COVID-19 AND CANNABIS: A GOOD OR BAD COMBINATION?

Are cannabis users more at risk for COVID-19? Should we stop smoking now? What are the best ways to use the plant during the pandemic?

 This new enemy is invisible and deadly, and it attacks regardless of race, creed, class, or color. It has made everyone aware that making some reasonable sacrifices now will help avoid utter catastrophe -- and personal suffering -- later.

One significant adjustment is occurring in our culture of sharing. Handshaking as a way of greeting will likely give way to bowing or touching your heart. People will probably begin to wink at each other (or "smize," smile with the eyes) since smiles are harder to see beneath a face mask. The idea of sitting cheek by jowl in a crowded restaurant sharing an intimate meal will be put on pause until we come to a new understanding about slowing the ways novel infectious diseases take hold and spread. 

So many of my patients are asking about other ways to use cannabis mindfully to lower their stress or make these times of social distancing and self-quarantining less difficult. There's also a lot of confusion about the effects of cannabis on the immune system. Here are some of the most commonly asked questions and what I recommend for smart, sensible cannabis use in the time of COVID-19.

Should cannabis users refrain from all smoking/vaping during this time?
Avoiding lung irritation is the first line of defense against this illness.  
Any inhaled substance may affect the respiratory system. Cannabis smoke can cause visible lung irritation and microscopic injury to the pulmonary epithelium (the tiny cells that line most of the respiratory tract as respiratory mucosa). Exposing lung tissue to vape aerosols (e-cigarettes) can increase the release of inflammatory cytokines, macrophages, neutrophils, and lymphocytes. Basically, the lung tissue is trying to mount an "immune response." 

Most healthy individuals can recover from this lung irritation -- but right now, I recommend you reduce your exposure to all irritants. Keep your house is dust-free. Get out into fresh air. Lower your use of aerosol products. Don't inhale bleach, ammonia, or anything with a noxious odor -- even small doses can irritate the eyes, skin, and respiratory tract.

Studies also show that angiotensin-converting enzyme-2 (ACE2) receptor increases in the lungs of smokers and patients with COPD. This makes smokers of anything more susceptible to COVID-19, and this is why scientists and physicians are recommending that users who smoke or vaporize stop. Of equal concern is the coughing that often occurs when inhaling products. Coughing can disperse COVID-19 pathogens into the air, and this is what we all want to avoid.

Bronchitis is another well-known side effect of cannabis smoke. It's not uncommon for regular users to develop a cough, chest congestion, and some phlegm. These symptoms are usually temporary and go away when you stop smoking, but it's best to avoid them in a respiratory flu pandemic.
 It's also allergy season, so everyone's respiratory health is going to be compromised.

Also, be aware that the degree of lung injury depends on multiple host factors: 

• Elderly patients are more vulnerable to lung injury than younger people
• People with allergies are more susceptible to bronchospasm than nonallergic people
• People with Reactive airway disease, Cardiovascular disease, Diabetes, and Auto-immune diseases are also more at risk.

What's the difference between cannabis smoke and tobacco?
The inhalation patterns of cannabis smoking are different than cigarette smoking. Compared to tobacco, cannabis inhalations are 66% larger in puff volume and a 33% larger in inhaled volume. Cannabis smokers also hold their breath four times longer and take in five times the concentration of carboxyhemoglobin. Carboxyhemoglobin is formed in carbon monoxide poisoning and leads to oxygen deficiency in the body.

Is vaping less dangerous than smoking? 
The long term effects of vaping aren't entirely known, but not are all vaporizers are the same.
If using vape pens, watch out for oil cartridges that are thinned with PEG (polyethylene glycol – it produces hazardous chemical byproducts which destroy lung tissue) or Vitamin E acetate, which have been linked to lung injury and chemical pneumonia. One way to avoid Vitamin E acetate is to buy cartridges in the legal market. Most, if not all, of the tainted products were found in the illegal market.
If you use a flower vaporizer, the key to a healthier draw is temperature control—a joint burns at around 950 degrees. Vaporization occurs at 350-400 degrees -- the sweet spot is around 390 degrees. That temperature variance makes a big difference if you want to protect fragile lung tissue. 
Clearly, vaporizers with technology that allow for temperature control are worth the investment. Some brands worth looking into include Crafty, and Pax 3.

If vaporizing, be sure to follow these harm reduction methods: 

• Flower vaporizers are preferable to vape pens 
• Wash your hands before and after a vaporizing session
• Sterilize the mouthpiece with an alcohol swap between inhalations 
• Take small "sips" of vapor. The smaller the sip, the more control you will feel, and the less  coughing will occur 
• Keep your temperatures as low as possible
• Vaporize outside and away from people. When exhaling, be sure that you are not facing another  person. Don't vape on the street if people are behind you.

Can you explain how COVID-19 affects the lungs of those who are infected? In layman's terms, please!

When COVID-19 attacks the respiratory lining becomes injured, causing inflammation. This irritates the nerves in the lining of the airway and can spread into the gas exchange units (alveoli). This article illustrates the changes COVD-19 can have on the lungs.
Normal, healthy lung tissue is light and fluffy, like whipped cream. COVID-19 coats the lung tissue with a yellow ooze and turns the lung texture to marshmallow. This thick coating blocks the free flow of oxygen. As the virus invades and takes over, patients lose their ability to breathe and may need a ventilator. At this point, the marshmallow coating of the lung tissue begins to stiffen, and the lungs' capacity to take in oxygen diminishes. This is often the point when the patient's life hangs in the balance. This virtual reality video brilliantly illustrates COVID-19's path of destruction. 

