Editor’s note: Are you too high right now? Go here to calm yourself or a friend.

One of the eternal questions in cannabis culture has finally been answered by science: After consuming marijuana, how long will you stay high?

In a 2021 study published in Neuroscience & Biobehavioral Reviews, researchers led by Danielle McCartney of the University of Sydney identified a “window of impairment” that lasts anywhere from three to ten hours, depending on the THC dose, the mode of ingestion, and the consumer’s previous cannabis experience.

After taking 20mg of THC, most consumers shed the high within four to five hours.

Those are a lot of factors, but the TL;DR is: generally, four hours.

The intoxicating high from a lighter inhaled dose will generally last for three hours, while a deep dabbing session or heavy edible may keep on hitting for six to ten hours.

Gathering data from 80 studies

McCartney and her colleagues undertook a comprehensive analysis of 80 scientific studies on cannabis dosage and intoxication.

Because the focus of their study was on the effect of cannabis intoxication on driving skill and awareness, much of the work skewed toward answering those questions.

The researchers found that cannabis consumers recovered most of their driving-related skills within five hours of inhaling 20mg of THC. Consumers who consumed the same amount of THC via an edible took longer to recover their driving skills. Most cannabis edibles in legal markets are dosed at 10mg per serving, and 100mg total THC per package.

“Overall, our results confirm that Δ9-THC impairs aspects of driving performance,” the researchers wrote. “There appears to be no universal answer to the question of How long to wait before driving? following cannabis use: Consideration of multiple factors is therefore required to determine appropriate delays between Δ9-THC use and the performance of safety-sensitive tasks.”

Edible highs hit later and last longer

The differences between inhaled THC and ingested THC (via edibles) were significant. It’s widely known that the effects of THC and other cannabinoids will be felt within minutes by consumers who smoke or vape cannabis products, while an edible or beverage can take up to an hour or more to hit.

In their review of the scientific literature, McCartney and colleagues found that the intoxicating effects of edibles and beverages usually last much longer than inhaled products.

Those researchers found that smoking or vaping 20mg of THC diminished a driver’s reaction time for roughly four hours. But ingesting 20mg of THC via an edible or beverage diminished reaction time for eight hours, twice as long. The study’s data indicated a THC-impaired driver’s reaction time was diminished at a significant but not dramatic level.

Heavy edible? Could be a 10-hour ride

“Our analysis indicates that impairment may last up to 10 hours if high doses of THC are consumed orally,” said McCartney, who works with the Australian university’s Lambert Initiative for Cannabinoid Therapeutics. “A more typical duration of impairment, however, is four hours, when lower doses of THC are consumed via smoking or vaporization and simpler tasks are undertaken.”

That impairment—which cannabis consumers may experience as feeling high, or stoned, or deeply relaxed, or sleepy, or mirthful, or creative—“may extend up to six or seven hours if higher doses of THC are inhaled and complex tasks, such as driving, are assessed,” McCartney added.

For the purposes of this study, McCartney and associates considered 10mg of THC to be a moderate dose. But a moderate dose for a regular consumer, they added, could be a high dose for an occasional one.

Regular consumers show less impairment

As many cannabis consumers know, regular use can result in the body and mind building up a tolerance for cannabinoids ingested from sources outside the body, such as weed. This was also confirmed by the University of Sydney researchers.

Co-author Dr. Thomas Arkell, also from the Lambert Initiative, said: “We found that impairment is much more predictable in occasional cannabis users than regular cannabis users. Heavy users show significant tolerance to the effects of cannabis on driving and cognitive function, while typically displaying some impairment.”

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Delta-8 THC is one of the hottest topics in cannabis right now. It’s a minor cannabinoid that can get you high like traditional THC, but much less so. It’s found in small amounts in the cannabis plant and is often converted from other compounds like CBD. If you haven’t heard of it yet, you surely will soon enough.

Reason #1 that interest in delta-8 is surging is its existence in a legal grey area: Delta-8 can be made from hemp and thanks to the 2018 farm bill, cannabis with less than 0.3% THC is considered hemp, and anything that naturally derives from hemp is federally legal.

That means if you convert hemp CBD into delta-8, you end up with a federally legal cannabis product that gets people high, although less high than traditional THC. Some states have begun to regulate delta-8, some not. Read more on what delta-8 is and its legality in this article.

Reason #2 people are so curious about delta-8 is because it’s supposed to be a much less intense, much more approachable experience than the high you feel from consuming traditional cannabis with THC.

So does it get you high? We put delta-8 to the test, for the people.

Is delta-8 less intense than THC?

To test out delta-8 THC, I slid to a dispensary in Portland, Oregon to grab up the 250mg pack (ten 25mg servings) of Smokiez Sour Blue Raspberry Gummiez. I chose Smokiez because their traditional gummies are some of my favorites, giving me a great comparative reference. Plus, when trying new products, it’s important to find reputable brands that you can trust to put out the good on a consistent basis.

With delta-8 expected to have less intense effects than traditional THC, I decided to try them in separate doses of 50mg and 100mg, or two and four gummies, respectively. Activation time on the package said 45 minutes.

I took each dose on an empty stomach for the fastest onset time possible, and then allowed a period of four hours to pass, since edibles are expected to peak within 3-4 hours. I did not consume any other cannabis that day, so I started from a completely sober state.

