Cannabis isn’t the health problem – the tobacco people mix with it is
Lecturer in Mental Health, University of York
Founder of the Global Drug Survey and Senior Lecturer, King’s College London
Ian Hamilton is affiliated with Alcohol Research UK.
Adam Winstock is founder and managing director of Global Drug Survey, an independently funded research hub. He is also a Consultant Psychiatrist and Addiction Medicine Specialist.
King’s College London and University of York provide funding as members of The Conversation UK.
The Conversation UK receives funding from these organisations
Europe may seem like an increasingly divided continent, but there is one thing that unites its people: an obsession with using tobacco to smoke cannabis. Up to 90% of European cannabis users smoke it with tobacco, according to the latest Global Drug Survey. By comparison, only 8% of Americans smoke cannabis this way.
Cannabis is illegal in many European countries – and it has known harms, but the reality is that many people use the drug anyway. Consequently, policy needs to reflect this reality.
For many Europeans, cannabis is a gateway drug to tobacco as many people are first exposed to tobacco when they smoke their first joint, a phenomenon referred to as the reverse gateway effect.
Smoking (combusting) anything is bad for your lungs. Smoking changes the properties of a substance, often forming toxic and carcinogenic compounds. For cannabis this includes brain changes that are thought to impair cognitive functioning, particularly in adolescents. And the harmful effects of smoking tobacco are well known. More than 8m people die each year as a result of smoking tobacco – mostly from cancer and cardiovascular disease.
But you don’t have to smoke cannabis with tobacco to enjoy the benefits. Alternatives to smoking cannabis include eating it – sometimes referred to as edibles – and inhaling via a vaporiser, pipe or bong.
Global Drug Survey
Joints are not the only way
Countries such as the US and Canada have a cultural disdain for combining tobacco with cannabis. Sweeping regulatory reforms, commercialism and a diversity of concentrated cannabis products have lent themselves to a gradual move to vaping.
There is now sufficient evidence to promote vaping as an healthier alternative method for cannabis. Vaping devices contain an element that heats the cannabis (bud or oil) to a temperature that turns the active ingredients, THC (tetrahydrocannabinol) and CBD (cannabidiol), into a vapour, but without burning it. Smokers need to take smaller and fewer hits to get the high than joint smokers.
Global Drug Survey
In countries where smoking joints is the norm, we need to focus on harnessing the success of anti-tobacco smoking campaigns to help people who like smoking cannabis to do so without tobacco.
Framing drug use as a health issue, rather than a criminal justice issue, is key. Apart from the moral arguments supporting such a shift there are clear economic gains. In the UK, research commissioned by the Liberal Democrats shows that it costs the taxpayer £2,256 for the police to deal with each case of cannabis use. An estimated £67m – spent treating tobacco-related health problems – could also be saved if the next generation of tokers grows up tobacco free.
Legalisation may not cut tobacco use
Before people start calling for law reform, legalising cannabis won’t necessarily be the solution to the issue either. The Netherlands has one of the highest rates of smoking with tobacco in the world, despite a more tolerant approach to drug use.
Changing cultural consumption norms of any substance is difficult. Many people in the UK still binge drink despite not having to be out of the pub at 11pm. Change requires governments to respect the choices individuals make. People who smoke cannabis should be offered practical advice on how to get high without smoking tobacco, rather than be legislated against. The government might also want to consider repealing the law that bans the sale of dry herb vaporisers. Changing norms may take a while, but this would be a good start.
Governments have a duty to protect people. Denying or ignoring the health risks this group face helps no one.European tokers are still smoking cannabis mixed with tobacco while Americans have shifted to vaping. It's time for Europe to catch up.
A Strange Blend: Why Are Europeans Mixing Cannabis and Tobacco?
This article was originally published on Leafly.
Cannabis doesn’t carry the sort of health hazards tobacco does, a majority of studies say. But that doesn’t change the European habit of mixing the two. It’s something North American cannabis consumers don’t often do: even cigarette smokers in Vancouver or L.A. tend smoke their flower pure, strictly separating nicotine and cannabinoids. So where does this difference come from?
