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Use exhibits a much more controlled pattern of mood management through a mild
stimulation with low repeated inhaled doses. Modulation of emotional reactivity
appears to be another significant desired effect of cannabis. The net effects
for the continuing moderate user are a unique combination of mood elevation with
a decrease in anxiety that is easily controlled.
ancient Greek, Indian, Persian, writings are replete with descriptions of antidepressant
Odyssey describes Helen using a potion obtained from Polydamna that lifted the
spirits at a morose gathering by slipping Nepenthe in the wine. Nepenthe means
"against sorrow" .
and Hindi writings characterize cannabis:
the 8th century an anti phlegmatic, Circa 1050: victorious (Vijaya), and victorious
in three worlds (Trailokyavijaya).
A.D. in The Rajanighantu of Narahari Pandita: the light hearted (Capala), the
joyful (Ananda), the rejoicer (Harsini), speech giving (vakpradatva) inspiring
of mental power (medhakaritva), and a most excellent excitant (cresthadipanatva).
Century Materia Medica The Rajavallabha: "It creates vital energy, the mental
powers, and internal heat, corrects irregularities of the phlegmatic humour, and
is an elixir vitae."
contemporary terms a case of severe and chronic depression may have been successfully
treated through self medication with cannabis.
Persian physician Mirza Abdool Rhazes wrote:"The oldest work in which Hemp
is noticed is a treatise by Hasan, who states that in the year 658 (Mahometan
era)(1258), the Sheikh Djafar Shirazi, a monk of the order of Haider, learnt from
his master the history of the discovery of Hemp. Haider, the chief of ascetics
and self-chasteners, lived in rigid privation on a mountain between Nishabor and
Romah, where he established a monastery of Fakirs. Ten years he had spent in his
retreat, without leaving it for a moment, till one burning summer's day, when
he departed alone to the fields. On his return an air of joy and gaiety was imprinted
on his countenance; he received the visits of his brethren, and encouraged their
conversation. On being questioned, he stated that: struck by the aspect of a plant
which danced in the heat as if with joy, while all the rest of the vegetable creation
was torpid, he had gathered and eaten of it's leaves. He led his companions to
the spot, all ate, and all were similarly excited. A tincture of the Hemp leaf
in wine or spirit seems to have been the favorite formula in which the Sheikh
Haider indulged himself. An Arab poet sings of Haider's emerald cup; an evident
allusion to the rich green colour of the tincture of the drug. The Sheikh survived
the discovery ten years, subsisting chiefly on this herb, and on his death his
disciples by his desire planted it in an arbour about his tomb. From this saintly
sepulcher the knowledge of the effects of Hemp is stated to have spread into Khorasan."
1845 J.J. Moreau de Tours, a French psychiatrist utilized cannabis in the treatment
of depression described the drug's effects:
seems that nothing can hurt you in this peace of mind, that you are inaccessible
to sadness. I doubt that the most unfortunate news could draw you out of that
imaginary bliss, which can only be appreciated through experience.
have just attempted to give an idea of the delights that hashish produces. I hasten
to add that I have presented them here in no more than raw form, as it were, and
at their simplest. It will depend upon external circumstances to confer upon these
feelings of happiness still greater intensity by directing them toward a determined
goal and by concentrating them on a single point. One imagines what reality can
add to this state of bliss and how much the joys of hashish can be enhanced by
external impressions, by direct sensory excitations, or by the stirring of passions
through natural causes. At that time, the rapture of hashish intoxication, taking
shape and form, will assume the dimensions of delirium. This disposition of the
mind, linked with another which I will discuss later, was, I feel, the fertile
source from which the fanatic inhabitants of Lebanon derived that happiness, those
ineffable delights for which they gladly sacrificed their lives.
is necessary here to clarify what I have just said. It is really happiness that
hashish gives, and by that I mean mental joy, not sensual joy as one might be
tempted to believe. This is indeed very curious, and one can draw strange conclusions-
this one among others, that all joy, all contentment, even though its cause is
strictly mental, deeply spiritual, and highly idealistic, could well be in reality
a purely physical sensation, developed physiologically, exactly like those caused
by hashish. At least, if one relies on inner feelings, there is no distinction
to be made between these two orders of sensations, in spite of the diversity of
the causes to which they are related for the hashish user is happy, not in the
manner of the glutton, of the ravenous man who satisfies his appetite, or even
of the hedonist who gratifies his desires, but in the manner, for example, of
the man who hears news that compounds his joys, of the miser counting his treasures,
of the gambler whom luck favors, or the ambitious man whom success intoxicates.
the preceding remarks were not intended to raise a psychological question. I am
merely recording observations, and have no other pretension than that of being
the faithful and exact historian of my sensations." This characterization
of the antidepressant effects of the drug in contemporary contexts would be unthinkable
pro drug sedition and would never be found in any advertisement.
as one of the conditions listed for treatment appeared in general Materia Medica,
or medical texts , , ,
clinical use in depression is described as having variable results. Clouston in
1871 from the Cumberland and Westmoreland asylum reported on five cases of melancholy
with some success in four and marked improvement in one. Villard describes similar
variable results in melancholia by physicians in France. The Indian Hemp Drugs
Commission in 1894 reviewed medical literature, testimony by both indigenous medical
practitioners and Western trained physicians and described cannabis to be used
as a tonic to increase stamina,
decreases emotional reactivity and intensity of affect while increasing introspection
as evidenced by the slowing of the EEG after initial stimulation. The unique sedative
effects of cannabis then begin to prevail. Obsessive and pressured thinking give
way to introspective free associations when in relaxed circumstances. Emotional
reactivity is smoothed out, worries are less pressing. The alteration of time
perception relieves the "hurry sickness".
