A panic attack and some unique symptoms as a result of cannabis use

The sudden onset of intense anxiety characterized by feelings of intense fear and apprehension and accompanied by palpitations, shortness of breath, sweating, and trembling. Also called anxiety attack.​
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It appears that the majority of users who experience a panic attack fit into a certain category. Victims of the panic attack tend to be younger, either in high school or in college. Their inexperience in the use of cannabis is a contributing factor to their perceived fears, which result in the classical panic attack. Often times consuming more cannabis than usual, or a more potent form than usual, can trigger a panic attack. This could mean smoking out of a device or form of cannabis that is new to you: a gravity bong, kif, hash, or a blunt to name just a few. The setting is also a huge psychological factor and depending on where you are, it can allow your mind—in combination with your personality—to distort what you see. Users typically think the cannabis is to blame, yet people often forget the power of their own mind to distort reality and make a fuss out of something that is just a perception. At the end of the day though, it is all in your mind.

A panic attack as a result of cannabis use has some unique symptoms to it that you should be aware of. A racing heartbeat, or the feeling that you are going to have a heart attack, is one of the most commonly reported effects. Another heart related symptom is being able to feel your heart beat throughout your entire body, like a pounding almost. Palpitations might accompany this feeling too, as your anxiety might focus on your heart skipping beats. Hot and cold flashes as well as sweating have been reported. Another common symptom is tingling in the body and numbness of the limbs. Trembling or uncontrollable shaking has been reported, especially if you go from one altitude to another, smoke cigarettes, consume lots of caffeine, or take medications like Ritalin. Some users report visual and auditory hallucinations, but these are often confused with the effects of cannabis to increase the vividness of colors and sounds. Just remember, this is a psychoactive drug, but it is also a drug that has been used for thousands of years and no one has ever died from it nor has anyone developed a mental disorder because of their use, unless of course you are predisposed to one.

Most studies contribute a panic attack to THC, the psychoactive part of the plant. Strains that are higher in cannabidiol (CBD) tend to counter THC. This would mean medical strains or an indica, which has a higher ratio of cannabidiol to THC than a sativa, which is mainly THC. Cannabidiol has anti-anxiety properties that counter the effect of THC. This is probably because it decreases the rate of THC to clear from the body, perhaps by interfering with the metabolism of THC in the liver. It is also responsible for a majority of the medicinal properties of cannabis and relieves things like convulsions, inflammation, anxiety, and nausea.

Users also confuse a panic attack with the notion that their bud is laced. Honestly, 99.999% of the time your bud is not going to be laced unless you specifically ask for it that way. It is not economically sound for a dealer to distort cannabis by pumping more money into it. Remember, some drugs cannot even be smoked, like LSD. Something like cocaine would be easy to recognize, and PCP has a very distinct odor that is nothing like the smell of cannabis. If you really do fear getting laced bud though, just do not smoke at a party or with someone you do not know. Make sure you roll or pack up your own bud if it is a big concern for you.

If you do experience a panic attack, there are a couple of things you can do to help cope with it. First off, relax! Try to lie or sit down and just close your eyes. While you are doing this, take a big, deep breath through your nose and hold it for a couple of seconds. Then exhale slowly through your mouth. Do this for a good minute. Keep reminding yourself that this “feeling” is all in your mind, that you are not smoking something that is laced, that it is just cannabis, and that no one has ever died from this. Breathing is the most important part of this, it really helps calm you down. Try stepping outside to get a breath of fresh air, and do it away from people. Often times being surrounded by a large group of loud people and music can further increase your panic attack, so just get away. Find an escape somewhere and just breathe! Get a glass of cold water and maybe some bread or crackers. Try to divert your attention away from your panic attack by watching the television, taking a cold shower, or even masturbation—as odd as that sounds. Anything that can take your mind away from what is going on is going to help, which is another reason why breathing is very important.

You can avoid future panic attacks by following a couple of guidelines. One, stick to smoking with close friends in a place that you are familiar and comfortable with. Turn the lights down a little bit, put some music on at a low level, maybe light a couple candles or some incense. When you do smoke, stick to what you know. You do not need to smoke out of a gravity bong or a five-gram blunt. You do not need to hold your hits in for as long as you can either. Also, next time you smoke just take one hit and nothing more. Wait for fifteen minutes and if you are not high, take another one. Eating a solid meal at least thirty minutes before smoking can also help. Moreover, if you are really new to smoking, stay away from other substances while you are smoking, such as alcohol. This will only increase your chances of you experiencing a panic attack. Meditation can drastically reduce your chances of having a panic attack, try doing it a couple times a week.

