I think people need to be educated to the fact that marijuana is not a drug Marijuana is an herb and a flower God put it here If He put it here and He wants it to grow what gives the government the right to say that God is wrong ID: 597499
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Slide1
Marijuana and the LungsSlide2
"I think people need to be educated to the fact that marijuana is not a drug. Marijuana is an herb and a flower. God put it here. If He put it here and He wants it to grow, what gives the government the right to say that God is wrong
?”- Willie Nelson
Golden LeafSlide3
The cannabis plant has been used by man for over 3000 years
Seeds:
Cooking oil, lubricants, solvents, ink, soaps
Stem/stalk:
Rope, apparel, paper, insulation, mulch
Leaves and flowers:
Recreation, medicine, religious ceremonies
Weed
National Institute
on Drug
Abuse,
Marijuana Research Findings: 1976,
1977Slide4
Pot
Historical uses of cannabis
600 BC:
anti- phlegmatic
and a cure for
leprosy (Ayurveda)
200 BC : earache, edema and
inflammation (Greece)
1 AD: gout, rheumatism, malaria and absentmindedness (China)
79 AD : cramped joints and gout
(Pliny the Elder, Rome)800-900 AD: migraines and syphilis (Arabia)
http://medicalmarijuana.procon.org/view.timelineSlide5
Historical uses of cannabis
1750-1850: George Washington and Thomas Jefferson reference hemp
- 1850: Cannabis is added to the US
Pharacopeia
-
neuralgia, tetanus, typhus, cholera, rabies, dysentery, alcoholism, opiate addiction, anthrax, leprosy, incontinence, gout, convulsive disorders, tonsillitis
http://medicalmarijuana.procon.org/view.timeline
FattySlide6
Historical uses of cannabis
1911-1927: 11 states ban marijuana as part of the prohibition movement
1936: Reefer Madness is released
1942: Cannabis is removed from the US Pharmacopeia
http://medicalmarijuana.procon.org/view.timeline
TokeSlide7
Globally, inhaled marijuana is used by almost
4% of adultsGrass
Inhaled marijuana is prepared from dried flowers and leaves
- Compacted and rolled (joint)
- Compacted but not rolled (pipe)
- Water pipe (bong or hookah)
- Heated without flame (vaporizer)
United Nations Office on Drugs
an
d Crime, World Drug Report 2013Slide8
“Of course I know how to roll a joint”
- Martha StewartKentucky BlueSlide9
Marijuana smoke contains as many or more hazardous chemicals as tobacco smoke:
Marijuana has: - 20 times the amount of ammonia
- 3 times the amount of aromatic amines
- 2.5 times the amount hydrogen cyanide
- similar amounts of polycyclic aromatic hydrocarbonsReefer
Moir
et al,
Chem
Res Toxicol, 2008Slide10
Marijuana smoke
causes
bronchodilation
Panama Red
Vachon
et al, NEJM, 1973
Baseline
After inhalation
High dose
Low dose
Flow
Resistance
FRCSlide11
Marijuana
Isoproterenol
Tobacco
Marijuana - THC
Dope
Tashkin
et al, NEJM, 1974
Bronchodilation is due to
THC
change in conductance
Time (minutes)Slide12
Ganja
Tashkin
et al, Am Rev
Respir
Dis, 1974
Tashkin
et al, Am Rev Respir Dis, 1977
Abboud et al, Chest 1976
THC causes bronchodilation in asthmatic patients
Time (minutes)
change in conductance
Isoproterenol
Saline
Marijuana
PlaceboSlide13
Cannabinoid receptors are expressed by airway nerves
Mary Jane
Calignano
et al, Nature,
2000
Guzman
, Nat Rev Cancer, 2003 (modified)
a
xon terminal
b
ronchial smooth muscle
CB1
Axon terminal
Lung parenchymal cellSlide14
Short-term effects of inhaled marijuana on the lung
Roach
Conclusions:
Inhaled THC has an acute
bronchodilatory
effect, likely due to CB1 receptors on airway axon terminals
Harnessing this effect for therapeutic benefit has failed to yield consistent resultsSlide15
“I have used cannabis all over the world”
- Rick Steves
Black MoteSlide16
Marijuana is smoked differently than tobacco
Blaze
Tashkin
et al, NEJM, 1988
Marijuana
Tobacco Slide17
Long-term effects of inhaled marijuana on the lung
- Respiratory symptoms
- Pulmonary function
- Lung cancer
- Miscellaneous
Herb
Fewer cigarettes
Deeper inhalation
Longer inhalationSlide18
Chronic
Chronic marijuana use causes cough
, wheeze, shortness of breath,
and sputum production
Similar results were found in young
adults aged 21!
