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
Marijuana Research Report
What are marijuana’s effects on lung health?
Like tobacco smoke, marijuana smoke is an irritant to the throat and lungs and can cause a heavy cough during use. It also contains levels of volatile chemicals and tar that are similar to tobacco smoke, raising concerns about risk for cancer and lung disease. 67
Marijuana smoking is associated with large airway inflammation, increased airway resistance, and lung hyperinflation, and those who smoke marijuana regularly report more symptoms of chronic bronchitis than those who do not smoke. 67,68 One study found that people who frequently smoke marijuana had more outpatient medical visits for respiratory problems than those who do not smoke. 69 Some case studies have suggested that, because of THC’s immune-suppressing effects, smoking marijuana might increase susceptibility to lung infections, such as pneumonia, in people with immune deficiencies; however, a large AIDS cohort study did not confirm such an association. 67 Smoking marijuana may also reduce the respiratory system’s immune response, increasing the likelihood of the person acquiring respiratory infections, including pneumonia. 68 Animal and human studies have not found that marijuana increases risk for emphysema. 67
Reports of Deaths Related to Vaping Marijuana
The Food and Drug Administration has alerted the public to hundreds of reports of serious lung illnesses associated with vaping, including several deaths. They are working with the Centers for Disease Control and Prevention (CDC) to investigate the cause of these illnesses. Many of the suspect products tested by the states or federal health officials have been identified as vaping products containing THC, the main psychotropic ingredient in marijuana. Some of the patients reported a mixture of THC and nicotine; and some reported vaping nicotine alone. No one substance has been identified in all of the samples tested, and it is unclear if the illnesses are related to one single compound. Until more details are known, FDA officials have warned people not to use any vaping products bought on the street, and they warn against modifying any products purchased in stores. They are also asking people and health professionals to report any adverse effects. The CDC has posted an information page for consumers.
Whether smoking marijuana causes lung cancer, as cigarette smoking does, remains an open question. 67,70 Marijuana smoke contains carcinogenic combustion products, including about 50% more benzoprene and 75% more benzanthracene (and more phenols, vinyl chlorides, nitrosamines, reactive oxygen species) than cigarette smoke. 67 Because of how it is typically smoked (deeper inhale, held for longer), marijuana smoking leads to four times the deposition of tar compared to cigarette smoking. 71 However, while a few small, uncontrolled studies have suggested that heavy, regular marijuana smoking could increase risk for respiratory cancers, well-designed population studies have failed to find an increased risk of lung cancer associated with marijuana use. 67
One complexity in comparing the lung-health risks of marijuana and tobacco concerns the very different ways the two substances are used. While people who smoke marijuana often inhale more deeply and hold the smoke in their lungs for a longer duration than is typical with cigarettes, marijuana’s effects last longer, so people who use marijuana may smoke less frequently than those who smoke cigarettes.
Additionally, the fact that many people use both marijuana and tobacco makes determining marijuana’s precise contribution to lung cancer risk, if any, difficult to establish. Cell culture and animal studies have also suggested THC and CBD may have antitumor effects, and this has been proposed as one reason why stronger expected associations are not seen between marijuana use and lung cancer, but more research is needed on this question. 67
Like tobacco smoke, marijuana smoke is an irritant to the throat and lungs and can cause a heavy cough during use. It also contains levels of volatile chemicals and tar that are similar to tobacco smoke, raising concerns about risk for cancer and lung disease.