Rotations are on hold as the old adage of “puff, puff, pass” has been replaced with “puff, puff, don’t pass” in the germophobic age of coronavirus.

In an era where we sing “Happy Birthday” while washing our hands, freak out about keeping six feet apart, and can clear out an entire grocery aisle by clearing our throats, we now hear from the World Health Organization that people with smoking-related lung conditions are “at higher risk of developing severe COVID-19 symptoms.” A much-discussed research paper in the Chinese Medical Journal found the odds of coronavirus infections developing into more serious conditions are 14 times higher for people with a history of smoking.

But do cannabis-smokers need to worry about these warnings? Does smoking pot put us at higher risk?

“Probably,” says Dr. Stanton Glantz, professor of medicine and director of the UCSF Center for Tobacco Control Research and Education. “Smoking doesn’t cause the flu, vaping doesn’t cause the flu. But people who smoke or are exposed to secondhand smoke are more susceptible to getting sick.”

Of course, Dr. Glantz is a known anti-smoking crusader who’s been called “the Ralph Nader of the anti-tobacco movement.” So we reached out to a health expert at one of San Francisco’s premier cannabis dispensaries for a second opinion.

“Smoking can irritate the lungs,” Apothecarium public education officer Sara Payan says. “For people who already have predispositions to respiratory issues, you should really stick to edibles during this time.”

We call this virus a “novel coronavirus” because it’s a new strain of infection that the world has never seen before. Doctors have only known about this coronavirus for about four months, so it’s difficult to draw conclusions yet.

“There’s not a lot of direct data on COVID,” Glantz admits. “But there’s a ton of evidence that smoking and vaping depress immune function in your lungs. If you look at cannabis smoke and compare it to tobacco smoke, it’s not that different. You have THC instead of nicotine, but the immunosuppressive effects do not seem to be primarily because of nicotine.”

Our lungs are massively complex, very delicate organs. They cleanse about 1,200 miles worth of your capillaries with each heartbeat, and deliver oxygen to around 300 million tiny air sacs within. But even the smallest failure in these processes can lead to serious infection or compromise of your immune system.

“When you’re breathing, you breathe in a lot of viruses and bacteria. So your lungs have an important immune function,” Glantz explains. “Both smoking and vaping destroy that immune function.”

But while there are mountains of research saying that smoking is bad for you, there are hardly any published papers exploring the effects of smoking cannabis on human lungs.

“That’s an area where there’s not a lot of literature because it’s very hard to study cannabis,” Glantz continues, noting that the still federally illegal status of cannabis makes this research all but impossible. “There’s a cannabis dispensary three blocks from my house. If I walked down there and bought some and took it to UCSF, and did anything with it, even just some chemistry on it let alone exposing it to people, that would put in jeopardy all federal funding for the entire 10-campus UC system. The amount of research we have around cannabis is very limited. And I think that’s a huge problem.”

As a cancer survivor who used medical marijuana to cope with chemotherapy treatments, the Apothecarium’s Sara Payan has done plenty of personal research on the topic (though her studies weren’t necessarily federally funded).

“For people who have healthy lungs and no respiratory illness, it’s up to them as adults whether they want to smoke,” she says. “But this is a novel coronavirus, we’re not sure how everyone’s going to react to it and we’ve already had deaths. Scientists and health officials have already said it’s directly linked to respiratory issues, we want to hedge our bets.
“People are saying ‘Puff puff, don’t pass.’ Absolutely. If you do decide you do want to inhale, you really want to keep good hygiene with your smoking implements. Washing those pipes and cleaning those bongs and not letting that water sit.”

And no, bongwater does not cleanse all the toxins out of your marijuana smoke. In fact, some research shows that dirty bong water can transmit higher levels of carbon monoxide and the harmful compound benzene. But there is some high-tech hardware that may make smoking safer.

“If I do inhale cannabis, I’ve been using my Pax 3 because that’s true vaporization, there’s no combustion going on there,” Payan says, describing a line of high-end dry herb vaporizers that also includes the DaVinci IQ. These may be less harmful than standard vape pens. “With the vape cartridges, you have high-temperature atomization, so there is combustion. Anything where combustion comes into play, you really want to exercise caution.”

But these fancy, ultramodern vaporizers can cost upwards around $300 after taxes. Given that the entire economy is falling ill, that might not be the best investment right now. If you’re choosing to make do with a bong or a bowl right now, Payan advises that you refrain from sharing and keep your pieces clean.

“I would suggest using 70 percent or greater isopropyl alcohol to swab it from time to time,” Payan advises. “For cleaning the resin out of your bong or your bowl, using 90 percent or greater isopropyl and soaking it is a good way to not only clean off the resin well, but also keep it clean and sanitary.”

Both Glantz and Payan agreed that edibles are one of the safest ways to consume cannabis, especially during the pandemic. Though Dr. Glantz adds one caveat.

“The problem with the edibles is dosing,” he says. “The one advantage of inhaling something, whether you’re talking about cannabis or nicotine or cocaine for that matter, is that it goes from your lungs to your heart to your brain very quickly. So your brain gets hit with it in a few seconds.

“With edibles, you eat some and nothing happens. Then you eat some more, and nothing happens. Then you eat some more and go to the emergency room.”

Edibles otherwise get a pretty clean bill of health as one of the safer forms of cannabis consumption in these times, as do ointmentstinctures, and cannabis oils.

“Lungs are designed to breathe air,” Dr. Glantz says. “When you ask the question, ‘Do we have bomb-proof evidence that cannabis is doing these things?’ The answer is No. If you ask the question, ‘Getting COVID is potentially life-threatening and I want to do everything I can to reduce my risk of getting infection and minimize the risk of how severe the infection will be if I get it, would it be sensible not to use inhaled cannabis products?’ I think the answer to that is ‘Yes.’”