Aldington et al, Thorax, 2007
Tashkin
et al, Am Rev
Resp
Dis,
1987
Taylor et al, Addiction, 2000Slide19
Chronic
Chronic marijuana use causes cough
, wheeze, shortness of breath,
and sputum production
Similar results were found in young
adults aged 21!
Aldington et al, Thorax, 2007
Tashkin
et al, Am Rev
Resp
Dis,
1987
Taylor et al, Addiction, 2000Slide20
Chiba
Chiba
Aldington et al, Thorax, 2007
Tashkin
et al, Am Rev
Resp
Dis,
1987
Taylor et al, Addiction, 2000
Chronic marijuana use causes cough
, wheeze, shortness of breath, and sputum productionSlide21
Marijuana
smokers have more outpatient visits for respiratory problems and injuries
Bong
Polen
et al, West J
Med, 1993Slide22
MJ smokers have
more outpatient visits for respiratory problems and injuriesDitch weed
Polen
et al, West J
Med, 1993Slide23
Roth et
al, AJRCCM, 1998
Fligiel
et al, Chest, 1997
Symptoms due to the effects of smoke on bronchial mucosa
Goblet cell hyperplasia
Squamous metaplasia
Doobie
Non-smoker
MJ-smokerSlide24
Spliff
Tashkin
et al, COPD, 2012
Smoking cessation decreases the symptoms of chronic marijuana useSlide25
Manhattan silver
Tashkin
et al, COPD, 2012
Smoking cessation decreases the symptoms of chronic marijuana useSlide26
Long-term effects of inhaled marijuana on the lung
Respiratory symptoms
Columbia Red
Conclusions:
Heavy MJ use (50 joint-years) causes upper respiratory symptoms due to airway inflammation
Symptoms can be reversed by smoking cessationSlide27
“I tried it once but it didn’t do anything for me.”
- John WayneKiffSlide28
Long-term effects of inhaled marijuana on the lung
- Respiratory symptoms
- Pulmonary function
- Lung cancer
- Miscellaneous
420
Fewer cigarettes
Deeper inhalation
Longer inhalationSlide29
Maggie
FVC
FEV1
FEV
1
FVC
FRCTLCRV
DLC0
Raw
Caw
Tashkin 1980
Tashkin 1987
Bloom 1987
Taylor 2000
Aldington 2007
Hancox
2010
Pletcher
2012
/
Long-term effects of inhaled marijuana on the lung
Pulmonary functionSlide30
Acapulco Gold
Long-term effects of inhaled marijuana on the lung Pulmonary function
FVC
FEV
1
FEV
1FVC
FRC
TLC
RV
DLC0RawCawTashkin 1980
Tashkin
1987
Bloom 1987
Taylor 2000
Aldington 2007
Hancox
2010
Pletcher
2012
/Slide31
Homegrown
Aldington et al, Thorax, 2007
O
ne cannabis joint
i
s equivalent to 5 tobacco cigarettes
Marijuana affects pulmonary function in a dose-dependent fashionSlide32
Don Juan
Pletcher
et al, JAMA, 2012
The association between marijuana and pulmonary function may be
non-linear
tobacco
tobacco
marijuana
marijuanaSlide33
Broccoli
Long-term effects of inhaled marijuana on the lung
Pulmonary function
Conclusions:
Marijuana causes
dose-dependent effects that may be
non-linearMarijuana increases airway resistance and decreases airway conductance
Marijuana may decrease FEV1/FVC, possibly due to elevated FVC rather than decreased FEV1Slide34
"I experimented with marijuana a time or two.“
- Bill ClintonHitSlide35
Long-term effects of inhaled marijuana on the lung
- Respiratory symptoms
- Pulmonary function
- Lung cancer
- Miscellaneous
Blue Sage
Fewer cigarettes
Deeper inhalation
Longer inhalationSlide36
Yellow Submarine
Long-term effects of inhaled marijuana on the lung
Lung Cancer
A
few early case series suggested a link between marijuana and
respiratory tract cancers in young patients (<40yrs old).
