Whether cannabis is used in a medical or recreational context, doing so in the safest manner possible is paramount. While there is good evidence that smoking cannabis is less risky than tobacco (1), it likely still poses some risk.
“When you burn something … it creates toxic compounds, carcinogens, and particulate matter” that may be harmful to health. (2) Whatever the true risk is from smoking cannabis, it isn’t a necessary risk to take. Cannabis can easily be used by inhalation while avoiding smoking risk.
However, even among the smoking alternatives there are approaches that are safer and those that are not. Unfortunately, two completely different device-types get lumped together under the heading of “vaporizers or vapes” - one of which is safer (whole-flower machines), and the other (vapes or oil-pens) is likely even worse than smoking.
Whole Flower Vaporizers
Whole flower vaporizers are the safest approach to inhaled cannabis and are ideal for both medication delivery and for harm reduction.
“The vaporizer runs heated air across the plant without igniting it, releasing the cannabinoids in a vapor free from the byproducts of combustion.” (3) Cannabis vapor from a flower vaporizer avoids all products of combustion. (3)
The crucial factor in vaporization is controlling the temperature. Cannabis vaporized at 350’F (180’C) releases most of the useful cannabinoids without any combustion (4). Combustion starts at 400’F (200’C) with the manufacture of benzene (a well known carcinogen).
Flower machines work using a microprocessor controlled negative feedback mechanism to regulate temperature. This ensures safe delivery of the medicine.
How to Introduce Patients to Flower Vaporizers
Clearly flower vaporizers offer patients a healthier alternative to smoking cannabis. Yet, many cannabis users ignore the risk posed by smoking and have developed habits around smoking that can be hard to overcome in the clinical setting. When patients are resistant to beneficial change, it is often helpful to appeal to their wallets.
Flower vaporizers are more efficient than smoking. Combustion only releases about 30% of the available THC in cannabis (or more properly only decarboxylates 30% of THC-A into THC) (4). Further, depending on the type of smoking apparatus, like a joint, up to approximately 80% of the smoke goes into the atmosphere (called the sidestream) (5).
Flower machines, by contrast, decarboxylate about 80%, and do so only when the user is drawing (inhaling) from the machine (so no loss to the sidestream). Overall, this makes flower vaporizers about 2.5 times more efficient, or put another way, users will spend considerably less for their medication.
Are Vape Pens the Same As Vaporizers?
“Vaping is the inhalation of an aerosol produced by heating a liquid or solid cannabis extract inside a vaping accessory.” (6) Vape pens are different from flower vaporizers, not only because they use concentrated liquids that can be dangerous to inhale, but because they’re dumb devices. They’re simply a battery screwed onto a cartridge full of oil with a heating element to turn the oil into vapor. (7)
There’s no microprocessor and no negative feedback loop to control temperature like in the flower machines. Even the vape pens that purport to control temperature only estimate the temperature based on time and current draw, which are not good estimators for repeated use.
Are Vape Pens Safe?
In a word, no. Without the technology we’ve mentioned, these machines simply combust the oil resulting in dangerous byproducts. For example, even at low temperature (approximately 425’F or 210’C), terpenes combust into carcinogens like Acrolein. (8)
Why are Vape Pens So Popular?
Vape pens are super popular at present and are a real health risk to users. Their major selling points for users are the ease of use, lack of smell, and ability to be used “discreetly”. Flower machines approximate these benefits, but are in reality just not as easy to use and discreet.
From the seller’s point of view, vape pens are cheap. The machinery is mass produced in China and costs nearly nothing. More importantly, however, the oil is made from cannabis biomass that would otherwise be un-sellable. Hence dispensaries like vape pens because they’re essentially getting a second product from the cannabis plant for free.
What to Recommend to Patients
If you’re recommending treatment by inhalation or if you have patients already smoking, recommending that they use a flower vaporizer is good practice. If patients are using vape pens, recommending that they switch to flower vaporization is also good practice. Discussion of safety and health is crucial, but emphasis on the financial benefits of saving money overall may be the best approach to encouraging change in some individuals.
- Chambers MD, J. (2023, August 11). Perceptions of safety of cannabis vs tobacco smoking and secondhand smoke exposure. JAMA Network Open. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2808206
- LaMotte, S. (n.d.). Many Americans wrongly believe exposure to marijuana smoke is safer than tobacco, study finds. CNN. https://amp-cnn-com.cdn.ampproject.org/c/s/amp.cnn.com/cnn/2023/08/14/health/marijuana-smoke-wellness/index.html
- Loflin, M., & Earleywine, M. (2015). No smoke, no fire: What the initial literature suggests regarding vapourized cannabis and respiratory risk. Canadian journal of respiratory therapy : CJRT = Revue canadienne de la therapie respiratoire : RCTR. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4456813/
- Filer, C. N. (2022, June 6). Acidic cannabinoid decarboxylation | cannabis and cannabinoid research. Cannabis and Cannabinoid Research. https://www.liebertpub.com/doi/10.1089/can.2021.0072
- Gouvernement du Canada. (2018, October 12). Information for Health Care Professionals: Cannabis (marihuana, marijuana) and the cannabinoids. For health care professionals: Cannabis and cannabinoids - Canada.ca. https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/information-medical-practitioners/information-health-care-professionals-cannabis-cannabinoids.html
- Gouvernement du Canada. (2023, August 8). Cannabis accessories for inhalation: Minimizing your risk when smoking, vaping and dabbing. Canada.ca. https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/personal-use/accessories-inhalation.html
- Williams, A. (2022, August 18). What is cannabis vaping and how does it work?. Leafly. https://www.leafly.com/learn/consume/what-is-cannabis-vaping
- Tang, X., Cancelada, L., Rapp, V. H., Russell, M. L., Maddalena, R. L., Litter, M. I., Gundel, L. A., & Destaillats, H. (2021, April 7). Emissions from Heated Terpenoids Present in Vaporizable Cannabis Concentrates. https://doi.org/10.1021/acs.est.1c00351