> researchers were unable to account for several potential confounding factors including the duration and amount of cannabis use or the use of tobacco or other drugs.
Personally I'd wager a bet it's the tobacco and/or smoking that is the harmful part, but it kind of dumbfounds me they failed to account for "details" like "duration and amount of cannabis use", that feels like a very vital thing to control for. Nothing is good for you in too great amounts, even water, so not taking that into account seems to not really give reliable and trustworthy results.
Exactly. Being unable to account for this covariate (tobacco use) pretty much invalidates this analysis. The odds ratio for tobacco use is basically the same (3x).
This article refers to two studies. The retrospective study of 4.6 million people did account for tobacco use.
> The findings are from a retrospective study of over 4.6 million people published in JACC Advances and a meta-analysis of 12 previously published studies being presented at the American College of Cardiology's Annual Scientific Session (ACC.25).
> Kamel and his team conducted the retrospective study using data from TriNetX, a global health research network that provides access to electronic medical records. Their findings indicate that over an average follow-up of over three years, cannabis users had more than a sixfold increased risk of heart attack, fourfold increased risk of ischemic stroke, twofold increased risk of heart failure and threefold increased risk of cardiovascular death, heart attack or stroke. All study participants were younger than age 50 and free of significant cardiovascular comorbidities at baseline, with blood pressure and low-density lipoprotein (LDL) cholesterol levels within a healthy range and no diabetes, tobacco use or prior coronary artery disease.
That's not really a fair standard by which to judge the study, abstract or not. The dosing mechanism information was not present in the underlying dataset available to them:
> This retrospective cohort study utilized the TriNetX health research network, which aggregates deidentified electronic medical records from health care organizations worldwide.
> 1) The cannabis-user group with cannabis use diagnoses (International Classification of Diseases, 10th Revision: F12.1, F12.9, F12.90).
You can't expect them to work miracles and come up with data they didn't have. They produced a valuable piece of research furthering our understanding of the cardiovascular risks of cannabis use based on a very large existing dataset that was available to them.
Of course they would love to be able to answer the question of whether smoking is worse for your heart than edibles and so on, and they stated they would like to do this in a future study. But that costs time and money to create an entirely new dataset, and you know what funding for science is like these days.
There's plenty of other evidence in the literature on the cardiovascular effects of THC if you want to see what our current understanding is there. TL;DR: smoking is worse than vaping or edibles; myocardial infarction risk spikes within the first few hours of using cannabis; but the risks are not limited to inhalation because THC itself has physiological effects that raise cardiovascular risk factors (increased heart rate, endothelial dysfunction, platelet activation raising clotting risk, inflammation and oxidative stress, etc.).
Did they though? Not accounting for confounding factors like “other drugs” seems to indicate it’s not about the risks of cannabis use so much as the risks from all sources that the average cannabis user faces. Using only cannabis might have zero impact or even be beneficial based on this evidence (if you hypothesize that most of the negative outcomes were cannabis+cocaine users, for instance).
Still good data, but I don’t think it’s predictive for what cannabis use leads to (unless you assume that taking up cannabis makes you proportionately more likely to also take up whatever the confounding factors were).
They didn't find that cannabis use leads to cardiovascular disease. They found a strong association between cannabis use and cardiovascular disease in a very large study. Correlation isn't causation. The study itself acknowledges that. That doesn't mean it's an invalid or useless study that didn't add to the body of scientific knowledge and evidence about the relationship between cannabis use and cardiovascular disease - I think we agree there. That's how science works. Observational studies do not definitively prove causality.
After reading the study, should we update our posterior on the hypothesis that cannabis use causes cardiovascular disease to nudge it in the direction that it does? Yes - that's just Bayes' theorem. Does the probability go to 95%+? No, of course not; I'm not claiming otherwise. It's still useful research.
Also, worth noting that MI risk spikes several-fold within the first hour after cannabis use (and that's not caused by cocaine).
The cannabis to cocaine pipeline sadly is real, whether we want to or not. As long as the same people we buy our weed from also have a chance of being the people that have cocaine for you to buy, all that’s left to figure out is the money and the willingness to buy some.
Cannabis is a multi purpose drug, cocaine is party drug and/or a "I haven't slept, don't want the 8 hour+ commitment of speed, but need to stay awake" drug.
The overlap of pot users and cocaine users is rather small in my anecdotal experience.
This is odd to me. The X to Y pipeline is real if A, B, and C also align. It’s a weak correlation that sounds a lot like the “gateway drug” propaganda.
That's interesting and probably an argument for pro-legalization.
Were I to pick a gateway drug into cocaine, it would be alcohol. It becomes a way to infuse more energy in a later night, which is usually one of alcoholic revelry.
When cannabis is just in a store and it's the only thing there, many potheads just stay in the pothead bubble.
I am aware of someone who does both, because I overheard someone discussing it with him. Cannabis will retain a black market when it becomes a government cash cow.
Back in college I had a friend find a new dealer who he thought was pretty cool until he tossed out a rock in the middle of a pot deal, my friend never went back.
Myself I have been involved with weed a long time and never seen cocaine though my son did go into town one night and lock himself out of his car and have an experience we call "the night of the living baseheads."
The best drug dealer at my old school was a guy who would take chances nobody else would; I knew him somebody who dealt weed, psychedelic mushrooms and acid to my friends although I was persona-non-gratis with him because he was seriously criminally minded and led a gay bashing gang that mostly bashed straight people who were perceived as allies, although it took just one snarky comment (my case) or advising somebody being shot at with a paint pellet gun to see the police (the popular president of the paint pellet gun club.)
He eventually got caught bashing in an RA in the face with a rock shot with one of those rubber band catapults people use to shoot water balloons at the beach. He was banned from campus but I saw him once when he was dropping off a delivery for a friend. My friend later told me that he'd been caught on videotape dealing 3kg of cocaine to an undercover cop and he did time.
That's an unusual case. Except for that guy and the Vietnamese kid who took money and never delivered the weed to my wife when she was in high school, all the pot dealers I knew were basically responsible and law-abiding people who only dealt pot and other soft drugs. Funny somebody dropped a dime on the later.
I live in a legalized Marijauna country and there is no black market. The prices in the legal stores are actually lower than the formerblack market prices.
Sauna raises HR without increasing blood pressure though (modulo some possible initial short spike at the beginning), because your blood vessels dilate.
Cannabis causes dilation of blood vessels and elevated HR, it’s the same effect. If you take a big dab you can definitely feel your blood pressure drop and muscles relax even though your heart rate has increased.
Yeah it raises heart rate and blood pressure bc it dilates your blood vessels. The raised HR/BP are to counter that so you keep pushing the same amount of O2 per unit time.
That's one of the reasons. The primary reason is THC is a partial CB1 receptor agonist - CB1 is abundant in the central and peripheral nervous systems - so it increases sympathetic nervous system activity and norepinephrine, both of which raise heart rate independent of vasodilation.
I mean, probably? There's definitely a statistical likelihood of folks who use cannabis also using tobacco products or other substances. It's not a "gateway drug" so much as a "anyone who enjoys thing X is likely to try related things" object. I recall those early studies about alcohol in moderation being good for you eventually being debunked as, "actually, folks who could afford alcohol consistently in moderation also ended up being able to afford health insurance and that created the better outcome"; I suspect there's something similar with cannabis when we look retrospectively, given its illegality for so long (users are less likely to seek medical attention for symptoms or precursors to avoid the stigma).
The thing is we don't know without doing more research, which I genuinely appreciate the authors essentially calling out point blank. They're not saying cannabis is bad, they're saying that looking at the thin amount of valid data we have available thus far, there's definitely a correlation there worth investigating further.
That's a weird statement. I don't think I'll ever visit a cardiologist (as a patient) unless I had a suspicion of heart disease. Is it common to get checked out by specialists for no reason in your locale?
I have been a heavy cannabis user (like that guy in the Bob Marley song who "smokes two joints in the morning, smokes two joints at night") on and off from my mid 20's onward. I've also been a heavy exerciser and have the constellation of symptoms known as "athlete's heart" including an A-Fib diagnosis that I don't really believe [1] as well as concerning findings that may or not really be concerning because doctors don't know to evaluate us. I'm the kind of person who might get told by a doctor to exercise less instead of more!
Mostly it's been smoking, though I've had access to edibles and was lately impressed by cannabis beverages that contain 10mg of THC and some CBD that give an experience competitive to drinking alcohol. I find it easy to not use it if is not around, but once I get into it I will keep using it and quitting is a few days of hell followed by almost forgetting it ever existed. But maybe I get depressed a bit a few months later and think "I will feel better if I use" and then I will use for a few weeks to months, start feeling strung out and quit. Never dabbed, I haven't found a vape I like the way I like smoking but for me it has always been green weed, not extracts. It is legal to grow in NY and I know enough amateur and pro growers who owe me a favor that I rarely have to pay for weed and don't expect to ever go into a dispensary.
I do know that I gain/lose several kg of wait depending on if I am using cannabis. Despite being rather athletic and having a lot of lean muscle mass I have many signs of "metabolic syndrome" including somewhat high blood sugar, blood pressure, etc. [2] I am off cannabis now and just started Zepbound which I am hoping will help with my metabolic syndrome.
