the interiors of bronchial cells, which develop a variety of abnormalities. Some of these changes, which are known to be precursors of cancer, have also been discovered in the respiratory tracts of marijuana and hashish smokers who did not use tobacco.

Another form of respiratory injury caused by tobacco smoke is a condition known as chronic obstructive pulmonary disease (COPD), a slow, progressive loss of elasticity in the passages that deliver air to the lungs. People with COPD become short of breath and exhibit symptoms of chronic bronchitis. Attempts to determine whether marijuana smoke also provokes COPD have produced conflicting results. For example, one group reported that smoking as little as a single joint per day significantly impaired small airway function,3 while another failed to detect similar damage even in people who smoked four joints a day for more than 10 years.4 It thus remains to be determined whether chronic marijuana smoking actually causes COPD, but there is good reason to suspect that it does.

While many tobacco smokers accept coughing and shortness of breath as part of the price they pay for the pleasure of smoking, fear of cancer sometimes persuades them to quit. (And then there are people who get little pleasure out of smoking but continue smoking to calm their nerves, that is, to avoid feeling anxious and irritable—the withdrawal symptoms of nicotine addiction.) Whether marijuana users should be similarly concerned remains to be conclusively proven. However, cellular, genetic, and clinical studies all suggest that marijuana smoke is an important risk factor in the development of respiratory cancer.

Many of the same carcinogenic, or cancer-causing, compounds present in tobacco smoke are also found in burning marijuana. In particular, unfiltered smoke from joints contains higher concentrations of a class of chemicals called polycyclic aromatic hydrocarbons (PAHs) than does smoke from tobacco cigarettes. Since marijuana users generally inhale more deeply than tobacco smokers, they may be exposing their lungs to even higher levels of these dangerous substances. Preliminary research also suggests that marijuana smokers' lung cells contain higher levels of an enzyme that converts PAHs into a cancer-causing form. Thus, it is not surprising that several studies implicate marijuana smoking



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