Drug Reaction Physiology

[funkytomtom]

So...I have had a couple interesting conversations at some parties recently. Although I do not personally use any drugs, I run into all sorts of users at parties in my area. Two particular stories make me curious. One girl discussed a recent syncopal episode brought on by a hit of marijuana. She said she took a hit, walked around for a minute or two, and then passed out, hit her head on the ground, and called 911 due to worry about a head injury (from the fall). I know standing up too fast can cause sycope due to blood settling lower in your body, but this does not sound like a proper explanation because she had stood up and been active for a minute or so. Is there something behind marijuana's effects that could cause this? Also, talked to a young gentleman who told me a story of someone actively seizing after a marijuana hit. Sounds like a full on grand mal seizure from what I could tell. Both people suspected marijuana was responsible for these effects. Is it? And why?

[Just Plain Ruff]

I've never seen marijuana do that type of effect and I've been to some really Rocking parties, just kidding.

I would suspect that each of those people were feeding you a line of bull and they weren't telling you the whole story.

It's sort of like once they know you are a medic/emt they seem to have some outlandish reactions to stuff sort of like when new emt/medics sit around the station house and swap who has a bigger penis (worst call) than the other.

Here's how it usually goes

"I took care of a partial decapitation on one wreck I worked" says new emt 1

New emt2 says well I took care of a complete decap and the guy was still breating

new emt3 says well I saved a guy who's head was 10 feet away from his body, we reattached it and he walked out of the hospital.

The bigger the boast the better the call.

So my suspicions are that these people were trying to impress you how wasted they were.

Maybe going to different parties (less drug use) would be a good idea.

[Timmy]

Maybe pot wasn't all they were smoking...

[ERDoc]

I wouldn't be surprised if there wasn't a little something extra mixed in with the pot.

[croaker260]

So...I have had a couple interesting conversations at some parties recently. Although I do not personally use any drugs, I run into all sorts of users at parties in my area. Two particular stories make me curious. One girl discussed a recent syncopal episode brought on by a hit of marijuana. She said she took a hit, walked around for a minute or two, and then passed out, hit her head on the ground, and called 911 due to worry about a head injury (from the fall). I know standing up too fast can cause sycope due to blood settling lower in your body, but this does not sound like a proper explanation because she had stood up and been active for a minute or so. Is there something behind marijuana's effects that could cause this? Also, talked to a young gentleman who told me a story of someone actively seizing after a marijuana hit. Sounds like a full on grand mal seizure from what I could tell. Both people suspected marijuana was responsible for these effects. Is it? And why?

Our own history (Medicine, that is) is full of Cause and effect assumptions based on inadiquate observation and data. Once our brain latcheds on to this, it becomes a "Bias" and is difficult to break.

Example: You see "A" (Smoking pot) and shortly after, you see "B", then you assume there is not only a relationship, but a causitive relationship (A caused B ) SOmetimes you even use A and B to come up with a further thoery ..."C". i.e. Patient smoked pot (A), Patient had Siezure ( B ), I assume they must be related (A + B ) thereore the pot must be tainted ( c ).

Example:

Patient goes into cardiac arrest, say V-Fib. As a result of this, the patient has brief SZ activity (A) that is observed by bystander, then the patient Stops breathing ( B ) , and this is observed by the bystander , then the patient dies...Therefore the SZ caused the patient to stop breathing and therefore the death. (A + B = C), not the 40 years of smoking, hamburgers, and obesity. And if only the doctors had found his SZ disorder, then he would be alive.

So, back to the pot and the syncope or SZ activity....Nevermind it could have been a hypoxic trigger on a pre-existing SZ disorder, a cardiac dysrythmia, or just good old fasioned coincidence or psychosomatic. In observational bias investigating these other possibilities...investigation is not only is not done (If it conflicts with A + B = C, then I dont want to believe it) but investigation is resisted (How dare you say I was wrong, I saw it with my own eyes!).

Example:

If Paramedic response is good (A), then more paramedics must be better ( B ) therefore A + B = C (Better outcomes). Overcoming this observational bias is difficult. Just look at the public resistence to reducing Paramedic first response units and improving response on critical .

Sometimes there is a relationship, just not the one we assume.

Example:

I have a patient in pain....I give them Morphine (A) and Phenegran ( B ) and they get quiet. I assume Morphine and Phenegran together have increased analgesia(potentiation)...( c )..when actually they increase SEDATION (Z), not analgesia...but the observational bias comes into play and this (Phenergan potetiates Analgesia) is still being taught today (incorrectly) in medic schools.

So my point is this...in a very rambling crazy way.....

If (BIG IF) the events were what they were reported as (It really was a SZ or Syncope), chances of it being the pots fault are equal to it being any number of other enviromental or physiological factors that may or may not be related.

Edited April 26, 2009 by croaker260

[VentMedic]

Since there are over 400 different chemicals documented in marijuana, it is very possible one could have a reaction from something. Marijuana has had a lot of research done since it is now used for medicinal purposes. Everybody will reacts a little differently to some outside chemicals and that includes marijuana. Even oxygen can have different effects on a patient depending on the chemical and cellualar make up of that person. This also varies with race and sex.

http://www.drugs.com/npp/marijuana.html

Edited April 26, 2009 by VentMedic

[TDP]

Marijuana laced with cocaine and or embalming fluid is pretty common. I'm guessing is it was more than just "green" as stated previously.

http://www.cesar.umd.edu/cesar/drugs/marijuana.asp

[joesph]

maybe the first one stumbled over a Cheetos and the second was traumatized a browny

[funkytomtom]

interesting, I suppose anything is possible really (the stories were fake, drugs were laced, the reactions were coincidental).

[VentMedic]

One of the hospitals I moonlight at is a medicinal marijuana center. I posted the drug information earlier because just like any other medication we monitor for reactions and interactions. First time users can react in many different ways. The medicinal marijuana is grown just like the good quality street stuff and will give people the same high. Marijuana has a lot of different chemical properties that will react with different people differently without being laced with another street drug. I do not believe the FDA has put their seal of approval on it due to the various side effects as well as benefits. It is also difficult to study something even for medical benefit if it is illegal.

Regardless of whether a drug is street or legit, assess it from its chemical properties and what systems it normally affects. Look at it as you would any drug rather than just a "street" drug. The same for heroin and cocaine. You should have a general idea about what systems they affect when you are assessing your patient and planning your treatment.