[1] once i got into a biosignals hobby and started looking at EEG traces to evaluate heart rate variability where I often can't make out the P wave on a two or three lead ECG, how can you say 20 beats out a million were bad with any accuracy?
[2] with somewhat aggressive pharmacological treatment including high dose fish oil without which my triglycerides would have another 0 on the right; showed up my docs with a sheaf of pubmed abstracts, switched to Montelukast as my asthma controller because it may be cardioprotective whereas my academic advisor and galactic astronomer Edwin Salpeter and his daughter wrote a paper finding LABAs are probably the opposite; my pulmonologist switched me to using a LABA/Steroid inhaler for rescue because a recent study has shown that the holy grail of "just one inhaler" has been attained for a lot of people and the LABA isn't much slower to hit than Albuterol. Also added Nebivolol as a BP med which I think should be more popular than it is.
Many people have had cardiologists say they have perfectly fine hearts go on to have heart attacks months later. My brother was one of these people. He was going in for spinal surgery, cardio said his heart was fine. Two weeks after surgery he was short of breath. Turns out he needed a triple bypass.
And that was a physical change. Heart attacks happen because of electrocardiac issues as well.
Information asymmetries are a bane in the medical doctor market.
Trust doctors with a grain of salt. There are many bad doctors that market themselves as good doctors, but are in reality terrible providers.
I recently had a scare, where I was encouraged by two separate general practitioners to seek immediate care with an ophthalmologist. I visited the ophthalmologist who I was referred to and they said everything was great, then booked my next appointment for a year out. Four days later, I started losing vision in my right eye.
After visiting a competent ophthalmologist, they were flabbergasted by what the other did. Ten appointments within 2 weeks later with the new specialist and we're undoing the damage that was easily preventable.
In short, some doctors are borderline DANGEROUS, but it's difficult to distinguish them with the ample legal protections they receive.
It comes down to the old saying for doctors, "when you hear hoofbeats, think horses, not zebras." Rare and dangerous things often manifest in ways that look really similar to relatively harmless and common things. Go forward with the most probable explanation and you're not only going to be right the overwhelming majority of the time, but also keep costs and stresses down for patients. Only when somebody does show up with a genuinely serious condition (or otherwise had significant red flags) do you jump to zebras.
This is likely even more true in modern times with such high rates of anxiety and other similar disorders paired alongside the internet - there's going to be a lot of hypochondriacs suddenly thinking, and subsequently claiming, that they have every symptom of [something awful].
Doctors have very little in the way of legal protections, but malpractice has to actually be malpractice. A recent study on the topic found that in low risk occupations, 75% of doctors end up getting sued for malpractice over their career, and in high risk it bumps up to 99%. [1] When people don't like the outcome, they sue, but in most cases the outcome was largely unpreventable even with a high standard of care.
this is so true. There's huge variability in competence. and many doctors have fled to boutique medical care, or whatever it's called, since the recent changes in healthcare.
> After visiting a competent ophthalmologist, they were flabbergasted by what the other did. Ten appointments within 2 weeks later with the new specialist and we're undoing the damage that was easily preventable.
Eeesh...sorry about that. Been there my whole life. It too ten years to get an appointment with a Hematologist and was finally diagnosed with Erythrocytosis which I told them I had but always said my HCT levels were "not really that high". The Hematologist looked at my records and wondered why they did not send me in twenty years ago. I am on Medicare which makes it much more difficult.
> Anyhow, hope your brother recovered well.
My whole family disowned me for no other reason than me having a serious mental illness so I do not care. But thanks.
No. This was about ten years ago. But not much has changed as I cannot get CAC score on Medicare even though they wanted to put me on statins. Cardiologist says I am fine. :/
Yeah, but I mean what can you do really? Many people have CAT scans then it turns out the technician/whoever missed something, or a surgeon forgets an instrument inside of the patients body, shit happens.
If people are this concerned about heart health, they'd be wise to continue a zero-covid lifestyle into 2026 and beyond, since each re-infection (which vaccines don't prevent) increases the risk of severe health outcomes, including heart-related issues among lots of others.
Yet I only see about .5-1% of the population in my area these days wearing any kind of mask/N95 respirator in public.
Quit recently after daily use for about 30 years. Took 3 years, and several regiments of hyperbaric therapy, I also took the time to cut out all other stimulants or depressents, alcohol, coffee etc.
Now I stimulate the Vegas nerve in the morning and at night with breathing regiments
Its hard to quit as there is a lot it does for you neurologically like caffeine does but I finally realized it was giving me neuroinflammation and wrecking my sleep quality so I stopped. Likely other long term health problems but those are harder to see/feel.
Now my body does biphasic sleep and I journal at night and read books. Never liked to do either. Get crazy amounts of energy now and people constantly comment on the difference in me.
Goodluck, you can in fact regulate this shit out of your daily habits if you find a way to do a cellular reset. Its not easy.
I quit smoking cigarettes and checked drinking way way easier than cannabis
I wonder about all the confounding effects. In my country (famous for cannabis to be easy to come by (for decades already), and I saw many smoke from age 16 up as I grew up in 90's, 00's). I have always felt that the heavy cannabis smokers had something to compensate; stress, unrest, impending depression, friction with parents. It was never the healthy sporty types with fulfilling relationships, good grades or a nice career that smoke cannabis heavily (like daily). Sure, some of those smoked, but more occasionally.
I’m not from a place where cannabis use was common, but it was present.
Growing up I definitely knew some people who had their demons who turned to drugs.
However we also had a lot of people who were in good situations who picked up drugs for purely recreational reasons. One of my friends at the time even boasted that drugs were actually more appropriate for people like him who were educated, in good situations, and rational (his description of himself) because they knew how to manage themselves and their usage better. He even had links to some subset of the rationality community who had become pro-recreational drugs with a lot of justifications.
His turn to drug use marked the end of his promising academic career. He started struggling with mental health in ways that were obviously related to the drugs. Holding a job had never been a problem until he starting smoking, which marked his turn toward job struggles. His friends and family relationships started declining and falling apart.
He’s not the only one I know like this. The first person I knew who had to go to rehab for drug addiction was a happy, successful guy who started using drugs as a way to party more and for longer. He thought his life was awesome and he was invincible.
I think there’s become a belief that drug use is purely a symptom, but I’ve seen enough people go from happy to falling apart as an obvious result of the drug use. Most of the people I know who started using drugs didn’t do it at their homes in private to cope, they started doing it at parties with friends.
This is even well known with alcohol: There is common belief that being a “social drinker” is a different risk profile than someone who does their drinking alone.
I think it’s a comforting idea that we tell ourselves that nobody chooses to use drugs, they are driven to do so by circumstances out their control. We like removing blame from people and hoisting it on to the world. I don’t think it’s always true, though. Many people use drugs because drugs are rewarding (at first) and they like the way the drugs make them feel. The negative consequences come later.
I feel by your logic, no one should ever use drugs or alcohol lest they become addicted to how good they make them feel. An abstinence approach. very modern!
You ever taken a hike or nature something and try it in that different context?
Set and Setting are also relevant too. If you do it a soecfic way with other soecific tools and activities while on it, that all gets packaged and reinforced.
I believe it’s an “artificial” reward mechanism for some people. The ability to control one’s own rewards is an easy habit to take up. If the rewards aren’t coming from externalities one needs to get them from somewhere.
Esp the last wording: "friction with parents" (which is by the way are very noble wording here, I have to state)
I have not met ANY regular drug user (regardless which drugs), who didnt had "frictions with parents" early in their life. (and some for which its still persisting into their 40ies)
Not really, it more depends if you are east coast or west coast. East coast has stigma associated with loss of control. They have a stick up their ass basically.
Yeah I think for any of the significant pot smokers I've known it's a way of avoiding other issues. As a positive it's probably much better they descend into pot than alcohol which I'm sure many would if it was the only other easy coping mechanism.
Yeah that's me. I quit for short periods but usually continue because my other coping mechanisms that replace it aren't any better. I naturally smoke little when life is busy and going well
In my country, California, we have so much cannabis use and it’s by basically everyone. People with spouse and children, fulfilling careers and exercise regimes. The culture of a place really can change the outcomes. It’s part of why Silicon Valley beat Route 128.
In American collegiate and professional athletic circles almost everyone uses marijuana. I was a nationally ranked junior tennis player and even in that sport almost every other top junior I knew smoked weed.
These nerds that have to biohack and optimize to be physically fit are coping by claiming that jocks don’t get high. Sporty types are genetically different and have plenty of capacity for cannabis use.
That is an opinion. I for one prefer talking to a happy, healthy mind, healthy body-type over someone with a life riddled with substance experiments. In fact, it was why I hardly talked to some of my family for a long time. Every weekend was the same, they were always angry and in the end they nearly killed themselves. I'm happy they got out of it and we have a much better relation now.
I was under the impression that breathing in burnt particulate of any sort was associated with serious cardiovascular risk? I would think a significant portion of cannabis users ingest smoke very frequently or at least second hand smoke more frequently than people who do not engage at all with a subculture that is largely smoke oriented.
but sure, still lets make to account by other "legal" substances (alco, tobacco, cocaine, pharmaceutics and other "lifestyle choices" infecting cardiovascular system)
and way they are consumed(smoked, ingested, pure or with say tobacco)
would love see data for a group who consumes cannabis by ingestion and especially not via smoking!
also- do they differ different thc/cbd grades used (high/low thc, "medical")?
im regards "research demonstrates something does this.." for many years alcohol was considered "healthier" over non consumption, just becauses non-drinkers were together with those of abstinent ex-alcholics.. thus average score was lower than for those who drunk minimal amounts and were considered "healthier".
