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Dose, strength and purity

Cannabis is an illegal drug and therefore not regulated.  This makes it very difficult to know how strong and pure the cannabis you are using is until after you have used it, making it hard to predict how much of the drug you will need to take to achieve the desired affects, which can lead to getting more ‘high’ than you had originally intended. 

Most people in Australia smoke hydroponic cannabis as this is more readily available than naturally grown varieties or 'bush buds'. Due to the way it is grown, hydroponic cannabis may have slightly higher THC potency than bush buds (up to twice as strong) and can produce different effects for the user.

The purity of cannabis can be affected in four different ways:

• contaminated in naturally occurring ways such as fungi
• contaminated by accident with fertilisers and other substances
• cut with substances such a crushed glass to make it appear of a higher quality than it really is
• it can be laced/mixed with other drugs such as LSD to create different effects (although this form of contamination is less common in Australia). 

Using cannabis with other drugs

When using cannabis with tobacco it is important to remember that nicotine is highly addictive.  This practice can lead to tobacco addiction.

Prescribed medication: Using cannabis with any sedatives, including benzodiazepines (such as Valium, Xanax, Serepax, Mogadon), anti-psychotics (such as Seroquel), some anti-depressants (such as Luvox), some anxiety medication, and older tricyclics, will make you feel a lot more drowsy compared to if you had twice the amount of just cannabis. Using sedatives and cannabis may also make you collapse, pass out or die from your brain's control of breathing stopping. Paradoxically, you might enter a high energy state - as if you were much higer in terms of disinhibition without being as sleepy - and you might be violent or do violent things without having any memory of what you've done.

If you are planning to take any illicit substance or alcohol while you are going to be on medication that is about to be prescribed to you, talk with your doctor. Unless they have immediate concerns for your safety it will remain confidential. Each drug is different and interactions can be unpredictable and very dangerous. This is especially so if you’re on any highly specialised drugs (e.g. for heart problems, neurological – brain and nerves – problems, blood thinning medications or drugs for cancer).

Overdose - what it looks like and what to do

The term overdose refers to the use of a drug or a mixture of drugs in a way which results in harmful or undesired physical or mental side effects.  These side effects can be long or short-term. Overdosing on cannabis is possible but there have never been any recorded deaths. 

Because cannabis is classed as both a depressant and a hallucinogen, overdose can present in two ways - 'greening out' and 'freaking out'.

'Greening out'

Greening out refers to a physical overdose. Signs of physical cannabis overdose include nausea or vomiting, dizziness and pale sweaty skin sometimes with a slight green tinge. Greening out can be a vey unpleasant , even frightening experience for some people. 

This form of overdose is more likely when cannabis is used with alcohol and can happen to even experienced cannabis users. This is because cannabis is an illegal drug and therefore is not regulated. This makes it very difficult to judge the dose and strength of the drug and makes it possible for users to take higher doses of the drug than they had originally intended.  

What to do - greening out

If you have a friend experiencing the above symptoms after using cannabis:

• First of all don’t panic, it will pass. 
• Take them to a quiet place with fresh air.
• Put them in a comfortable position and let them take small sips of water, a sweet drink such as juice or have a nibble on a piece of fruit. 
• Never leave anyone who is vomiting alone because if they pass out they could choke on their vomit.

'Freaking out'

Freaking out refers to having an anxiety attack or drug assisted psychosis as a result of cannabis use. Signs of this kind of overdose are paranoia, delusions, restlessness, aggression, feelings of anxiety, hallucinating, irrational behaviour, increased heart rate and shallow laboured breathing. 

Although anxiety attacks and mild paranoia can be common side effects of cannabis use, cannabis- assisted psychosis is rare.

The research on this topic is still ongoing but so far suggests that those at the highest risk of having this kind of reaction are those who are already prone to developing a mental illness such as people who have a history of mental illness like schizophrenia or depression in their family. 

If you have already developed a mental illness, using cannabis can make your symptoms much worse.

What to do - anxiety

If you have a friend experiencing anxiety after using cannabis:

• First of all don’t panic, it will pass. 
• Remove person from any overstimulating situation, reassure them, that these feelings will pass and that you are there to help.
• Stay calm and talk slowly and quietly.
• Get the person to slow their breathing rate by counting breaths with them.
• Allow them to drink water in small sips.
• Stay with them until the anxiety passes or help arrives.

What to do - paranoia/psychosis

If a friend becomes paranoid or delusional and begins displaying irrational behaviour after cannabis use the likelihood is they may be experiencing drug-assisted psychosis.  This experience as a result of cannabis use is temporary, lasting from a few minutes to 12 hours if the drug was ingested. 

