So the study is actually called "Development of an anxiety disorder following an emergency department visit due to cannabis use" and you can check it out here: https://www.thelancet.com/journals/eclinm/article/PIIS2589-5...

The study isn't establishing a direct link between cannabis and anxiety, it's looking very specifically at anxiety diagnoses following an ER visit. The findings are interpreted in the study as the following: "ED visits for cannabis use were associated with an increased risk of having an incident healthcare visit for an anxiety disorder, particularly in young males."

What exactly that means on the broader context of cannabis use isn't the focus of the study, but it invites further research to explore the implications of their findings.

I know a family with some sort of genetic disposition to anxiety disorders. Every generation up until recent times had at least one functioning alcoholic in it. The second to last was the beloved family matriarch, not the black sheep. Trying to drown out the maelstrom.

It’s called self medication, and people have a sense of when something is wrong with them without a doctor telling them (or for that matter, believing them). Neurodivergent people know this especially well, since “all in your head” was the ultimate dismissal of medical complaints up until the last decade.

Might as well study hospitalizations for stimulants and tendency to impulsiveness and intrusive thoughts. People with ADHD have been self-medicating with stimulants since the trade routes brought tea and coffee ( and probably with beer and wine before that).

I maintain that the original motto for Coca Cola (with real coca leaves) was a nod to high functioning ADHD customers. The Thinking Man’s Drink. Most measurable gains in cognitive ability from mild stimulants are enjoyed by the neurodivergent. But if we are 10% of the human population, that’s a demographic even Apple could love.

This begs the question, which is whether self-medication with cannabis makes anxiety worse, rather than better, for most people who try it. It might, or it might not, establishing to what degree the correlation is causal is fairly important.

I'd guess that it makes it better at first, worse in the long run. Depression and anxiety are known Cannabis withdrawal symptoms, so it seems like drinking to cure a hangover. There's a great Huberman episode on Canabis/THC.

> Huberman episode on Canabis/THC.

You mean the same episode where he claimed that something like 25% of pregnant mothers use Cannabis without providing any sources?

I'm not saying Huberman has to be right about everything, but I think he just cherrypicks too many studies, sometimes overestimates the value of animal research, and, once in a blue moon, just completely makes up stats to fit his narrative.

His on wikipedia page even says,

> Huberman has promoted anti-sunscreen views on his podcast, saying he's "as scared of sunscreen as I am of melanoma", and claiming that sunscreen molecules can be found in neurons 10 years after application; without providing any evidence.

I think his intentions are good, but I sometimes question his intentions when he never fails to mention that you can also use the code Huberman to get 25% off your first order of Athletic Greens.

I specifically referred to this episode: https://www.youtube.com/watch?v=UCbqfBAhmPY. I do not recall him talking about pregnant mothers using Cannabis. Do you have a source (video link, ideally with timestamp) for that?

If you can find the full episode, and not just the clip you provided, the timestamp is at 02:14:08.

Let me know if you are having trouble finding the full video. I do not want to search it at work, so I cannot link it now.

Huberman is the joe rogan of people who think reading a dozen inconclusive studies solves life's mysteries.

So Joe Rogan minus 11 studies?

I can tell you from experience that it is exactly that. It depends quite a bit on the variety and dose but overall, this is how it feels.

When you take it, everything is great, the next day there is the leftover that makes it a "chill" day but then it slowly goes away and anxiety comes back stronger the following days. At 3-4 days you deal with withdrawal a bit depending on how much you consumed which may increase anxiety or not depending on factors (experience, current situation, etc). I would say you get back to baseline after about 5 days to a week, which is quite long!

Cannabis probably doesn't cause anxiety on its own, but definitely do not really help the case for anxious people, in the long term. Unless you want to consider being "high" every day and for quite long. So, using cannabis to treat anxiety is a pretty bad idea but from my point of the view the biggest problem is the cognitive performance penalty you get from using cannabis and the problem is largely compounded by the fact that you do not feel that way at all when you are under influence or after (up to 2 full days after in my experience). Yet I can attest that the impact is very real, and it is quite easy to demonstrate if you have high level activities where you can collect stats (video games are great for that).

Cannabis and anxiety definitely have a relation, but it is really not the principal concern to have. I wish it would be legal everywhere so people could talk about it openly...

It could be, it also could just be that desperate people are drawn to a drug that's illegal but less 'illegal' in the court of public opinion than other drugs.

It's probably both.

Personally, if I went into an already mildly anxious situation (like going to work or driving, etc) pot would make me more anxious. At the end of the day, it made me less anxious and helped me unwind. It also helped me focus on coding when I was working on my own projects and/or learning. It's been a long time since I've indulged since I don't live in a free state, so it might be different now that I'm older.

Talking about the ADHD thing, there's a similar problem with some research that claims stimulants cause Parkinson's disease. The study authors didn't seem to account for the fact that people with more severe ADHD would be more likely to be treated with stimulants and that severity of ADHD could instead be the causal factor.

