Cannabis use and myocardial infarction in young adults: a cross-sectional study | Hacker News Reader

Cannabis use and myocardial infarction in young adults: a cross-sectional study

cmaj.ca

128 pointsvixen99153 comments

I appreciate the study calls out that most cannabis is smoked, and it may be general smoke inhalation driving these results rather than an inherent property of cannabis

I too wonder if it is due to the way it was consumed primarily (smoking).

There is a bit about the impact of cannabinoids on the cardiovascular system however.

> The impact of exogenous cannabinoids on the cardiovascular system has been well described.7,33 After acute exposure, cannabis induces dose-dependent tachycardia and, in some cases, decreased ventricular contractility, palpitations, atrial fibrillation and arrhythmia.

Table 2 differentiates the form of consumption but I couldn't find them controlling for it. Did I miss that somehow?

In the "Interpretation" section of the paper they specify: "Although a similarly elevated odds of history of heart attacks was observed across methods of recent cannabis consumption, only smoking as a primary method achieved statistical significance."

>After acute exposure, cannabis induces dose-dependent tachycardia and, in some cases, decreased ventricular contractility, palpitations, atrial fibrillation and arrhythmia

i feel like this is saying what a lot of us already know about cannabis usage, more specifically about THC as this won't be found as much in low THC strains: higher doses have a tendency to cause anxiety sometimes. all of those symptoms tend to be, at least in my experience, pretty comorbid with a state of high anxiety, and more often than not, I would think, the more easily observable ones than the neurological or psychological effects associated therewith.

It doesn't say that at all.

>The effect estimates for history of MI were similar across methods of consumption, including among people using other forms of cannabis, including edibles, as a primary method of consumption. This finding is consistent with a case study reporting an acute MI triggered after consumption of a lollipop containing a large dose of Δ-9-tetrahydrocannabinol.36 The Canadian government recently legalized cannabis edibles;2 however, the risks associated with edibles are poorly understood and are of concern to Canadian physicians.37 Edibles are often perceived as a safer alternative for cannabis consumption, but recent evidence suggests that edible cannabis is attributed to a larger proportion of cannabis-related emergency department visits for cardiovascular symptoms compared with inhaled cannabis

“Although a similarly elevated odds of history of MI was observed across methods of recent cannabis consumption, only smoking as a primary method achieved statistical significance.“

That is honestly a pretty confusing sentence in need of clarification. My read would be that statistical significance was not achieved due to the small sample size of users who are primarily using other methods of consumption than smoking.

If there isn't statistical significance there isn't statistical significance. It does not matter what caused the lack of it. Without statistical significance there is "no evidence".

It very likely is due to smoke inhalation or even mixing with tobacco; IIRC inhalation of any kind of micro- and nanoparticles is linked to higher risk of myocardial infarction.

I got a few new sativa vapes recently and was hitting them both pretty hard. I got smacked with a really disturbing heart issue that felt like it was being severely over worked. It was so bad I was on my front porch in n the dark resolved to dying. I didn't in now what was going to happen.

I'll admit that I'm a lightweight but I had to stop with the "turpine pens." Now I just smoke dry herb because I know how to regulate it and it never presented any issues like I experienced.

In the run up to that I did experience heart issues (racing/skipping?) but it was no where near that episode. I have noticed that sugar greatly exasperates the heart issues for me.

Sativa can give people anxiety and it can feel like a heart issue.

Pens make it easier to get a bigger hit than a normal joint dose, so take smaller puffs.

I think it is completely dependent on the person. Some people get anxiety from the bodily effects of indicas while some people seek out those muscle-relaxing, stress-clearing ”stoned” effects.

Some people get anxiety from the high-flying thoughts brought about by sativas and some people seek out those idea-provoking cerebral ”high” effects.

Of course I can't rule out that you actually had a cardiovascular problem, but of the people who get really high and think they have a medical problem, it's usually an anxiety attack.

Everyone likes to say that but as a cannabis user for 20+ years, most cannabis does raise HR when it "hits." It also can cause anxiety. Those two things combined can make HR even higher through a feedback loop. But it's disingenuous to think it doesn't raise HR in higher doses - that it's just an anxiety issue. Indica or sativa, they both cause a HR increase during intake. In my experience, it can taper off and one still remains high. But other times, the effect can last a while and the anxiety can turn into a full blown panic attack.

Imagine the scenario where someone legitimately has a HR of 150 from Cannabis. They have anxiety about their heart rate and possibly dying, and their friend OP keeps insisting that they just need to "calm down and be cool" because this is "all in your head." That's what ignorant friends are for :-)

"One of the most consistent effects of cannabis smoking on heart is 20% to 100% increase in HR which can last up to 2–3 hours, often accompanied by a slight increase in supine blood pressure. This effect of cannabis on HR is thought to be due to cannabis induced vasodilation causing reflex tachycardia (15,16)."

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5542986/

>They have anxiety about their heart rate and possibly dying, and their friend OP keeps insisting that they just need to "calm down and be cool" because this is "all in your head." That's what ignorant friends are for :-)

999 times of a thousand (likely much more) this is the correct response. As you acknowledged there's a feedback loop and external reasons to justify it are likely to increase your HR even further. Given that it increases anxiety and paranoia the times when people have a real problem are going to be extrme rarer compared to the amount of times they are just causing themselves extra anxiety by freaking out.

Also 150 is still not really an issue. Anxiety can cause that and it can safely drop after calming down.