Cannabis may produce directly an acute panic reaction, a toxic delirium, an acute paranoid state, or acute mania. Whether it can directly evoke depressive or schizophrenic states, or whether it can lead to sociopathy or even to "amotivational syndrome" is much less certain. The existence of specific cannabis psychosis, postulated for many years, is still not established. The fact that users of cannabis may have higher levels of various types of psychopathology does not infer a casual relationship. Indeed, the evidence rather suggests that virtually every diagnosable psychiatric illness among cannabis users began before the first use of the drug. Use of alcohol and tobacco, as well as sexual experience and "acting-out" behavior, usually antedated the use of cannabis. When the contributions of childhood misbehavior, school behavioral problems, and associated use of other illicit drugs were taken into account, it was difficult to make a case for a deleterious effect of regular cannabis use. Thus, it seems likely that psychopathology may predispose to cannabis use rather than the other way around.


This adverse psychological consequence of cannabis use is probably the most frequent. About one in three users in high school reported having anxiety, confusion, or other unpleasant effects from cannabis use. These unpleasant experiences were not always associated with unfamiliarity with the drug; some subjects experienced these adverse reactions after repeated use. The conventional wisdom, however, is that such acute panic reactions occur more commonly in relatively inexperienced users of cannabis, more commonly when the dose is larger than that to which users may have become accustomed, and more commonly in older users who may enter the drug state with a higher level of initial apprehension.

The acute panic reactions associated with cannabis are similar to those previously reported to be caused by hallucinogens. The subject is most concerned about losing control or even of losing his or her mind. Reactions are usually self-limited and may respond to reassurance or "talking down"; in the case of cannabis use, sedatives are rarely required as the inherent sedative effect of the drug, following initial stimulation, often is adequate. Occasionally one may see a dissociative reaction, but this complication is readily reversible. Depersonalization may be more long lasting and recurrent, somewhat akin to "flashbacks" reported following hallucinogens; the electroencephalogram shows no abnormality.


Very high doses of cannabis may evoke a toxic delirium, manifested by marked memory impairment, confusion, and disorientation. This nonspecific adverse psychological effect is seen with many drugs, but the exact mechanism is not clear in the case of cannabis as it is in the case of datura stramonium smoking, for instance, which produces potent anti-cholinergic actions. As high doses of any drug tend to prolong its action, delirium is self-limited and requires no specific treatment. Highly potent preparations of cannabis are not as readily available in North America as in other parts of the world, so these reactions are less commonly observed in the United States and Canada.


It is difficult to gauge the frequency of these reactions. In a laboratory setting, they are frequently encountered. Quite possibly the experimental setting creates a paranoid frame of reference to begin with. That this reaction is not peculiar to the laboratory is evident from reports in which it has been experienced in social settings. The illegal status of the drug might contribute in such instances, for while intoxicated, one might be more fearful of the consequences of being caught. Undoubtedly, the degree of paranoia of the individual is also an important determinant, so that this reaction may represent interplay between the setting in which the drug is taken as well as the personality traits of the user.


A variety of psychotic reactions has been ascribed to cannabis use. Many are difficult to fit into the usual diagnostic classifications. Two cases of manic reaction were reported in children who were repeatedly exposed to cannabis by elders. Both required treatment with antipsychotic drugs but ultimately showed a full recovery. Hypomania, with persecutory delusions, auditory hallucinations, withdrawal, and thought disorder, was observed in four Jamaican subjects who had increased their use of cannabis. Twenty psychotic patients admitted to a mental hospital with high urinary cannabinoid levels were compared with twenty such patients with no evidence of exposure to cannabis. The former group was more agitated and hypomanic but showed less affective flattening, auditory hallucinations, incoherence of speech, and hysteria than the twenty matched control patients. The cannabis patients improved considerably after a week, while the control patients were essentially unchanged. Thus, a self-limiting hypomanic-schizophrenic-like psychoses following cannabis has been documented.


This curious phenomenon, in which events associated with drug use are suddenly thrust into consciousness in the non-drugged state, has never been satisfactorily explained. It is most common with LSD and other similar hallucinogens but has been reported fairly often with cannabis use. At first, it was thought that the phenomenon occurred only in subjects who had used LSD as well as cannabis, but recent experience indicates that it occurs in those whose sole drug use is cannabis. One possibility is that flashbacks represent a kind of déjà vu phenomenon. Another is that they are associated with recurrent paroxysmal seizure-like activity in the brain. The most unlikely possibility is that they are related to a persistent drug effect. They may occur many months removed from the last use of either LSD or cannabis, so that it is highly unlikely that any active drug could still be present in the body. Further, the interval between last drug use and the flashback is one in which the subject is perfectly lucid. For the most part, the reactions are mild and require no specific treatment.

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