Marijuana Smoke versus Cigarette Smoke: A Comparison
By Dipan Patel, MD

In my office, I am commonly asked which is better.

With the new changes in legislation sweeping across the United States with legalization of recreational marijuana (at the state level), the timing of this article is excellent.

Opinions on this topic vary, but useful information comparing marijuana smoke versus cigarette smoke can be drawn from this article.

Marijuana Smoke vs. Tobacco Smoke
Any direct smoke inhalation can be detrimental to the oral cavity and lungs with regular, repeated use (inflammation, coughing, bronchitis/lung infections, increased phlegm/sputum/secretions, etc.).

According to medical literature, cigarette smoke and marijuana smoke have similar chemical properties, but the two have different pharmacological activities and are not equally carcinogenic (cancer-causing).

Cigarette Smoke and Cancer
Cigarettes are culturally known to have a higher incidence of causing cancer.

This is because cigarettes contain a higher number of additives that have been directly linked to causing cancer.

The risks of cigarette smoking include the smoke itself, effects of nicotine, and additives such as N-nitrosamines that can cause cancer.

The CDC states that cigarette smoking causes more than 480,000 deaths each year in the United States. This is nearly one in five deaths.

Smokers are more likely than nonsmokers to develop heart disease, stroke and lung cancer.

Estimates show cigarette smoking increases the risk:

  • For coronary heart disease by 2 to 4 times

  • For stroke by 2 to 4 times

  • Of men developing lung cancer by 25 times

  • Of women developing lung cancer by 25.7 times

Smoking causes diminished overall health, increased absenteeism from work and increased health care utilization and cost.These statistics are backed up by well-documented peer-reviewed research studies.

Marijuana Smoke and Cancer
Marijuana refers to the dried leaves, flowers, stems and seeds from the cannabis plant.When smoking marijuana compared to cigarettes, there is a longer and deeper inhalation and it is smoked to a shorter butt length and at a higher combustion temperature.

This can result in approximately more carbon monoxide concentration and tar exposure in the lungs.

Higher levels of ammonia and hydrogen cyanide have also been found in marijuana smoke, compared to tobacco.

While marijuana smoke contains a similar range of harmful chemicals to that of cigarette smoke, studies have failed to identify an association between cannabis smoke exposure and elevated risks of smoking-related cancers, such as cancers of the lung and neck.

“We hypothesized that there would be a positive association between marijuana use and lung cancer, and that the association would be more positive with heavier use. What we found instead was no association at all, and even a suggestion of some protective effect.”
-Dr. Donald Tashkin, Professor Emeritus at the David Geffen School of Medicine at UCLA

At this point in time in medical literature, multiple studies have drawn similar conclusions.

Reducing Marijuana Smoke Exposure
The use of a water-pipe filtration system (bong) primarily cools cannabis smoke, which may reduce throat irritation and cough.

However, this technology is not particularly efficient at eliminating the potentially toxic byproducts of combustion or other potential lung irritants.

Smoking devices that use water filters have been shown to involve equivalent amounts of tar and do not reduce risks of marijuana smoke inhalation.

Vaporizers (“Vaping”) have been theorized to be a safer method of administration, producing lower levels of tar than cigarettes and fewer respiratory symptoms reported by users.

However, these devices have also been shown to release ammonia which, when inhaled, can cause irritation and central nervous system effects, as well as asthma and bronchial spasms.

More research on the potential use of vaporizers as a harm reduction technique is needed.

Oral cannabis (“edibles”), such as capsules and foods, possess delayed onset compared to inhaled herbal cannabis, making these options less suitable for patients desiring rapid symptomatic relief.

Eating “edibles” is perhaps a more obvious means to reduce the respiratory effects when using the drug.

However, it typically takes longer for the effects of the drug to appear (30–60 minutes compared to seconds), making it more difficult to monitor dose.

Additionally, the effects last longer than some users prefer.

In conclusion, it is clear why cigarette smoking should be avoided. When it comes to marijuana, the decision is more challenging and more research is needed (and is ongoing).

Before making a decision, it is worth having a conversation with your doctor about the potential risks/benefits of marijuana when it comes to recreational or medical marijuana.

Dipan Patel, MD is a Double Board Certified Interventional Pain Physician and Anesthesiologist at Garden State Pain Control Center in Clifton, New Jersey.

He is a graduate of the prestigious NYU pain medicine fellowship and has extensive knowledge in non-opioid options for pain, including medicinal marijuana.

Dr. Patel enjoys providing health care and health education seminars for first responders.