There's really nothing wrong with going to the hospital to get checked up if you've taken something that might be killing you. 150 is pretty high for a body that isn't exercising. If I had insurance and my HR was that high from a substance, and wasn't falling, I'd be on my way to the hospital if the diazepam I keep on hand didn't help. Your risk assessment is different. Trying to give stats on something neither of us can reliably give, is very silly.

I'd recommend looking into vaping dry herb with a Volcano to avoid the combustion of organics as well as the chemicals on the pens.

Sounds like an anxiety or panic attack. The latter often sends people to the ER because they think they're dying.

I know of at least one company that was founded to provide cigar enthusiasts a way to get access to tobacco to roll their own cigars at home, because the industry usually requires you to purchase the product by the bale. Because of the fragility of wrapper tobacco, they would place these in humidified sealed pouches.

They soon learned that there was a large market for this and now they make 99% of their revenue selling wrappers in convenience stores. The cigar tobacco shop is still there, because it was mostly a labor of love instead of a true business venture.

So what used to be paper wrappers is now replaced with a more premium product, but that premium product happens to be black tobacco which is much harsher than the cigarette tobacco people inhale regularly.

> Smoking cannabis was the most prevalent primary method of consumption (76.3%, 95% CI 74.3%–78.4%) relative to vapourization (11.3%, 95% CI 9.8%–12.8%) and other forms of consumption, including edibles (12.4%, 95% CI 10.8%–13.9%).

> Compared with nonusers, the prevalence of recent cannabis use was higher among males (62.9% v. 49.3%), unmarried respondents (68.0% v. 46.4%), current combustible cigarette users (31.6% v. 13.2%), current e-cigarette users (18.1% v. 5.1%) and heavy alcohol drinkers (17.4% v. 5.2%).

You run into cannabis users that have massively high tolerances because they dab all day. I wonder how d8, d10, etc would come out, cause that's probably a big part of the future, that an other cannaboid mixes.

This study is really just "smoking linked to higher risk".

I think it's any marijuana use, not just smoking:

The primary exposure for our study was any recent cannabis use, categorized as a binary outcome. In the BRFSS, participants were asked, “During the past 30 days, on how many days did you use [marijuana or hashish (2017)] [marijuana or cannabis (2018)]?” We defined any recent cannabis use as using cannabis 1 or more time during the past 30 days.

Results for other methods of consumption were not statistically significant:

"Similarly, a higher odds of history of MI was observed with vapourization as a primary method of cannabis consumption (adjusted OR 2.26, 95% CI 0.58–8.82) and other forms of cannabis consumption, including edibles (adjusted OR 2.36, 95% CI 0.81–6.88) when compared with nonusers; however, these were not statistically significant."

When they say "primary method of cannabis consumption" do they mean the primary method of consumption in the past 30 days? Or do they mean the primary method of lifetime consumption?

I'm also not sure "primary method of consumption" is the right question to ask? If someone smokes three days a week and has edibles the other four their primary method would be edibles but that doesn't erase the risk of the smoking.

CDC has archival surveys at https://www.cdc.gov/brfss/questionnaires/index.htm

The phrasing based on 2018 form was:

"During the past 30 days, which one of the following ways did you use marijuana the most often? Did you usually…"

Smoking a joint is every bit as bad as smoking a cigarette, in terms of carcinogens/tar and other nastiness, but most people aren't two-pack-a-day joint smokers so dose is typically lower. It still isn't healthy though.

IIRC smoking a joint is actually worse than smoking a cigarette, one-for-one, because of the filter a cig has. Smoking joints, the activity, is still said to be healthier than smoking cigarettes, because of the disparity in cylinders-consumed-per-day in average users, as the parent points out. That said, outliers, like Sublime's frontman Bradley Nowell, do exist. [0] Humour on HN is a risky business, but what I'm trying to imply is that I've known people who would find it quite reasonable to smoke two joints before they smoked two joints, and then they'd smoke two more. That's worse than a cigarette habit. Vapes, on the other hand...

[0] https://www.youtube.com/watch?v=h0i62GnQoo0

Not likely- the odds ratio vs non-users for smoking (2.01) is lower than that for vaping (2.26) and "other" (2.36).

They say that this is not statistically significant, however all forms of cannabis use vs non-users is statistically significant, with an odds ratio of 2.07 overall, and 2.31 for frequent users.

So if anything, the data suggests the opposite: smoking was lowest odds ratio.

Also, they adjust the findings to account for users that smoke, vape, etc, so it's not due to the fact that users are also more likely to smoke (compared to non-users).

It’s strange that all of the comments are looking for ways to dismiss this result (and this seems to happen generally with negative cannabis findings online).

Is it not entirely possible a drug and method of consumption which stresses the cardiovascular system increases odds of an adverse cardiovascular event?

I think that many of the commenters are pointing out that this study is poorly done in some key areas, which make any kind of conclusions based on it of little value.

We’re not going to get large scale randomized controlled trials for marijuana use any time soon.

We can definitely debate the methods.. but the findings from this growing body of evidence should probably be the ‘default’ stance, until we see more causal or controlled correlational evidence pointing the other way.

Every HN science article is commenters dismissing the results of the study.

I would think that people who disagree with an article would have more to say.

People like cannabis. Naturally they minimize any suggestion that it's not all good. I do the same with Lisp, smoked meats, and predestination. I see no mystery here.

It’s certainly not all good but I’d put it in a different league from alcohol, for example. Cannabis might cause elevated heart risk over a period of years. Alcohol can stop the heart of a healthy person in a single night of binge drinking.

Thank you for illustrating my point so nicely, in response to absolutely no assertions about cannabis.

