We asked a psychiatrist for you.
"Chanello's is the only fucking plan. It's 2:30 am." My friend Dean finished his joint and threw me his keys. I assumed he wanted me to drive his car to Chanello's, the pizza spot two miles off campus. A few of us had just finished ingesting a baking sheet of the finest of pot brownies.
"Bro," I told him, "I am in no condition."
"Does anyone want to drive?" Dean yelled, his voice echoing throughout the row house.
After a round of rock paper scissors, we settled on our friend Roy*. He wasn't someone I knew as well as the rest of the group, but that didn't matter. All that did matter was that slice of chicken supreme pizza.
It only took a quarter of a mile before things went horribly wrong. Roy was waiting to make a left turn at a red light and saw a police cruiser flying down the street in the opposite direction, lights flashing. Roy panicked and ran the red light into oncoming traffic, hopped the median, and skidded onto a grassy access road before coming to a stop on someone's front lawn. We were in shock—the only sound was Roy, hyperventilating in the driver's seat. We learned something that night: Weed gives Roy really bad highs.
We knew, of course, that driving or riding with someone who is impaired is dangerous. But dangerous can quickly become deadly if your driver is having a bad high. Everyone has different reactions to weed depending on the strain or whether it's eaten instead of smoked. We're like pothead snowflakes—no two people have the same exact high or physiological response.
Three main factors play into the effect a drug has on you—the drug itself, the person who uses it, and the environment you're in, says Beatriz Carlini, a senior research scientist at the Alcohol and Drug Abuse Institute at the University of Washington. In the case of weed, specifically, your reaction is influenced by everything from the drug's cannabinoid profile to your genetics, mental health status, and mood. "Using cannabis on a Sunday afternoon in a quiet environment with close friends around can feel different from using it at a loud party with strangers," Carlini says.
Bad highs are sometimes labeled "overdoses," but that term can be misleading—implying that there's a point of no return. In fact, no deaths have ever been reported from a marijuana overdose, according to the DEA. And while more people are smoking weed regularly, a CDC report found that fewer of us are abusing it. But even if it's not ripping you apart physically, a bad high can still feel like a debilitating anxiety attack, which is why it's important to know how to deal with someone in the throes of one.
"A lot of people just go by these urban myths they hear about helping people who are freaking out," says Cliffard Sussman, a psychiatrist and professor at George Washington University. "They don't use approaches based on evidence."
If your friend is just getting a little spooked, Carlini suggests reminding them that their discomfort is temporary. "The best advice is to calm them down," she says. "Tell them it'll pass with time—that it's okay. Reassure the person having the bad reaction." But if someone is having bad high to the point where they're being combative, Sussman says, move them into a space where they can't hurt themselves—or you. "Pick a location where knives or other weapons aren't present. You might move furniture. You have to attempt to remove all possible dangers and consider all possible scenarios," he says. "Marijuana can be unpredictable."
At first, I bristled at Sussman's alarmist tone—after all, weed's most salient effect is to help you chill. But bad highs do occasionally bring on manic behavior in susceptible people. In Colorado and Washington state, Carlini says, calls to poison control centers related to cannabis intoxication have increased since legalization. And while I'm a cannabis advocate, I'm not a recreational smoker because of the negative experiences I've had—some of which made me lose my coordination, and even hear things that weren't there.
In Roy's case, the stimulative factors included a three-ton motor vehicle, oncoming police lights, and sirens. Roy told me later that he'd never had a bad high like the one he'd had that night, and I believed him. But what he didn't tell me before that night was that he'd been diagnosed with PTSD after his mother died in a car accident; Roy had been in the car. His psychological trauma, when mixed with psychedelic drugs, turned out to be a recipe for disaster. And we didn't know enough at the time to get him into a space where he couldn't "harm himself or others." So we did the exact opposite of what a medical professional would have suggested. (To be fair, we were also 21.)
After his car came to a halt on the neighbor's lawn that night, Roy wasn't doing well. He had sweat through his shirt, and was only mumbling slightly in response to his name. We considered taking him to the campus hospital, but didn't want to overreact. Taking our ordeal public didn't seem like a wise decision either—but as Sussman warned me, sometimes it's necessary.
"If you're dealing with someone else's bad high [and] think the marijuana could be laced, going to the hospital can be the only viable option," he says. "At the hospital, vital signs can be checked, certain diagnoses can be ruled out." But since the rest of us had ingested the same weed without incident, we'd all assumed there wasn't anything un-kosher about our stash. We got the car off the lawn before another cop rolled by.
I remembered that, during my bad highs, total silence helped my body shut down and brought me peace. So we had Roy switch to the passenger side, and we reclined his seat. Then we took the keys out of the ignition, and called his girlfriend to drive us home.