Medicinal cannabis is an invaluable adjunct therapy for pain relief, nausea, anorexia, and mood modification in cancer patients and is available as cookies or cakes, as sublingual drops, as a vaporized mist, or for smoking. However, as with every herb, various microorganisms are carried on its leaves and flowers which when inhaled could expose the user, in particular immunocompromised patients, to the risk of opportunistic lung infections, primarily from inhaled molds. The objective of this study was to identify the safest way of using medicinal cannabis in immunosuppressed patients by finding the optimal method of sterilization with minimal loss of activity of cannabis. We describe the results of culturing the cannabis herb, three methods of sterilization, and the measured loss of a main cannabinoid compound activity. Systematic sterilization of medicinal cannabis can eliminate the risk of fatal opportunistic infections associated with cannabis among patients at risk.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Price includes VAT (USA)
Tax calculation will be finalised during checkout.
Abrams DI, Vizoso HP, Shade SB, Jay C, Kelly ME, Benowitz NL (2007) Vaporization as a smokeless cannabis delivery system: a pilot study. Clin Pharmacol Ther 82:572–578
Cescon DW, Page AV, Richardson S, Moore MJ, Boerner S, Gold WL (2008) Invasive pulmonary aspergillosis associated with marijuana use in a man with colorectal cancer. J Clin Oncol 26:2214–2215
Chusid MJ, Gelfand JA, Nutter C, Fauci AS (1975) Letter: pulmonary aspergillosis, inhalation of contaminated marijuana smoke, chronic granulomatous disease. Ann Intern Med 82:682–683
Denning DW, Follansbee SE, Scolaro M, Norris S, Edelstein H, Stevens DA (1991) Pulmonary aspergillosis in the acquired immunodeficiency syndrome. N Engl J Med 324:654–662
Gargani Y, Bishop P, Denning DW (2011) Too many mouldy joints—marijuana and chronic pulmonary aspergillosis. Mediterr J Hematol Infect Dis 3:e2011005
Hamadeh R, Ardehali A, Locksley RM, York MK (1988) Fatal aspergillosis associated with smoking contaminated marijuana, in a marrow transplant recipient. Chest 94:432–433
Kagen SL (1981) Aspergillus: an inhalable contaminant of marihuana. N Engl J Med 304:483–484
Levitz SM, Diamond RD (1991) Aspergillosis and marijuana. Ann Intern Med 115:578–579
Marks WH, Florence L, Lieberman J, Chapman P, Howard D, Roberts P, Perkinson D (1996) Successfully treated invasive pulmonary aspergillosis associated with smoking marijuana in a renal transplant recipient. Transplantation 61:1771–1774
Mechoulam R, McCallum NK, Burstein S (1976) Recent advances in the chemistry and biochemistry of cannabis. Chem Rev 76:75–112
Nations U (2009) Recommended methods for the identification and analysis of cannabis and cannabis products. Manual for use by national drug analysis laboratories In: Editor (ed)^(eds) Book Recommended methods for the identification and analysis of cannabis and cannabis products. Manual for use by national drug analysis laboratories Laboratory and Scientific Section, United Nations Office on Drugs and Crime, City.
Scheretz RJ, Belani A, Kramer BS et al (1987) Impact of air filtration on nosocomial aspergillus infection: unique risk of bone marrow transplant recipients. Am J Med 83:709–718
Schwartz IS (1985) Marijuana and fungal infection. Am J Clin Pathol 84:256
Shay AH, Choi R, Whittaker K (2003) Impairment of antibacterial activity and nitric oxide production in alveolar macrophages from smokers of marijuana and cocaine. J Infect Dis 187(4):700–4
Sutton S, Lum BL, Torti FM (1986) Possible risk of invasive pulmonary aspergillosis with marijuana use during chemotherapy for small cell lung cancer. Drug Intell Clin Pharm 20:289–291
Szyper-Kravitz M, Lang R, Manor Y, Lahav M (2001) Early invasive pulmonary aspergillosis in a leukemia patient linked to aspergillus contaminated marijuana smoking. Leuk Lymphoma 42:1433–1437
Verweij PE, Kerremans JJ, Voss A, Meis JF (2000) Fungal contamination of tobacco and marijuana. JAMA 284:2875
Weinrieb RM, Lucey MR (2007) Treatment of addictive behaviors in liver transplant patients. Liver Transpl 13:S79–82
The use of medicinal cannabis was approved by the chief national psychiatrist of the Israeli Health Ministry.
Study design and manuscript writing were under the responsibility of Rosa Ruchlemer, David Raveh, Michal Amit-Kohn, and Lumír Hanuš. David Raveh also cultured the cannabis. Lumir Hanus was also responsible for the sterilization studies.
Conflict of interest
Data sharing statement
No additional data available.
About this article
Cite this article
Ruchlemer, R., Amit-Kohn, M., Raveh, D. et al. Inhaled medicinal cannabis and the immunocompromised patient. Support Care Cancer 23, 819–822 (2015). https://doi.org/10.1007/s00520-014-2429-3
- Immunocompromised host