People are so excited that they get to consume cannabis that all other bets are off… and we have a huge responsibility and opportunity to make sure that we reduce harm. If we get the message out early and wisely enough, that is literally prevention. — Adie Rae, PhD
I was in Paris, an annual holiday that always brings me joy, relaxation and detox from the hectic pace of The States. I was a bit on edge that I didn’t have access to cannabis. So much so, I began to question if I would even return to France until cannabis is legal. Having to decide between my favorite city and my favorite plant was the first sign of some type of dependency brewing.
I knew the tolerance dance well and it took a few decades for this to set in, but lets be real, I’ve smoked more in the last two years than I have in my entire life.
With accessibility, dependency lurks in the shadows for many of us. Learning how to have a healthy, sustainable relationship with cannabis is like any other relationship. One that requires respect and absence of abuse to ensure that it continues to be a happy, rewarding, and above all, an enduring one.
After returning home, my first call was to Dr. Adie Rae Phd, an award-winning neuroscientist with more than 15 years of experience with addiction, cannabis, and opioid replacement. When she explained dependency could lead to Cannabis Hyperemesis Syndrome (CHS), I thought about Alice Moon, a cannabis influencer, who has been vocal about her ‘almost daily’ usage turning into an awful full blown cannabis allergy — a story that deserves attention.
So for today’s newsletter, a friendly reminder that on occasion, absence does make the heart grow fonder and every once in a while we need to take a T-break. Because, if you love this plant the way I do, understanding that this is intuitive medicine and we have to own how we treat it — will keep us, our loved ones and the reputation of this magical plant in tact.
Side note: I was shocked to discover that the last real study on cannabis dependency was in 2012? Say what? 🖤 Nina
In Conversation with Dr. Rae
ON PERCENTAGE OF USERS THAT DEVELOP DEPENDENCY ISSUES
Dr. Rae: The latest numbers were from 2012, and it was roughly 9% of the people who ever tried cannabis; however, that data comes from the era that was before all potent products, extracts, and vaporizer pens. It was also when many people chose not to engage with cannabis because it was illegal. With reduced barriers to consumption and less experienced users entering the mix, we're going to see the numbers go up.
ON SIGNS OF DEPENDENCY
Dependance is a diagnosable condition that totally exists. DSM-V diagnostic criteria to qualify for the disorder, you have to have cannabis interfere with your life--your social relationships and/or your economic performance.
The number one red flag and leading indicator that happens in that whole litany of effects is tolerance. Tolerance is the first step on the way to physical dependence. You need more of the drug to achieve the same effect. Physical dependence rears its ugly head when you experience withdrawal which has tell-tale symptoms like irritability, lack of appetite, insomnia, and the all too familiar sense that, ‘I'm having a bad day.’ With increased dependency then comes more difficult consequences, whether they be social, economic, or physical.
ON THE WAYS THE BODY FIGHTS BACK
All the same things that contribute to cannabis use disorder also contribute to Cannabis Hyperemesis Syndrome (CHS) which is a nightmare. ( See Alice’s story below)
CHS is where you have cyclic periods of nausea and vomiting. You have used so much cannabis over such a great amount of time you've completely dysregulated your endocannabinoid system to now essentially having an allergy because your body is telling you ‘you're poisoning me.’
ON GIVING IT A REST
When you notice you have developed tolerance, it is time for a tolerance break, a ‘T break.’
Every single human being who consumes cannabis, with perhaps the exception of terminal patients, requires a minimum of a 48-hour tolerance break on some kind of regular basis. How often? This is where it’s intuitive, but with our chronic pain patients we recommend one break every 30 days.
It’s also just good for your brain. Your endogenous cannabinoid system is involved in so many homeostatic processes that you really want to give yourself the opportunity to function at your maximum potential.
We've got lots of moonshine but we have no rosé. We're severely lacking moderate products. In Oregon, retail intake managers are not permitted to buy flower from a wholesaler that is less than 17% THC and yet, it’s exactly that kind of moderation people find enjoyable. Balanced with a tiny bit of CBD is going to provide the most insulation and protection from cannabis use disorders and hyperemesis.
Using a handheld vaporizer for flower (not to be confused with vaping oil) like The Mighty or the PAX, you're getting whole-plant vaporization which is essentially a symphony. You've got the conductor THC up there doing it's thing, and you've got all of the winds and all of the string instruments and then you've got the choir in the background as the terpenes.
ON VAPING OIL (not to be confused with flower vaporizers)
Here we are again, no regulation, preying on the public's perception that this is better.
If you look at the E-vape juices, flavorings and terpenes from other sources, such as essential oils, no one has ever studied their effects when they are heated, broken up into smaller molecules and then absorbed into the human body. We have no idea of the toxicity of those things. Lavender oil is fine to put on your skin or to put in your smoothie but it's not okay to heat it up to a point where it's no longer lavender oil. It has completely morphed into something else. It has broken down into its constituent smaller molecules, some of which are totally carcinogenic.
