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'''Cannabis-associated respiratory disease''' can refer to ] or to structural damage to the ].

It is often compared to the damage done by ], but it is the subject of much less study. ] is sometimes considered more dangerous because filters are usually not used, and sometimes considered less dangerous because different molecules are involved.

The process most popularly used to ingest cannabis is smoking, and for this reason most research has evaluated health effects from this method of ingestion. Other methods of ingestion may have lower or higher health risks. Tobacco smoking has well-established risks such as ], ]ing, overproduction of ], ], and ]. Similar risks for smoking cannabis related to airway ] have been suggested in a study of healthy cannabis users who exhibited similar early characteristics to ].<ref>{{cite journal |title=Airway Inflammation in Young Marijuana and Tobacco Smokers |author= M.D. Roth, et al. |journal=American Journal of Respiratory and Critical Care Medicine |volume=157 |issue= 3 |date=1 March 1998 |pages=928–937 |url=http://ajrccm.atsjournals.org/cgi/content/full/157/3/928 |pmid=9517614}}</ref>

The effects of tobacco and cannabis smoking differ, however, as they affect different parts of the ]: whereas tobacco tends to penetrate to the smaller, peripheral passageways of the ], cannabis tends to concentrate on the larger, central passageways. One consequence of this is that cannabis, unlike tobacco, has not been shown to cause ], though this claim is disputed{{By whom|date=January 2012}}. A 2002 report by the ] estimated that three to four cannabis cigarettes a day were associated with the same amount of damage to the lungs as 20 or more tobacco cigarettes a day.<ref>{{dead link|date=January 2013}}</ref> Unlike tobacco, regular cannabis use does not appear to cause ].<ref>{{cite journal |author=Tashkin DP, Simmons MS, Sherrill DL, Coulson AH |title=Heavy habitual marijuana smoking does not cause an accelerated decline in FEV1 with age |journal=American Journal of Respiratory and Critical Care Medicine |volume=155 |issue=1 |pages=141–8 |year=1997 |month=January |pmid=9001303 |doi=10.1136/thx.2006.077081}}</ref>

In some cases, cannabis users mix commercial tobacco in ], called "Spliff" (popular in Europe), tobacco mixed with hash in a ] (India), or cannabis rolled in tobacco leaves (a ]), which would expose the user to the additional risks of tobacco, such as rapid physical addiction to ].<ref name="groups.psychology.org.au">, page 4. "Cannabis has been described as a 'Trojan Horse' for nicotine addiction, given the usual method of mixing cannabis with tobacco when preparing marijuana for administration."</ref>

== Studies regarding cancer risk ==
Cannabis smoke contains numerous ]s.<ref>{{cite journal |author=Hashibe M, Straif K, Tashkin DP, Morgenstern H, Greenland S, Zhang ZF |title=Epidemiologic review of marijuana use and cancer risk |journal=Alcohol |volume=35 |issue=3 |pages=265–75 |year=2005 |month=April |pmid=16054989 |doi=10.1016/j.alcohol.2005.04.008}}</ref><ref>{{cite journal |author=Novotny M, Lee ML, Bartle KD |title=A possible chemical basis for the higher mutagenicity of marijuana smoke as compared to tobacco smoke |journal=Experientia |volume=32 |issue=3 |pages=280–2 |year=1976 |month=March |pmid=1253890 |doi=10.1007/BF01940790}}</ref><ref>{{citation|url=http://www.norml.org/pdf_files/NORML_Cannabis_Smoke_Cancer.pdf |title=Cannabis smoke and cancer: assessing the risk |author=Paul Armentano |publisher=NORML.org |date=2006-05-03 |accessdate=2013-01-09}}</ref> Cannabis smoke (but not the plant itself) has recently been added to a "list of substances California regulators say cause cancer".<ref>''Sunday Examiner''. June 21, 2009</ref> A 2012 literature review by the ] identified cannabis smoke as a carcinogen and also found awareness of the danger was low compared with the high awareness of the dangers of smoking tobacco particularly among younger users. Other observations include increased risk from each cigarette due to drawing in large puffs of smoke and holding them; lack of research on the affect of cannabis smoke alone due to common mixing of cannabis and tobacco and frequent cigarette smoking by cannabis users; low rate of addiction compared to tobacco; and episodic nature of cannabis use compared to steady frequent smoking of tobacco.<ref name=BLA2012>{{citation |title=The impact of cannabis on your lungs |url=http://www.blf.org.uk/Files/8ec171b2-9b7e-49d9-b3b1-a07e00f11c05/ |publisher=British Lung Association |year=2012 |month=June |accessdate=2013-01-09}}</ref>

