It was a quiet evening in the suburbs, and I found myself awake in bed, shaking and nauseous. My head was hot, but my skin was covered in goosebumps and a cold layer of sweat, and I was feeling like I had to vomit.

It was my third day of taking a break from vaping marijuana. In 15 years of using cannabis on and off, I haven’t quit, but I do take breaks. Usually, the first few days are consistent with quitting cigarettes or coffee: irritability, cravings, a nagging headache. But this time, it was terrible. I didn’t just miss THC, my body hardly knew what to do without it. I coughed over the sink, hardly able to get a breath, until I gagged and drooled into the drain.

“It’s very common for people to have just the withdrawal symptoms that you describe from stopping cannabis,” Michael Ostacher, a professor of psychiatry and behavioral sciences at Stanford University, later tells me in an interview. “It’s probably much more likely as the potency of cannabis increases.” I remembered digging through the trash that nightwhere a few days before I had tossed the vape pen I’d purchased based solely on the budtender’s recommendation. I was shocked to see it contained “95 percent THC.”

Drooling, gagging, and shaking—it’s not the laid-back image of a weed smoker I admired when I started regularly smoking pot. It was just before the legalization of marijuana in Colorado, and I was a junior at a “hippie” college where smoking weed was already the norm. One of my favorite party questions used to be: Who’s in your dream blunt rotation? Mine was always Seth Rogen, Rihanna, and Ilana Glazer. These were elder millennial icons who seemed to prove that heavy cannabis use and massive creative success could coexist, and maybe even fuel each other. Weed was part of their brands. They were creative powerhouses not in spite of being stoners, but, seemingly, because they adopted weed as part of their identities.

My (actually hippie) boomer parents smoked as part of the counterculture. Gen X grew up in the D.A.R.E.-program era. For me, marijuana was fitting in, never an act of rebellion. We weren’t living in Reagan’s America, we were living in Lady Gaga’s, Wiz Khalifa’s, even President Obama’s—he has famously admitted to getting high in his youth. Compared to alcohol, or even cigarettes, weed was even—maybe—a little bit responsible. The worst outcome I could imagine was a case of the sillies, sleepies, or munchies.

As an adult, my Instagram feed includes #gardenmoms smoking in their garages to get through their domestic duties, stoner influencers who review and document all the ways they get high, and viral reels poking fun at how necessary weed is to people’s psychological well-being. All grown up, the people in my blunt rotation have invested in cannabis cocktails, marijuana pipes, and makeup containers that double as weed storage.

Weed became, for me, even a kind of medicine that I could take without much oversight from doctors. At 20, I broke my back skiing and began smoking daily—I preferred it to painkillers, which gave me nightmares and made me irritable. While stoned, I slept soundly through the night. Later, a longtime therapist of mine gave me his blessing to regularly use cannabis instead of taking an SSRI antidepressant, suggesting that I simply take breaks every few months to assess how I was feeling at baseline.

For a while, this worked. Self-medication seemed to work for my anxiety, but every time I started smoking weed again, I seemed to want it more than before I quit. Years later, those breaks were showing me the darker truth of weed addiction. Now I was lifting myself from the bathroom floor with shaking hands for a fitful night of tossing in bed, a raging headache waiting for me in the morning.

There is still a public assumption that cannabis rarely causes issues like addiction or physical side effects. Yet, data from a 2015 national survey found that nearly 31 percent of adults who had used cannabis in the past year met the criteria for cannabis use disorder, in which you need more THC to feel the same effects, and can have symptoms from irritability to difficulty sleeping if you stop using it. There is, according to Yale Medicine psychiatrist Deepak Cyril D’Souza, an “urgent need” to develop treatments that will help people quit pot. The outcomes of CUD can be quite bad: Last year, a study found that people who received hospital care for cannabis use disorder were, after the data was adjusted for other health issues, nearly three times more likely to die within the next five years compared to members of the general population. “Notably, the relative risk increase was most pronounced in individuals aged 25 to 44 years,” wrote the author of an op-ed that accompanied the study. The overall risk of death was still low, at just a few percent, and more research is needed to untangle whether cannabis is truly involved in that increase in deaths (perhaps by exacerbating cardiovascular issues, for example) or if the increased risk is merely association. But it seems that when things go really wrong with cannabis use, millennials may bear the brunt.