Not to mention the fact that the tobacco companies have long known that some flavors are more addictive than others. So if you find an orange pen, that pen is more rewarding than those other pens simply because of the flavor.
I think, honestly, the first thing that's going to happen is states are going to start outlawing concentrates because we already have 17-year-old girls coming into the ER with pneumonia because they're dabbers, which is really bad for lung health. I think after that, we're going to start to see all the similar kinds of concerns we have with concentrates are even more magnified and varied because of the vape cartridges.
ON EDUCATION THROUGH PURCHASING
The ‘regular tolerance breaks’ conversation should happen at retail.
In the State of Oregon, we have this regulation where you have to send out a 3x5 card with every consumer that says, ‘Marijuana can hurt your baby.’ That 3x5 card also needs to say, ‘Cannabis is rewarding. Here are the warning signs to look for. If you notice any of these things, take a break for a couple of days. If you're still having trouble, here's a phone number to call, an addiction hotline.’
ON SOCIAL RESPONSIBILITY
People are so excited that they get to consume cannabis that all other bets are off. No other considerations are made. If it's there [on the retail shelf], then it's okay and we have a huge responsibility and opportunity to make sure that we reduce harm. If we get the message out early and wisely enough, that is literally prevention.
The Mariana Trench of pharmacology. We have many decades of work left to sort out exactly what we’re dealing with and how we can better tailor it to our needs, as humans.
Cannabis Hyperemesis Syndrome (CHS) with Alice Moon
If I was in a hot tub, I wouldn't puke. But within seconds of getting out, I was vomiting. I spent so many nights on my bathroom floor rotating between the two. One day I passed out in my front yard puking. A neighbor came and found me and was like, can I take you to the hospital? What can I do for you? I was just crying because I was like, I don't know what you can do for me. There's no answers. Just leave me be. I just continued to lay there and vomit. — Alice Moon
I’ve been following Alice on Instagram for a couple of years now. She’s been talking a lot about her ordeal with CHS. Of course, it’s the one story that never gets echoed.
In 2016, Alice, a cannabis ‘influencer’, began having random vomiting episodes once a month with a misdiagnosis of acid reflux. By 2018 the vomiting became weekly and dangerous. She was diagnosed with Cannabis Hyperemesis Syndrome — a developed cannabis allergy. On the night before the big day to quit, Alice went out for her last hoorah. The last hoorah kicked up a 14 day full blown attack of daily vomiting and things haven’t been same since.
Alice’s routine was mostly edibles ranging between 5 mg and 20 mg and smoking approximately half joints in a sitting. Her routine was ‘almost daily’ and she hadn’t been taking long breaks.
ALICE: It was very scary. Just not knowing, when is this going to stop? When am I going to be able to have a sip of water? Am I going to die?
People were saying that this is pesticides. So I started smoking pesticide free weed and wasn't using a lot. Just a few hits here or there. And after a few months I had a four day episode.
I quit using cannabis for three months, and ended up taking CBD which made the next episode shorter. So from there, I was like, okay maybe I can use CBD. I used hemp derived CBD for a few months. Then December 2018, I had my period and used more CBD than I had been using. That triggered my worst episode which was 16 days. With that I got two ulcers, a hernia and a bacteria infection. I had two urgent care visits, one at-home nurse visit and was in the hospital for four days.
I was near death with both of those severe episodes due to severe dehydration that can cause organ failure if you don't know what's going on or if you can't afford to go to urgent care.
I know of people who've developed this within one year but the majority of the people who answered my survey have been using for over eight years. So it does seem to be a lot of use over an extended period of time. Basically your endocannabinoid system is overloaded and your body just can't handle it anymore and completely rejects it. It's like once that switch is flipped, you can't turn it back.
Now even secondhand smoke bothers me. I can't live the life that I used to live. I can't go to all the events I used to go to. I get so pissed off with all of this, honestly. I get a lot of online hate. Whenever a new article comes out, people are like, you work for the government. I'm like, ‘you guys, I love weed!’ These days, I do have a few people who will repost some stuff but ultimately, people are afraid to talk about it. It's a career ruiner, you know.
One thing that's been really hard for me this year is my mental health. I was using cannabis for depression and anxiety. People need to realize, this isn't just like, ‘oh, this girl can't smoke weed anymore.’ It's like, ‘no, this has affected my whole entire life.’
From all the data I've collected, there's no core commonality between all of us with CHS, and there’s tons of us. It's literally people of every age range all over the place and all different forms of consumption.
I want to be able to smoke weed again. And I don't want anyone to have to go through what I went through. It’s been so traumatizing.
We need research but we also need honest voices. These people know. They know that they haven't tested everything. Do you know what I mean?
I miss it so much.
Find ‘Hi’ 5X
Without any real research, it’s through anecdotal conversations that will keep our relationship with cannabis one that lasts through sickness and health, and has many anniversaries. That’s the magic of cannabis — the conduit to open dialog and communication with ourselves, Earth, and each other. Thanks for reading all the way to the end. 💨 Nina
My headphones got me through it
— Highly Epiphanies
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