How to Smoke Medical Marijuana

Physicians weigh in on how to best smoke medicinal pot.

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Recreational and habitual use of marijuana, as romanticized by the media, is far different from the medical use of marijuana.

In countries like Canada, where physicians are able to prescribe marijuana as mandated by federal law, drug dependence is always a concern. Physicians want to prescribe pot to alleviate symptoms associated with serious illness like multiple sclerosis without exacerbating dependence on the drug.

In order to minimize dependence and regulate misuse, some Canadian physicians have suggested guidelines on how to prudently partake of medical pot.

Marijuana Dependence and Tolerance

A myth surrounding marijuana is that the drug is not addictive. Please remember that marijuana, like any drug, has abuse, tolerance and dependence potential. In fact, between 9 and 12 percent of all users are problem users whose dependence on the drug causes both physical and social consequences. Such repercussions include compromised global functioning, squandered resources on acquiring the drug, impaired performance at work and school, fractured social relationships and increased risk of motor vehicle accidents.

Marijuana dependence gradually develops in those who smoke marijuana regularly. Over time, people who become dependent on the drug start to use pot daily and in increased dosages. Marijuana users who are dependent on the drug also look for more potent strains and preparations.

As is the case with any drug, dependence on marijuana decreases the pleasurable or euphoric effects of the drug. This decrease in pleasure for dependent users reflects tolerance to marijuana's behavioral and physiological effects. Other signs of tolerance for the drug and its effects also develop including tolerance for marijuana-induced increases in heart beat (tachycardia) and an eventual decrease in associated conjunctival injection (blood-shot eyes).

After cessation of drug use, habitual users of marijuana develop symptoms of withdrawal. These symptoms peak a few days after cessation and include irritability, craving, anorexia and sleep disturbances. Fortunately, such symptoms pass within a couple weeks of discontinued use, and ex-habitual users lose tolerance to the physiologic and psychological effects of the drug.

When compared with withdrawal from other drugs like heroin and alcohol, withdrawal from marijuana is relatively mild and doesn't require hospitalization. However, individual and group therapy is useful in those who plan to quit the drug.

In recent years, pot growers and distributors have developed marijuana strains like sinsemilla and hash-oil preparations of marijuana that are really high in THC content, the main active ingredient in marijuana. 

In the 1970s, average THC concentration in smoked pot was 1 percent but now it's about 13 percent! This increased potency intensifies dependence and worsens withdrawal.

Advice on medical marijuana use

No good evidence-based guidance exists on how to best smoke marijuana for medicinal use.

Such guidance depends on good research, and there is little research on the subject. Nevertheless, based on what we do know about weed, physicians publishing in the Canadian Medical Association Journal in 2014 have issued some advice on hot to best consume medical marijuana. Here is some of their advice:

  • Before medical marijuana is prescribed, patients should first try oral preparations like nabilone.
  • Medical marijuana shouldn't be mixed with nicotine or alcohol.
  • Medical marijuana users shouldn't smoke every day.
  • Patients who smoke marijuana should use a vaporizer to decrease inhalation of carbon monoxide and potentially harmful products of combustion.
  • People with mood disorders, anxiety disorder and other types of mental illness should be carefully and cautiously screened before receiving a prescription for medical marijuana.  Additionally, such users should smoke medical marijuana only occasionally.
  • Dried cannabis should be limited to a 9 percent THC concentration.
  • Medical marijuana users should restrict the amount smoked to 400 mg a day or anywhere between 4 and 8 puffs on days that they are using.
  • People who smoke medical marijuana shouldn't hold their breath while smoking.  Although it's really hard to quantify the amount of THC and cannabinoids that make its way into circulation via the lungs, it's believed that holding your breath increases such bioavailability.
  • Medical marijuana use should be restricted to patients 25 years and older.  (The researchers cite evidence that marijuana may affect the developing brain.)
  • Medical marijuana shouldn't be prescribed to people with substance-abuse disorders.
  • People shouldn't drive or operate heavy machinery for 6 hours after smoking medical marijuana.
  • Medical marijuana should be used only to alleviate symptoms of disease and not to induce intoxication and cognitive impairment.  In other words, people who smoke medical marijuana shouldn't get "super high."

Ultimately, medical marijuana should only be used to treat symptoms associated with serious illness. People with a medical marijuana prescription should not use their prescriptions to abuse the drug and get high on a regular basis.

In the United States, federal and state authorities are so preoccupied with the legality of marijuana that they have spent little time dealing with the most important issue at hand: In certain states, people are prescribed marijuana is a loosely regulated fashion and a fashion that exacerbates dependence, tolerance, and withdrawal. More specifically, a person with mild anxiety can obtain a marijuana prescription, walk into a dispensary and purchase half an ounce (enough to fill a small Ziploc bag) and go home and smoke all day and all night long.

Selected Sources

Article titled "New medical marijuana regulations: the coming storm" by M Kahan and A Srivastava published in the Canadian Medical Association Journal in 2014.  Accessed on 5/30/2015.

Martin PR. Chapter 15. Substance-Related Disorders. In: Ebert MH, Loosen PT, Nurcombe B, Leckman JF. eds. CURRENT Diagnosis & Treatment: Psychiatry, 2e. New York, NY: McGraw-Hill; 2008. Accessed May 30, 2015.

Mello NK, Mendelson JH. Chapter 394. Cocaine and Other Commonly Abused Drugs. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson J, Loscalzo J. eds. Harrison's Principles of Internal Medicine, 18e. New York, NY: McGraw-Hill; 2012. Accessed May 30, 2015.

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