Here’s my experience.

NOTE: The following experience is a single human trial, not a true scientific experiment. Experience with cannabis, frequency of use, and your body chemistry all come into play when deciding how high one will get. Consumption results may vary.

50mg dose

I ate the first dose at 10:30am, and after about 30 minutes, I started to feel the familiar head and body buzz that let me know there’s some weed in my system. Or excuse me, hemp.

The first thing to know before discussing the delta-8 experience is my tolerance. I chain smoke joints all day, every day, with dabs tossed in the mix here and there. It would take a lot of weed to floor me at this rate.

However, with traditional edibles, it tends to be the opposite. They always creep up on me because I forgot I ate them and then BAM—it’s Couchlock City, USA. That’s why I usually stay away from them.

That said, normally, a 50mg dose of edibles would absolutely rock me to sleep within a couple of hours, but the delta-8 gummies produced a stimulating, sort of energetic experience that comes from a good morning wake ‘n’ bake mixed with a nice cup of coffee.

It was almost like smoking a joint of CBD-dominant flower, where you feel alert, clear-headed, and ready for any obstacles the day may throw your way. Within less than an hour of eating those gummies, I was locked into Google Docs knocking out days worth of writing work.

Truthfully, I expected to feel absolutely nothing when I ate those two gummies. I was ready to hate. But the Smokiez delta-8 gummies experience had me blasting music, dancing around my Airbnb, and punching out sentences that writer’s block had been stifling for over a month.

Sometimes, my head can get pretty foggy from the weight of the world’s news and personal anxieties around them. It leads me to a state where it’s hard to even approach daily life, let alone daily work. Cannabis is one of my remedies for this, and delta-8 proved to have the same benefits that I get by smoking a joint and telling myself that everything is going to be all right. All without the sleepy comedown.

It was a really pleasant surprise, honestly. Something tells me delta-8 might actually be as advertised. It might really be the weaker version of THC that makes cannabis more approachable for people with lower tolerances.

By 12pm, the delta-8 high had started to subside, and at 2pm the only lingering effects of the high were dry mouth and dehydration.

All in all, if I were to describe the high in one word, I’d say: energizing.

Never once did I feel a groggy comedown. Never once did I feel my body succumb to the THC. Instead, I felt productive, motivated, and happy. It was the same type of high I get from consuming strains like Apple Fritter, Super Silver Haze, and Chocolope.

This is opposed to traditional edibles, where it’s only a matter of time before I’m horizontal on the couch with the Roku remote in-hand ready to waste hours of life watching Joe Budden Podcast episodes on YouTube. With delta-8, I popped a few of those bad boys and locked into Google Docs for four straight hours. Ernest Hemingway could never.

So yes, based on personal experience alone, I’d say that delta-8 gummies do get you high, and that the high is less intense than smoking joints of traditional flower or eating traditional edibles.

100mg dose

I ate the 100mg dose of delta-8 gummies at 4pm. If I’m keeping it real, the experience felt exactly the same as the 50mg dose. I wasn’t higher or anything, it was just right back to a quick head and body buzz that never once tailed off into a sleepy comedown, even as I moved well into the evening.

I was low-key disappointed with that—I thought boys were about to take off for the moon. In the end, it showed me that I could probably pop delta-8 gummies all day long without feeling like I need a 48-hour nap to clear out the oh-my-god-I’m-so-high cobwebs I sometimes get from traditional THC.

Does delta-8 THC get you high?

Yes, delta-8 definitely gets you high, but it was a lighter high than I’m accustomed to from smoking joints, taking dabs, and eating regular edibles.

These gummies were definitely less intense than the normal Smokiez fruit chews, and in the end, this home-cooked experiment left me feeling like delta-8 could be great for people who want an energizing experience from cannabis but don’t want to smoke joints or take dabs for it.

Or if you simply get way too high from joints and dabs and you’ve been running from cannabis and its many benefits, delta-8 could be the training wheels you’ve needed all along.

Most of the time, people expect edibles to hit hard and have you stuck to the couch in slump mode. Perhaps delta-8 is the solution to avoid that.

Or perhaps it’ll be outlawed before we get the chance to see.

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How one woman is adjusting, getting older, and getting wiser about weed

When I first started consuming cannabis, I was a 21-year-old college student. My cannabis routine consisted primarily of shared bowls, bongs, and blunts packed with THC-dominant cannabis flower, and I typically only consumed on nights and weekends.

Just as it does now, cannabis helped me relieve stress, anxiety, pain, and depressive symptoms back then. It helped me fall asleep faster and sleep better as well. But in the near-decade that’s passed since my first toke, aging has changed my cannabis routine in so many ways. Everything from my preferred method of cannabis consumption to my dosing preferences to my THC tolerance is completely different now.

The topic of cannabis and aging has been on my mind since I entered my 30s in 2020. So, I asked two cannabis-informed physicians — Jordan Tishler, MD, and Dr. Laszlo Mechtler, Medical Advisor at Jushi Holdings, Inc. and Medical Director of Dent Neurologic Institute — to weigh in on the primary ways aging has changed my cannabis routine, and how it might change yours as well.

How aging has changed my preferred method of cannabis consumption

Until my late 20s, smoking and vaping were my favorite ways to consume cannabis. As someone who has always used the plant to relieve stress, pain, and anxiety — and later in my cannabis journey, PTSD symptoms as well — I appreciated the instant relief inhalation provides.