For me, cannabis causes anxiety, and it’s pretty well established that anybody with anxiety or bipolar or schizophrenia should not be using cannabis because it can make these much worse. I don’t suffer anxiety anymore, but there’s plenty of scientific evidence about the relationship between anxiety and cannabis use.
Would be nice to know how much of a role a sedentary lifestyle plays in it or if it puts everyone at risk regardless of other habits. Maybe this just means you need to do cardio several times a week to keep using THC.
FWIW, I've smoked cannabis daily for maybe 15 years, I'm not exactly sedentary (have dogs, a partner and like to (lazily) swim in the sea) but generally don't exercise. Visited a cardiologist like two months ago and have perfectly fine heart despite the smoking.
Anecdotal of course, many could probably bring up counter-stories too, but I do think you bring up a good point, it seems to me a completely sedentary lifestyle seems to be way more destructive to your health than moderate usage of various drugs and/or eating habits. People who just walk a bit daily already seem way healthier and happier than peers in their same age.
The study controlled for general health but I would note that the odds-ratio reported for cannabis use (4-6) is not so different from the odds-ratio associated when studying high vs. low income cohorts (3-5). This study is not a random blinded clinical trial it's reporting a trend present in ~5 million electronic health records which I assume record yes/no to patients ever telling a doctor they have used cannabis.
I would assume that cannabis use correlates with a few other important heart health variables and we would expect the odds ratio to be lower when accounting for those (alcohol doesn't have an OR more than 1.0, tobacco smoking ~1.5)
I'm sure that cannabis use is bad for cardio health but the reported odds ratio is very high. I personally do not use cannabis.
What has worked for me is (1) Buy 4+ boxes of coconut water (2) remove cannabis from your house, (3) drink coconut water whenever you feel like smoking, (4) get some exercise going (swim, push-ups, gym, sports) - whatever the "MVP" of exercise is to start thinking of your body as fit, athletic & strong.
Yeah I know someone who is having real trouble stopping, he can cold-turkey for a few days but always starts up again. I think he has poor impulse control, which maybe GLP-1s could help, as some studies seem to indicate they help with cravings/impulsive behavior generally. I don't know if any MD would prescribe it for that, he's not obese so could not get it on that basis.
It's not addictive along the same pathways (as far as I'm aware) from what I observe in my own life you either smoke casually and could stop whenever you want to (I used to then I stopped no problem) or you are dealing with psychological stress factors that are best treated with the help of a mental health professional.
Some commenters here talking about anxiety, but I think the bigger cause, which many people don't know, is that THC significantly increases your heart rate despite it's usual characterization as a depressant. If I recall correctly (big "if" considering the circumstances hah) my heart rate after smoking would go up by 10-20 BPM (from 65-70 to 80-90) while still feeling relaxed; ~~finding some numbers on this from a reputable source is difficult right now and this symptom is suspiciously missing from the wikipedia page~~.
Edit:
Realized this comment sounds like fear mongering, so decided to dig up some actual sources. The wiki page I needed to find was:
There's more going on here than just the substance's effect.
There's a mind body connection that an altered state can throw into disarray.
Under the influence of cannabis, one may be a lot more aware of physical pain, dehydration, and so on. The key word is aware. Suddenly becoming aware of the fact that you are stressed out, you are carrying tension, can lead to something of a latent processing effect of some of these suppressed or physically felt emotions.
However, if you're generally not tense, ingesting cannabis itself does not always raise the heart rate. I can validate this myself right now, given I wear an Apple Watch and can vaporize cannabis. Looking at my historical data, there is no relationship, and my resting heart rate remains in the 40s.
It's anecdotal, but at the same time we need to be careful with something that acts on the physical, the mental, and dare I say it, the spiritual. If we focus too much on one dimension, we lose the important synergy from processing all dimensions.
for the anxiety crowd: don't buy street weed and avoid sativas
about the 'study': I do not trust anything that comes out of meta studies given how many base studies are found to be either garbage or very lacking in controls. And without knowing an accurate life history it is hard to rule out or quantify damages done much earlier in life.
The entire field of statistics is based off not making critical type 1/2 errors (which meta studies are not able to control well) so I would say it is not just his "gut" feeling.
What the literature definitely finds is that CBD ratio is crucial for anxiety (higher CBD = less anxiety). Some of the first lab experiments were pure THC and quite intense/unpleasant relative to what you'd get from a plant naturally "full spectrum." If you're ever in california, NY, Maryland, whatever then try something with 1:1 THC:CBD and maybe get some of the other CBs in there too.
[Strain sativa/indica can sort of be an indicator, but going by the dose of each active ingredient is the more scientific approach]
For clean weed - not laced with anything - sativas are more prone to causing anxiety. I doubt one will find any kind of study proving this, it is anecdotal - myself, friends and the internet at large.
While not universally true, it seems that many of the sativas for sale are very high THC which probably is a primary factor. Other factors are terpenes, though there is still a lot of debate on whether it these are real or imagined effects.
Moderate THC (15-20%) indica or indica dominant hybrid flower, using a flower vape, IMHO, is the best way to go. Always a good idea to read strain reviews prior to purchase (or growing) as people will note those that have caused them to be anxious, sleepy, hungry, horny, etc.
People can also have very different reactions when taking a drug (weed, shrooms, lsd, etc) alone vs with friends, something to consider as well.
Agreed. Blending in CBD and other cannabinoids is way more effective than relying on strains. Basically everything out there is extremely high in THC and nothing else. Mixing in high CBD flower reduces anxiety a lot for me
quite a few people I know consume edibles as the main form of cannabis. but it seems underrepresented in all the studies I've seen so far. as several others have pointed out, you would think the act of smoking would itself have nontrivial effects on health
I mean, it's good that we have data showing some sort of connection between heart attacks and cannabis, but I appreciate the callout toward the end more:
> Since both studies were limited by their retrospective nature and the meta-analysis was limited by the challenges inherent in pooling data from multiple studies, researchers said that additional prospective studies would help to confirm the findings and determine which groups may face the highest risk.
Here's the thing that both the alarmists and the naysayers keep ignoring: all this data is new, it's recent, and decades of effective global prohibition have meant the only sources of reliable data came from either post-war/pre-prohibition studies (often by Defense Departments) or from "anecdata" gathered retrospectively among large cohorts. We still lack a substantial amount of direct, quality, long-term data on drug use and Nth-order impacts on the body, and these studies are the first steps towards getting more data from higher quality research to draw better conclusions from.
If anything, I try to be quite open with my Doctors about my own use precisely because I know that data is thin and dated, and any contributions from patients in an honest manner is going to help draw better conclusions for healthcare guidance tomorrow. Letting alarmists use these thin precursors as justification for a return to total prohibition is the wrong move.
correct. the push for dispensaries has been financial not medical. now that we are getting large scale trials there will be more real evidence to show the public health effects. my guess: it will go the way of smoking eventually. realization around public health effects -> cost of those effects on public services -> taxes and costs go up. I'm curious as to why heart attack and not stroke. seems like bp isn't the only thing at play.
Not really related, but the other thing I found out recently that cannabis can cause is the worst panic attack I have ever experienced: a DPDR (derealization / depersonalization) panic attack. I’ve had regular panic attacks before. I get one a year, roughly, where I get essentially heart attack symptoms. But this was something else. It felt like something was truly, irrevocably broken with my mind and I couldn’t even describe what. Utterly terrifying. I was a heavy user but dropped it the next day.
I had a similar experience when I was young. Bought a vape and some Cannabis, which probably had really high THC concentration as it tends to have nowadays. Took a bit, didn't feel anything, then took a bit more, and boom, a panic attack. Might even had some hallucinations, I'm not fully sure what was real and what wasn't.
After the experience I felt kind of weird and "slow" for several days. Later I found out that there is also a genetic risk of schizophrenia in my family. No way I'm going to touch anything with THC ever again. I've tried CBD oil though and that was okay, slightly calming effect. But ultimately I prefer beer over that too.
In social systems or spiritual systems where cannabis is used, this is often called "going clear".
We (general West) have no overarching myth or support system to help people navigate this type of pure madness. We have a psychological framework, and anything that interferes with our capacity to construct an I, a me, an ego in real time is seen in the most ultimately negative terms. And the experience is terrifying, such to support these terms.
Though, if through meditation, through religious constructs, or similar, there is a learned capacity to sit with the experience, it is considered less of a breaking and more of a liberation.
Wouldn't recommend it, wouldn't prescribe it. Though this decoupling of self from experience isn't a universal ill.
THC increases glutamate release[1], which is most likely the source of this panic. I have psychotic episodes even with a a few big hits but then again I have schizoaffefctive disorder. Glutamate is my arch enemy.
Anecdotally this isn't uncommon among heavy users, I've heard of similar things happen to a few people. You did the right thing stopping, where people really go off the deep end is when they don't listen to the warning signs and keep blazing.
I think weed should be legal and for the majority of people used in moderation it's going to be fine, but at the end of the day it's a psychoactive drug. It's probably not optimal to use it daily and in particular waking and baking every day is asking for trouble.