Or the self-care failings of ADHD people predispose them to earlier onset. Or that ADHD people chew on things they really shouldn't.

Going to an ER after taking cannabis seems like something only someone with an existing anxiety disorder might do.

A more accurate headline might read: People with anxiety disorders who take cannabis may unnecessarily visit the ER.

> Going to an ER after taking cannabis seems like something only someone with an existing anxiety disorder might do.

Twenty or thirty years ago, I'd have agreed with you on this, but potency that's normal today wouldn't even have been a dream back then. If you think that makes no difference, I'm here to tell you you are wrong.

I constantly see this, but haven't people been making concentrates for 1000s of years? I imagine ancient Nepali hash would probably rock a lot of people's world still to this day.

Sure, but Nepali hash was being taken in a much different cultural context (religious, often) by people who were generally very prepared for its consequences.

You both are correct, I've seen it countless times. Folks sometimes don't admit even to themselves how insecure and anxious they are. And THC will highlight that, sometimes a bit, sometimes massively. Same with alcohol, other drugs, intense stressful situations and so on.

If you are not anxious, this is no story, this won't bulge even after decades of copious consumption (some very close folks fall here and only here, no exception ever heard of).

Now if you are completely clueless or just a (again clueless) kid and say eat 5 space cakes to show off, yeah this will not be a nice story. 5-10 hours of catatonic despair will leave some mark, but this id self-inflicted harm due to stupidity, many wonderful harms and deaths have been caused by very same thing and if we want bans due to that, alcohol should be the first in line by huge margin.

Educate from childhood, regulate (age, potency, how much daily, optimize for harmless consumption of quality products without impurities), but otherwise let folks do their thing. Anything else leads long term to worse results for whole society, any gut feeling is easily beaten by long term statistics.

Oh, it's nothing anyone can't get through with a little help from someone who can take a broader perspective. That's a lot harder to come by these days than should be, or at least than is healthy for primates as social as we. Stronger communities would yield fewer such ER visits, too.

I don't advocate a ban; Prohibition is a salutary example and it would be worse today for all involved. But I also don't like to see anyone talk about any drug, and certainly not this one, as entirely benign.

My father in law gets super paranoid and anxious on weed and LSD but he will never admit it because he wants people to believe that he's completely chill

Man, I wish my father-in-law was using LSD with me!

The problem I have with studies like this is that the implied scoping really distorts any conclusions that could be drawn. People who don't go to the doctor - by definition - don't get diagnosed with anything.

Finding causality is hard and this study has so many hidden confounders that even implying causality from weed to anxiety disorder is bullshit.

Anecdotally, the only people I know that ended up in ED due to weed either took it unknowingly or have Cannabinoid hyperemesis syndrome from heavy heavy usage. Surely someone with a tendency for anxiety is more likely to seek medical help.

I know cannabis smokers who have anxiety issues, but it isn't obvious whether their tendency for anxiety leads them to smoking. I'm ignoring temporary anxiety. Disclosure: not a pot smoker.

What does it mean to visit an ER for cannnabis? Wouldn’t that typically be an anxiety attack in the first place?

If you've never had a panic attack before, the first one is easy to mistake for something a lot more dangerous.

During a mental health first aid course, I remember being told those mistakes can (admittedly rarely) happen in the other direction too. ie someone thinking they were having a panic attack actually having a heart attack instead.

The advice was to go call an ambulance anyway for someone having a serious panic attack. But for what it's worth, that advice was given somewhere where calling ambulances won't cost you.

A friend of my father unfortunately had a similar issue. Complained of acidity in the morning, dead from a heart attack by afternoon. It's much better to be over-cautious in such cases.

The key word here is father. If you're in your 20s or 30s, chances of it being heart attack instead of panic attack are incredibly low.

While I mostly agree, I myself unfortunately very likely experienced pericarditis after my covid shot. Worst pain I've had in a long time, but I was "sure" it was just gas and "couldn't be a heart issue because it's been going on for x hours or else I'd have been dead". I wish diagnostics was easier for health & heart conditions.

Indeed, while not cannabis related, I visited the ER once due to a panic attack (which I did't know at the time). My combination of high heart rate, mild abdominal pain, and a low grade fever triggered their sepsis protocol. This constellation of symptoms caused me to spiral more and eventually I was discharged with nothing more than some chill pills and constipation.

I experienced this personally about 3 years. I had a panic attack so bad I didn't understand what was happening. Cue 3AM ambulance ride to the ER and all that. What was crazy was that when they did the tests in the ER, the main biomarker they look for a heart attack was mildly elevated. Higher than you'd like. But - barely - in the diagnostic range. Three days later, after a battery starting at ECG, and continuing through a full stress test and heart cath I was given a clean bill of health and sent home.

Elevated troponin? If so I had a very similar experience.