Professor ], a UK drug expert, points out that the study cited by the British Lung Foundation has been accused of both “false reasoning” and “incorrect methodology”. Further, he notes that other studies have failed to connect cannabis with lung cancer, and accuses the BLF of "scaremongering over cannabis".<ref>{{citation|last=Le |first=Bryan |url=http://www.thefix.com/content/david-nutt-cannabis-carcinogenic90225 |title=Drug prof slams pot lung-danger claims |publisher=The Fix |date=2012-06-08 |accessdate=2013-01-09}}</ref>

In the largest study of its kind, researchers found no cancer-cannabis connection.<ref name="UCLA study">{{cite news |url=http://www.washingtonpost.com/wp-dyn/content/article/2006/05/25/AR2006052501729_pf.html |title=Study finds no marijuana-lung cancer link |publisher=Washington Post |date=2006-05-26 |accessdate=2006-07-13 |first=Marc |last=Kaufman}}</ref> Donald Tashkin, a pulmonologist at ] who studied marijuana for 30 years, "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". Instead, the study found "no association at all, and even a suggestion of some protective effect".<ref name="UCLA study"/> The study, which involved a large population sample (1200 people with lung, neck, or head cancer, and a matching group of 1040 without cancer) found no correlation between marijuana smoking and increased ] risk, with the same being true for ] as well. The results indicated no correlation between long and short-term cannabis use and cancer, indicating a possible therapeutic effect. Extensive cellular studies and some studies in animal models suggest that THC or ] has ] properties, either by encouraging ] of genetically damaged cells that can become cancerous, or by restricting the development of the blood supply that feeds tumors, or both.<ref name="WebMDcancer">{{cite web |title=Pot smoking not linked to lung cancer |date=23 May 2006 |url=http://www.webmd.com/content/article/122/114805.htm}} , </ref>

Prior, a 1997 study examining the records of 64,855 Kaiser patients (14,033 of whom identified themselves as current smokers), also found no positive correlation between cannabis use and cancer.<ref>{{cite journal | title=Marijuana use and cancer incidence (California, United States) | author=S. Sidney | journal=Cancer Causes and Control | volume=8 | issue=5 | month=September | year=1997 | pages= 722–728 | url=http://www.springerlink.com/link.asp?id=l221477720240752 | doi=10.1023/A:1018427320658 | pmid=9328194 | last2=Quesenberry Jr | first2=CP | last3=Friedman | first3=GD | last4=Tekawa | first4=IS}}</ref>

A ] study concluded that THC, a dilative agent (]), may help cleanse the lungs by dilating the ], and could actively reduce the instance of tumors.<ref>{{cite journal |author=Huff J, Chan P |title=Antitumor effects of THC |journal=Environmental Health Perspectives |volume=108 |issue=10 |pages=A442–3 |year=2000 |month=October |pmid=11097557 |pmc=1240145 |doi=10.2307/3435034}}</ref> Additionally, a study by Rosenblatt ''et al.'' found no association between marijuana use and the development of ].<ref>{{cite journal | title=Marijuana Use and Risk of Oral Squamous Cell Carcinoma | author= K.A. Rosenblatt ''et al.'' | journal=Cancer Research | volume= 64 | date= 1 June 2004 | pages=4049–4054 | url=http://cancerres.aacrjournals.org/cgi/content/full/64/11/4049 | doi=10.1158/0008-5472.CAN-03-3425 | pmid=15173020 | issue=11}}</ref> However, a contrasting study conducted in 2000 linked the smoking of cannabis to the growth of cancerous tumors through the impairment of anti-tumor defenses in mice.<ref name=TumorGrowth>{{cite news|url=http://www.drugabuse.gov/MedAdv/00/NR6-20.html|title=Study Finds Marijuana Ingredient Promotes Tumor Growth, Impairs Anti-Tumor Defenses|org=Journal of Immunology|author=Dr. Steven M. Dubinett|date=July 2006}}</ref>