Also a case to be made that modern strains are worse. I fully believe that the risk of losing the plot is higher when you're smoking some lemon sherbet bubblegum flavours every day instead of old fashioned moroccan hash
Without a clear mechanism of action, this sure requires monitoring (like any drug), but the conclusions are terribly oversold. Correlation does not imply causation, no matter the sample size
Come on people, it is a drug. Exercise, cardio, eat well, sleep well, it's your choice the risks you take, but try to balance the good with the bad, if you partake in "bad".
Literally no mention of ROA. It matters whether they smoke plant matter, vape, use it orally, etc. This, combined with their inability to account for a number of other factors such as tobacco use, makes this study literally useless. Earned a flag from me.
Substances approved by the FDA are done based on specific treatments, with multiple trials and approval per use case
Substances declared scheduled are illegal by the substance itself, instead of per use case
paradoxically because there is no FDA approved use case and almost no way to get one
meaning that places in the US that diverge in legality and are ignored by the federal government have done so without any clinical trial, which would be some level of peer reviewed objective information by use case instead of the whole substance
we can’t even get a simple list of side effects, or a disclaimer about what kind of users shouldn’t use it
The US government is now in thrall to the Kratom industry though isn't it? No reason to expect any logical consistency from them.
(Literally the person currently responsible for the branch of government that keeps illegal drugs out of the country is an investor in a Kratom company)
The most ridiculous thing about cannabis remaining schedule 1 (high risk of abuse, no known medical use) so long is that there is both prescription THC and CBD. It should have been changed|to a higher (less strict) schedule decades ago with the release of marinol in 1985. Then we could have had a lot more studies being done. Needless to say, not easy to do studies on schedule 1 drugs.
Just a few years ago cannabis was presented online as a miracle drug that could cure all physical and psychological diseases. Any criticism of the sacred cannabis was strictly forbidden and dissenters were burned alive in the figurative fire of social media. Interesting how times are changing.
When it was legalized, there was a documentation push and clear presentation of the downsides. In fact, as above, the language is mostly presented in the negative.
This matches the general sentiment of the broad population.
And let's not conflate things. The article is discussing smoked cannabis. This does not invalidate the essential substance and benefit of the experience. If we remove the ingestion method from the basket of effects, it's a different discussion.
Not all positive, yet smoking is clearly not good for you.
What I find fascinating is how smokers rationalize their
behaviour, e. g. "weed is harmless". When they compare it
to fentanyl or heroine/cocaine, but compounds are never
intrinsically harmless. But you can not get that message
across most folks who are smoking weed. It's a somewhat
similar issue, to some extent, when you look at sumo
wrestlers. These have a significantly lower life expectancy
on average than the rest of the society in Japan, but the
sumo association does not acknowledge that. It's really
strange how the human mind operates.
There's a saying: don't throw stones if you live in a glass house. The same human mind that rationalizes the intake of substances is the same one that rationalizes social networks, junk food, eating meat, whatever it is. I wouldn't be so quick to condescend.
At some point in time, it's important to realize that not everyone optimizes for longevity, correctness, rationalism, and so on, and they just simply do what makes them feel good within the limited life that they have.
Nothing is intrinsically harmless. Cannabis can be devastating. But I was just sitting here doing work one day, got a hemorrhage in my eye, and lost half the sight in it. Otherwise, I'm supremely healthy. The cause: a gene.
Or alcohol, or whatever others are doing. In Italy, where I live, people on the ‘left’ side of the political spectrum (let’s say ‘progressives’) tend to think it’s perfectly ok to smoke dope, irregardless of what any scientific study may or may not say. This seems very weird to me.
Yes, people want to recreate, doing all kinds of activities with various levels of risk. They don't need to concern themselves with whether you can respect it.
There are (illegal) substances that are highly effective for treating these issues, PTSD, etc. Psilocybin, ibogain, etc. Obviously when administered correctly, with therapy, etc.
It seems to me that cannabis users aren’t seeing the benefits of the aforementioned group. My experience of cannabis stoners is that it’s used to numb out and for escapism, which certainly aligns with what you’re saying.
sure but you aren't going to help mental/emotional problems by getting stoned
there are far better, legal supplements to treat that anyway, less expensive too
dope activates AMPK in the brain/CNS and turns off AMPK in the body/heart it's an incredibly stupid thing to do to yourself (also why people get "the munchies")
literally why it's called dope (before dope meant "cool")
which blocks the receptor that THC binds to and led to weight loss and further improvements of the “metabolic syndrome” beyond weight loss alone. Unfortunately it caused major depression in some people including suicide.
So looking at it that way it would be no surprise that cannabis causes weight gain and metabolic syndrome and in fact my experience is that if I am using cannabis I get a few kg. I think that is the THC and on top of that if you are smoking you are inhaling small particles that turn your blood into sludge (e.g. your blood is a “complex fluid” with cells in it that can be damaged) and doing damage to your lungs and capillaries and promoting inflammation and all that.
The data is from EMR records. The researchers stated themselves ~ “people should be more forthcoming with their doctors.” I don’t think anything meaningful can be concluded other than most people don’t like having the fact that they have done cocaine on their medical records.
> researchers were unable to account for several potential confounding factors including the duration and amount of cannabis use or the use of tobacco or other drugs.
Personally I'd wager a bet it's the tobacco and/or smoking that is the harmful part, but it kind of dumbfounds me they failed to account for "details" like "duration and amount of cannabis use", that feels like a very vital thing to control for. Nothing is good for you in too great amounts, even water, so not taking that into account seems to not really give reliable and trustworthy results.
The physical act of smoking itself is harmful. Not just tobacco specifically, burning and inhaling anything.
Exactly. Being unable to account for this covariate (tobacco use) pretty much invalidates this analysis. The odds ratio for tobacco use is basically the same (3x).
Also, title needs a 2025.
This article refers to two studies. The retrospective study of 4.6 million people did account for tobacco use.
> The findings are from a retrospective study of over 4.6 million people published in JACC Advances and a meta-analysis of 12 previously published studies being presented at the American College of Cardiology's Annual Scientific Session (ACC.25).
> Kamel and his team conducted the retrospective study using data from TriNetX, a global health research network that provides access to electronic medical records. Their findings indicate that over an average follow-up of over three years, cannabis users had more than a sixfold increased risk of heart attack, fourfold increased risk of ischemic stroke, twofold increased risk of heart failure and threefold increased risk of cardiovascular death, heart attack or stroke. All study participants were younger than age 50 and free of significant cardiovascular comorbidities at baseline, with blood pressure and low-density lipoprotein (LDL) cholesterol levels within a healthy range and no diabetes, tobacco use or prior coronary artery disease.
I know you can't judge a study by its abstract, but they don't even mention the dosing mechanism, it's just "cannabis use".
That's not really a fair standard by which to judge the study, abstract or not. The dosing mechanism information was not present in the underlying dataset available to them:
> This retrospective cohort study utilized the TriNetX health research network, which aggregates deidentified electronic medical records from health care organizations worldwide.
> 1) The cannabis-user group with cannabis use diagnoses (International Classification of Diseases, 10th Revision: F12.1, F12.9, F12.90).
You can't expect them to work miracles and come up with data they didn't have. They produced a valuable piece of research furthering our understanding of the cardiovascular risks of cannabis use based on a very large existing dataset that was available to them.
Of course they would love to be able to answer the question of whether smoking is worse for your heart than edibles and so on, and they stated they would like to do this in a future study. But that costs time and money to create an entirely new dataset, and you know what funding for science is like these days.
There's plenty of other evidence in the literature on the cardiovascular effects of THC if you want to see what our current understanding is there. TL;DR: smoking is worse than vaping or edibles; myocardial infarction risk spikes within the first few hours of using cannabis; but the risks are not limited to inhalation because THC itself has physiological effects that raise cardiovascular risk factors (increased heart rate, endothelial dysfunction, platelet activation raising clotting risk, inflammation and oxidative stress, etc.).
Did they though? Not accounting for confounding factors like “other drugs” seems to indicate it’s not about the risks of cannabis use so much as the risks from all sources that the average cannabis user faces. Using only cannabis might have zero impact or even be beneficial based on this evidence (if you hypothesize that most of the negative outcomes were cannabis+cocaine users, for instance).
Still good data, but I don’t think it’s predictive for what cannabis use leads to (unless you assume that taking up cannabis makes you proportionately more likely to also take up whatever the confounding factors were).
They didn't find that cannabis use leads to cardiovascular disease. They found a strong association between cannabis use and cardiovascular disease in a very large study. Correlation isn't causation. The study itself acknowledges that. That doesn't mean it's an invalid or useless study that didn't add to the body of scientific knowledge and evidence about the relationship between cannabis use and cardiovascular disease - I think we agree there. That's how science works. Observational studies do not definitively prove causality.
After reading the study, should we update our posterior on the hypothesis that cannabis use causes cardiovascular disease to nudge it in the direction that it does? Yes - that's just Bayes' theorem. Does the probability go to 95%+? No, of course not; I'm not claiming otherwise. It's still useful research.
Also, worth noting that MI risk spikes several-fold within the first hour after cannabis use (and that's not caused by cocaine).
Not to mention cocaine.