I had a random episode of afib about 10 years ago and my EKG has been known to make doctors nervous (I've been told that its strange but apparently its "normal" for me). After the afib episode, I became very paranoid about my heart rhythm and I think the paranoia exacerbated a previously latent anxiety issue. One day the paranoia became so bad that I thought I was having another afib episode but I wasn't 100% sure. I was self aware enough to know that I was mild hypochondriac and that it was likely that nothing was wrong. It was a Sunday so I went an urgent care. I figured they would check my heart, tell me everything was fine and it would put my mind at ease. They gave me and EKG and when urgent care doc saw it, he told me to go to the hospital immediately.

Long story short. The ER doctor thought everything was fine and was going to release me until my troponin levels came back elevated. I was put in ICU, given an ECG, and hearth cath. They didn't fine anything and released me. My anxiety became a lot worse after that. A few days later I went back to the ER. They checked my troponin levels and they elevated again (they dropped over the course of the first hospital stay) so I was admitted again. This time I did a full heart MRI. They didn't find anything. No signs of heart attack or heart damage (which high troponin is supposed to be an indicator of).

My anxiety was almost debilitating after that. Took me years to recover.

That sounds familiar?

I even had a little scare about a decade ago when a little transient tachycardia showed up during a sleep study.

Yeah, anxiety has not returned to baseline. COVID has certainly not helped. I haven’t caught it - but I am medically… complicated and a lot of my stuff is respiratory. I mask when I can, which helps but one can only do so much. At least I have a sympathetic GP so I have Ativan for when things are bad now.

It’s a hell of a feedback loop. When I’m super anxious - surprise surprise - my HR and BP are way up (and if I’ve had to use my asthma meds… oh lawd.) thus they want to keep you because you’re not “normal”. Want that stuff to come down? Gimme something nice to relax me, and let me sleep for 5 or 6 hours without a bunch of leads on or someone waking me up every minutes to stick a thermometer under my tongue.

Some consequences of illegal substances are things like "lack of standard dosage" and "lack of consumer education."

Someone who has never taken cannabis before, accidentally not realizing they've consumed too much, not knowing how to handle it, and wondering if they're okay, and calling 911 or going to the ER, is not an unfamiliar story.

Cannabinoid hyperemesis syndrome? Asthma attack? Being way too high?

Just some guesses.

The only I've heard about:

- psychosis

- green out/being absolutely ripped, and found by others, who in turn will take you to the ER.

> people who visited an emergency room for cannabis use

?

it's not uncommon for naive (first-time) consumers, especially of edibles, to have intense reactions that lead to ER visits; I suspect that many of those are just folks who have no idea what is going on and interpret the feeling as being dangerous. IIRC the symptoms often include racing heart, intense paranoia, and a general feeling of lack of control.

Also the ER is the first line of treatment for many individuals.

Most people wouldn’t visit an ER for cannabis unless they already had some anxiety disorder that lead to insane amounts of anxiety.

That's a strange thing to say, why do you think that? I know a lot of people who don't have anxiety disorders who had an anxiety attack when they first got high, and yes they might think they need to go to the hospital. The physical experience of weed can feel like you're dying

Most people know you can’t die from cannabis no matter what so in my experience they just sleep through it. I’m assuming people with anxiety disorders can’t rationally think through this scenario when they have taken too much and end up going to the ER.

Also, what's the base rate of developing an anxiety disorder?

NIH says:

> An estimated 19.1% of U.S. adults had any anxiety disorder in the past year.

https://www.nimh.nih.gov/health/statistics/any-anxiety-disor...

That's pretty high already, and I imagine the base rates for anxiety developing among "people who have to be hospitalized for any reason" are much higher than the general pop.

Am I right in seeing that the data referenced in that article was collected between 2001-2004? If so, I wonder how that compares to today. I suspect we'd see much higher numbers for data collected 2019-2023, given the pandemic and associated garbage fires.

yes, its bunk science as usual. soft sciences cannoy isolate the variables necessary to make evidence supported conclusions. They are only opinions.

What this study says to me is that emergency rooms cause the anxiety disorders. If you visit the ER and mention you have consumed any illegal substance, that information is entered into your medical record and can be used against you by the government later. ER's also try to force people into "treatment" and social programs that they cannot participate in if they use cannabis.

I'd be interested in reading about some of what you describe in more detail. Can you provide any links to things?

This study isn't "bunk science", nor is medicine a "soft science". It's just silly to apply your own government paranoia to the 12 million people in the study cohort without rational reason to do so.

"government paranoia" makes a person a historian. What I said and the consequences of it, are fact. Feel free to try yourself. Perhaps read some history on the FBI, war on drugs, ATF, etc. It's all on wikipedia and well sourced from those orgs themselves. Studying 12 million people and controlling the variables properly is not possible, thats why it's a "soft science" study that cannot honestly make any good conclusions. There is no version of this kind of study that can produce good results because the details necessary make that scale impossible.