Can I Overdose on Marijuana?

Is there such a thing as too much weed?

Close Up Of Man Rolling Marijuana Joint At Home
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Marijuana (cannabis) has a reputation for being a totally benign drug. To read the claims from the proponents of weed, it would seem that cannabis only has beneficial effects. Ask any stoner from the 60s about his or her bad experiences and it becomes clear that marijuana isn't always rainbows and unicorns.

Don't get me wrong, there is plenty of evidence that as drugs go, marijuana is significantly less dangerous than many other oft-abused substances, including alcohol.

But less dangerous is a far cry from saying it's completely safe.

How Much Pot Is Too Much?

Marijuana doesn't come with a clear definition of overdose. In fact, doctors aren't entirely sure how much tetrahydrocannabinol (THC)—the active ingredient in marijuana most likely to induce the high users are seeking—it takes to overdose. We haven't even agreed on a common test to determine levels. Typically, THC in the bloodstream is measured as nanograms per milliliter (ng/ml) and refers to how much THC there is in a milliliter of blood or plasma. 

Can You Die From Smoking Weed?

We aren't sure how much is too much. We do know from animals and a handful of human cases that it is possible to die while ingesting marijuana alone (no alcohol or other drugs along with it). What medical professionals aren't clear about, is whether those cases had other contributing factors (like pre-existing cardiac conditions).

What Does a Marijuana Overdose Look Like?

Marijuana is a strange drug in that it contains a lot of active ingredients. Although scientists cite different numbers, in addition to THC, there are thought to be over 100 other cannabinoids in cannabis. Not all of these act the same way. Get too much THC and you're likely to have a psychoactive reaction that is not unlike that of a stimulant like methamphetamine.

Cannabidiol (CBD) is associated more with sedative effects. 

The effects of marijuana use are all over the map. There have been cases of heart arrhythmias and sudden cardiac arrest while smoking weed. There are reports of both seizures and the reduction of seizures, which seems to be based on which type of cannabinoid we're looking at.

Here are some examples of THC toxicity that have been published:

  • Psychosis or paranoia: Users report severe psychotic episodes with hallucinations and negative associations. In some cases, the psychosis can last significantly longer than the amount of time it should take to metabolize the THC.
  • Uncontrollable vomiting: Although THC often has anti-nausea properties, it can rarely be associated with a syndrome of persistent vomiting. More often associated with chronic cannabis use, uncontrollable vomiting is sometimes relieved with a hot shower.
  • Heart arrhythmias: Some doctors believe that heart disturbances are under-reported in marijuana use. Since smoking weed and taking other drugs often go together, it's really hard to isolate the cause when the heart starts doing crazy things. Even drinking alcohol intensifies the effects, which means you can't say for sure whether it was the pot or the booze that caused a problem.

    Incredible Edibles

    Even the method of consumption makes a difference. THC that is ingested is metabolized differently than when it's inhaled. It takes longer to absorb THC in edibles, which can lead to the user thinking they didn't get enough. If one brownie doesn't work, they take another...and maybe just one more. Suddenly, they have a serious reaction.

    Edibles are also much more prone to accidental overdoses. Smoking marijuana doesn't usually happen accidentally. Even second-hand smoke from your neighbor's ganja party isn't really going to do anything but stink up your apartment. Leaving laced cookies lying around, however, pretty much begs for someone to try a bite.

    Kids are especially likely to munch on marijuana goodies. In states that legalize pot, emergency department visits for intoxicated kids goes from nearly unheard of to relatively common.

    When grandma is trying a little medical marijuana for the first time and accidentally leaves it out for the grandkids to explore, you have a recipe for overdose. Children presenting to the emergency department with accidental ingestion of marijuana becomes increasingly common in every state that legalizes marijuana for recreational use. Once it's legal and tolerated, it's a lot easier to accidentally leave your marijuana out on the coffee table for the kids to find.

    We Really Don't Yet Know the Answer

    Many in the medical world report being a bit surprised by the marked increase in marijuana use in states where it has been fully legalized. Many paramedics and EMTs and emergency department healthcare providers figured that those who really cared about getting high had their medical marijuana prescriptions and could get it when they wanted. It's been available for medicinal use since California legalized medical marijuana in 1996.

    By contrast, in Oregon the number of dispensaries doubled after weed went from strictly medicinal to recreational. As it turned out, there were plenty of people interested in trying the recently illicit substance. All that new consumption has led to significant increases in marijuana-induced emergency department visits.

    Alaska, California, Colorado, Maine, Massachusetts, Nevada, Oregon, and Washington all allow the recreational consumption of marijuana. Several other states are fast on their heels. As the momentum of recreational pot burns across the country (the puns really do come easily), people you probably didn't expect to see getting high are trying weed for the first time in years. While they might have smoked a little pot in college (and despite what they tell you, they inhaled) this isn't the same thing.

    A Lot More THC Today

    Just like how modern farmers are able to get much bigger yields from crops like corn and beans, weed farmers today are much more successful than they were in the past. The levels of THC in marijuana are well above what it was before the current farmers were born. The concentrations of THC increased from 3.4 percent in 1993 to 8.8 percent in 2008. Some folks say that just means you don't have to roll the blunts as fat as you used to, but let's face it: When you're chasing the high, the bar just keeps getting higher.

    Marijuana overdose is still a debated topic and there isn't really a clear answer on how much pot is too much. Until there is, it's important to be diligent if you choose to use and to keep yourself informed. Don't accept the mantra that weed is natural and therefore, safe. What makes anything safe is an informed consumer and a critical mind.

    Sources:

    Fitzgerald KT, Bronstein AC, Newquist KL. Marijuana poisoning. Top Companion Anim Med. 2013 Feb;28(1):8-12. doi: 10.1053/j.tcam.2013.03.004. Review.

    Greydanus, D., Hawver, E., Greydanus, M., & Merrick, J. (2013). Marijuana: Current Concepts†. Frontiers In Public Health1. doi:10.3389/fpubh.2013.00042

    Mehmedic Z, Chandra S, Slade D, Denham H, Foster S, Patel AS, Ross SA, Khan IA, ElSohly MA. Potency trends of Δ9-THC and other cannabinoids in confiscated cannabis preparations from 1993 to 2008. J Forensic Sci. 2010 Sep;55(5):1209-17. doi: 10.1111/j.1556-4029.2010.01441.x.

    Orsini, J., Blaak, C., Rajayer, S., Gurung, V., Tam, E., & Morante, J. et al. (2016). Prolonged cardiac arrest complicating a massive ST-segment elevation myocardial infarction associated with marijuana consumptionJournal Of Community Hospital Internal Medicine Perspectives6(4), 31695. doi:10.3402/jchimp.v6.31695

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