As I age, however, I prefer sticking with edibles and tinctures, partially due to health issues that weren’t present in my life until 2019, but also because I’m more health-conscious in general now and I want to protect my lungs.

When asked about it, Tishler said he doesn’t think preference is the right way to look at one’s consumption methods.

“As a cannabis specialist, I think preference isn’t really the right way to look at it. Different routes of administration cause different outcomes, so the approach is best tailored to the symptoms,” he explains.

Mechtler says something similar: “In general, the best method for cannabis consumption depends on what is the person using the cannabis product for. Are they simply using it to ‘catch a buzz,’ or are they trying to treat an underlying health condition?”

Mechtler recommends tinctures and capsules because they typically yield six to eight hours of relief for patients while inhaled products only yield two to three hours of relief.

Additionally, both Tishler and Mechtler discourage smoking and vaporizing cannabis since those methods put our health at risk. “I would not recommend smoking because it’s not good for us, which is something that becomes of greater concern to people who are older,” Tishler says.

As an oncologist, Mechtler says he has a very hard time recommending a smoked or vaporized cannabis product to his patients. “This is something that is even more important now with the ongoing COVID-19 pandemic. One should really be doing everything they can to protect their cardiopulmonary system,” he says.

How aging has changed my dosing preferences and my THC tolerance

I moved from California to Missouri in 2019. I still can’t afford my Missouri medical marijuana card — but that’s only partially why my cannabis routine consists primarily of full-spectrum, hemp-sourced CBD products and has for nearly two years. Simply put: when it comes to THC, I feel like less is more.

When I was younger, smoking an entire bowl, taking multiple bong hits, or eating a 20 milligram edible in one sitting felt great.

For years, high doses of THC-dominant cannabis products and strains effectively squashed my anxiety and PTSD symptoms with little or no negative side effects.

But shortly after I turned 29, large doses of THC started making me feel worse. I’m not alone in this experience, either. Anecdotal evidence suggests age can play a role in how a person experiences THC. Additionally, the results of a 2007 study support a connection between age and THC sensitivity.

Over the course of the study, two age groups of rats were given THC and then put through tasks designed to test their stress and anxiety levels. The study results led researchers to conclude that the older rats were more likely to suffer from higher levels of stress and anxiety after consuming THC than the younger ones.

Whereas I used to smoke and vape almost exclusively, often several times a day, these days I prefer taking 15 to 30 milligrams of high-quality CBD two or three times a day. I feel like my current routine works beautifully to ease anxiety and promote sleep. And I love that there’s little risk for impairment or paranoia with CBD. Even when I do manage to get my Missouri medical marijuana card, I’ll probably keep consuming hemp-sourced CBD oils daily and consume low-dose THC edibles only.

Aging won’t necessarily affect your ideal dose or your THC tolerance in the same way it’s been affecting mine, though. Tishler says dose doesn’t seem to correlate well with age. “Some of my highest dose patients are the older ones, even if they started from completely cannabis naive,” he says.

Regarding anxiety and PTSD, Tishler says THC dose can have a very fine line, and crossing it exacerbates those conditions. “I also suspect that the mindset of the patient is very important to where that line lies, and as you age concerns about both existential issues as well as your cannabis use may contribute to shifting that line lower,” Tishler says. Indeed, a number of factors can affect a person’s cannabis high.

Why consistency is crucial for any cannabis routine

Ultimately, aging looks different for everyone, and no two bodies are exactly the same. There are multiple ways to have a healthy cannabis routine, and it’s entirely possible mine will change — possibly many times — as I continue to age.

But one thing is for certain: consistency is essential for any cannabis consumer.

“Sticking to a routine is key,” Tishler says. “Working with your cannabis specialist to find the right route and dose and then taking it consistently (like a medicine) leads to best benefit.”

Whatever your preferences regarding consumption methods and THC content, you can’t go wrong with this standard cannabis advice: start low and go slow.

And with the COVID-19 pandemic still raging, cannabis consumers of all ages should be extra careful to protect themselves and their lungs.

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We’re probably all familiar with the belief that cannabis flower burning to “white ash” indicates it was grown right or is otherwise good bud. Similarly, we likely all know the old-school belief that holding in a hit gets you higher (“if you cough you don’t get off”), which was disproved by research over 30 years ago.

So if the long-held belief that holding in hits gets you higher is not true, yet persists, what about white ash?

Is there something about bud that burns to white that makes it better than bud that burns to black?

Leafly reached out to a team of cannabis experts, researchers, growers, and patients to try and ascertain what truth is behind the beliefs around white ash.

Common white ash theories

Before turning to the experts, Leafly wanted to see what folks were saying on social media about the white vs. black ash debate.

We saw three main responses:

• People who felt a growing step called “flushing” was the cause of white ash and a sign of good bud;
• people who felt it was a measure of moisture in the bud (too moist bud = black ash);
• and people critical of the entire premise.

“A properly grown bud flushed of nutrients with water for the last 10 days of growth will give you a white ash when the bowl is cashed,” said Jake Sassaman.

“I used to think that was the case, but I have come to learn that it may not be indicative, actually, of residual salts, completed cure, or otherwise,” said Demetrius Daniels.

