Why the MMJ industry's lack of regulations has nothing to do with bad reactions to weed

Why the MMJ industry's lack of regulations has nothing to do with bad reactions to weed

VicesJune 12, 2014

For most people, weed is this magical drug; a natural remedy to all their problems whether it’s insomnia or introversion, ADD or anal hemorrhoids. It’s been hailed as a cure-all for everything from depression to cancer, and its inability to kill everyone who uses it has given it the pristine reputation as a wonder drug with no side effects.

Weed is so safe, in fact, that a smoker would theoretically have to consume nearly 1,500 pounds of it within fifteen minutes to induce a fatal response. But just because Mary Jane isn’t what’s keeping your friendly neighborhood coroner in business doesn’t mean people don’t have profoundly abysmal experiences with the stuff.

I’m one of those people. And last year, weed nearly ended me.

After accidentally eating a literal nibble of a cookie I didn’t know was chock-full of weed, I had a panic attack that sent me to the hospital, where my heart rate reached a cool 270 beats per minutes, my throat closed up, the left side of my face and body went numb, one of my pupils dilated, and I lost control of my muscles. The ER staff thought I was the youngest stroke patient they’d ever seen until my blood work revealed that I was just insanely full of THC.

Eat it, Maureen Dowd. I was freaking out on weed years before you and you AARP subscription made it cool.

Here’s what’s strange about my reaction. Until my blood work came back, I didn’t know I had eaten weed. I thought I ate a little bite of a normal cookie. That means that by itself, THC initiated a cascade of negative physical processes in my body, before I knew I had eaten it. I didn’t realize I was high and then panic, I panicked before I knew anything was wrong.

I know. It was an extremely rare, extremely adverse reaction to weed that is seldom experienced by the bulk of Marijuana Nation. But it happened. And it happens more often than you'd think.

A small, but growing percentage of smokers react pathologically to THC, spiraling down into panic and psychosis even after the smallest hit or bite. I, clearly, am one of those anomalies. While everyone else giggles at the absurdity of their own knees or goes off and cures their lymph cancer, I almost die and run up the sort of hospital bill that would make Bill Gates pissed.

It’s easy to blame the marijuana industries for these negative incidents. Sure, there’s a general lack of labeling and education regulations in states like Colorado where weed is legal, but that’s not the the only thing to blame when it comes to adverse reactions to today’s newest pseudo-legal drug. It’s actually your fault, and mine; personal biology and genetic misfortune are as much to blame as regulatory errors when it comes to people who can't handle their weed.

So, why had I practically died while everyone else typically just eats a lot of Cheetos? What’s different about me and a small contingent of other hypersensitive people, that would make us physically melt down on THC?

Approximately 11% of marijuana users have reported experiencing panic attacks or psychosis after smoking or ingesting THC. But, considering the other 89% of marijuana users feel fine and dandy after a bong rip or seven, it’s clear that weed itself isn’t the issue.

It’s the way our bodies receive it.

When THC binds to endogenous cannabinoid receptors (CB1R) in a certain brain structure, it sends a message to other brain structures to either increase or decrease the amount of that same receptor in those respective areas. This means either more, or less, THC can bind in certain areas. The process is called upregulation or downregulation.

In the average person, this change in receptor quantity in various brain structures results in a lovely, “Dude Where’s My Face?” high. In others, it makes them more alert and focused. In others still, it blocks the sensation of pain.

But, for people like me, the genetic lottery has awarded us a little problem with the receptor system. We make either too much, or too little of the CB1 receptor in parts of the brain called the prefrontal cortex and midbrain. Guess what? Those two areas are associated with the initiation of the panic response in the human nervous system. Starting to make sense, right?

In the prefrontal cortex, the amount of CB1 receptors increases in response to THC, so that more THC can bind there. When it does, prefrontal cortex activity is suppressed. This suppression activates the amygdala, the part of the brain which sparks the fear cycle. Panic ensues.

In the midbrain, THC decreases the amount of CB1 receptors. This has the effect of increasing one’s perception of pain, over-exaggerating threat and activating the defense response, causing both pain and panic. Fun!

That would explain why I had a very rapid heartbeat, difficulty breathing, and I was sure I was about to die.

And as for the numbness in the left side of my body? That’s called a parasthesia, which means “imagined sensation.” Parasthesias occur in the wake of the panic response, often as a result of increased blood pressure or restriction of blood flow to the nerves. Both of these things happened: my insanely high heartbeat increased my blood pressure and the panic response diverted blood away from my nerves and towards my lungs and brain.

And my pupil dilated because THC inhibits the neurotransmitter acetylcholine, which is largely responsible for constriction and dilation of the pupil. Don’t ask me why only one eye did that; I’m not a rocket scientist.

So there it is. Genetics makes some peoples’ brain receptors miscommunicate in response to THC, which can activate the panic response, which in turn makes you think you’re dying. That explains the panic side of bad reactions to weed.

Personal biology, 1 … societal factors, 0.

But some people skip the panic and go straight for the psychotic.

Psychotic reactions are becoming increasingly more common as more and more THC-infused products sprout up on the market. Remember when that college kid ate a weed cookie and jumped off the balcony to his death in April? Or the time where a man fatally shot his wife after taking a combination of paid meds and marijuana candy? According to the coroners and police departments that handled these cases, marijuana played a fatal contributing factor in both incidents.

These reactions include delusions, hallucinations, and dysphoria. They occur when THC increases the amount of dopamine in the brain’s mesolimbic reward pathway. And, excessive dopamine in that pathway, for all you amateur neurosurgeons out there, goes hand-in-hand with with psychotic symptoms.

