chapter 11

Le Club des Hachichins (The Hashish Club)

A club that met in Paris during the 1840s where hashish was consumed in a sweetmeat called dawamesc before dinner and discussions. Theophile Gautier, a famous and influential French author, wrote about his graphic initiation into this club. His writings included descriptions of the experience as fully of mystery and intrigue as well as a mix of ecstasy and anxiety.

Early Medicinal Use in the US

American physicians used cannabis as a general all-purpose medication in the 1800s and by 1850 it was listed in the US Pharmacopeia, a list of legitimate therapeutics where it remained until 1942.

Worldwide Prevalence Trends

Between 128.5 and 232.1 million people between the ages of 15 and 64 had used canabis in the past year, representing between 2.7% and 4.9% of the world's population. Highest per capita was in Oceana and Pacific Ocean countries like Australia. 7.5% for the Americas, with North America being 12.1% rate of that. Although prevalence of cannabis use in Asia (1.9%) was lower than the global average, the absolute number of user in Asia, estimated at 56.5 million, was highest worldwide, due to Asia's large population.

What is Hashish and how does it compare to marijuana?

Both marijuana and hashish are derived from the cannabis sativa plant. Marijuana is the leafy portion of the plant, whereas hashish is made from the dust of the resin that the hemp plant produces for protection from the sun and heat and for maintaining hydration. Plants that grow in warmer climates produce greater amounts of the resin, which generally has stronger psychoactive effects. Hashish was first discovered around the 10th century among the Arabs and in the 11th century in Egypt.

Some people who smoke marijuana find that it affects their short-term memory. For example, they can go into a room to get something and forget what it is they wanted. This might be due to the action of THC on which type of brain receptors?

CB1

Distribution

Cannabinoids are lipids, so they are lipid-soluble and they are almost entirely insoluble in water. Cannabinoids are a dark, viscous, oil-like substance. Plasma levels of THC decrease rapidly because THC is deposited in tissues of various organs, particularly those with fatty material. Even when blood levels of THC are zero there can be substantial concentration in other organs. THC is carried through the bloodstream and is metabolized primarily in the liver. THC metabolites are excreted slowly through the feces and urine, and can be detected in the body atleast 30 days following ingestion of a single dose and longer if use is chronic.

what was marijuana first used for?

Cannabis Sativa is a hemp plant that grows freely throughout the world. It was primarily harvested for its strong hemp fibers that were used in the production of rope, clothes, and ship sails.

Long-Term Effects: Immune System

Cannabis poses no significant long-term threat to the immune system. Although it can act as an immunosuppressant and decrease resistance to some viruses and bacteria, it wasn't a significant rate.

Carmen wants to make sure she gets really high before her favorite band takes the stage at the Summer Jam concert. What should Carmen do to achieve her mission?

hold each drag off a joint for a long time

Early Recreational Use in the US

Descriptions of the psychoactive effects were not common and neither was the recreational use of the drug. There was an occasional publication, like a book in 1857 called the Hasheesh Eater where he lovingly describes his experience and identifies two laws of the hasheesh operation in which the drug swings the user from fantasia to some other entirely different stage.

Which of the following is most likely to be a regular user of marijuana?

a 23-year-old native alaskan man

Impediments to Future Research

a variety of regulatory barriers, including the continuing classification of cannabis as a Schedule I substance, impedes the advancement of research in this area.

Which of the following factors limits the ability of researchers to study the therapeutic uses of marijuana?

access

Globally, how many people have used cannabis over the past year?

between 1 and 5%

What is the most common physiological effect of smoking marijuana?

bloodshot eyes

Which of the following is a unique risk of dabbing?

burns

Which methods of using marijuana incorporate water?

vaping and bong

Which term best describes marijuana usage trends among high school students since the 1970s?

variable

Marijuana was first used for pharmacological purposes by people in which country?

china

Which term best reflects the role of cannabidiol?

complementary

A person who wants a marijuana product with over 50% concentration of psychoactive ingredients should buy which of the following?

hash oil

First Uses of Marijuana

earliest known use occurred during the stone age over 10,000 years ago, where they found hemp fibers used in pots in Taiwan. The first time it was used for pharmacological properties was by Shen Nung, a mythical Chinese emperor and pharmacist in 2800 BC. During his rule the drug was used for sedating, pain treatment, countering evil spirits, and general psychoactive effects.

