Hello, Dr. G.H.,
I was pleased to read your question, although saddened, as I'm sure your patient was, by the effects he experienced upon smoking the second batch. I'm a first-year med student (albeit a 45-year-old one) and am married to a cardiologist. We have my older sister, who's in the process of dying from widely metastasized ovarian cancer, living here at our house, and I came to this forum several months ago looking for info for her, particularly while she was still struggling with the side effects of her last round of chemo.

She experienced similar differences to what your patient experienced from different strains of weed she tried. Some, and I now know these were the Indica-dominant strains, were relaxing, comforting and easy to take. But the more sativa-dominant strains caused her to be jittery, uneasy and panicky. I'm firmly convinced it's sativa-heavy strains that set off complete panic attacks and even psychotic episodes in some susceptible people. Most of the reading I've done about differences between strains confirms this. You can Google marijuana strains and read the differences in effect between indica vs. sativa. I'm not at all convinced these reactions have anything to do with the smoker being new to the smoking experience. Certainly some people have more experience and comfort than others, but the anxious, psychotic-like response happens even to people who are seasoned mj users on occasion.

Therein lies the problem with buying mj from a street dealer rather than in a state with real medical dispensaries that know the characteristcs of the weed they're providing to medical users. I'm guessing you're in a non medical mj state. That second batch could indeed have been laced or tainted with something. It could have simply been a sativa-heavy strain that set off the jittery, anxious, psycotic episode. It could have been the unique ability of one patient's brain to take a psycho-neuroactive chemical and interpret it in some unique and unsual way. Just as neurontin might act differently in 10 different people who took it, so can weed. And if might have been aggravated by combination with any other meds the patient was on.

The solution my sister ultimately arrived at was to find a weed source from someone who provided to medical patients and knew the strains he was selling. This wasn't a street dealer, and unearthing this provider involved some discreet work. If your patient is brave enough to try again, I'll be happy to share with you how we did this. For medical users, I'm firmly convinced, after watching my sister's experience, that weed from street dealers is not the way to go.

Let me know if you'd like further information, and we can make an arrangement to use this forum's chat feature, where I'll be happy to share information with you through a private chat. That'll keep any names and emails I may share with you out of the public eye. Nice talking with you!