Can you overdose from weed?

Image by Releaf via Cannabis Images

It is Australia’s most popular illicit drug and probably the most popular drug worldwide. Like most popular substances, it has a number of names: cannabis, hemp, weed, ganja, marijuana, hooch, green, buds, buddha, wacky backy (if you really must), dope and grass are just some the terms Australians use for cannabis.

Can you overdose from it? The short answer is yes, you can, but not fatally: cannabis alone will not kill you. To date, there has never been a death reported from cannabis overdose.

What is an overdose? How much is too much?

Some substances can kill you if you take a large enough dose. Cannabis won’t kill you, but an overdose doesn’t have to be lethal or potentially lethal. Overdosing is having too much of something. But how much is too much? This question is not easy to answer.

People sometimes deliberately use recreational drugs in excess. People talk about getting “wasted” or “smashed” or “fucked up” as a positive experience. What is “too much” for some people might be the intended dose for other people.

What is too much in one situation might be fine in another. Having uncontrollable laughing fits might be fun in certain social situations but not on a crowded peak hour train. Being unable to put a coherent sentence together or get up from your seat without an extreme amount of effort might be fine if you’re at home watching telly but not so great if you’re about to sit an exam.

Cannabis effects each of us differently. For example, you may get paranoid or you may not. Even when the effects are similar, what one person enjoys might be unpleasant for another person. Some people enjoy the effects of cannabis in small amounts but not in large amounts because, for example, they dislike the sensation of being “out of it” or not in control. But other people enjoy the same sensation.

Negative effects

An overdose generally refers to acute (immediate and short-term) medical effects from using a substance on a specific occasion, not damage accumulated over a lifetime.

Many drugs damage our health in some way — whether it is the substance itself or the way we take it. But so do a lot of other things we consume, such as processed food and car exhaust-laden city air. Smoking, food additives and air pollution all increase the risk of getting cancer and any or all these things might be a factor in any individual death from cancer. However, even in a case where a heavy smoker dies of lung cancer, their death would be considered a smoking-related death but not an overdose.

The psychological effects of weed can be negative. Paranoia is a common reaction. Depending on its severity, and the disposition of the person affected, this can be part of the experience or totally take the fun out of it. Longer term psychological effects include amotivational syndrome, which, as the name suggests, means chronic apathy, lethargy and a lack of motivation to do things. However, there can be a bit of a “chicken and egg” question as to whether people consume a lot of weed because they already lack motivation to do other things or whether the lack of motivation is a result of consuming weed.

This is even more the case with anxiety and depression: some of the literature says that cannabis use can cause it, but cannabis is now commonly prescribed as a treatment for anxiety and depression.

Nobody wants to get cancer, heart disease or emphysema. The thing for cannabis users to be aware of here is that smoking anything damages your lungs and can lead to lung cancer, emphysema or other respiratory diseases. Cooking with cannabis reduces all of the physical risks associated with lung damage but may increase the negative psychological effects and increase the duration they are experienced.

Trying to mitigate the negative effects can be difficult, and it is a matter of knowing risk and making the decision that is right for you.

What about the kids?

Any discussion of how much of a drug is too much should note that any dose is likely to be dangerous for children and that there are serious additional risks.

Intentional use of cannabis by older children and adolescents has been linked to issues with brain development.

Since legalisation of recreational cannabis use in some US states, there have been at least 2 cases of mothers getting charged with homicide after their baby or toddler died after accidentally eating cannabis gummies. However, in these criminal cases the evidence that the gummies actually killed the kids is speculative, and medical and legal experts have raised concern about the cases. More generally, the literature seems to say that there is no evidence of cannabis killing babies.

What does overdose look like and what should you do?

• Panic attack. This is the most common type of overdose from consuming cannabis. A panic attack often involves the sensation of not being able to breathe and sometimes an intense belief that death is imminent. They can also be accompanied by physical tics, such as repetitive movements, and vomiting or nausea.

Generally, cannabis-induced panic attacks will pass within 20 minutes to an hour. However, if the attack is from eating cannabis products, it can last for several hours. This is very unpleasant for the person having the attack, and not much fun for those around them.

Panic attacks can happen to anyone, but are more likely to happen to someone who is experiencing a lot of stress and to people with a low tolerance for cannabis who have consumed much more than they are used to.

The good news is that, because the physical sensations are actually caused by what’s going on in the brain, the person suffering the attack can breathe and isn’t going to die.

Do be calm and relaxed, reassuring the person having the attack and helping them control their breathing by encouraging them to breathe slowly in and out. Reassure whoever’s having the attack that they definitely won’t die.

Don’t immediately call an ambulance or rush the person to the ER. There isn’t much health professionals can do except try and calm the person. Because it is not a life-threatening condition, someone presenting at an ER for a panic attack is likely to be triaged to the end of the queue, which means spending hours in an ER waiting area, which could increase their stress.

However, if the person has consumed other substances in addition to cannabis, and are experiencing trouble breathing, then call an ambulance.

• Orthostatic hypotension (acute low blood pressure). This is something that can happen if you have a tendency to low blood pressure. It means an acute loss of blood pressure, usually associated with changing position, such as standing up. Symptoms include cold sweats, impaired vision, loss of physical strength and fainting. The biggest danger comes from fainting, which can be very sudden, creating the risk of injury when falling.

Orthostatic hypotension can be triggered by consuming large amounts of cannabis. This is particularly the case if the cannabis consumption is combined with lack of sleep and lack of food.

If someone has an attack of orthostatic hypotension or suddenly faints, call an ambulance or take them to an ER.

Not technically an overdose, but serious nonetheless

• Cannabinoid hyperemesis syndrome (CHS). This condition is rare but, for reasons which are not understood, is becoming less rare. It occurs in some people who have been consuming moderate to heavy amounts of cannabis over a sustained period. What CHS means is having recurring bouts of serious vomiting, nausea and abdominal pain. Typically the bouts last 24 to 48 hours, during which time the sufferer is continually vomiting and experiencing nausea and pain. The bouts recur: sometimes every few weeks, in other cases after intervals of a few months. Not much fun, and the sad news is that total abstinence from weed is the only way to stop the condition.

• Psychosis. If someone is showing symptoms like delusions and compulsive talking that mostly doesn’t make sense (“word salad”), then this could be a psychotic episode, not a panic attack. There are a lot of different opinions in the literature on the relationship between cannabis and psychosis and some of it isn’t much better than the notorious 1936 anti-drug movie Reefer Madness.

Cannabis can be a trigger for people susceptible to having psychosis but people experiencing psychotic episodes often self-medicate, so knowing which caused which can be difficult. Furthermore, while drug use is stigmatised, psychosis is often more stigmatised — even the term “psychosis” has stigma attached — and people often use their drug use to mask or manage symptoms of psychosis or other mental illness.

While the literature typically encourages getting medical help, and if a person is threatening to harm themselves or others this might be necessary, it is important to take into account that while the treatment of those considered mentally ill has improved a lot in recent years, treatment for psychosis can still be punitive and counterproductive. Calling an ambulance for someone against their wishes should very much be a last resort. There is information available on how to help someone suffering an episode without necessarily getting medical intervention. There are also ways to cope if you are having an episode. These are some other resources on the topic.

[Can we believe Dr Google? A short note on sources]