Short-term effects

• Feeling relaxed, euphoric, sleepy, or unusually talkative
• Altered sense of time, perception, and judgment
• Poor concentration, short-term memory, reaction time, coordination, and driving ability
• Red eyes, dry mouth, increased appetite
• Fast heartbeat, sometimes increased blood pressure
• Anxiety, panic, suspiciousness, or paranoia, especially with high doses
• Nausea, dizziness, impaired balance
• At high doses: severe confusion, hallucinations, or acute psychosis in susceptible people

Longer-term or frequent-use effects

• Tolerance, meaning larger amounts may be needed for the same effect
• Cannabis use disorder or dependence: cravings, difficulty cutting down, continued use despite harm
• Withdrawal after regular use stops: irritability, anxiety, poor sleep, vivid dreams, low appetite, restlessness
• Ongoing cough, phlegm, wheeze, and bronchitis-like symptoms if smoked
• Problems with learning, attention, memory, and academic/work performance, particularly when regular use begins during adolescence
• Higher risk of anxiety disorders and psychotic symptoms in people with a personal or family vulnerability to psychosis
• Possible cyclic severe vomiting in some heavy users, called cannabinoid hyperemesis syndrome

Higher-risk situations

• Are under 25, and particularly under 18
• Are pregnant or breastfeeding
• Have heart disease, panic disorder, bipolar disorder, schizophrenia/psychosis, or a close family history of psychosis
• Need to drive, operate machinery, work at heights, or make safety-sensitive decisions
• Are using alcohol, opioids, benzodiazepines, or other sedating drugs

Seek urgent medical help now if

Management of charas (cannabis resin) use

1. Acute intoxication

• Stop further use. Do not mix with alcohol, opioids, benzodiazepines, or stimulants.
• Stay in a quiet, low-stimulation place with a trusted sober person.
• Reassure the person, provide oral fluids if they can swallow safely, and let them rest.
• Do not drive, ride, operate machinery, or make important decisions until fully recovered.
• A clinician should check pulse, blood pressure, temperature, mental status, and screen for co-ingested substances if symptoms are significant.
• Severe anxiety, panic, agitation, delirium, or psychosis may require emergency observation and clinician-prescribed medication. Do not self-medicate with sedatives.

2. If stopping regular charas use

• Irritability, anxiety, restlessness
• Craving
• Poor sleep or vivid dreams
• Low mood
• Reduced appetite, headache, stomach upset

• Pick a quit date and remove charas, pipes, rolling materials, and trigger contacts.
• Tell one supportive person and avoid places or friends strongly linked to use, especially early on.
• Keep a regular sleep-wake schedule, daily exercise, meals, hydration, and structured activities.
• Use non-drug coping for cravings: delay 15 minutes, leave the triggering setting, call someone, shower, walk, or do a short task.
• Seek assessment for depression, anxiety, trauma, psychosis, alcohol use, or tobacco/nicotine dependence. Treating coexisting problems improves the chance of recovery.

3. Treatment for dependence or problematic use

• Motivational interviewing / motivational enhancement therapy: helps clarify personal reasons to reduce or stop.
• Cognitive behavioral therapy (CBT): identifies triggers, teaches craving management, refusal skills, and relapse prevention.
• Contingency management: structured rewards for attendance or negative drug tests where available.
• Family/couple support may be useful, particularly for adolescents and young adults.
• Addiction psychiatrist, psychologist, or substance-use service referral if repeated failed quit attempts, daily use, impaired work/study, or mental health complications occur.

4. Relapse prevention

1. What triggered it?
2. What warning signs were missed?
3. What one practical change can reduce the chance of another episode?

Emergency management of charas (cannabis) intoxication

1. Initial stabilization

• Airway, breathing, circulation (ABC)
• Check consciousness, oxygen saturation, respiratory rate, pulse, blood pressure, temperature, and blood glucose.
• Give oxygen and secure the airway if there is reduced consciousness, aspiration risk, or respiratory compromise.
• Obtain IV access and cardiac monitoring if severe symptoms, chest pain, marked tachycardia, syncope, or suspected mixed-drug exposure.
• Look for injury, dehydration, hyperthermia, seizure, or self-harm risk.

2. Focused assessment

• What product was used: charas, edible, vape, or possibly synthetic cannabinoid?
• Amount, route, and time of use
• Use with alcohol, opioids, sedatives, stimulants, or other drugs
• Past psychiatric illness, heart disease, seizures, and medicines used

3. Supportive treatment

• Put the patient in a quiet, dimly lit, low-stimulation room
• Calm reassurance and close observation, preferably one-to-one if confused or anxious
• Oral fluids if alert, or IV fluids if vomiting/dehydrated
• Avoid unnecessary procedures and avoid discharge while impaired

4. Symptom-directed treatment by clinicians

• Severe anxiety or panic: a short-acting benzodiazepine may be used under monitoring.
• Severe agitation, violence, hallucinations, or psychosis: verbal de-escalation first; if safety remains at risk, clinicians may give an antipsychotic. Physical restraints are a last resort, with continuous observation.
• Seizure: follow standard seizure protocol, protect airway, correct hypoglycemia/electrolyte causes, and investigate co-ingestants or synthetic cannabinoids.
• Chest pain, arrhythmia, severe hypertension, or syncope: investigate and manage as a cardiac emergency, not as “just cannabis intoxication.”
• Persistent vomiting: assess for dehydration, electrolyte abnormalities, acute kidney injury, and cannabinoid hyperemesis syndrome; give IV fluids and antiemetic treatment as clinically appropriate.

5. Admit or obtain urgent specialist review if

• Persistent psychosis, suicidal thoughts, dangerous agitation, or inability to ensure safety
• Reduced consciousness, repeated vomiting, seizure, or hyperthermia
• Chest pain, abnormal ECG, severe persistent tachycardia, or suspected heart disease
• Suspected synthetic cannabinoid exposure or mixed intoxication
• Child ingestion, pregnancy, major comorbidity, or lack of safe supervision at home

6. Discharge only when