Psychotic reactions to THC are hardly common, but smoking and eating weed does place you at a higher risk for psychosis than you’d be at if you didn’t smoke at all. One study found that out of a sample of 4,045 psychosis-free individuals, those who smoked marijuana were 2.7 times more likely to develop some sort of acute or chronic psychotic condition than those who did not.

Furthermore, when it comes to THC-induced psychosis, there is a significant dose-response effect. Another study showed that psychosis increases between 50-200% with more frequent marijuana use.

However, the chances of a psychotic episode are significantly more likely when coupled with an existing psychological disorder like depression or schizophrenia, whether that disorder is known about or not. THC can also induce psychosis in people who are otherwise mentally healthy, and worsen the psychological conditions of those who are not.

Personal biology 2 … societal factors, 0.

Other factors that can ignite a panic or psychotic episode when you stuff your face with weed are your mindset, your metabolism, what you’ve eaten that day, when, and how much. In my case, my mindset was calm, my metabolism is high as shit and I was fucking starving. I hadn’t eaten all day. In your small intestine, THC, which is actually THC-9, is converted to THC-11, the psychoactive version of the stuff. If you haven’t eaten anything recently and your body is prone to burning through food like Charlie Sheen would burn through your cocaine stash, you’ll end up with a lot more psychoactive stuff in your veins than not. Hello, panic attack.

… And it’s personal biology for the hat trick with three points … societal factors, zip.

So, what can be done on a biological level about mitigating rare but serious adverse reactions to THC? There’s one ridiculously easy solution, and it comes in a convenient over-the-counter form.

Meet citricoline.  It’s the completely street legal drug that’ll take your high to a low in 15 minutes flat by essentially reducing the psychoactive effect of THC. It works by halting THC’s ability to decrease acetylcholine (it’s partly that effect that makes you feel high.) When your acetylcholine levels can stay stable in the presence of THC, you stop feeling like the patient that makes her ER doctor question their career choice, and more like a person that really needs like 37 Bagel Bites, stat. If you’re panicking or psychosis-ing, citricoline is what’s going to save you. If I had taken it during my panic attack, I would have avoided a really obscene hospital bill. And if Maureen Dowd had taken it, she probably would have taken a different perspective on the edibles game in Colorado.

But, for being the miracle remedy that it is, citricoline is surprisingly obscure. I’ll bet my meager life savings of $66 dollars that you haven’t heard of it until right now.

Here’s where the societal stuff comes in.

There’s a widespread lack of adequate training and education for dispensary employees in Colorado, and other states with medical and recreational weed. Employees are trained to harp on the benefits of the product they’re selling, but not always the consequences.

That’s not to say that there aren’t a lot of well-educated dispensary workers out there who can offer you an informed option; there’s just no legal requirement that they discuss the potential side effects of the product you’re buying. And because of the current lack of educational standards in the weed business, accurate and consistent information for patients and retail customers isn’t always available. 

That same general lack of training and education accounts for widespread mislabeling of edibles, a problem our BFF Maureen Dowd encountered when she ate an entire pot candy bar that was intended to be cut into 16 pieces. Dosage issues are not uncommon in edible products, which can mean that while you think you know how much to take, you might end up ingesting way more, or way less than you intended.

A recent study by the Denver Post tested these concentration inconsistencies. They commissioned a state-licensed cannabis testing lab to determine the actual amount of THC in a variety of edible products sold in local dispensaries.

The lab found some surprising things, like that a chocolate bar made by Dr. J's Hash Infusion, had only 0.28 milligrams of THC when its label claimed it had 100 milligrams. Other products were found to have either significantly less or significantly more THC in them than advertised. In one case, the THC content of an edible was almost 150 percent of what its label said. Imagine Maureen and I on that shit.

An even lesser talked-about barrier to safe edible consumption is the absence of legislation that allows research on marijuana. It’s still federally illegal to conduct human-THC trials, even when those trials are aimed at making marijuana consumption safer.

How can something be legal for consumption, but not for research? How would a dispensary or lab go about standardizing does and ensuring accurate THC concentrations in their products if it’s illegal to perform the very experiments that would elucidate the methods whereby edible makers could ensure proper dosages?

There’s still efforts being made though, and Colorado is taking small steps towards better legislation. In May, Governor John Hickenlooper signed a bill that approved the creation of a task force of edible labeling experts who would design packaging and labeling to ensure pot-edible products are clearly distinguishable from regular food products.

A similar measure approved a scientific study to guide the Colorado State Licensing Authority in establishing the equivalency of one ounce of pot in cannabis concentrates and hash oil.

So, as you can see, Colorado is trying. But no matter how many votes they collect, how many petition ballots are signed and how much regulatory laws they pass, the solutions will never mediate the effects of THC on personal biology.

In my case, my own biological landscape was a much bigger factor than mislabeling and concentration errors; I never had to step foot in a dispensary, speak with an expert, or research an edible product to have an adverse reaction. All I had to was fuel my cookie addiction to do that.

Personal biology, 4 … societal factors, valiant effort.

Adverse reactions to THC like the one I had are rare, but a better understanding of how your own body works, your personal mental state, and the biological factors that influence THC’s effect on you can keep them even rarer. Because if even when you consider improving labeling, chemistry, product testing and education, there’s no amount of improvement that can change how THC interacts with you on a personal, chemical level. The rest of that stuff wouldn’t hurt though. At the very least, it could have saved Maureen Dowd from writing a really shitty article.

And you know what? All this legal marijuana and edibles stuff is only four years old in Colorado (six months for recreational). In the grand scheme of things, it hasn’t been around long enough for these positive interventions to take place. In a few years, it’s likely that THC content in both buds and edibles will become standardized, and cannabis education will become more regulated. Maybe by then, people will have had time to more fully understand how their own bodies work. And when that happens, I have a sleeve of weed cookies with my name on it.