thousand years ago Chinese used cannabis in high doses to induce a state of altered
consciousness to permit major surgery. The analgesic effects of cannabis, which
are less potent than the opiates, appear in part to be from decreased affective
reactivity, which is modulated by altered time perception.
the time that this remarkable drug is relieving pain a very curious psychical
condition sometimes manifests itself; namely, that the diminution of pain seems
to be due to its fading into the distance, so that the pain in a delicate ear
would grow less and less as a beaten drum was carried farther and farther out
of the range of hearing.
condition is probably associated with the other well known symptom produced by
the drug, namely, the prolongation of time." Cannabis was mentioned in most
general medical texts as an analgesic but with lesser potency than the opiates.
types of pain respond differently to cannabis. Review of clinical literature discloses
two general categories that respond affirmatively: Intermittent spasmodic pain
and inflammation. (See table 1)
Headache is a specific type of pain for which cannabis was first described to
be useful by J. Russell Reynolds . After some thirty years clinical experience
after this initial observation, he described "Migraine: very many victims
have for years kept their sufferings in abeyance by taking hemp at the moment
of threatening, or onset of the attack." In Osler's medical text it was the
treatment of choice for migraine headache. The most recent (and last) mention
of cannabis for the treatment of migraine was from Morris Fishbein, M.D., Editor
of the Journal of the American Medical Association in 1942.
was compared with alcohol in cross-cultural comparisons in India. Daru vs Bhang.
G. Morris Carstairs described differences in emotional reactivity: contrast of
cannabis comparable effects of alcohol intoxication that increases emotional reactivity.
Cannabis cools the passions. Alcohol inflames them. I have never heard of a pot
Eyes: Increased Blood Circulation to the Brain
in his description of the clinical pharmacological effects on the brain were to
increase blood circulation during effects of the drug.
phenomenon of dilated eye blood vessels with cannabis intoxication has been described
extensively in writings on the drug. The meninges, the membrane covering the brain,
covers the external eye. (except for the corneal area) The reddened eyes represent
a general increase in cerebral blood flow (CBF). This increase in blood circulation
is due to decreased peripheral resistance from dilation of the capillaries in
the cerebral cortex. CBF changes reflect mental effects; increased CBF: stimulation
of cognition, decreasing CBF: sedation. Chronic heavy users appear to have decreased
CBF when deprived of the drug.
and Heart Rate
heart rate is due to central nervous system modulation of the tenth cranial nerve
(the vagus nerve). There are no direct effects on the heart's electrical conduction
system nor general peripheral vasodilation. Heart rate increase is dose related
but not greater than moderate exercise.
hypotension which takes place with some cannabis users is due to a transient lag
in changes in the muscle tension in artery walls when standing up after sitting
or lying down. It is a feeling of faintness or dizziness that is relieved by sitting
or reclining. This phenomenon is due to effects of interfering with the reflex
response readjusting the muscle tension in arterial walls. Again, mediated through
the vagus nerve.
and Frank in 1971 serindipitously discovered that Marijuana smoking significantly
lowered pressure in the eyeball in 9 of 11 normal subjects. Frederick Blanton,
M.D. , A Florida ophthalmologist in private practice read about Hepler and Frank's
findings and tried cannabis in the form of marijuana spiked brownies and marijuana
cigarettes in 100 administrations with positive results as compared to pilocarpine.
In his series of 20 glaucoma patients their intraocular pressure was dropped from
an average of 25 to 18 mm Hg*. (Which is from the moderately elevated to a normal
value) Rather than being greeted by his colleagues and the medical profession
he was censured by his county medical society and suspended for 6 months. The
Hepler and Frank team in a legal controlled study at U.C.L.A. confirmed Dr Blanton's
Randall, a sufferer of glaucoma, after his arrest for cultivation for personal
use, successfully sued the federal government on the basis of medical necessity
and is currently maintained on cannabis supplied by the National Institute on
Drug Abuse. He continues to hold his symptoms at bay through smoking marijuana
but if he attempts to stop experiences characteristic symptoms of "halo"
effects around lights and eye pain. These symptoms cease when he starts inhaling
marijuana smoke again.
contradictory properties of irritation to the throat and lungs causing bronchitis
and the antiasthmatic effects acknowledged by the Indian Hemp Drugs Commission:
asthma and bronchitis inhalation of ganja smoke appears to be very frequently
prescribed; while on the other hand, there is evidence which tends to indicate
that both affections may be induced by charas or ganja smoking indulged in as
Western medicine where the smoked route was rarely employed cannabis was described
as effective in controlling asthma and cough. Since cannabis Prohibition the same
seemingly paradoxical properties have been confirmed.
resin, with the consistency of pine pitch, insoluble in water is irritating to
tissues although it has some topical anesthetic properties. The crude plant also
has bactericidal properties.
Tree and Lungs
the most common route of administration is the smoked route irritation to these
organs is a safety concern. The additional products from burning are undeniably
irritating. Animal experiments indicate that cannabis is different from tobacco
in its irritating effects on the lungs. The frequently heard coughing fits of
the cannabis smoker give irrefutable involuntary vocal testimony to this undesirable
side effect from smoking cannabis.
from contact dermatitis in hemp harvesters and processors at high levels of exposure,
some allergenic individuals react similarly to exposure to small amounts of cannabis.
powdered crude plant is moistened and applied to arthritic joints.
cannabis resin is topical anesthetic. Applied directly to a nerve, the electrical
impulses are inhibited. It was mentioned as used on dental caries for treatment
to removal from the market it was combined with salicylic acid, a proteolytic
agent, and collodion to keep it in place for callus removal on feet.