The cannabis to cocaine pipeline sadly is real, whether we want to or not. As long as the same people we buy our weed from also have a chance of being the people that have cocaine for you to buy, all that’s left to figure out is the money and the willingness to buy some.
(Sadly speaking from experience)
No.
Cannabis is a multi purpose drug, cocaine is party drug and/or a "I haven't slept, don't want the 8 hour+ commitment of speed, but need to stay awake" drug.
The overlap of pot users and cocaine users is rather small in my anecdotal experience.
Legal cannabis sends its greetings, if you're lucky enough to live in a country where you can acquire it without having make any shady acquaintances.
I have smoked cannabis for 20 years and I have never known anyone fall into the "cannabis-to-cocaine pipeline."
Everyone I knew who developed coke problems had drinking problems first. Bar none.
This is odd to me. The X to Y pipeline is real if A, B, and C also align. It’s a weak correlation that sounds a lot like the “gateway drug” propaganda.
That's interesting and probably an argument for pro-legalization.
Were I to pick a gateway drug into cocaine, it would be alcohol. It becomes a way to infuse more energy in a later night, which is usually one of alcoholic revelry.
When cannabis is just in a store and it's the only thing there, many potheads just stay in the pothead bubble.
Exactly, alcohol IMHO affects judgment significantly worse than cannabis.
AND its a heavy party drug, which cannabis is notoriously not
I am aware of someone who does both, because I overheard someone discussing it with him. Cannabis will retain a black market when it becomes a government cash cow.
Back in college I had a friend find a new dealer who he thought was pretty cool until he tossed out a rock in the middle of a pot deal, my friend never went back.
Myself I have been involved with weed a long time and never seen cocaine though my son did go into town one night and lock himself out of his car and have an experience we call "the night of the living baseheads."
The best drug dealer at my old school was a guy who would take chances nobody else would; I knew him somebody who dealt weed, psychedelic mushrooms and acid to my friends although I was persona-non-gratis with him because he was seriously criminally minded and led a gay bashing gang that mostly bashed straight people who were perceived as allies, although it took just one snarky comment (my case) or advising somebody being shot at with a paint pellet gun to see the police (the popular president of the paint pellet gun club.)
He eventually got caught bashing in an RA in the face with a rock shot with one of those rubber band catapults people use to shoot water balloons at the beach. He was banned from campus but I saw him once when he was dropping off a delivery for a friend. My friend later told me that he'd been caught on videotape dealing 3kg of cocaine to an undercover cop and he did time.
That's an unusual case. Except for that guy and the Vietnamese kid who took money and never delivered the weed to my wife when she was in high school, all the pot dealers I knew were basically responsible and law-abiding people who only dealt pot and other soft drugs. Funny somebody dropped a dime on the later.
I live in a legalized Marijauna country and there is no black market. The prices in the legal stores are actually lower than the formerblack market prices.
Edible forms of cannabis raise heart rate and blood pressure substantially as well.
I think this is making the assumption that temporally elevated HR and BP is bad.
Right, the rationale for why saunas and heat stress is good for you is specifically because it raises the heart rate.
Hot sauna is often cautioned against for those with existing cardiac or vascular problems, with some reason.
Exercising or stressing damaged or degenerated tissues = bad
Sauna raises HR without increasing blood pressure though (modulo some possible initial short spike at the beginning), because your blood vessels dilate.
Cannabis causes dilation of blood vessels and elevated HR, it’s the same effect. If you take a big dab you can definitely feel your blood pressure drop and muscles relax even though your heart rate has increased.
It's a fair assumption being a known potential cause of death. Of course I'm now assuming death is bad.
By that argumentation sport is bad and a potential death risk factor, it also elevates heart rate and blood pressure!
I think you'd be surprised how often doctors still say that
It has substantially more benefit than that risk. Physical exertion also has the added benefit of lowering rest hr and bp.
Not to mention art, sex, walking, etc, etc
Yeah it raises heart rate and blood pressure bc it dilates your blood vessels. The raised HR/BP are to counter that so you keep pushing the same amount of O2 per unit time.
That's one of the reasons. The primary reason is THC is a partial CB1 receptor agonist - CB1 is abundant in the central and peripheral nervous systems - so it increases sympathetic nervous system activity and norepinephrine, both of which raise heart rate independent of vasodilation.
Dilation lowers blood pressure
I tried to look up the source article, but there doesn’t seem to be any mention of consumption of edibles versus smoking.
I mean, probably? There's definitely a statistical likelihood of folks who use cannabis also using tobacco products or other substances. It's not a "gateway drug" so much as a "anyone who enjoys thing X is likely to try related things" object. I recall those early studies about alcohol in moderation being good for you eventually being debunked as, "actually, folks who could afford alcohol consistently in moderation also ended up being able to afford health insurance and that created the better outcome"; I suspect there's something similar with cannabis when we look retrospectively, given its illegality for so long (users are less likely to seek medical attention for symptoms or precursors to avoid the stigma).
The thing is we don't know without doing more research, which I genuinely appreciate the authors essentially calling out point blank. They're not saying cannabis is bad, they're saying that looking at the thin amount of valid data we have available thus far, there's definitely a correlation there worth investigating further.
> Nothing is good for you in too great amounts, even water
https://youtube.com/watch?v=XewVicFzRxw&t=152s
Yep, https://en.wikipedia.org/wiki/Median_lethal_dose
cf. paracelsus on the dose and the toxin
Do you smoke?
Literally just wrote about that: https://news.ycombinator.com/item?id=48794178
> I've smoked cannabis daily for maybe 15 years [...] Visited a cardiologist like two months ago and have perfectly fine heart despite the smoking.
That's a weird statement. I don't think I'll ever visit a cardiologist (as a patient) unless I had a suspicion of heart disease. Is it common to get checked out by specialists for no reason in your locale?
[delayed]
I have been a heavy cannabis user (like that guy in the Bob Marley song who "smokes two joints in the morning, smokes two joints at night") on and off from my mid 20's onward. I've also been a heavy exerciser and have the constellation of symptoms known as "athlete's heart" including an A-Fib diagnosis that I don't really believe [1] as well as concerning findings that may or not really be concerning because doctors don't know to evaluate us. I'm the kind of person who might get told by a doctor to exercise less instead of more!
Mostly it's been smoking, though I've had access to edibles and was lately impressed by cannabis beverages that contain 10mg of THC and some CBD that give an experience competitive to drinking alcohol. I find it easy to not use it if is not around, but once I get into it I will keep using it and quitting is a few days of hell followed by almost forgetting it ever existed. But maybe I get depressed a bit a few months later and think "I will feel better if I use" and then I will use for a few weeks to months, start feeling strung out and quit. Never dabbed, I haven't found a vape I like the way I like smoking but for me it has always been green weed, not extracts. It is legal to grow in NY and I know enough amateur and pro growers who owe me a favor that I rarely have to pay for weed and don't expect to ever go into a dispensary.
I do know that I gain/lose several kg of wait depending on if I am using cannabis. Despite being rather athletic and having a lot of lean muscle mass I have many signs of "metabolic syndrome" including somewhat high blood sugar, blood pressure, etc. [2] I am off cannabis now and just started Zepbound which I am hoping will help with my metabolic syndrome.
[1] once i got into a biosignals hobby and started looking at EEG traces to evaluate heart rate variability where I often can't make out the P wave on a two or three lead ECG, how can you say 20 beats out a million were bad with any accuracy?
[2] with somewhat aggressive pharmacological treatment including high dose fish oil without which my triglycerides would have another 0 on the right; showed up my docs with a sheaf of pubmed abstracts, switched to Montelukast as my asthma controller because it may be cardioprotective whereas my academic advisor and galactic astronomer Edwin Salpeter and his daughter wrote a paper finding LABAs are probably the opposite; my pulmonologist switched me to using a LABA/Steroid inhaler for rescue because a recent study has shown that the holy grail of "just one inhaler" has been attained for a lot of people and the LABA isn't much slower to hit than Albuterol. Also added Nebivolol as a BP med which I think should be more popular than it is.
Have you tried battery-free vapes?
That song was made popular by Sublime. Not written and never performed by Bob Marley. Great track though!
Many people have had cardiologists say they have perfectly fine hearts go on to have heart attacks months later. My brother was one of these people. He was going in for spinal surgery, cardio said his heart was fine. Two weeks after surgery he was short of breath. Turns out he needed a triple bypass.
And that was a physical change. Heart attacks happen because of electrocardiac issues as well.
Information asymmetries are a bane in the medical doctor market.
Trust doctors with a grain of salt. There are many bad doctors that market themselves as good doctors, but are in reality terrible providers.
I recently had a scare, where I was encouraged by two separate general practitioners to seek immediate care with an ophthalmologist. I visited the ophthalmologist who I was referred to and they said everything was great, then booked my next appointment for a year out. Four days later, I started losing vision in my right eye.
After visiting a competent ophthalmologist, they were flabbergasted by what the other did. Ten appointments within 2 weeks later with the new specialist and we're undoing the damage that was easily preventable.
In short, some doctors are borderline DANGEROUS, but it's difficult to distinguish them with the ample legal protections they receive.
Anyhow, hope your brother recovered well.