COVID-19 patients can be placed into four broad categories:

1) Patients who are "sub-clinical." This means they have the virus but have no symptoms.
2) Patients who have minor symptoms: fever, cough, headache, fatigue. These patients are still able to transmit the virus, but they may not be aware of it as these symptoms are common in so many other illnesses.
3) Patients who have an infection in the upper respiratory tract -- coughing, congestion, and flu-like symptoms.
4) Patients that are admitted to hospitals and likely to develop complications such as cardiac symptoms or severe illness that leads to pneumonia.

In COVID-19 the lining of the respiratory system becomes injured, causing inflammation. This, in turn, irritates the nerves in the lining of the airway and can spread into the gas exchange units (alveoli) at the end of the air passages. If these air sacs become inflamed, it can cause a flood of fluid and inflammatory cells into the lungs, and patients end up with pneumonia. 

Could cannabis' benefits outweigh potential harm for those who are affected or even at risk?  Should COVID-19 patients abstain entirely?

No, I do not believe you have to abstain from cannabis, but you should explore alternatives to inhaling.

Cannabis has medicinal and therapeutic benefits. It is anti-inflammatory, anti-anxiety, anti-pain, antiviral and immune-modulating. THC in small doses have been found to be a bronchodilator and has been shown to quell the cytokine storm (when the immune system goes into overdrive and causes an inflammatory flare) in animal models.  

Cannabinoids have also been shown to decrease the overall inflammation in the body, which means it's one less thing for your body to fight against. You can also lessen inflammation through diet and regular restorative sleep. Anything that reduces inflammation or stress in your body and mind benefits your immune system. So whether you're using cannabis for muscle spasm, to keep calm, or to sleep – it can be a therapeutic adjunct to your self-care, wellness, or health regimen. 

What about CBD? 
CBD has antiviral and antibacterial properties, but its main virtue is that it decreases inflammation. As mentioned above, the common thread of all disease states is chronic inflammation. Diseases as diverse as Diabetes, low back pain, or migraines that come are all the result of some underlying inflammation. Reduce the inflammation, and very likely, you'll reduce the symptoms of many illnesses.

Should medical cannabis patients be shifting to edibles or drinkables? 
In the last few months, I have been encouraging patients and adult use consumers to change the way they're consuming. Consider exploring edibles and drinkables. See if a 5 mg or 10 mg chocolate bar or drinkable works for you, or experiment to find your optimal dose. Just start low and go slow. Once you know your dose, edibles, or drinkables can turn a hike through the woods or a park a more sensory adventure. You smell, see, and hear nature more vividly. You'll likely feel closer to the people you're with, even if you are 6 feet apart. Remember that ingesting takes an hour or two for effects to kick in -- so time your dosing accordingly!

Can I use cannabis to relieve stress?
Cannabis interacts with GABA receptors in our brain. GABA tells our body to power down. It reduces the fight or flight response, which is associated with stress. This can be extremely helpful during this time of uncertainly and when many of us are afraid for our own health or the health of loved ones. Cannabis can also help with panic attacks and insomnia as the prevalence of depression and PTSD mounts in response to this pandemic. 

It's important to mention that a lot of people with anxiety might be on prescription medication or antidepressants. So be careful when you are supplementing with cannabinoids as they can interact with these meds and make their effects more powerful. Talk to your doctor to be sure you're not over-consuming one or the other if the doctor increases your Zoloft, that doesn't mean you should also up your cannabis intake.

What foods or supplements can I take to boost my immune functioning? 
1. Brazil nuts are the richest known source of selenium, a trace element that is essential for your thyroid and immune system. Be careful not to over-consume because you can get selenium toxicity -- just 2 nuts per day.
2. Spirulina is blue-green algae rich in protein, vitamins, minerals, and antioxidants to boost the immune system and help protect against allergic reactions. It has antiviral and anticancer properties!
3. Vitamin D3 helps modulate innate and adaptive immune responses. Vitamin D deficiency is associated with increased autoimmunity and susceptibility to infection.
4. Goji berries are packed with antioxidants and known for their immune-enhancing qualities and ability to fight harmful free radicals and inflammation. Full of vitamins A & C.
5. Exercise! It helps move lymph fluid through the lymphatic system. Lymph fluid contains white blood cells that fight infection.
6. SLEEP! Without restorative sleep, optimal immune function is nearly impossible!​

The Bottom Line?

1. Smoking cannabis raises the risk of COVID-19 complications. Since it can irritate the nasal passages and respiratory system, you are weakening your immune defenses and increasing your susceptibility to any infection. This includes a cold or flu, not only COVID-19.​ Minimizing inhalation in favor of edibles, drinkables, tinctures is safer and smarter. 
2. Don't share joints, pipes, or vaporizers. This will help stop the contagion. So does frequent hand washing (especially after opening a door or touching your face), social distancing, and reducing the number of people you come in contact with. 
3. This new enemy is invisible and deadly, and it attacks regardless of race, creed, class or color. Many people are asymptomatic and still carry COVID-19. You may not be coughing or having a fever, but lack of symptoms are not accurate ways of determining your health or anyone else's.