Ask Dr. Mike: Is It Safe for Me to Smoke Weed or Not?

Mike Cirigliano, aka Penn’s Dr. Mike, explains whether it’s safe to use marijuana these days.

Meet internal medicine physician Michael Cirigliano, affectionately known as “Dr. Mike” to not only his 2,000 patients, who love his unfussy brilliance, tenacity, humor, and warmth (he’s a hugger!), but also to viewers of FOX 29’s Good Day Philadelphia, where he’s been a long-time contributor. For 32 years, he’s been on the faculty at Penn, where he trained. And he’s been named a Philadelphia magazine Top Doc every year since 2008. Now, he’s our in-house doc for the questions you’ve been itching (perhaps literally) to ask a medical expert who’ll answer in words you actually understand. Got a doozy for him? Ask Dr. Mike at victor@phillymag.com.

I used to smoke a lot of pot when I was younger and only recently began to dabble again. And, honestly, I don’t think I can handle 2026 weed. One experience really scared me and almost sent me to the hospital. Should I just avoid the stuff?
Victor, this is not your grandma’s weed. This is not Cheech and Chong’s weed. This is big-time weed that has been cultivated and can be very strong.

You’re telling me!
This stuff can really affect your cognitive abilities. So many people are getting pulled over for driving under the influence of marijuana. And that really bothers me. My father was killed by a drunk driver.

Some of my friends claim they would never drive when they are drunk, yet these same friends say they are perfectly capable of driving when they are high.
They’re wrong. They can’t.

Are there any other major downsides, besides severe intoxication?
For one thing, marijuana use can absolutely increase the risk of a bad cardiovascular event, like a heart attack. So that is something I am really concerned about. Also, if you are predisposed to psychotic episodes or schizophrenia, there are definitely risks associated with marijuana use.

I’m guessing that smoking pretty much anything can lead to problems.
Yes! I don’t like anything going in the lungs. Weed doesn’t contain the thousands of carcinogens that cigarettes do, but smoke should not be in the lungs. Period.

So I should just eat edibles and I’m fine?
Well, I don’t want to sound like a Debbie Downer, but then there is still cannabis hyperemesis syndrome to think about.

I’m assuming this is something I don’t want?
This is something associated with long-term marijuana use, and it basically means you can’t stop vomiting.

That sounds awful.
You end up in the ER getting IV fluids and sometimes the traditional medicines we use to stop vomiting don’t work all that well. You just have to deal with it. Constant vomiting.

Are we talking only about products containing THC or do these troubles also extend to the litany of perfectly legal CBD products out there – the sodas, the gummies, the … you name it.
CBD is generally well-tolerated when used alone but does carry risk with liver toxicity. It also interacts with a lot of different medications, and should never, ever be used with children or during pregnancy. For people with psychiatric disorders, the risks of using CBD likely outweigh the benefits of using it. And you must keep in mind that CBD products are generally unregulated by the government, and there have been many instances of mislabeling and contamination.

So be honest, when was the last time you sparked up some sour diesel?
I can’t remember, buddy. I have to be running on a full 88 cylinders every moment of every day. I do have alcohol from time to time, on the weekends; I can’t do it during the week, not with my frenetic little life. How am I supposed to do this interview otherwise? It’s six in the morning right now. If I’d had anything to drink last night, I’d be a pool of wasteland by now.

Do you think it makes a difference if I get my weed from the guy at the gas station or convenience store versus from a licensed medical dispensary?
Let me put it to you this way. I enjoy sushi. My son loves sushi. I only go where I’m convinced they know what they are doing, because I don’t want to get a parasite. Same thing here.

I know so many younger people who won’t go anywhere near alcohol but they smoke weed like fiends — California sober, as they say. Do you like that tradeoff?
Well, listen, alcohol causes about seven cancers, at the least. It leads to death and destruction. It can cause liver damage and cirrhosis. But there’s nothing free in this world, whether it be pot or alcohol. That said, I’m a lot more concerned with young people eating highly processed foods than I am with their pot use. These foods may really be affecting their microbiome, which is leading to that uptick in the risk of colon cancer. If you take away the alcohol and you take away the sodas and all the highly processed foods, you’re doing yourself a big favor. Oh, and invest heavily in your 401(k).

So I should lay off the Fritos, eat more apples and bananas, steer clear of two-martini lunches, but a little hit on a joint once in a while isn’t going to kill me.
That sounds like a reasonable plan to me.