Puff, Puff…Pass Out? Have you ever seen someone smoke weed then faint? Or has it happened to you? I’ve witnessed these episodes five times in very different settings but one thing has been constant - it’s always been men, generally on the thinner side, standing upright while consuming. Read on for my exploration into why this happens mainly to men and my anecdotal, but possibly amazing, theory about it’s connection to estrogen.

An important person in my life recently fainted in front of me while we were getting high, an activity we do regularly together. The episode frightened me to a degree that I needed to delve deeper into why this occurred to make myself feel better but to share it with you. I’m 99% sure that you or someone you know has witnessed someone or been the person who has experienced what's called syncope (sink-oh-pee) otherwise known as fainting. Fainting is defined as when the brain doesn’t receive enough oxygen causing the person to lose consciousness temporarily - this is evolution’s way of diverting the body’s priority from consciousness to other bodily functions to maintain survival. We were smoking herb in the low-mid 20% THC range and after one hit (!) my loved one lost consciousness almost falling backward out of a stool. From a few feet away I noticed immediately that something was wrong and ran over in time to help ease them to the ground. They were unconscious for probably 10 seconds as I cradled them and another person dialed 911, they then woke up with a beautiful little smile and said “hi, what's up?”. This person had absolutely no idea what had just happened - complete blackout. After a moment or two it was clear that my loved one was fine and we declined to have an ambulance deployed but he did see his own doctor shortly after and was cleared of any concerns. This is actually the second time I've seen this particular person pass out after smoking weed but the first time it was when we were smoking potent hashish, so it made a little bit more sense. This time around, we’d just had a small amount of basic weed, not of particularly high potency, literally one hit off of a hand pipe. I was perplexed.

After diving into deeper research and chatting with some docs and nurses (some of whom are my own clients, fun fact), I’m confident that cannabis-induced syncope mostly has to do with the bodys’ metabolization function and blood pressure. THC lowers the blood pressure in consumers, which is one reason folks with heart problems and/or taking heart meds should be educated about this if also using herb, OR, particularly thin folks - all FIVE times I’ve personally witnessed this happen, the man using the weed was of thinner stature, physically fit, with age varying from 30s to 60s, as well as the consumption method type and potency, which notably has always differed: Lozenges (2), Hash (1), Flower (1), Concentrates (1). I’ve never seen someone pass out off of edibles, but they do make some people very sleepy after they kick in, which makes me think metabolization matters. Because it must be digested to become psychoactive, eating cannabis takes a longer time to kick-in than any other consumption method, somewhat avoiding a rush of THC to the bloodstream to cause syncope. According to pubmed.gov and a comparative (and absolutely scientifically tiny) study done in 1992 ( I know, it's been a while), called  “Middle Cerebral Artery Velocity During Upright Posture After Marijuana Smoking”, it’s stated that “marijuana is known to cause symptoms suggestive of orthostatic hypotension such as dizziness and fainting during upright posture”. In the study researchers examined changes in cerebral blood velocity (cbv) and peripheral circulation during upright posture after smoking marijuana in 10 right-handed male subjects” Layspeak: they measured how fast blood reached extremities while subjects smoked weed vs. a placebo.

While I don’t have a clear idea of the importance right handedness holds (other than maybe a connection to being opposite the heart?), but six of the 10 subjects reported moderate to severe dizziness smoking herb while standing upright. Subjects who experienced severe dizziness during standing showed marked decreases in their blood pressure and cbv; those who reported moderate dizziness showed reduction in cbv but not blood pressure; subjects who reported mild dizziness after marijuana. Placebo-smoking subjects showed minimal changes in blood pressure in cbv after consuming marijuana in an upright position. So, the weed faints are likely caused by “hypotension and impaired cerebral autoregulation” or how well your blood is being transported to your extremities from your heart - including your brain.

Now for the part I’m really intrigued by - it’s known that cannabinoids are “estrogenic”, which means they are more effective when estrogen is present. I’ve never witnessed a woman pass out right after gettin’ high; are women not passing out because we process THC more effectively? Estrogen(s) is a group of female sex hormones associated with reproductive development and maintenance of female body characteristics. Estrogen specifically plays a role in our menstrual cycles, mood, and metabolization; it’s produced by the ovaries although the adrenal glands and even fat cells also excrete small amounts of the hormones. Could it be that because of the way female bodies metabolize cannabis we are less likely to experience an accidental weed nap?!  Definitely an area I’m going to be watching. 

So how do we NOT pass out my sweet, stony friends? 

• First of all, sit down if you feel dizzy - even if that’s on the ground (best not to add a head injury to your episode);

• Pay attention to other warning signs like facial paleness, tunnel or blurred vision, a cold sweat or getting very warm, feeling suddenly nauseated, or a sudden onset of a combo of these; 

• Truly respect yourself and your body’s limits. If you’ve fainted when weed’s involved, mindful about how, when, and around which folks you consume. And never, ever drive and toke; 

• Tell your friends - they want to watch out for you; 

• Take a break from herb for a bit, change strains, and possibly most importantly, consider the method with which you consume - metabolization matters; 

• Eat well and make sure you’re well rested before smoking; 

• Again, sit down while ya smoke. While seated, your heart’s not working quite as hard against gravity to effectively pump your blood, but when you elongate that journey by standing up your blood oxygen activity changes; 

• Tell your doc. Seriously, they’re not going to narc on you but they may wanna run some tests to make sure your heart’s in good shape.

What do we do if someone we’re seshing with passes out?  

• Call for help and emergency personnel - better safe than sorry;

• If they’ve fallen, in case of neck, head or spinal injury, do not move them unless absolutely necessary to remain safe;

• Find a pulse using index finger (not your thumb as it has it’s own pulse), a pulse means blood is circulating;

• Check breathing by looking at the person’s chest to make sure it’s rising and falling;

• When person awakens (it usually happens within seconds of losing consciousness), keep them comfortable, tell them what happened, give them space to breath;

• Once alert, offer the person water, maybe a snack, and ask some basic questions to rule out stroke (what year is it? Who is the current president?).

What are your thoughts? What would you add to this discussion?