“My layperson’s understanding is that this is a rough measure of remaining water content,” said Jay Reynolds.

“For us old hippies, white ash is not a factor. Smoke to the last hit—as long as we can get high it’s good,” said Janet Benaquisto.

The Dank Diplomat and the star of Netflix’s Cooking on High, Ngaio Bealum, said, “I have noticed that white ash tends to indicate a better bud.”

Tappié Dufresne, a longtime cannabis patient and consultant who formerly worked at the historic early collective C.H.A.M.P., added, “White burning ash (from anything burning) indicates a clean combustion. You can think of campfires you might have watched. If the wood is green, it leaves a chunky charcoal.”

The ‘flushing’ controversy swirls

While there is some divide over what white ash signifies, there is pretty wide consensus around the importance of a weed grower’s common practice called “flushing.”

Hydroponic indoor growers “flush” the plant for the last 10 days before harvest by only feeding it water, instead of a nutrient mix.

Dufresne compared flushing cannabis with water to fasting for people, “It forces any stored nutrients to be used up by the plant and triggers a push to ripen.”

While Dufresne supports flushing, she also noted, “Even well-flushed flowers that are rushed through the drying and curing process will not burn perfectly.”

But what does the research on flushing say?

Flushing science is thin

Dr. Robert Flannery (Dr. Robb), an expert in cannabis biology, said, “There isn’t much research that supports this concept,” and pointed to a Master’s Thesis which found flushing “to be ineffective in removing any significant amount of nutrient from the bud.”

Dr. Robb is co-authoring The Cannabis Grower’s Handbook with Ed Rosenthal and Angela Bacca, which will be released this September and delves deep into flushing, how it is done, and if it actually does anything.

It specifically points to a lack of “double-blind studies that have been performed to test the efficacy of flushing,” but notes that despite that absence of research, “the overwhelming majority of cannabis growers flush.”

Josh Wurzer, the president and co-founder of SC Labs in California, said he personally “can taste a poor flush when smoking flowers.”

Why wet weed won’t burn white

While the majority of cannabis growers flush and it is a concern for some consumers, others wonder if black ash may be the result of too much water, rather than not enough.

Despite being able to taste the difference in flushed vs. not flushed flowers, Wurzer at SC Labs was clear that “black ash is a sign of incomplete combustion,” adding, “I’m not aware of a plausible explanation that a cause of poor combustion would be a poor flush.”

Wurzer listed the potential reasons for incomplete combustion, such as:

• too much moisture in the flower (as is the case with a poor dry and cure);
• a poorly rolled joint;
• or a really resinous flower.

Wurzer said taste, not ash color, is “probably a better indicator” of good bud.

Of bowls and black ash

White ash may not have as much to do with the bud itself, but how it is smoked, specifically, in a joint or a blunt.

SC Labs’ Wurzer explained the science behind joints burning more:

“Joints/blunts also heat the material that is about to be burned, vaporizing both the resin and moisture in that part of the bud, which means that two of the major contributors to an inefficient combustion—and therefore black ash—are removed from the equation, or at least reduced before that part of the joint even combusts.”

Additionally, Wurzer noted that “the airflow is much more optimized for an efficient combustion in a joint vs. a bong or bowl.”

That is why pipes tend to burn black while joints burn white.

It really comes down to if you like the smell, taste, and the high—not the ash, it seems.

White ash on its own is an insufficient proxy for quality; there’s too many other factors at play. (I mean, cigarettes burn pure white, and no one’s Instagramming their Camel Lights.)

So if it burns white and you like it—great! If it doesn’t—that can be OK, too.

What are your thoughts on the white vs. black ash debate? Leave us a comment and join the conversation.

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They say the endocannabinoid system (ECS) is as unique as a fingerprint, and cannabis affects us all differently. Company EndoCanna Health is exploring this by offering a DNA test that will show your body’s genetics and suggest a cannabis profile accordingly, as well as products for that profile.

This tool wouldn’t be with us today without a real Bob Ross of a happy accident—the moment Len May, CEO of EndoCanna Health, accidentally found an effective way to manage his ADD. According to May:

“I was kind of hanging out with some older kids, and they asked me if I wanted to smoke a cigarette—and I was like, yeah, you know, I’m dabbling with cigarettes, I’m gonna be cool—and the cigarette was actually filled with weed instead. After I got done coughing, I went back to class, and the windows in my head [referring to what it’s like to think with ADD] they sort of slowed down, and I could focus. So I found my medicine, it was mine.”

After getting kicked out of the house for cannabis—ironically, his parents now use his cannabis formulations—he became a cannabis activist and started working in medicinal genomics, which eventually led to EndoCanna Health, and the ability to use cannabis on a truly personal level.

How does EndoCanna Health’s DNA test work?

While receiving the $199 test can take a month or two, taking the test is a matter of seconds: carefully swab the inside of your cheek, then pop the swab into a tube. After registering your test into their HIPAA-compliant, fully anonymous portal, seal the swab and tube in a plastic bag, pop it into the provided paid envelope, and send ‘er off to the lab. If you have DNA data already, it’s faster and only costs $49.95.

