Dependency and Cannabis

[Jim Finnel]

Pre Prohibition
O'Shaughnessy in 1839 visited cannabis buyers centers in India and mingled with the "dissolute and depraved" to learn about the preparations of this social drug for clinical medical trials finding it to be useful in the treatment of tetanus and seizures.

Cannabis substitution for more harmful medicines
In 1843 Clendinning utilized cannabis substitution for the treatment of alcoholism and opium addiction. Potter recommended full dose Squibb cannabis extract for withdrawal from opium addiction .

The Indian Hemp Drugs Commission Report in 1894 recognized the comparative safety of cannabis. Its unsurpassed ethnographic studies within different cultures, voiced a concern that if prohibited would cause the use of more dangerous drugs.

Cannabis combination with other medicines:
decrease of dose, suppression of side effects
Mc Meens citing Fronmueller in 1860 described the use of cannabis either alternating or combined with opiates reduced harm from increased dose, tolerance, dependence, and side effects. Cannabis was confirmed as useful in the treatment of delirium tremens and alternative to opium for analgesia . Dutt independently described the comparative safety in Materia Medica of the Hindus . Yeo warned about addiction to morphine in the treatment of neuralgia and suggested cannabis as an alternative.

Cannabis and mood disorders
The connection between dependency on drugs and mood disorders may represent unsuccessful attempts to self medicate uncomfortable feelings with the "cure" causing more harm and aggravation of the underlying condition.

Moreau described cannabis as being useful in the treatment of depression in 1845.
The drug is listed in medical texts and pharmaceutical catalogs for treatment of melancholia or mania.

Patients report that cannabis facilitates both anti-mania and antidepressant medications. Cannabis used in combination with antidepressants appears to decrease the side effects of nervousness, muscle tension, and nausea for SSRI type antidepressants. Other patients report that cannabis is complementary. A typical report is that the SSRI elevates mood overall and cannabis improves affectual responsivity. Cannabis can either diminish the dosage needs for sufferers of bipolar disorders or substitute altogether for anti-mania medications. With symptoms of mania or agitation cannabis appears to decrease affectual lability.

Cannabis substitution for more harmful non-medical drugs
Notwithstanding some polysubstance abusers who maladaptively combine cannabis with other psychoactives, there appears to be a significant number of persons who have learned that cannabis can be totally substituted for other, more harmful, substances..

Following the therapeutic path of Clendinning, throughout the 19th and early 20th century, cannabis was found useful in the treatment of opiate and sedative abuse. Brunton describes use of cannabis for the treatment of opiate dependence or as a substitute when opiates were not tolerated. Shoemaker finds in some instances cannabis to be useful for the cure of opium or chloral habit. Birch advocated for the use of Indian Hemp in the treatment of chronic chloral and opium poisoning. Mattison, an early addiction specialist, recommended cannabis as a substitute of morphine and cautioned his fellow physicians about hypodermic use of the drug.

Alcohol abuse, stimulant, sedative, and opiod abuse and dependence are conditions potentially treatable with cannabis substitution. All of these conditions involve management of mood and emotional reactivity. While there have been numerous synthetic homologs developed, short acting psychotropics continue to have high potential for dependency and abuse. The quality of immediacy for mood management would appear to be inseparable from abuse potential, however cannabis appears to be the exception because of lesser or milder withdrawal symptoms.

Pharmacologic mechanisms
This may be accounted for by the lipophillic water insolubility of the tetrahydrocannabinols that appears to act through the prostaglandins as eicosanoids, precursors, whose structures are similar. While largely unknown in specific details, tetrahydrocannabinols appear to modulate the behavior of the CNS either directly, or through the adrenopituitary axis. Additionally, eicosanoid peripheral physical activity in specific organ systems like lung tissue has been demonstrated in animals.

California cannabis center members and patients in my private practice independently rediscovered and confirmed cannabis as a safer substitute for prescribed and non medical psychoactive drugs in the control of depression, anger, and anxiety. Cannabis substitution may be a gateway drug back to sobriety and dealing with the underlying psychopathologic etiologies.