You did imply plenty though, by putting it in the same category as _Lisp_.

Indeed, you made no assertions about cannabis; you made an ad hominem assertion that people only minimize any suggestion that cannabis (or smoked meats, or Lisp or anything else) is "not all good" because they like it; as if they could never use any objective tools, like data.

All that oceanplexian's response proved "so nicely" is that people will sometimes fall for ad hominem assertions and try to engage them.

Chill, man, maybe have a joint.

Someone in Seattle said this to me once when I was sitting on his front stoop. I was on the phone and saw him walk up and I jumped and hurried off his steps. I will never forget his words because I was high af at the time

All European preserved meats are categorically terrible for you. It doesn’t matter where the nitrates come from — celery or otherwise. We’re talking a 20% jump in cardiovascular issues so it’s not marginal.

We should have had these kinds of studies nearly 100 years ago, but the Reefer Madness era bans stunted our science based knowledge of the plant. Within just a short time frame of the rules being relaxed, we've learned how to extract so many different compounds from this one plant from CBD, CBG, CBN, Delta-8, Delta-9, Delta-10, etc. We now know which compounds get you high, and which ones can be used without fear of testing positive.

There seems to be a mad rush on people being able to do research and be first to publish, so I'd expect some results to be questionable. However, isn't that exactly how it is supposed to work? Do a test, release the results, others verify/validate. If something comes up questionable, refine the test, release the results, verify/validate again.

Yeah. I'm not trying to die of cancer or have reduced mental capacity. I want these studies.

I know from my own anecdotal experience that d9 (reg THC) gives me incredible anxiety but d8 does not. My mental health is better than it was before I had access to it. I don't want to be a guinea pig, but we've been hearing fear, fear, fear for the last six decades.

Reefer Madness was released in 1936, so closer to eight decades. The rule changes in the 60s were more about racial, for lack of better word, control than anything.

Without wanting to sound all pot-head hippy, this plant seems to be pretty magical. If it turns out that the "good" stuff can be used by removing the one part that gets you high, then we've lost so much potential because of fearmongering. It's infuriating that in the 20th century into the 21st we were no better than the days of Capernicus for stopping science because of fear.

Science as a whole is under attack, from the right.

while i don’t disagree with you at all, it’s not just from the right. the whole anti-vaccination movement started on the opposite side of the political rainbow.

It started everywhere, for every liberal hippy mom there was a christian conservative mom home schooling their kid to avoid vaccine requirements of public schools.

This transcends politics, humans are dumb fearful critters.

yeah, agreed. that was the point i was trying to make to the parent comment — that this behavior isn’t exclusive to the “right” or “left.” it’s a people problem. or, more exactly, it’s a religion problem (not in the sense of spiritual faiths, but in the tendency for people to seek out and congregate around a shared system of beliefs.. and then stick to those beliefs beyond all reason).

It's not exclusive to right or left but we need to look at which side has the anti-science momentum going on. Which side has leaders who advocate injecting bleach to kill Covid?

My two heaviest marijuana smoker friends are 100% sure that any study that mentions some detrimental effect from marijuana is part of a big-pharma conspiracy. Their argument is that "it's a natural herb, it's impossible for it to do harm".

The correct response: "So is hemlock".

"Care for some foxglove salad?"

Sounds like Tesla fanatics and the phantom ICE manufacturers they think are out to get them.

Pretty sure different companies competing in similar sectors aren't above stoking FUD about their competitors, no matter who they are or what industry they are in.

I heard Tesla fans speculate that coverage of Tesla's cars failing is driven by a secret cabal of short sellers and car manufacturers that are conspiring with the media, which apparently is also out to get Tesla.

This is the default for any motivated reasoning where people are interested in a specific outcome (regardless of what's true): https://astralcodexten.substack.com/p/too-good-to-check-a-pl...

It's hard work to fight against it, but the first step is recognizing it all over the place and in your own thinking.

Recognizing it and trying to correct for it is one of the core bits of the rationality community (imo).

I think it's also because many of us have seen extreme exaggerations on the dangers of cannabis that turned out to be wrong. It definitely take me years of using it to acknowledge the (lesser) negative effects after seeing how much of the negative things I was told about it as a kid were fake.

Just because others have made the same mistake in the other direction doesn't mean it's good to do the same thing in pursuit of a different conclusion.

Skepticism is good, but if you find yourself preferring one outcome over another then you should be extra critical of stuff that supports your preferred outcome because you're more likely to want to give it a pass.

Similarly you should be more willing to entertain stuff that goes the other way because you're more likely to incorrectly dismiss something that's actually true.

I'm not saying it's good, I'm just giving another potent reason beyond self-interest.

Yeah - I think we agree.

More specifically, whenever such an article hits the headlines most comments will gladly assume that the authors are insultingly ignorant about basic statistics and overlooked a glaring confusion between causation and correlation, which the commenter immediately spotted without even reading the article.

I think there’s been a bit of an overcorrection about weed in the last couple years. Weed smokers have been on the defensive against a lot of bullshit (and untrue/hyperbolized) propaganda for almost a century, and thus a lot of them have gotten somewhat inoculated against any negative findings about cannabis, to a point where they will dismiss virtually anything that has even a remote chance of making weed look bad.

Notice this more. When people have a side on a topic they tend to find every excuse for its shortcomings and easily believe every positive.

People seem to have a lot of trouble accepting that things they favor have negative aspects and things they don’t have merit. The world isn’t just good and evil, most of it is striking a balance between positives and negatives and we all need to get better at doing this objectively instead of picking a side and afterwards finding a justification.

