Smoking Marijuana Poses Health Risks Similar to Those of Smoking Cigarettes
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A survey of over 5,000 people published on August 11 in JAMA Network Open found that 44 percent of adults believe that smoking a joint every day is safer than smoking a daily cigarette — a misperception that researchers say could have significant public health consequences.
“We certainly have more research about the long-term health effects of tobacco, because it has been studied for a longer period, and there are challenges to studying cannabis because it is illegal at the federal level,” says lead author Beth Cohen, MD, a researcher and professor of medicine at the UCSF School of Medicine in San Francisco. And while more research on smoking cannabis is needed to fully understand the risks of smoking or vaping cannabis, what we already know is troubling, Dr. Cohen says.
“The results are concerning since in reality, and as the study points out, numerous studies show that cannabis use and secondhand [marijuana] smoke have effects on the body similar to tobacco use,” says Bonnie Halpern-Felsher, PhD, a professor of pediatrics and psychiatry and behavioral sciences at Stanford Medicine in California.
“Smoking or vaping cannabis and tobacco are both harmful to our heart and lungs, and to the developing brain for teens. And [marijuana] has been linked to mental health issues, including schizophrenia,” says Dr. Halpern-Felsher, who was not involved with this study.
People Increasingly View Marijuana as Less Risky Than Tobacco
To find out what people think about the safety of smoking cannabis or exposure to secondhand marijuana smoke, compared with tobacco smoking or exposure, and how those beliefs might be changing, investigators surveyed 5,035 U.S. adults in 2017, 2020, and again in 2021.
The average age was 53 years old, and 50.7 percent of survey respondents were male, 78 percent were white, 6 percent were Black, and 9 percent were Hispanic.
Investigators asked participants, “How does smoking one marijuana joint a day compare with smoking one cigarette a day?” with response options of “Smoking one marijuana joint a day is much less safe, somewhat less safe, as safe as, somewhat safer, or much safer than smoking one cigarette a day.”
In 2017, 34 percent of respondents said that smoking marijuana once a day was either much or somewhat more dangerous than smoking a daily cigarette. That year, 37 percent said cannabis was safer, and 29 percent said they carried equal risks.
By 2021, just 26 percent still believed that smoking cannabis was more dangerous than smoking tobacco, while 44 percent said marijuana was safer than cigarettes — a 21 percent increase from four years earlier.
Similar trends were seen when respondents were asked about the risks of being exposed to secondhand cannabis versus cigarette smoke.
Is Marijuana Smoke Safer Than Tobacco Smoke?
These findings suggest that the medical and scientific community need to do a better job communicating what is known about the health risks of smoking marijuana to the public, says Cohen.
Analyses of cannabis smoke have shown it contains many of the same toxins and carcinogens as tobacco smoke, Cohen points out. Animal studies have suggested that even one minute of secondhand smoke from cannabis may be associated with impeded endothelial function — and therefore could impart the same cardiovascular risks as tobacco, according to the authors.
“Combustion of cannabis also creates particulate matter that can be inhaled deep into the lungs and cause tissue damage and inflammation,” says Cohen.
Smoking marijuana “clearly damages the human lung,” has been linked to chronic bronchitis, and may negatively impact the body’s immune system, according to the American Lung Association.
Cigarette Smoking Acceptance Has Gone Down While Marijuana Acceptance Is on the Rise
This isn’t the first study to find that many Americans believe smoking marijuana is safe: In an American Psychiatric Association (APA) poll released in June 2023, 84 percent of Americans agreed that cigarettes are unsafe, but only 38 percent of respondents thought cannabis or marijuana was unsafe.
These attitudes aren’t necessarily surprising, says Halpern-Felsher. “Over at least the past two decades, cigarette smoking has become less and less socially normative, with more tobacco control policies, education, and knowledge of health harms leading to much lower cigarette use and a greater understanding of the significant health harms linked to cigarette smoking,” she says.
“In contrast, cannabis use amongst adults and even youth has increased, owing in part to legalization of cannabis in many states across the country, fewer restrictions on cannabis use compared with tobacco use, and less research on and education about the harms of cannabis,” Halpern-Felsher says.
About 3 in 10 Younger Adults Regularly Use Marijuana
Marijuana is now legal for recreational use in adults aged 21 and over in 23 states, along with Washington, DC, and two U.S. territories, per the National Conference of State Legislatures. Medical-use marijuana is legal in 38 states, 3 territories, and Washington, DC.
Perhaps it’s not surprising, then, that a Gallup poll released on August 10, 2023, found that marijuana use in America is at an all-time high: 50 percent of U.S. adults say they have experimented with marijuana.
About 1 in 6 (17 percent) adults currently use marijuana, and current use is the highest in people between 18 to 34 years old, with nearly 3 in 10 (29 percent) reporting current marijuana use.
More Acceptance May Lead to Greater Cannabis Use
Why are changing attitudes concerning? Halpren-Felsher points out that research has shown (including a study she co-authored in 2018 in JAMA Internal Medicine) that more positive attitudes are associated with greater cannabis use.
“I think we need to get the word out that cannabis can harm our heart, lungs, brains, addiction potential, and mental health, similar to tobacco use. I am always particularly concerned about young people, as our brains continue to develop until we are about age 25, and therefore young people are significantly more likely to become addicted,” she says.
This Is Not Your Mother’s Cannabis: THC Levels Up to 10 Times Higher
“Many people also do not realize that cannabis THC levels have increased, with today’s THC levels about 10 times the levels when I was a kid. Further, we have more concentrated forms of cannabis such as dabbing, which can have about 80 percent THC, which is a cause for even more concern,” says Halpren-Felsher.
THC, which stands for delta-9-tetrahydrocannabinol, is the major psychoactive component of the marijuana plant and causes the euphoria or “high” that many people feel after using the drug.
The term “marijuana” is generally used to describe any product that contains THC, while the term “cannabis” is more general and can describe anything derived from the Cannabis sativa plant, according to the National Center for Complementary and Integrative Health.
Where to Find Accurate Information About the Health Risks of Marijuana
Cohen believes that these findings also highlight the need for more research on the health impacts of cannabis.
“I would advise people to be cautious about getting information from social media and websites that aren’t from reputable health and science sources,” says Cohen. She points to a study published in March 2021 in the Journal of General Internal Medicine that highlights the inaccuracy of many internet claims about cannabis use.
“The National Center of Complementary and Integrative Health has a good section covering the data on potential benefits of cannabis for medical conditions as well as what we know about risks. Talking to your primary healthcare provider is a good step, though provider knowledge may vary,” she says.
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