As you know, if you’ve been following along with me over the years, I generally do not recommend smoking cannabis. I tend to recommend vaporizing whole flower as the safest approach to inhalation that actually allows us to estimate dose fairly accurately. Recently, however, I was confronted with the question of whether using a bong vs. joint was better. Let’s explore.
Risk of Smoking
Why do I generally recommend against smoking? Smoking exposes us to a wide array of nasty chemicals from the combustion of the plant material and terpenes. Most of these nasty chemicals are known to promote cancer, heart disease, high blood pressure, and lung disease. The overlap in nasty chemicals between cannabis smoke and tobacco smoke is impressive. Hence I recommend avoiding these when we can.
Interestingly, and in full transparency, cannabis smokers don’t seem to get the same emphysema and lung cancers that we see with tobacco smokers. You may have heard of the study that Dr. Donald Tashkin at UCLA started back in 1980s following recreational cannabis smokers that has amply demonstrated these differences. Nonetheless, we clearly don’t understand why these differences should exist given the similarities in the nasty chemicals in both that we’ve already discussed. Perhaps there are some chemicals in cannabis smoke that mitigate the negative effect found in tobacco smoke, but that seems less plausible. Perhaps we just aren’t looking at the right harms and cannabis smokers do get something bad from these nasties. We just don’t know. Again, this is why I recommend avoiding the avoidable exposure.
Risk of Dosing
Inhalation as a method of cannabis use poses some risk itself due to dosing effects. Whether we’re talking about smoking or vaporizing flower, there is a tendency for users to not focus on their dose. When I teach patients to use cannabis via a flower vaporizer, I teach them to take a “puff” in a specific manner that leads to a consistent dose per puff. Nonetheless, even if the dose per puff is known, it requires the user to pay attention to how many puffs they take. This is easily done for many, but for some it is just too easy to not pay attention and puff away. Very quickly this can lead to taking much more cannabis than intended. This becomes problematic as higher doses push up tolerance, which then lead to using a still higher dose, and this can escalate the dose ever higher. At some point these ever higher doses lead to down-regulation of endocannabinoid receptors, malfunction of the Endocannabinoid System, dependence, and even addiction.
The best way to avoid this vicious cycle is, of course, to use the flower vaporizer with care and to respect your dose. Counting puffs is not that difficult.
Bong vs. Joint for Dosing
If someone is hell-bent on smoking (and this article really shouldn’t be used to justify that), the bong does present a better option than the joint.
When you smoke a joint, you watch much of the smoke spiral off into the universe, lost from being available to help you. Estimates of how much that may be vary and are not well documented. However, it appears to be somewhere between 50-70% is lost to the “side stream” meaning into the ether. This makes understanding how much you’re actually taking in very difficult. You can do the math, but it’s woefully imprecise.
Furthermore, most patients and cannabis users are quite cost conscious, so losing >50% of your medicine seems like a dramatic, avoidable waste of money.
Bongs are different. Not only do they trap the smoke in a container so that it is not lost when you stop inhaling, and that smoke remains available in that container when you resume inhaling, but they generally don’t stay lit when you cease the inhalation. This means that much less is lost to the side stream. It appears that the loss is about 10% – meaning that you get to use about 90%.
Since bongs are so much more efficient, we can do dosing much more precisely. To do this we start with the dose we need, back calculate how much cannabis needs to go into the bong, and at 90% retention, we have a good idea what you’re getting. Let me give you an example:
If your dose is 10mg THC, and you buy a 20% THC strain, then 50mg of cannabis equals 10mg THC (here’s the math – 10/0.2 = 50). You can do the same math with odd percentages too. If the strain has 17.3% THC, then the 10mg THC dose is 10/0.173 = 57.8mg cannabis.
So if you put 57.8mg of 17.3% THC cannabis into your bong and smoke it, you’ll be getting about 9mg THC which, as they say, is close enough to 10mg for rock and roll.
Vaporizing is Best
In the end, there’s really no good reason to smoke cannabis. It’s really an unnecessary risk when you consider that you’re using cannabis as a medicine. Dosing is really important too, for all the reasons I’ve given above. So if you must smoke, then a bong at least allows control of dose. It’s up to you to follow the math (I’ll be happy to help) and to stick to the dosing and timing we discuss in your care plan.
Consult with a Qualified Massachusetts Medical Marijuana Expert Today
Those considering using THC, CBD, or any type of medicine found in cannabis to help manage their condition should consider speaking to a trained medical expert who is knowledgeable about using cannabis therapeutically.
Massachusetts medical marijuana doctor Jordan Tishler, M.D. sits on the faculty of Harvard Medical School and has years of experience helping patients treat pain and other ailments using cannabis. He and the team at inhaleMD stand ready to assist patients in determining whether medical marijuana is right for them.
For more information, or to set up a virtual consultation with the team at inhaleMD, call us at (617) 477-8886 today.