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I know a lot of cannabis fans (and count myself as one). Very, very few of them acknowledge that cannabis affects people inconsistently; one person's reaction t

I know a lot of cannabis fans (and count myself as one). Very, very few of them acknowledge that cannabis affects people inconsistently; one person's reaction to it can be very different than others. This is inconvenient for calling it a "medicine" so let's just ignore it. Psychedelics are even worse. The same dose of the same drug can produce wildly vary effects in the same person depending on factors we have trouble nailing down. "Set and setting" and the Erowid wisdom are all very well, but they are barely enough to describe the area and edges of the therapeutic window in a general way. Your trip, today, is still going to be an experiment.

vmoore 5y ago
And we lack actual shamanic centers where we can do this stuff safely, where the dose is exact and you know what you're getting, and you can have guides to help you through the trip if things start feeling sketchy. And we could even have people on standby to administer anti-psychotic medicine in-case you have adverse reactions and need to calm down quickly before you do something stupid. The illegality of these substances is illegal in itself!
- suction 5y ago
  I think the issue starts with the moniker "shamanic", which does not sound like a place many people would trust their health to.
  - hutzlibu 5y ago
    Well, I would rather say there are probably way too many people, who would totally trust such a place with their whole health, just because of the name and some other esoteric buzzwords like indigenous, ancient wisdom. I do have great respect for "real" shamans. But I met way too many fake ones, handing out horrible and dangerous advice, while glowing in their self declared illuminative state of higher consciousness.
    - aaaaaaaaata 5y ago
      Where'd you find these?
      - hutzlibu 5y ago
        All around the world. Most are quite harmless and you still can have interesting conversations with them. Some are more weird and even dangerous, like this individual, which I have not met personally, but people like him. https://en.m.wikipedia.org/wiki/Jake_Angeli https://en.m.wikipedia.org/wiki/Jake_Angeli
    - mountainriver 5y ago
      Yeah its interesting because I've had absolutely game changing experiences with real shamans, and then bad experiences with phony ones. If you find a good one, stick with them
- npteljes 5y ago
  I agree. And I also think that for the same reasons, the psychiatry system, at least the parts that I was exposed to, is abysmal. They prescribe according to whatever scriptbook is en vogue at the jurisdiction and the substances themselves are very far from proven - and also the part where you're guided on the trip you're having can be almost completely missing. There's a huge room for improvement in this area.
- darod 5y ago
  Check out the Cover Story podcast mentioned in the article. It's pretty eye opening. They mention a few centers that historically you can categorize as unsafe. The key would be to find professionals that have your best interests in mind but the podcast and this article reveal how surprisingly difficult that is.
bitxbitxbitcoin 5y ago
As they say: everyone’s endocannabinoid system is different. They also say everyone’s brain is wired differently. Completely agree that every first use whether it is THC or psilocybin is at the end personal experimentation with non zero risk.
jamal-kumar 5y ago
It's fun to send this "MAYBE YOU JUST HAVENT TRIED THE RIGHT STRAIN" [1] image to friends who don't like weed because it's a pretty hilarious embodiment of the downright anxiety the stuff engenders in a lot of people. I'm pretty sure it's like a genetic thing. I think I remember hearing something about the COMT gene being potentially affected if you smoke too much too early in life as a teenage stoner or whatever, and how this can lead to mental illness down the line... There's a lot we really don't understand yet fully about these things. [1] https://i.imgur.com/mJrlu1C.jpg https://i.imgur.com/mJrlu1C.jpg
- endorphine 5y ago
  Cannabis triggered my first panic attack, which then triggered my depression for a few months. It wasn't the first time I was doing Cannabis, but I haven't done any more ever since then.
- standardUser 5y ago
  I'm convinced that the "normal" way Americans consume weed is basically an overdose for most people. Heavy users drive the market and the 30% THC and higher strains are targeted at those high-spending, high-tolerance users. I started to enjoy weed again when recreational stores opened up and I could find 10-15% THC weed that gets me pleasantly high, not paranoid and incapacitated.