Once your results are ready, log into your profile, which will have an itemized breakdown of your report and suggestions for types of cannabis. The report is broken down into:

• Anxiety
• Cognitive function & behavior
• Digestive
• Drug dependence
• Drug metabolism
• Fitness
• Metabolism
• Mood
• Musculoskeletal & immune
• Pain, nausea, & neurologic
• Sleep
• THC side effects

Digging into my report

Clicking through the various reports shows how cannabinoids interact with your genetic profile in specific ways. For instance, clicking on “Anxiety” brings three more reports: “Fear Extinction,” “PTSD,” and “Stress Reactivity.”

Under “Fear Extinction,” for example, is this summary of my specific DNA marker findings, as well as suggestions for types of cannabis to use:

In this case, it suggests I start using high-CBD ratio products, as well as cannabis with terpene profiles that include linalool and beta-caryophyllene. These responses are called “formulations,” and my report suggests seven different ones for specific needs.

Also, the Personalized Wellness Plan links to relevant scientific studies and provides a link to products that match the formulation.

CEO May explained that although EndoCanna Health does sell terpene blends used in some recommended products, they don’t profit directly from sales of products recommended on the Wellness Plan: “We look at certificates of analysis from different product manufacturers and run them to a matching algorithm, and we look for several things: Number one, we look for the percentage of CBD, THC; Secondary, terpene profile; and then some others, like essential oils.”

How to use your cannabis DNA test results

“The best way to get the most out of your results is to understand what your genetic predispositions are to avoid an adverse effect and then to understand which products you can actually take,” said May.

With your test results, you’re equipped to treat symptomatic conditions based on specific genotypes in your body. “If you have a predisposition to anxiety or stress reactivity, you will know that there are certain cannabinoid and terpene profiles that can actually turn that genetic expression on,” said May.

For example, if you have a marker associated with not producing endocannabinoids when anxious—as the body ought to—you’ll be able to know what kind of cannabis can be substituted effectively.

And it’s a living document as well, meaning it will evolve as research does. “We have a HIPAA-compliant portal that is dynamically built with lifetime updates, meaning that if there is any research that is happening now that gets published, we provide that as an update to your report on a lifetime basis. And we’re fully secure and anonymized. All the data resides on Amazon’s AWS; it’s fully encrypted,” said May.

May continued to speak on what’s ahead: “The future is this whole feedback loop: It’s the ability to be able to get a response from people, how you know product ‘A’ is really working for you, learn from your experience, and then be able to produce better individualized products.”

EndoCanna Health is a research lab as well, working on studies all over the world. The company is also looking into expanding the use of epigenetic data and using biomarkers, like Fitbit info, to create a dashboard that will further personalize your experience.

Is the test worth it?

My take is probably obvious by now: I think this is a fantastic resource. I love that it breaks down which cannabinoids and terpenes will help various aspects of my body makeup. As a medical cannabis user, I find this especially relevant—it also confirmed I’m high-risk for flu severity—but these reports will also be helpful for anyone without any medical issues because we all have different bodies and cannabis will interact with each body differently.

EndoCanna Health is also looking to collaborate on research, even with competitors, because “the only way to remove this ridiculous stigma is through science,” said May.

I love it. Let’s science our way from being disregarded as just stoners to having data to improve specific conditions or for overall health, and knowing how best to use cannabis for those specifications.

And all this magic started with a teenager trying to smoke a cig, and failing. C’est la vie, eh?

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Cannabis is celebrated for the benefits it offers in the management of certain medical conditions. As awareness around cannabis grows, consumers are becoming better versed in the therapeutic potential of cannabinoids in the treatment of specific autoimmune diseases, inflammation, and gastrointestinal disorders.

But how does cannabis affect the immune system as a whole? If you’re a regular consumer, you may have pondered whether cannabis weakens or boosts your immune system. Can frequent cannabis use render you more prone to infections or contagious diseases?

As it turns out, research into cannabis and the immune system hasn’t historically piqued the interest of scientists. However, as our understanding of the effects of cannabis on the body becomes more sophisticated, we need to also broaden our knowledge of how cannabis influences the immune system.

Present evidence suggests that cannabis can suppress immune system function. While this can be helpful for individuals with autoimmune illnesses, it may not be so beneficial for those with functional immune systems.

Meet your immune system

The immune system is one of the body’s most sophisticated networks. A collection of specialized cells, endogenous chemicals, and organs work in concert to ward off pathogens and infections, protecting the health and homeostasis of the body.

The immune system is multifaceted, and its core components that actively combat infection include white blood cells, the complement system, antibodies, the lymphatic system, the spleen, the thymus, and bone marrow, but we’ll mainly talk about white blood cells.

Memories of every microbe previously defeated by the immune system are logged in white blood cells. These memories enable the fast tracking and elimination of infections that have already been experienced. The immune system is also responsible for detecting and eradicating malfunctioning cells.

The knowledge we have about the interaction of cannabis with specific immune elements is limited. While there is some research exploring the effects of cannabinoids on white blood cell count and the lymphatic system, we know less about how cannabis impacts the thymus or the complement system.

Cannabis, the endocannabinoid system, and the immune system

An elegant connection exists between the body’s endocannabinoid system (ECS) and its immune system. The ECS is generally considered to be one of the gate-keepers of the immune system, preventing the onset of overwhelming inflammatory responses that may result in disease. The ECS can also influence the function of immune cells.