Corn Remedy Advertisement]
cannabis is water insoluble powdered cannabis has been moistened and applied as
a poultice to arthritic joints.
powder has also been used as a topical antiseptic applied to wounds to promote
healing and prevent infection.
antibiotic properties of cannabis appears to be in the cannabidiolic acid and
has been recognized as an appetite stimulant for hundreds of years in non-western
medicine. Mirza Abdool Rhazes, "a most intelligent Persian physician...considers
Hemp to be a powerful exciter of the flow of bile, and relates cases of its efficacy
in restoring appetite.." " "produces a healthy appetite,..digestive,
easy of digestion,..and the digestive faculty" .
its' century long prescriptive availability before being taken off the market,
stimulation of appetite was frequently described, as a secondary effect during
its use as an analgesic or sedative in comparison with the opiates. McConnell
in 1888 specifically described success in treating anorexia "One of the conditions
in which the drug has proved useful in his hands is anorexia- loss of appetite
consequent upon exhausting diseases such as prolonged fevers, diarrhoea, dysentery,
described the drug as a mild stimulant to overcome constipation and gastritis
that is nervous in origin
the introduction of cannabis to Western medicine in 1838
and Sandyk 507
Effects of Marijuana Treatment on Features of Neurological Disorders Described
in the 19th Century and Possible Contemporary Analogies to These Neurological
of the Contemporary Effect of
century disorders marijuana
recurrent. Tonic-clonic seizures: Benefit
tonic. clonic generalized epilepsy
petit mal Absence seizures:
epilepsy No effect
of torticollis torticollis;
Dystonic movements: spasmodic No effect
cramp writer`s cramp
movements: Sydenham`s Benefit;
chorea no effect
of paralysis agitans Resting tremor: No effect
painful spasms; jerky Spasticity and Ataxia: Benefit
of spinal sclerosis
cord injury: no effect
of neuropathy. Sustained pain: No effect
pain Pain of neuropathy Paroxysmal pain, trigeminal neuralgia neuropathic pain
headache Migraine headache Benefit
described by O'Shaughnessy in the treatment of acute and chronic arthritis in
1839, Clendinning confirmed the findings in 4 of his 18 patients in 1843. Acute
rheumatism was successfully treated by Buckingham in 1858
chemical structure to steroids
chemical structure diagram]
metabolic pathway of the Eicosanoids
of Prostaglandin and decrease of PG production.
of healing of viral infection
of marihuana effects by indomethacin
of Optic Nerve
in 1843 described 18 cases of whom 6 presented with cough- both acute and chronic
that responded favorably to cannabis. In addition to mention in most Materia Medica
and general medical literature as an antitussive, cannabis was included in proprietary
cough medicine like Piso's cough cure that were available until 1937.
effects are described with both oral and smoked routes of administration although
the bronchitis from chronic use was recognized as an undesirable side effect.
was recognized to be useful "in some cases of Spasmodic Asthma"
and acute itching appear to respond well to cannabis and is mentioned in several
general medical texts. Grinspoon and Baklar in Marijuana Forbidden Medicine reports
a case of self-medication with marijuana for intractable itching.
Opioid, and Sedative Substitute
reduction through substitution
also must be credited with substituting cannabis for opium dependence in 4 of
the 18 cases reported. Mattison in 1891 described cannabis as treatment of choice
for the treatment of opiate and alcohol dependence and cautioned the practitioner
to think twice before resorting to prolonged opiate use for pain: "Would
that the wisdom which has come to their professional fathers through, it maybe,
a hapless experience, might serve them to steer clear of narcotic shoals on which
many a patient has gone awreck.
hemp is not here lauded as a specific. It will at times, fail. So do other drugs.
But the many cases in which it acts well, entitle it to a large and lasting confidence."
and Substitute For Alcohol, Opioids, Sedatives, and Nicotine
of Clendinning's cases were withdrawal from alcohol dependence . Birch in 1889
and Mattison described cannabis as useful in withdrawal from and substitute for
chronic chloral and chronic opium dependence. Reed described cannabis for the
treatment of nicotinism
mention in the 17th century Persian medical text Makhzan-el-Adwiya as "imparting
a gentle heat, and then a considerable refrigerant effect." The Indian Hemp
Drugs Commission took note: There is a large body of evidence showing that hemp
drugs, both as smoked and as drunk, are used as a febrifuge or preventive of diseases
common in malarious tracts or arising from bad water." Cannabis continues
to be used in contemporary Ayurvedic Medicine to treat malarial fever.
in 1843 described effectiveness in the treatment of four cases of febrile illness.
this property of cannabis went largely unnoticed by Western medicine, it was rediscovered
in the classified Army research done from 1954 - 1959 reported by Van M. Sim,
M.D., chief of the Edgewood Arsenal research program in an interview: "The
tetrahydrocannabinols also are capable of lowering the body temperature three
to four degrees centigrade under conditions of severe hyperpyrexia." While
Dr Sim is credited with getting the findings declassified, at this writing there
has been no clinical follow-up.
sedative and sleep inducing properties of cannabis were described in both general
and medical literature as the end phase after an initial stimulation.
