"No medicine is smoked." This argument is frequently made by prohibitionists simply to dismiss the subject of medical marijuana. It is also raised by others who recognize that smoking tobacco is the greatest single preventable health risk. When we are engaged in a great crusade against "smoking," it does seem a bit odd to advocate smoking a medicine. However, there are several points about this argument that need to be considered.

1. Most important: marijuana does not have to be smoked. It can be drunk as a tea, eaten in foods, or inhaled as a vapor. This last point seems to be a surprise, not only to prohibitionists who do not want to know it, but also to conscientious physicians who are genuinely concerned about the effects of smoking on sick people. If marijuana is heated to a point below the point of combustion, the active ingredients vaporize and can be inhaled without the particulates that might irritate the respiratory system. Inhaling either a smoke or a vapor has two very important advantages.

• First, someone who is vomiting cannot realistically be expected to swallow something to make them stop throwing up.
• Secondly, the onset of the effect of inhaling is so rapid that it not only gives immediate relief, it also allows the patient to control (titrate) the dosage. This is in contrast to other means of administration, especially oral ingestion, which can require up to an hour to know whether the dosage is too much or too little. This is one of the disadvantages of Marinol, the synthetic THC pill.

2. Most medical marijuana users do not smoke very much, or for very long, and most of the risks associated with tobacco smoking are cumulative over a period of many years. At the NIH Medical Marijuana Workshop the physicians expressed their concern only about patients with chronic conditions that would require many years of smoking large amounts.

• Vaporization would eliminate or greatly reduce the risks in even long term very heavy use.
• It has not been established that long-term heavy use is a major health risk. The eight legal medical marijuana smokers, who smoke an average of ten joints per day, which is very heavy marijuana use, do not show any adverse health consequences as a result of this.

3. Compare the risks of long term smoking with long term intravenous injection. (If medical marijuana should not be smoked because tobacco smoking is bad for you, what do the adverse consequences of IV drug abuse tell us about injecting a medicine? "No medicine should be injected, because junkies are unhealthy?" Both are non-sequiturs, but smoking is less injurious than injecting.)