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Respiratory Health Effects Heather Giroux RRT, CRE

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1 Respiratory Health Effects Heather Giroux RRT, CRE
Marijuana Respiratory Health Effects Heather Giroux RRT, CRE


3 Myth vs Reality Smoking Marijuana is much better for me than smoking cigarettes right?? ……Inhaling smoke from any burning material is hazardous to your health!! Aside from being an illegal substance, people who smoke Marijuana once or more per week: Experience more chest colds, bronchitis, emphysema and Asthmatic episodes Issues with organization, motivation, short-term memory and compromised decision making People build up a tolerance to marijuana requiring them to smoke more to feel the same effects and look to smoke more often

4 Definition: n.1.A strong-smelling Asian plant (Cannabis sativa), also called hemp, from which a number of euphorogenic and hallucinogenic drugs are prepared. The euphoric effect is predominantly due to tetrahydrocannabinol (THC). Thought by many to be safe because it grows naturally: Many drugs originate from plants but that doesn’t make them safe THC, found in Marijuana is a powerful hallucinogen that can impair judgment The 400 other chemicals found in Marijuana can put you at risk for mouth, esophageal and lung Cancers, COPD and Immunosuppression

5 Marijuana vs Cigarettes
Pot, Grass, Weed, Hashish, Hash oil (eat, smoke or drink) Originates from the Cannabis plant Smoke contains more than 400 Chemicals The main psychoactive ingredient is Tetrahydrocannabinol (THC) Illegal uncontrolled substance Heavy users can become dependent (less addictive than tobacco) Impairs decision making ability, reaction time, and concentration Usually unfiltered Cigarette, Pipe, Cigar, Chew Originates from the tobacco plant Smoke contains more than 4000 Chemicals Nicotine is the addictive ingredient Legal controlled substance Addiction can occur after using a Nicotine product only a few times (can be more addictive than Heroin) Does not impair judgment. Often used to cope with stress. Usually filtered

6 Smoking Marijuana or Smoking Cigarettes releases dangerous TAR into the Lungs!!!
1 joint has 4 times the amount of tar than a cigarette

7 Methods of Use: Smoking: Self-prepared hand-rolled cigarette (called a joint), as a cigar where tobacco is removed and replaced with Marijuana (called a blunt) or as a water pipe (called a bong). Oral Ingestion: Mixed in food, baked in cookies or brownies, cannabis tea or tablet form for therapeutic purposes (Marinol) **

8 Duration of Effects: When Smoking from a Joint, Blunt or Bong: The effects appear within a few minutes and can last up to three hours. When eating or drinking Cannabis-Containing Substances: At oral ingestion, the effects are felt approximately within the first hour, but last longer (for more than 4 hours). The “High” feeling can be decreased long before THC has been eliminated from the users body, due to storage in the fatty tissues . After 5-7 days half of the original dosage remains in the body and it can take weeks or as long as a month for THC to leave the body completely.

9 Tolerance, Dependence and Withdrawal Effects:
Tolerance: Depends on dose, duration, exposure and metabolism. In comparison with other psychoactive drugs, the tolerance from Marijuana is milder. The mechanism of Marijuana’s tolerance is directly related to the receptor regulation process. Dependence: Developed by regular users. Can lead to difficulties stopping usage, cravings and withdrawal symptoms. Withdrawal: Symptoms consist of restlessness, irritability, sleep disturbances, decreased appetite, depression and tremors (heavy users of drug).

