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A Strange Blend: Why Are Europeans Mixing Cannabis and Tobacco?

This article was originally published on Leafly.

Cannabis doesn’t carry the sort of health hazards tobacco does, a majority of studies say. But that doesn’t change the European habit of mixing the two. It’s something North American cannabis consumers don’t often do: even cigarette smokers in Vancouver or L.A. tend smoke their flower pure, strictly separating nicotine and cannabinoids. So where does this difference come from?

To answer the question, let’s go back in time to the cannabis renaissance of the 1960s and ‘70s. Consumers in Europe at the time almost exclusively smoked hashish, often crumbling it into cigarettes, as hardly anyone was aware of the dangers of nicotine and smoking tobacco. The vast majority of cannabis consumers in the U.S., on the other hand, overwhelming had access only to dried flower, which could easily be used to roll pure joints.

These differences influenced the size of what was being rolled in North America and Europe. In the U.S. and Canada, pure “mini-joints” became the standard, while on the continent a king-size joint is preferred. A European-sized joint that contains only cannabis might contain 1.5 grams to 2 grams of flower — far too much for most. An American joint, on the other hand, contains about as much herb — about 0.2 grams to 0.5 grams — as a European mixed joint (often called a spliff in the U.S.), but without the nicotine. Scientists have even pinpointed the average amount of cannabis in an American joint at 0.32 grams. In Germany, the Netherlands, or Denmark, that amount of cannabis is typically mixed with another gram or so of tobacco, depending on personal preference.

Smoke Raw

Not only does consuming a cannabis–tobacco blend affect your health more than pure flower, it also complicates efforts to gauge the health effects of cannabis itself. The legalization debate often revolves around the dangers of “smoking,” because almost every European study on cannabis is not about smoking it pure but about cannabis mixed with tobacco. Even in medical programs, little attention is paid to whether patients smoke pure. That means that Europeans who use cannabis alone has to justify the consequences of a substance that has little to do with cannabis.

Even without tobacco, smoking is the unhealthiest form of any medical application. Yet other, healthier forms of consumption, such as vaporization or edibles, seem to catch on much more slowly in Europe. That’s in part because tobacco has long been engrained in European culture; as cannabis grew in popularity among Europeans, that affected how people chose to consume. In other cultures, where cannabis has been part of everyday life for millennia, people consume orally or at least smoke cannabis pure.

Mixing tobacco into a joint increases the addictive risks immensely. Many casual users have only begun to smoke cigarettes because they use tobacco for their joints. “Without cannabis I have no problems, but I then smoke more cigarettes” — you’ll never hear such a statement from a pure-cannabis consumer. Doctors in Germany or the Netherlands treating cannabis patients are often unaware of this phenomenon and fail to advise patients to quit tobacco— or at least to separate the consumption of both drugs so the positive effects of cannabis remain intact. The unfortunate reality is that in most instances in Europe, the pairing of cannabis and tobacco simply isn’t discussed.

Last but not least, pure cannabis acts quite differently than a cannabis–tobacco blend. Patients report that the combination of nicotine and cannabis can lead to pain relief and relaxation, but very often they note fatigue as a negative side effect.

Lung-Killer Nicotine

All these facts should be worrying enough for European cannabis fans to reflect on their consumption habits. To make things worse, there’s the political aspect. Prohibitionists use the dangers of the legal drug nicotine to protest against legalization of cannabis: “How can we have ever stricter laws to control tobacco and at the same time legalize cannabis?”

Professor Donald Tashkin has been a leading American pulmonologists for decades. In the past he was a vocal supporter of cannabis prohibition. Tashkin was convinced that smoking cannabis flowers created a high risk of developing lung cancer or chronic obstructive pulmonary disease (COPD). At one point, he was convinced that cannabis and lung cancer had a causal relationship worse than tobacco.

But more recent evaluations of long-term studies, however, made him change his mind in 2009: “Early on, when our research appeared as if there would be a negative impact on lung health, I was opposed to legalization because I thought it would lead to increased use, and that would lead to increased health effects,” he has said. “But at this point, I’d be in favor of legalization. I wouldn’t encourage anybody to smoke any substances, because of the potential for harm. But I don’t think it should be stigmatized as an illegal substance. Tobacco smoking causes far more harm. And in terms of an intoxicant, alcohol causes far more harm.”

If the legislators take their task to protect public health seriously, European studies that evaluate the risk potential of pure cannabis consumed in various forms (smoking, vaporizing, edibles) have to be undertaken. These studies should take the international state of research into account, focusing on safer ways of consuming.

