https://www.msn.com/en-us/health/other/some-cannabis-types-are-safer-than-others-what-experts-recommend/ar-AA277Ans

Some cannabis types are safer than others. What experts recommend
Story by Sarah Klein

More than a quarter of adults in the United States and Canada use cannabis for medical purposes. And the overwhelming majority — nearly 80 percent — smoke it.

“For a number of reasons, that’s a bad idea,” said Peter Grinspoon, a primary care physician and board-certified addiction specialist at Massachusetts General Hospital, an instructor in medicine at Harvard Medical School and the author of “Aging Well With Cannabis.”

“I can understand why people smoke, because it can be really clinically effective,” he said. “If you have chemotherapy-induced nausea and vomiting, you can’t exactly take an edible and wait 45 minutes for it to kick in.”

While the relief from smoking can kick in within minutes, the effects last only about two to four hours, which means you would need to keep smoking frequently to manage medical concerns, he said.

And that’s a problem when you think about what smoking cannabis is actually doing to your body. Smoking and vaping heat up compounds in cannabis. Smoking, whether tobacco or cannabis, leads to combustion, which releases toxins, carcinogens and irritants, according to the American Lung Association.

Vaping doesn’t involve combustion, but it can still degrade various compounds in cannabis and in vape cartridges in ways that can directly damage the lungs, said David Kroll, a professor at the University of Colorado Anschutz Skaggs School of Pharmacy and Pharmaceutical Sciences.


Vape juice or oil, the THC-containing liquid, can sometimes have compounds that may damage the lungs. (EVALI, or E-cigarette or vaping product use-associated lung injury, is a potentially life-threatening illness that was first linked to THC-containing vapes in 2019. It has caused 2,807 hospitalizations and 68 deaths as of 2020.)

Kroll encourages cannabis users to think about their consumption method as a “medical delivery device.” And just like with any over-the-counter or prescription medicine, you want to take the safest and lowest dose that helps with your symptoms.

So what are the safest forms of cannabis? Here’s what the experts told us.

Cannabis tinctures top the list of Grinspoon’s preferred delivery methods. It’s easy to control the dosing of these concentrated liquids based on the capacity of the bottle’s dropper, he said.

Administered under the tongue, tinctures can kick in as quickly as 15 minutes later, slower than smoking but faster than edibles. The effects can last four to six hours, he said.

“When you have these yummy, delicious edibles, it’s hard to get someone to use a tincture, but I do think edibles are a very safe way to take [cannabis], provided you take the right dose,” Grinspoon said. Taking the wrong dose is, unfortunately, common in new users, who often underestimate the strength of gummies and other edibles and take more before their first dose has kicked in, he said. Most people who end up going to the emergency room for the effects of too much cannabis used edibles, according to research published in the Journal of Medical Toxicology.

Edibles take longer to work than smoking, vaping or tinctures, but their effects last longer, Kroll said. Research suggests edibles can take one to three hours to kick in, with the effects lasting six to 12 hours. The long-lasting effects enable users to take edibles at regular intervals to keep blood levels of cannabis compounds stable and things like chronic pain at bay, Kroll said, a big benefit over having to smoke multiple times each day for similar relief.

Whether your edible is a gummy, a chocolate bar, a cookie or a drink won’t make much difference, safety-wise, as long as a third-party laboratory can guarantee the product contains what it says it does, Kroll said. If the products are relatively comparable, you can feel safe buying the least expensive or tastiest option for you, he said. Preliminary research suggests cannabis drinks kick in faster than cannabis products you eat, but more studies are needed on the effects of cannabis-infused beverages.

And if you’re taking a lot of edibles, don’t overlook the nutrition aspect of these products. The sugar, fat and calories can add up if you’re eating a lot of gummies, chocolate or brownies, Grinspoon said. To paraphrase his words: If marijuana is medicine, don’t make it taste good.

In the search for a quicker onset of action, manufacturers have also started making cannabis pills you can take orally. The THC — or tetrahydrocannabinol, the primary psychoactive compound from the cannabis plant — is mixed with ingredients that help the particles get absorbed faster to “kind of Trojan-horse the THC into the bloodstream,” Kroll said.

Grinspoon considers pills as effective as tinctures and edibles. They may be slightly safer than edibles simply because they don’t tempt anyone to take too much with their tasty flavors, and they don’t come with fat, sugar or calories, he said.

Topicals are applied directly on the skin. These creams and gels are made with cannabis compounds to deliver localized pain relief. They don’t cause whole-body, psychoactive effects, so they’re a popular choice among people who don’t want to feel high. Grinspoon likens them to any other anti-inflammatory topical solution for achy joints. Topicals can start working within minutes, but how long the effects last can vary.

Cannabis suppositories are small, solid forms of marijuana that are inserted into the rectum or vagina and are both safe and effective, Kroll said, although more research is needed to determine how they can best be used medically.

“The idea is to put the medicine where it needs to go, so we can have anti-inflammatory effects in very high concentrations in the local area, and there’s less that gets into the brain, so you don’t get as high or have as many side effects,” Grinspoon said.

These suppositories can often contain higher concentrations of cannabinoids to provide relief from symptoms such as pain without a high. This might be helpful for endometriosis pain, for example, because the suppository can deliver a high concentration of cannabinoids in the uterus but not in the blood, Kroll said.

They are a bit harder to find at your average dispensary, Grinspoon said, but a doctor may be able to help you access them.

“Some people think they’re kind of messy or gross, but the people who use them say they’re really, really effective, so I think we’re going to be increasingly entering the age of suppositories,” he said.

Ultimately, like with many things, “it’s a question of magnitude,” Grinspoon said. An occasional sugary, buttery cannabis brownie isn’t going to wreck your whole diet. One puff of a joint once a week probably isn’t going to seriously damage your lungs or heart, he hypothesized. But “smoking a joint every hour to control pain is going to be bad for [your] lungs,” he said. A trusted health care professional can help you determine the safest form of cannabis for you and the lowest possible dose to address your symptoms while minimizing your risk of side effects.