One of the most anticipated trials of last year was the John Morgan Smoking lawsuit against the State of Florida. He contended that the legislature had erred when they banned smoking in the implementation bill for Amendment 2, now Article X, Section 29 of the Florida Constitution.
The Amendment, which passed with 71.3% of the vote in 2016, had a clause which noted that you could not smoke medicinal cannabis in a public place. Therefore, as writer of the amendment and lead attorney for the case, former Speaker of the Florida House Jon Mills had stated, banning smoking was unconstitutional.
Not so, stated Attorney Rachel Nordby for the State of Florida. It is up to the state to regulate the medical program in a safe and appropriate fashion. And that, and she noted, is not smoking, it is vaping.
But did she understand what she was saying?
What is vaping?
In the world of consuming cannabis, vaping, which is short for vaporizing, is the newest route of administration. Since the Florida medical program began, that, for the most part meant vaping of concentrated, processed oils.
The first style of vaping came from heating the ground herb to a temperature that allows the compounds in the plant to boil and evaporate, from 310o for the terpene pinene and 315o for THC all the way up to 388o for linalool and 428ofor THC-V. As it turns out, this is the most efficient method of delivering the entourage effect. Many devices allow you to dial the temperature on the vaporizing mechanism, in either a hand-held or one of the “towers”, block or “Volcano” table models which can be inhaled with a plastic tube or ones you fill a bag with a valve that lets to inhale it or squeeze the bag. The latter is preferred in hospitals and retirement homes in Israel.
Also, as mentioned above, you can adjust the temperature of the vaporizer and customize the utilization of the flower, based on which cannabinoids and terpenes are vaporized. For instance, according to an article in leafly.com, at 310°F to 330°F, expect mild euphoria, focus, productivity, and subtle relaxation. At 330°F to 370°F, you get moderate euphoria, enhanced sensory awareness, mood elevation, for functional relaxation. Finally, at 370°F to 430°F is best for intense euphoria, sleep, heavy relaxation, and meditation. These are options not available when you just burn the flower as smoking.
Then came pre-filled oil vape-pen cartridges and prefilled disposable all-in-one vape pens, with the non-rechargeable battery inside.
These pens are great for their convenience. Carry them in your pocket where ever you go, press the button to heat the element inside and inhale for a few seconds, and that’s it. In some cases, you don’t even need to press a battery, the negative air pressure of your inhalation turns it on.
Just what is in those cartridges?
But what is inside those cartridges? Highly concentrated processed oils, with the proper viscosity to work in the pens. Many of the MMTC’s used CO2 methods. Certain high grade “winterized”(cooled) CO2 oils are uniquely compatible with vaporizer cartridges due to the fact that they do not require additives of any kind to meet the viscosity levels.
Then there is cannabis distillate . According to Leafly, they are highly refined oils containing pure cannabinoids and almost nothing else, like Trulieve’s specialized Truclear and TruStick TruPods. The upside to using distillates in vaporizer cartridges is that the oil can be produced from a range of starting materials. Virtually any hash oil variety from CO2 to BHO and everything in between can be purified into a distillate. The downside to using distillates in vaporizer cartridges is that because there are no residual terpenes left behind, there is nothing to cut the viscosity of the material. For a distillate to be used for cartridges, a thinning agent of some kind is often required.
Often, the processor is adding back terpenes, but not necessarily the original ones that came with the strain that was processed. Some CO2 processing still retained some of the original terpenes. However, food-grade terpene flavorings are the most prevalent used in cartridges. Terpenes are found all over nature (cannabis included) but can also be synthesized in a lab.
d-limonene is a popular terpene additive found in some cannabis varietals. Many manufacturers use food-grade d-limonene as the sole flavoring additive for their pre-loaded cartridges. Although this helps to cut the viscosity and add a flavor enhancement, these infusions tend to be one-dimensional and offer very little in enhancing the user’s experience.
Newer products are expected to be cut with a mixture of the original terpene profile, for a better and more genuine outcome.
Florida’s medical cannabis market evolves
But Florida’s market was no doubt different than a large part of the rest of the world that has had legalized medicinal cannabis. Up until now, most of the legalized world had access to flower, but not us. Here in Florida, we started with just the tinctures, oils, capsules and suppositories, followed by the vape cartridges.
Even getting vape pens into the law was a struggle, with legislators looking at reports of inexpensive Asian vape cartridges having asbestos fibers and some vaping mechanisms creating incomplete combustion that produced unacceptable amounts of carbon monoxide. Of course, the prevalence of these circumstances was low and due to shoddy product standards, that could occur in any industry. Vaping is still far safer than tobacco and tobacco-substitute use, although there have been problems with unregulated products in the e-cig industry that have been incorrectly tagged to the cannabis vaping products, such as popcorn-lung and pneumonia that can occur from various carrier oils including PG and Vape pens with lithium batteries that explode.
But for the rest of the world that had access to flower while Florida fought for the right to use what had been use for thousands of years, at least legally, smoking was still the favored method.
A few of the MMTCs had flower in highly sealed receptacles for vaping in a hand-held device or table-top specially engineered “volcano”. In the rest of the cannabis consuming world, they put their flower in these devices as loose flower that they ground and loaded themselves. But is it preferred?
