Every few weeks, published surveys reveal that American approval of cannabis is trending up. The most recent Gallup consumption survey revealed that 50 percent of Americans admit to having tried the plant in some form. This acceptance also comes with a recognized safety regarding cannabis products and consumption methods. 

As a long-time medical patient and cannabis journalist, I have been vigorously reading studies and watching the tides shift for over a decade. 

One study from the University of California San Francisco Department of Medicine polled 5,053 Americans over the course of five years about their views on the safety of cannabis smoke and tobacco smoke. Researchers found that the public increasingly considers cannabis smoke safer than tobacco. 

The published study cites a need to “curb the increasing social acceptance of cannabis smoke exposure, similar to past education about secondhand tobacco smoke.” 

Dr. Beth Cohen, co-director of the residency investigation methods and epidemiology at UCSF, expressed alarm about the results in an email to CNN.

“I do not believe that comparing the health risks of marijuana smoking and tobacco smoking is useful any more than asking, ‘Are eating cookies healthier than eating cake?’ All smoke is an irritant to the respiratory tract, and at a time in human history when humans breathe polluted air, NO added smoke is good,” Dr. Cohen explained.

Why do we compare cannabis and tobacco?

This article continued on to cite myriad studies that support the claim that cannabis smoke and vaping are harmful to the pulmonary system. I don’t hope to argue against these studies. Nor do I intend to rally to decree combustion as safe. What stuck with me was the deafness to the battle for legalization through normalization.

The good doctor doesn’t understand why comparing cannabis and tobacco might be necessary. That could be due to a few factors. 

This comparison has served advocacy efforts for decades now. The World Health Organization reports that tobacco kills half of its users, equating to eight million people yearly. Of those 8 million, 1.3 million only inhale tobacco smoke secondhand. 

To this day, not a single person has died of pure cannabis consumption alone. Yet tobacco products are being sold at local corner stores alongside candy and Takis while cannabis is federally illegal. Cannabis advocates assert that is absurd. 

So, while Dr. Cohen’s point about all smoke-carrying pulmonary risks is astute, there is reason to raise the comparison. Looking at cannabis and tobacco through the same lens is a powerful tool for the legalization component of the plant’s journey. 

Of course, it isn’t a medical doctor’s job to understand the inner workings of the cannabis movement. But maybe there is more room to learn.

The need for education is real

Medical professionals might need to informed about medical cannabis, but as a journalist and not a doctor, I’m not sure what that looks like. 

Doctors are trained to trust science-based research, and until recently, there wasn’t much of that for cannabis. And obviously medical schools aren’t updating curriculums monthly to keep up with every piece of research. But that doesn’t mean practicing doctors can’t regard and assess new data on medical cannabis. 

There’s a wide gap between medical cannabis and medical doctors, and it’s high time we build a bridge. One way that I do this is by disclosing my cannabis consumption to my own medical practitioners, especially when it’s relevant. It’s because I’ve been doing this for years while obsessing over every new development with cannabis that I identified this gap.

Disclosing consumption looks like declining pain prescriptions prescribed with a procedure and explaining the cannabis regimen I plan to use instead. I’m also honest about consuming during the routine questionnaires. I’d like to hope my practitioners take this into their mental zeitgeist as an anecdotal testimony worth some merit. 

Obviously, this isn’t an option for some people in prohibition states. It’s also risky for people of color as medical racism persists in some institutions. However, those with the privilege may consider being less opaque about consumption with their doctors and other practitioners. 

The ongoing cannabis conversation

This is just my little brick to bridge the gap, but it will take more research and clinical trials to breach medical school textbooks. GreenState emailed Dr. Cohen for more insight into the general consensus about cannabis in the medical community. 

“Technically, doctors can’t ‘prescribe’ marijuana because it’s illegal at the federal level, but they can make recommendations. States differ in terms of what type of documentation is required for that recommendation,” Dr. Cohen said.

Even with varying degrees of legality, there are several methods to obtaining cannabis products. There are also limitations. For example, some product effects vary by batch. 

Doctor-prescribed pharmaceuticals, on the other hand, undergo extensive development, testing, and clinical trials for FDA approval. In that process, the drugs are purified to elicit the same effects every time. 

While Epidolex and a few other cannabis pharmaceuticals have gone through this process, other applications are backed by conflicting studies or what Dr. Cohen called low quality trials.

“In these situations, I think the best we can do is discuss the evidence we do have on the potential risks and benefits of cannabis for a given patient,” she said. “This type of shared decision making is common in medicine, though more challenging when the topic is understudied.”

So while the CNN article saying that cannabis smoke is as dangerous as tobacco may have felt inflammatory to the cannabis advocates, Dr. Cohen is not against cannabis medicine. As she mentioned to CNN:

“I am not anti-cannabis, I just want people to make informed decisions,” Dr. Cohen explained. “Even if we do more research and find out that cannabis smoke is less harmful than tobacco smoke, that still doesn’t mean it’s safe.”

And to that, she has a point. Smoking anything, whether the compound has medicinal value or not, poses a risk to lung health. But that doesn’t diminish the capacity of cannabis medicine, just some of the consumption methods.