What to do if you have consumed too much cannabis
Cannabis can be difficult to dose. Smoking or vaporizing too much cannabis, or ingesting "edibles" - such as the famous marijuana brownies or cookies - can lead to excessive psychoactive effects and unwanted symptoms. What can you do if this happens?
Tetrahydrocannabinol or THC is the main psychoactive cannabinoid in marijuana. It is synthesized and stored along with the other cannabinoids within the trichomes of the plant. THC is usually ingested by smoking the dried flower of the plant, but it can also be consumed orally in the form of "edibles" or edible, infused foods and beverages. [3,4]
To date, there has not been a single reported case of death caused by excessive use of cannabis or THC, but the intoxicated person may not have a good time.
THC is the main phytocannabinoid that interacts with CB1 receptors, which are found in high concentrations in brain regions responsible for movement, memory processing and pain modulation. Fortunately, there are few of them in the brainstem, the site that controls breathing and circulation, which may explain the low incidence of acute medical complications related to cannabis use. [1]
It is relatively common for inexperienced consumers to try edibles such as marijuana-based candies, cookies or breads and consume too much THC.
Intoxication problems can happen by accident, as in the case of accidental consumption of edibles by children, the elderly, people with disabilities or even pets. It is even possible that it happens in new responsible adult users, since there is always a friend who eats a marijuana cookie, gets desperate because he doesn't feel anything and eats another one, and another one, and another one, and another one. And then they "hit him" all together....
Unfortunately, another common problem in unregulated markets are those products that lack certificates of analysis and their content of cannabinoids and other compounds is unknown, making dosage impossible and putting consumers at risk.
Symptoms and effects
The psychoactive effects of cannabis include relaxation, drowsiness and mild euphoria, but when a high quantity of cannabis with a high THC content has been consumed, the effects can be very different.
These will depend on factors such as the age, weight, sex and state of health of the person consuming it, as well as the amount ingested and the route used.
Eating marijuana cookies, gummies or candy is not the same as smoking a vape or cigarette. Smoking or vaporizing cannabis leads to quick and predictable signs and symptoms, while ingesting it in an edible can cause slower and more prolonged effects, which can become more varied and unpredictable.
The effects of smoking too much can last a few hours, while the effects of ingesting too much THC usually last 6 to 8 hours. In some cases detoxification could take up to 24 hours. [6]
Cannabis can cause undesirable side effects that increase with higher doses. These side effects include: [2,3,5]
Decreased short-term memory.
Dry mouth.
Altered perception of time.
Impaired perception and motor skills.
Red eyes.
Sedation.
Dizziness.
Anxiety.
Coughing.
Incoordination.
Dysphoria, etc.
While more serious side effects include: [1,5]
Panic or extreme anxiety.
Acute paranoia or psychosis, which may be more common with new users or in those who already have an existing or latent psychiatric illness.
Altered heart rhythm, especially in patients suffering from an untreated or uncontrolled heart condition.
Seizures.
Sudden elevation of blood pressure with headache.
Side effects can be affected by situations external to the individual. For example, if the person suffering from intoxication is in a stressful situation or in a place with too many stimuli (bright lights, loud noises, sudden movements, etc.), he or she may have a more unpleasant experience than someone who is at home in a quiet environment under the care of a trusted family member or friend.
Other similar compounds: synthetic cannabis
Normally these products do not contain derivatives of the cannabis plant, but illegal synthetic cannabinoids. They are produced in clandestine laboratories and are usually not suitable for human consumption. Their consumption involves great risks and in severe cases can even cause the death of the consumer.
The terms "Spice" or "K2" are names for illicit synthetic products that mimic the effects of marijuana. Although these include synthetic compounds that resemble cannabinoids, they are not safe and should be avoided.
General recommendations
In most cases of excessive cannabis use, it is not necessary to seek medical attention, however, it is important to know what the person has consumed and how much. It is also good to know if they have mixed cannabis with other substances and if it is really cannabis and not K2 or some other dangerous synthetic.
It is important to remember that there are no reported deaths from marijuana overdose, so if we know that the person only consumed cannabis we should not panic.
The basic recommendations are as follows:
Rule out the use of other drugs or stimulant substances.
Take the intoxicated person to a quiet and isolated place.
Reassure the intoxicated person and accompany him/her during the symptoms.
If the person is able to calm down, it may be suggested that he or she try to sleep.
Keep the person away from potential hazards such as moving vehicles or heavy machinery.
If the intoxicated person is very agitated, the symptoms worsen or you are unable to communicate adequately with him/her, do not hesitate to consult a doctor or take him/her to the hospital.
