijuana.
Under the simplest forms of legalization, a drug is made entirely legal to at least posses and use, but the manufacturing and distribution channels remain illegal. The Netherlands’ marijuana policy is technically one of decriminalization (in theory it’s illegal to have/buy/sell marijuana) but the laws are not enforced for petty offenders or stores (‘coffee shops’) that abide by regulations, creating a situation of de facto legalization. This form of legalization fails to do away with the black market, but because the users themselves do not risk prosecution, they have considerably more protection from dishonest dealers (since they can always complain to police.)
The most comprehensive (and controversial) method of drug control would legalize all aspects of the trade surrounding a particular drug, but in doing so would create strict controls on manufacturing and sale, not unlike the current prescription system. Under controlled legalization all aspects of the drug trade are addressed, uniting Harm Reduction and counseling/treatment services with sanctioned drug sales/manufacturing in order to suppress the black market drug trade.
1. Comprehensive education of users. In many cases, drug users are harmed not simply because they took a drug, but because they took a drug without understanding its risks and effects. By creating legal, regulated channels to get drugs through, you can require users to attend classes about safe use, medical risks, addiction, etc.
2. Keep people away from the black market drug trade. Drugs that are impure and of unknown strength are more dangerous to users, as are the sorts of people that tend to be involved in any sort of illegal trade. Decriminalization without regulation would only allow this bad situation to continue.
3. Early identification and counseling of addicts. When people get their recreational drugs through a controlled and traceable channel, you can identify people when they develop patterns of heavy use and offer them help.
4. Provide an income stream for social services. If somebody becomes addicted, there needs to be resources available to treat them as quickly and effectively as possible. By bringing recreational drug sales into the open, controlled legalization would allow us to gather billions of dollars in sales/excise taxes.
5. Stop wasting money where it doesn’t accomplish anything: When the police catch Jimbo with a joint and arrest him, process him, run him through the courts and stick him in jail for week then probation for a year, it can cost the taxpayers thousands of dollars. And when Jimbo gets out, there is virtually no chance that he will stop using drugs as a result of the experience. If the goal of your social policy is to hurt people you catch disobeying you, the current system works. If the goal is to protect people from being hurt by drugs (or even reduce use) it’s an abject failure. Chasing the potheads simply isn’t sound social policy: We aren’t going to change them. We aren’t going to stop them. We might as well keep an eye on them and make a buck or two instead of endlessly pouring tax dollars into the bottomless pit that is Prohibition.
Given these goals, what might the future of drug control in America look like? Perhaps something…like this:
The Controlled Substances Permit Concept
Q: How would it work?
A: The card contains a computer chip and a secret encryption key. When you wish to buy a Controlled Substance, you would present the card, which would be connected to a computer hooked up to the national CSP system. The card would tell the servers who the owner was, such as “Bob Smith, #139102938543545”. The servers would then send out an encoded message that only “Bob Smith’s” card would be able to decode. By decoding the message correctly, the CSP smart card is able to prove its identity to the CSP system servers.
Q: OK, so the government system knows which card it is. Then what?
A: Then it’s the human’s turn to identify you. The CSP servers would send a photo, signature copy, and other identifying information to the computer terminal you connected the smart card to. By comparing your appearance and signature, the staff at the store should be able to identify you beyond any doubt.
Q: So, then I can buy my drugs?
A: You will be able to buy drugs that you are certified for, yes. The CSP system will track and record all activity: What you buy, how much, and when/where.
Q: Hey, wait a minute…what do you mean by “certified”?
A: Unlike the way things are currently done under the Prohibition model, not just anybody will be able to walk in off the streets and buy drugs. In order to get a permit, you will be required to attend classes on addiction, responsible drug use, and medical affects/risks.
Q: But once I do that I can buy drugs?
A: No. After the introductory class, you will be able to take classes on specific groups of drugs, such as Cannabis, Opiates, Amphetamines, Psychedelics, etc. Each class will contain extensive information on what the drugs do, relative risks of injury, death and addiction, and information on safe and responsible ways to use. You will have to pay a small fee for these classes, and will be tested on the material.
Q: Shit man, that sounds hard.
A: It wouldn’t be too bad. Most people would have no trouble passing on their first try. The goal is not to prevent people from getting a certification for a certain class of drugs, only to give them the information and understanding they will need to stay relatively safe.
Q: Umm. So…can I get stoned now?
Q: Who will be able to sell drugs?
A: Licensed pharmacies, under an extension of the current system of federal controls on prescription drugs. As the system evolved, particularly safe drugs like marijuana might migrate to less controlled points of sale (liquor stores, etc.)
Q: Will ‘hard’ drugs like heroin be available?
A: Eventually I believe they would be, if only to confirmed addicts as part of maintenance and treatment programs. However, the system would start out with safer, less addictive drugs as a test of the concept. If all went well, harder drugs could be made available to give users an alternative to the often dangerous black market. The system would be very flexible, able to create different requirements and restrictions on each drug/drug class as needed, and could be adjusted to suit local concerns and needs.
