Consuming Cannabis Safely

Tod H. Mikuriya, M.D.*

Oral vs Inhalation

Cannabis may be ingested orally or inhaled. Users of cannabis usually inhale. Inhalation may be smoked or vaporized.Marinol's fixed dose increment form is, for some patients, suboptimal for induction

Gradual upward adjustment from a minimal initial dose over a period of days was the standard of practice with cannabis extract prior to removal in 1940 from prescriptive availability.

Anecdotal reports of users of both Marinol and cannabis describe enhancement or constructive supplementation. Others who have tried both have described cannabis as superior to Marinol. The inhalation route is significantly more consistently effective.

Marinol (dronabinol) synthetic delta -9 tetrahydrocannabinol dissolved in sesame oil. Supplied in fixed doses of 2.5, 5.0 and 10.0 milligram soft gelatin capsules. Taken orally.

Cannabis extract:

9 known delta -9 Tetrahydrocannabinols

2 known delta -8 Tetrahydrocannabinols

50 other cannabinoids that may interact with or modify reactions with the Tetrahydrocannabinols, the primary active principles.

( Source: Marijuana and Health Institute of Medicine, National Academy Press, Washington, DC, 1982, P13-15)

Oral ingestion of either cannabis or Marinol is characterized by:

delayed onset of effects

variable level of effects

prolonged effects

Inhalation is characterized by:

quick onset of effects

consistent level of effects

shorter lasting effects.

Inhalation: Vaporization vs Smoke

Significant irritants and toxic products of combustion accompany smoking and can be minimized by vaporizing the cannabinoids contained within the plant materials. Tetrahydrocannabinols vaporize at 400 Fahrenheit while cellulose combusts at 451 F. Two crude vaporizer prototypes have been successfully demonstrated: a modified manually operated auto cigarette lighter element, and a heat gun for electronic shrink tubing set at 400 F. Unfortunately, vaporizers are currently defined by law as illegal paraphernalia, a citable offense.

Inhalation: Smoking: Harm Reduction Considerations

Contrary to anti-marijuana statements that more potent or stronger material is more dangerous, the opposite is true. Admittedly cannabis smoke is irritating to the throat and lungs. The less exposure the better. The more potent, the less exposure is needed for effect. The potency before prohibition of medicinal cannabis was greater than any illicit cannabis available- so far.

For those using the drug infrequently or are sensitive to cannabis, the lower potency of inexpensive illicit canabis may be suitable.

The cooler, cleaner, and further the better.

A bong or water pipe is the best, a long pipe better than a short pipe, a long joint better than a roach.

Not sharing a smoke is safer than passing it around and possibly contracting infections diseases.

Never had it before? Use it with a friend who has. Find a safe, quiet, and private place. Relax, and let the drug take its effect.

Never use cannabis before or during driving or other activities that need your full attention.

Clinical Research Needed

Only clinical research comparing Marinol to other Tetrahydrocannabinols and cannabinoids for therapeutic efficacy can clarify this controversy.

Tentative and preliminary clinical findings indicate a significant difference between Marinol and natural crude cannabis preparations in favor of the crude product. Route of administration and fixed incremental dosage may be factors in comparative efficacy and unwanted effects.

April 13, 1994