It comes down to the old saying for doctors, "when you hear hoofbeats, think horses, not zebras." Rare and dangerous things often manifest in ways that look really similar to relatively harmless and common things. Go forward with the most probable explanation and you're not only going to be right the overwhelming majority of the time, but also keep costs and stresses down for patients. Only when somebody does show up with a genuinely serious condition (or otherwise had significant red flags) do you jump to zebras.
This is likely even more true in modern times with such high rates of anxiety and other similar disorders paired alongside the internet - there's going to be a lot of hypochondriacs suddenly thinking, and subsequently claiming, that they have every symptom of [something awful].
Doctors have very little in the way of legal protections, but malpractice has to actually be malpractice. A recent study on the topic found that in low risk occupations, 75% of doctors end up getting sued for malpractice over their career, and in high risk it bumps up to 99%. [1] When people don't like the outcome, they sue, but in most cases the outcome was largely unpreventable even with a high standard of care.
[1] - https://www.reuters.com/article/us-doctors-idUSTRE77G5YS2011...
If zebras cause blindness, perhaps you should consider zebras?
Q: What do you call the person that graduated medical school with the worst grades?
A: Doctor
this is so true. There's huge variability in competence. and many doctors have fled to boutique medical care, or whatever it's called, since the recent changes in healthcare.
> some doctors are borderline DANGEROUS, but it's difficult to distinguish them with
Bingo.
Some medical practitioners were the bottom of the class.
No different than mechanics.
Can’t hero-worship.
> After visiting a competent ophthalmologist, they were flabbergasted by what the other did. Ten appointments within 2 weeks later with the new specialist and we're undoing the damage that was easily preventable.
Eeesh...sorry about that. Been there my whole life. It too ten years to get an appointment with a Hematologist and was finally diagnosed with Erythrocytosis which I told them I had but always said my HCT levels were "not really that high". The Hematologist looked at my records and wondered why they did not send me in twenty years ago. I am on Medicare which makes it much more difficult.
> Anyhow, hope your brother recovered well.
My whole family disowned me for no other reason than me having a serious mental illness so I do not care. But thanks.
Did you brother have a Coronary Artery Calcium score scan?
No. This was about ten years ago. But not much has changed as I cannot get CAC score on Medicare even though they wanted to put me on statins. Cardiologist says I am fine. :/
They only cost about $100.
Yeah, but I mean what can you do really? Many people have CAT scans then it turns out the technician/whoever missed something, or a surgeon forgets an instrument inside of the patients body, shit happens.
If people are this concerned about heart health, they'd be wise to continue a zero-covid lifestyle into 2026 and beyond, since each re-infection (which vaccines don't prevent) increases the risk of severe health outcomes, including heart-related issues among lots of others.
Yet I only see about .5-1% of the population in my area these days wearing any kind of mask/N95 respirator in public.
Doesn't this apply to colds and flus too?
If you look into the effects, they're two separate categories of damage. Also, considering COVID keeps mutating, it's much harder to control.
Anybody curious might consider scanning the sticky posts on /r/zerocovidcommunity for more information and links to external sources.
Quit recently after daily use for about 30 years. Took 3 years, and several regiments of hyperbaric therapy, I also took the time to cut out all other stimulants or depressents, alcohol, coffee etc.
Now I stimulate the Vegas nerve in the morning and at night with breathing regiments
Its hard to quit as there is a lot it does for you neurologically like caffeine does but I finally realized it was giving me neuroinflammation and wrecking my sleep quality so I stopped. Likely other long term health problems but those are harder to see/feel.
Now my body does biphasic sleep and I journal at night and read books. Never liked to do either. Get crazy amounts of energy now and people constantly comment on the difference in me.
Goodluck, you can in fact regulate this shit out of your daily habits if you find a way to do a cellular reset. Its not easy.
I quit smoking cigarettes and checked drinking way way easier than cannabis
I wonder about all the confounding effects. In my country (famous for cannabis to be easy to come by (for decades already), and I saw many smoke from age 16 up as I grew up in 90's, 00's). I have always felt that the heavy cannabis smokers had something to compensate; stress, unrest, impending depression, friction with parents. It was never the healthy sporty types with fulfilling relationships, good grades or a nice career that smoke cannabis heavily (like daily). Sure, some of those smoked, but more occasionally.
I’m not from a place where cannabis use was common, but it was present.
Growing up I definitely knew some people who had their demons who turned to drugs.
However we also had a lot of people who were in good situations who picked up drugs for purely recreational reasons. One of my friends at the time even boasted that drugs were actually more appropriate for people like him who were educated, in good situations, and rational (his description of himself) because they knew how to manage themselves and their usage better. He even had links to some subset of the rationality community who had become pro-recreational drugs with a lot of justifications.
His turn to drug use marked the end of his promising academic career. He started struggling with mental health in ways that were obviously related to the drugs. Holding a job had never been a problem until he starting smoking, which marked his turn toward job struggles. His friends and family relationships started declining and falling apart.
He’s not the only one I know like this. The first person I knew who had to go to rehab for drug addiction was a happy, successful guy who started using drugs as a way to party more and for longer. He thought his life was awesome and he was invincible.
I think there’s become a belief that drug use is purely a symptom, but I’ve seen enough people go from happy to falling apart as an obvious result of the drug use. Most of the people I know who started using drugs didn’t do it at their homes in private to cope, they started doing it at parties with friends.
This is even well known with alcohol: There is common belief that being a “social drinker” is a different risk profile than someone who does their drinking alone.
I think it’s a comforting idea that we tell ourselves that nobody chooses to use drugs, they are driven to do so by circumstances out their control. We like removing blame from people and hoisting it on to the world. I don’t think it’s always true, though. Many people use drugs because drugs are rewarding (at first) and they like the way the drugs make them feel. The negative consequences come later.
I feel by your logic, no one should ever use drugs or alcohol lest they become addicted to how good they make them feel. An abstinence approach. very modern!
I have largely stopped smoking because when I smoke regularly I end up weighing 20-30lbs more from eating everything.
Going on an actual calorie restricted diet while consuming cannabis is basically impossible for me.
Then instead of walking 60 minutes I end up sitting and listening to music.
There is really not anything for me that correlates with healthy behavior when I smoke.
You ever taken a hike or nature something and try it in that different context?
Set and Setting are also relevant too. If you do it a soecfic way with other soecific tools and activities while on it, that all gets packaged and reinforced.
> stress, unrest, impending depression, friction with parents
Well, Id guess these are reasons for any case of substance missuse?
Wouldn't they also be potential causes that lead to worse heath outcomes that were not measured in the study?
I believe it’s an “artificial” reward mechanism for some people. The ability to control one’s own rewards is an easy habit to take up. If the rewards aren’t coming from externalities one needs to get them from somewhere.
If I had to guess, this is also the appeal of many video games.
Absolutely. I have abused games this way, and the only way I can play them responsibly is physically present multiplayer.
Nothing more biological than looking for rewards.
True.
Esp the last wording: "friction with parents" (which is by the way are very noble wording here, I have to state)
I have not met ANY regular drug user (regardless which drugs), who didnt had "frictions with parents" early in their life. (and some for which its still persisting into their 40ies)
Definitely. The healthy sport academic types stay pretty far away from any kind of mind altering drugs.
not alcohol, they will use that no problem, they can handle it unlike others
Not really, it more depends if you are east coast or west coast. East coast has stigma associated with loss of control. They have a stick up their ass basically.
Yeah I think for any of the significant pot smokers I've known it's a way of avoiding other issues. As a positive it's probably much better they descend into pot than alcohol which I'm sure many would if it was the only other easy coping mechanism.
Yeah that's me. I quit for short periods but usually continue because my other coping mechanisms that replace it aren't any better. I naturally smoke little when life is busy and going well
In my country, California, we have so much cannabis use and it’s by basically everyone. People with spouse and children, fulfilling careers and exercise regimes. The culture of a place really can change the outcomes. It’s part of why Silicon Valley beat Route 128.
In American collegiate and professional athletic circles almost everyone uses marijuana. I was a nationally ranked junior tennis player and even in that sport almost every other top junior I knew smoked weed.
These nerds that have to biohack and optimize to be physically fit are coping by claiming that jocks don’t get high. Sporty types are genetically different and have plenty of capacity for cannabis use.
> Sporty types are genetically different and have plenty of capacity for cannabis use.
I’m not sure what the first sentence is after, but this one reminded me of Michael Phelps.
It was never the healthy sporty types with fulfilling relationships, good grades or a nice career that smoke cannabis heavily (like daily)
^^ many of those are boring people.
That is an opinion. I for one prefer talking to a happy, healthy mind, healthy body-type over someone with a life riddled with substance experiments. In fact, it was why I hardly talked to some of my family for a long time. Every weekend was the same, they were always angry and in the end they nearly killed themselves. I'm happy they got out of it and we have a much better relation now.
Weird as the only normal folks in my family are the pot smokers. Others along with neighbors seem to want to fight folks on a dime
I was under the impression that breathing in burnt particulate of any sort was associated with serious cardiovascular risk? I would think a significant portion of cannabis users ingest smoke very frequently or at least second hand smoke more frequently than people who do not engage at all with a subculture that is largely smoke oriented.
