Uh oh: Chronic weed smoking is not great for your lungs

As if we didn't have enough to worry about, now we've got Bong Lung. Dr. Benjamin Caplan, MD, explains.

Courtesy of Dr. Benjamin Caplan

FYI, Dr. Caplan and I will do an Instagram Live SUNDAY AT 5 PM PACIFIC to answer viewer/reader questions about this subject on both of our accounts: @jacqbry @drbenjamincaplan. Follow both of us to join!

Also, I was on KPBS today discussing rescheduling to Schedule III and what it means (and doesn’t).

Before everyone comes at me with pitchforks, know that I am a documented bongswoman. This is personal for me! I’m hurting, too.

I hate to be the bearer of difficult news, but we smokers are all destroying our lungs. I mean, we knew that. I’ve written about knowing that. But, still, I have a hard time cutting back. Some of my bong smoking is surely a tic, a habit. Some of it is just because I love it and it’s my preferred method. I’m a quick, big-hit kind of gal, which is also why I like dabbing.

This topic has been on my mind, most recently because of Instagram. I admit I stopped in my tracks the other day while scrolling when I encountered the phrase “Bong Lung.” High & Polite posted an Instagram reel referencing new research based on The Dunedin Study, an ongoing study of human health, development, and behavior at the University of Otago in New Zealand.

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The Dunedin Study followed 1037 babies born between April 1972 and March 1973 at Dunedin's former Queen Mary Maternity Centre to produce groundbreaking research that evaluates how childhood environmental factors impact mental and physical health as people age. It wasn’t intended to be ongoing, as researchers couldn’t have predicted that the subjects would want to continue to be followed and studied, but that’s exactly what happened. The research continues today and follows the original subjects and is done in collaboration with international researchers, including a team at Duke University in North Carolina.

This brings us to today. Cannabis research is very much a part of this ongoing study, and in the last couple of years, the group has produced groundbreaking research. Professor Bob Hancox published this study in 2022, “Differential Effects of Cannabis and Tobacco on Lung Function in Mid-Adult Life.” It’s a sobering read, even for the medically uninitiated, but we will untangle some of it here to make it clearer for mere mortals.

The TLDR is this: the respiratory effects of cannabis and tobacco are distinct and different. Smoking both can lead to compounded lung damage, including a condition called “bong lung,” a severe form of emphysema found in chronic cannabis users, which highlights the potential for early lung damage from heavy smoking. Hancox’s research also found that long-term cannabis use significantly affects lung function, causing the sacs to over-inflate and increase airflow resistance more so than tobacco does. It also details that cannabis smoke hinders the lungs’ ability to extract oxygen, a problem previously associated only with tobacco smoking. The complete study is published in the American Journal of Respiratory and Critical Care Medicine.

With that being said, It’s impossible to read “bong lung” without screaming it in a doom-metal voice in your head. It’s a gnarly term, and merely looking at it makes me hate myself a little bit. But I like smoking cannabis; I like inhaling it. So do many of you. What are we to do?

I asked Boston-based Dr. Benjamin Caplan, MD, author of an excellent, to-the-point, and exceptionally searchable book, The Doctor-Approved Cannabis Handbook: Reverse Disease, Treat Pain, and Enhance Your Wellness with Medical Marijuana and CBD. He understands harm reduction and the realities of human behavior, so he’s a practitioner whose opinions I trust. He’s also not going to bullshit you or treat you like a baby and will shoot you straight, even though he’s compassionate towards cannabis use and believes in its medical value.

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Here’s what Dr. Caplan has to say about smoking cannabis and lung health.

“Smoking cannabis, like smoking spinach, kale, or broccoli, doesn’t make much sense when you think seriously about what you’re actually doing, and can certainly have negative effects on your breathing and lung health.

While cannabis smoke contains far fewer carcinogens than tobacco smoke, it still produces some harmful substances that can irritate the respiratory system. In long-term consumers, it can lead to overinflation.

Many regular cannabis users believe that smoking cannabis is significantly safer than smoking tobacco. Still, we don't yet know the full impact of chronic consumption of the potent varieties of cannabis on the market today.

