Accurate Education - "Medical Marijuana" - Getting High

Medical Marijuana:

Getting High

The elephant in the room…

When considering trying marijuana for medical purposes, those who have never experienced marijuana may be confronted with a concern regarding the experience of “getting high,” especially if they have never used any recreational drugs in their past. The closest experience many people may have had to relate to the concept of getting high is the “buzz” of mild alcohol intoxication which may share certain qualities with the high of marijuana but is distinctively different.

Unfortunately, the subject of getting high is often ignored or completely avoided by medical professionals who instead focus on the purported therapeutic benefits of marijuana. This section will explore the experience of getting high with marijuana including its potential therapeutic benefits and concerns.

Before pursuing a trial of therapy with cannabis-based products, first read:

Links to ALL Marijuana Educational Pages

The medical information on this site is provided as a resource for information only, and is not to be used or relied upon for any diagnostic or treatment purposes and is not intended to create any patient-physician relationship. Readers are advised to seek professional guidance regarding the diagnosis and treatment of their medical concerns.

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Understanding Getting High

The subject of getting high, whether it be from marijuana, other drugs or non-drug related experiences or activities is an enormous one. This section will simply focus on its role in the use of marijuana products.

What is it, exactly?

To begin with, the definition of a marijuana “high” is somewhat elusive largely because the experience differs between individuals and between different times for the same individual. It is sometimes described as “euphoric, excited, elated, or exhilarated” which for many people overstates the “feel good” experience of marijuana. For many a high is a mental state where sensory experiences – sound or music, taste or foods, smells – are enhanced and more pleasurable than normal. Other experiences may also feel enhanced and more meaningful, profound or even more funny when compared to the non-high state. Accompanying these perceptions, the high may also include a more care-free, relaxing state of mind where one is less burdened by the stresses of daily living. These manifestation of the high associated with marijuana use are positive, rewarding features in of themselves and are generally considered therapeutic benefits.

When the high is not

The use of marijuana may also include unpleasant, negative experiences as well, most commonly anxiety and paranoia, when THC dosing is too high and the feel good experience is lost. With extreme doses or with highly-sensitive individuals, hallucinations may occur which may be unpleasant and induce anxiety. Careful dosing is required to avoid these side effects especially with the use of edible cannabis products (dosing greater than 5-10mg for the inexperienced) or high-potency marijuana flower (THC content greater than 15-20%).

Therapeutic Implications of Getting High

Little study has been performed to specifically assess the therapeutic benefits of getting high when using marijuana products. In fact, it is often thought of as an unfortunate side effect when marijuana is prescribed for conditions such as pain or muscle spasm. However, an interesting study has recently been published that focused on the associations between subjective patient experiences of feeling “high” and therapeutic treatment outcomes. In the evaluation of 1,882 people using marijuana for therapeutic benefit, people reported feeling high in 49% of their cannabis treatment sessions. The authors of the study concluded that feeling high when using marijuana is associated with increased symptom relief for pain, anxiety, depression and fatigue (but not for insomnia) as compared to those sessions not associated with feeling high. Of note, increased side effects (both positive and negative) were also reported.

These relationships were statistically significant even after controlling for the quantity of cannabis consumed, the characteristics of the flower product (plant phenotype and THC and CBD potencies) and the mode of consumption (pipe, joint, vaporizer). In other words, changes in thought processing that characterize the distinct experience of feeling high may play a statistically and clinically significant role in the medicinal effects of marijuana for some patients.

Conclusions

The study demonstrated that higher THC levels are most effective at increasing symptom relief if they induce feeling high. These results argue against a common belief that the experience of feeling high is a negative, undesirable side effect of cannabis-based therapies, but instead feeling high may be a fundamental factor for effective cannabis-based treatment, perhaps even more relevant than THC potency in determining symptom relief. It was noted however that the correlation between feeling high and therapeutic benefit was stronger in younger vs older patients but not affected by gender.

Although THC potency levels were the only independent predictors of an increased likelihood of reporting feeling high, feeling high was an independent variable for therapeutic outcome, not a proxy for THC. However, regardless of whether a patient reports feeling high, higher THC levels appear to be strongly associated with increased side effect reporting. These results suggest that ever-increasing THC levels per se are not the key to therapeutic benefits.

Implications

For some people, the negative impact of cognitive impairment from feeling high may outweigh the perceived benefits of using marijuana. For example, when treating health conditions associated with cognitive and behavioral impairments, feeling high maybe detrimental. In other patients with chronic pain, depression or anxiety, the positive manifestations of feeling high such as increased reported quality of life, improved behavioral motivations, experiencing creativity and improved social relations may have positive superimposed therapeutic benefits.