Which of the following is most likely to be affected by use of marijuana?

executive functions

Which of the following best reflects the pharmacokinetics of smoking marijuana?

fast but incomplete

Which term best describes THC that is ingested by eating a cookie made with marijuana?

filtered

How does the potency of marijuana in the United States today compare to that of 1980?

five times stronger

The ________ that can occur with smoking marijuana could explain why many artists and musicians like to use it during the creative process.

flight of ideas

The potential for physical dependence on marijuana ________.

is a focus of debate

Getting high from smoking marijuana is a(n) ________ process.

learned

Amotivational Syndrome

loss of effectiveness and reduced capacity to accomplish conventional goals as a result of chronic marijuana use. Both preexisting personality characteristics and some drug effects together probably account for this label.

Dr. Leung has repeatedly told her college-age son to stop smoking marijuana due to the long-term health impacts. What is Dr. Leung likely most concerned about for her son?

lung cancer

Psychological Effects

most marijuana users use the drug to experience the psychological effects, although the "marijuana high" and its effects are generally learned behavior. The user first learns to inhale the smoke and then, due to environmental cues, learn to interpret the effects as positive.

Marijuana Tax Act

(1937) The fear of the negative effects of marijuana use began in the US in 1926 when a series of articles published in New Orleans sensationally, and falsely, exposed marijuana as a direct connection to heinous criminal acts. The publicity lead to a Louisiana law that mandated new fines and restrictions but had very little effect. When Harry J. Anslinger became the director of the federal bureau of narcotics, he was convinced that marijuana represented a major threat to the safety and well-being of the country. This act did not officially ban marijuana; rather, it acknowledged the medicinal uses and permitted the prescription of marijuana following the payment of $1 for a licensing fee. Otherwise, any possession of marijuana would result in a 2K fine and 5 years imprisonment. The efforts were overall successful in decreasing the spread of marijuana through legal outlets like physicians.

LaGuardia Committee Report

(1944) Although the first committee to report on the comrephensive use of marijuana and its effects was in 1894, and several more exist, they all yield somewhat similar results. The committee was created at the request of the NYC Mayor, Fiorello LaGuardia. The study was a multidisciplinary report, including coordinated input by physicians, psychologists, pharmacologists, and sociologists. Data was gathered both in clinical settings and in tea-pads. The conclusion was that marijuana use was not particularly harmful to users or to society at large and the use did not directly cause violence or aggression.

United States Prevalence Trends

117.9 million Americans (44% of the population) have used marijuana at least once in their lives and at least 18 million are current marijuana users (8.3%). By age, the group most likely is 18-25 (19.8%). The 26-34 age range used to be the second-highest but now it's basically tied with the younger 12-17 generation. Men are more likely to be users (10.6%vs 6.2%). It is spread through ethnicities but is highest in native Americans/Alaskans. In 1993 the data reveals that marijuana started making a comeback, over 80% of seniors reported it would be fairly easy to obtain marijuana. Overall trends probably reflect broad cultural factors, growing concerns about health and fitness, and concerns over possible negative side effects of drug use in general.

The current professional perspective that marijuana use is not harmful reflects research conducted in what year?

1894

If you were suffering from a particular illness, when would you first be able to legally obtain marijuana from a medical professional?

1937

Despite its long historical use as a psychoactive substance, the properties which cause the effects of marijuana were not identified until the ________.

1960s

How much of the THC in a joint is actively processed by the body to enable the smoker to get high?

