A few years ago, the options for stoners seeking a different way to get high were slim. But in the age of legal medical cannabis (at least in some places), there are more ways than ever to toke.
As of June, cannabis was legal medicinally in 23 states and Washington, D.C., including four (Alaska, Colorado, Oregon, and Washington) where the plant is legal for recreational purposes, too.
But while some people do use the drug just to get high, others swear by its medical powers: in alleviating pain and anxiety, and quelling nausea. And cannabis’s potent ingredient — a cannabinoid (or chemical compound) called tetrahydrocannabinol (THC) — can be consumed or applied via foods, lotions, medicines, and more dangerous forms of inhalation, such as “dabbing.”
The negative side effects of cannabis are hotly debated. For instance, cannabis smoke is an irritant to the throat and lungs, and smokers report more symptoms of chronic bronchitis. But despite the fact cannabis smoke also has many of the same carcinogens as cigarette smoke, a cannabis habit doesn’t seem to increase the risk of lung cancer.
While docs aren’t sure why this is, it could be twofold: that for research purposes, it’s hard to ID straight cannabis smokers from those who smoke both cigs and cannabis; or that cannabis may have protective effects on lung tissue.
In general, most researchers agree more conclusive studies are needed to determine all of the possible health impacts of cannabis.
As for all of the ways to use as of today? We shed light on the common methods of using cannabis (and what to expect from each).
Lighting up might be the most popular way to get high — and one of the quickest. “When you smoke, THC goes into the brain almost instantaneously,” Ruben Baler, PhD, the Health Science Administrator at the National Institute of Drug Abuse (NIDA)
When it does, THC interacts with cannabinoid receptors in the brain, affecting regions involved in pleasure, thinking, and coordination.
Of course, how much you’re affected is influenced by a slew of factors, including how much you smoked, the potency of THC in the joint, and your past experiences with the drug, says Baler.
In general, though, higher concentrations of THC are more likely to lead to negative effects — and these days, higher concentrations in joints are common. To help paint the picture: In the 1990s, the average joint had about 3 percent THC. In 2013, that had risen to a figure closer to 12.5 percent (and is likely to be increasing).
Smoking not your thing? Vaporizers are small machines that heat cannabis up to a temperature at which the plant doesn’t ignite, but the active ingredients boil — creating a vapor where cannabinoids are released. Mitch Earleywine, PhD, a professor of psychology at the University at Albany-SUNY who studies cannabis, says that research he’s conducted (published in the Harm Reduction Journal) shows that people who vape see fewer respiratory irritations than those who smoke. “Because the cannabis never really catches on fire, you don’t get those ashy irritants,” he says. “There really isn’t a smoke, so much as a mist.”
It’s worth noting that using a vaporizer pen — a pen-like device similar to an e-cigarette that vaporizes active ingredients in the cannabis oil — is not the same as using a vaporizer, Earleywine says, since “standard vaporizers use plant material.” Meanwhile, vape pens use concentrates from the oil — which not only can be higher in concentration but, during extraction, may pose a risk of exploding. There is also no medical literature on vape pens, he says.
“Drug abusers are very creative,” says Baler of a headline-making form of administration called dabbing. What are dabs? Concentrated doses of cannabis made by extracting chemicals from the plant, he explains, using solvents like butane to heat it up. You’re left with a waxy, honey-looking paste that you can put into an e-cigarette or burner, which then produces smoke that you inhale.
The problem: Dabbing — specifically the extraction process — can be seriously dangerous, as butane is known to cause explosions, says Baler. He also says the doses can contain between 40 and 80 percent THC — extremely high concentrations compared with the 12.5 percent THC in street cannabis.
Earleywine notes that some data suggest that people who dab have reported developing a tolerance to the drug more rapidly than if they were smoking, and that a subset reported more withdrawal symptoms.
Everything from chocolate and baked goods to drinks can be infused with THC. "The key with edibles is dosage,” says Earleywine. If you overdo it, adverse reactions are possible. But in terms of overdosing — or dying from too much cannabis — it’s not very likely, Baler says. What is more likely: extreme anxiety, panic attacks, or injuring yourself because of cannabis’s effects on judgment, perception, and coordination, he explains.
So why are people more likely to overdo it on edibles? When you consume cannabis — rather than smoking it — your body responds differently. When you smoke, THC goes straight from your lungs to your brain; you’ll likely feel the high within minutes. But because of the digestion process, it can take an hour to 90 minutes to feel the effects of an edible, notes Earleywine, so you may consume more early on, mistakenly thinking the cannabis is just not kicking in. Also, your liver transforms consumed THC into a different compound, 11-hydroxy-THC — which has greater psychoactive effects than regular THC, says Earleywine.
Another issue? It’s hard to tell what you’re actually putting in your body. “The potency of THC in edibles varies widely — it’s really Russian roulette,” says Baler. In fact, a JAMA study found that fewer than one in five edible labels accurately reflect THC content.
If you’re purchasing an edible in a state where it’s legal to do so, like Colorado, most labels say products contain about 10 milligrams of THC per serving (sometimes, this is the amount in just one cannabis-infused gummy). But while 10 milligrams may be a standard dose for experienced users, Earleywine says anyone who hasn’t used may want to start with 5 milligrams — or even half of that.
Earleywine says skincare products that contain THC and CBD (a non-psychoactive cannabinoid thought to have anti-inflammatory properties) also have lots of fans. The effects may not be very noticeable, though.
“These don’t really reach the central nervous system — they don’t enter the bloodstream — so if they do help pain and inflammation, it’s got to be through the periphery,” he says. “These shouldn’t be intoxicating or make folks fail drug tests.” Topicals tend to be used by those seeking the therapeutic benefits of THC (to reduce soreness, inflammation, or pain) or folks who don’t want the smell of smoke or the unpredictability of edibles.
Earleywine also notes that there have been attempts to make transdermal patches to get THC into the bloodstream, which work somewhat like nicotine patches. They would likely be used for anything from a high, to relief from pain or anxiety. While these may work, Earleywine says he hasn’t seen any published data on their effectiveness.
To some extent, cannabis is used in hospitals, too. Marinol® — an FDA-approved medication — is essentially THC that is created in a lab. The drug is mainly used for appetite stimulation for patients with AIDS and nausea as it relates to chemotherapy.
The problem: Synthetic THC doesn’t have other cannabinoids in it, as smoke does — and because of that (and absorption issues that go back to consuming THC), it may make you feel more high than cannabis that’s smoked, says Earleywine. This poses a problem for patients hoping to reap the healing properties of THC — like pain relief or stimulation of the appetite — instead of the high.
Synthetic THC, as in Marinol, is not the same thing as the “synthetic cannabinoids” that have recently been making headlines.