Following widespread media coverage of a UCSF study published in JAMA Cardiology linking cannabis to potential cardiovascular risks, board-certified family physician Dr. Benjamin Caplan provides an evidence-based clinical appraisal of cannabinoid hemodynamics. While acute delta-9-THC inhalation can trigger transient tachycardia, peripheral vasodilation, and sympathetic nervous system activation, broad observational registries frequently conflate combustion-related toxins with pure cannabinoid pharmacology. This comprehensive clinical guide examines the physiological mechanisms of CB1 and CB2 receptors in vascular tissue, identifies high-risk cardiac contraindications, and details safe monitoring protocols for patients and physicians.