29%

Acute Physiological Effects

Are not dramatic and are of little clinical significance. Most commonly experienced are cardiovascular. As a result of vasodilation, injection of the conjunctiva produces bloodshot eyes that are most obvious an hour after smoking. There does tend to be a cannabis-induced sluggish reaction to light. Theres also an increase in heart rate and pulse rate and these effects peak 20 min but last up to an hour. Generalized decrease in motor activity and users report drowsiness. THC can decrease the total REM sleep achieved but typically only with higher doses. Other less reported symptoms are dry mouth, hunger, and dizziness which peak 2-3 hours after smoking.

Long-Term Effects: Reproductive System

Cannabis does disrupt the reproduction system in both male and females. For men it decreases the number and motility of sperm and for women it can produce non-ovulatory menstrual cycles where menstruation is not followed by the release of an ovum. It might have teratogenic effects. The active agents present when smoking readily cross the placental barrier and expose the fetus to an array of cannabinoids. The use of marijuana by pregnant women is associated with an increased risk of premature brith, shorter body length, and lower infant birth weight. Children born to mothers who smoked during pregnancy may be at greater risk of developing certain forms of childhood cancer. Newborn infants exhibit tremor, startle response, and altered visual responses. They are found to show deficits on sustained attention task and more likely ti be impulsive, hyperactive, and delinquent later.

Current Medical Uses of Marijuana

Chronic pain in adults, as an anti-emetic in the treatment of chemotherapy-induced nausea and vomiting, and for improving multiple sclerosis spasticity symptoms. Limited evidence that proves marijuana increased appetite in AIDS patients enough to offset weight loss. Evidence that it isn't helpful for improving symptoms associated with dementia, improving intraocular pressure associated with glaucoma, and reducing depressive symptoms in individuals with chronic pain or multiple sclerosis.

Psychological Effects - Behavior

Generalized decrease in psychomotor activity and feelings of relaxation and tranquility. Talk is rapid or slurred and circumstantial. Some describe more intense perceptions of touch, vision, hearing, and smell. Decreased sensitivity to pain. Dysfunctions in motor coordination, signal detection, and the ability to monitor a moving object. Long-term or heavy use of marijuana has been associated with temporary impotence among men and temporary decreases in sex drive among women.

Cannabis in the New World

In 1545, Spainards brought the drug to Chile. In North America, the settlers at Jamestown were growing cannabis for hemp fiber in 1611. New England started harvesting the plant in 1629 and continued to bring revenue in this way until the Civil War. The center of hemp production int eh US was Kentucky. Although it was widespread the plant was relatively unknown as a mind-altering substance.

Methods of Use

Ingested in India in liquid and food form, like chewing leaves. The most common is smoking a joint or a blunt. Other methods are with a water pipe (bong) or vaping (cannabis material is heated to a temperature at which an aerosolized mixture of water vapor and the active ingredients of cannabis are released and then inhaled by the user). Dabbing hash oil is inhaled by first heating the substance with a blowtorch, increasing the risk of burns.

Absorption

Inhalation results in absorption direction through the lungs and the onset of the drug effects can start within minutes, peak concentration in the blood is 30-60 minutes later. This can depend on the potency, because only half of the THC available in the marijuana cigarette is in the smoke, and the amount ultimately absorbed into the bloodstream is less. The amount of time the inhaled smoke is held in the lungs can effect it. Oral ingestion of marijuana is much slower and relatively inefficient. Onset of action is longer through the GI tract and the peak is 2-3 hours. One difference is that blood containing orally ingested marijuana goes through the liver before going to the brain. The liver processes or clears much of the THC, so the dose needed to induce comparable high effects is 3x when ingesting than smoking.

Western Introduction to Marijuana

It wasn't until the 19th century that the West knew about marijuana, and they found out through popular recounting of person experiences in medical writings and press. In Great Britain it was introduced by an Irish physician named William O'Shaughenessy and in France, by a physician named Dr. Jacques Moreau. It wasn't widespread used for its psychoactive properties until the 1960s, when it was reintroduced to the UK through American tourists.