Q: How can you even consider providing a horrible drug like heroin?
A: The question of providing heroin is one of those classic examples of the world not working the way we think it should. Ask yourself, where do heroin dealers come from? In many cases, dealers are addicted users who needed a way to pay for their own habit. Likewise, addicts form the backbone of the black market heroin trade, keeping the dealers in business while they ‘develop’ new customers. By providing a legal, affordable way to get heroin you undermine the black market by removing the drug dealer’s core customer base and removing much of the motivation for addicts to become dealers. Perhaps heroin would not be made available to non-addicts, but to provide it to people who are already addicted (in the context of a greater substance abuse treatment program) is simply the smart thing to do. Under such a program, you undermine the black market, reduce risks to the addicts through education and clean needles, and can ensure that they receive counseling/treatment.
Q: Would the system include alcohol and cigarettes?
A: I would like it to. Given the logistics of alcohol, it would likely remain sold by traditional liquor stores (the sheer bulk of alcohol makes it virtually impossible to integrate into a pharmacy model.) Cigarettes should certainly require training and certification; the rate of death, addiction, and injury from cigarettes almost makes heroin look safe. To allow people to simply buy such extraordinarily dangerous products without any education is grossly irresponsible.
Q: Who would produce and distribute the drugs?
A: Production would be done by licensed companies. Distribution would probably be handled by the government to reduce diversion and ensure the collection of taxes. There’s no reason we can’t grow our own opium poppies and coca trees in the US if we do choose to make such drugs legally available on some basis. It’s time we stopped the Prohibitionists from driving billions of dollars into the hands of terrorists and other violent criminals.
Q: You mentioned getting help to addicts early on…how would this be done?
A: First, the national tracking system would identify when a person’s use went up suddenly or reached levels that casual use couldn’t explain. At this point, social services would be notified, and they would make contact with the individual.
Q: And if they don’t want to talk to them?
A: You would be required to provide some minimal cooperation with social services to keep your CSP.
Q: If somebody becomes addicted, would they be cut off?
A: Under most circumstances, no. Drug abusers (as opposed to the majority casual users) are almost universally self-medicating for underlying psychiatric problems. To cut them off simply because they’ve become heavy users is sadistic and would likely be ineffective: They could always just go to the black market (which could survive if there were enough people denied access to the CSP system) or switch to more easily available drugs like alcohol. Rather than try to force them to stop using drugs, they would be allowed to continue to purchase their drug of choice so long as they met with social services. You can’t force people to take help, but you can make sure they know it’s available.
Q: Would it be illegal to resell drugs you purchased through the CSP system?
A: Yes. For unusually dangerous or addictive drugs, the purchaser would have to keep the drugs in their original container, which would be serialized/bar coded with a number traceable to the purchaser.
Q: Would there be age limits?
A: Yes. For soft drugs like marijuana, I can’t see more than 18 as the minimum. Harder drugs would have higher requirements. There may also be additional requirements for getting a CSP, such as basic mental and physical health screening.
Q: How would you keep the system secure?
A: Heavy two-way encryption. Hacking into the system between the pharmacy and the CSP net would be about as close to impossible as anything gets. The CSP servers themselves would of course be heavily guarded, perhaps located at the current DEA headquarters.
Q: There’s very little information on the card itself…why?
A: To prevent abuse if the card is lost or stolen. There isn’t a home address or phone number to protect the privacy of the card holder, and there isn’t a signature on the card because that would be provided by the CSP servers themselves; placing it on the card would only assist forgeries. The bar code is simply backup card identification, allowing a card to be identified in terms of owner without the relatively ‘heavy’ hardware of the encrypted point-of-sale terminals or in case the card’s circuitry became damaged (so if you needed to replace it, the bar code could be used to identify the old card and bring up your personal information for verifying who you are.) Sales would probably not be permitted with only the bar code, however.
Philosophical and other issues:
Q: Won’t even this restricted system of drug legalization cause an increase in drug abuse?
A: I doubt it. It will almost certainly lead to increases in the use of some drugs, but the shift will not be from people who never use drugs; it will come from alcohol and tobacco users. Yes, maybe we’ll get a few million more heavy pot smokers…but it will be the same people who would otherwise have been alcoholics. Legalization does not mean creating vast new legions of drug abusers; it simply means more efficiently and fairly managing the people who are already abusing drugs. A drinker who decides they’d rather be stoned than drunk does not represent an increase in drug use unless you’ve fallen for that old straw that alcohol ‘isn’t really a drug.’
Q: Isn’t such a shift still a bad thing?
A: Not really. Marijuana use is less expensive to society and less dangerous than alcohol use. America would be far better off with ecstasy and marijuana as its drugs of choice than it is with alcohol and tobacco. (Visit the Statistics page of the Risks section for more information.)
Legal marijuana alternatives Alternative Responses to the Drug Problem There seems to be an amusing idea among the Drug Warriors that there are only two possible ways a society can deal with