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Should you stop smoking cannabis because of COVID-19?

Should you stop smoking cannabis because of COVID-19?

COVID-19 is not an equal opportunity virus. Some groups, particularly the elderly, are at greater risk of severe illness, including death. Other vulnerable people include immunocompromised groups and those with ailments like diabetes or chronic respiratory conditions.

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As the virus is known for destroying lung tissue and can ultimately result in severe complications like pneumonia, health authorities have warned that cigarette smokers might be at greater risk.

Woman smoking marijuana
‘Smoking is a hand-to-mouth action, which has been shown definitively to be a behavior that is a primary means of transmission for COVID-19.’ (Joshua Resnick/123rf)

Considering that risk, many patients might be wondering if they should continue to smoke medical marijuana during the COVID-19 pandemic.

While there has been no direct research on cannabis and COVID-19 risk, what we know about how smoking can affect the lungs might lead some to look for alternative ways of consuming their marijuana — at least for the time being.

How smoking cannabis affects the lungs

Many cannabis patients prefer inhalation, either by smoking or vaporizing, as it provides rapid relief compared to other administration routes. Others simply find it more enjoyable.

While there is little data on the long-term effects of vaporized cannabis on the lungs, we know that some long-term, chronic cannabis smokers report respiratory issues. These can include anything from a smoker’s cough to tightness in the chest and wheezing.

The pulmonary effects of inhaling cannabis are not one-dimensional, however. The acute administration of cannabis can actually act as a bronchodilator that improves airway conductance.

The effects of chronic, long-term exposure, on the other hand, are decidedly more complex. Nevertheless, one meta analysis of 14 studies found cannabis use had little impact on relevant measures of lung function, “particularly when investigators applied appropriate statistical controls for cigarette smoking, age, and weight.” 

Are cannabis smokers at higher risk for COVID-19?

“Smokers of both cigarettes and cannabis may be considered at higher risk for contracting COVID-19,” explained Dr. David Knox, co-founder of American Cannabinoid Clinics.

“Smoking itself is a hand-to-mouth action, which has been shown definitively to be a behavior that is a primary means of transmission. In addition, smoking can damage some of the protective mechanisms of the airways, which can then allow the virus a foothold to establish an infection.”

Smoking marijuana water pipe
‘Smoking can damage some of the protective mechanisms of the airways, which can then allow the virus a foothold to establish an infection.’ (Darrin Harris Frisby/Drug Policy Alliance)

“It is most important to change your social consumption habits,” said Dr. Sarah Mann, MD, a member of the Society of Cannabis Clinicians. “If you smoke joints, everyone should have their own. If you are passing around a bong, use a ‘bong condom.’ Get a free Zoom account and have an online circle.”

“The question is not necessarily if you get COVID — it might be a question of when,” Dr. Mann continued. “The goal is to delay it as long as possible. Slow the spread and let the healthcare resources rebound. Give a few weeks for the first round of sick nurses and doctors to return with their new immunity. Allow time for gloves, masks, and medications to be restocked. Keep making smart choices and keep yourself protected.”

How COVID-19 affects the lungs

Like most viruses, COVID-19 takes over our existing cells and manipulates them into making copies of itself, which then spread throughout the body. When that takes place in your lungs, your immune system’s response can lead to a cough, congestion, mucus production, and fever.

Most people, an estimated 80% of those who are infected with the new novel coronavirus, will recover having experienced only mild cold or flu-like symptoms.

Doctor looking at chest X-ray
A doctor examines a chest X-ray. (thodonal/123rf)

“However, in some patients there may be a more severe degree of viral growth and spread into the lower airways and lungs, accompanied by a markedly more pronounced inflammatory response,” said Dr. Knox. “The increased inflammation can attack the tissues and blood vessels as well, causing fluid leakage into the alveoli of the lung.”

When those tiny air pockets in the lung fill with fluid instead of air, Dr. Knox continued, it becomes visible via X-ray and other imaging, and is described as pneumonia.

Oxygen then has a hard time getting into the bloodstream. In worse cases, that can kick off a series of very severe symptoms that can become fatal — particularly among those with underlying medical conditions.

Does THC suppress the immune system?

Dr. Knox also advised choosing cannabis products high in CBD or CBG (Cannabigerol) as these two cannabinoids have been shown to modulate inflammation by decreasing production of inflammatory cytokines. 

He also noted that THC can, “inhibit T-cell function which is involved in fighting viral infections.”

The endocannabinoid system is closely involved in modulating the body’s immune system, but exactly what effect cannabis has on it is not yet fully understood. While it has been shown to help some patients suffering from auto-immune disorders like rheumatoid arthritis and Crohn’s disease, those same effects might actually suppress some useful immune responses.

“The best advice is to follow CDC recommendations on limiting potential transmission. Avoid smoking or other inhalation methods that involve frequent hand-to-mouth behavior and may exacerbate airway issues,” Dr. Knox added. “Switch to a higher CBD-to-THC profile in the products you are using, and limit doses to avoid possible immunosuppression.”

Other ways to consume cannabis

marijuana tincture
For many patients, it may be beneficial to use alternative methods, like cannabis tinctures. (Darrin Harris Frisby/Drug Policy Alliance)

Cannabis patients must ultimately consider the pros and cons of the various types of cannabis administration.

“For someone using cannabis for general day-to-day symptomatic relief without major medical conditions, it may be reasonable to continue using cannabis, although preferably not by an inhalation route,” says Dr. Knox. 

“For a patient using cannabis to manage medical conditions that could relapse by abstaining, it may be more beneficial to continue use, but maybe with a different method or dose,” he added. 

Alternative delivery methods include sublingual administration (tinctures/oil under the tongue), transdermal applications (patches), topical formulations (creams applied to skin), suppositories and edibles. Each method has its own pros and cons, of course. Elements to consider include average onset time, typical duration, and bioavailability.

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