December 22, 2020 7 min read
We’ve all been there. You weren’t feeling the effects of a pot brownie so you ate another. An hour later, you’re lying on the floor staring at a ceiling fan. An experienced dabhead convinces you to try his Dandy’s True OG, and now you feel like you might need to go to the ER.
The psychoactive effects of cannabis can be scary if you don’t expect them or aren’t used to them. But in most cases, a trip to the hospital isn’t necessary. “Just ensuring someone else is around for support and waiting it out with you will be sufficient,” says Dave Gordon, MD, a medical cannabis and Integrative Medicine physician, educator, and advisor based in Denver, Colorado.
We asked Dr. Dave for a plan of action next time you find yourself completely baked.
Green Entrepreneur: First of all, what are the common psychoactive effects of THC in cannabis? What is that “high” feeling?
The psychoactive effects of THC lie on a spectrum. At low dosages, they are often not even noticeable, with increasing effects as the dose increases. Some of the earliest feelings people have with a low dose THC are a sense of calmness, relaxation, and an overall general sense of well-being. It just pulls people out of their chronic fight-or-flight-response, slows them down, and makes them a bit more present. For many people, that is all their looking for, and we hit a sweet spot at that low dose.
But a low dose for one person is different for another. Typically a low dose might be one brief inhalation of flower or less than 2.5 mg of an oral product. As you increase the dose, the psychoactivity becomes more noticeable and more prominent. The primary sensation is an increasing sense of euphoria, which is just the overall sense of well-being on steroids. We define this as a more intense feeling of pleasure and happiness.
All external stimuli and things that activate our senses tend to be more intense, pleasurable, and enjoyable. For example, it’s common to hear people say something like, “This song (meal, movie, art, etc.) is amazing,” and this increased sense of enjoyment of everything around you is likely one of the biggest reasons for cannabis’ social use.
So you can see how cannabis could have value from a medicinal standpoint, especially for those dealing with depression, chronic pain, other conditions in which enjoyment and pleasure are lacking. Akin to the euphoria and enhanced sensations can be disruptions in what we call psychomotor function. This includes things like attention, short-term memory, and coordination. The combination of the increased euphoria and impaired psychomotor function can result in someone who is intoxicated with THC being “lost in their own world.” This feeling is the overall classic realm of “being high,” where you’re in an altered reality.
This world is typically a positive place, which again can be both socially beneficial and therapeutic. But you can see how using too much continuously can essentially create a persistent altered sense of reality, which could become counter-productive.
How long does it typically take to get high, and how long does the feeling last?
Inhalation typically causes these effects to kick in within 5 to 10 minutes, hitting a peak around 20 to 30 minutes and dissipating by 2 to 4 hours, depending on the dose. However, there are often residual positive effects even after the intoxication is resolved.
Ingesting cannabis is much more variable. Classically, effects take 1 to 2 hours after ingestion to kick in, reach a stable peak shortly after that, and last for 6 to 8 hours. But some newer ingestible formulations found at dispensaries can kick in within 30 minutes and only last in the 3 to 5-hour range. There will also be quite a bit of variability between individuals with ingested products due to differences in gut digestion and absorption, as well as liver metabolism of THC.
When someone feels “too high,” what is it they’re experiencing biologically?
The majority of the psychoactive effects of THC are due to direct stimulation of the CB1 receptor. This receptor is always being stimulated to various degrees by our endocannabinoids, but at very low levels so we don’t feel “high” just going through daily life. When we take in more than a minuscule amount of THC, we’re stimulating those receptors more than is typical. As we push the THC dose, we continually overstimulate those receptors and cause various adverse effects. There are certainly other receptors and physiologic effects involved, but most of it is overstimulation of the CB1 receptor. When that happens, we get the extreme of intoxication, which is an entirely altered sense of reality. This typically causes anxiety and paranoia, and, in severe cases, psychosis.
What are things you do to lessen the unpleasant effects?
Few remedies are actually studied, so much of our recommendations are based on experience and what “should” help based on what we know happens physiologically.
- The most important thing is to know that THC/cannabis over-intoxication is not dangerous. No one has ever died from taking too much THC. Thus, my primary recommendation is to have a non-high (or much less high) support person around to give reassurance.
- I recommend that someone create an environment that they can focus on but is also familiar to them. Watching a movie or listening to music you know by heart and don’t have to think about is great. You can just be immersed in that, and then the effects will dissipate relatively quickly, especially if you’ve been inhaling. With too many edibles, you’re going to have longer-lasting effects and the need for continued support.
- While not proven in the research, I think it’s quite reasonable to use CBD to blunt increased anxiety and paranoia that occurs with over-intoxication. CBD may not dampen the psychomotor effects, but most of the research suggests it will help the anxiety and paranoia. Ideally, using CBD without additional THC is best.
- I like using other calming herbs/nutraceuticals. Taking a supplement capsule or drinking tea that includes various combinations of passionflower, camomile, theanine, kava, GABA, or other typically calming agents can help. There is some suggestion that two different terpenes, beta-caryophyllene, and limonene, can counteract the THC effects but not studied at all.
- Some people have found a benefit chewing on black peppercorns (a source of beta-caryophyllene), or eating some lemon rind (source of limonene) can help. There is no downside, but I’d certainly focus on other things first.
Is there ever a scenario where you’re so high you should go to the ER?
Almost never. Especially if the symptoms are anxiety and paranoia. Again, cannabis overdose will never be fatal or cause irreversible organ damage. There are a couple of scenarios where one should consider the ER. If you are old and at high risk of heart disease or stroke and experience increasing chest pain, shortness of breathing, irregular and very fast heart rate, or extreme dizziness, it’s worth getting checked out.
But in a healthy young person, this is not a concern. For those at high risk (which includes many new users now), it’s essential. Another situation is if you’re alone and cannot get someone over to support you. You’re having severe psychosis (hallucinations, severely altered perception), then the ED is reasonable to ensure you don’t do something that could be life-threatening. At the same time, intoxicated (drive, try to fly, etc.).