10 Medicinal Use Medical Uses: Currently the medical use of marijuana is limited, mainly due to the cannabinoid potency. However, Marinol (dronabinol) is approved and being used in treating nausea and vomiting after chemotherapy among patients with cancer, improving appetite of AIDS’s patients who have developed the “wasting syndrome”, or in treating other disorders, such as: spinal cord disease/injury, multiple sclerosis, chronic pain, etc. Marinol: It takes over one hour for Marinol to reach full systemic effect, compared to minutes for smoked or vaporized cannabis. Some patients accustomed to inhaling just enough cannabis smoke to manage symptoms have complained of too-intense intoxication from Marinol's predetermined dosages. Health Canada: week processing time to authorize applications for medical marijuana possession and/or license to produce drug for medical purposes. NB ranks fourth per capita in the number of people authorized to possess medical marijuana (as of June 2009) Marinol is an orally administered pure isomer of THC. Prairie Plant Systems in Manitoba has been under contract with Health Canada to grow medicinal marijuana since 2000.

11 ~ High concentrations of Cannabinoid receptors exist in the Basal Ganglia, Hippocampus and Cerebellum. ~The Basal Ganglia controls unconscious muscle movements, which impairs motor coordination when bound to THC. ~ The hippocampus is located within the temporal lobe and is important for short-term memory. When THC binds with the Cannabinoid receptors inside the hippocampus, it interferes with the recollection of recent events. ~ Coordination is further impaired when THC binds with Cannabinoid receptors in the cerebellum.

12 Goes from mouth to brain within seconds!

13 National Geographic Video: How Marijuana Works

14 Pulmonary Effects of Marijuana Inhalation: Lung Function
Studies examining the effect of marijuana smoking on lung function have produced somewhat variable results. This is likely to be related to the difficulty in obtaining random samples of smokers and the potential for under-reporting of marijuana use due to its illegal status. Overall, the majority of studies suggest that marijuana smoking may be associated with elevated lung volumes and slightly greater airway resistance but no change, or an increase, in spirometry values (FEV1 and FVC normal or elevated) This suggests that hyperinflation may be one of the primary physiological abnormalities in marijuana smokers. The increased airway resistance and reduced conductance is consistent with mucosal edema and inflammation, which has been observed in the large airways of marijuana smokers. The bronchodilating effect of THC is far outweighed by the irritative effects of marijuana on the airways. Diffusion capacity does not appear to be effected by solely smoking marijuana but when marijuana in combination with tobacco are smoked further impairment of gas transfer has been noted (DLCO normal according to single study). Nitrogen washout also normal. If you are already immunocompromised damage to cilia can cause fatal pneumonia. Macrophages consume and absorb toxins.

15 Tissue Damage Smoking 1 or more joints/day has been shown to cause damage to the cells in bronchial passages (cilia) and to pulmonary macrophages, which protect the body from inhaled microorganisms. This decreases the lungs ability to fight off fungi, bacteria and tumor cells. Reduced lung density noted on high resolution CT. Video-assisted Thoracic Surgery of 10 marijuana smokers exposed a predominance of intra-alveolar pigmented histiocytes, interstitial scarring and irregular bullae and blebs. The tobacco smokers had a relatively minor accumulation of pigmented histiocytes. Increased histiocytes and scarring due to pattern of inhalation. A histiocyte is a non-motile macrophage of extravascular tissues.

16 Pneumothorax Risk Several cases of collapsed lung have been reported among marijuana smokers. Those at risk tend to have existing congenital blebs on their lungs, a condition that would remain otherwise silent (inhaling deeply with breath hold poses risk). Smoking marijuana produces a 5-fold greater increase in blood carboxyhemoglobin compared to smoking tobacco, which results in decreased blood oxygen levels. Bleb is a small collection of air (air-filled blister) on the pleural surface of lung

17 Malignancy One joint has 4 times the amount of the known cancer causing agent, tar, than a cigarette. Several reports indicate an unexpectedly large proportion of marijuana users among cases of lung cancer and cancers of the oral cavity, pharynx, and larynx. Marijuana smoke contains a higher concentration of polynuclear aromatic hydrocarbons than a cigarette, including 50% more of the carcinogens benzypyrene and benzanthracene, which are known to produce tumors in certain animal species. N-nitrosamines, which have carcinogenic potential, are present in both marijuana and tobacco smoke (roughly equal amounts).

