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Cannabis Safety: How Safe is Cannabis Really?

Cannabis safety seems to come in two extremes- the holistic cure-all and the reefer madness stereotypes. But it is time to put both of those aside and see it for the personalized medicine or recreational substance that it is. In either case, cannabis may be less dangerous than other substances. However, it is not without its own risks and adverse effects. In this article we will focus of the effects of marijuana and THC.

Many believe that you cannot overdose or die from smoking cannabis. While there is some truth in this, it is also an oversimplified perspective of cannabis safety. In fact, the first possible death directly attributed to THC was recorded in 2019 in Louisiana. While the physical cause seemed to be respiratory failure, the end result is still tragic.

Table of Contents

The Medicinal Value of THC

Cannabis can refer to both hemp and marijuana, and the two species are similar except having different proportions of cannabinoids. Delta-9-tetrahydrocannabinol (THC) is the primary cannabinoid in marijuana, but is less than 0.3% in hemp. That is why hemp does not get you high.

THC is the cannabinoid responsible for the intoxicating effects of cannabis. While it gains a lot of attention for its recreational use, its medicinal properties are becoming more and more popular and well understood. Indeed, THC

While patients with intractable pain are an obvious target, other groups of patients may benefit in situations where strong analgesics are already used (for example, adjuvants in cancer, muscle spasm with acute injury, sedation in intensive care, premedication, etc.).

Hirst, R. A., Lambert, D. G., & Notcutt, W. G. (1998). Pharmacology and potential therapeutic uses of cannabis. British journal of anaesthesia81(1), 77-84.

Effects of Cannabis in the Body

The medicinal value of cannabinoids like THC has become undeniable. However, while many people report feeling better using cannabis vs conventional treatments, others do not experience the same cannabis benefits.

Every person's body is a little different. The endocannabinoid system that processes cannabinoids is not the same in every body. That is why cannabis is a personalized form of medicine that does not have standard dosages like pharmaceuticals.

Since every person is a little different, there are also individuals that will not respond well to THC. There are also sensitivities and problems that can develop over time.

Cannabis Overdose

Cannabis overdose is still rarely serious. If someone uses too much marijuana, they may feel paranoid, nauseous, or sick to their stomach. However, it rarely requires hospitalization or leads to death like overdose from other drugs. Most medical professionals agree that cannabis is safer than drugs like heroin, opioids, and cocaine. Many people feel the same way, that cannabis safety is in some ways better than the many other substances that could be used.

Cannabis Withdrawal

Any time you take a substance regularly and stop suddenly, there is the potential to experience withdrawal symptoms. Miller, et al (2017) note that More than 50% of regular cannabis users do report symptoms of withdrawal:

Cannabis Withdrawal Symptoms

  • Dysphoria (anxiety, irritability, depression, restlessness)
  • Disturbed sleep
  • Gastrointestinal symptoms
  • Decreased appetite
  • Abdominal pain
  • Shakiness/tremors
  • Sweating, Fever, and/or Chills
  • Headache

Cannabis Addiction

Among the cannabis safety risks, addiction, or dependence is one major concern. Cannabis use can be problematic, but as Scientific American explains, it is rarely addictive:

...of those who had tried marijuana at least once, about 9 percent eventually fit a diagnosis of cannabis dependence. The corresponding figure for alcohol was 15 percent; for cocaine, 17 percent; for heroin, 23 percent; and for nicotine, 32 percent. So although marijuana may be addictive for some, 91 percent of those who try it do not get hooked. Further, marijuana is less addictive than many other legal and illegal drugs.

Arkowitz, H. 2012 01 Mar. Experts Tell the Truth about Pot. Scientific American.

Cannabis addiction is more accurately called 'dependence.' A diagnostic standard called 'DSM-5' is used to diagnose cannabis dependence, a condition that mainly affects long-term users, frequent users, and users who take very high doses of THC. The DSM-5 Criteria for Cannabis Dependence, described by Miller, et al (2017), is as follows:

Criteria for Cannabis Dependence

  1. Cannabis is often taken in larger amounts over a longer period than was intended.
  2. There is a persistent desire or insignificant effort to cut down or control cannabis use.
  3. A great deal of time is spent in activities necessary to obtain cannabis, use cannabis or recover from its effects.
  4. Craving or a strong desire or urge to use cannabis.
  5. Recurrent cannabis use resulting in failure to fulfill major role obligations at work, school or home.
  6. Continued cannabis use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of cannabis.
  7. Important social, occupational or recreational activities are given up or reduced because of cannabis use.
  8. Recurrent cannabis use in situations which is physically hazardous.
  9. Cannabis use is continued despite knowledge of having persistent or recurrent physical or psychological problems that are unlikely to have been caused or exacerbated by cannabis.
  10. Tolerance, as defined by either: A need for markedly increased amounts of cannabis to achieve intoxication and desired effect, or a markedly diminished effect with continued use of the same amount of cannabis.
  11. Withdrawal, as manifested by either: The characteristic withdrawal symptoms for cannabis, or a closer related substance is taken to relieve or avoid withdrawal symptoms.

Cannabis and Alcohol

While cannabis safety is not perfect, further risks can be introduced when it is combined with alcohol. Hussain, et al. (2018) note that cannabis overuse can lead to malignant arrhythmia leading to cardiac arrest. They elaborate to add:

Alcohol withdrawal following binge drinking combined with cannabis abuse can lead to malignant arrhythmia, seizure, and at times culminating in cardiac arrest

Hussain, A., Bhakta, P., Singh, V., Thomas, J., & Zietak, E. (2018). Cardiac Arrest and Seizure Following Cannabis Overdose and Alcohol Withdrawal. Annals of Case Reports and Images (ACRI).

Cannabis-Induced Mental Disorders

While cannabidiol (CBD) is thought to have anti-psychotic properties, the case seems to be the opposite for delta-9-tetrahydrocannabinol (THC). Highly potent marijuana may induce psychosis in some individuals. The main concern seems to be for heavy cannabis users and those who have a history of mental illness. Indeed, THC is known to also cause weed paranoia and anxiety for some individuals.

Cannabis and Pregnancy

Women who are breastfeeding and are/or may become pregnant should not use any cannabis or CBD product without direction and monitoring from a licensed healthcare provider. There certainly exist some situations where taking cannabis may outweigh other risks during pregnancy. To be clear though, all cannabinoids cross the placenta and may contaminate breast milk.

This young physician breaks down the science and the risks with some humor and common sense while withholding ethical judgment:

Final Thoughts on Cannabis Safety

While cannabis can be a great option for some, it is not the best option for everyone. Even natural products can have risks, dangers, and adverse effects. It is always important to be cautious for this reason. Starting at low amounts of THC or CBD and giving plenty of time is a common recommendation for people trying cannabis products. Be aware that in addition to immediate effect, cannabinoids can also build up in the body and have long term effects. Finally, it is always advisable to talk with a licensed healthcare provider, especially if you are currently taking medication or have any medical condition.


  1. Iffland, K., & Grotenhermen, F. (2017). An Update on Safety and Side Effects of Cannabidiol: A Review of Clinical Data and Relevant Animal Studies. Cannabis and cannabinoid research, 2(1), 139–154.
  2. Miller, N. S., Oberbarnscheidt, T., & Gold, M. S. (2017). Marijuana Addictive Disorders and DSM-5 Substance-Related Disorders. Journal of Addiction Research & Therapy, S11.


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