while unsuccessfully treating headache relieved a patient of nightmares. As late
as 1937 it was officially described by the American Medical Association as being
"...the average physician will readily admit that Indian hemp is employed
in various preparations for internal use as a sedative and antispasmodic"
Hindu and Persian writings give many different accounts of the biphasic effects
of the drug. The legendary nepenthe in Greek mythology may have been cannabis.
stimulant and contracting agent
was discovered in an ancient tomb in Israel; a woman who ha apparently died in
chilbirth . Used in Africa by the smoked route. Studied by Christison , Willis
, Dey, Stille" , Grigor , and Batho all reported help with uterine dysfunction
as well as stimulation of labor. Treatment of dysmenorrhea and premenstrual syndrome
and sexual aid
controversial, the alleged aphrodisiac properties are mentioned frequently in
the Indian literature, there have never been any definitive studies. A book was
devoted to the sexual power of marijuana. Sex and drugs continue to have continuing
and complex relationships.
the development of the philosophy and psychology of the individual with scientific
methodology in the mid 19th century, the study of effects of cannabis on the mind
were diverse. O'Shaughnessy's opening of a medical transcultural portal with his
1838 monograph, On the Preparations of the Indian Hemp, or Gunja (Cannabis Indica)
Their Effects on the Animal Systems in Health, and Their Utility in the Treatment
of Tetanus and Other Convulsive Diseases a timeless paradigm of modern scientific
method. Review of the literature, social observation, animal studies, healthy
human studies, and effects with diseases. Psychotropic effects of cannabis were
a salient aspect of this drug which was new to western medicine. This basic primary
knowledge disseminated throughout medical and lay literature saw a diverse application
of cannabis' effects on the mind.
Stuart Mill suggested using cannabis for the recall of forgotten memories.
de Tours described study of the effects to mimic mental illness, self administration
to experientially understand pathologic mental states of dementia, mania, and
delusional conditions suffered by patients. He also recommended personally experiencing
the effects of therapeutic drugs in order to be a more empathetic and effective
clinician. Self-study through the effects of cannabis was not only acceptable
but necessary for a proper understanding of the drug.
proposed its use in the treatment of mania, dementia, and melancholia and cited
Moreau's model of simulation of different forms of mental disorder.
and Margolin described cannabis as useful in recovering repressed memories during
dissociative mental states caused by the drug. Rolls and Stafford-Clark described
success with the use of a single session cannabis experience in the treatment
of a case of depersonalization where pentobarbital and methamphetamine narcosynthesis
properties of cannabis and the disruption of cognition at higher dose were evaluated
as chemical weapons by the secret government research from 1947 through 1977 .
It was an original candidate as an aid in interrogation designated the "Truth
Power of Cannabis: A General Theory
of any drug are more than the pharmacology. The effects include the set (or expectations),
setting, physical and psychological makeup of the user. The set and setting includes
the culture which is expressed in its language. Semantics and pharmacology define
Indian Hemp Drugs Commission reviewed Other beneficial effects:
drugs are said to be cheering in their effects, and to be prized by many on this
account. An interesting illustration of this may perhaps be found in the popular
belief existing in many parts that these drugs protect against cholera and other
epidemic diseases. One very intelligent witness, who had seen much of this use,
explains it to as due to the stimulating and inspiriting* nature of the drugs."
semantic attitudinal component is synergistic with the pharmacology of the drug
in producing its therapeutic effects. This affirmative "popular belief"
may be seen as a factor that favorably affects the physiology of the user including
the immune system in optimizing its resistance to stress. Psychogenic factors
play a significant role in the mediation of the immune response.
the Sanskrit and Hindi references are to the attributes of healing, strength,
victorious in three worlds
leaf of heroes
the light hearted
inspiring of mental power
a most excellent excitant
these product images of cannabis the set and expectations are not of forbidden
deviance or illicit sensual pleasure implicit in the contemporary argot- marijuana.
fact that medical marijuana was "discovered" despite the heavy prohibitionist
censorship and pejorative semantics in descriptions of characteristics of the
drug attests to the significant and strong pharmacological component of the therapeutic
effects of cannabis.
am left with the question as to the relationship between social, psychological,
and physical elements; the sequence, and eventual accomodation. At this writing
the salient problem is a generalized ignorance within the medical and scientific
communities resulting from unavailability for clinical use- a serious case of
disuse atrophy. The vaccuum of clinical experience with cannabis has been filled
by poisonous fiction. Medline, the computer data base of medical and scientific
abstracts and listings memorializes (if memorialize can be said of volatile and
evanescent data bases) the absence of therapeutic applications. This temporocentric
window of a decade or less on the topic of cannabis is a poisonous memory hole.
Drug policy based upon this structurally mandated ignorance is harmful and stupid.
A social form of dementia. This ignorance is then defended by the policy makers
as they make wrongheaded and harmful decisions that perpetuate these policies.
These are collective delusional behaviors. The courts, prosecutors, and police
play an excessively active role in facilitating and perpetuating- if not actively
perpetrating this social illness. On the tricentennial of the Salem Witch Trials
Satan is alive and well; fed on the demonology of Prohibition. William Bennett,
first recent Drug Czar designate of the United States, proclaimed Satan as etiology
of drug woes.