To answer the question, let’s go back in time to the cannabis renaissance of the 1960s and ‘70s. Consumers in Europe at the time almost exclusively smoked hashish, often crumbling it into cigarettes, as hardly anyone was aware of the dangers of nicotine and smoking tobacco. The vast majority of cannabis consumers in the U.S., on the other hand, overwhelming had access only to dried flower, which could easily be used to roll pure joints.
These differences influenced the size of what was being rolled in North America and Europe. In the U.S. and Canada, pure “mini-joints” became the standard, while on the continent a king-size joint is preferred. A European-sized joint that contains only cannabis might contain 1.5 grams to 2 grams of flower — far too much for most. An American joint, on the other hand, contains about as much herb — about 0.2 grams to 0.5 grams — as a European mixed joint (often called a spliff in the U.S.), but without the nicotine. Scientists have even pinpointed the average amount of cannabis in an American joint at 0.32 grams. In Germany, the Netherlands, or Denmark, that amount of cannabis is typically mixed with another gram or so of tobacco, depending on personal preference.
Not only does consuming a cannabis–tobacco blend affect your health more than pure flower, it also complicates efforts to gauge the health effects of cannabis itself. The legalization debate often revolves around the dangers of “smoking,” because almost every European study on cannabis is not about smoking it pure but about cannabis mixed with tobacco. Even in medical programs, little attention is paid to whether patients smoke pure. That means that Europeans who use cannabis alone has to justify the consequences of a substance that has little to do with cannabis.
Even without tobacco, smoking is the unhealthiest form of any medical application. Yet other, healthier forms of consumption, such as vaporization or edibles, seem to catch on much more slowly in Europe. That’s in part because tobacco has long been engrained in European culture; as cannabis grew in popularity among Europeans, that affected how people chose to consume. In other cultures, where cannabis has been part of everyday life for millennia, people consume orally or at least smoke cannabis pure.
Mixing tobacco into a joint increases the addictive risks immensely. Many casual users have only begun to smoke cigarettes because they use tobacco for their joints. “Without cannabis I have no problems, but I then smoke more cigarettes” — you’ll never hear such a statement from a pure-cannabis consumer. Doctors in Germany or the Netherlands treating cannabis patients are often unaware of this phenomenon and fail to advise patients to quit tobacco— or at least to separate the consumption of both drugs so the positive effects of cannabis remain intact. The unfortunate reality is that in most instances in Europe, the pairing of cannabis and tobacco simply isn’t discussed.
Last but not least, pure cannabis acts quite differently than a cannabis–tobacco blend. Patients report that the combination of nicotine and cannabis can lead to pain relief and relaxation, but very often they note fatigue as a negative side effect.
All these facts should be worrying enough for European cannabis fans to reflect on their consumption habits. To make things worse, there’s the political aspect. Prohibitionists use the dangers of the legal drug nicotine to protest against legalization of cannabis: “How can we have ever stricter laws to control tobacco and at the same time legalize cannabis?”
Professor Donald Tashkin has been a leading American pulmonologists for decades. In the past he was a vocal supporter of cannabis prohibition. Tashkin was convinced that smoking cannabis flowers created a high risk of developing lung cancer or chronic obstructive pulmonary disease (COPD). At one point, he was convinced that cannabis and lung cancer had a causal relationship worse than tobacco.
But more recent evaluations of long-term studies, however, made him change his mind in 2009: “Early on, when our research appeared as if there would be a negative impact on lung health, I was opposed to legalization because I thought it would lead to increased use, and that would lead to increased health effects,” he has said. “But at this point, I’d be in favor of legalization. I wouldn’t encourage anybody to smoke any substances, because of the potential for harm. But I don’t think it should be stigmatized as an illegal substance. Tobacco smoking causes far more harm. And in terms of an intoxicant, alcohol causes far more harm.”
If the legislators take their task to protect public health seriously, European studies that evaluate the risk potential of pure cannabis consumed in various forms (smoking, vaporizing, edibles) have to be undertaken. These studies should take the international state of research into account, focusing on safer ways of consuming.
Michael Knodt is Leafly’s Germany correspondent.A Strange Blend: Why Are Europeans Mixing Cannabis and Tobacco? This article was originally published on Leafly. Cannabis doesn’t carry the sort of health hazards tobacco does, a majority ]]>