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Regular Cannabis Use Causes a Too-Chill Side Effect at the Doctor’s Office

“Unfortunately, the basic science has not really been done on this.”В

Even in states where marijuana is legal, some patients may feel reluctant to tell their doctors exactly how much they smoke. But per a report in the Journal of the American Osteopathic Association, having that honest conversation may be even more important than it seems. Marijuana’s side effects could have consequences for patients undergoing medical procedures.

In the paper, released Monday, Mark Twardowski, a doctor of osteopathic medicine affiliated with Grand Junction, Colorado’s Community Hospital, reports that patients who regularly smoked marijuana required as much as 220 percent more anesthetic chemicals to become fully sedated — a relaxed, but not fully unconscious state. This too-chill side effect, he and his co-authors argue in the paper, could have serious consequences, requiring doctors to up the dosage of chemicals like fentanyl, midazolam, and propofol. Those are drugs usually used to help knock patients out before procedures like colon cancer screenings.

Importantly, the sedatives Twardowski analyzed were all used legally, for medical reasons. It’s just that patients who “regularly smoked weed” seemed to require a lot more of these chemicals to go under than they should have needed.

“We were surprised by the extent and consistency of the effect that cannabis use had on the increasing doses needed to achieve adequate sedation for the procedures,” he tells Inverse. “One of our great hopes of this study is that we will create awareness that the effects of some medications are distinctly affected by cannabis use.”

Twardowski analyzed the records of 250 randomly chosen patients who went in for endoscopic exams — the procedure used during a colonoscopy, where a doctor inserts a camera into the intestine — at a Colorado hospital. Only 25 of those patients smoked or ingested cannabis on a daily or weekly basis, but Twardowski noticed a significant pattern in the amount of sedatives used in their procedures. On average, those patients required 14 percent more fentanyl to get to sleep, 19.6 percent more midazolam, and 220.5 percent more propofol to achieve the correct level of drowsiness for their colon exams.

This study only looked at past medical records — so it’s hard to narrow down exactly what it is about cannabis that creates this association. But in the paper, Twardowski makes the argument that it comes down to lingering neurological effects of marijuana use that may blunt the impact of sedatives. These hypotheses hinge on THC, the chemical that induces marijuana’s psychoactive effect.

THC interacts with many different cannabinoid receptors in the brain — which impact functions like memory, mood, and pain sensation. In the paper, Twardowski writes that THC may also “interact with specific cannabinoid receptors, which could include opioid and benzodiazepine receptors,” the same targets in the brain that these anesthetic chemicals use to achieve their sedative effects.

It’s unclear what he means by “interact” at this point, but the takeaway right now is that there’s something going on in the brains of regular cannabis users that makes it more difficult for the sedatives to start working.

“We and others suspect that the effect lies at the receptor level, possibly through some sort of down-regulation, but the specifics are not known,” Twardowski says. “Unfortunately, the basic science has not really been done on this or many issues around cannabis. This is largely due to the federal designation as a Schedule I drug.”

“Unfortunately, the basic science has not really been done on this or many issues around cannabis.”

Identifying a biological explanation for this effect could go a long way toward finding a way around increasing sedative doses. But in the meantime, Twardowski makes it clear the big takeaway is that it’s worth confiding to a doctor about marijuana use even if it’s a tricky conversation to have.

This study was conducted in Colorado, where both medical and recreational marijuana are legal, but marijuana is still tightly controlled in some states. And even in places where it’s legal, stigma around the drug — it’s still Schedule I, after all — makes it harder for patients to be honest about using it. Making doctors aware of what other substances may be affecting the body, Twardowski adds, may allow them to provide better care when it comes to putting someone under.

It’s already hard enough to get people to participate in colon exams, but making sure they have all the sedative levels right can go a long way in making an uncomfortable process more manageable. This study just provides more evidence showing that disclosure is the best policy.

Objective: To determine whether regular cannabis use had any effect on the dose of medication needed for sedation during endoscopic procedures.

Methods: A total of 250 medical records were reviewed from 1 endoscopy center and 1 endoscopist to minimize the variability in sedation technique for the study purposes. The cohort was reviewed with regard to age and gender to determine whether differences were present among different groups as to the relative amount of sedation medication required in cannabis users vs nonusers.

Results: Medical records from 250 patients were reviewed, and researchers found that compared with people who did not regularly use cannabis, people who regularly used cannabis required an amount of sedation for endoscopic procedures that was significantly higher (P=.05). The statistical significance persisted when adjusted for age, sex, and use of alcohol, benzodiazepines, and opiates.

Conclusion: Determining cannabis use before procedural sedation can be an important tool for planning patient care and assessing both medication needs and possible risks related to increased dosage requirements during endoscopic procedures.

"Unfortunately, the basic science has not really been done on this."

Chill or Anxious AF? How Weed Affects Anxiety

There are plenty of people out there who claim cannabis is the key to quieting anxiety and achieving a state of blissed-out relaxation. Yeah, you know who you are.

But there’s probably just as many people who claim that weed sends them spiraling into panic, paranoia, and anxious thoughts — making their anxiety about a million times worse.

Personally, I’ve experienced both. Sometimes, a few hits are all it takes for my mind to stop racing, for my shoulders to relax, and for me to (finally!) chill the eff out.

Other times, those same few hits can send me into a full-blown panic, hyperventilating on the floor of the bathroom, convinced I’m going to be high and trapped in the hot, anxious mess that is my brain from now until eternity.

So, what’s the deal? Why is weed a virtual miracle cure for some people’s anxiety and completely anxiety-inducing for others?

And, more importantly, how can you make sure your experience with cannabis has you feeling less anxious and totally relaxed — instead of on the verge of panic?

