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On one hand, the culture of sharing is a beautiful aspect of the cannabis using community. We like to share, and to do it in a fair and orderly manner. When people smoke together they bond. Some of the most unexpected groups of people come together over cannabis and a lot of that happens in circles of smokers, happily passing their joints.

But this cultural habit is not without its problems. One of the biggest issues is the transmission of germs. Sharing joints, pipes, e-cigs and anything else that you put your mouth against is a pretty personal act. Like kissing, it might bring you closer together, but it will also swap the germs in your mouths. Unfortunately we are likely puff, puff, passing any illnesses around the circle with our joints and pipes; putting ourselves and others at risk for anything from the flu to oral HPV. Even for healthy people, much less for patients with compromised immune systems, this can be a dangerous way to socialize.

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As most could probably infer, puff puff pass is a smoking rule that means you can take two hits from the joint before you pass it to the next person in the circle. When the next person receives the joint they too will take two hits from it and then pass it to the next person. The joint will eventually make its way back to you where you will again take two puffs from it and then pass it in the same direction to the next person in the circle. Worth noting that this rule doesn't typically apply to smoking bongs, or pipes.

This continues until the whole joint is smoked or until everyone reaches their desired level of high. Puff puff pass is extremely simple and it will become second nature to you in only a few smoke sessions.

Without joint etiquette, someone may smoke half the joint before passing it off to the next person, leaving the rest of the group unable to get as high as they wanted to. The point of puff puff pass is to create a good and fair sociable environment, and it works great at doing that.

While this principle is based on laudable values like generosity and equity, medical experts have repeatedly warned cannabis users about the risks of passing inhaled forms of cannabis between different users' mouths. Previous studies have found sharing cannabis in this way risks transmitting serious diseases such as oral HPV and tuberculosis. And during the pandemic, organizations like The World Health Organization warned cannabis users that sharing cannabis in this way could increase the risk of Covid-19 transmission.

The study found that only 12.4% of respondents had completely abstained from sharing cannabis before the pandemic. This rose to 24.9% during the height of the pandemic. While the percentage of cannabis users avoiding cannabis sharing more than doubled, the number shows that a large majority continued to share cannabis. Still, only 11.2% reported sharing most of the time (down from 19.5% before the pandemic), and only 3.1% reported always sharing (compared to 5.2% before the pandemic). These results suggest that many cannabis users may have been using their own judgment on who was safe to share with, and abstained from sharing in other contexts. Still, the overall trend was a shift away from puff puff passing.

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