Regular smoking can bring on respiratory issues, including chronic bronchitis (irritation of the breathing tubes) and some impaired lung functions. However, it does not seem to carry the same risk of lung cancer as tobacco, or perhaps the components inside the cannabis mitigate the cancer risk as it occurs.

It's important to consider safer alternatives and practice moderation to mitigate potential harms.”

On vaporizing vs. smoking flower:

“Vaporizing cannabis flower is a much healthier, safer, smarter, and more precise alternative to smoking. Just as boiling water turns to steam at 212°F, vaporization involves heating cannabis to temperatures that release cannabinoids and terpenes into the air well before burning the plant material.

The temperatures required to vaporize cannabinoids are up to ten times lower than combustion temperatures, virtually eliminating the inhalation of harmful toxins, irritants, and carcinogens produced by burning. This significantly reduces the risk of respiratory issues, often referred to as "bong lung," which are associated with chronic cannabis smoking.

Understanding the medical benefits of different cannabis compounds and the temperatures at which they vaporize allows you to tailor-make your own medications.

With a high-quality vaporizer oven that offers precise temperature control, ideally between 315°F to 440°F (157°C to 227°C), and clean, unadulterated flower, you can create a DIY pharmacy of cannabis effects. Adding a different variety of kief can further customize a tailor-made cannabis experience.

A full list of boiling points (cannabinoids, terpenes, and flavonoids) are charted in ‘The Cannabis Plant’ chapter of The Doctor-Approved Cannabis Handbook!”

On dabbing and safe temperatures: “Dabbing, which involves inhaling vapor from concentrated cannabis extracts rather than just the flower, is the "espresso" version of cannabis inhalation—more intense and potent than flower vaporization.

To optimize dabs, it's key to consume much smaller amounts, and, like flower vaporization, expert-level use comes with temperature-controlled, oil-compatible vaporization ovens to achieve precise goals and avoid releasing harmful byproducts.

High-temperature dabs can bring overly intense sensations and typically contribute to rapid tolerance buildup, and at some temperatures, carcinogens and other toxic compounds may be released, too.

Moderation is crucial when it comes to frequency. Limiting dabbing sessions and ensuring that dabs are done at the safest temperatures can help maximize benefits and reduce potential downsides.”

On chronic cannabis use: 

“Chronic cannabis use generally refers to daily consumption over long-term periods, often defined as daily or near-daily use over several months or years.

For smoking or dabbing, this could mean using cannabis multiple times a day. Dependency on the benefits of cannabis is commonly associated with chronic consumers, and as the years accumulate, so do the health downsides. Changes in breathing, lung capacity, chronic cough, and upper respiratory irritation are expected, and impacts on mood, sleep, and appetite are common.

It's important to monitor usage patterns and consider breaks or alternative methods of ingestion, as well as other forms of self-care and stress relief, to counterbalance potential risks from long-term use.”

On safe cannabis ingestion methods:

“Almost any method beyond smoking and excessive dabbing can be considered relatively safe. Other safe and effective methods of enjoying cannabis include edibles, tinctures, and topical applications. Newer forms have also found their way to retail shelves, including infused drinks, mouth sprays, and formulations that can be added to household foods and drinks. Edibles and tinctures avoid inhalation-related risks entirely while allowing for more system-wide precise dosing.

However, these methods often come with delayed onset, so it's common for newbies to consume too much or too high dosages out of impatience. For fair expectations of dosages and an explanation of low doses vs high dosages of CBD and THC, to avoid overconsumption, check out the chart on page 61 in "The Shopper's Guide to Cannabis Products" chapter of my book (see below).

Tinctures offer a flexible dosing method and can be used sublingually for faster onset.

Topicals provide localized relief without psychoactive effects and are great for patients seeking regional relief of pain or inflammation.

Sprays are a new superstar, with quicker onset (within minutes) and shorter duration than edibles.

Drinks and other methods minimize respiratory risks and provide safer consumption options with variable expectations for timing and strength.

With so many choices that are each different in composition and impact, it's easy to see how knowledge really can equal power—and empowerment!”

So, that’s the deal.

One question I didn’t ask the good doctor was what to do if, like Led Zeppelin or Brokeback Mountain, I just can’t quit it (smoking the damn stuff). It’s because I know the answer, which is, most likely, “Grow up.” I don’t need a doctor to tell me that at this point, and frankly, neither should you. Of course, our lungs possess incredible regenerative properties, and with only occasional smoking, they can thrive with likely no problems. But chronic use is a much different story.