18 Marijuana Smoking Is Associated with a Spectrum of Respiratory Disorders:
Two NIDA-funded studies identify health risks that underscore the importance of curbing marijuana abuse. Research Findings: National Institute on Drug Abuse Vol. 21, No. 1 (October 2006) “ Although far fewer marijuana than tobacco cigarettes are generally smoked on a daily basis, the pulmonary consequences of marijuana smoking may be magnified by the greater deposition of smoke particulates in the lung due to the differing manner in which marijuana is smoked. Whereas THC causes modest short-term bronchodilation, regular marijuana smoking produces a number of long-term pulmonary consequences, including chronic cough and sputum, histopathologic evidence of widespread airway inflammation and injury and immunohistochemical evidence of dysregulated growth of respiratory epithelial cells, that may be precursors to lung cancer. “ National Institute on Drug Abuse (NIDA). Histopathologic means disease of lung tissue.

19 Study performed between 1988-1994. Published in 2006.

20 The Journal of American Chemical Society: Chemical Research in Toxicology
OTTAWA, Dec. 20 (UPI) -- A 2007 Canadian report says marijuana smoke contains more toxic compounds, including ammonia and hydrogen cyanide, than tobacco smoke. Read more: Researchers, including David Moir of the Safe Environments Program in Kitchener, Ontario, determined ammonia levels were 20 times higher in marijuana smoke than in tobacco smoke, while hydrogen cyanide, nitric oxide and certain aromatic amines occurred at 3-5 times higher in marijuana smoke.

21 Inhalation of Ammonia Ammonia fumes are very irritating and corrosive to the eyes, nose and airways.  Fumes may cause a burning sensation, coughing, wheezing, shortness of breath, laryngitis, rhinitis and watery eyes, even at low levels. Breathing highly concentrated ammonia fumes may cause headache, loss of sense of smell, nausea, vomiting, increased heart rate, and high blood pressure. Breathing in very high levels may cause pulmonary edema. Repeated or prolonged exposure to high levels may damage the eyes, liver, kidneys, and lungs, and may cause bronchitis to develop, with cough, phlegm and shortness of breath. (Chemical Encyclopedia ~ Healthy Child Healthy World)

22 Inhalation of Hydrogen Cyanide
Frequent exposure of low concentrations have been associated with weakness, headache, nausea, vomiting, respiratory tract irritation, difficulty breathing, confusion eye and skin irritation. Hydrogen cyanide (AC) is a systemic chemical asphyxiate. It interferes with the normal use of oxygen by nearly every organ of the body. Breathing highly concentrated hydrogen cyanide fumes may cause seizures, temporary blindness, shock, arrhythmias, low BP, pulmonary edema and cardiac or respiratory arrest. (National Institute for Occupational Safety and Health)


24 Conclusion Unfortunately, a large majority of marijuana smokers also smoke cigarettes so it is difficult to accurately conclude the respiratory effects of smoking marijuana alone. The illegal nature of Cannabis also makes obtaining data much more complicated. Despite this, there is evidence to suggest that regular marijuana smoking is associated with slightly increased airway resistance, hyperinflation, large airway edema, chronic cough, sputum production and frequent wheezing. Numerous studies have also suggested a correlation between marijuana usage and significant bullous disease in relatively young subjects due to chemical composition and technique of smoking (ie: breath hold) Some studies have also suggested an association between lung cancer and Cannabis smoking. Inhaling smoke from any burning material is hazardous to your health!!

25 References:
“For Every High There’s a Low. Be Drug Wise. Straight talk About Marijuana”. Health Canada Publication, “Pulmonary Effects of Marijuana Inhalation: Literature Review”. National Geographic Channel “How Marijuana Works” video. Effects of Marijuana Smoking on Pulmonary Function and Respiratory Complications: A Systematic Review. Arch Intern Med Feb. 12; 167(3):

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