An extract from a Wild Rose College’s online course: Cannabis: An Introduction for Healthcare provider, starting mid-January 2020.

The 1970’s song “One Toke Over the Line” written and performed by American folk-rock duo Brewer & Shipley; is still echoing through the minds of researchers and consumer of cannabis. As we enter a time of the year were there is more festive cheer going around, this possibility is pretty real. With the fresh entry of edibles into the marketplace in Canada, this situation can be easily compounded. Most long-term chronic consumers have had this phenomenon happen more than once. Sometimes it ok, but other times it seems like a hell to wait out. The best concept to remember is this too will be over in 2 – 6 hours. But at the time, that seems like a long wait.

What are the things a person can do if they find themselves in this situation? Often the consumer has ataxia or ‘cough lock’ and can’t move from there location, not to mention prepare or obtain the somewhat antidote for this. This points to one major thing; always have someone around that is less affected by the cannabis than the too buzzed person, preferable a non-consumer.

Be the designated straight one!

How do we reduce the ‘buzz’ of THC, if a person perceives they have consumed too much? There are many things to consider with this issue. The following are some:

1. The phenomena around buzz is one of personal perception. That being said, both placebo and nocebo effects will strongly influence outcomes.
2. There is only one true way of clearing THC levels once it is in the blood stream and that is time.
3. There are mixed symptoms, some conflicting with others.
4. There has never been a lethal overdose of THC.

All this being said there are substantial things that can be done in this area.

As we all know, cannabis is not new to the worlds of either medicinal or recreational use. It has been used for thousands of years. The problem of ‘overdosing’ has come up in every era that it has been used. So, first of all we should turn our attention to what some of the greatest minds in medicine of their time used. Maybe we can get some hints here to see what we should use.

In 10th century Persia, Al-Razi suggested a formulation in his Manafi al-agdhiya wa-daf madarri-ha (p.248), to reduce the strong effects of cannabis seeds or hashish, by drinking fresh water and ice or eat any acid fruits. This idea can be found repeating itself in through the ages, by many authorities including ibn Sina (ibn Sina (Avicenna), 1294), and Ibn al-Baytar (ibn al-Baytar, 1291), until O’Shaughnessy brought Indian hemp to Britain in 1843 (O’Shaughnessy, 1843). Robert Christison from England listed lemon as an antidote to acute intoxication in numerous cases (Christison, 1851).

We can find similar support from around the world for the citrus treatment in the 19^thcentury, notably Bayard Taylor after travels in Syria, and Fitzhugh Ludlow after his voluntary experiments with ever higher cannabis extract doses in the USA. These ideas were repeated by Calkins (1871), who noted the suggestion of a friend in Tunis that lemon retained the confidence of cure of overdoses by cannabis users in that region. This is supported by the observation that lemon juice, which normally contains small terpenoid titres, is traditionally enhanced in North Africa by the inclusion in drinks of the limonene-rich rind, as evidenced by the recipe for Agua Limón from modern Morocco (Morse and Mamane, 2001).

In his comprehensive review of cannabis in the first half of the 20th century, Walton once more supported its prescription (Walton,1938). Some have even gone as far as stating this is why the favourite Moroccan feasting foods like tagine has preserved lemon peels in them, as usually hashish was also consumed at these feasts in great quantity.

Cannabis has been heavily used over the millennia in India. Calamus root (Acorus calamus) is used in the Ayurvedic tradition of India to reduce side effects: “Calamus root is the best antidote for the ill effects of marijuana. “. . . if one smokes a pinch of calamus root powder with the marijuana, this herb will completely neutralize the toxic side effects of the drug.” (Lad, 1990, p. 131)

This claim has gained credibility, not only through force of anecdotal accounts on the Internet, but with formal scientific case reports and scientific analysis documenting clearer thinking and improved memory with the cannabis–calamus combination, and with provision of a scientific rationale: calamus contains beta-asarone, an acetylcholinesterase inhibitor with 10% of the potency of physotigmine.

Interestingly, the cannabis terpenoid, – pinene, also has been characterized as a potent inhibitor of that enzyme, bolstering the hypothesis of a second antidote to THC contained in cannabis itself.

Historical precedents also support pinene in this pharmacological role. In the first century, Pliny wrote of cannabis in his Natural History, Book XXIV: Of the components, palm wine is perhaps the most mysterious. Ethanol does not reduce cannabis intoxication. However, ancient wines were stored in clay pots or goatskins, and required preservation, usually with addition of pine tar or terebinth resin. Pine tar is rich in pinene, as is terebinth resin (from Pistacia terebinthus), while the latter also contains limonene. Likewise, the pine nuts prescribed by Pliny the Elder harbour pinene, along with additional limonene.

Al-Ukbari also suggested pistachio nuts as a cannabis antidote in the 13th century, and the ripe fruits of Pistacia terebinthus(known commonly as terebinth and turpentine tree) similarly contain pinene.

Black pepper, might offer the mental clarity afforded by pinene, sedation via myrcene and helpful contributions by caryophyllene and possibly piperine (which does combine with endocannabinoid system receptor sites). The historical suggestions for cannabis antidotes are thus supported by modern scientific rationales for the claims, and if proven experimentally would provide additional evidence of synergy.

It doesn’t matter if the consumer is a complete novice or a long-term coinsurer of cannabis, things happen, and adverse reactions do occur from time to time. One can at least rest assured (often in their paranoid mind) that there has never been a fatal dose of THC and this too will pass in a few hours.  Doing too much THC seems to be most common in social situations where the party atmosphere has often induced a person to ‘. . . have 1 toke over the line . . .’.  This has become even more true in the current era of higher THC percentages, new technologies of producing cannabis product of higher cannabinoid concentration (DAB) and of course edibles.

Substances that have been shown to reduce side effects

• Exercise
• Food and Water
• Black Pepper
• Lemons (containing terpene limonene)
• Pine nuts (pinene).
• CBD
• Chocolate
• Kava
• Smoke a small amount of Calamus (Acornus calamus)
• Caryophyllene
• Medicinal Mushroom: Reishi, Cordyceps, Lion’s manes

Other Phytocannabinoids to consider are:

• THCV
• CBG
• CBC
• CBCV

To be continued . . .