So, I know the answer is cutting down and making peace with the occasional smoke treat. I’m not quite ready to do that, but I’ll call it a goal. I’ll check back in, but please feel free to let me know what you’re thinking (and how you’re smoking) in the comments.

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For more ways to access Dr. Caplan and his work, including how to make him your doctor:

Buy his book 

Buy a signed copy of his book

See Dr. Caplan as your doctor (worldwide)

“Ask Dr. Caplan” cannabis questions

More free cannabis knowledge

and on social media: Twitter, Instagram, YouTube, LinkedIn, TikTok

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What do we do now?! A few device and consumption recommendations

While we’re here, allow me to make a recommendation I’ve made many times before. I’m a big Storz & Bickel fan and believe they are the gold standard of vaporizers. Not paid to say that either, though they have been generous in gifting me their products to try. A few years ago, I wrote a love letter to the Volcano, which I used for the first time as a college senior in autumn 2007. I regularly use the Venty these days for vaporizing and bust out the Volcano for special occasions. Hopefully, that’ll prove to everyone how much of a fan I really am, public relations notwithstanding! There are other good vaporizers on the market, too and I’ll likely talk about them in upcoming issues and on Instagram Live with Dr. Caplan as a follow-up to this.

Lots of people are going to ask me about vape carts, which I mostly think is a garbage genre that I completely avoid unless necessary (lol). I do not vape THC distillate. I wrote about why in this Uproxx piece from a few years ago. Here are some highlights from the piece about the variability in cannabis oil vape carts:

“In layman’s terms, think of distillate like concentrated orange juice, live resin as pasteurized orange juice, and solventless products like fresh-squeezed orange juice — most of the time, consumers would rather have the fresh stuff,” says Nate Ferguson, co-founder and head of production at Jetty Extracts.

“One of the most common misconceptions is that all vapes are created equal,” adds Caleb Counts, co-founder of Connected Cannabis Co. “Many consumers are unaware of the vast difference between vape carts filled with distillate extracts and those that use whole plant live resin.”

I will say that if I were to use THC distillate, I’d go with Jetty or Connected on the legal market. I will happily vape high-quality live resin when I need to be discrete, provided I trust the person making it. For this, these days, I order from Dank Tank in LA, which has been making high-quality oil since 2011. I am also borderline psychotic about which devices I will use, and I don’t trust most 510-thread batteries and their heating apparatuses, and furthermore, don’t trust that they’re not feeding me carcinogenic material through reclaim. Dank Tank makes his own vape devices and oil, and I trust he knows what he’s doing.

I’ve also written about the variable safety and questions surrounding e-rigs for dabbing. Someone involved in this piece tried to sue me over what was published, to which my Gear Patrol editors politely said, “fuck off.” I have recently written that I’m not using full e-rigs anymore and am dabbing with my G Pen Hyer and a glass rig.

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I also wanted to remind everyone about my still-active special-for-readers discount code with Bong Candles. It’s not an affiliate link, so I don’t make money off it–just a homie hook-up. My gifts, which I paid for (to be clear!), got to their recipients across the country with much joy and fanfare.

Obviously, this might be a weird sell in this letter. But, truthfully, I’m not off the bong yet, though I will be adding more consumption methods to my routine, and I still think all of these devices and methods have their time and place. Plus, you don’t need to smoke this bong when you’re done…you can refill it with wax! I’ve been washing and re-using all my candle votives after they burn, filling them with Siblings microwaveable soy candle wax. I’m a bit of a candle junkie, and this has saved me money, as well as provided a nice way for me to “make” gifts for friends using recycled materials.

Also, Megan at Bong Candles recently released her stash jar candles, which are exactly as they sound. I got the grass smell, which I am obsessed with, and I just washed out the wick and wax to put some brand-new buds in it.

They generously gave me a discount code that’s live until May 31 at 4:20 PM. Use code CANNABITCH for 15% off.

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And, of course, I would be remiss if I didn’t remind you about my High on Plants earring collab. Use code Jackie10 for 10% off anywhere on the site! (The earrings come in other colors, like pink, too! Just black is my collab.)