Long-Term Effects: Cardiovascular System

No evidence shows that smoking marijuana produces deleterious cardiovascular effects among healthy individuals. The acute effects produced may be dangerous among people who have existing cardiovascular problems such as abnormal heart functioning or atherosclerosis.

Psychological Effects- Emotional

Positive emotional changes following cannabis intake are key motivators to smoke marijuana. Non-pharmacological factors can contribute to the drug effects experienced, like past experiences, attitudes about drugs, expectancies, and situational contexts.Typical response is a carefree and relaxed state but the intensity of the response is positively correlated with the dose. The negative effects are often reported more by inexperienced cannabis users. Cannabis use increases one's risk of psychotic behavior outcomes (including schizophrenia) and not just among heavy users. Users have a 40% higher chance of developing a psychotic condition later in life. The positive relationship may reflect the impact of cannabis on the dopaminergic pathways, perhaps especially among genetically vulnerable individuals.

History of Therapeutic Use

Scientists found traces of marijuana buried with the body of a young woman who apparently died during childbirth 1600 years ago, and other evidence of this practice was found in Assyrian tablets and Egyptian papyrus. Legitimization of the medical use of marijuana was provided by Dr. William O'Shaughnessy in 1838 when he suggested the use of marijuana to treat problems like rheumatism, pain, rabies, convulsions, and cholera. Well into the 1930s it was used as an ingredient in a variety of over-the-counter medicines like for stomach pain. The Marijuana Tax Act of 1937 greatly decreased the number of prescriptions. Today, synthetic products that chemically resemble cannabinoids have been used in treatments efforts because they provide active elements of THC in a more stable manner, providing better solubility as well. The absence of a rapid effect is a downside and synthetic THC is ingested orally, broken down prior to entering the bloodstream, and slowing down absorption.

Long-Term Effects: Respiratory System

Smoking cannabis raises the risk of worse respiratory symptoms and more frequent chronic bronchitis episodes, but these are typically reversed after abstinence. Marijuana cigarettes contain more tar than tobacco cigarettes and cannabis tar contains greater amounts of cancerous agents than does tobacco tar. This is noteworthy because in an effort to maximize the effects of the drug users will inhale deeply and hold the smoke in their lungs, but long-term regular smoking of marijuana does not impair lung functioning and found no link between cannabis and lung cancer.

Designer Cannabis

Synthetic Designer cannabinoids are sprayed onto herbal or plant material and advertised for sale as an herbal preparation. Called Spice, K2, and other names on the street. These substances have often been found to contact potent CB1 agonists so that smoking these plant materials mimics a powerful marijuana-like high. It is most commonly sold as dried leaves in small bags labeled things like incense or potpourri. Acute effects include elevated heart rate and blood pressure, agitation, paranoia, loss of physical control, and vommitting. It can also result in kidney failure. 3.5% of high school seniors had used it.

Malcolm wants to get the quickest, strongest effect from using cannabis. Which method should he use?

inhaling it

Active Ingredients

The first chemical analysis of cannabis was preformed in 1821 where they discovered cannabinoids, a chemical compound unique to the cannabis plant and it has over 60 different cannabanoids. The principal psychoactive agent was isolated in 1964 in Isreal and called delta-9-tetrahydrocannabinoil (D-9-THC or just THC).

Marijuana as a Gateway Drug

The gateway or "stepping-stone" theory of frug use says that the use of substances follows a predictable pattern. Research has proven that most users step from alcohol to marijuana and then to so-called harder drugs. Opponents of the legalization of marijuana say that it is the first step on a path that leads to the use of illicit and addictive drugs like heroin or cocaine. The other theory discussed is the "Correlated Vulnerabilities" where the pattern is explained by the common characteristics (like general predisposition to use drugs) of those who use cannabis and other drugs.