A smokin’ poll
In a poll taken in February with 1004 adults in the US and 700 in Canada, the results showed an overwhelming preference for smoking. However, it should be noted that smoking has been around for these folks far, far longer than vaping.
According to the poll, “The preference for smoking marijuana in a traditional way as opposed to vaporizing marijuana was true for both American and Canadian respondents, with 70% of Americans and 69% of Canadians answering that they prefer to smoke cannabis in some way than vape the herb. More specifically among Americans, 34% prefer joints/blunts, 24% prefer pipes, and 11% prefer bongs, while only 9% prefer to vaporize cannabis, and among Canadians, 44% prefer joints/blunts, 13% prefer pipes, and 12% prefer bongs, and only 11% prefer to vape marijuana.”
But what about Floridians? For the benefit of the Morgan Smoking trial, Florida for Care did a survey of its 41,580 members. Of those responding, 63.8% said that they were registered patients or caregivers. When those who identified themselves as people who did not attempt to become patients were asked why, the number one answer, at 41.5% of those in that category, was that smokable flower was not available under the current law. When the question was posed a different way, ‘if smokable flower was legal to buy, would you purchase it’, 92.4% said yes.
So even with the convenience of vape-able sealed herb cartridges and oil cartridges, based at least on this unscientific non-randomized, non-sampled survey, those involved in the movement seemed to have a preference.
This may or may not play out among the current patient population in Florida, with its average age of 54 and a different demographic then those who started this legalization movement. We in this state may have already gotten used to vape pens as the norm even though smokable flower finally is legalized.
The new legislation morphs
But the new law has a host of restrictions that make it difficult to get a recommendation from your doctor for “smokable flower”.
So now that a “smoking recommendation” gives to access to whole flower, when you get it home, what will you do with it? The law does not require that you put it in a joint or bowl.
When the bill was being worked out in committee, the original idea was to sell it only in the form of “pre-rolls” – cone shaped cannabis cigarettes, often with a rolled cardboard end, and made from rice or hemp paper (but hemp paper, deemed “illegal” in the state of Florida was blocked from use in the bill).
During that time, the House even required that the prerolls had fiber filters, to help block “toxins”, just like tobacco cigarettes and cigars.
However, once the legislators were educated by advocates that multiple studies show smoking cannabis was healthier than tobacco cigarettes, (due to the anti-inflammatory, tumor-antagonist and bronchodilation effects of cannabinoids that tobacco does not have), they backed down on the filter, which could have blocked vital cannabinoids.
Then, we confronted them with scientific evidence that pre-rolls were a far less efficient method to deliver the entourage effect. In a paper by the Johns Hopkins University School of Medicine Behavioral Pharmacology Research Unit, it was shown that smoking prerolls was only 70.1% efficient as vaping the whole flower to deliver the medicine. According to the double-blind study, “Vaporized cannabis resulted in qualitatively stronger drug effects for most pharmacodynamic outcomes and higher peak concentrations of THC in blood, compared with equal doses of smoked cannabis (25-mg dose: smoked, 10.2 ng/mL; vaporized, 14.4 ng/mL).”
It seems that smoking the pre-rolls loses cannabinoids through combustion and “Side-stream smoke” (also known as second-hand smoke) pipes. Bongs and ultimately vaping the whole flower are more efficient. HHS Committee chair Rep. Ray Rodriguez had originally stated that, once in the privacy of their homes, patients could do what they wish with the pre-rolls, including ripping off the filter and dropping whatever was in the pre-roll into a pipe or vaporizer. But, confronted with the differential in cost (three times the cost of loose buds and more likely to go stale and less potent with time) they finally dropped the pre-roll mandate. However, because this was a smoking ban bill, they compromised with a mandate that all MMTC’s carry at least one type of pre-roll.
The “Morgan Smoking Case” is now gone, after a joint motion (not a pun) to dismiss the case by both the Morgan team and the state. But Ms. Nordby’s words still resonate.
“Marijuana is a form for smoking” is now legal to purchase, after your doctor goes through all the hoops and caveats to approve a separate recommendation for smoking, proving to the state that smoking was a better alternative than the other available modes of administration. But the best alternative to deliver the medicine, vaping the whole flower, is not available until you get the smoking recommendation. Otherwise, you are still relegated to purchasing the sealed ceramic cartridges with chunks of buds or lower-resin leaves reduced to powder in an inhalation recommendation.
It was noted to the legislature that the cartridges were not an efficient means to vaporize the dried herb, because the edges of the cartridge were hotter than the center of the packed receptacle, and air-flow as impeded by the dozen or so minute holes at the bottom of the cartridge. So, the mandate of selling the flower in “sealed receptacles for vaping” were no longer a mandate. At least not for a smoking recommendation.
But, at the end of the day, this really was not a smoking issue, but about access to the whole flower, to vape if you so wish. But the constitutional argument from the amendment regarding smoking made smoking the issue and the legislation focused on its task.
It looks like or next task will be to find a way to create a “Whole Flower” recommendation, so that the issue of whether to smoke or to vape will once again be between the doctor and patient, not the House and the Senate.