Are hashish customers at increased danger for COVID-19? A physician solutions
Dr. Junella ChinApril 13, 2020
Dr. Junella Chin advises on smoking, steaming and lung health during the coronavirus pandemic. (AdobeStock)
Editor's Note: Dr. Junella Chin is a doctor in New York, where she treats adults and children in her integrative and holistic medical practice. Dr. Chin co-wrote the book Cannabis and CBD for Health and Wellness with Aliza Sherman and co-founder of Medical Cannabis Mentor, an online education platform.
Dr. Chin offered this FAQ to her patients and we believe she answers some of our readers' most pressing questions about cannabis and COVID-19.
Each of my patients asks about ways to use cannabis carefully to relieve stress or to make these times of social distance and self-quarantine less difficult. There is also a lot of confusion about the effects of cannabis on the immune system.
Here are some of the most frequently asked questions and what I recommend for intelligent, sensible cannabis use in the period of COVID-19.
Should cannabis users stop smoking?
I encouraged adult patients and consumers to think about researching oral forms of cannabis: tinctures, capsules, foods, and beverages instead of inhaled forms of cannabis. Avoiding lung irritation is the first line of defense against this disease.
Any inhaled substance can affect the respiratory tract. Cannabis smoke can cause visible lung irritation and microscopic injury to the pulmonary epithelium (the tiny cells that line most of the airways as respiratory mucosa). Exposing lung tissue to vape aerosols (e-cigarettes) can increase the release of inflammatory cytokines, macrophages, neutrophils and lymphocytes. Basically, the lung tissue tries to build up an "immune response".
Most healthy people can recover from this lung irritation – but at the moment I recommend that you reduce exposure to all irritants. Keep your house dust free. Get some fresh air. Reduce the use of aerosol products. Do not breathe in bleach, ammonia or anything with a harmful smell – even small doses can irritate the eyes, skin and respiratory tract.
Studies also show that the angiotensin converting enzyme 2 (ACE2) receptor increases in the lungs of smokers and patients with COPD. This makes smokers more susceptible to COVID-19, and for this reason scientists and doctors recommend that users who smoke or vaporize quit. The cough, which often occurs when inhaling products, is equally worrying. Coughing can cause COVID-19 pathogens to get in the air, and we all want to avoid that.
Bronchitis is another known side effect of cannabis smoke. It is not uncommon for regular users to develop cough, chest congestion, and some mucus. These symptoms are usually temporary and go away when you quit smoking. It's best to avoid them if you have a pandemic flu pandemic.
It is also an allergy season, so the health of all respiratory tract is impaired.
Also note that the degree of lung injury depends on several host factors:
- Older patients are more susceptible to lung injuries than younger people.
- People with allergies are more prone to bronchospasm than non-allergic people.
- People with reactive respiratory diseases, cardiovascular diseases, diabetes and autoimmune diseases are also at greater risk.
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What is the difference between cannabis and tobacco smoke?
The inhalation patterns of cannabis smoking differ from cigarette smoking. In comparison to tobacco, cannabis inhalations have a 66% larger puff volume and a 33% higher inhalation volume. Cannabis smokers also hold their breath four times longer and ingest five times the concentration of carboxyhemoglobin. Carboxyhemoglobin arises from carbon monoxide poisoning and leads to a lack of oxygen in the body.
Is steaming less dangerous than smoking?
The long-term effects of steaming are not fully known, but not all vaporizers are created equal.
When using vape pens, watch out for oil cartridges that are diluted with PEG (polyethylene glycol – dangerous chemical by-products that destroy lung tissue) or vitamin E acetate that has been associated with lung injuries and chemical pneumonia . One way to avoid vitamin E acetate is to buy cartridges on the legal market. Most, if not all, of the spoiled products were found in the illegal market.
When using a flower vaporizer, temperature control is the key to a healthier drawing – a joint burns at around 950 degrees. The evaporation takes place at 350-400 degrees – the sweet spot is at 390 degrees. This temperature deviation makes a big difference if you want to protect fragile lung tissue.
Evaporators with a technology that enables temperature control are clearly worth the investment. Some brands that are worth a look are Firefly 2+, Crafty and Pax 3.
When vaporizing, be sure to follow the damage mitigation methods below:
- Flower vaporizers are preferable to steam pens
- Wash your hands before and after an evaporation session.
- Sterilize the mouthpiece by swapping alcohol between inhalations.
- Take small "sips" of steam. The smaller the sip, the more control you will feel and the less cough you will experience
- Keep your temperatures as low as possible
- Evaporate outside and away from people. When exhaling, make sure that you are not facing anyone else. Don't steam on the street when there are people behind you.
How does COVID-19 affect the lungs?
If COVID-19 attacks, the respiratory mucosa is injured and causes inflammation. This irritates the nerves in the lining of the respiratory tract and can spread into the gas exchange units (alveoli). This article shows the changes that COVD-19 can have in the lungs.
Normal, healthy lung tissue is light and loose like whipped cream. COVID-19 coats the lung tissue with a yellow mud and turns the lung texture into marshmallow. This thick coating blocks the free flow of oxygen.
