#RdRMixing: cannabis (THC) with stimulants, depressants and hallucinogens

The first observation to make to anyone thinking of mixing cannabis with other psychoactive substances is that it would be wise to find out beforehand what effects each of these substances has on their own. Furthermore, they should consider that mixing the effects of certain substances can lead to unexpected situations as a result of interactions; for example, they have an excessively intense experience or they engage in risk behaviours because inhibitions and self-control are diminished. In this text, we will review the main risks of mixing cannabis with stimulants, depressants and hallucinogens, and we will explain one of the main theories of the risk reduction philosophy: the memorable “Zinberg triangle”.

Combining the effects of different psychoactive substances can basically have three results. First of all, an additive effect: that is, each substance has the effect that would be expected from them separately. Thus, the two substances’ effects are “added” to each other. Second, a “synergistic effect”, which is when two substances have a greater effect than when each one is taken separately. And finally, an “antagonistic effect”, which means that one or more of the substances taken simultaneously are less effective than when they are taken on their own.

However, if we are talking about the subjective experience of when a psychoactive drug is consumed, beyond the effects and properties of each substance in particular we must take into account the setting in which they will be consumed and the consumer’s physical and mental state at the moment. One of the seminal theories of the risk reduction philosophy in drug consumption was propounded by American psychoanalyst and psychiatrist Dr Norman Earl Zinberg (1922–1989) in his book Drug, Set, and Setting. The Basis for Controlled Intoxicant Use (1984).

Dr Zinberg studied the life stories of recreational heroin users and, using data and case reports, showed why people’s relationships with drug consumption can change depending on: A) the type of drug consumed, B) the person’s mindset, and C) the social setting. In the course of his early research, Dr Zinberg studied a group of North American soldiers who had started consuming heroin during the Vietnam War. According to Zinberg, they did so in an attempt to “blot out” the intensity of war. After they had returned to the United States, most of them ceased to consume heroin. Specifically, 88% did not become readdicted.

Dr Zinberg’s work contradicts the idea that some people have “addictive personalities” and others do not. His contribution explains that drugs’ effects are not just a consequence of biochemistry. He showed that an individual’s expectations, his psychological set and his social milieu interact to produce the effects on the consumer’s behaviour. In other words, using the “Zinberg triangle”, we were able to explain how it is that a drug affects a person differently at different times and how it affects various people in different ways.

In this respect, as we have seen, anyone wanting to predict how consumption of one or more substances will affect them would first need to have a good idea of their own physical, mental and emotional state; second, they would need to be in control of where consumption will take place (it’s not the same to consume sitting on the settee at home than under the summer sun on the beach, or to consume alone or in company, etc.); and third, they would need to have sufficient information about the effects and interactions of the psychoactive substances they intend to take. For our purposes here, when cannabis is taken with stimulants, depressants or hallucinogens the following must be borne in mind:

- Cannabis and stimulants: One of the most common scenarios when these two types of substance are taken simultaneously is that people end up consuming compulsively more of both. Among other things, this may cause a more debilitating hangover the next day and increased expenditure. Overloading the lungs with smoke will mean that the neck, mouth and throat feel more irritated than usual.

From the psychological and emotional viewpoints, cannabis can have depressant, stimulant and even hallucinogenic effects; this variability complicates the interaction with stimulants. But specifically referring to the effects on the nervous system, cannabis acts as a relaxant and vasodilator, so that when it is combined with a substance that stimulates and contracts the blood vessels, it may intensify the negative side effects of both substances. There are people who prefer to keep cannabis for when the effects of stimulants are wearing off, for example, at the end of the party, so that they can go home and sleep.

In predisposed people, stimulants such as cocaine or speed can cause anxiety or paranoia. These two symptoms are also found with cannabis consumption, so people with such predisposition should be very careful about mixing them, because it could increase the experience’s intensity much more quickly than if they are consumed separately.

- Cannabis and depressants: The most frequent combination of cannabis is with alcohol, and we already discussed this in a previous note. When other depressants, such as opiates or benzodiazepines, are used, mixing with cannabis can increase drowsiness and dizziness. People should also be aware of the possibility of fainting and vomiting. Since our psychomotor performance is affected, the mixture should be avoided in unsafe environments or while risk activities are being performed (driving, heights, darkness, etc.). Some depressants act on the sensation of pain, such as analgesics. Cannabis has an analgesic effect as well and the additive effect may cause the user to lose the perception of risk in situations that would normally make them react sooner. The effects of mixing marijuana or hashish with antidepressants have been scarcely documented; in some cases, people experience an improvement in their mood while others are more likely to experience symptoms of depression and anxiety.

- Cannabis and hallucinogens: An important variable to be taken into account is the consumer’s emotional and psychological state. Before consuming a powerful psychoactive substance, the person must be positively disposed mentally and in good company. Psychedelic substances may produce intense experiences that can even become overwhelming for the user, who may experience sensations of loss of control or of going mad. This is commonly known as “having a bad trip”.

Some people say that they only use cannabis before taking a hallucinogen, to mitigate the nervousness and nausea associated with the early stages of a trip. When cannabis is consumed simultaneously, it may cause a sudden increase in the experience’s intensity, especially in people with low tolerance. It is also true that some users report that smoking cannabis diminished the intensity of the hallucinogenic experience or distorted it. Inserting the THC variable in a psychedelic trip can have unforeseeable results. So it is safer to add it at the end; this helps the consumer relax and come down more gently from the trip.