  - supertofu 5y ago
    I find that CBD-rich hemp still gets me "high", but the effect is extremely therapeutic. I hope low-THC cannabis is more widely studied. High-THC cannabis has a very negative effect on my mind, mood, and motivation. But CBD-rich strains with low THC are perfect for handling my anxiety and autoimmune symptoms.
    - aaaaaaaaata 5y ago
      That's moreso "stoned" than "high" — a calm, vs a stimulant sort of thing, with CBD vs THC.
PragmaticPulp 5y ago
Psychedelic enthusiasts can be even worse in this regard. When someone does have a bad trip, they tend to reach for every possible excuse to avoid blaming the drug. This ranges from criticizing their "set and setting" to blaming "triggering an underlying mental health issue". The latter is particularly concerning in the context of treating mental health issues, because by definition everyone in that category has some level of underlying mental health issues. Research is particularly difficult in this area because the study volunteers are self-selecting for psychedelic research. Basically, anyone ending up in a psychedelic research study is doing so because they think psychedelics are promising for mental health and they want to try it out. This creates a huge risk of placebo effect when your patients are arriving with huge enthusiasm and preconceived notions of efficacy. Combine that with the weirdness of a psychedelic trip and it's a recipe for a sort of super-placebo. However, that's doubly interesting in that maybe the real reason psychedelics show efficacy in depression is that they are a sort of super-placebo. Put someone through a weird, confusing psychedelic experience and tell them that it their life will be radically different afterward and maybe they'll believe it so much that it becomes their new reality. Weirdly enough, we have the opposite problem with SSRIs right now because so many patients will start googling side effects and become convinced that they're not going to work before they even take the first dose. It's an interesting area of research, but I think right now there's too much crossover between the research and the pop-culture phenomenon of "psychedelics cure everything". It's also strange that so few people are questioning why all of the previous psychedelic users didn't notice that the drugs were treating depression. In fact, the common wisdom among psychedelic enthusiasts years ago was that psychedelics were to be avoided if someone was not in a good mental state, largely due to all of the negative reactions they noticed. It seems that telling someone "this will cure your depression" provides a different set and setting than just giving them the psychedelics without context.
- criticaltinker 5y ago
  Listen, your comments on all these threads make it clear you’re seriously pessimistic about psychedelic medicine, and that’s perfectly ok. What bothers me is the incessant pushing of this agenda: > anyone ending up in a psychedelic research study is doing so because they think psychedelics are promising for mental health and they want to try it out > maybe the real reason psychedelics show efficacy in depression is that they are a sort of super-placebo This amounts to uninformed armchair dismissal that is inconsistent with a growing body of scientific evidence, and easily refuted by a cursory survey of recent literature and clinical trial results. Surely you’re familiar with double blind randomized placebo controlled studies? I’ve linked you to recent ones in other comments. These methods aren’t perfect and your concerns certainly have merit in general - I just don’t understand why you continue to make these broad and suggestive claims without any supporting evidence.
newbamboo 5y ago
Some psychedelics are more unpredictable than others, and incidentally these seem to be the ones that are hyped the most. LSD is much more predictable than mushrooms for instance, and is well researched partially because of that. The seems generally true for synthetic vs naturally occurring substances across the board, though there are plenty of horrible synthetic drugs like bath salts, synthetic weed. Advocates seem favor this as it allows them a no true Scotsman defense. “You didn’t get real ayauasca”, or with cannabis the hand wavey talk of the “entourage effect.” The biggest problem facing psychedelic research are the researchers involved. They have little credibility, almost like that’s their intention.
- cmrdporcupine 5y ago
  I agree LSD may be more predictable than mushrooms, but it is also a crazy intense 12 hour voyage that leaves one with at least two days of recovery time after. Vs 4 hours for mushrooms. Both are extremely "set and setting" sensitive. Take either on a bad mood day with bad weather, a dirty house, and stuff on your mind... and you won't have a good time.