CB1 and CB2 receptors in the endocannabinoid system mediate the effects of cannabis within the immune system. The two major cannabinoids, THC and CBD, appear to have distinctive effects on the immune system due to their unique interactions with cannabinoid receptors. Abundant literature suggests that cannabinoids affect the functions of most types of immune cells.

A 2020 review found robust evidence that CBD suppresses certain inflammatory responses in the immune system and may induce cellular death in immune cells. Immune cell death isn’t always a bad thing—it’s a normal part of the cellular life cycle, and helps to protect a person by alleviating inflammatory responses.

Like CBD, THC also suppresses immune activity, dialing down inflammatory responses. THC has also been shown to alter the function of immune cells responsible for antimicrobial activity.

How does cannabis affect the immune system?

When scientists discuss cannabis and the immune system, they often discuss its effects as immunomodulatory or immunosuppressive. Immunomodulation refers to any therapy that modifies the immune system response. When cannabis suppresses the expression of aspects of the immune system, this form of modulation is known as immunosuppression.

It’s vital to point out here that marijuana’s ability to subdue or suppress immune system cells can be useful if the immune system is dysregulated and in need of suppression. If not, immune suppression might not be helpful.

Research published in 2017 indicated that both CBD and THC have an immunomodulatory effect on the human intestinal lymphatic system, the major host of immune cells. The lymphatic system also contains more than half the body’s lymphocytes—white blood cells that play a critical role in finding and destroying foreign cells or substances that have infiltrated the body.

The study’s authors found that oral administration of CBD and THC with fats resulted in extremely high cannabinoid levels in the intestinal lymphatic system: CBD concentrations in lymph cells were 250 times higher than in plasma, while THC concentrations in lymph cells were 100 times higher than in plasma.

So, what’s the significance of this? For individuals with autoimmune diseases, cannabis can achieve higher concentrations in the lymphatic system and suppress unhealthy inflammatory immune responses more successfully.

The pros and cons of cannabis as an immunosuppressant

While the immunosuppressive properties of cannabis may be just what the doctor ordered for autoimmune patients, they can cause problems for other cannabis users.

Research carried out in 2003 on healthy volunteers suggests that regular cannabis may subdue immune function. Cannabis users were found to have fewer proinflammatory cells and more anti-inflammatory cells.

While less potential for inflammation may sound like a win, in this case, it was associated with a significant reduction in white cell functionality, and impaired white cells can mean a hindered ability to fight off infections. Regular cannabis users also had decreased amounts of natural killer cells, which limit the spread of tumors and microbial infections.

The study also indicated that there may be a dose-response relationship between cannabis use over an individual’s lifetime, and a decrease in certain immune system markers, meaning those who use cannabis regularly may be more susceptible to the progression of infectious disease.

What about the effects of cannabis on extremely immunocompromised individuals? Unfortunately, cannabis can substantially decrease infection-fighting cells in people undergoing chemotherapy. This suppressive response may further add to the detrimental effects of chemotherapy on immune systems of those with cancer.

Research on people with HIV+ and AIDS, who are particularly vulnerable to infections, however, indicates that there is no firm evidence that cannabis adversely affects immune function.

Instead, findings suggest cannabis use among HIV+ patients may enhance the immune system by producing a statistically significant decrease in viral load and an increase in CD4 cells. CD4 cells can be considered a marker that indicate the robustness of the immune system.

While existing research allows us to glean insights into cannabis and the immune system, we need more rigorous data to paint broad brushstrokes. According to the most recent 2017 report from the National Academies of Science, Engineering, and Medicine (NASEM), there’s insufficient research on the effects of cannabis or cannabinoid-based medicines on the human immune system to draw firm conclusions.

Cannabis in the time of coronavirus

Within the current global climate shaped by COVID-19, there’s an impulse among the research community to enhance our understanding of the impact of cannabis on the immune system. Some cannabis researchers are currently channeling their focus into investigating whether cannabis may be helpful or harmful in treating COVID-19.

More profound exploration into the effects of cannabinoids on the immune system is also being encouraged. Watch this space as new frontiers are forged.

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In order for a prescription drug to reach the market, it must be extensively studied, first in animal and then in human clinical trials. Safety, efficacy, and risks must be determined. But as anyone who has seen a commercial for a prescription drug knows, there are still side effects. There are risks in stopping a prescription. And, of course, there are the risks of addiction.

Prescription opioid painkillers have increased drastically from common-use pill to massive public health crisis. At the same time, the perception of marijuana has shifted away from it as a gateway drug to using it as medicine.

Now, several recent studies show that public opinion is shifting to the point of substituting cannabis for opioids and other prescription drugs that have high risks or low efficacy. In addition to opioids, drug substitution is most common for benzodiazepines, like Valium or Klonopin, and antidepressants.

The benefits of substituting a substance for an addictive drug seem obvious, but there is a serious hidden risk in doing so without talking to a doctor. For example, with CBD, its interactions with prescription drugs have barely been studied. Complications can arise from drug interactions and withdrawal symptoms, resulting in incorrect dosages and potentially unknown side effects.

Patients are substituting prescriptions with cannabis

With unregulated whole-plant and hemp-derived CBD easily available online and in grocery stores across the United States, as well as recreational and medical cannabis in shops in the US and Canada, some people are doing just that.

One specific substitution holds promise, but also danger: benzodiazepines.

