- The Scream by Edvard Munch
In the '90s, I wrote a script treatment for "Seinfeld," with the title of "George Smokes Pot." I never submitted it. I didn't even quite finish it — I never came up with a B story — but I thought what I had was pretty good: George falls for a hip woman, she convinces him to get high, and since George is the personification of neurosis, he completely freaks out, melting down into a puddle of anxiety and paranoia (and stupidity).
Years later, I would kick myself for never finishing it, because "Seinfeld" creator Larry David, who had modeled George Costanza on himself, smoked pot and freaked out in a brilliant scene for his show "Curb Your Enthusiasm." It accurately depicted pot paranoia not as fear of external forces, but as internal insecurity and self-loathing. That is, not as "the cops are coming to get me," but as "I am a terrible person and a failure." Larry, alone in a bathroom, is being chastised by his own image in the mirror. "You do nothing!" the mirror image hisses at him. "You gotta change the diet!" "Get a card for your father-in-law's birthday! You're not gonna get it! You're not gonna do a FUCKING THING!"
Larry, terrified, meekly promises his image that he will change his ways and become a better person. "TV, TV, TV, that's all you like to do!" responds Larry-in-the-mirror. "Read a fucking book!" Here, Larry starts to argue back.
And that might be the best lesson of all for people who struggle with paranoia and anxiety when they ingest cannabis. As with hallucinogens such as mushrooms and LSD, what you bring into it is often what you will get out of it. If you're anxious and paranoid before you get high, it's possible that cannabis, rather than relieving those problems, will only magnify them. And the best remedy for paranoia might simply be to deny it. Even to yell at it, as Larry did. It might not totally work, but it's better than simply succumbing.
Beyond that, preventing paranoia pretty much amounts to a crapshoot. Research indicates that avoiding the ingestion of too much THC will help (well, duh), and that newcomers to pot and those who partake infrequently are much more susceptible than are regular users. For those new to pot, or perhaps new to all the newfangled dosing options (vapes, edibles, tinctures, etc.), the best advice is "start low and go slow," said Barbara Blaser, director of clinical services at Magnolia Wellness in Oakland. That is, take in small amounts of THC, over time, until you're sure of yourself.
It must be noted that when it comes to cannabis, "paranoia" is a colloquial term. In formal clinical settings, it describes a very serious mental illness. That's not what this is, bad as adverse reactions to cannabis can be. A better term would be "anxiety," but "paranoia" is used far more often and is more readily understood. Most people who come to Magnolia Wellness in Oakland asking how to deal with pot paranoia "think it's kinda funny," said Blaser, a registered nurse with many years of experience in mental health. "Nobody comes in devastated."
Often, such people are looking for just the right cannabis concoction to avoid paranoia. Unfortunately, there is no pat answer. In terms of the biochemistry, different people will react to different products. As with so much else having to do with desired outcomes, consumers are left to experiment.
It's possible that a high CBD-to-THC ratio will do the trick, so that's probably a good place to start. This is where the cannabis conundrum reveals itself: Pot is often prescribed to relieve anxiety. It has been shown to be effective for PTSD in some cases. Recreational consumers often use it to relax. And yet, it can also cause someone to freak out so severely that they end up calling 911, as has happened a bunch of times. The oversimplified (but broadly accurate) explanation is that CBD tends to relax people, while THC (the stuff that gets you high) tends to have the opposite effect. So budtenders and clinicians will often advise people to make sure that along with their THC, they're getting a healthy dose of CBD as well.
One approach might be to begin with perhaps a 10:1 ratio. If that doesn't get you high enough, try 3:1. If that makes you too paranoid, try 5:1. Etc. Also, edibles tend to catch people by surprise, so be extra-careful with those, and make sure you understand the dosing instructions.
If you find yourself starting to feel edgy and anxious when you're high, "the good news is that it won't last," Blaser said. Taking some pure CBD extract will likely help. And she recommends inhaling black pepper and lemon vapors (alone or in combination), the terpenes of which, Blaser said, can disrupt THC action in the brain. Otherwise, she said the best course is to "push fluids, lie down, and remember that it will pass."