  - tsimionescu 5y ago
    > Take either on a bad mood day with bad weather, a dirty house, and stuff on your mind... and you won't have a good time. That doesnt sound like the start of an apparently very promising candidate for treating depression and PTSD. Just goes to show how different experiences are, I guess...
    - cmrdporcupine 5y ago
      Yeah, that's because it isn't (imho a promising candidate). It's an interesting experience, though.
      - tsimionescu 5y ago
        Sure, I imagined as much. My point was that your experience (and others like yours) seems to differ significantly from the experience of, for example, the people penning these studies. I personally have no experience with psychedelics (and no desire to get any), so I am just looking with a bit of wonder at the differences from the sidelines.
asdff 5y ago
IMO the tolerance factor is huge with cannabis. Even for experienced daily smokers if you were to take a few days off, the effects are very noticeably more powerful. When you have zero tolerance, the drug feels like on another planet compared to something more familiar like alcohol. When you have a lot of tolerance, its a comfortable buzz you can be productive on, like a workingman's whisky drunk but without the slop.
- supertofu 5y ago
  This is an anecdotal and slightly off topic response to your note on cannabis tolerance. I am a frequent cannabis user and have been for a long time. While I no longer use psychoactive cannabis regularly (not in a fully legal state anymore) but I do use CBD, which purports to be non-psychoactive and, by law, has THC delta-9 levels of below 0.3%. What I find fascinating is that CBD absolutely has a psychoactive effect on me. I suspect that this is because of my prolific use of typical cannabis. The components of CBD must tickle the same pathways that are so accustomed to psychoactive cannabis. The result is that I often get reasonably high from CBD hemp and CBD tinctures. A high tolerance for cannabis seems to create a stronger response to CBD, at least in my case!
  - colechristensen 5y ago
    I think the opposite is what is happening, the regulated CBD products aren't regulated in a way that keeps them free of psychoactive components and nobody noticed yet or aren't too excited to try to change it, legalization being on the menu all over the place.
    - aaaaaaaaata 5y ago
      CBN, CBG, and terpenes, are all responsible for medical and recreational things that regulators don't have a single clue on, and medical folks are only beginning to.
    - deleted 5y ago
      [deleted]
    - deleted 5y ago
netizen-936824 5y ago
Medicines in general can effect people very differently based on their individual biochemistry/proteome
perardi 5y ago
Yup, from experience, you can give the same dose from the same batch of a hallucinogenic drug to people who are broadly similar in terms of age and overall mental health, and you can get a real wild range of results. (Except maybe ketamine. Ketamine seems pretty consistent, in my anecdotal experience.)
jasonvorhe 5y ago
All of medicine has a lot of possible side effects depending on the person taking them. Current anti depressants can have severe side effects, whether just until they're properly dosed or not. No one says we should start handing out shrooms to everyone over lunch. But either we allow illegal, unhealthy, corruption-causing criminal markets to flourish with a lot of negative effects on society or we legalize and control it.
operator-name 5y ago
You may find this recently released video facinating as I did: https://youtu.be/2rUV4TAP46U https://youtu.be/2rUV4TAP46U The idea that cannabis would have inconsistent effects, or the effects of different strains was always a mystery to me until I watched it.
Fnoord 5y ago
(Speaking a bit from experience given past drugs use.) Isn't the same true for stuff like SSRIs? We don't know if/how they are going to affect the patient.
- h2odragon 5y ago
  Yes, but talking about that makes one a "science denier" etc. My wife has a good one: she burns opiates different, so they don't really benefit her. she just gets nausea from them. They've got her down as a "drug seeker" now cuz she refuses them.
  - Fnoord 5y ago
    The two times I got SSRIs prescribed both psychistrists underlined that fact. We are trying to find something which worked for me, and the first choice might not work out. For example, Fluoxetine (Prozac) got the adverse side effect that I got severe muscle fatigue. Basically, it makes me more sensitive to pain. But it also makes me less edgy. I find it counts for all drugs and even food (sugar makes thirsty, requires good dental hygiene; salt makes thirsty, pee less; yet we crave both in our food).