Hashish, Cannabis, or Hemp?: What's in a Name?
with reluctance I have chosen to utilize the term marijuana over cannabis or hemp
drugs because of its contemporary meanings. Etymologically, one sees this distinction
in the 1839 paper by O'Shaughessey
term "marihuana" is a mongrel word that has crept into this country
over the Mexican border and has no general meaning, except as it relates to Cannabis
preparations for smoking. It is not recognized in medicine..." testified
William C. Woodward, M.D., lobbyist for the American Medical Association before
congress at hearings for the 1937 Marihuana Tax act that ended the medicinal use
of cannabis after a century's availability.
one finds this in medical and scientific literature not listed under marijuana-
but under cannabis or hemp drugs.
the availability of one of the active principles, delta 1, 9 tetrahydrocannabinol
(dronabinol) dissolved in sesame oil, (Marinol) since 1986 as a schedule II drug
with approved applications as an antiemetic for side effects of cancer chemotherapy
and since 1993 for AIDS wasting syndrome. The numerous other medicinal uses of
cannabis- or hemp drugs remain largely undocumented and unreported (including
use of Marinol for applications not authorized under federal law but permitted
under California law) The chilling effect of policies of the federal Drug Enforcement
Administration and its precursors since the removal of cannabis from the U.S.
Pharmacopeia and National Formulary in 1940 continues to maintain the fiction
that cannabis drugs have no medicinal uses.
this harmful fiction has devastating consequences for the many patients with serious
painful debilitating and lethal conditions. The poisonous immoral, illicit and
illegal image of marijuana has caused numerous sufferers to reject efficacious
treatment with cannabinoids.
in consultations with elderly patients in proffering Marinol to patients for anorexia,
nausea, and vomiting, an occasional victim rejects the "pot" pill "because
it is wrong", I curse the deluded ignorance of our contemporary medical and
scientific realities distorted by putting prosecutors and police in charge of
medical decisions. Sick? Call a cop.
Future of Marijuana lies in the Past
contemporary font of knowledge of the therapeutic uses of cannabis is poisoned
by official moralistic lies and censorship. Besides the immediate toxicity of
inappropriate withholding of the drug, the resulting loss of credibility of these
statements by those with personal experience diminishes trust and belief in the
sources. Thus the clinical research reported by medicine before marijuana prohibition
in 1937 becomes even more important.
perseverative voices claiming "We don't know enough to proceed further!"
merely articulate their ignorance of the existing clinical literature.
below the layer of fouled and distorted information of the present lies a convincing
body of objective clinical information on therapeutic attributes of the drug.
in Western Medicine
to Western medicine by Sir William B. O'Shaughnessey, M.D. in 1839 , he acknowledged
both medical and non-medical uses and confirmed previous observations cited in
earlier literature: "...the kind of mental excitement it produces depends
on the temperament of the consumer." an observation described in 1695 in
Rumphius Herbarium Amboinense . O'Shaughnessy, not confining himself to the minimal
information in contemporary Western medical literature, turned to Ayurvedic, Persian,
and Arabic systems for additional descriptions:
pre-synthetic era pharmaceutical industry confronted problems with wide variations
in potency of different preparations of cannabis. The descriptions of inadvertent
overdose with the drug are the most numerous in medical literature of the 19th
clinical protocol whose applicability transcends time and technologic innovation
is that of Sir J. Russell Reynolds, M.D., F.R.S. in 1890:
dose should be given in minimum quantity, repeated in not less than four or six
hours, and gradually increased by one drop every third or fourth day, until either
relief is obtained, or the drug is proved, in such case, to be useless."
patient, prudent, and cautious regimen by this physician to Queen Victoria's court
summarized his thirty years of clinical experience with the drug. The Reynolds
Protocol should be used whenever possible.
is of prime importance since it compensates for idiosyncratic sensitivity, lengthy
onset time when taken orally, and variability in potency of the preparation.
the 1800's, Transportation, storage, handling, shipping, and processing problems
caused significant variation in potency from one sample to another. Today, the
illicit market for cannabis produces similar variability.
a century ago, a salient issue is the availability of the crude drug in quantities
adequate for continued personal therapeutic trial.
Legal Cannabinoid: Marinol
Roxane Laboratories, Inc. , a synthetic single tetrahydrocannabinol dissolved
in sesame oil (dronabinol) in doses of 2.5, 5.0, and 10.0 milligram soft gelatin
capsules may be quite useful in some cases. A schedule II drug requiring a triplicate
prescription, it is restricted for use in nausea and vomiting for side effects
in cancer chemotherapy, and (since 12/93) AIDS wasting syndrome.
my clinical experience with Marinol it has been useful not only in these indicated
conditions and also in the treatment of depression, insomnia, agitation, muscle
spasm, migraine headache and pain.
others, Marinol is either ineffectual or produces undesirable side effects. With
some who experience side effects it is due to improper administration.
of Administration: Inhalation vs Oral.
at all possible, the oral route is preferable since the throat and lungs are not
irritated by the drug. The clinical medical literature and pharmaceutical catalogs
prior to the removal of cannabis in 1937 indicates the oral route was the medicinal
standard. While crude powdered cannabis was available through pharmacies that
could be smoked, it was apparently minimal compared with the use of tinctures
(alcoholic solutions of cannabis) and extracts (cannabis resin). In addition,
cannabis was added to sedative mixtures that would contain combinations of other
plant extracts and bromine salts.
of the oral route
No irritation to throat and lungs
Stable levels of the drug
Lengthy period of action
of the oral route
Difficult to estimate dosage with single doses
Once eaten, the dose cannot be adjusted
Slow onset of effects
Dependent on activity and content of stomach and small intestines
Lengthy period of action
Slow wearing off of effects
Inefficient use of the drug
an empty stomach in a relaxed situation, effects may start in a an hour or so.