Taylor,
South Med J, 1988
Fung
et al, Tumori, 1999Slide37
Blonde
An association between heavy marijuana use and lung cancer may exist
Aldington
et al, Euro
Respir
J, 2008
Risk of lung cancer increased by 8% with each additional joint-yearSlide38
Callaghan et al, Can
Caus
e Control, 2013
Puff the Dragon
Early marijuana use may increase the risk of lung cancerSlide39
Cannabinoids may have anti-neoplastic activity
Chakravarti
et al,
Oncotarget
, 2014
- Breast cancer
Prostate cancerPancreatic cancerBrain tumors
- ApoptosisDecreased proliferation
BlanketSlide40
Non-small cell lung cancers express cannabinoid receptors (CBs)
Preet
et al, Cancer
Prev
Res
, 2011CB1 and CB2 are expressed by non-small cell cancer cells
CatnipSlide41
Ramer
et al, Mol
Cancer
Ther
,
2013
Cannabinoids may have anti-neoplastic activity in lung cancer
Cannabinoids kill primary non-small cell cancer cells
in vitro
Dirt GrassSlide42
Ramer
et al, Mol
Cancer
Ther
,
2013
Cannabinoids decrease tumor burden of engrafted non-small cell lung cancer cells
in vivo
Aunt Mary
Cannabinoids may have anti-neoplastic activity in lung cancerSlide43
Long-term effects of inhaled marijuana on the lung
Lung Cancer
Conclusions:
There may be association between heavy marijuana use and lung cancer.
Limited evidence may have a biologic basis- cannabinoids have anti-neoplastic effects
Colorado cocktailSlide44
“I used to smoke marijuana. But I'll tell you something: I would only smoke it in the late evening. Oh, occasionally the early evening, but usually the late evening - or the mid-evening. Just the early evening, mid-evening and late evening. Occasionally, early afternoon, early mid-afternoon, or perhaps the late-mid-afternoon. Oh, sometimes the early-mid-late-early morning. . . . ...But never at dusk."
- Steve
Martin
Pakistani BlackSlide45
Long-term effects of inhaled marijuana on the lung
- Respiratory symptoms
- Pulmonary function
- Lung cancer
-
Miscellaneous
Domestic
Fewer cigarettes
Deeper inhalation
Longer inhalationSlide46
Long-term effects of inhaled marijuana on the lung
Pneumorachis
and
pneumomediastinum
Hazouard
, Ann
Emerg
Med, 2001
Sweet LucySlide47
Long-term effects of inhaled marijuana on the lung
Pneumothorax
Gowala
, Lung India, 2012
Mexican RedSlide48
Long-term effects of inhaled marijuana on the lung
BullaeMatchbox
Gowala
, Lung India, 2012
Johnson et al, Thorax, 2000
Beshay
et al,
Eur
J
Cardiothorac
Surg, 2007Slide49
Long-term effects of inhaled marijuana on the lung
Pneumothorax and Bullae
Conclusions:
Toxins in marijuana smoke combined with the unique way it is inhaled may cause bullae formation and barotrauma in predisposed patients
Maui
WouiSlide50
Juanita
''You bet I did. And I enjoyed it.''
- Michael BloombergSlide51
Summary:
- Marijuana causes acute bronchodilation
- Long-term marijuana use causes cough, wheeze and sputum production due to airway inflammation and cellular hyperplasia
- Long-term marijuana use increases airway resistance and has a dose-dependent effect on PFTs and lung volumes
- Heavy marijuana use may increase the risk of lung cancer
- Marijuana inhalation may increase the risk of barotrauma in susceptible individuals
Wacky
TerbackySlide52
The End!
“When I was a kid I inhaled frequently. That was the point.”-Barack ObamaSlide53
Long-term effects of inhaled marijuana on the lung
Bullae
Johnson et al, Thorax, 2000
Phan
et al,
Australes
Radiol
, 2005
27
yo
man
15 pack-years
Several MJ pipes/day
46
yo
man
7 pack-years
2-3 joints/day
26
yo
man
2.5 pack-years
50
joint-years
BhangSlide54
Fewer joints
Anti-tumor effects of cannabinoids
Unfiltered carcinogens
Deeper, longer inhalation
Inflammation and metaplasia
Long-term effects of inhaled marijuana on the lung
Lung Cancer
African BlackSlide55
Hashibe
et al, Can
Epi
Biomar
Prev, 2006
Alice B.
Tolkas
An association between heavy marijuana use and oral cancer may existSlide56
Things to add?:
Add an infection category to cover the aspergillus stuff
Dry highBooMoocah