Marijuana Overdose

girl smoking a marijuana joint in a Washington forest

Overdosing on marijuana is not like overdosing on opioids, where the affected individual stops breathing and dies. Rather, marijuana overdose may be thought of more as marijuana poisoning, or marijuana toxicity.

People do not usually directly die from taking too much cannabis, but they can get very sick and end up requiring hospital care. When deaths do occur, it is most often the result of accident or injury from behaviors while under the effects of intoxication.

Marijuana overdose is the third most common illicit drug overdose seen in emergency rooms in U.S. hospitals.

While there are short-term and long-term adverse effects of marijuana use, acute overdose is also a concern.

How Do Marijuana Overdoses Occur?

Many of the marijuana overdoses that occur are from accidental ingestion by children, particularly with edibles. In fact, 78% of all pediatric accidental exposures occur by ingestion of marijuana edibles.

Edibles also cause overdoses in adults because the marijuana effects are delayed when ingested orally. People often continue eating more of the drug when the expected effects do not immediately appear, believing that they did not ingest enough.

How much marijuana does it take to overdose? This is a difficult question to answer because the dose of THC is unknown in most forms of marijuana and the amount that ends up in the blood depends upon the route of ingestion. Individual factors come into play, such as:

  • Age
  • Weight
  • Gender
  • Tolerance
  • Concurrent drug use
  • Presence of mental health disorders
  • General health, kidney and liver function

Overdoses also occur because of the unpredictability of the cannabinoid content of the specific strain being used. As legalization leads to improved strains with varying amounts of THC content, more and more potent strains are entering the market.

A recent study of marijuana-related Emergency Department visits in Colorado show that the number of visits has increased by more than 300% since marijuana was legalized there, and that although most overdoses were from inhaled marijuana, the large increase was due to psychiatric and cardiovascular overdose symptoms from edibles (in adults as well as children).

Marijuana Overdose Signs and Symptoms

What happens if you overdose on marijuana? Marijuana overdose symptoms are often more intense manifestations of the usual intoxication effects of the drug, but specific symptoms may also develop. Typical intoxication symptoms that may be intensified in overdose include:

  • Euphoria
  • Time and spatial distortion
  • Intensified sensory perception
  • Impairment of muscle movements
  • Depression
  • Anxiety and fear
  • Inflammation of the eyes
  • Rapid heart rate
  • Low blood pressure
  • Psychosis

Symptoms that are more specific to marijuana overdose include:

  • Panic
  • Delirium
  • Respiratory suppression
  • Jerky muscle spasms (myoclonus)
  • Loss of control of body movements
  • Spasm of the airways, similar to asthma

In children, lethargy and excessive muscle movements (hyperkinesis) may be signs that the overdose is life-threatening.

Cannabinoid hyperemesis syndrome (CHS) is a recently recognized manifestation of chronic marijuana use. This form of chronic marijuana overdose is characterized by bouts of intense, persistent and incapacitating vomiting lasting for days. Hospitalization is required for intravenous fluid resuscitation and supportive care.

Effects of Marijuana Overdose

Although death directly from marijuana overdose in unlikely, marijuana overdose effects can cause harm or injury, including death, in other ways.

Marijuana-associated psychosis — in particular paranoia — has been identified as a factor in a number of homicides and suicides. It has also been strongly associated with domestic abuse and assault. Given that symptoms such as psychosis are increased in marijuana overdose, it is likely that overdose plays a role in these manifestations of marijuana use.

Because marijuana overdose doesn’t have a specific definition, such as death or a certain dose taken, it has not been well studied by the research community. However, it is reasonable to assert that some of the adverse effects of marijuana use may be magnified in cases of overdose.

Children are far more susceptible to certain marijuana overdose effects than adults, most notably:

  • Respiratory suppression and failure
  • Rapid heart rate and disrupted heart function
  • Coma

Dangers of Overdose

One of the dangers of marijuana overdose — and marijuana use in general — is the increasing incidence of marijuana being laced with fentanyl and other lethal synthetic opioids. Some dealers do this without the knowledge of their customers in order to increase the addictiveness of their weed, thereby securing repeat customers who unknowingly become addicted to the opioid.

People who do not usually use opioids are very susceptible to overdose on the ultra-potent fentanyl, so many people who use marijuana are unknowingly at great risk when they purchase weed on the street.