The length of action is related to the dosage or sensitivity. With a small dose
some three or four hours, with a large dose twelve or more hours.
intensity of mental effects is directly dose related.
while traditionally associated with social or recreational use, may be desirable
for certain users but unsuitable for others.
advantages to inhalation are:
Rapid onset of effects- a minute or less
Accurate adjustment of dose
Fast disappearance of effects
Efficient use of drug
Not effected by contents of stomach or intestines
Not impeded by liver
Difficult- if not impossible to overdose
as with most things there is no free lunch; smoked crude cannabis is undeniably
irritating to the throat and lungs. If the user opts for the smoked use of cannabis
reducing harm is possible.
stronger, cooler and cleaner the better.
more potent the cannabis, the less the throat and lungs are exposed to irritating
impurities as fewer puffs are needed for the desired effects. The further away
from the mouth and throat, the cooler the smoke which decreases irritation both
by the heat, itself, and by the mix of compounds carried in the smoke. Bubbled
through water, water soluble irritants are lessened.
from smoked cannabis can be minimized by using a water pipe which will absorb
some of the unwanted impurities and cool the smoke. The cooler the smoke, the
less irritation. The use of hand rolled cannabis cigarettes "joints"
add additional impurities from the burning paper. The small burnt down end of
the joint, a "roach" has the hottest and most irritating mix of impurities.
from hot, impurity laden smoke from the roach can be diminished by holding the
stub away from the lips with a tube made from a rolled up paper. Better yet; use
a pipe instead.
further from the throat and lungs, the cooler. A pipe with a long stem is better
than a short stem.
pipes (and bongs) must provide adequate scrubbing of the smoke with a minimum
of "dead space" inside the vessel.
countries where cannabis is inexpensive and available like Morocco and Nepal the
cannabis smoker lights a pipe and smokes it much like a tobacco pipe with a medium
sized breath with immediate exhaling. (and in Morocco tobacco is added) Coping
with scarce and expensive cannabis, the United States and European cannabis smokers
learn techniques to maximize the efficiency of using the drug. The smoker exhales
as much as possible before taking in the puff of carbureted smoke with a puff
of air following to push it past the "dead space" of the throat, trachea,
and bronchi. The breath is then held for some five seconds before exhaling.
from low grade cannabis is felt immediately but irritation from high resin cannabis
has a delay of a few seconds before the irritation is felt. The user thinks "this
wasn't so harsh" before the fit of coughing begins as the receptors in the
lungs respond to the irritation by the resin. (This delay may be from topical
anesthetic properties of cannabis resin slowing the transmission of signals from
receptors to the nervous system.) The user then adjusts by increasing the dilution
of the smoke with air on subsequent puffs. Continuing adjustment is needed because
of the variability of the quality and potency of the illicit plant. Even long
time experienced users still may be seen with fits of coughing from inhaling too
concentrated puffs of smoke. Heavy cannabis smokers suffer a chronic bronchitis
from this irritation. "As in long-continued and excessive cigarette smoking
considerable bronchial irritation and chronic catarrhal laryngitis may be induced,
so to may a similar condition be caused by excessive ganja (buds of the female
plant without seeds) or charas (hashish) smoking..."
there is access properly stored large supplies that will last for long periods,
the chronic cannabis user can expect this variability. While the medicinal cannabis
user of a century ago may have had to put up with variability, under cannabis
prohibition today must cope with variability in addition to expense and scarcity.
of the rapid onset of effects through the inhaled route self adjustment of dose
(autotitration) is easy. The user stops when the desired state is attained and
waits until the effect starts to wear off before taking another puff.
Behavior: Set and Setting
and circumstance are important in the effects of cannabis. The effect of the drug
will be different in different situations. Sitting alone or with friends in a
safe and private place versus speeding down the highway at the wheel of a car
with a police cruiser pulling up from behind, lights flashing, would produce different
we are not islands unto ourselves one must consider the effects of smoking upon
others which are not without consequences. Putting oneself and others at risk
are not responsible behavior. Operation of any complicated machinery like driving
a car under the influence of cannabis is a poor idea.
long as cannabis is illegal being caught and punished is far more dangerous to
one's well-being than any of the effects of the drug. Depending on one's circumstance,
it may be the end to a career path, employment, or reputation. The poisonous personal
effects from social sanctions should not be minimized. Cannabis users must be
discreet to avoid these most harmful of side effects of ignorance and viciousness
that will befall if found out. Knowledge of cannabis use can easily be used for
blackmail in a Prohibition society.
throat and lung irritation is undesirable. Exposing others to these effects without
agreement is even less desirable. If you didn't like or were allergic to the smoke
you wouldn't want it inflicted upon you. Cannabis smoke tends to be less noxious
than tobacco smoke because there is less of it. Ten times as expensive, the cannabis
smokers take fewer puffs and hold their breath for better absorption. Smokers
of high potency cannabis take even fewer puffs with less resultant exhaled smoke.
