Cannabis is a flowering plant containing cannabinoids, primarily THC (psychoactive) and CBD (non-psychoactive). Used recreationally for relaxation, euphoria, and sensory enhancement. Increasingly legal and widely used in sexual contexts to enhance intimacy, sensation, and reduce inhibition.
How It Works
THC binds to CB1 receptors in the brain and nervous system, modulating neurotransmitter release (dopamine, serotonin, GABA, glutamate). Effects include altered perception, mood elevation, appetite stimulation, and pain modulation. CBD acts on different pathways with anti-anxiety and anti-inflammatory properties.
Legal Status
Federally Schedule I in the US, but legal for recreational use in 24+ states and DC. Legal in Canada, Uruguay, and parts of Europe. Medical use legal in most US states and many countries.
Dosage Guide (Inhalation / Oral)
| Level | Amount (mg THC (or puffs for inhalation)) |
|---|---|
| Threshold | 1-2 mg THC (1 puff) |
| Light | 2.5-5 mg THC (1-3 puffs) |
| Common | 5-15 mg THC |
| Strong | 15-30 mg THC |
| Heavy | 30+ mg THC |
Note: Potency varies wildly. Modern flower is 15-30% THC vs 3-5% decades ago. Concentrates can be 60-90% THC. Edible doses should start at 2.5-5mg for beginners. Tolerance develops quickly with daily use.
Organ System Impacts
- neurological — Moderate
- THC alters neurotransmitter release throughout the brain. Impairs short-term memory, attention, and coordination while intoxicated. Adolescent use linked to altered brain development. In adults, most cognitive effects reverse with abstinence.
- respiratory — High
- Smoking damages airways — chronic bronchitis, increased mucus, airway inflammation. Vaping avoids combustion but carries risks from additives. No conclusive link to lung cancer from cannabis alone, but chronic smoking irritates lungs.
- cardiovascular — Moderate
- Acutely increases heart rate 20-50%. Mild blood pressure effects. Generally low risk for healthy individuals. May trigger events in those with pre-existing heart conditions.
- gastrointestinal — Moderate
- Appetite stimulation. Anti-nausea effects (therapeutic). Chronic heavy use can cause Cannabinoid Hyperemesis Syndrome — severe cyclic vomiting.
- hepatic — Low
- Metabolized by liver (CYP450 enzymes). Can interact with other medications metabolized by same pathway. Minimal direct hepatotoxicity.
- ocular — Low
- Reduces intraocular pressure (therapeutic for glaucoma). Causes red eyes from vasodilation. No significant damage.
- renal — Low
- Minimal direct kidney effects.
- dermatological — Low
- Minimal skin effects. Smoke exposure may contribute to premature aging with chronic heavy smoking.
- hematological — Low
- Minimal blood effects at recreational doses.
- musculoskeletal — Low
- Muscle relaxation. No significant musculoskeletal harm.
Effects
Desired Effects
- Euphoria and mood elevation
- Deep relaxation and body comfort
- Enhanced sensory perception (music, food, touch)
- Increased sociability and laughter
- Enhanced sexual sensation and intimacy
- Creative thinking
- Pain relief
- Appetite stimulation
Negative Effects
- Anxiety and paranoia (especially with high doses or unfamiliar settings)
- Impaired short-term memory
- Impaired coordination and reaction time
- Coughing and throat irritation (smoking)
- Cognitive impairment while intoxicated
- Dizziness, especially when standing
- Nausea ('greening out' — usually with edibles or high doses)
Rare but Serious
- Cannabinoid Hyperemesis Syndrome (CHS) — cyclic vomiting in chronic heavy users, relieved only by hot showers and cessation
- Acute psychosis (more common with high-THC, low-CBD strains, and predisposed individuals)
- Panic attacks
- Cannabis-induced depersonalization/derealization
- Severe cardiovascular events (rare, mostly with pre-existing conditions)
Drug Interactions
Alcohol — moderate
Alcohol increases THC blood levels. Combining intensifies impairment, nausea, and dizziness ('crossfading'). Dramatically increases risk of 'greening out'.
Action: Use one or the other, not both. If combining, use much less of each. Drink water. Have a safe place to sit/lie down.
