The Massachusetts vaping product ban now in effect until Jan. 25 affects medical marijuana patients among other consumers. We asked Dr. Jordan Tishler, president of Inhale MD and the Association of Cannabis Specialists, what the ban will mean for patients.
What's your reaction to the ban?
I think that it was a good move on the part of the governor to do what he said it was to do, which was to allow time for physicians and scientists to figure out what's going on. There is a concern that if you remove legal regulated mechanisms, then people will go to illegal and therefore potentially riskier mechanisms. I think that's kind of a balancing act.
I would hope that most people are tuned in and smart enough to see that there is a problem here, and that they're putting themselves at risk by using these sorts of devices, and this ban is intended to protect them while people do what needs to be done to understand the real risks.
I would also go so far as to say that the current crisis is really only part of the real problem, and that none of these devices were particularly safe to begin with. For that reason, I've been advising my patients to avoid these "vaporizer pens" or "oil pens" forever. Independent of this current problem, I don't think that they're safe because they do emit a whole host of carcinogens.
When I have patients who I want to use cannabis by inhalation, we vaporize using cannabis flower, meaning the botanical material, simply because those devices are more sophisticated about how they work, and thus they actually provide the medicine without all of the products of combustion. Frankly, those oil pens shouldn't be called "vapes" because they're not really vaporizing, they're really combusting.
So what would be your advice to patients who'll be now be confronted by what sounds like the removal of all vaping devices and products from stores?
Well, the first thing I would say is, don't run out to the corner and get a vape, an oil pen, because that's the way that people have gotten sick and died. So don't do that. But what I would say is vaporizing botanical material with a quality cannabis vaporizer — meaning flower — is safe, and avoids all of the products of combustion, avoids all the risk of these additives, and that's really the best and safest way to be vaporizing cannabis at this point.
Could you explain a little more about the differences, about flower vaporizers?
When we talk about using cannabis, people think about leaves, but it isn't the leaves that we actually use, it's the flower, like a rose. When you get cannabis at the dispensary, what you're buying is dried up balls of the cannabis flower. And that's because the plant concentrates most of the medical chemicals in the flower. And we dry it out and grind it up and then we put it into some sort of a delivery service system. It could be as simple as rolling a joint or sticking it in a pipe, but burning it that way exposes us to products of combustion that we don't want.
So a flower vaporizer is a device with a little bowl into which you put this ground cannabis material but it has a battery and most importantly it has a thermostat. So it's actually measuring the temperature in the bowl as it achieves and maintains the temperature. You set the temperature to the proper number, which is 350 degrees, and the machine is smart enough to stay there, and not to go significantly above 350 degrees. Once you get up to 400 degrees, now you start to burn things, and produce benzene and other carcinogenic chemicals, and that's exactly what we want to avoid.
The vape pen is basically a cartridge full of some sort of cannabis oil, a battery and a heating element, and there's no control built into it. Some pretend to have control but they don't actually measure the temperature. And they can get up to many hundreds of degrees above what is safe — and it's burning the oil. Oil is a hydrocarbon, so when it burns, it's kind of like burning gasoline, it produces all kinds of noxious chemicals and we don't want to inhale those.
Are the flower vaporizers expensive?
I think people use vape pens because they're easy. You stick them in your mouth and you suck on them, and there you go. They're also very small and discreet — they look like a pen — so you can sneak around with them, although that's not so compelling now that this stuff is completely legal.
Cost: Yes, a quality vaporizer used to be a $250 investment. The one that we're recommending right now, on the other hand, is $129, so it's significantly less, And just as effective as the older, more expensive ones. So for most people that's within the realm of affordability, at least, compared with a vape pen.
But would it be subject to the ban?
I hope it's not subject to the ban. It would be foolish if it were. And since I would imagine the ban applies to the particular types of oil cartridge-handle type thing. I don't see them as being in the same class — and chemically they're not in the same class. But I don't know the answer yet.
Can patients also shift to edible products?
That's complicated. It's often argued on the internet that if you don't want to smoke, you can just take an edible. But that actually defies the medicine and the chemistry, because when you eat it, you're not getting the same medicine as when you inhale it. In certain circumstances, for certain illnesses, you want the characteristics that you get from inhalation. And in other circumstances, you want what you get from taking it orally. In a pinch, yes, you can interchange them. But in terms of best practices and what is most efficacious, it's not a real direct substitute.
So bottom line, could the ban eliminate options that are actually good for patients?
I don't think so. At least in my practice, I'm always telling people to stay away from those vape pens. We still have the option of vaporizing flower, assuming the Baker administration hasn't banned that too by accident. So that's the substitute there, and then for the people who need edibles, that's still in play.
Another thing about a flower vaporizer is that you don't buy it more than once. When you buy a vape pen you have to go back and get a cartridge over and over again and you don't know what you're getting. A flower vaporizer that somebody purchased is reusable.
What's your take on the lung illnesses that prompted this ban?
The CDC has preliminarily pointed their finger at vitamin E acetate, and that doesn't surprise me at all. It surprises me that somebody out there thought that vitamin E was a good thing to put in these devices: it causes an allergic reaction in many, many people.
There needs to be greater science and there needs to be stricter regulations so that things like putting unproven additives in doesn't happen. But, as is the case for so much of the cannabis industry, the cart is before the horse, and the products go to market long before anybody actually tests them. So the people using them are the guinea pigs.
This text has been lightly edited.