THE HIGH HEALTH COST OF SMOKING A JOINT

Disease Fills the Lungs of Heavy Users With Cysts

THE very name given to the latest disorder associated with
cannabis-smoking has a sinister ring to it.

Cancer, schizophrenia and impotence have been joined in the litany of
ill-effects by vanishing lung syndrome.

It is a distinctive feature of the 30-somethings - and some even
younger - regularly turning up at Glasgow Royal Infirmary with what
they thought were routine respiratory symptoms.

Dr Martin Johnson, who first encountered the syndrome in Bristol, is
alerted by apparent emphysema, insufficient tobacco exposure to
account for it, and a history of cannabis smoking. High resolution CT
scans confirm the diagnosis.

The alveoli - the air sacs in the lung which permit the transfer of
oxygen into the blood - have been displaced by big cysts, called giant
bullae, cutting the lung's function by up to a third and crowding the
chest cavity. Sometimes the effect is a collapsed lung.

Marijuana has already been implicated in lung cancer, and a report
last year by the British Lung Foundation - challenged by the drug
liberalisation lobby - claimed that three joints a day caused the same
damage to the airways as 20 cigarettes.

Lung cancer patients are now appearing at younger ages than in the
past.

As with lung cancer, the problem with vanishing lung syndrome may not
be so much to do with the content of the drug as with the way it is
smoked.

"We were wondering what the mechanism was and we suspect it is because
when you smoke drugs you tend to take much deeper breaths and hold it
in longer than you would with tobacco, in order to get the effect,"
said Dr Johnson.

"We have also come across it in heroin smokers. It might not be
damaging their veins, as injecting would, but it does damage their
lungs.

"It is not normally a common condition, but there is a possibility
that it is common in heavier cannabis smokers - more so than they
might think. You can develop quite a lot of lung damage before you
become symptomatic. We had one whose lung was collapsing and another
disabled by breathlessness."

Typically, a patient will come in with some other respiratory
complaint, like a flare-up of asthma. The patients Dr Johnson sees are
relatively young, they have all been male, typically 30-40, but some
in their mid-twenties - much younger than the typical sufferer from
tobacco-related lung disease. If they have symptoms, these tend to be
associated with other problems.

Given the growing political lobby to legalise marijuana, Dr Johnson
believes that its possible that toxic effects on the lungs need
further study.

"We haven't had time to follow through the long-term effects. I would
think it is permanent. That is the usual course. They will run out of
lung by the time they are 70 or 80."

Young cannabis smokers have also been a growing phenomenon recently at
another Royal Infirmary department - the sexual health clinic. It has
been blamed for lowering testosterone levels and causing impotence.

Its psychiatric effects have also been a growing concern. It is
suspected of causing schizophrenia, or provoking the illness where it
is latent. Heavy daily use has also been linked to a condition known
as toxic psychosis, resulting in panic, fear, and hallucination, and
the effects most often associated with the drug - lethargy, poor
concentration, and short-term memory.