6x sounds too clickbaity.
but sure, still lets make to account by other "legal" substances (alco, tobacco, cocaine, pharmaceutics and other "lifestyle choices" infecting cardiovascular system) and way they are consumed(smoked, ingested, pure or with say tobacco)
would love see data for a group who consumes cannabis by ingestion and especially not via smoking!
also- do they differ different thc/cbd grades used (high/low thc, "medical")?
im regards "research demonstrates something does this.." for many years alcohol was considered "healthier" over non consumption, just becauses non-drinkers were together with those of abstinent ex-alcholics.. thus average score was lower than for those who drunk minimal amounts and were considered "healthier".
For me, cannabis causes anxiety, and it’s pretty well established that anybody with anxiety or bipolar or schizophrenia should not be using cannabis because it can make these much worse. I don’t suffer anxiety anymore, but there’s plenty of scientific evidence about the relationship between anxiety and cannabis use.
That's a very blanket statement, lots of people are in fact prescribed low dose cannabis for anxiety.
Excessive THC exposure, not blanket cannabis use, is what’s really being condemned here.
Hemp, meaning very low THC, higher terpene and CBD content, is for you (and most!).
What strains have you tried?
Would be nice to know how much of a role a sedentary lifestyle plays in it or if it puts everyone at risk regardless of other habits. Maybe this just means you need to do cardio several times a week to keep using THC.
FWIW, I've smoked cannabis daily for maybe 15 years, I'm not exactly sedentary (have dogs, a partner and like to (lazily) swim in the sea) but generally don't exercise. Visited a cardiologist like two months ago and have perfectly fine heart despite the smoking.
Anecdotal of course, many could probably bring up counter-stories too, but I do think you bring up a good point, it seems to me a completely sedentary lifestyle seems to be way more destructive to your health than moderate usage of various drugs and/or eating habits. People who just walk a bit daily already seem way healthier and happier than peers in their same age.
What tests?
The study controlled for general health but I would note that the odds-ratio reported for cannabis use (4-6) is not so different from the odds-ratio associated when studying high vs. low income cohorts (3-5). This study is not a random blinded clinical trial it's reporting a trend present in ~5 million electronic health records which I assume record yes/no to patients ever telling a doctor they have used cannabis.
I would assume that cannabis use correlates with a few other important heart health variables and we would expect the odds ratio to be lower when accounting for those (alcohol doesn't have an OR more than 1.0, tobacco smoking ~1.5)
I'm sure that cannabis use is bad for cardio health but the reported odds ratio is very high. I personally do not use cannabis.
Is there something that can help a habitual cannabis user stop? GLP1s maybe?
What has worked for me is (1) Buy 4+ boxes of coconut water (2) remove cannabis from your house, (3) drink coconut water whenever you feel like smoking, (4) get some exercise going (swim, push-ups, gym, sports) - whatever the "MVP" of exercise is to start thinking of your body as fit, athletic & strong.
You can cold-turkey it. Know daily smokers who (temporarily) quit for multiple reasons, e.g. medical reasons, job, extended travelling.
From what I have seen, there are no side effects at all. They go back to smoking when the opportunity arises, but that's another story.
> From what I have seen, there are no side effects at all.
You haven’t seen enough.
Yeah I know someone who is having real trouble stopping, he can cold-turkey for a few days but always starts up again. I think he has poor impulse control, which maybe GLP-1s could help, as some studies seem to indicate they help with cravings/impulsive behavior generally. I don't know if any MD would prescribe it for that, he's not obese so could not get it on that basis.
It's not addictive along the same pathways (as far as I'm aware) from what I observe in my own life you either smoke casually and could stop whenever you want to (I used to then I stopped no problem) or you are dealing with psychological stress factors that are best treated with the help of a mental health professional.
Controlled tapering.
A supplement called genistein mitigates the risk:
https://www.med.stanford.edu/news/all-news/2022/04/marijuana...
Some commenters here talking about anxiety, but I think the bigger cause, which many people don't know, is that THC significantly increases your heart rate despite it's usual characterization as a depressant. If I recall correctly (big "if" considering the circumstances hah) my heart rate after smoking would go up by 10-20 BPM (from 65-70 to 80-90) while still feeling relaxed; ~~finding some numbers on this from a reputable source is difficult right now and this symptom is suspiciously missing from the wikipedia page~~.
Edit:
Realized this comment sounds like fear mongering, so decided to dig up some actual sources. The wiki page I needed to find was:
https://en.wikipedia.org/wiki/Effects_of_cannabis
Also, the CDC page mentions it:
https://www.cdc.gov/cannabis/health-effects/heart-health.htm...
And links to this paper (though I can't read past the abstract bc no institutional access):
https://doi.org/10.1002/j.1552-4604.2002.tb06005.x
There's more going on here than just the substance's effect.
There's a mind body connection that an altered state can throw into disarray.
Under the influence of cannabis, one may be a lot more aware of physical pain, dehydration, and so on. The key word is aware. Suddenly becoming aware of the fact that you are stressed out, you are carrying tension, can lead to something of a latent processing effect of some of these suppressed or physically felt emotions.
However, if you're generally not tense, ingesting cannabis itself does not always raise the heart rate. I can validate this myself right now, given I wear an Apple Watch and can vaporize cannabis. Looking at my historical data, there is no relationship, and my resting heart rate remains in the 40s.
It's anecdotal, but at the same time we need to be careful with something that acts on the physical, the mental, and dare I say it, the spiritual. If we focus too much on one dimension, we lose the important synergy from processing all dimensions.
This. Street weed and medical cannabis are not the same thing.
for the anxiety crowd: don't buy street weed and avoid sativas
about the 'study': I do not trust anything that comes out of meta studies given how many base studies are found to be either garbage or very lacking in controls. And without knowing an accurate life history it is hard to rule out or quantify damages done much earlier in life.
Any literature on this or is is just your gut?
The entire field of statistics is based off not making critical type 1/2 errors (which meta studies are not able to control well) so I would say it is not just his "gut" feeling.
What the literature definitely finds is that CBD ratio is crucial for anxiety (higher CBD = less anxiety). Some of the first lab experiments were pure THC and quite intense/unpleasant relative to what you'd get from a plant naturally "full spectrum." If you're ever in california, NY, Maryland, whatever then try something with 1:1 THC:CBD and maybe get some of the other CBs in there too.
[Strain sativa/indica can sort of be an indicator, but going by the dose of each active ingredient is the more scientific approach]
CBD can definitely defuse an anxiety attack and it is a good idea to keep some available just in case.
What literature are you referring to?
>> for the anxiety crowd: don't buy street weed and avoid sativas
I don't think blanket advice like this is helpful. For me indicas increase my anxiety significantly while sativas do the opposite.
For clean weed - not laced with anything - sativas are more prone to causing anxiety. I doubt one will find any kind of study proving this, it is anecdotal - myself, friends and the internet at large.
While not universally true, it seems that many of the sativas for sale are very high THC which probably is a primary factor. Other factors are terpenes, though there is still a lot of debate on whether it these are real or imagined effects.
Moderate THC (15-20%) indica or indica dominant hybrid flower, using a flower vape, IMHO, is the best way to go. Always a good idea to read strain reviews prior to purchase (or growing) as people will note those that have caused them to be anxious, sleepy, hungry, horny, etc.
People can also have very different reactions when taking a drug (weed, shrooms, lsd, etc) alone vs with friends, something to consider as well.
Agreed. Blending in CBD and other cannabinoids is way more effective than relying on strains. Basically everything out there is extremely high in THC and nothing else. Mixing in high CBD flower reduces anxiety a lot for me
quite a few people I know consume edibles as the main form of cannabis. but it seems underrepresented in all the studies I've seen so far. as several others have pointed out, you would think the act of smoking would itself have nontrivial effects on health
I wonder if they're doing these studies, finding no significant effect, and just dropping them.
I mean, it's good that we have data showing some sort of connection between heart attacks and cannabis, but I appreciate the callout toward the end more:
> Since both studies were limited by their retrospective nature and the meta-analysis was limited by the challenges inherent in pooling data from multiple studies, researchers said that additional prospective studies would help to confirm the findings and determine which groups may face the highest risk.
Here's the thing that both the alarmists and the naysayers keep ignoring: all this data is new, it's recent, and decades of effective global prohibition have meant the only sources of reliable data came from either post-war/pre-prohibition studies (often by Defense Departments) or from "anecdata" gathered retrospectively among large cohorts. We still lack a substantial amount of direct, quality, long-term data on drug use and Nth-order impacts on the body, and these studies are the first steps towards getting more data from higher quality research to draw better conclusions from.
If anything, I try to be quite open with my Doctors about my own use precisely because I know that data is thin and dated, and any contributions from patients in an honest manner is going to help draw better conclusions for healthcare guidance tomorrow. Letting alarmists use these thin precursors as justification for a return to total prohibition is the wrong move.
correct. the push for dispensaries has been financial not medical. now that we are getting large scale trials there will be more real evidence to show the public health effects. my guess: it will go the way of smoking eventually. realization around public health effects -> cost of those effects on public services -> taxes and costs go up. I'm curious as to why heart attack and not stroke. seems like bp isn't the only thing at play.
Not really related, but the other thing I found out recently that cannabis can cause is the worst panic attack I have ever experienced: a DPDR (derealization / depersonalization) panic attack. I’ve had regular panic attacks before. I get one a year, roughly, where I get essentially heart attack symptoms. But this was something else. It felt like something was truly, irrevocably broken with my mind and I couldn’t even describe what. Utterly terrifying. I was a heavy user but dropped it the next day.