Avoid smoking in a closed or poorly ventilated space.
the Pipe, Joint- and Maybe Disease
passing the joint or pipe may be a primal social behavior that add to feelings
of acceptance and help the relaxing effects of the drug, the user is exposed to
all saliva borne infectious diseases in the group.
can one minimize this not so obvious but real risk in cannabis use?
share with others. Either smoke solo or pass up the pipe or joint when it is passed
your way. "No thanks, I have a cold and don't want to give it to you"
should be an acceptable reason.
let the pipe or joint touch your lips. Hold it so as to inhale in such a way as
not to let it touch. This may take some practice. Others may think you are a bit
strange. If you must use a joint, put it in your own personal holder that is not
picture of hand with joint or holder]
the mouthpiece of the pipe for a second with flame or wipe it with an alcohol
Safer Inhalation of Cannabinoids
unique physical property of consistency like pine pitch and lack of water solubility
of the active principles of cannabis pose unique problems for administration.
cannabis to a temperature where the drug portion of the plant turns into a vapor
which can be inhaled without burning is safer than smoking. Vaporization avoids
exposing the throat and lungs to the irritating and toxic products of combustion
of the crude plant. In the 5th century BC, Herodotus' description of the Scythians
throwing cannabis atop a fire in an enclosure and inhaling the vapors may be a
an early description of vaporization- or an inexact translation confusing smoke
Cannabidiols, and cannabinols vaporize in the range of 400* Fahrenheit; below
their ignition point. These resinous portions come to a boil and condense into
tiny particles which are dispersed in a fine air emulsion that is then inhaled.
Vaporization devices have been around since the sixties but, because of their
inefficiency (and illegality as drug paraphernalia), have never become popular.
lighter element & chamber
cannabis is placed in a thin layer on the heating element which is heated until
white vapor appears in the chamber. The vapor is inhaled through a tube in the
floor of the chamber (made from a small glass jar or bowl).
cannabis is placed on a small mesh brass screen in glass funnel with rubber or
plastic tubing for inhalation. A hand held electric heater with a small fan used
for heating shrink tubing on electronic parts is calibrated with a thermometer
held in the stream of hot air. (400 degrees Fahrenheit).
wire and extracted resin
resin with the consistency of pine pitch is placed dropwise on the end of an iron
or steel wire which is then applied to a hot soldering iron or glowing charcoal.
The ensuing puff of vapor is captured by a large drinking straw placed close above
the point where the droplet is applied inhaled through the straw. The application
is timed with the beginning of the taking in of a breath.
pellet and heat exchange chamber
by the Premier cigarette by the Phillip Morris Co. developed and test marketed
in 1989 before dropped after protests from nicotine prohibitionists and poor sales.
This device it was claimed could be converted from using enclosed the nicotine
pellet to other drugs- namely crack cocaine.
Physical and Mental
Bell shaped curve
to cannabis products vary from totally beneficial and necessary for life, to harmful,
dangerous, and to be avoided. They can be life saving to life threatening. An
AIDS wasting patient whose appetite is restored or a person violently allergic
or sensitive to smoke
combination of individual sensitivity with amount taken add up to the effects
experienced. Route of administration also affects the results. Effects both in
terms of intensity and length are directly related.
and Route of Administration
inhaled route avoids overdose since the rapid onset of effects permits the user
to cease intake of the drug when the level of drug effect is reached. The oral
route with it's slow onset and variable absorption after eating does not allow
this fine degree of control in the case of a single dose.
other sedative compounds, cannabinoids have their effect in the upper portions
of the brain with physical effects mediated downward, rather than affecting lower
centers of the brain as with alcohol, barbiturates, or benzodiazepines.
the existence of receptor sites have been identified in homogenates of rat brains
using radioisotopes, precise anatomic sites have not been located in humans.
limbic system is a prime candidate as an area that lies below the cerebral cortex
and plays a significant role in mediating connections with upper and lower centers
within the central nervous system.
diagram of limbic system]
on the central nervous system
effects on the electroencephalogram (EEG) are a biphasic stimulation and sedation
that are mediated by dose, set, setting, physiology, and personality. Initially,
there is a speeding up of brain wave activity and a reactive slowing as the drug
effects wear off. The higher the dosage, the more intense the effects and longer
the experience. As the effects wear off, the stimulation gives way to sedation.
The buzzing ideation of the beta state gives way to introspection, then dream
imagery of alpha and theta frequencies moving towards sleep. With continuing low
level use, the effects are less intense but more frequent in need to take inhaled
of both beta and theta frequencies.
waves, high frequency (>14 Hz) reflect the increased cognitive activity subjectively
experienced as a "flow of ideas" that characterize the onset of cannabis
mental effect. The distortion of time with this "speeding up of thoughts"
causes subjective perception that there is a slowing of time.
waves, low frequency (4-7 Hz) are seen with visual imagery. These images break
through a background of thinking and disrupt the train of thought. The thinking
is distracted by these intrusions which then modify thought content to varying
degrees, depending on dose, expectations, setting, and personality.
Effects of Cannabis
with any drug, cannabis is a tool. There will always be individuals that experience
adverse consequences from any drug use. The abuse of cannabis has been recognized
for millennia. These problems were described by O'Shaughnessey during his observations
in India in 1839 which included references in the Persian medical literature.
