Vaping vs Smoking Cannabis: Why Encourage Patients to Vape
Cannabis is historically known as a plant inhaled for recreational purposes, usually via a joint or water pipe (bong). When it comes to cannabis medicine, most people think of CBD and CBD oil. However, according to the TGA, as of 2022, flower has become the second most approved form of medicinal cannabis product.
Because of the villainisation of cannabis, many new prescribers have significant concerns about flower products and how patients will consume this medicine. While Australians are known for smoking cannabis with spin (tobacco), many self-medicating patients are moving to medical cannabis to reduce smoking, cut out tobacco and get safer cannabis products. In addition, most patients are open to vaping cannabis products – a healthier option for patients who need rapid onset relief for various conditions.
In this article, you’ll read about dry herb vaporisers. You’ll learn the primary differences between a dry herb vape and concentrate vapes and why you should encourage your patients to move away from smoking and toward dry herb vaporisation. It’s also important to note that if you want to be a well rounded medicinal cannabis prescriber, it’s critical to know about the various product types, minor cannabinoids and terpenes.
Here’s what this article covers in case you’d like to jump ahead:
What is a dry herb vaporizer?
When most people hear vaporisation, they think of vape pens or cartridges. However, a dry herb vaporiser is a device that has a chamber for ground-up plant material. The vaporiser heats to a preset temperature, and instead of burning the plant material, it releases the oils as a vapour.
When using a dry herb vaporiser, the individual only gets the bioactive cannabis compounds needed for medicinal benefits. Patients can vaporise cannabis at the best temperatures for terpenes and cannabinoid activation by varying the temperature settings.
Types of dry herb vaporisers
There are two main types of dry herb vaporizers:
Convection devices are better quality devices. They pass hot air through a chamber so that the plant material is heated evenly. This creates good quality vapour and more even extraction of the plant matter from the chamber. Therefore, these devices tend to be more efficient with your plant matter.
These devices are usually larger and more expensive because of the technology required to provide a more even distribution of heat. However, due to the efficiency of these devices, many experience patients and cannabis consumers will tell you that they make up for their device cost in the amount saved on the product.
In conduction devices, a heating element sits closest to the plant material. Therefore, the cannabis closest to the heating element gets heated first and often at a higher temperature than the rest. Because of this, the chamber usually needs to be mixed frequently, and consistent doses are harder to achieve.
These devices are usually smaller, more discreet and cheaper.
Vape oils (pens and cartridges) vs dry herb vapes
While this article is about dry herb vaporisers, it’s vital to mention electronic vapes which use oils (vape juice or e-liquid) so that you understand the differences.
These vapes use oils that combine plant resin with a solvent, usually something like propylene glycol or vegetable glycerine. The suppliers often include additives that will ‘improve’ the experience, but the additives can potentially be harmful.
Dr Jim said, “I’m sure most people will be familiar with the E-cigarette or Vaping Product Use Associated Lung Injury (EVALI) outbreak. People were getting damage to their lungs due to chemicals like vitamin e acetate and squalene – a type of terpene that can break down into harmful chemicals. People were also inhaling the wrong fats and getting lipid accumulation in their lungs, forming pneumonia.”
Many vape pens also have poorly made heating elements and metals that can spill into the vape juices and cause further harm. In addition, poor product manufacturing can lead to heating elements getting too hot and causing the combustion of solvent solutions.
These issues and potential issues are not possible with a dry herb vaporiser.
Legalities of smoking vs vaping cannabis
When the TGA provides approval for a flower product, it is approved and prescribed for vaporisation. The TGA website clearly states that flower products are for vaporisation. So, inhaling a medicinal cannabis product via a joint, water pipe (bong), pipe, or any device other than a vaporiser is not how the medicines are intended to be used.
The laws around consuming medicinal cannabis in public are grey. However, it’s generally accepted that vaping in a smoking area is acceptable.
TGA approved vaporizers
There are only a few TGA approved dry herb vaporizers on the market:
- The Mighty Medic – portable vape
- The Mighty+ Medic – portable vape
- The Volcano Medic – desktop vape
These are convection devices and can be purchased from various online shops. When a patient purchases a medic device, it’s important they ask the supplier about a warranty. Some suppliers offer a two year warranty on the mighty and mighty+ medic and a three-year warranty on the volcano medic.
NOTE: it’s important to note that prescribers may apply for other vaporisation devices to be approved via the SAS B pathway on the TGA portal.
One of the main issues with the TGA approved devices is the cost. The Mighty and Mighty+ are between $400-$600, and the Volcano is approximately $900. If a patient’s primary form of medicinal cannabis is a flower product, it’s recommended they purchase one of these devices as they’ll make up for the cost of the device in the lower quantity of product they’ll buy over time.
Why choose a TGA approved vaporiser over others?
The TGA-approved devices’ benefit is that they have been vetted to be at a medical standard. In addition, researchers have tested the volcano for clinical trial use. While there are other popular vaporisers available, as a health professional, you want to be confident that the device your patient uses doesn’t have potential toxins or components that can get into the flower because of poor manufacturing practices.
Downsides of smoking cannabis
Negative health impacts
The first thing to consider when inhaling smoked cannabis is the potential for respiratory damage. All smoke, whether it comes from a joint, cooker or fire in the open, is potentially damaging to the lungs.
Research has shown that inhaled cannabis consumption (without any other substance, i.e. tobacco) does cause bronchial irritation. In addition, smoking cannabis may cause increased mucus production, damage to the cilia (little hairs within the lungs), increased difficulty clearing mucus properly, and an increased likelihood of developing pneumonia.