Michael Knodt is Leafly’s Germany correspondent.

A Strange Blend: Why Are Europeans Mixing Cannabis and Tobacco? This article was originally published on Leafly. Cannabis doesn’t carry the sort of health hazards tobacco does, a majority

Comparing cannabis with tobacco

Britain now has 13 million tobacco smokers. This number has been steadily decreasing due to public awareness of the harm caused by tobacco smoking. At the same time the number of cannabis smokers is increasing. Between 1999 and 2001, the number of 14-15 year olds who had tried cannabis rose from 19% to 29% in boys and 18% to 25% in girls, and a Home Office document estimates that 3.2 million people in Britain smoke cannabis. 1 ,2 However, the harmful effects of smoking cannabis are widely known and have recently been highlighted. 3 ,4 Although the active ingredients of the cannabis plant differ from those of the tobacco plant, each produces about 4000 chemicals when smoked and these are largely identical. Although cannabis cigarettes are smoked less frequently than nicotine cigarettes, their mode of inhalation is very different. Compared with smoking tobacco, smoking cannabis entails a two thirds larger puff volume, a one third larger inhaled volume, a fourfold longer time holding the breath, and a fivefold increase in concentrations of carboxyhaemoglobin. 5 The products of combustion from cannabis are thus retained to a much higher degree. How is this likely to translate into adverse effects on health?

We already know that regular use of cannabis is associated with an increased incidence of mental illnesses, most notably schizophrenia and depression, 4 but it is also worth examining its potential to cause other illnesses, especially those of the heart and respiratory system.

At present, there is an understandable dearth of epidemiological evidence of cardiopulmonary harm from cannabis, because its use is a relatively new phenomenon and its potency is changing. The amount of the main active constituent, tetrahydrocannabinol (THC), in cannabis has increased from about 0.5% 20 years ago to nearer 5% at present in Britain, whereas “Nederweed” (the variety smoked in the Netherlands) has an average of 10-11% tetrahydrocannabinol. At the same time little study has been undertaken of any concomitant change in the content of tar. Case-control studies are difficult to perform since cannabis cigarettes do not come in standard sizes, which makes dose-response relations difficult to establish. Furthermore, most users of cannabis also smoke tobacco, which makes it difficult to dissect out individual risks. As with tobacco, there will be a latent period between the onset of smoking and the development of lung damage, cardiovascular disease, or malignant change.

Tobacco smoking is responsible for 120 000 excess deaths each year in Britain, 46 000 from cancers, 34 000 from chronic respiratory disorders, and 40 000 from diseases of the heart and circulation. However, there are indications that smoked cannabis may cause similar effects to smoking tobacco, with many of them appearing at a younger age. Smoking cannabis causes chronic bronchitis, emphysema, and other lung disorders, which were recently summarised in a review released by the British Lung Foundation. 3 A striking feature of cannabis smoking is that it is associated with bullous lung disease in young people. 6 Inflammatory lung changes, chronic cough, and chest infections are similar to those in cigarette smokers, but may also be commoner in younger people. 7 – 9 Premalignant changes have been shown in the pulmonary epithelium, and there are reports of lung, tongue, and other cancers in cannabis smokers.

Tetrahydrocannabinol has cardiovascular effects, and sudden deaths have been attributed to smoking cannabis. 10 Myocardial infarction is 4.2 times more likely to occur within an hour of smoking cannabis. 11 However, despite these alarming facts, there is no evidence at present on whether smoking cannabis contributes to the progression of coronary artery disease, as smoking cigarettes does. More studies of the cardiovascular and pulmonary effects of cannabis are essential.

It may be argued that the extrapolation from small numbers of individual studies to potential large scale effects amounts to scaremongering. For example, one could calculate that if cigarettes cause an annual excess of 120 000 deaths among 13 million smokers, the corresponding figure for deaths among 3.2 million cannabis smokers would be 30 000, assuming equality of effect. Even if the number of deaths attributable to cannabis turned out to be a fraction of that figure, smoking cannabis would still be a major public health hazard. However, when the likely mental health burden is added to the potential for morbidity and premature death from cardiopulmonary disease, these signals cannot be ignored. A recent comment said that prevention and cessation are the two principal strategies in the battle against tobacco. 12 At present, there is no battle against cannabis and no clear public health message.

Comparing cannabis with tobacco Britain now has 13 million tobacco smokers. This number has been steadily decreasing due to public awareness of the harm caused by tobacco smoking. At the same