Stimulants (Cocaine, Meth, MDMA) — moderate
Opposing effects on heart rate and blood pressure. Cannabis may mask stimulant warning signs. Increased cardiovascular strain.
Action: Be cautious of doses. Monitor heart rate. Cannabis may increase paranoia alongside stimulants.
Psychedelics (Mushrooms, LSD) — moderate
Cannabis significantly intensifies psychedelic effects. Can trigger anxiety, paranoia, or overwhelming experiences. Often enjoyable for experienced users but risky for novices.
Action: Only combine if experienced with both substances individually. Use very small amounts of cannabis. Avoid during peak of psychedelic experience.
CNS Depressants (GHB, Benzodiazepines, Opioids) — moderate
Additive sedation. Cannabis can increase nausea risk when combined with depressants.
Action: Reduce doses of both. Be especially careful with opioids — cannabis may mask warning signs of respiratory depression.
Detection Times
THC metabolites (THC-COOH) are fat-soluble and can persist in the body for weeks in regular users.
Urine
Standard immunoassay. Single use: 3-5 days. Regular use: 15-30+ days. Detection window: up to 30 days.
Blood
Active THC clears quickly but metabolites persist. Detection window: up to 7 days.
Hair
Hair follicle test can detect use over months. Detection window: up to 90 days.
Saliva
Detects recent use within hours to days. Detection window: up to 3 days.
Harm Reduction Tips
- NEVER use black market vape cartridges — EVALI (lung injury) was caused by vitamin E acetate in unregulated cartridges
- Start low, go slow — especially with edibles (2.5-5mg THC for beginners, wait 2 hours before redosing)
- Stay hydrated and have snacks ready
- Avoid daily use if possible — tolerance and dependence develop with regular use
- Be cautious mixing with alcohol — the combination is much stronger than either alone
- Know your strain and potency — ask your dispensary or source about THC percentage
- Avoid smoking if possible — vaping flower is less harmful than combustion. Edibles avoid lung exposure entirely
- If anxious or paranoid: you are safe, it will pass, breathe deeply, chew black peppercorns (contains beta-caryophyllene which may reduce anxiety)
- Don't drive — cannabis impairs reaction time and coordination for hours
- CBD can partially counteract THC anxiety — keep CBD oil on hand
Withdrawal Symptoms
Severity: Low
Onset: 1-2 days after cessation. Peak: days 2-6. Resolution: most symptoms gone within 2-3 weeks. Sleep disruption and vivid dreams may persist 4-6 weeks.
Physical
- Insomnia and sleep disruption
- Decreased appetite
- Mild nausea
- Sweating and night sweats
- Headaches
Psychological
- Irritability and anger
- Anxiety and restlessness
- Vivid and disturbing dreams
- Depressed mood
- Difficulty concentrating
- Cravings
Emergency Information
Call 911 If:
- Loss of consciousness
- Seizures
- Chest pain with shortness of breath
- Severe allergic reaction
- Child has consumed edibles
- Psychosis with danger to self or others
What To Do
- Move to a calm, safe environment
- Reassure them: 'You're safe. This is temporary. It will pass.'
- Offer water and light snacks
- Try black pepper — chew or smell peppercorns (terpene beta-caryophyllene may reduce anxiety)
- If they can sleep, let them sleep it off
- For edible overdose: symptoms may last 6-12 hours. Ride it out in a safe place
What To Tell EMS
The patient consumed cannabis (THC). Route was [smoking/edibles/other]. Approximate dose if known. Duration since consumption. Main symptoms: [anxiety/vomiting/chest pain/psychosis]. No known lethal dose of THC in adults.
Seek Help If
- Severe unrelenting vomiting (possible CHS — especially in chronic daily users)
- Chest pain that persists
- Severe panic that doesn't resolve with reassurance and time
- Psychotic symptoms — hearing voices, severe paranoia, delusions
- Accidental ingestion by a child
Normal Discomfort
- Anxiety or mild paranoia that resolves within 1-3 hours
- Dry mouth and red eyes
- Increased heart rate (up to ~120 bpm)
- Mild dizziness
- Feeling 'too high' — usually resolves by sleeping it off