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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."

What Are The Cannabis Shakes And Why Do They Happen?

Ever started shaking uncontrollably after smoking a large amount of weed? Well, you’re not alone. The “cannabis shakes” have numerous causes and are most likely nothing to worry about.

Contents:

Breaking down the cannabis shakes: what they are, why they happen, and how to deal with them.

So, you’re relaxing, enjoying a smoking session with friends, when suddenly your leg starts to twitch, then your shoulder, and your eyelid. You start to freak out and the tremors get worse. Panicked, you wonder what’s happening to you. Don’t worry, it’s probably just the cannabis shakes (and you should be fine in a few minutes).

What are the cannabis shakes?

“The shakes” are involuntary muscle twitches and tremors. This phenomenon can sometimes occur after consuming weed. If you typically associate the shakes with alcohol withdrawal or more serious health conditions, don’t stress. When it comes to cannabis, the shakes are generally no big deal.

Cannabis has a very good safety profile [1] . While no formal studies have been conducted on cannabis shakes, a plethora of anecdotal reports tell us they’re relatively common and typically harmless. Like other symptoms of consuming too much weed, such as increased heart rate, sweating, and nausea, they tend to subside as quickly as they began.

Why do you shake after smoking cannabis?

So, what causes the cannabis shakes? Are they just a side effect of getting too high for your own good? There are actually a variety of factors that could contribute to the shakes, including:

• Cold environment
• Over-stimulation
• Anxiety
• Too much THC

Let’s break it down:

Cold environment

You might be shaking or shivering because you’re cold. Cannabis actually lowers your body temperature [2] —an effect known as “THC-induced hypothermia”. Before you start imagining yourself freezing to death as your couch morphs into a snow-covered mountain, take a beat. THC-induced hypothermia only causes a slight drop in basal body temperature. You might shiver and shake what your mama gave you, but it isn’t dangerous or life-threatening.

Over-stimulation

In a lot of places, it’s common to roll a little tobacco into your joint. Nicotine is a stimulant: it excites the nervous system and boosts dopamine levels. While this boost is the reason a lot of people like to add a pinch of tobacco to their weed, it can cause twitching and anxiety in higher doses. If you’ve been enjoying this combo and find yourself with a case of the shakes, the problem could actually be the tobacco, not the cannabis. Likewise, if you’ve been drinking a lot of coffee, tea, or soda, caffeine could be contributing to your tremors.

Anxiety

It’s well-known that weed can cause acute anxiety and paranoia, and some people are more susceptible to it than others. If you’re one of those people, or if you just caught a bad break, nervousness could be at the root of your shakes. Of course, your body acting in ways that feel out of your control can amplify anxiety. If you get the shakes, try not to panic. Instead, keep calm and carry on.

Too much THC

To go back to the original question: Are the shakes just a side effect of getting way too high? Often, the answer is yes. The cannabis shakes are commonly due to a mild THC overdose. Don’t let the word “overdose” freak you out too much, especially if you’re young and healthy. We’ve all flown too close to the sun at some point, but nobody has died from overdosing on cannabis alone [3] . Freaked out and embarrassed yourself in front of all your friends? That’s another story.

What can you do if you get the cannabis shakes?

To recap, the cannabis shakes are not life-threatening, but they can leave you feeling alarmed and uncomfortable. While time is a key factor, waiting for them to subside on their own isn’t your only option. Here are some quick harm-reduction tips to help combat the shakes:

• Adjust your environment
• Move around, distract yourself, breathe
• Stay away from stimulants
• Consider switching strains
• Try some CBD

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Adjust your environment

Regardless of the precise cause of your shakes, sitting there and panicking or focusing on how uncomfortable you feel won’t help. Instead, take control of the things you can.

Environment plays a huge role in our emotional state, especially when psychoactive substances are involved. Feeling comfortable, warm, and safe is key. That could mean going to a different room or a more relaxing place. It could mean leaving an overwhelming social situation. It could be as simple as adjusting the lighting and putting on your favourite tunes. And, if your shakes are actually shivers, crank the heat. Cosy blankets are a chilly stoner’s best friend.

Move around, distract yourself, breathe

If you feel yourself starting to panic, switch gears from straight up shaking to shaking it off. Get up and move around. Distract yourself with a simple task, even if it’s counting steps. Take slow, deep breaths to calm down, or try some other strategies to calm anxiety. Movement and breathing help you recenter yourself in your body and focus on something other than your anxiety. Walking or moving around also gets you to stretch and warm up your tense, twitching muscles.

Stay away from stimulants

If you’ve been rolling your joints with tobacco or drinking caffeine, it’s time to try less-stimulating alternatives. Switch to non-caffeinated beverages and limit the amount of tobacco in your joints. If using pure cannabis feels too basic, spice it up with something different. A number of herbs make great tobacco alternatives. Just avoid anything with strong stimulant properties. You don’t want to end up back where you started, with the shakes (version 2.0).

Switch strains

A few of the factors that cause the shakes—anxiety, over-stimulation, too much THC—could boil down to the strain you’re smoking. There are hundreds of cannabis strains out there, each with its own unique mix of properties. In general, sativa-dominant strains tend to be more stimulating (and possibly anxiety-inducing) than indica-dominant strains.

Many people love the boost they get from a good sativa. But, if you’re prone to anxiety or paranoia, look for indica strains that tend towards relaxation. Of course, the indica/sativa split isn’t a hard rule. The best choice is an informed one, so don’t be afraid to check strain reviews from other users or ask your budtender for a recommendation.

Try some CBD

It’s also possible that the THC content of your strain is simply too high. Instead, look for a strain that’s high in CBD (cannabidiol). CBD isn’t psychoactive, and scientific studies [4] have found that it mitigates some of the side-effects of THC. Research also suggests it has potential as an anxiolytic, meaning it may help to combat anxiety. Depending on your preference, choose a strain with a 1:1 ratio of THC and CBD, or one that’s higher in CBD and lower in THC. These popular high-CBD strains are an excellent starting point.

What if it’s too late to switch strains and you’re already high? If you find yourself caught in the midst of those twitches and tremors, CBD could still help. You probably don’t want to add more THC to your system, so choose CBD oil or isolates with quick delivery mechanisms. A few drops of high-quality CBD oil or tincture under the tongue is your best bet.

How long do the cannabis shakes last?

Luckily, the cannabis shakes usually don’t last too long. Of course, this depends on a few factors, including the amount of cannabis you took (and how you took it). If you vaped, smoked a joint or indulged in one too many bong rips, you should feel better within 15–20 minutes. If you overdid it on the edibles, you might be in for a longer haul.

If you experience truly alarming symptoms, have underlying health conditions, or suspect something more is going on, check with your doctor or a cannabis-informed healthcare provider. Beyond that, a few key adjustments and a little bit of patience (or CBD) should do the trick.

Twitches and tremors after smoking weed are generally harmless. Here's what causes the cannabis shakes and how to combat them.