Cannabis gummies (Aileen Wingblad/MediaNews Group)
Visit your local cannabis store and you’ll likely see a wide range of customers — from 20-somethings to gray-haired grandmas and grandpas.
Some who use marijuana consistently say they turn to it for pain relief, to ease symptoms of medical conditions, to resolve sleep issues or for other therapeutic purposes. But for the majority of people who imbibe in cannabis, as studies and surveys have shown, it’s a recreational thing.
It’s all about the buzz.
Cannabis is an option over alcohol for relaxation or socializing, and some strains are particularly used for inducing joy and/or enhancing the senses: Fire up a preroll, break out an infused cookie, pop a gummy or three…and enjoy the ride.
But load up on too much, and that smooth sailing can turn into rough waters.
Symptoms, treatment
Dr. Glen Clark, an emergency room physician for Corewell Health, said “overdosing” or over-consuming cannabis likely won’t kill you — but the paranoia and other adverse reactions it may induce can make you feel like you are going to die.
“The OD happens when the body can’t metabolize (cannabis) quickly enough,” Dr.l Clark said. “And when you can’t metabolize it quickly enough, that can lead to adverse effects. People use THC (the main active component in marijuana) because they want to be relaxed and get that euphoric feeling, but it can cause paranoia, heart palpatations … panic attacks, chest pain, (a feeling of) heart racing.”
Dr. Glen Clark (Corewell Health)
Some also experience sweating, nausea and vomiting, Clark said.
In his experience as a physician, Clark said, the emergency department is seeing an increasing number of patients with cannabis OD symptoms since recreational marijuana was legalized. “There’s no question we’re seeing more of it … one or two a week,” he said.
Typically, treatment in the ER includes IV fluids and sometimes medication such as Xanax or Ativan “to calm them,” Clark said.
Stressful situations and mixing alcohol with cannabis can make OD symptoms — and other health conditions — worse; the heightened anxiety that results from too much THC can also unmask underlying psychiatric issues that can present when one ODs, Clark noted, requiring follow-up.
Dr. Jason Vieder, vice chairman of emergency medicine at Henry Ford Health, also weighed in on cannabis use — and overuse. He, too, said symptoms include heightened anxiety and on rare occasions, psychosis. Dehydration, dizziness, “slower than usual” movements are also seen.
“It can make them feel pretty badly,” he said.
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If someone has used marijuana with pain medication or sleep medication, they can become overly sedated and appear “really out of it,” Vieder added.
Unlike Clark, Vieder said there was his experience as a physician showed a sharp increase in the number of people who sought emergency help after “overdosing” on marijuana a few years back when it became legal in Michigan, but the cases have since tapered off.
“The gates were open (when it was legalized), and people normally not using marijuana were using it,” Vieder said. Their inexperience led to some ODs for which people sought medical care, but that doesn’t seem to be happening much anymore, he said.
Marijuana flower and preroll (Aileen Wingblad/MediaNews Group)
“Actually, we’re seeing less of this in the community now … there’s so much more information available now, so my educated guess is that it has become more prevalent and widespread, so many more people out there know how to use it,” Vieder said.
Both doctors say while there’s no known “antidote” to reverse a cannabis OD, someone who overconsumes can likely just stay at home and wait for the symptoms to subside — which can take several hours. Added Clark: “I’d never discourage someone from seeking help, but if they are feeling a bit anxious and a little nauseous, they don’t need to rush to the hospital,” he said.
‘Just wanted it to stop’
Jerry Millen, owner of Oakland County’s first fully-licensed marijuana store, Greenhouse in Walled Lake, knows all about cannabis — including the troublesome reactions that can come from over-consuming.
A number of years ago during a stress-filled leg of a family vacation, Millen said he needed something to help him chill out. When he opened his suitcase, he was pleasantly surprised to see a cannabis-infused edible which had inadvertently been left over from an earlier trip.
“I was glad to see it, and ate it,” Millen said. Then, he read the package and saw that it was 100 mg — an exceedingly large amount for him to consume.
“I started thinking, ‘Oh lord, oh lord…,” he said, realizing he had ingested four times more than he had known people to use in a single dose.
“I told my wife, and she said I had been smiling a lot for the past few minutes,” Millen said.
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But then it really started to kick in. And it wasn’t fun, he said.
“I started making deals with God, saying I’d never do this again,” Millen said. “I just hid under the blanket in bed, the television seemed 10 times louder (than usual). I wanted to make myself throw up but I couldn’t. I wanted something to bring me down.
“I was so high it was insane … I just wanted it to stop. I felt like I was in a spinning ride at a carnival and I couldn’t get off — but I knew I knew I wasn’t going to.”
Start low, go slow
Hours later, the effects had worn off for Millen. But the ordeal gave him first-hand knowledge about what can happen if you use more cannabis than your body can handle — and he and his trained staff at Greenhouse are ready with guidance for customers so they don’t have the same unpleasant experience.
Millen’s credo: Start low, go slow.
“It’s always good to start less and work your way up,” he said, noting that some edibles can take two to three hours before effects are felt.
Greenhouse owner Jerry Millen and manager Ashleigh Baynes welcome cannabis-related questions via email, by phone or in-person at the store. (Aileen Wingblad/MediaNews Group)
Also, he advises people — especially newer users — to keep a journal detailing what they consume, the amounts and dosages, and how it affects them.