Regarding Pain

With the understanding that the experience of pain is a complex interplay of not only painful sensory input but also of memory, emotion, learning and other higher order executive brain functions, the impact of getting high on these major brain functions can clearly alter the pain experience. It has been proposed that the dominant mechanism behind the benefit of marijuana use in chronic pain is not a reduction of pain severity per se, but actually an improvement in the patient’s ability to cope with their pain. In other words, there is a change in the conscious experience and character of pain in which the pain sensation becomes less hurtful, not necessarily less severe, when getting high from marijuana. The mechanisms underlying the experience of getting high may impact the same mechanisms that interpret the hurtful component of pain.

Traditional Analgesics vs Marijuana

Traditional analgesics, including opioids, mainly affect the intensity of the pain, whereas marijuana affects the pain experience in a more holistic way, affecting factors such as emotion, mood, and mindfulness in a manner suggestive of the “high” experience. That is, in addition to lessening its intensity, marijuana may affect the pain experience more broadly, influencing pain tolerance, functionality, and overall well-being. In this way, the consciousness-altering psychoactive “high” effects of marijuana can be a part of its therapeutic mechanism, instead of being considered a negative side effect.

In a 2023 Finish study assessing marijuana and opioids in the management of pain, participants perceived marijuana and opioids as equally effective in reducing pain intensity. The strongest differences between the two treatments.were, in order of magnitude, marijuana’s impact on improving relaxation, sleep and mood. However, it was also noted that marijuana allowed patients to be able to feel pain without reacting to it. In other words, to experience pain with less of the hurtful component. This is a mindful process that includes pain acceptance and detachment from pain, two important tools in contemporary pain management.

These findings imply a broad range of cognitive-emotional processes. Feeling relaxed is one of the most common benefits attributed to marijuana use as well as one of the most common driving motivations for marijuana use. Relaxation can be defined as “a relative absence of anxiety and physiological tension, manifested as calmness, peacefulness, and being at ease,” certainly some of the most important goals of mindfulness training for pain management. Upon closer inspection, these holistic benefits attributed to marijuana use in fact embody “getting high” in many ways. While the experience of being high with marijuana manifests in many different ways for many people, these responses represent the fundamental aspects of the marijuana high experience.

It is important to emphasize that the altered state of consciousness described here is not one that distorts one’s cognitive processes or perception of reality, but instead it holistically alters consciousness in a more positive direction towards “normality” to improve memory, focus and clarity of thought. The results of this study suggest that the psychoactive effects of marijuana, “getting high,” can be therapeutically positive and have beneficial effects on mood and functioning.

Medicinal or Recreational Marijuana Use?

Given the widespread prevalence of clinical and sub-clinical medical conditions in the general population, this study suggests that some “recreational” cannabis use in which the user is solely motivated to get high, may actually be providing medicinal benefits, whether the user is aware or not. Survey data shows a strong overlap between medicinal and recreational use among cannabis users suggesting that it may be inappropriate to make a distinction between medical versus recreational cannabis use.

Factors Influencing Getting High with Marijuana

THC Dosage

As noted above, the primary factor in getting high is related to THC dose. Of course, the underlying affect and mood of the individual will influence the high with marijuana use. One interesting finding reported in the study was that vaping was associated with a reduced likelihood of feeling high, although the authors did not distinguish vaping extracts vs dry flower.

Of note, pharmacokinetic studies comparing smoking with vaping marijuana flower has demonstrated that vaping is more efficient than smoking and leads to higher blood levels of THC, 11-OH-THC, THCCOOH and THCCOOH-glucuronide concentrations. (it should be noted however, blood and oral fluid cannabinoid concentrations and cognitive/psychomotor performance are only moderately correlated at best, and often not correlated at all with blood levels of these cannabinoids. In fact, as described elsewhere, self-reported drug effects and cognitive/psychomotor impairment often persist for several hours after cannabinoid concentrations in blood and oral fluid fell below very low to undetectable levels. Interestingly, no single cannabinoid measured, either in blood or oral fluid, is universally associated with cannabis-related drug effects including getting high, physiological changes and cognitive performance).

Other Cannabinoids

CBD and THC are the two main cannabinoids in cannabis, but CBD does not make one high. However, CBD, CBN, CBG, and THCV are other cannabinoids that may influence the high. THCV and CBD may reduce negative side effects (especially anxiety) of THC. CBD has been reported to reduce high symptoms but research is inconclusive.

Terpenes

There does not appear to be any definitive literature as to which terpenes contribute most to euphoria. According to Leafly.com, however, anecdotal evidence suggests that the best terpenes for euphoria among their most euphoric strains are caryophyllene followed by terpinolene, myrcene and limonene. That being said, the website also acknowledges that there are nearly 2,700 strains in their database that have euphoric properties, likely reflecting the fact that it is THC that is mostly responsible for euphoria.

According to Labeffects.com, the terpenes best for euphoria are:

Consumption Method

Ingestion of edibles may be more potent and long-lasting compared with vaping or smoking, but experiences will vary among consumers. One interesting finding reported in a 2023 study was that vaping was associated with a reduced likelihood of feeling high, although the authors did not distinguish vaping extracts vs dry flower.