If the intoxicated person is a child, elderly or disabled person, it is important to take him/her to the hospital.
If a pet is intoxicated, it is important to take it to a veterinarian. Animals CAN die from THC overdose, especially if they have ingested edibles and there is a greater risk if they contain chocolate.
In some people with pre-existing or latent psychiatric conditions (such as schizophrenia) cannabis can induce a psychiatric episode. In these individuals, safe detoxification from cannabis usually requires 24 hours of medical monitoring, but sometimes longer is required if persistent psychosis occurs. [6]
Medical treatment: administration of drugs
The following recommendations should not be used without the advice of a trained physician.
CBD
In some cases the administration of CBD is recommended as it is a modulator of the effects of THC. It has been shown to help counteract intoxication, sedation and tachycardia, while providing analgesic, anti-emetic and anti-cancer properties. [7] It has been noted that improvement does not occur in all cases and a product that may contain traces of THC should never be used as it will only worsen the circumstances.
Olivetol
Products containing olivetol (known by its trade name Undoo), which also binds to CB1 receptors, are available on the market.
Olivetol is believed to have a higher affinity for these receptors, reducing the effects of THC by binding to them earlier than THC.
This compound works, but it is not known exactly how. More research is needed, but in theory its mechanism of action is very similar to that of naloxone in reversing opioid overdoses. [8,9]
Naloxone
Naloxone is a drug that rapidly reverses an opioid overdose. It binds to opioid receptors, reversing and blocking the effects of other opioids. [12] Cross-tolerance between compounds of opioid and cannabinoid nature has been suggested, so the use of substances such as naloxone may be suggested by the treating physician. [13] Isolated cases have been described in which naloxone has been successfully used to reverse neurological depression due to cannabis intoxication. [11]
If you know someone who has consumed a lot of cannabis or eaten a lot of marijuana cookies and you recognize any of the symptoms described above, stay calm and tell someone you trust. If necessary, they can go for a medical check-up. If the person who accidentally ingested cannabis is a person who requires additional help such as an infant or an elderly person, or is a pet, seek medical help for them.
References
[1] American Addiction Centers Editorial Staff. (s.f.). Marijuana Overdose. Recuperado de <sitio web>, última revisión 2 de junio de 2020.
[2] D.O.H. Goverment Of The Districtict of Columbia. (s.f.). Medical Cannabis Adverse Effects & Drug Interactions. Recuperado de <pdf>, última revisión 2 de junio de 2020.
[3] ICAN. (2020). Un vistazo al Sistema Endocannabinoide. Recuperado de <sitio web>, última revisión 2 de junio de 2020.
[4] Josephson, S.A. (2014). Neurologic Complications of Recreational Drugs. Aminoff's Neurology and General Medicine. https://doi.org/10.1016/C2012-0-03031-1
[5] National Institutes of Health. Medline Plus. (2020). Marijuana intoxication. Recuperado de <sitio web>, última revisión 2 de junio de 2020.
[6] Turner, A.R., Agrawal, S. (2020). Marijuana Toxicity. In: StatPearls [Internet]. Recuperado de <sitio web>, última revisión 2 de junio de 2020.
[8] Russo, E., Guy, G.W. (2006). A tale of two cannabinoids: The therapeutic rationale for combining tetrahydrocannabinol and cannabidiol. Medical Hypotheses. 66, 234–246. Recuperado de <sitio web>, última revisión 2 de junio de 2020.
[9] Undoo. (s.f.). The Clarity Molecule. Recuperado de <sitio web>, última revisión 2 de junio de 2020.
Patente. (2017). Recuperado de <sitio web>, última revisión 2 de junio de 2020.
[10] Gutiérrez de Salazar, M. (s.f.). Marihuana en Urgencias Toxicológicas. Intoxicación por Marihuana. Recuperado de <sitio web>, última revisión 2 de junio de 2020.
[11] Croche Santander, B, Alonso Salas, M.T., Loscertales Abril, M. (2011). Accidental cannabis intoxication: presentation of four pediatric cases in a tertiary hospital in southern Spain. Arch Argent Pediatr.109(1):e4-7.
[12] NIDA. (2019). Naloxona. Recuperado de <sitio web>, última revisión 2 de junio de 2020.
[13] Arévalo-Martín, A., Baño, M. D., Berrendero, F., Cabranes, A., Carrascosa, A. J., et al. (2002). Guía Básica sobre los Cannabinoides. Sociedad Española de Investigación sobre Cannabinoides. Recuperado de <pdf>, última revisión 2 de junio de 2020.