Andrew Meltzer, a professor of emergency medicine at the George Washington University, has seen how cannabis can land someone in the ER, both firsthand and through surveying people who have suffered an extreme condition called cannabinoid hyperemesis. CHS, which is thought by researchers to be on the rise, is marked by recurring episodes of nausea and vomiting, and is the most extreme manifestation of gastrointestinal issues related to long-term regular cannabis use. Its most harrowing symptom is called scromiting—a combination of screaming and vomiting at the same time.

At first, Meltzer says that even his own colleagues found the existence of scromiting—which he now hears the sound of in the ER multiple times a week—hard to believe. “Initially people thought they were faking or drug-seeking, but it wasn’t true,” he explains. “They’re just in so much discomfort.” Extreme stomach upset combined with psychological distress seems to be the cause of scromiting, as doctors have found anti-psychotics give some relief to the screaming. Very hot showers and baths also provide a reprieve from nausea. Meltzer has even seen patients come in with burns from excessive showering. But the only lasting cure is to stop using cannabis.

I described the regimen my therapist had suggested to me, up to three drags of a vape pen daily, to Meltzer, imagining he would quell my fears that someone like myself could develop something as nightmarish as CHS. But when I asked if I might be susceptible to it, he replied, “Oh, totally.” It’s the regular use that’s risky. And while scromiting is, overall, thought to be rare among cannabis users, there’s not a lot of data.

I have to think that my therapist was offering an opinion on cannabis use based on observations with other patients, and perhaps also backed by his personal millennial understanding of the substance. Today, he might not have given the same advice. Ostacher and his colleagues at the American Psychiatric Association put out a position statement at the end of last year titled “Opposition to Cannabis as Medicine for Psychiatric Disorders” for this reason: to make sure that mental health professionals understand that the idea that cannabis is useful for anxiety and depression is not backed     by evidence. In fact, the statement says there “is a strong association of cannabis exposure and use with the onset and exacerbation of psychiatric disorders.” More research is needed, the statement emphasizes, to understand both the harms and potential benefits of cannabis     use. In the meantime, “people can make claims about cannabis, and they do, but the claims are marketing claims,” says Ostacher. It’s true that because we already have cannabinoid receptors in our brains responsible for pain, nausea, and mood, small doses can have a positive effect on issues related to those areas. But if they are overstimulated, they will have the opposite effect, creating stomach cramping, vomiting, nausea, irritability, and panic when exposed to even a small amount. Meltzer describes it as similar to developing an allergy, something he and his colleagues hope to expand research on.

The average THC content in cannabis has quadrupled over the past 25 years. And “that’s just the potency of plants,” Ostacher says. The concentration in smokable and edible products can be higher than ever before. The higher the THC concentration, the stronger its effects on the brain, including potentially leading to addiction.

Yet, “exposure over time may be even more to blame than potency,” says Meltzer. Weed is a drug: There are side effects. “I’m not trying to create a panic state or ‘reefer madness,’ I just feel like we’re doing a public health experiment on people, especially young people.”

For years, reformers rightly pushed back against scare tactics meant to keep marijuana illegal. The truth is that now it can be far easier and economical to find marijuana to attempt to treat your pain or mental illness than it is to find a doctor. Others consider it part of their culture. But we may have overcorrected in our acceptance of weed. None of what I learned firsthand or while writing this piece fits easily into the laid-back mythology of weed that I grew up with. How many of us are quietly dealing with chronic coughs, nausea, dependency, or intrusive thoughts about our next high?

I wonder who else is struggling. I used to fantasize about my blunt rotation, but now I fantasize about talking to that same group about our dependencies. From the moment I shared my first apple bong stuffed with weed stolen from my friend’s dad, I have loved the effects of marijuana, but my experience has been far different than the “I can quit any time” feeling I thought I was signing up for.

Not everyone will develop issues from marijuana use. As they were lighter users, many of my college friends quit quietly after graduation, and have a hard time not raising an eyebrow when I use words like “addiction” and “withdrawal” in connection to cannabis. And I can’t blame them. Growing up we were all but promised that pot users were immune to such pitfalls. While largely maintaining their millennial, pro-pot stance, they moved on from using themselves. My friends sometimes tease me for being the only remaining “cool one.” But I don’t feel cool. I feel stuck.

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