I had a similar experience when I was young. Bought a vape and some Cannabis, which probably had really high THC concentration as it tends to have nowadays. Took a bit, didn't feel anything, then took a bit more, and boom, a panic attack. Might even had some hallucinations, I'm not fully sure what was real and what wasn't.
After the experience I felt kind of weird and "slow" for several days. Later I found out that there is also a genetic risk of schizophrenia in my family. No way I'm going to touch anything with THC ever again. I've tried CBD oil though and that was okay, slightly calming effect. But ultimately I prefer beer over that too.
In social systems or spiritual systems where cannabis is used, this is often called "going clear".
We (general West) have no overarching myth or support system to help people navigate this type of pure madness. We have a psychological framework, and anything that interferes with our capacity to construct an I, a me, an ego in real time is seen in the most ultimately negative terms. And the experience is terrifying, such to support these terms.
Though, if through meditation, through religious constructs, or similar, there is a learned capacity to sit with the experience, it is considered less of a breaking and more of a liberation.
Wouldn't recommend it, wouldn't prescribe it. Though this decoupling of self from experience isn't a universal ill.
THC increases glutamate release[1], which is most likely the source of this panic. I have psychotic episodes even with a a few big hits but then again I have schizoaffefctive disorder. Glutamate is my arch enemy.
[1] https://link.springer.com/article/10.1186/s42238-025-00277-9
Anecdotally this isn't uncommon among heavy users, I've heard of similar things happen to a few people. You did the right thing stopping, where people really go off the deep end is when they don't listen to the warning signs and keep blazing.
I think weed should be legal and for the majority of people used in moderation it's going to be fine, but at the end of the day it's a psychoactive drug. It's probably not optimal to use it daily and in particular waking and baking every day is asking for trouble.
Also a case to be made that modern strains are worse. I fully believe that the risk of losing the plot is higher when you're smoking some lemon sherbet bubblegum flavours every day instead of old fashioned moroccan hash
Can relate to this experience. How old were you?
Is this really the largest factor they found in all our medical data?
He who attacks the munchies..
It's rare to see a study where "no link was found"
Without a clear mechanism of action, this sure requires monitoring (like any drug), but the conclusions are terribly oversold. Correlation does not imply causation, no matter the sample size
Come on people, it is a drug. Exercise, cardio, eat well, sleep well, it's your choice the risks you take, but try to balance the good with the bad, if you partake in "bad".
From what I've seen it's faced with a more stony resolve compared to side-effects of many USP substances.
Literally no mention of ROA. It matters whether they smoke plant matter, vape, use it orally, etc. This, combined with their inability to account for a number of other factors such as tobacco use, makes this study literally useless. Earned a flag from me.
Agree on ROA, but the retrospective cohort study (one of two discussed in this article) did account for many other factors including tobacco use.
I’m annoyed by the bifurcated regulatory regime
Substances approved by the FDA are done based on specific treatments, with multiple trials and approval per use case
Substances declared scheduled are illegal by the substance itself, instead of per use case
paradoxically because there is no FDA approved use case and almost no way to get one
meaning that places in the US that diverge in legality and are ignored by the federal government have done so without any clinical trial, which would be some level of peer reviewed objective information by use case instead of the whole substance
we can’t even get a simple list of side effects, or a disclaimer about what kind of users shouldn’t use it
only anecdotes
that annoys me and it’s not just about weed
The US government is now in thrall to the Kratom industry though isn't it? No reason to expect any logical consistency from them.
(Literally the person currently responsible for the branch of government that keeps illegal drugs out of the country is an investor in a Kratom company)
Yes we are living in a kleptocracy / kakistocracy hybrid
The most ridiculous thing about cannabis remaining schedule 1 (high risk of abuse, no known medical use) so long is that there is both prescription THC and CBD. It should have been changed|to a higher (less strict) schedule decades ago with the release of marinol in 1985. Then we could have had a lot more studies being done. Needless to say, not easy to do studies on schedule 1 drugs.
Just a few years ago cannabis was presented online as a miracle drug that could cure all physical and psychological diseases. Any criticism of the sacred cannabis was strictly forbidden and dissenters were burned alive in the figurative fire of social media. Interesting how times are changing.
I'm not so sure.
There's always been a pragmatic center on cannabis, especially if you're somewhere where it's legalized.
In Canada, we have legal cannabis.
https://www.canada.ca/en/health-canada/services/drugs-medica...
When it was legalized, there was a documentation push and clear presentation of the downsides. In fact, as above, the language is mostly presented in the negative.
This matches the general sentiment of the broad population.
And let's not conflate things. The article is discussing smoked cannabis. This does not invalidate the essential substance and benefit of the experience. If we remove the ingestion method from the basket of effects, it's a different discussion.
Not all positive, yet smoking is clearly not good for you.
Full stop, no matter what it is.
That was likely a reaction to the DARE/reefer madness propaganda many of us grew up with, which was obvious bullshit.
See also: Bitcoin, Tesla/Musk, Apple
What I find fascinating is how smokers rationalize their behaviour, e. g. "weed is harmless". When they compare it to fentanyl or heroine/cocaine, but compounds are never intrinsically harmless. But you can not get that message across most folks who are smoking weed. It's a somewhat similar issue, to some extent, when you look at sumo wrestlers. These have a significantly lower life expectancy on average than the rest of the society in Japan, but the sumo association does not acknowledge that. It's really strange how the human mind operates.
There's a saying: don't throw stones if you live in a glass house. The same human mind that rationalizes the intake of substances is the same one that rationalizes social networks, junk food, eating meat, whatever it is. I wouldn't be so quick to condescend.
At some point in time, it's important to realize that not everyone optimizes for longevity, correctness, rationalism, and so on, and they just simply do what makes them feel good within the limited life that they have.
Nothing is intrinsically harmless. Cannabis can be devastating. But I was just sitting here doing work one day, got a hemorrhage in my eye, and lost half the sight in it. Otherwise, I'm supremely healthy. The cause: a gene.
Or alcohol, or whatever others are doing. In Italy, where I live, people on the ‘left’ side of the political spectrum (let’s say ‘progressives’) tend to think it’s perfectly ok to smoke dope, irregardless of what any scientific study may or may not say. This seems very weird to me.
“They say coke kills but they don’t know when” is a refrain I have heard.
>but the sumo association does not acknowledge that
That's just wrong. Why do you think their force retirement ages are so low?
Have you ever smoked/ingested cannabis before?
people rarely compare cannabis to fentanyl they normally compare it to alcohol and tobacco...
I mean let's face it, most of us reading this comment are medically obese and would probably live at least 2-3 years longer if we lost 20 pounds.
So why don't we?
people just want their recreational drugs
it's as stupid as smoking/vaping and not even black box warnings will get people to stop
now if you need pain management I can respect that 100%
but you need to investigate Palmitoylethanolamide and Geraniol as alternatives
* https://news.ycombinator.com/item?id=48700498
> people just want their recreational drugs
Yes, people want to recreate, doing all kinds of activities with various levels of risk. They don't need to concern themselves with whether you can respect it.
Can you respect folks who are treating mental/emotional pain or just physical?
The folks I know who attempt to 'treat' themselves with substances generally just get worse. That's not a judgement, just an observation.
There are (illegal) substances that are highly effective for treating these issues, PTSD, etc. Psilocybin, ibogain, etc. Obviously when administered correctly, with therapy, etc.
It seems to me that cannabis users aren’t seeing the benefits of the aforementioned group. My experience of cannabis stoners is that it’s used to numb out and for escapism, which certainly aligns with what you’re saying.
sure but you aren't going to help mental/emotional problems by getting stoned
there are far better, legal supplements to treat that anyway, less expensive too
dope activates AMPK in the brain/CNS and turns off AMPK in the body/heart it's an incredibly stupid thing to do to yourself (also why people get "the munchies")
literally why it's called dope (before dope meant "cool")
With enough tolerance, you don't get stoned anymore. This is where you want to be, side-effects gone, just the good stuff left.
> less expensive too
Marijuana is dirt cheap compared to any prescription medication, at least in the US.
They did say “legal supplements”, not prescriptions. But I’m not sure what they’re actually suggesting.
Good. This crap has been to normalized, especially online.
It’s starting to look like THC ( found in gummies, too ) causes vascular problems.
Before we got Ozempic there was great hope for
https://en.wikipedia.org/wiki/Rimonabant
which blocks the receptor that THC binds to and led to weight loss and further improvements of the “metabolic syndrome” beyond weight loss alone. Unfortunately it caused major depression in some people including suicide.
So looking at it that way it would be no surprise that cannabis causes weight gain and metabolic syndrome and in fact my experience is that if I am using cannabis I get a few kg. I think that is the THC and on top of that if you are smoking you are inhaling small particles that turn your blood into sludge (e.g. your blood is a “complex fluid” with cells in it that can be damaged) and doing damage to your lungs and capillaries and promoting inflammation and all that.
You get the munchies
https://www.youtube.com/watch?v=yN1AQDxwrSg
The data is from EMR records. The researchers stated themselves ~ “people should be more forthcoming with their doctors.” I don’t think anything meaningful can be concluded other than most people don’t like having the fact that they have done cocaine on their medical records.