That’s because you can’t have a rational discussion about cannabis online. Anything negative is dismissed, apologised away, compared immediately to alcohol or you are accused of providing anecdotes by the proponents.

This in itself dismisses the credibility of the proponents in my mind.

The funny thing is you don’t see this with alcoholics. They know what they’re doing is bad and admit it easily but can’t stop.

The funny thing is you saying "you can't have a discussion online" as we are having a discussion online and you are responding to someone who said what you were thinking.

I am completely open to the concept that cannabis consumption is not always healthy for people, depending on delivery method, quantity, and the state of mind of the individual.

I also, almost without qualification, will dismiss the health risks as a rationale for continuing its general prohibition. And (wait for it)... yeah, it's because there are myriad substances and behaviors that can cause harm, but we don't outright ban them.

So no, I'm not saying "don't tell me how it could be harmful" - especially as an occasional user, I want to know as real studies (and trusted anecdotes among friends) come about. Just don't use evidence of some adverse effects as a justification for prohibition, which politicians and puritans are quick to attempt.

To clarify a point on the latter, it’s a temporal thing. I used to be a proponent so there’s no Puritanism here.

In my 20s I knew people who used it. I used it myself occasionally. Hell I even dated a dealer once. No problems. Pro legalisation.

In my 30s some of those people drifted away or grew out of it. Apart from a few. They ended up burning their relationships for it due to it being tied intimately to their identity.

In my 40s now I’ve seen the last few people I know who used it suffering through mental health problems. On top of that there have been a few specific events including someone rolling a car onto my front lawn through my fence when speeding. They were prosecuted for drug driving.

I see a lot of people who haven’t tread this path yet and were where I was. This slow decline and the realisation that there are people who genuinely are unable to act rationally and put others at risk suggests that apart from medical use the net benefit to society is negative.

Now the real negative basis is mental health and at least here in the UK there isn’t the care or support for anyone already. Adding cannabis usage to that is a disaster waiting to happen.

Ultimately the long term study is something we’re not going to have the answers to for over 30 years as we see the impact on society. Hopefully by then it won’t be another fuck up like adding lead to gas.

But even ignoring that effect, most people smoke it and smoking is monumentally bad for you regardless of what you are smoking.

It’s common sense that inhaling smoke is bad for you. If you defy common sense, you’re unlikely to suddenly embrace the logic of a scientific study.

This strikes me as a bit weak, and an answer looking for a question.

> the current evidence is limited to case–control studies that are prone to bias and studies relying solely on administrative data.9–14 It is also limited in its definition of exposure, as these studies assess patients with heavy cannabis use (cannabis abuse or cannabis use disorder).9–14 Very few studies have assessed the prevalence of recent cannabis use (any use within past 30 days) and its association with MI.7,9,15 Prevalence estimates of the primary method of cannabis consumption and the frequency of cannabis use are incompletely characterized, and the potential impact of these factors on the risk of MI remains undefined.

Is it just me, or does that sound like they are admitting that there were no real controls, except they tried to select for people who had an "abusive" (a level of use not defined in the abstract) relationship with Cannabis.

The conclusions they drew sound a bit heavy-handed for such a vague survey of corellations, or is that just me?

There is no control because there was no experiment. There is no independent variable that was controlled. This is epidemiology, not a trial. At best it can show a link, not causation.

There was an independent variable that was controlled as stated in the abstract and I pointed out already: they selected for people that had "abusive" relationships with cannabis according to whatever standard they chose.

They firmly state the presence of a link between heart attacks and cannabis consumption without outlining whether the selected group had any other existing health or genetic issues.

Maybe the data didn't contain that information—in which case the data sounds useless for this kind of study.

How can you draw a link (read: connection) when there is no causal proof? You can draw a correlation and state that further investigation is needed to draw a link, but they state there is a link.

That's why I'm calling it weak.

For link, read correlation, not connection. They can only show evidence of correlation with this design, not connection.

I think you're misunderstanding the nature of an independent variable. To be independent it has to be controlled by the experimenter. If an abusive relationship with cannabis was an independent variable, subjects would have to be assigned an abusive relationship with cannabis, which is obviously not practical. There must be such an intervention. Since they are only selected from the existing population, with no independent intervention, this is a survey, not an experiment. It is the difference between observational and experimental science, and this study is the former.

I'm not misunderstanding.

The word link literally means a connection or relationship.

There is neither of those two things in this data, except that their 1.3% of "abusive" smokers had heart attacks versus 0.5% of non-smokers.

You cannot draw a link from that alone, but they are stating there is a link.

You can state there is a link between diet and heart disease, because there's a proven causal relationship. Not so in this case.

Also, the variable was independent because they study stated that they only included "abusive" smokers, implying they excluded casual or occasional smokers.

They split the data on that variable. That's a selection process.

You are describing epidemiology, which is not an experimental science, because it does not have the luxury of independent variables.

And you are correct that it is weaker at establishing links than a controlled experiment. So it's mostly a resort for when an RCT is impractical or as a way to select which RCTs to pursue.

I didn't say it was experimental science.

I said their use of the word link implies a causal relationship because that is precisely what the word link means.

If they are not describing a link, and instead are describing a correlation then they should do so.

Calling their findings a "link" is much more final and implies causation. It's not an arcane definition I'm pointing to here—it's the only definition for the word.

There is no link. There is an apparent correlation based on their filtered dataset.

Epidemiology isn't meant to create problems, it's meant to resolve them. They are borderline fabricating a problem with their misleading study.

Maybe next time they should indicate a "possible link" since that is all they actually have.