However, research also shows that individuals who use cannabis only don’t seem to have significant increases of permanent damage to the lungs. There doesn’t seem to be a correlation between smoking cannabis only and increased rates of COPD or the development of lung cancer. A retrospective study looking at hospitalised COPD patients found that individuals using cannabis had a longer stay within the hospital and low mortality rates.
Patients may often turn to a water pipe, aka bong. They think that because they’re filtering the smoke through water, they’re removing some harmful chemicals. Unfortunately, recent research has shown that the filtration of the water removes the cannabinoids and other beneficial components and doesn’t filter out any of the harmful toxins. Dr Jim said, “When the smoke actually gets into the lungs, there’s a disproportionate amount of harmful chemicals versus protective components from the cannabis plant when using a water pipe.”
Smoked cannabis is often mixed with tobacco
“Quite often, people will have cravings – a need to smoke cannabis. But what’s happening is that they are getting cravings for nicotine.”
Australians are known for smoking cannabis with tobacco (spin). As we all know, tobacco is very harmful to the lungs. So if someone is smoking tobacco and cannabis, there’s increased damage to the lungs, increased risk of cancer and a large increase in addiction potential.
Moving patients away from smoking anything, particularly with spin, to a vaporiser is a great harm reduction strategy.
Plant benefit loss
The damage that smoking can do to your lungs is only one downside. The loss of many beneficial chemicals within the plant is another major reason to stop smoking.
The cannabis plant is composed of hundreds of compounds with varying boiling points. Terpenes, the compounds that give each chemovar its unique scent and therapeutic profile, are among the most fragile of constituents. Terpene boiling points generally range from 150 degrees Celsius to around 200 degrees Celsius, and cannabinoid boiling points range from about 120 degrees Celsius to 220 degrees Celsius.
When smoking cannabis, the burning temperature ranges from around 400-800 degrees Celsius. This means that many terpenes and cannabinoids are destroyed before they’ve even fully been activated. While activation of these chemicals does happen, the destruction of a large portion of these crucial chemicals can result in a bad experience and reduce the medicinal impact of the plant.
Finally, you’re destroying an estimated 30% of the THC and other beneficial compounds, which means you’re wasting medicine and money.
What are some of the potential benefits of vaping?
There are lots of benefits of vaping over smoking cannabis.
Rapid onset of action without irritants
The first benefit is that patients still get the rapid onset of action when vaping. Patients can access ‘instantaneous’ relief without releasing other potential irritants. It’s also a smoother experience which means patients will be able to hold the vapour in their lungs for an adequate amount of time (about 3 seconds) to improve the bioavailability of the medicine.
Ability to control the experience
The ability to change the temperature of your device is also an important factor when using cannabis as medicine. Vaporisers allow the consumer to select a temperature or range of temperatures at which they would like to consume their medicine. By understanding the terpene boiling points, patients can choose the compounds they’d like to activate and modify their experience when taking their medicine.
“By understanding a chemovar’s boiling points and terpene profile, you can better set goals. Once you understand a patient’s intentions for medicating, why they’re using this medicine, what their functional goals are in the daytime and at night, controlling the intake of the medicine can help reach those goals.”
Product selection is a part of this, but having some basic guidelines will also help. More volatile terpenes, the monoterpenes, have a lower boiling point (160-180 C). These are the terpenes that are generally more energising and uplifting. The complex terpenes tend to be more sedating, and analgesic and have higher boiling points (180-210 C). Pairing this understanding with a good method for evaluating the chemovar will put patients in a position for greater success.
Potential reduction in overall consumption
There are a few reasons that vaping should help reduce the overall consumption of cannabis.
Consumption of cannabis without tobacco will often lead to lower overall cannabis use because the individual won’t have the same cravings. In addition, the benefits from a larger amount of cannabinoid and terpene uptake and the ability to control the experience should also provide better medical outcomes with less product.
We don’t want patients beyond their optimum dose where they’re impaired to the point that they can’t engage in other health-promoting activities. The vape allows patients to set those intentions and meet their functional goals.
There’s also less temptation to overindulge. When someone is smoking a joint or bong, they generally finish what’s there because those devices are harder to pick up and put down. The vape makes it easier to stay within your therapeutic window.
However, many patients new to vaping will complain that they don’t get the same effects. This may be because the patient’s ECS is flooded due to the amount of cannabis they are used to consuming. It may be beneficial to recommend a tolerance break to help reset the cannabinoid receptors..
It’s more discreet
While this isn’t necessarily a goal for patients, it can be a benefit due to the stigma of cannabis. While cannabis is a legal medication and many patients travel with it, discretion is always a good practice in public so that patients don’t draw unwanted attention.
Conclusion and takeaways
You should now understand the many benefits of patients using a dry herb vaporiser over smoking cannabis in other forms. Here’s a recap of the reasons to encourage patients to vaporise their cannabis flower over other methods of inhalation:
- Reduce negative health impacts
- Remove tobacco from cannabis consumption
- Get the full benefits of the plant (cannabinoids and terpenes)
- More cost-effective (over time)
- Better ability to control the experience
If a patient is hesitant to try a vaporiser, encourage them to purchase something less expensive than the TGA-approved devices to give vaping a chance. It’s may also be a good idea to recommend a THC tolerance break for patients who have been smoking large amounts of cannabis for a long time.