Smoking remains one of the most popular methods of consumption for medical cannabis patients. Despite the lingering popularity, smoking is still controversial. The reputation of the tobacco industry has tarnished the conventional method of burning dried herb and arguably, bringing smokable cannabis into healthcare seems at odds with healthcare itself.
As society familiarizes itself with cannabis in medicine, the question of smoking continues to make lawmakers pause. Florida and Louisiana are both recent examples of states with medical cannabis programs which continue to debate the merits of smoking. Florida only recently adjusted their legislation to allow doctors to prescribe smoked flower, while Louisiana, whose program is still inactive, has just announced its decision to head in the opposite direction.
With the explosion of new technologies, medical programs across North America may need to reassess their legislation. Smokable methods of consumption are largely allowed, as vaporizer technology was imperfect and unfamiliar at the time of their creation. New vaporizer technology has come a long way in only a few short years.
Florida and Louisiana, relatively new markets, have chosen to head in different directions when it comes to smoking versus inhalation of plant nutraceuticals. With healthier methods of consumption now widely available, how will this influence the passage of new medical cannabis legislation?
Louisiana’s’ Evolution Towards Safe Medicinal Cannabis Legislation
Louisiana, a state which legalized medical cannabis in 2015, still does not have an effective means of dispensing it. In the four years post-legalization, state lawmakers have continued to update and revise the legislation, but patients await access. The expected release date for the first product is likely delayed yet again past the June 15 deadline. What is holding the program back from launch?
Part of the problem is the flip-flopping within Louisiana’s House of Representatives. In May, Rep. Ted James (D) sponsored a bill allowing for the inhalation of cannabis, but not smoking of cannabis. At the time, edibles, oils, and extracts were permissible, but not dried flower. Although this initial attempt to expand the methods of consumption passed by 73-3 in the House, the Senate had other ideas and voted against it by a 21-14 margin.
The Louisiana Senate wanted tighter language within the bill before passage. In a speedy turnaround, uncharacteristic within Louisiana’s medical cannabis program, a revised bill passed through both the House and the Senate. The revision included a much stricter definition of inhalation without smoking. The language now includes “Metered dose inhaler.” It’s this specific terminology which differentiates Louisiana’s from most others across the country.
What the Passage of House Bill 358 Means for Patients and Retailers
Inhalation (without incineration) gives Louisiana cannabis retailers a new product to improve their bottom line and meet patient needs. Before this bill came to life, patients in the state faced significant restrictions on methods of consumption, which went fell beyond other states with medical cannabis programs. Edibles and topicals fill a specific therapeutic need but do not meet the requirements of every patient.
Although a bit clumsy in their approach, lawmakers in Louisiana are working to protect patients from the effects of smoked cannabis. The scientific studies comparing the effects of smoking cannabis versus vaporization are few but growing. There is nearly no comparison between a tobacco cigarette and a cannabis one, but cannabis smoke isn’t without adverse effects. Most research indicates incineration of cannabis is imperfect at best, and unhealthy at worst.
Inhalation Toxicology published “Cannabis smoke condensate III: The cannabinoid content of vaporize Cannabis sativa” in 2009 out of Leiden University, in The Netherlands. The research team behind the study compared total yield, total cannabinoids, total THC and total by-products of a cannabis cigarette versus that produced by a table top vaporizer. Although the vaporizer technology was outdated by today’ standards, it provided the comparison needed for the purpose of this study.
Once set at the ideal vaporizing temperature, the vaporizer beat the cannabis cigarette in all areas. Not only did it produce cleaner vapor with fewer by-products, but it also pulled more THC and other valuable cannabinoids from the source material. Although this experiment was done under laboratory settings instead of using patient consumption, presumably there are parallels for patient directed use.
Incineration of any material naturally produces a by-product. Smoke is visible to the human eye, thanks to the microscopic incinerated material. When inhaled, this particulate moves with any medicinal content into the lungs. Again there is no comparison of toxicity between a tobacco cigarette and a cannabis one, but cannabis smoke is still smoke. Smoke inhalation is always undesirable for human lungs.
As Jorge Lopez, a Florida physician, put it when discussing his state’s, medical cannabis laws, “No other medication in the United States is delivered like that.” With more precise and trackable vaporizers on the market today, it’s likely patient, and provider preference will eventually prefer non-smokable methods of consumption.
Why “Metered” Was a Critical Revision in Louisiana’s Medical Cannabis Legislation
Cannabis has historically been challenging to dose accurately. Up until recently, physicians have based their recommendations on inaccurate and vague prescription models, for example, one gram per day or a few puffs before bed. Compared to other pharmaceuticals which are prescribed by the milligram and millilitre, perfect cannabis dosing has eluded most patients and their physicians. Its primarily been left to patient driven self-experimentation models.
Accurate dosing devices are relatively new, but a critical, development in medical cannabis. Tools like RYAH, and the linked RYAH MD platform for healthcare providers, are giving everyone complete control over the experience. Metered dose vaporizers are changing the way people approach dried flower in medicine. Instead of vague recommendations, doctors may soon have the ability to provide detailed instructions to their patients and make small adjustments to find the ideal dose.
Louisiana legislators decision to include “metered dose inhaler” within House Bill 358 is a progressive and intelligent step forward. It’s the first detailed regulation of its kind in a country with a patchwork of laws. Vaporizers with an ability to collect precise patient data on a per session basis give providers a unique ability to guide treatment plans. In time, the use of vaporizing devices will spread across many medicinal cannabis programs, well beyond Louisiana.