When studies make hard-nosed, misleading conclusions about health subjects that are presently on the political fence I get suspicious.

I'll gladly take this risk considering cannabis preserves my sanity and keeps me away from the trough of sorrow.

Everyone with PTSD nods in agreement.

Sounds like therapy would be very useful then. If you’re having to self-medicate to maintain sanity, the substances are only a crutch. Speaking from personal experience.

Sweeping generalizations based on personal experience aren't much better than sweeping generalizations that aren't based on personal experience.

I don't think it's a stretch or generalization to mention mental health services to people who may be struggling with mental health issues.

The sweeping generalization I was referring to is "the substances are only a crutch". Your comment also suggests that you assume the author of the comment you replied to isn't pursuing therapy. People can do both at the same time.

A lot of things can be a crutch, but cannabis provides meaningful relief for many.

I never argued it doesn't provide relief, what I'm arguing is that relief is somewhat of an illusion if you're suffering from persistent mental health issues, hence a crutch.

In your mind, does this only apply to cannabis, or any mental-health related medication?

There are people who need to use prescribed medications to help regulate their mental health (usually in addition to psychotherapy), however I don't include cannabis in that realm.

Cannabis (THC) has properties that (in some, not all and sometimes the reverse) reduce anxiety however, from what I've seen and experienced, cannabis is by in large used to self-medicate instead of seek real treatment.

We all need relief. You have your television, others have a substance that makes them more relaxed, introspective, creative, and appreciative of art and life.

Life is tough, it’s not hard to understand that a substance that has the above effects with less side effects than most popular drugs could be enjoyed responsibly.

Only a person who doesn’t drink caffeine, alcohol, or any other drug (including aspirin and other non psychoactives) can approach making this claim.

Hell, you could say the same thing to someone who enjoys a small dessert every night. Or a bath. So long as they’d feel sad to not have it, they are then avoiding a problem, right?

Or… humans just really enjoy having diverse things to do, and all find different balances of what those things are. And THC suits very well to certain brain physiologies much like a bubble bath does for others.

I'm not going to go into the nuances of prolonged THC exposure and how it affects brain chemistry, especially under the guise of self-medication but you're not acting in good faith of our discussion by comparing THC to taking a bath.

I could link to a handful of very positive studies for THC, and a handful of negative. Here's a fun recent one showing that THC has potential mTOR1 activation and CNS myelination effects.

https://pubmed.ncbi.nlm.nih.gov/32956517/

I could similarly link to about 10 pretty scary studies for caffeine, especially effect on brain structure and sleep quality.

Or should we do sugar?

The dose makes the poison for anything, it's not clear THC isn't beneficial at a lower dose. It's medically prescribed for cancer pain relief, and for a segment of people its anxiolytic effects are incredible.

> I'm not going to go into the nuances of prolonged THC exposure and how it affects brain chemistry

I'm not even apart of this debate, and now I am curious. Do you mind sharing what you have found?

And there's really nothing wrong with crutches. If your leg hurts they help you get around. I don't get all this anti-crutches rhetoric

I'm quite sure that most HN posters are aware that mental health services are available. Did you provide any helpful tips for making use of such services, or just make low IQ lazy generalizations about substance users?

I would challenge your assumption as I have many friends in the HN world who are either skeptical, ambivalent or unaware of what mental health services are available or the benefits they can provide.

I'm not here to diagnose or mentor people with potential health issues but I thought it might be meaningful to post a small comment about how I thought the exact same way once and how it turned out I wasn't actually helping myself but sabotaging myself.

If the OP is curious enough about addressing their mental health issues, that's on them but I'd rather at least post something that might spur some thought instead of play into the "weed is inherently good and causes no issues" hivemind that is incredibly prevent on the internet (and on HN) today.

I'm quite sure that most HN posters are aware…

Now I’m confused; who is it again who’s making the low-effort generalizations?

Most heavy cannabis users I know are either currently in therapy or have spent a lot of time in therapy. This kind of careless posting is a great way to discourage people from seeking therapy, though!

Maybe bowsersghost isn't even a heavy user, and alternates between cannabis and other substances, like caffeine and capsaicin, which are two of my favorites.

Is therapy really that threatening? Sad is a society where we've stigmatized mental health services (which are proven to work) to such a degree and instead laud self-medication through substances, no matter the amount or frequency.

Not saying one shouldn't check in to make sure its a healthy habit but things you may want to consider before judging the habit is:

1) Cost: $120 of cannabis every month is cheaper than a therapist and more effective than 1 session

2) Some issues are perspective: where your perspective needs to be changed and it's making your life worse but not a DSM-5 diagnosis leaving a majority of therapists/psychologists without tools to treat

2.1) The amount of therapy needed to sus out that point of view thats hurting you is way more expensive.

3) Forced release valve: it forces you to not care and be apathetic at the end of the day. In my case, doing 10-12 hour days and feel yourself wanting to push for longer is also a very unhealthy feeling. I'm not in a position to slow down or the start-up fails/loses investors. I don't need it to relax at the end of the day, where I'm not smoking now as a test. Regardless, I do notice being burnt out faster now without it.

Financials aside (which I agree are a factor), this is a very short-sighted view. Therapy is not about finding a diagnosis, it is about finding perspective. Sure, for insurance billing purposes you need to be diagnosed but I'd bet most people seeking therapy are just given GAD (generalized anxiety disorder) and it plays very little baring in how your therapy is executed.

If what you seek is a healthier emotional and psychological outlook, substituting cannabis for therapy is self-sabotage. There are other ways to gain the "release valve" that don't involve smoking weed.

