The Cannabis Chronicles: Just a Little Smoke Among Friends

Cannabis

Now, about that bad news.  Internal toxicity is what we call intoxication. So, when does being “high” end and intoxication begin? That question has many different perspectives.  The first feeling of change in awareness of the euphoria is the evidence of internal toxicity…“Hey, a little toxicity done safely and not overindulgently is ok.”  Well, perhaps they won’t say it exactly that way, but you get the drift. Whether it’s happy hour or a little  cannabis “smoke” among friends, you feel good because you are impairing some of your nervous system functioning. No, you aren’t killing nerve cells. But the internal cell functioning does not “like” the way it’s being driven, and makes changes to resist it. This is a moving target for most people. It can happen slowly or relatively quickly. It depends on the drug or compound, frequency of use, the individual and other circumstances.  It’s a natural process, not based on a malicious or irresponsible intent to drive your system to abuse or addiction. We call this tolerance.  Most people believe that this “resistance” or tolerance is due to the body metabolizing or breaking down the substance of abuse. Unfortunately, it is actually the brain tissue where the drug or alcohol works that is the major source of the resistance.

When cells become toxic by the drug or alcohol, it ultimately causes changes in the production of proteins, via changes in gene expression, to resist the drug effects. This process works at several levels. Most importantly, it can change receptor sensitivity, ease of transport across nerve cell membranes and enzyme reactions that respond to the drug. We have long standing evidence that receptors are “plastic” and besides changing in sensitivity, they can be removed to reduce availability for response. Lastly, the brain is actually a neural network so issues in one area get monitored and cause subtle changes elsewhere that can have unintended consequences.  This process of adjustment to the intoxicating effects leads to embedding of nerve “memory” on how to respond to the agent when it returns.   The bottom line is that drugs, including cannabis, only work because they overdrive a system that normally responds to an internally made similar nerve transmitter in the brain. That’s why ibuprofen does not get you high despite it going to the brain and stopping pain at the same location where cannabis, for instance, works on your mood and consciousness.

However, if you really like the drug’s effect and use it more frequently, you increase the likelihood of this outcome. When narcotic medication is prescribed in FDA approved doses to people without prior family or personal history of abuse/addiction, we find tolerance increasing in about 25% of patients after 4-6 weeks. The same is true for narcotic sleep and anxiety medications.  Cannabis smoking is no different.  Many of my patients, young and old, report a slow increase in tolerance over time to cannabis. This isn’t crack, you know. So, a few hits on a pipe or draws on a blunt have to increase in number to get the desired effect. Whether it’s more stimulation to play video games or to kick back to watch a movie with more “immersion” in the content, they find the drug effect wears off more rapidly or they have to increase amount of time or quantity of smoking.  The drug effect tells them a different story. They feel better from the dose and the detriments are not viewed as troublesome or don’t exist at all. When you are feeling good, even your mistakes seem correct.  Then they learn one more thing… if it can make a good time better, it can also make a “bad” time, like boredom, stress or depression, better. 

I frequently get the argument that since cannabis exists naturally and we have a internal transmitter it mimics, isn’t this the best of both worlds and what “God” put here for our enjoyment? More to come…