Marijuana Overdose Statistics

There is controversy over whether or not marijuana overdose can cause death. However, medical literature has documented that it can.

Even a recent death that was documented by the medical examiner as being the result of a cannabis overdose has been hotly disputed in the press. The death has been headlined as “the first death from marijuana exposure in the U.S,” despite evidence to the contrary.

The lack of a definition of what constitutes a marijuana overdose also inhibits the gathering of statistics. As such, there are no statistics available for direct marijuana overdoses per year, or even indirect deaths, such as from motor vehicle accidents.

However, in 2011, there were 456,000 documented visits to emergency departments in the U.S. where marijuana was a factor. 

Death From Overdose

There have been case reports of adults suffering respiratory suppression from marijuana overdose similar to that seen in opioid overdose. Children are particularly susceptible to this effect.

Cannabis overdose has been associated with heart attacks and fatal blood clots, as well as other adverse cardiovascular effects.

With the legalization of marijuana in many parts of the U.S. and further legalization likely in the future, the development of statistics and knowledge of marijuana overdose are in flux.

The legalized cultivation and application of cutting-edge cloning and gene-editing techniques are resulting in increasingly more potent strains. In the 1970s, marijuana contained around 2% THC; today strains with 20–25% THC are the norm. Extracts of THC are available that are nearly pure.

In other words, when it comes to knowing the real risks of overdose and death from marijuana overdose, we may have to wait a while.

Treating Marijuana Overdose

Treatment of marijuana overdose involves supportive care, such as supporting heart function and breathing, and treating low blood pressure. The two most common problems that put people in the hospital are psychiatric problems and cardiovascular demise.

Children who overdose on marijuana commonly require admission to an intensive care unit (ICU) because of their particular susceptibility to serious life-threatening effects.

The opioid antagonist naloxone (Narcan) is often used to treat a life-threatening overdose. The reason behind this is that marijuana exerts varying degrees of effects on opioid receptors in the brain, which is likely the main reason that marijuana overdose can result in respiratory distress.

An important part of the treatment of marijuana overdose involves identifying and treating overdose from other drugs that may be present. 

Marijuana Overdose Prevention

At the legislative level, more needs to be done to regulate marijuana edibles to help prevent overdose. For example, Colorado state law limits the dose of THC to a maximum of 10mg per edible, but single-serving edibles have been identified as containing as much as 100mg of THC.

Here are some tips to prevent marijuana overdose:

  • Do not mix marijuana with other drugs
  • Obtain the drug or medication from a safe, legal source
  • Wait to feel the full effects before deciding to take more, especially with edibles
  • Avoid synthetic cannabis products
  • Do not drive or engage in activities requiring concentration for 3 hours after inhaling and six hours after ingesting marijuana
  • Remember that even legal marijuana is largely unregulated and may have unpredictable THC concentrations
  • Keep marijuana (especially edibles) out of sight and out of reach of children and pets

If you are concerned about your marijuana use or the drug use of a friend or loved one, The Recovery Village Ridgefield can help. Call today a confidential discussion with a representative who can help you learn more about addiction treatment.

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Galli, Jonathan; Sawaya, Ronald; Friedenberg, Frank. “Cannabinoid hyperemesis syndrome.” Current Drug Abuse Reviews, December 2011. Accessed August 7, 2019.

Paton, Callum. “THC overdose: Has first death from marijuana exposure been recorded in the United States?” Newsweek, July 6, 2019. Accessed August 7, 2019.

Powell, Denise. “Cannabis-related ER visits in Colorado jump threefold after legalization, study says.” CNN Health, March 26, 2019. Accessed August 7, 2019.

Richards, John; Schandera, Verena; Elder, Joshua. “Treatment of acute cannabinoid overdose with naloxone infusion.” Toxicology Communications, November 1, 2017. Accessed August 7, 2019.

Subramaniam, Venkat; Menezes, Arthur; DeSchutter, Alban; et al. “The cardiovascular effects of marijuana: Are the potential adverse effects worth the high?” Missouri Medicine, March-April 2019. Accessed August 7, 2019.

Turner, Anisha; Agrawal, Suneil. “Marijuana toxicity.” StatPearls, January 2019. Accessed August 7, 2019.