> GAD (generalized anxiety disorder) and it plays very little baring in how your therapy is executed.

No there's set work books that many therapist agree on, but I'm talking about situations where your GAD is now at a state that isn't obstructive in your day-to-day life. You're doing the work still yet still feel less than or unhappy. There isn't more diagnoses for just feeling unfulfilled in life, depression is too harsh a term for it since your functional(which is core to most diagnosis is how much it changes your day to day). So that's when it comes to the therapists 'talk therapy' skill and how much time and money you have to throw at it

>this is a very short-sighted view. Therapy is not about finding a diagnosis, it is about finding perspective.

Yes, however, finding the therapist that can do that for you is exponentially harder. Since they have to understand you and your situation, and that comes with time and their personal insight on it. So at that point you have to then find someone that has faced similar issues or has specialized in helping people through them. If you're a minority, finding that insight is even more costly, so you have to choose talk therapy with someone that doesn't get it but is trying or pay the premium for the person that does.

For instance, I'm trans passing as a woman that's public about being trans. It's just inherently stressful navigating business environments, since I can get a mix of sexism and/or vailed transphobia. There isn't some magical answer my therapist has for me other than mediation and working through accepting myself and the situation. That involves re-diving into the stressful situation mentally to accept it, which is just more work and stress.

Examples: - Knowing that people are speaking down to me irl, more so than when I was an unqualified student. - Having people completely change their responses/personality around me when they find out I'm trans - Intense Anxiety not about day-to-day activities/interactions anymore but dealing with any authority figures in cases like crossing the border means TSA shouldn't but could force me to strip naked to prove I'm male

Therapy isn't going to help me de-stress from these, it would give me work to make those less stressful later by working through why it stresses me. For which I've been given the tools already to do so

> There are other ways to gain the "release valve" that don't involve smoking weed.

Yea, I know I'm not smoking right now, and I'm doing the others already do a 45m - 1 hour work out daily, 30 minutes mediation, I work while I eat and get 7-8 hours of sleep work 10-12 hours. It is still the most effective way to relax in 20 minutes for me, and I'm probably going back to it as a way to end my day in another month once I'm done the 3-month test abstaining from it. What else can I do in maybe the hour or two I have left in the day that is clinically shown to reduce stress...

> substituting cannabis for therapy is self-sabotage

It's not substitution it's in conjunction when I can afford it, otherwise I do the homework that I got from therapy. Which like I mentioned before is more work and stress, which isn't relaxing at all. Weed helps me keep up with the work and not let it add to work stress too, I have been noticing I'm falling behind on my homework in that sense.

Speaking from personal experience, weed therapy is way more useful and beneficial than talk therapy or pharma therapy. Cheaper too.

Funny how no one ever says this about caffeine intake. Surely you also think people who drink coffee every day are relying on a crutch and are drug addicts that need therapy.

Yes. Anyone who claims that they will gladly keep drinking coffee despite serious health risks because it preserves their sanity is either making a joke or should probably consider therapy.

I do have doubts about whether caffeine every day long-term is effective. We seem to develop tolerance, and at least personally, I eventually need it in the morning just to get back to baseline. But caffeine as a situational stimulant has been my practice since early adulthood. Rarely it is daily use for short stretches when very busy. But usually just one or two cups of coffee a week, in the early afternoon when I'm feeling sluggish. It's a drug and like any other it has its uses and its downsides :)

> Funny how no one ever says this about caffeine intake. Surely you also think people who drink coffee every day are relying on a crutch and are drug addicts that need therapy

Lots of people say this. I'll even say it right now. If you need caffeine to function, you should probably talk to a doctor.

Drinking coffee every day does not mean it's a crutch. If it becomes a crutch, you should talk to a mental health professional.

There's no need to get upset because someone recommends you talk to a doctor.

You say this when someone brings up their daily coffee in real life, and not just this one time online?

> You say this when someone brings up their daily coffee in real life, and not just this one time online?

We're talking about degrees. If someone I knew could not function without coffee, yes, I would suggest they talk to a doctor.

I don't know why this is controversial. Vices are great. I have plenty myself. But it's not good to have a dependency on anything...

I've quit caffeine cold turkey for at least two months every year for the last decade. It's an interesting experience. I don't otherwise use drugs, but I think it would be a good thing for most people to do with the drugs they do use.

Caffeine as found in a big mug of drip is pretty intense if you don't have a tolerance to it. You really learn to appreciate that by doing something like this.

I know many frequent cannabis users. Most of them could use a month or two off to stop orbiting weed.

Mental illness is really difficult and complicated, and I don't think there's a strategy that works well for everyone. My experience was the opposite of yours: I experienced horrible depression for years on end, and therapy always seemed to make me feel better for the afternoon, but when the feeling faded after a couple hours, I was no better than I had been. I concluded that it was a nice relief, but it wasn't resolving the problem.

To my mind, resolving a mental health issue is a bit like resolving a technical issue like a slow-loading web page. Similar looking problems can be caused by a lot of different things in the toolchain. Just in my case alone, I have identified causes in the spiritual, physical, psychological, and lifestyle domains. As in, I know certain things cause the problem because I can trigger it via those methods, and ameliorate it by avoiding certain things or embracing certain strategies!

I think if you have a problem with a cause that is well-addressed by therapy, it will work very well for you. That doesn't invalidate that other people have other problems in other areas addressed by other strategies.