The first thing to understand about cannabis and anxiety is that not all weed is created equal.

There’s hundreds of compounds (known as cannabinoids) produced by the cannabis plant, but when it comes to anxiety, there’s two you need to know about: tetrahydrocannabinol (THC) and cannabidiol (CBD).

THC is what most people think of when they think of cannabis. It’s the compound responsible for getting you “high.”

CBD, on the other hand, is non-psychotropic — meaning it’s not going to produce the same “oh man, I’m so stoned” feeling you get from THC.

There’s no one-size-fits-all approach to cannabis — it’s not like CBD is better than THC or vice versa.

But understanding the differences between the two — and how it relates to your particular brand of anxiety — can help make your experience with cannabis more anxiety-relieving and less anxiety-inducing.

“There are a lot of different types of anxiety which will definitely influence how people respond to different forms of treatment or therapeutic intervention with something like cannabis.

“Anxiety can be anticipatory or it could be generalized or it can be connected to depression or it could be more of a panic disorder,” says Emma Chasen, cannabis educator and founder of Eminent Consulting Firm. “And so all of those different types will respond differently to cannabis.”

If your anxiety goes hand in hand with an overall “blah” feeling, THC can be just what you need to lift your spirits. “For people who have anxiety connected to depression [or] general dysphoria, THC can actually be really helpful because it is euphoric,” says Chasen.

But THC — especially in high doses — can cause a cascade of side effects, like elevated heart rate or racing thoughts. This can actually exacerbate certain kinds of anxiety. And that’s where CBD comes in.

“CBD is non-psychotropic, so it’s not going to give you any of those negative side effects,” says Chasen.

“It may help to alleviate some more anticipatory anxiety, some more generalized social anxiety and may even help with panic disorders because it does influence and interact with your serotonin system.”

So, in a nutshell, too much THC can definitely create a more anxiety-inducing smoke sesh, while CBD can help you chill out, but won’t get you stoned.

Luckily, you can have your cake and eat it too — according to Chasen, a mix of THC and CBD may be the best approach to using cannabis to feel less anxious and more relaxed (and get a nice buzz in the process).

“I would definitely look for something with a mixed ratio of cannabinoids,” says Chasen. “A 1:1 or a 2:1 ratio of THC to CBD will typically be very helpful at stimulating euphoria and decreasing anxiety — especially if you take it very slow and low [with your] dosage.”

Finding the right balance of CBD and THC is key to keeping your anxiety in check when using cannabis. But if you want to take weed’s anxiety-fighting benefits to the next level, there’s something else you want to be mindful of — and that’s terpenes.

Terpenes are the fragrant oils that give each cannabis plant its distinct aroma. And just like cannabinoids, different terpenes produce different effects — including effects that can lower anxiety.

Chasen says there are terpenes that have “documented anti-anxiety properties.”

According to Chasen, there are three terpenes you should be on the lookout for if you want to use cannabis to treat your anxiety — limonene, linalool, and beta-caryophyllene.

If your anxiety has you feeling down or depressed, look for limonene, which can create euphoria and put a little anxiety-busting pep in your step.

“Limonene [is] the terpene found in the rind of citrus fruit [and] it does interact with your serotonin and dopamine receptors and helps to stimulate euphoria, so that is a great one to help reduce anxiety,” says Chasen.

If you’re more in the market for a major de-stressor that will help you chill out and log a solid night of shut-eye, try linalool, a compound of lavender that has a more sedative, relaxing effect.

“We know that lavender is a good de-stressor, and linalool is a compound of lavender — so it does the same type of thing in cannabis,” says Chasen.

And if you’re looking for something in between the euphoria of limonene and the chill sleepiness of linalool, try beta-caryophyllene.

“Beta-caryophyllene, which is found in black pepper and cinnamon, also has some really wonderful anti-anxiety properties,” says Chasen.

“If limonene is the more uplifting one and linalool is the more sedating one, then beta-caryophyllene is kind of right in the middle. It’s more analogous to like a glass of red wine at the end of a long day [to help you unwind.]”

Getting the right blend of THC, CBD, and anxiety-busting terpenes is key to having a positive experience with cannabis. But there’s a few other things you’ll want to keep in mind to make sure your next foray into the world of weed is chill, relaxed, and anxiety-free:

  • Control your consumption. There’s lots of different ways to consume cannabis (tinctures and gummies and flower, oh my!). But if you want to have the most control of your experience, try edibles. “With edibles, you can really take a very precise dose,” says Chasen. “With smoking, it’s a lot harder to measure your dose.”
  • Take it low and slow. If you’re using THC, the best way to keep anxiety at bay is to start with a low dose and then slowly add more THC until you find the dose that gives you the high you’re looking for — without the side dish of anxiety. If you’re using edibles, Chasen recommends starting with 2.5 milligrams. “Monitor how it makes you feel and don’t consume any more for that entire [episode],” says Chasen. If you feel like you need more, increase your dosage by 1 milligram per consumption period until you find your sweet spot.
  • Counteract THC-induced anxiety with CBD. If you find yourself feeling overly anxious from THC, you can counteract those anxious feelings with a healthy dose of CBD. “Smoking or vaping CBD can provide immediate relief from THC-induced anxiety,” Chasen explains. Depending on your dose of THC, you may need to consume a decent amount of CBD to get rid of the anxiety — but it will definitely help you feel better (and fast).

Why is cannabis a miracle cure for some people’s anxiety — and totally anxiety-inducing for others? A cannabis educator shares everything you need to know, plus tips for how to make sure your next experience with weed leaves you chill to the max and not on the verge of panic.