Cannabinoids

Marijuana Strain

According to some, OG Kush is a favorite but the most important variable is the potency of the THC content

Tolerance

All other factors aside, an individual’s tolerance level to THC may be the most critical component to how a high is experienced. If one is new to cannabis, their tolerance level is low and they can and should start with less potent strains and lower dosages.

Frequency of Use

Another study collected data on 260 participants from online cannabis forums who used cannabis from an average of five to six times per week, to a minimum of three times a week. The group consisted primarily of males (76 percent), but included a mix of white (56 percent) and Black (38 percent) individuals,

The study evaluated people’s thoughts and feelings regarding getting high with marijuana as they were going about their daily lives, as opposed to being in a clinical setting. It also evaluated chronic users with different rates of use—several times a week versus several times a day—and changes in the experiences of each individual when high versus sober.

In this study participants reported being high 64 percent of the time when smoking dried cannabis. Numerous motivations for getting high were identified, but the primary reason was simply that they liked the feeling but it was also frequently reported to help concentrate and focus.

Contrary to a common belief that cannabis use flattens people’s emotions, this study seemed to reveal heightened emotions among the study subjects, but how depended on how frequently they used tcannabis. Those who got high two to four times a week reported increases in positive emotions—greater awe, silliness, happiness, inspiration, even love—while they were high. They also said they felt less scared and less stressed while high.

However, results were different for the heaviest users—those who got high multiple times a day. Heavy users reported feeling greater levels of negative emotions compared to the moderately frequent users—including feelings of embarrassment, disgust, and guilt—both when high and when sober. The study did not distinguish if the negative emotions precipitated the more frequent use of cannabis, or if increased cannabis use lead to more negative emotions.

The study also contradicted the belief cannabis use is associated with lack of motivation and focus. It was found that being high did not make participants less motivated than when they were sober. According to self-reports, those who used cannabis several times a day tended to be even more motivated to complete tasks than less frequent users.

Euphoria

As noted above, not all people who use marijuana even those who express getting high do not necessarily associate this with euphoria. That being said, however, understanding euphoria is important. The experience of euphoria is generally characterized by feelings of excitement, intense happiness and a sense of well-being along with an amplified sense of pleasure.

Euphoria may be induced by activities outside of the use of drugs or medication’s. Examples include a euphoric mood often associated with aerobic exercise, sexual activity and expressions of love. The high associated with running for example is often described as euphoric and is one of the driving motivation for frequent long-distance runners..

Euphoric moods can be broken down into specific types:

Activity-induced euphoria
Religious Experience-induced euphoria
Disorder-induced euphoria
Medication-induced euphoria
Substance-induced euphoria

Activity-induced euphoric moods can result from natural experiences including exercise, listening to music and social activities such as dancing and having sex with someone. Is believed that activities such as these result in the manufacture and release of natural-based endorphins which may trigger euphoria. The effect of endorphins can be maximized by engaging activities that are synchronized with others, both human and pets.

Religious Experience-induced euphoric moods are not uncommon, especially in some denominations, including Baptists, who may experience trance-like raptures of euphoria.

Disorder-induced euphoric moods can be associated with certain mental health conditions including bipolar disorder and schizophrenia. In these cases, euphoria can sometimes be trigger anxiety, confusion, mood swings, feelings of restlessness and in some cases hallucinations. Euphoria under these circumstances may be detrimental which is the reason the use of psychoactive drugs, such as marijuana, should probably be avoided in those with history of bipolar or schizophrenia disorderss.

Medication-induced euphoric moods may also be produced by prescription medications (in addition to opioids), including nitrous oxide and somewhat rarely, benzodiazeoines (such as alprazolam (Xanax) and clonazepam (Klonopin) as well as steroids (such as prednisone, a corticosteroid).

Substance-induced euphoric moods are associated with substances commonly used for recreational purposes, including LSD psilocybin, marijuana, methamphetamines, ecstasy, and in some cases, benzodiazepines, heroin and other opioids.

Of note, despite their euphoric properties, the psychedelic substances LSD and psilocybin (mushrooms) are generally not addictive. In contrast, the other substances, cocaine, methamphetamines, opioids, and marijuana are associated with euphoria are associated with addiction.

It is believed that the addictive potential of substances are largely due to their activation of the brain’s reward system (especially the nucleus accumbens). In this case, these substances have a significant impact by markedly activating the brain reward system, which in turn reinforces the use of these substances and contributes to addiction. Although use of these substances may always activate the brain reward system, it is those people with an inherent reward deficiency that are most impacted by the rewarding effects of these substances which in turn makes them most vulnerable to developing addiction.

To make a point, euphoria in itself does not predict addiction.

References:

Medical Marijuana – Getting High

Cannabidiol (CBD)- Overviews

CBD – Anxiety

CBD – Interaction with THC

Medical Marijuana –Misc

Medical Marijuana – Product Evaluation

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Accurate Education – "Medical Marijuana" – Getting High