As the virus invades and takes control, patients lose their ability to breath and may need a ventilator. At this point, the marshmallow coating on the lung tissue begins to stiffen and the ability of the lungs to absorb oxygen decreases. This is often the point at which the patient's life begins to falter. This virtual reality video brilliantly shows the way to destroy COVID-19.
COVID-19 patients can be divided into four broad categories:
1) Patients who are subclinical. This means that they have the virus but have no symptoms.
2) Patients with minor symptoms: fever, cough, headache, fatigue. These patients are still able to transmit the virus, but they may not be aware of it because these symptoms are common with so many other diseases.
3) Patients with upper respiratory tract infection – cough, congestion and flu-like symptoms.
4) Patients who are admitted to hospitals and are likely to develop complications such as cardiac symptoms or serious illnesses that lead to pneumonia.
With COVID-19 the lining of the respiratory tract is injured, which leads to inflammation. This in turn irritates the nerves in the lining of the airways and can spread into the gas exchange units (alveoli) at the end of the airways. If these air sacs become inflamed, this can result in a flood of fluid and inflammatory cells in the lungs, and patients develop pneumonia.
Should COVID-19 patients avoid all cannabis?
No, I don't think you have to do without cannabis altogether, but you should look for alternatives to inhale.
Cannabis has medical and therapeutic benefits. It is anti-inflammatory, anxiety-relieving, pain-relieving, antiviral and immunomodulating. THC has been found to be a bronchodilator in small doses and to suppress the cytokine storm (when the immune system is in full swing and causes an inflammatory flare) in animal models.
Cannabinoids have also been shown to reduce general inflammation in the body, which means your body has less to deal with. You can also relieve inflammation through diet and regular restful sleep. Anything that reduces inflammation or stress in the body and mind benefits your immune system. Whether you use cannabis against muscle spasms to keep calm or to sleep, it can be a therapeutic addition to your self-care, wellbeing, or health program.
What about CBD?
CBD has antiviral and antibacterial properties, but its main virtue is that it reduces inflammation. As mentioned above, the common thread of all disease states is chronic inflammation. Diseases as diverse as diabetes, lower back pain and migraines are the result of an underlying inflammation. Reduce inflammation and most likely reduce the symptoms of many diseases.
Should medical cannabis patients switch to food or beverages?
Yes. In the past few months, I have encouraged patients and adults to change their consumption habits.
Think about whether you want to examine oral forms of cannabis: tinctures, capsules, food, and beverages instead of inhaled forms of cannabis. Check to see if a 5 mg or 10 mg candy bar or drink is right for you, or experiment to find the optimal dose. Just start low and go slowly.
Once you know your optimal dose, food or drink can make a hike through the forest or a park a more sensual adventure. They smell, see and hear nature more vividly. You will likely feel closer to the people you are with, even if you are 6 feet apart. Remember that it takes an hour or two for the effects to take effect. So adjust your dosage accordingly!
Can I use cannabis to relieve stress?
Cannabis interacts with GABA receptors in our brain. GABA asks our bodies to switch off. It reduces the fight or flight response associated with stress. This can be extremely helpful in this uncertain time when many of us are worried about our own health or the health of loved ones. Cannabis can also help with panic attacks and insomnia.
It is important to mention that many people with anxiety may be taking prescription drugs or antidepressants. So be careful when supplementing cannabinoids as they can interact with these drugs and increase their effects. Talk to your doctor to make sure you don't overuse one or the other. If the doctor increases your Zoloft, it does not mean that you should increase your cannabis use as well.
What foods or supplements can I take to boost my immune system?
- Brazil nuts are the richest known source of selenium, a trace element that is essential for your thyroid and your immune system. Be careful not to consume too much as you can get selenium toxicity – only 2 nuts a day.
- Spirulina is a blue-green algae that is rich in proteins, vitamins, minerals and antioxidants to strengthen the immune system and protect it from allergic reactions. It has antiviral and anti-cancer properties!
- Vitamin D3 helps modulate innate and adaptive immune responses. Vitamin D deficiency is associated with increased autoimmunity and susceptibility to infection.
- Goji berries are full of antioxidants and are known for their immune-boosting properties and their ability to fight harmful free radicals and inflammation. They are full of vitamins A & C.
What can I do to strengthen my immune system?
- exercise. It helps move lymphatic fluid through the lymphatic system. Lymphatic fluid contains white blood cells that fight infections.
- sleep! Optimal immune function is almost impossible without restful sleep.
The bottom line?
Smoking cannabis increases the risk of COVID-19 complications. Because the smoke can irritate the nasal passages and the respiratory tract, you weaken your immune system and increase your susceptibility to infections. This includes every cold or flu, not just COVID-19. During this time, it is safer and smarter to minimize smoked or vaporized cannabis in favor of food, beverages, and tinctures.
Dr. Junella Chin
Dr. Junella Chin is a practicing doctor and co-author of "Cannabis and CBD for Health and Wellness". She is a chronic pain survivor who has devoted her medical career to finding effective, inclusive and holistic approaches to patient care. Dr. Chin is registered with the New York State Medical Cannabis Program. She currently treats both children and adults in New York.