With widespread non medical use of the drug for the past thirty years, psychiatrists
have developed classifications of cannabis presented in the latest Diagnostic
and Statistical Manual, Revision IV (DSM-IV)
is most common by the oral route since the time from taking the drug until the
experience of effects begin is from one to three or more hours. Inexperienced
and ignorant first time users will have an unforgettable experience.
effects of overdose have been numerously described in general, clinical, and scientific
literature. Cannabis overdose comprises the majority of listings in the Surgeon
General's List, 19th century precursor of the Indicus Medicus. American literary
accounts in books: FizHugh Ludlow's Hasheesh Eater and An Essay on Hasheesh by
Victor Robinson M.D. are expressly devoted to cannabis. Descriptions of experience
with the drug as part of travel to areas of indigenous use may be found in English
and European literature over the past three centuries. Scientific and medical
descriptions of effects of cannabis overdose have been numerous extensive. Before
and after its removal in 1937.
effects of overdose are from the stimulation and sedation of the central nervous
system. Stimulation with a flooding of ideas and images that are vivid and rapidly
changing. Attention and concentration are markedly impaired. Time perception is
significantly altered with minutes seeming like hours. There may be distortion
of spatial perception.
physical effects, aside from a speeding up of the heart rate from the central
nervous system stimulation, are remarkable in their absence. The acceleration
of the heart rate is generally no more than that associated with mild to moderate
Recent use of cannabis.
Clinically significant maladaptive behavioral or psychological changes (e.g.,
impaired motor coordination, euphoria, anxiety, sensation of slowed time, impaired
judgment, social withdrawal) that developed during, or shortly after, cannabis
Two (or more) of the following signs, developing within
hours of cannabis use: (1) conjunctival injection (2) increased appetite (3) dry
mouth (4) tachycardia
The symptoms are not due to a general medical condition and are not better accounted
for by another mental disorder.
Perceptual Disturbances: This specifier may be noted when hallucinations with
intact reality testing or auditory, visual, or tactile illusions occur in the
absence of a delirium. Intact reality testing means that the person knows that
the hallucinations are induced by the substance and do not represent external
reality. When hallucinations occur in the absence of intact reality testing, a
diagnosis of Substance-Induced Psychotic Disorder, With Hallucinations should
Cannabis Intoxication Delirium
Cannabis-Induced Psychotic Disorder, With Delusions Specify if With Onset During
Cannabis-Induced Psychotic Disorder, With Hallucinations Specify if With Onset
Cannabis-Induced Anxiety Disorder Specify if: With Onset During Intoxication
or chronic use.
or abuse? Cannabis, like any other drug, is a tool. Properly utilized with realistic
expectations and awareness of its properties, cannabis is a safe and effective
medicine. Improperly used with unrealistic expectations and ignorance, adverse
effects may result. The onset of unwanted effects may be obvious or insidious.
The general etiology is some emotional discomfort for which cannabis is taken
to relieve producing undesirable consequences from using the drug itself.
and delusional thinking are not uncommon effects of cannabis both acute and chronically.
In the acute experience it appears to be from the perceptual distortions of space,
time and feelings of detachment.
chronic use paranoid and delusional thinking appear to be the consequences of
the suppression of feelings, The dulling of feelings may alienate the cannabis
users from others by diminishing empathetic capabilities. This emotional insensitivity
then results in conflict through misperception. Misperception results from the
dulling of affect that is important contextual collateral information source.
An effective relief of emotional distress then becomes an impediment to relationships
with the cannabis user. Feelings are an integral dimension of social perception
that convey important contextual information. Cannabis, as an effective sedative
and antidepressant, has this undesirable side effect when misused. The relief
afforded by the drug may be paid for by complications caused by avoiding dealing
with the causes of the emotional pain as well as diminished functioning while
under its influence.
impairment by continuing or overuse of cannabis creates a form of mild dementia
that may persist for up to several weeks after discontinuing the drug. Individuals
sensitive to the drug report a persistent "hangover" that diminishes
the ability to pay attention and concentrate. The onset may be insidious, subtle,
and gradual. This condition is reversible with abstinence from cannabis.
maladaptive pattern of cannabis use, leading to clinically significant impairment
or distress, as manifested by three (or more) of the following, occurring at any
time in the same 12-month period:
tolerance, as defined by either of the following:
a need for markedly increased amounts of the substance to achieve intoxication
or desired effect
markedly diminished effect with continued use of the same amount of the substance
withdrawal, as manifested by either of the following:
the characteristic withdrawal syndrome for the substance
the same (or a closely related) substance is taken to relieve or avoid withdrawal
cannabis is often taken in larger amounts or over a longer period than was intended
there is a persistent desire or unsuccessful efforts to cut down or control cannabis
a great deal of time is spent in activities necessary to obtain cannabis (e.g.,
visiting multiple dealers or driving long distances), use the substance (e.g.,
chain-smoking), or recover from its effects
important social, occupational, or recreational activities are given up or reduced
because of cannabis use
cannabis use is continued despite knowledge of having a persistent or recurrent
physical or psychological problem that is likely to have been caused or exacerbated
by the substance
A maladaptive pattern of cannabis use leading to clinically significant impairment
or distress, as manifested by one (or more) of the following, occurring within
a 12-month period:
recurrent cannabis use resulting in a failure to fulfill major role obligations
at work, school, or home (e.g., repeated absences or poor work performance related
to substance use; cannabis-related absences, suspensions, or expulsions from school;
neglect of children or household)
recurrent cannabis use in situations in which it is physically hazardous (e.g.,
driving an automobile or operating a machine when impaired by cannabis use)
recurrent cannabis-rclatcd legal problems (e.g., arrests for cannabis-related
continued cannabis use despite having persistent or recurrent social or interpersonal
problems caused or exacerbated by the effects of the substance (e.g., arguments
with spouse about consequences of intoxication, forgotten promises)
The symptoms have never met the criteria for Cannabis Dependence for this class
Cannabis-Related Disorder Not Otherwise Specified
Cannabis-Related Disorder Not Otherwise Specified category is for disorders associated
with the use of cannabis that are not classifiable as one of the disorders listed