If this happens:

• allow the person plenty of personal space
• avoid arguing and avoid sudden movement toward the person
• do not try to reason with the person
• express sympathy for the person’s emotional distress but don't buy in to their delusions
• if the person becomes threatening, call an ambulance or the police and ask for a plain-clothed police officer.  Police do not routinely attend overdoses unless it is suspected that there is violence or threatening behaviour occurring.

Mood, environment and personal factors

Mood

How you are feeling when you use cannabis can influence how the drug will affect you. If you are feeling anxious or depressed the drug may only enhance these feelings.

Environment

The setting in which you choose to use cannabis can influence the effect it will have on you. It is best to use the drug in a place where you feel safe and relaxed to reduce the chance of anxiety attack or paranoia and as with all drugs have a close friend nearby in case anything goes wrong.

Personal factors

Like alcohol, personal factors such as weight, height, sex and general health all influence the way in which a drug may affect you. Make sure you eat and sleep well if you are planning on taking drugs as this will better equip your body to deal with the substance.

Tolerance and withdrawal

Tolerance refers to how people build up a resistance to a drug after prolonged use. This means that the person will gradually have to use more and more of the drug to achieve the same effects. If you are using cannabis again after taking a break, keep in mind that your tolerance for the drug may have gone down and you may not need the same dose as previously to get the same effects.

Method

There are many ways to use cannabis and each has it pros and cons. 

• Eating - Eating cannabis is often considered the least harmful way of using the drug because it takes away the risk of developing a variety of respiratory illnesses associated with smoking. When eating cannabis it is important to keep in mind:
   - that it takes much longer for the drug to take effect (1 - 3 hours), so wait the full three hours before re-dosing 
   - it also may take longer for the effects of the drug to wear off than it does when using other methods
   - it's difficult to judge and people can get more 'high' than they had anticipated when using the drug in this way.
• Joints - When marijuana is burned it releases toxins such as carbon monoxide and carcinogens which are then inhaled when smoking. It is important to keep in mind when rolling joints to use proper cigarette papers and to be mindful of the materials used for ‘roaches’(cardboard filter tips). This is because often dyes and other contaminants can be present in materials people commonly use for roaches. These toxins will also be inhaled and absorbed when the joint is smoked. Tobacco, which cannabis is usually mixed with is highly addictive and if smoked regularly on its own or mixed with cannabis will be very difficult for most people to give up or cut down. Smoking cannabis in this way increases the risk of respiratory illnesses such as lung cancer and is associated with increased risk of heart disease.
• Bongs and pipes - A bong is a water pipe used for smoking cannabis.  Using a bong, the cannabis is burned and the smoke travels through the water in the pipe to be inhaled.  Smoking through a bong also cools down the smoke so it is less harsh on the throat but smoking cannabis this way is still harmful to the lungs and is associated with many respiratory illnesses.
  To reduce the risk of these illnesses when using bongs:
   - Take shallow puffs. 95% of THC is absorbed into the blood steam within the first few seconds of inhaling so inhaling deeply and holding the smoke in will not increase the 'high'.   It will however increase the surface area of your lungs exposed to the smoke and the risk of developing lung cancer.
   - Use glass or stainless-steel bongs and pipes, which  tend to be less likely to produce toxins compared with wood aluminium and especially plastic bongs are more likely to produce toxic fumes. 
   - Use a screen to prevent you from inhaling small particles. Sharing bongs with friends can pass on germs including colds, flu’s, hepatitis and herpes.
• Vaporising - vaporisers are devices that heat cannabis until the active ingredient THC is converted into a vapour to be inhaled. When using vaporisers make sure you follow the instructions carefully to avoid burning the drug.

Driving

Cannabis is often classed as a depressant. This means it affects the central nervous system by slowing down the messages going between the brain and the body. Driving after using cannabis is as dangerous as driving while drunk because it slows down reaction times, affects coordination, it affects your ability to concentrate, it slows the processing of information and often causes confusion and impaired thinking. 

As cannabis is also classed as a hallucinogen it can distort perception while driving. This means that you may see or hear things that are not actually there. In Australia the police use random road side saliva testing to determine if someone is driving under the influence of cannabis. 

Cannabis can be detected in the saliva for several hours after use. Like driving under the influence of any drug, driving under the influence of cannabis is illegal.

Pregnancy

Although more research needs to be done on the effects of using cannabis during pregnancy, plenty of research has been conducted on the effects of smoking while pregnant. Smoking often mixed with tobacco is the most common way of using cannabis. 

Using cannabis in this way during pregnancy increases the risks of premature birth, low birth-weight, respiratory problems and infections for the baby. 

This does not mean that taking cannabis by other methods during pregnancy will not have negative effects. The effects for the most part are unknown due to the ethical considerations of exposing mothers and unborn babies to drugs.