If you hang out around people talking about mental health issues, you will hear some really weird stories. Like, I'll tell you one about me: the final lingering symptom of the depression was suicidal ideation. It was more or less of a problem for me for about ten years -- more or less once a week I'd wake up thinking, "I hate my life, I want to die". You know what finally put it to bed, dead and gone, really truly doesn't bother me anymore? Tactical firearms training. I kid you not.

Buuuuuuuuut it's not really a path I'd recommend to anyone else. ;)

Medicating mental health issues -- either under professional supervision or not -- is a huge hot button issue for some people. It can be a lifesaver and it can be a life destroyer and people have really strong experiences with it and strong opinions about it. I think the whole discussion is emotionally magnified precisely because insanity is so horrible and people need there to be solutions that work. Desperation and trauma are an environment that breed superstition and excessive faith, and make thoughtful inquiry and understanding difficult. That's not evil - it's just human. Nasty problems are hard to think about clearly.

It sure is a funny space, though, because there seem to be so many solutions that work for some people. Some people are able to solve seemingly intractable mental health problems with diet - Jordan Peterson is a famous case, for example, of someone who approached a terrible anxiety problem with a very exotic diet and found it effective. You can find a lot of less famous cases of that. And the recreational drug side of it has some remarkable stories, too. Some that seem miraculous and amazing, and some that seem like people haven't really gotten a handle on what's going on.

I'd say "let people try stuff", but I don't even think that's the right approach. As you say, a substance may be a crutch for a specific person, which doesn't rule out the possibility that it's a cure for another, but which on the other hand doesn't rule out the possibility that someone who thinks it's a cure for them is wrong. I think it's good to tell each other about the pitfalls we know of and to try to improve our understanding. Sometimes people think they've gotten things right, and they're really wrong. Then again, sometimes extraordinary things are right. And on the third hand, perhaps you're one of those weird cases that really won't respond unless you eliminate broccoli from your diet or have a priest pray for you or go on a guided meditation with the right guide or become a decent marksman with pistols. Perhaps you need something weird and you haven't found it yet, and maybe you never will, and a crutch that lets you live your life in the mean time is very important.

I guess all I'm trying to say is this whole thing is a big, complicated, messy problem. I certainly have my own fears and bad experiences in the domain, and I do try to let people know about the dangers I wish I'd known of. In fact, I mostly agree with you - long term medication of mental health issues is very scary for me, and I'd have a hard time not wanting to check up on someone who was doing it and make sure they were sure sure that this was a good idea, just because so often it turns out not to be. But I also think in this space, you have to give people a lot of room to do what works for them. Sometimes it's really weird stuff.

I'm not a doctor, so please note that this is a genuine question, and not a rhetorical speculation: That said, smoking has always made my heart race. I'd be curious to know if this is common for people, and if it is common, then whether or not this could be a contributing factor.

>edit, sorry, that should have said "I'm not a doctor."

It can lead to anxiety and panic attacks due to the high levels of THC relative to the past.

Agreed. I'm always on the lookout for what are now low percentage strains. Perhaps I'm an odd ball lightweight but the current trend of ingesting as much THC as an possible in as little smoke as possible is not something I look forward to.

20+% come the fuck on...I'm not trying to make hash out of it.

It's the same with Wine, once upon a time a bottle was only 9-10% in alcohol volume and now an average bottle in the super market is up in the 13-14% range.

I've been complaining about this for years. Instead of optimizing for a pleasant sensation, growers have been trying to push THC as high as possible (while also pushing CBD to near non-existent levels). This 20%+ THC .5% CBD stuff tends to make me anxious and unhappy to the point that I've almost completely quit smoking.

Not that that's necessarily a bad thing overall. But still, I'd love to see some more moderate options take root in the marketplace. If my state ever legalizes, I think it might be fun to try my hand at breeding a personal strain with better ratios!

My heart has never raced when smoking, but 2 other people in my family have never liked it because it always made their hearts race.

THC is a vasodilator (it makes your blood vessels relax and become larger) which is thought to cause reflex tachycardia which means your heart has to beat faster in order to keep blood circulating because the "pipes" (blood vessels) have suddenly become larger. The vasodilation is also the cause of bloodshot eyes.

There is also something to said for the anxiety which high THC cannabis can cause, as well as a sort of circular anxiety due to the fast heart rate (my heart is beating fast due to reflex tachycardia, which makes me anxious and worried, which makes my heart beat even faster, etc.).

Sounds like why my heart beats faster when I drink

I think that is thinning the blood but a similar result

I know Ive consumed too much when my heart races. At one point in my life I had enough of a tolerance that I could smoke all day every day and had no heart racing. I don't use cannabis anymore since I dont know anyone who can provide it and I live where the legal status is that its treated like a parking ticket for personal use. Ive visited Colorado and California and tried the legal options. Its generally way to strong for me. A half of a hit of current weed in the average potency available is enough to get me where I want to be- which is to reduce stress and have a slight head change.

Anecdotally, such conditions have been common in strains that have high amounts of THC, and not much CBD. Haze was a big thing in the UK for a long while, as was Skunk. Both strains have high THC and little to-no CBD and these strains would cause me to flip badly. My friend who swears to never touch it again after he tried once and had bad-trip. When compared to other strains with more CBD, I would obtain more of the beneficial effects.

And that it could also be linked to if the strain is Indica (in-da-couch) or Sativa with the same % of THC. Cannabis science an interesting field.

For those like me who had to look it up, "myocardial infarction" is a fancy way of saying "heart attack"

How does this compare to the myocardial infarction risk that occurs in the same population due to cigarette smoking?

* smokes a pack of cigarettes while chugging a pot of coffee * I don't take any medications doc, it must have been the cannabis!

