The Cannabis Chronicles: Cannabis, Tolerance And You

March 28, 2014 Updated: April 23, 2016

How does the development of tolerance happen?  This process works at several levels. Most importantly, it can change receptor sensitivity, ease of transport across nerve cell membranes and enzyme reactions that respond to the drug.  Receptors, besides changing in sensitivity, can be removed to reduce the amount available for reactions. Lastly, the brain is actually a neural network, so issues in one area cause subtle changes elsewhere that can have unintended consequences.  This process of adjustment to the intoxicating effects leads to embedding of nerve “memory” on how to respond to the agent next time.   The bottom line is that drugs, including cannabis, only work because they overdrive a system that normally responds to an internally made, similar nerve transmitter in the brain. That’s why ibuprofen or blood pressure meds don’t get you high, despite getting into the nervous system and brain like cannabis does.  They aren’t similar in structure or function. 

If you really like the drug’s effect and use it more frequently, you increase the likelihood of this outcome. When narcotic medication is prescribed in FDA-approved doses to people without prior family or personal history of abuse/addiction, tolerance increases in about 25% of patients after 4-6 weeks. The same is true for some insomnia and anxiety medications.  Cannabis smoking is no different.  Many of my patients, young and old, report a slow increase in tolerance over time to cannabis. This isn’t crack, you know, so you won’t be running out and robbing a store to get the next rocks.  But a few hits on a pipe or draws on a blunt will slowly increase in number to get the desired effect. Whether you want more stimulation to play video games or to kick back to watch a movie with more “immersion” in the content, the drug effect wears off more rapidly and you have to increase the amount of time, quantity, or potency of the drug. The drug effect tells a different story.  It says you are feeling good and getting exactly what you want.

Then, the brain has to adjust back to normal in the hours or days after use. This can lead to lethargy, dulled thinking or moodiness.  The best way to get rid of that is to get high again. Over the years, many patients have admitted to just not staying on point with their obligations the next day, or they wind up taking off earlier so can get back to getting high.  They then have more time to make up for the delays. No, they aren’t quitting their job just to get high. But it’s the let up on the little disciplines that compound over time.  It’s that slight edge thing.  Either it’s working for you or against you.  Those unintended consequences…