“Treat it like a medicine, whether you are using it for medical purposes or for recreation,” Millen said. “Write it down — be aware of what you’re taking and keep track of it.”
And he cautions against consuming alcohol or other drugs with cannabis. Just don’t, he said.
Those on his staff called “budtenders” have access to an extensive library of literature and can further advise about dosing, effects and the dos and don’ts, he added. That goes for medical as well as recreational cannabis.
“Everyone who works here uses cannabis. We do our research, and can tell people what works and tell them why it works,” Millen said. “Cannabis science has evolved so much in the past five years, and there’s so much being discovered. We pride ourselves on having the knowledge and talking to customers about it all…it’s all about education.
Celine Lee of Novi (left) making a purchase from Maria Wilson recently in Greenhouse of Walled Lake (Aileen Wingblad/MediaNews Group)
“Not many marijuana stores can talk about health like we can. There aren’t many medical marijuana stores left, but I made a promise long ago to my (medical marijuana) customers that I’m going to be here till the end.”
Keep it from kids
Clark and Vieder remind people to take precautions to keep marijuana products away from children.
“Be responsible about it. You have to treat it like prescription drugs or alcohol. Put it in a safe spot where children can’t get to it,” Vieder said, adding that occasionally he’s known of parents bringing their kids into the emergency room because they’ve ingested marijuana.
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Clark said since children metabolize cannabis differently than adults, it’s best not to delay seeking help. Poison Control is another resource, he said.
According to National Capital Poison Center, a nonprofit organization and accredited poison center, unintentional exposure to marijuana-infused edibles is on the rise. Common effects included vomiting, dizziness, rapid heart rate, difficulty walking, dizziness, confusion and breathing difficulties. Hallucinations, low blood pressure and abnormally slow heart rate can occur in severe cases. Severe symptoms might require admission to a hospital.
Medical professionals also advise those who are pregnant or breastfeeding to stay away from marijuana, as well as those with a history of mental health problems. Studies have also shown cannabis can affect brain development in adolescents and young adults.
Cannabis hyperemesis syndrome
Besides overconsumption, another marijuana-related issue pushing people to an emergency room is a fairly new condition known as cannabis hyperemesis syndrome — cyclical vomiting that can emerge in chronic users. According to the National Institute of Health, it was initially described in a 2004 case series..
Corewell Health’s Clark said it involves “actively wretching” and can show up years after someone first starts using marijuana. Research suggests longterm cannabis use changes the way the brain reacts to it and perhaps “rewiring transmitters” connected to the digestive system.
“(Patients) don’t want to hear that’s the reason for it — they say they’ve been smoking weed for years and it never happened. But this is what it is,” Clark said.
Dr. Jason Vieder (Henry Ford Health)
Henry Ford Health’s Vieder also sees it in patients coming to the ER “really in distress,” suffering from unrelenting vomiting and intense abdominal pain. And it’s not yet completely understood, he said.
“Generally, cannabis hyperemesis syndrome is seen in heavy marijuana users — often those who are frequent, multiple-times-per-day users. They can be fine for a long time and then suddenly develop it,” Vieder said. “Even small amounts can trigger it once you’ve had it.”
Five years ago, Vieder noted, if someone came into the emergency room with those symptoms, chronic marijuana use wouldn’t have been a suspected culprit.
“But we’ve seen a big spike so now we commonly ask if they’ve been using marijuana,” he said.
The only cure for the syndrome is to stop using marijuana, Vieder said.
‘Not here to judge’
Recreational marijuana was legalized in Michigan in 2018, and stores began selling it about a year later. While some people are still hesitant to disclose that they consume cannabis, medical professionals say it’s a good idea to do so.
Clark noted that marijuana can interact with many medications, such as blood thinners, antivirals and sleep aids, for example.
“A lot of times, people might not admit (they use marijuana) but it’s important to know,” Clark said. “You really should be honest with your medical care provider … I hope that when people come to an ER or any physician that they open up. All we can do is appropriate care and ask — but we’re not here to judge.”
Vieder also advises people to inform their doctor about their cannabis use, noting that while it can increase the effectiveness of certain medications including blood thinners, it can also decrease the effectiveness of others, such as antipsychotics, anti-inflammatories, muscle relaxants and more.
“Certainly at times people are hesitant, there’s still a stigma even though they can (consume) legally,” Vieder said. “I tell folks, when you come into the ER, the doctor-patient relationship is sacred. And we just want to make sure we’re giving the proper medication and treatment, and doing the right thing for them.”
Cannabis consumption is here to stay, Clark noted.
“Let’s face it, people are going to use,” he said.
Cannabis-infused syrups and gummies (Aileen Wingblad/MediaNews Group)
For a safer experience, Clark suggests:
• Use only a regulated product purchased from a store with listed potency and amount
• Take breaks from using to avoid building a tolerance
• Don’t use other depressants or sleep aids when using marijuana
Vieder also offers advice for marijuana users:
• Use in moderation
• Don’t drive or operate machinery after using cannabis
• Don’t make important decisions after using cannabis
• Stay hydrated and be in a safe place with other people around you
“And put it away so children can’t access it,” he said. “Just be responsible.”