Now that organically grown, super high quality marijuana gummies and candies are legally available in many places, why do people still smoke vs. eat it? It seems so much safer and the precise dose predictable.

The effects are quite different for most people due to the lack of first-pass metabolism with inhalation which converts digested THC to a different form. Dry herb vaporizers might be a better suggestion.

A friend of mine who's a daily smoker finds the edible effects completely unpredictable and challenging to dose and enjoy compared to smoking or vaping.

Oh I see. Interesting. Thanks.

Not to derail what you've said, you can get capsules that have a very precise dosage. Here is an example:

https://herb.co/products/capsules/aurora-indica-liquid-gels/

The section “Study design and participants“ is rather questionable based on dependence upon the BRFSS survey. Most of their citations about this survey attempt to adjust for and explain how they have accounted for the fact that a random telephone survey is extremely unreliable in this age, and several of their citations do not even link to anything functional.

A history of MI was more frequent among recent cannabis users (n = 61 of 4610, 1.3%) relative to nonusers (n = 240 of 28 563 [0.8%], adjusted odds ratio [OR] 2.07, 95% CI 1.12–3.82).

One point three percent. Someone tell Willy Nelson before its too late.

It's less than 1.3%; it's a +0.5% delta (+0.3-3% for the confidence interval).

Well it’s a +63% relative increase. Not so tiny.

As a stoner from 16y onwards, I am thrilled to find out I actually survived this risk.

According to this study your odds went up from 0.8% to 1.3% so it’s hardly dodging a bullet.

I am still thrilled.

The more shocking takeaway for me is that ~1% of people under 45 have had a heart attack (cannabis use is a rounding error)! That's higher than I would have guessed.

More than 1% are fat slobs. So is it really surprising?

The obesity prevalence was 40.0% among adults aged 20 to 39 years, 44.8% among adults aged 40 to 59 years, and 42.8% among adults aged 60 and older. (2021)

https://www.cdc.gov/obesity/data/adult.html

I'm not sure the effect of obesity is that massive. Look at the curves in Fig 2 here https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6503652/bin/VHR... From the text of that paper it looks like being obese ~doubles your risk at a given age, and it looks like age is the highest risk. It looks like the cumulative risk of being obese AND 80 puts your risk at about ~12% for having a heart attack. Hard to tell from that graph if the 45 year old data is consistent with the study in this paper or not.

I would gander it is because the underlying reason is cardiovascular damage, not fat. But the two have a strong correlation. Even the tests for stenosis of arteries aren't very reliable or exact.

If we had good stats for vascular obstruction and looked at that instead, it'd probably be even more depressing than the obesity stats, knowing the diet most people eat..

> Competing interests: Karim Ladha and Hance Clarke are principal investigators of an observational medical cannabis study funded by Shoppers Drug Mart.

If there are no controls around the strain / type of cannabis I'm not entirely sure what we are testing and concluding.

When smoking at least 4 times a month.

i mean, if you're not even going to try. does that even qualify as smoking? users smoke 4 times before noon.

So vaping is safer?

The effects when vaping were not statistically significant in this study so we can’t say one way or another (according to this study).

I had my MI at age 43. Other than _smoking_ weed (via a bong) daily I was in good shape with regular exercise, etc. (5+ miles hiking in hills every day with my dog, at the bare minimum). After 3 stents I became much more conscientious about all my intakes and activities. I reduced my weed consumption, but began to notice that I would get angina pain about 20 minutes after smoking. Not after hiking or biking, or any physical activity, but almost always after smoking. At first I wondered if it was coincidence, so I reduced smoking further. But that served to further confirm it -- I would get angina pain only after smoking, and practically every time.

So bye-bye to the bong and smoking. I quit altogether, made tinctures (which I grew to like), and edibles for a while, but then tried a vaporizor (this was 2006). In hindsight, the idea of smoking is now unthinkable to me. I have felt no cardiac symptoms at all since vaping instead. YMMV.

Did you switch to vaping concentrates or dry herb?

I recently switched to a dry herb vape because concentrates were concerning me for other reasons.

Just dried herb/flower. Yeah, concentrates would be hard for me to trust, too.

I just bought a nice new bong but I think I need to swap to vape. What vape did you try? I owned a volcano but found the bag to be cumbersome for semi-regular use.

Pretty much anything from Arizer or Storz & Bickel are good bets. Dynavap is a great option if you're willing to deal with butane torches.

Adding to the the sibling comment, the “MIGHTY” is a portable dry herb vape by Storz & Bickel (they also make the Volcano) and is generally considered one of the best portable dry herb vapes on the market. The primary downside is that it’s still a bit large for a portable device.

I wanted something a bit smaller and less pricey to start with, and went with the “Fury Edge” by Healthy Rips. I’m a happy customer.

Pax by Ploom, threadwinner.

Awesome, thank you!

I’ll second the suggestion for the Mighty. It’s a fantastic vape. I’ve also heard the Crafty is quite good if you want something a little smaller. Prior to the Mighty I had a Pax 3, which worked quite well but the hits off the Mighty are much smoother.

As a side note, you can also buy water pipe adapters to connect your vape to a bong. This looks stupid, but gives by far the smoothest hits. I still occasionally will smoke papers with others, but dry herb vapes are far and away my preference.

People who make poor health decisions also have poor diet and exercise habits. Shocking and has never been proven before.

That is not what the study showed. They controlled for health and exercise.

In fact, the study they cited which also showed an increase in stroke risk actually showed cannabis users exercised more.

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