Potency

The marijuana smoked in the US today is considerably stronger than before. Before the average THC was around 2% and now its 10-12%. Typically these THC levels are higher when the drug is "homegrown". These are all still lower in potency than hash oil, which is around 60% THC.

Marijuana's spread to India

The use of marijuana spread from China to India and other surrounding Asian countries. In India, it was used during religious functions. It was even included as one of the five sacred plants in the oldest book of Hinduism. This protected and allowed the drug to gain reverence because of religious acceptance.

Smoking in the 1920s

The wider use of cannabis in this time is attributed to the prohibition and the limitation on alcohol production. Also, social clubs called tea-pads gained popularity at this time. This is where groups of people would get together in an apartment or a hotel room and smoke marijuana. The orgins of this practice in the US aren't completely known but it is theorized that it was brought in by Mexican laborers crossing the border into the US and dispensing it to the rest of the country up the Mississippi River. By the 1930s it was available in most major cities but was mostly used by black Americans and usually jazz musicians.

THC Receptors

There are two types of cannabinoid receptors, CB1 and CB2 and they are uniquely stimulated by THC. CB1 receptors are located primarily in brain areas that control memory, cognition, the motor system, and mood. CB2 receptors are more in the immune system. Researchers have discovered an endogenous chemical called anandamide that binds to the smae receptors on brain cells as do cannabinoids. Another endogenous chemical is 2-AG (arachidonoylglycerol). Through PET scans (positron emission tomography) we are able to assess cerebral blood flow and concluded that THC increases blood flow in most brain regions, greatest in the frontal cortex which is critical to "executive" brain function.

Tolerance/Dependence

Tolerance is more likely to occur with higher doses used over longer periods of time. The mechanisms by which tolerance occurs are still unknown, but a likely candidate is cannabinoid receptor down-regulation and desensitization. There are no cluster of withdrawal indicators for marijuana like there are for other drugs. Some symptoms that they feel are sleep disturbances, nausea, irritability and restlessness following cessation of marijuana use, but there is a lot of debate over where these symptoms are more indicative of a psychological as opposed to a physical dependence on marijuana. But, the newest edition of the DMV includes a diagnostic category of cannabis use disorder.

A recent TV public service announcement showed two young guys getting high in a bedroom. One says that smoking pot isn't a problem and doesn't affect him. Then we hear his mother yelling at him to go out and find a job—and we realize that he's almost 30 and still living with his parents. What does this message reflect?

amotivational syndrome

Psychological Effects- Cognitive

impaired short-term memory and perception that time passes more slowly. The degree of impairment increases rapidly with the complexity of the task. impairs multiple aspects of memory, including the encoding, consolidation, and retrieval of information. A curtain of interference that blocks or hinders intake or retrieval of material may explain but also a theory is that marijuana causes a decreased ability to concentrate and attend to the material presented. Cannabis drug action may interfere with the neurochemical processes that operate in memory and retrieval. Users are easily distracted by a flight of ideas that is sometimes perceived as enhanced creativity. There is some hope that these neurocognitive deficits can be reversed with abstinence, but it is questionable.

Mechanisms of Action

psychotropic actions of marijuana occur in the brain because of the drugs effect on chemical neurotransmission. THC facilitates the release of the neurotransmitter serotonin and produces changes in the dopamine system, thus enhancing the activation of movement. The drug also decreases the turnover in acetylcholine (neurotransmitter involved in memory) particularly in the hippocampus, resulting in a decrease in neurotransmitter activities.

Which of the following played a key role in the widespread recreational use of marijuana in the United States?

restrictions on alcohol access

Which term best describes the sperm of a long-time heavy user of marijuana?

slower and fewer

Which method of using marijuana presents elevated long-term health risks?

smoking blunts

Which of the following people should NOT seek out marijuana to alleviate their medical condition?

someone who has glaucoma

Synthetic medications that resemble the cannabinoids offer which of the following benefits?

stability

Matt is experiencing a cognitive effect as a result of smoking a blunt with some friends. Which of the following is related to this effect?

time