When Gov. Ron DeSantis and the Legislature made it legal last month to smoke medical marijuana, they did it in the name of better health — the idea that thousands of Floridians would gain relief from a variety of illnesses.
Yet it seemed to run counter to everything modern medicine says about smoking. Isn't it really bad for you?
Physicians say yes: Smoking anything, be it tobacco or cannabis, comes with some risk. But the answer is more complicated.
The Florida Department of Health — the agency in charge of implementing and enforcing the rules for Florida's burgeoning medical marijuana industry — still has to come up with guidelines for licensed cannabis companies to follow for selling smokable "flower," or the actual granules of the plant. As part of those guidelines, patients will have to sign consent forms outlining the risk associated with smoking.
"With tobacco cigarettes, the concern is nicotine, which is not found in marijuana products," said Dr. Cary Pigman, an emergency room physician with AdventHealth in Sebring and a Republican state representative from Avon Park.
"What I am concerned about with marijuana, as a physician, is the combustion of plant products, which is basically the inhalation of ash," Pigman said.
But there is a caveat to that.
While burning plant material and inhaling it isn't good for your lungs, cannabis has benefits that may outweigh the cons of smoking it. That depends on the patient, said Dr. Lora Brown, who recommends cannabis to her patients at Access Marijuana RX in St. Petersburg. She also has worked in pain management medicine for 15 years.
"Interestingly enough, the little data we do have on cannabis from the '60s to the '80s is based on smokable cannabis," Brown said. "Some of it suggests that chronic users have improved pulmonary function, as opposed to cigarette smokers and non-smokers, because they're used to inhaling deeply and holding."
She added: "We've seen smoking (marijuana) help with bronchial secretion, which can lead to upper respiratory infections and cut down on the risk of bronchitis."
One example is Cathy Jordan, who smoked marijuana to ease the painful symptoms of Lou Gehrig's disease and became the face of a movement for smokable medical marijuana in Florida.
Jordan argued that cannabis did more for her than temporarily mask her pain. Smoking it, she said, generated a cough and actually helped clear phlegm from her lungs, a common issue among patients with her disease, who sometimes use a vest-like medical device for help.
Smoking marijuana also dried out Jordan's mouth, which kept her from choking on excess saliva.
In 2013, the Cathy Jordan Medical Cannabis Bill was introduced by then-Sen. Jeff Clemens, D-Lake Worth, and then-Rep. Katie Edwards-Walpole, D-Plantation.
But Dr. Ryan Floyd, a pulmonary and critical care medicine specialist with Tampa General Hospital and USF Health, said there is not enough research out there to suggest smoking marijuana is safe in the long-term.
"It's the ongoing question. There is very limited data," he said. "For cigarettes, we have decades and decades of research that was used to develop standards based on links to cancer and chronic obstructive pulmonary disease. For marijuana smoke, we don't have those standards."
The research is limited in the United States because marijuana was, and still is, considered an illegal substance at the federal level.
"With more states approving it, and given the growth we're probably going to see, we need large-scale studies on the daily use and the pulmonary effects," Floyd said.
For now, Floyd said he cautions his own patients against smoking marijuana.
"What I tell patients is that we know it's smoke. If there's a clinical indication to use marijuana for pain or sleep, I try to point them to other products like edibles where there is no smoke risk," he said.
"But you're kind of stuck between a rock and a hard place because people are going to use it. But I can't condone the potential injury based on the smoke."
Pigman, the state lawmaker, said he believes the health risks from smoking marijuana are far lower compared to those from cigarette use.
"The average person smoking cigarettes is probably smoking 20 to 40 a day," he said. "The average person smoking cannabis may be using one to four marijuana cigarettes a day."
And compared to vaping, where electronic devices use heat to evaporate cannabis products in oil form, smoking may be safer, said Brown, the pain management doctor. Vaping nicotine products have come under fire from federal agencies for their risks related to seizures and addiction.
"A lot of the patients I see who want to smoke have a hard time finding a vape product that isn't too harsh. It causes a burning sensation," Brown said. "The patients who have whole flower recommendations tell me how easy it is to use, and how smooth."
She said she recommends smoking marijuana to patients wanting quick pain relief and those looking for a product that lasts only a short time.
But there are still concerns to be addressed.
"There is some worry for patients who use marijuana for behavioral health conditions," Pigman said. "If they are exposed to high rates of THC (the psychoactive ingredient in marijuana that creates a euphoric high), that could exacerbate those symptoms."
Times Staff Writer Emily Mahoney contributed to this report. Contact Justine Griffin at firstname.lastname@example.org or (727) 893-8467. Follow @SunBizGriffin.