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Cannabis Conundrum: Is the ‘High’ a Side Effect or a Separate Show?

The Controversy Surrounding Medical Cannabis

In the ever-evolving world of medicine, the use of medical cannabis has been a subject of intense debate and research. A key point of contention are the psychoactive effects of Tetrahydrocannabinol (THC), often described as the feeling of being “high” or “stoned”.

Understanding the ‘High’: A New Perspective

The prevailing perception among many doctors is that these effects are a side-effect to be avoided, disconnected from the therapeutic benefits of medical cannabis. However, a recent study invites us to reconsider this perception.

The Study: A Closer Look at the ‘Cannabis High’

The study by Stith et al. published in Frontiers in Pharmacology, measured for the first time the associations between subjective patient experiences (1,882 patients) of feeling “high” and treatment outcomes during real-time Cannabis flower consumption sessions. It presents a nuanced view of the ‘cannabis high’ which is revealed as a complex, multidimensional construct, associated with both positive and negative effects.

Patients reported feeling high in 49% of therapeutic sessions. The results show that reporting feeling high was associated with a 7.7% decrease in symptom severity, a 14.4% increase in negative side-effects, and a 4.4% increase in positive side-effects.

Tetrahydrocannabinol (THC) levels and dose were the strongest statistical predictors of reporting feeling high, while the use of a vaporizer was the strongest inhibitor of feeling high. In symptom-specific models, the association between feeling high and symptom relief remained for people treating pain (p < 0.001), anxiety (p < 0.001), depression (p < 0.01) and fatigue (p < 0.01), but was insignificant, though still negative, for people treating insomnia.

Psychoactive Effects: A Side Effect or a Separate Phenomenon?

Interestingly, the study found that the feeling of being ‘high’ was not necessarily linked to the therapeutic benefits of cannabis. Some patients reported therapeutic benefits without the accompanying ‘high’, suggesting a potential disconnect between the psychoactive and therapeutic effects of cannabis.

Challenging Prevailing Notions: The ‘High’ as a Separate Phenomenon

The findings are significant as it challenges the prevailing notion that the ‘high’ is an unwanted side effect that should be eliminated to harness the therapeutic potential of cannabis. Instead, it suggests that the ‘high’ is a separate phenomenon that may not interfere with the therapeutic benefits of cannabis.

Implications for Patient Treatment: The Need for Individualized Approach

As the study found that the feeling of ‘high’ in some cases were associated with side effects such as anxiety or paranoia, it underscores the need for a careful and individualized approach in the use of medical cannabis, considering the patient’s personal experience and response to the treatment.

Comparing THC with Other Medications: The Case of Opioids

It’s important to note that many commonly used medications, such as opioids for pain relief, also have psychoactive effects and potential for misuse. Yet, these medications continue to be prescribed because their therapeutic benefits outweigh the potential risks when used responsibly and under medical supervision. The same principle should apply to THC. The psychoactive effects of THC, rather than being viewed as a side-effect to be avoided, should be seen as part of the therapeutic process.

Conclusion: Moving Beyond the Traditional Dichotomy

In conclusion, the study invites us to reconsider our understanding of the ‘high’ in medical cannabis use. It challenges us to move beyond the traditional dichotomy of therapeutic effects versus psychoactive side effects, towards a more nuanced understanding that considers the complexity of the ‘high’ and its role in patient outcomes.

Stefan Broselid, Ph.D.
Editor-In-Chief, Aurea Care Medical Science Journal


Stith SS, Li X, Brockelman F, Keeling K, Hall B, Vigil JM. Understanding feeling “high” and its role in medical cannabis patient outcomes. Front Pharmacol. 2023;14:1135453. Published 2023 May 24. doi:10.3389/fphar.2023.1135453