The story we’ve been told about cannabis—safe, simple, and mostly benign—doesn’t match what we’re seeing at the bedside. Two ER-turned-addiction doctors pull back the curtain on how high-potency products can quietly undercut psychiatric meds, complicate procedural sedation, and nudge recovery off course even when everything else looks better. This isn’t a panic piece; it’s a practical guide to staying safer and getting more from treatment.

We start with psychiatry and a pattern that’s easy to miss: chronic cannabis use can upregulate ABC transporters along the gut, liver, and blood-brain barrier, pushing certain antipsychotics and mood meds out of cells faster and blunting their effect. What looks like “noncompliance” may be pharmacology. We talk through which agents lean on these transporters, which alternatives may perform better, and how to have a stigma-free conversation that protects trust while fixing the plan.

Then we roll into the procedure room. Heavy cannabis use can decrease sensitivity to propofol and other sedatives by altering GABA activity and endocannabinoid tone, often requiring higher doses and tighter monitoring. Add a lesser-known risk—post-propofol hypersalivation in frequent users—and disclosure becomes a safety tool. We share exactly what to tell anesthesia, what clinicians can prepare for, and how to keep airways protected without surprises.

Finally, we examine the “Cali sober” idea through data, not dogma. Large cohort studies link cannabis use to higher rates of alcohol recurrence and new substance use disorders over time, especially with potent concentrates. We cover why potency and pattern matter, how cannabis can dampen the gains of CBT, MI, and contingency management, and what a realistic harm reduction path looks like when abstinence isn’t the first stop. Throughout, we keep language careful—reported use, not admitted; return to use, not relapse—because words shape trust.

If you care for patients, care about someone in recovery, or care about your own health, this conversation offers a clear framework: ask better questions, match meds to biology, and align goals to protect progress. Subscribe, share with a colleague or friend, and leave a quick rating to help others find the show. What did you learn that changes your practice—or your plan—today?

Link to State by State Alternatives to California Sober: https://www.mcsweeneys.net/articles/local-alternatives-to-california-sober

To contact Dr. Grover: [email protected]