vmoore 5y ago

And we lack actual shamanic centers where we can do this stuff safely, where the dose is exact and you know what you're getting, and you can have guides to help you through the trip if things start feeling sketchy. And we could even have people on standby to administer anti-psychotic medicine in-case you have adverse reactions and need to calm down quickly before you do something stupid. The illegality of these substances is illegal in itself!

suction 5y ago
I think the issue starts with the moniker "shamanic", which does not sound like a place many people would trust their health to.
- hutzlibu 5y ago
  Well, I would rather say there are probably way too many people, who would totally trust such a place with their whole health, just because of the name and some other esoteric buzzwords like indigenous, ancient wisdom. I do have great respect for "real" shamans. But I met way too many fake ones, handing out horrible and dangerous advice, while glowing in their self declared illuminative state of higher consciousness.
  - aaaaaaaaata 5y ago
    Where'd you find these?
    - hutzlibu 5y ago
      All around the world. Most are quite harmless and you still can have interesting conversations with them. Some are more weird and even dangerous, like this individual, which I have not met personally, but people like him. https://en.m.wikipedia.org/wiki/Jake_Angeli https://en.m.wikipedia.org/wiki/Jake_Angeli
  - mountainriver 5y ago
    Yeah its interesting because I've had absolutely game changing experiences with real shamans, and then bad experiences with phony ones. If you find a good one, stick with them
npteljes 5y ago
I agree. And I also think that for the same reasons, the psychiatry system, at least the parts that I was exposed to, is abysmal. They prescribe according to whatever scriptbook is en vogue at the jurisdiction and the substances themselves are very far from proven - and also the part where you're guided on the trip you're having can be almost completely missing. There's a huge room for improvement in this area.
darod 5y ago
Check out the Cover Story podcast mentioned in the article. It's pretty eye opening. They mention a few centers that historically you can categorize as unsafe. The key would be to find professionals that have your best interests in mind but the podcast and this article reveal how surprisingly difficult that is.

bitxbitxbitcoin 5y ago

As they say: everyone’s endocannabinoid system is different. They also say everyone’s brain is wired differently. Completely agree that every first use whether it is THC or psilocybin is at the end personal experimentation with non zero risk.

jamal-kumar 5y ago

It's fun to send this "MAYBE YOU JUST HAVENT TRIED THE RIGHT STRAIN" [1] image to friends who don't like weed because it's a pretty hilarious embodiment of the downright anxiety the stuff engenders in a lot of people. I'm pretty sure it's like a genetic thing. I think I remember hearing something about the COMT gene being potentially affected if you smoke too much too early in life as a teenage stoner or whatever, and how this can lead to mental illness down the line... There's a lot we really don't understand yet fully about these things. [1] https://i.imgur.com/mJrlu1C.jpg https://i.imgur.com/mJrlu1C.jpg

endorphine 5y ago
Cannabis triggered my first panic attack, which then triggered my depression for a few months. It wasn't the first time I was doing Cannabis, but I haven't done any more ever since then.
standardUser 5y ago
I'm convinced that the "normal" way Americans consume weed is basically an overdose for most people. Heavy users drive the market and the 30% THC and higher strains are targeted at those high-spending, high-tolerance users. I started to enjoy weed again when recreational stores opened up and I could find 10-15% THC weed that gets me pleasantly high, not paranoid and incapacitated.
- supertofu 5y ago
  I find that CBD-rich hemp still gets me "high", but the effect is extremely therapeutic. I hope low-THC cannabis is more widely studied. High-THC cannabis has a very negative effect on my mind, mood, and motivation. But CBD-rich strains with low THC are perfect for handling my anxiety and autoimmune symptoms.
  - aaaaaaaaata 5y ago
    That's moreso "stoned" than "high" — a calm, vs a stimulant sort of thing, with CBD vs THC.

