Understanding the Unintended Effects of Cannabis

Medical cannabis has emerged as a transformative option in healthcare. For many, it offers new hope in managing symptoms of chronic pain, epilepsy, multiple sclerosis, and other conditions. As more regions legalize cannabis for medical use, its popularity has skyrocketed. People seeking relief often see it as a natural alternative to conventional treatments. However, cannabis isn’t without its complexities. Healthcare providers must be aware of the unintended effects of cannabis.

While it brings therapeutic promise, cannabis also comes with risks. From its intricate pharmacology to potential side effects and legal implications, being well-informed is essential to ensuring safe and effective use. In this article, we will unpack these key considerations, providing a comprehensive guide to the often overlooked and unintended effects of cannabis.

THC and CBD: The chemistry behind cannabis

Cannabis contains over 125 cannabinoids, but the two most common are THC (delta-9-tetrahydrocannabinol) and CBD (cannabidiol). THC, the psychoactive component, is responsible for the “high” that recreational users seek. It interacts directly with CB1 and CB2 receptors in the body’s endocannabinoid system, influencing mood, perception, and motor skills.

CBD, on the other hand, takes a more subtle approach. It is non-intoxicating and interacts minimally with these receptors. Instead, it helps balance the effects of THC and works through other mechanisms to offer relief from anxiety, seizures, and more. For instance, Epidiolex, a CBD-based medication, is FDA-approved for certain seizure disorders.

The effects of these cannabinoids can vary significantly based on the ratio of THC to CBD in a product. High-THC products tend to be more intoxicating and can exacerbate side effects like paranoia or impaired judgment. Meanwhile, CBD-rich products are often better tolerated and may counteract some of THC’s adverse effects. For example, CBD can help mitigate THC-induced anxiety in some patients.

However, both THC and CBD have their side effects. THC can impair judgment, create dependency, and cause intoxication. CBD might not get you high, but it can still lead to drowsiness or upset stomachs. This contrast between the two underscores the need for precise formulations and carefully managed dosing to get the benefits without the downsides.

The common side effects: What patients should expect

Cannabis affects people differently. Its side effects can range from mild to severe. Understanding these reactions, especially when starting or adjusting a dosage, is crucial. Here are some of the common side effects to watch for:

Cognitive changes: Temporary memory issues, altered perception, and impaired decision-making are common, especially with high-THC products. This is particularly concerning for individuals in roles that require quick thinking and precise judgments, such as drivers or machinery operators.

Physical symptoms: Red eyes, dry mouth, and an increased appetite—often referred to as “the munchies”—are hallmark effects. While typically harmless, these effects can still be inconvenient or undesirable, particularly for patients managing conditions like diabetes.

Mood swings: While some experience relaxation or euphoria, others may feel anxiety, paranoia, or irritation. Factors such as the strain of cannabis, dosage, and the user’s mental state can heavily influence these outcomes.

Drowsiness: Particularly with CBD-heavy formulations, fatigue can interfere with daily routines. While this can be beneficial for those struggling with insomnia, it’s problematic for individuals needing to remain alert.

Patients need to work closely with their healthcare providers to adjust dosages and formulations to minimize these effects. Start-low-and-go-slow is a widely recommended approach for those new to cannabis therapy.

Long-term risks of cannabis use

Cannabis can also have serious long-term health consequences, especially with heavy or prolonged use. Here’s what clinicians and patients need to keep in mind:

Mental health risks: Frequent use has been linked to anxiety, depression, and, in severe cases, psychosis. For young men with genetic predispositions, there’s an elevated risk of developing schizophrenia. These findings highlight the importance of screening for mental health conditions before initiating cannabis therapy.

Respiratory problems: Smoking cannabis exposes the lungs to harmful toxins, leading to chronic bronchitis and other respiratory issues. Even vaping, often marketed as a safer alternative, has been associated with severe lung injuries. Encouraging patients to explore non-inhaled methods like tinctures or capsules can reduce these risks.

Cardiovascular strain: Cannabis can temporarily spike heart rate and blood pressure. Over time, this may increase the risk of arrhythmias, strokes, and heart attacks, particularly in older adults or those with preexisting heart conditions.

Cannabinoid Hyperemesis Syndrome (CHS): A lesser-known condition, CHS involves cycles of nausea and vomiting in heavy users, often requiring complete cessation to resolve. Early recognition of symptoms is key to managing this condition effectively.

Dependency and withdrawal: Up to 30% of regular users may develop cannabis use disorder, with withdrawal symptoms like irritability, insomnia, and cravings. These challenges underscore the need for regular monitoring and open dialogue between patients and providers.

Pregnant individuals and children exposed to secondhand smoke face even more significant risks. These include low birth weight and developmental delays. These unintended effects of cannabis call for open, honest conversations between patients and healthcare providers.

Drug interactions with cannabis

Cannabis interacts with other medications, sometimes in unpredictable ways. That is why reviewing a patient’s entire medication history is vital. Here are a few common interactions:

Blood thinners: Cannabis can interfere with drugs like warfarin, increasing bleeding risks. Monitoring coagulation parameters becomes essential for patients on these medications.

Sedatives and opioids: Combined use may amplify sedation and, in extreme cases, lead to respiratory depression. Providers should educate patients on the dangers of combining these substances.

Antidepressants: THC can either counteract or intensify their effects, depending on the specific medication. This interaction highlights the need for individualized treatment plans.

Immunosuppressants: Transplant patients on drugs like tacrolimus may experience altered drug levels when using cannabis. Adjusting doses and monitoring drug levels can mitigate these risks.

Such interactions emphasize the importance of transparent communication between patients, pharmacists, and healthcare providers.

Routes of administration of cannabis

The way cannabis is consumed significantly impacts how quickly it works, how long it lasts, and what side effects it might produce. Examples of its routes of administration include:

Smoking/vaping: These provide fast relief but come with risks to lung health due to inhalation of irritants. The rapid onset makes them appealing for acute pain relief but less ideal for long-term therapy.

Edibles: They take longer to kick in but last much longer. However, the delayed onset often tempts people to overconsume, leading to unpleasant overdose-like effects. Clear labeling and education on proper dosing are crucial for new users.

Tinctures and oils: These offer flexible dosing, with sublingual administration providing faster effects than swallowing. This method is particularly useful for those who need precise control over their dose.

Topicals: Perfect for localized pain relief, they minimize systemic absorption and avoid psychoactive effects. Athletes and individuals with arthritis often favor this route.

Capsules: These ensure consistent dosing but may have slower onset times compared to inhaled methods. They are ideal for patients who value convenience and discretion.

Legal complexities and reporting adverse effects

Navigating cannabis laws can feel like walking through a maze. In the U.S., the 2018 Farm Bill legalized hemp-derived products with less than 0.3% THC. However, marijuana remains a federally classified Schedule I substance. This patchwork of laws complicates everything from research to prescribing practices.

To improve safety and understanding, adverse events related to cannabis use should be reported. Patients and providers can use tools like the FDA’s MedWatch system to document these experiences. Thorough reporting—detailing the product, dose, and observed effects—can help identify trends and refine guidelines for safer use. Advocacy for clearer and more consistent regulations is also crucial to making cannabis therapy safer and more accessible.

Conclusion

As medical cannabis becomes increasingly mainstream, healthcare providers play a critical role in guiding its safe and effective use. By understanding the science behind THC and CBD, recognizing potential side effects and interactions, and staying informed on legal developments, clinicians can help patients navigate this complex terrain. Through informed decision-making and open communication, both patients and providers can harness the therapeutic potential of cannabis while minimizing its risks.