Benzos—such as Klonopin (clonazepam) and Valium (diazepam)—are commonly prescribed for anxiety, insomnia, seizures, alcohol withdrawal, and muscle spasms, all of which also have the potential to be treated with medical cannabis, especially CBD. But unlike CBD, benzodiazepines have been around the scientific block, completing the clinical trial process and landing on the market in the 1960s. Also unlike CBD, they are known to be addictive.

“There’s this great opportunity because of the opioid crisis to find alternatives,” said Dr. James Corroon, Medical Director at the Center for Medical Cannabis in California, who published a study on cannabis substitution for pharmaceutical prescriptions last year. Of 2,774 participants, 46% reported substituting cannabis for a pharmaceutical drug. “There’s reason to be hopeful,” he said, “but we need more data.”

There’s also reason to be concerned. Self-identified “medical” consumers were about five times as likely to substitute drugs with cannabis than recreational consumers, according to the study. And almost a quarter of recreational consumers also reported substitution.

Non-prescribed swapping of THC or CBD for a prescription drug often occurs accidentally at first: A chronic pain patient might smoke marijuana recreationally and notices it helps; an insomnia patient might eat a CBD chocolate for anxiety but then is able to sleep; a person might get a medical marijuana card for anxiety and discover it helps with pain and insomnia.

While this might seem like a serendipitous coincidence for patients, the pattern is a warning to doctors. “These people aren’t getting the right care,” said Dr. Corroon. The concern is with drug interactions.

If you add CBD to a drug regimen of an opioid or a benzo, it creates an amplification effect, Dr. Corroon explained. With CBD and Valium, for example, the liver metabolizes CBD first. The Valium is then sent back into the bloodstream, allowing the same dose to last longer. As a result, the patient may be unintentionally overmedicating. This also means a patient could be prescribed a lower dose of Valium to experience the same relief.

This can be great if a healthcare worker is supervising a patient and their drug substitutions, but doses of benzos need to be slowly decreased to be safely stopped, regardless of whether another drug is added.

Rapid decreases of any drug can be dangerous. Benzodiazepines depress the central nervous system and an abrupt change can leave the brain struggling for balance. Benzodiazepine withdrawal can cause a return of symptoms, additional anxiety, insomnia, and flu-like symptoms. More severe symptoms include panic attacks, hand tremors, depression, and seizures.

Without medical advice and supervision, a person could experience withdrawal, unnecessarily low or high doses, or vacillation between the two as anxiety decreases and returns, said Dr. Corroon.

Can cannabis help?

Cannabis treatment is being broadly studied as a partial or full substitution for opioids, but research is just beginning on its possible use in reducing benzodiazepine use.

“There is a role for benzodiazepines in clinical practice,” said Dr. Chad Purcell, a surgical resident at Dalhousie University. But there’s an issue with benzodiazepines that is similar to that of opioids, he said.

In a small study, Dr. Purcell and his associates analyzed information provided by patients new to cannabis treatment who were already taking benzodiazepines. Almost a third stopped their benzodiazepine treatment within two months. And almost 45% ended use by four months.

“There seems to be something at play here,” Dr. Purcell said. But he cautioned against drawing a direct line between the two. Just because two things happened—starting cannabis and stopping benzodiazepines—doesn’t mean one caused the other.

Another recent study, led by Dr. Phillipe Lucas, VP of Patient Research at cannabis producer Tilray, showed high trends of cannabis substitution across all types of prescription drugs.

Dr. Lucas and authors analyzed cannabis use patterns and substitutions of 2032 Canadian medical cannabis patients who responded to a survey.

Many participants reported more than one substitution. About 45% reported substituting cannabis for alcohol, 31% substituted it for tobacco, and 26% substituted it for illicit drugs. A whopping 69% reported substituting cannabis for prescription drugs.

Unsurprisingly, opioids were the most common among pharmaceutical substitutions, at 35%. Antidepressants and anti-anxiety prescriptions came in close behind at 21%.

Detailed questions revealed that chronic pain and mental health issues were the two most common reasons participants took cannabis, both at just under 30%.

Chronic pain is often accompanied by mental health conditions, especially anxiety and insomnia, said Dr. Lucas. It’s a common trifecta of diseases and a troubling one. The conditions can exacerbate each other and the knot of symptoms can be difficult to untangle. It’s not uncommon for endless pain to cause severe anxiety and prevent sleep, Dr. Lucas said. Roughly half of participants reported experiencing all three as primary symptoms, according to the study.

Patients experiencing this medical triad often take more than one daily prescription as treatment, so it’s not surprising that many study participants substituted for more than one drug, Dr. Lucas explained. And it’s possible that, if a cannabis substitution could more effectively treat a root cause of chronic pain, medications for anxiety, insomnia or depression could become unnecessary.

For those people who are making a conscious choice to substitute, and doing so with medical guidance, there seems to be only an upside. It’s the people who accidentally substitute or self-prescribe that worry Dr. Lucas. “It gives me great concern.”

Stay informed and healthy

Always talk to your doctor before starting or stopping a new medication. Ask about potential prescription interactions and options. If you already take a prescription medication, talk to your prescribing physician about your marijuana and/or CBD use.

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Among women who enjoy marijuana, there’s no shortage of anecdotal evidence that adding a bit of cannabis can bring a thrill to the bedroom, and in states where the drug is legal, marketers have capitalized on that claim. THC-infused lubricants promise increased arousal and better orgasms, and some sexual health advocates have built entire careers on cannabis-enhanced intimacy. But is there anything behind the hype?