PragmaticPulp 5y ago

Psychedelic enthusiasts can be even worse in this regard. When someone does have a bad trip, they tend to reach for every possible excuse to avoid blaming the drug. This ranges from criticizing their "set and setting" to blaming "triggering an underlying mental health issue". The latter is particularly concerning in the context of treating mental health issues, because by definition everyone in that category has some level of underlying mental health issues. Research is particularly difficult in this area because the study volunteers are self-selecting for psychedelic research. Basically, anyone ending up in a psychedelic research study is doing so because they think psychedelics are promising for mental health and they want to try it out. This creates a huge risk of placebo effect when your patients are arriving with huge enthusiasm and preconceived notions of efficacy. Combine that with the weirdness of a psychedelic trip and it's a recipe for a sort of super-placebo. However, that's doubly interesting in that maybe the real reason psychedelics show efficacy in depression is that they are a sort of super-placebo. Put someone through a weird, confusing psychedelic experience and tell them that it their life will be radically different afterward and maybe they'll believe it so much that it becomes their new reality. Weirdly enough, we have the opposite problem with SSRIs right now because so many patients will start googling side effects and become convinced that they're not going to work before they even take the first dose. It's an interesting area of research, but I think right now there's too much crossover between the research and the pop-culture phenomenon of "psychedelics cure everything". It's also strange that so few people are questioning why all of the previous psychedelic users didn't notice that the drugs were treating depression. In fact, the common wisdom among psychedelic enthusiasts years ago was that psychedelics were to be avoided if someone was not in a good mental state, largely due to all of the negative reactions they noticed. It seems that telling someone "this will cure your depression" provides a different set and setting than just giving them the psychedelics without context.

criticaltinker 5y ago
Listen, your comments on all these threads make it clear you’re seriously pessimistic about psychedelic medicine, and that’s perfectly ok. What bothers me is the incessant pushing of this agenda: > anyone ending up in a psychedelic research study is doing so because they think psychedelics are promising for mental health and they want to try it out > maybe the real reason psychedelics show efficacy in depression is that they are a sort of super-placebo This amounts to uninformed armchair dismissal that is inconsistent with a growing body of scientific evidence, and easily refuted by a cursory survey of recent literature and clinical trial results. Surely you’re familiar with double blind randomized placebo controlled studies? I’ve linked you to recent ones in other comments. These methods aren’t perfect and your concerns certainly have merit in general - I just don’t understand why you continue to make these broad and suggestive claims without any supporting evidence.

newbamboo 5y ago

Some psychedelics are more unpredictable than others, and incidentally these seem to be the ones that are hyped the most. LSD is much more predictable than mushrooms for instance, and is well researched partially because of that. The seems generally true for synthetic vs naturally occurring substances across the board, though there are plenty of horrible synthetic drugs like bath salts, synthetic weed. Advocates seem favor this as it allows them a no true Scotsman defense. “You didn’t get real ayauasca”, or with cannabis the hand wavey talk of the “entourage effect.” The biggest problem facing psychedelic research are the researchers involved. They have little credibility, almost like that’s their intention.

cmrdporcupine 5y ago
I agree LSD may be more predictable than mushrooms, but it is also a crazy intense 12 hour voyage that leaves one with at least two days of recovery time after. Vs 4 hours for mushrooms. Both are extremely "set and setting" sensitive. Take either on a bad mood day with bad weather, a dirty house, and stuff on your mind... and you won't have a good time.
- tsimionescu 5y ago
  > Take either on a bad mood day with bad weather, a dirty house, and stuff on your mind... and you won't have a good time. That doesnt sound like the start of an apparently very promising candidate for treating depression and PTSD. Just goes to show how different experiences are, I guess...
  - cmrdporcupine 5y ago
    Yeah, that's because it isn't (imho a promising candidate). It's an interesting experience, though.
    - tsimionescu 5y ago
      Sure, I imagined as much. My point was that your experience (and others like yours) seems to differ significantly from the experience of, for example, the people penning these studies. I personally have no experience with psychedelics (and no desire to get any), so I am just looking with a bit of wonder at the differences from the sidelines.