== UCLA study ==
On 23 May 2006, Donald Tashkin, M.D., Professor of Medicine at the David Geffen School of Medicine at UCLA in Los Angeles announced that the use of cannabis does not appear to increase the risk of developing lung cancer, or increase the risk of head and neck cancers, such as cancer of the tongue, mouth, throat, or esophagus.<ref name="Study Finds No Link Between Marijuana Use And Lung Cancer">{{cite news |url=http://www.sciencedaily.com/releases/2006/05/060526083353.htm |title=Study Finds No Link Between Marijuana Use And Lung Cancer |newspaper=Science Daily |date=2006-05-26 |accessdate=10-12-2011}}</ref> The study involved 2252 participants, with some of the most chronic marijuana smokers having smoked over 22,000 marijuana cigarettes.<ref name="Study Finds No Link Between Marijuana Use And Lung Cancer"/><ref name="Tobacco">{{cite news|url=http://www.mapinc.org/drugnews/v05/n1106/a09.html?275821|title=Marijuana Smoking Does Not Cause Lung Cancer|org=Anderson Valley Advertiser|author=Fred Gardner|date=2006-07-06}}</ref><ref name=tashkin1997>Tashkin, D. P., Simmons, M. S., Sherrill, D. L., and Coulson, A. H. 1997. . ''American Journal of Respiratory and Critical Care Medicine'' '''155'''(1): 141-148. Retrieved on 5 March 2007</ref><ref name="UCLA study"/> The finding of Donald Tashkin, M.D., and his team of researchers in 2006 refined their earlier studies published in a Dec. 17th 2000 edition of the peer-reviewed journal Cancer Epidemiology Biomarker and Prevention.<ref>{{citation |url=http://www.sciencedaily.com/releases/1999/12/991220082058.htm |title=Researchers At UCLA's Jonsson Cancer Center Report Smoking Marijuana May Increase Risk Of Head And Neck Cancers |publisher=Sciencedaily.com |date=1999-12-20 |accessdate=2011-04-20}}</ref> Many opponents of marijuana incorrectly cite the original finding of UCLA Medical Center from 2000 as "proof" that marijuana leaves the users at higher risk for cancer of the lung, and cancerous tumors,<ref name=TumorGrowth/> even though the researchers at the UCLA Medical Center have revised their finding with a more in-depth study on the effects of the use of marijuana. This seemed to contradict assumptions made after some studies, like those from Dale Gieringer et al., which found that 118 carcinogens were produced when marijuana underwent combustion, and two carcinogens {2-Methyl-2, 4(2H-1-benzopyran-5-ol) & 5-azulene-3,8-dione} formed when marijuana underwent vaporization with the ].<ref name="Sarafian TA, Kouyoumjian S, Tashkin D, Roth MD 2002 171–9">{{cite journal |author=Sarafian TA, Kouyoumjian S, Tashkin D, Roth MD |title=Synergistic cytotoxicity of Delta(9)-tetrahydrocannabinol and butylated hydroxyanisole |journal=Toxicol. Lett. |volume=133 |issue=2-3 |pages=171–9 |year=2002 |month=July |pmid=12119125 |doi= 10.1016/S0378-4274(02)00134-0|url=http://linkinghub.elsevier.com/retrieve/pii/S0378427402001340}}</ref><ref name="Gieringer D., St. Laurent J., and Goodrich S.">{{cite journal |author=Gieringer D., St. Laurent J., and Goodrich S. |title=Cannabis Vaporizer Combines Efficient Delivery of THC with Effective Suppression of Pyrolytic Compounds |journal=Journal of Cannabis Therapeutics |volume= 4 |issue=1 |pages=7–27 |year=2008 |month=Oct |doi=10.1300/J175v04n01_02 |url= http://www.tandfonline.com/doi/abs/10.1300/J175v04n01_02}}</ref> To help explain this seemingly chemical proof of carcinogenicity inherent in the process of combustion, Tashkin noted that "one possible explanation for the new findings, he said, is that THC, a chemical in marijuana smoke, may encourage aging cells to die earlier and therefore be less likely to undergo cancerous transformation."<ref name="Study Finds No Link Between Marijuana Use And Lung Cancer"/>

In a study of ten smokers with mild respiratory issues Hii et al. found evidence of lung disease in the form of severe bullae (fluid-filled, thin-walled blisters) of different shapes and sizes. Despite such lung disease, the patients' chest x-rays were normal and lung function was only mildly reduced in nearly half of the patients. The cannabis-smoking patient group was, on average, 41 years old—considerably younger than previously research tobacco-smoking patients with lung disease, who had an average age of between 62–67 years. The researchers conclude that the younger age of lung disease and poorer lung function may be due to different smoking patterns demonstrated in cannabis smokers,<ref>Hii, S.W., Tam, J.D.C., Thompson, B.R. & Naughton, M.T. (2008). Bullous lung disease due to marijuana. ''Respirology 13, 122-127''</ref> who have been found to inhale larger amounts of smoke, which is held in the lungs for longer periods of time.<ref>{{cite web|url=http://ncpic.org.au/ncpic/publications/factsheets/article/cannabis-and-tobacco-use// |title=NCPIC Cannabis and tobacco factsheet |publisher=Ncpic.org.au |date=2011-03-11 |accessdate=2011-04-20}}</ref>

== Reference ==
{{Reflist|30em}}

{{Cannabis}}

{{DEFAULTSORT:Cannabis-Associated Respiratory Disease}}
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