While researchers are still trying to tease out the precise relationship between cannabis and sex, a growing body of evidence indicates the connection itself is very real. The latest study, which asked women who use marijuana about their sexual experiences, found that more frequent cannabis use was associated with heightened arousal, stronger orgasms and greater sexual satisfaction in general.

“Our results demonstrate that increasing frequency of cannabis use is associated with improved sexual function and is associated with increased satisfaction, orgasm, and sexual desire,” says the new study, published last week in the journal Sexual Medicine.

“Increased cannabis use was associated with improved sexual desire, arousal, orgasm, and overall satisfaction.”

To reach their conclusions, the team analyzed online survey results from 452 women who responded to an invitation distributed at a chain of cannabis retail stores. Researchers asked respondents about their cannabis use and had each fill out a Female Sexual Function Index (FSFI) survey, a questionnaire designed to assess sexual function over the past four weeks. The survey scores six specific domains, including desire, arousal, lubrication, orgasm, satisfaction and pain.

“To our knowledge,” the authors wrote, “this study is the first to use a validated questionnaire to assess the association between female sexual function and aspects of cannabis use including frequency, chemovar, and indication.”

Generally speaking, a higher FSFI score is understood to indicate better sexual function, while a lower score indicates sexual dysfunction. Comparing frequency of cannabis use to each participant’s FSFI score, the researchers determined that more frequent consumption was associated with lower rates of sexual dysfunction.

“For each additional step of cannabis use intensity (ie, times per week),” the report says, “the odds of reporting female sexual dysfunction declined by 21%.”

“We found a dose response relationship between increased frequency of cannabis use and reduced odds of female sexual dysfunction.”

Women who used cannabis more frequently had higher FSFI scores in general, indicating better sexual experiences overall. More frequent consumers also had higher specific FSFI subdomain scores—indicating things like greater arousal and better orgasms—although not all of those differences reached the threshold of statistical significance.

Another weak relationship showed that women who used cannabis frequently reported lower levels of pain related to sex.

“When stratified by frequency of use (?3 times per week vs <3 times per week), those who used more frequently had overall higher FSFI scores and had higher FSFI subdomain scores except for pain,” the study says.

The research doesn’t shed much light on what marijuana products might work best for sexual stimulation, however.

“Our study did not find an association between cannabis chemovar (eg, THC vs CBD dominant), reason for cannabis use, and female sexual function,” the researchers, who included members of the Stanford Medical Center’s urology department and the medical director of the Victory Rejuvenation Center, wrote. “Neither, the method of consumption nor the type of cannabis consumed impacted sexual function.”

Researchers said a number of mechanisms could explain the overall results, noting that prior studies have postulated that the body’s endocannabinoid system is directly involved in female sexual function. It’s also possible, authors wrote, that cannabis could be improving sex by reducing anxiety.

“As many patients use cannabis to reduce anxiety,” the report says, “it is possible that a reduction in anxiety associated with a sexual encounter could improve experiences and lead to improved satisfaction, orgasm, and desire. Similarly, THC can alter the perception of time which may prolong the feelings of sexual pleasure. Finally, CB1, a cannabinoid receptor, has been found in serotonergic neurons that secretes the neurotransmitter serotonin, which plays a role in female sexual function thus activation of CB1 may lead to increased sexual function.”

As the study notes, cannabis’s potentially positive effect on women’s sexual function was first noted in research from the 1970s and ’80s, when women in research interviews who used cannabis reported better sexual experiences, including more intimacy and better orgasms. But subsequent research has yielded mixed results. Some studies have found that women’s orgasms were actually inhibited by cannabis use. Authors of the new report said that past studies used interviews rather than a validated questionnaire to conduct research.

“The mechanism underlying these findings requires clarification,” the authors said of their report, “as does whether acute or chronic use of cannabis has an impact on sexual function. Whether the endocannabinoid system represents a viable target of therapy through cannabis for female sexual dysfunction requires future prospective studies though any therapy has to be balanced with the potential negative consequences of cannabis use.”

Regardless of the mechanics at work between marijuana and sex, emerging evidence is overwhelming that there’s some sort of relationship at play. A nationwide survey conducted by an East Carolina University graduate student last year found that “participants perceived that cannabis use increased their sexual functioning and satisfaction.” Marijuana consumers reported “increased desire, orgasm intensity, and masturbation pleasure.” Numerous online surveys have also reported positive associations between marijuana and sex, and one study even found a connection between the passage of marijuana laws and increased sexual activity.

Yet another study, however, cautions that more marijuana doesn’t necessarily mean better sex. A literature review published last year found that cannabis’s impact on libido may depend on dosage, with lower amounts of THC correlating with the highest levels of arousal and satisfaction. Most studies showed that marijuana has a positive effect on women’s sexual function, the study found, but too much THC can actually backfire.

“Several studies have evaluated the effects of marijuana on libido, and it seems that changes in desire may be dose dependent,” the review’s authors wrote. “Studies support that lower doses improve desire but higher doses either lower desire or do not affect desire at all.”

CBD Is A ‘Promising’ Therapy In Treating Cocaine Misuse, Meta-Study Finds