asdff 5y ago

IMO the tolerance factor is huge with cannabis. Even for experienced daily smokers if you were to take a few days off, the effects are very noticeably more powerful. When you have zero tolerance, the drug feels like on another planet compared to something more familiar like alcohol. When you have a lot of tolerance, its a comfortable buzz you can be productive on, like a workingman's whisky drunk but without the slop.

supertofu 5y ago
This is an anecdotal and slightly off topic response to your note on cannabis tolerance. I am a frequent cannabis user and have been for a long time. While I no longer use psychoactive cannabis regularly (not in a fully legal state anymore) but I do use CBD, which purports to be non-psychoactive and, by law, has THC delta-9 levels of below 0.3%. What I find fascinating is that CBD absolutely has a psychoactive effect on me. I suspect that this is because of my prolific use of typical cannabis. The components of CBD must tickle the same pathways that are so accustomed to psychoactive cannabis. The result is that I often get reasonably high from CBD hemp and CBD tinctures. A high tolerance for cannabis seems to create a stronger response to CBD, at least in my case!
- colechristensen 5y ago
  I think the opposite is what is happening, the regulated CBD products aren't regulated in a way that keeps them free of psychoactive components and nobody noticed yet or aren't too excited to try to change it, legalization being on the menu all over the place.
  - aaaaaaaaata 5y ago
    CBN, CBG, and terpenes, are all responsible for medical and recreational things that regulators don't have a single clue on, and medical folks are only beginning to.
  - deleted 5y ago
    [deleted]
  - deleted 5y ago

netizen-936824 5y ago

Medicines in general can effect people very differently based on their individual biochemistry/proteome

perardi 5y ago

Yup, from experience, you can give the same dose from the same batch of a hallucinogenic drug to people who are broadly similar in terms of age and overall mental health, and you can get a real wild range of results. (Except maybe ketamine. Ketamine seems pretty consistent, in my anecdotal experience.)

jasonvorhe 5y ago

All of medicine has a lot of possible side effects depending on the person taking them. Current anti depressants can have severe side effects, whether just until they're properly dosed or not. No one says we should start handing out shrooms to everyone over lunch. But either we allow illegal, unhealthy, corruption-causing criminal markets to flourish with a lot of negative effects on society or we legalize and control it.

operator-name 5y ago

You may find this recently released video facinating as I did: https://youtu.be/2rUV4TAP46U https://youtu.be/2rUV4TAP46U The idea that cannabis would have inconsistent effects, or the effects of different strains was always a mystery to me until I watched it.

Fnoord 5y ago

(Speaking a bit from experience given past drugs use.) Isn't the same true for stuff like SSRIs? We don't know if/how they are going to affect the patient.

h2odragon 5y ago
Yes, but talking about that makes one a "science denier" etc. My wife has a good one: she burns opiates different, so they don't really benefit her. she just gets nausea from them. They've got her down as a "drug seeker" now cuz she refuses them.
- Fnoord 5y ago
  The two times I got SSRIs prescribed both psychistrists underlined that fact. We are trying to find something which worked for me, and the first choice might not work out. For example, Fluoxetine (Prozac) got the adverse side effect that I got severe muscle fatigue. Basically, it makes me more sensitive to pain. But it also makes me less edgy. I find it counts for all drugs and even food (sugar makes thirsty, requires good dental hygiene; salt makes thirsty, pee less; yet we crave both in our food).