Gieringer summarized 2479 California cannabis users interviewed by the author noted 5.5% (136) described that the use of cannabis to be less harmful than alcohol, opiate, and other drug dependencies as primary presenting illness. For this group of self medicators cannabis has found to have far fewer adverse effects than opioids, sedatives, and stimulants. This small percentage represents only dependencies as primary conditions, and, as such, grossly underreports dependencies in chronic pain conditions.

Antabuse® (disulfiram) and alcoholism
I have personally successfully treated two patients suffering severe alcoholism with a combination of disulfiram and cannabis substitution. This "carrot and stick" approach appears to address the needs of pharmacologic management of mood and avoids relapse with emotionally stressful events.

Posttraumatic Stress Disorders- A specialized category of dependencies
Adult children of alcoholic families are doubly harmed by abuse and functional ignorance. Violence, sexual abuse or emotional absence by one or both parents is compounded by failure to provide coping skills to deal with normal feelings and pathologic role models. Alcoholism and polysubstance dependence is significant with destructive and symbiotic family involvements.

Vietnam veterans and other survivors of horrific experiences of adulthood suffer from living nightmares and flashbacks triggered by certain specific stimuli that cause overwhelming fight-flight reactions. Chronic depression with insomnia and fearfulness frequently incapacitate and isolate.

Many of each group have come to realize that cannabis is less toxic or harmful than alcohol, opiods, and other psychotropics in their continuing struggles with indelible memories and their physiologic concomitants. Cannabis is used to relieve depression, decrease emotional overreactivity, and sleep deficit.

The alternative medical movement represents a populist rebellion against conventional medicine for treating chronic relapsing illness that include alcohol and other drug dependencies. Cannabis self-medication has been discovered to be a viable alternative to treat these conditions and may enhance or substitute for conventional pharmacotherapy.

American Drug Policy, Dependencies, and Cannabis

The complex interplay of cannabis use with physiology and psychology challenges research. Outcomes are combinations of pharmacology, expectations, setting, personal and social forces. The contemporary ambiguity, a product of ignorance from deprivation of contemporary clinical experience, may be somewhat assuaged by two facts: Firstly, cannabis has been used for millennia by numerous cultures without serious adverse consequences. Secondly, neither the composition of cannabis nor the physiology of humans have changed since the drug was taken from the armementarium of medicine.

Perceptions of cannabis and its effects--distorted by sixty years of prohibition--are embedded in official policy . The Controlled Substances Act of 1970 classifies cannabis as Schedule I: high potential for abuse, no currently accepted medical use, and lack of accepted safety. A 1999 Institute of Medicine report favorably compares the psychophysical profile of cannabis to other conventional medication in chronic pain and spastic conditions but avoids any recommendation of using cannabis for the treatment of alcohol and drug dependencies.

To circumvent prohibition censorship and dissimulation of contemporary official propaganda a review of medical and pharmaceutical literature prior to the passage of the Marihuana Tax Act in 1937 is mandatory. Cannabis was available and utilized extensively in medical practice until its removal from availability. There was an overall decline in its use with the development of newer synthetic sedative, stimulant, and analgesic drugs.

Criminalization of dependencies in the United States began in 1869 when the Temperance party became the Prohibition party. The ensuing state by state war of the "drys" against the "wets" culminated 1919 with the passage of the Vollstedt Act and the Prohibition of alcohol.

The Harrison Narcotics Act of 1914 criminalized non medical use of opiates and cocaine. In 1921 the Federal Prohibition Commissioner criminalized the maintenance of unconfined narcotic addicts. The subsequent demonization and persecution of narcotic addicts, and physicians that sought to treat them, significantly limited treatment . Methadone maintenance programs, available since the 1970's, remain heavily bureaucratized and functionally rationed. Alcohol and drug dependency treatment remain frequently unavailable. The last to be funded, first to be cut from public budgets and often not covered by private insurance. In America drug policy is controlled by the Attorney General- not the Surgeon General. Drug dependencies are defined as moral defects and not medical problems. Police become the armed pharmacologists. Drug Awareness and Resistance Education celebrated its 17th birthday with uniformed police in the class rooms.

Meanwhile, television and print media tell us to ask your physician about Paxil® (paroxetine), a SSRI antidepressant.

THM Berkeley, CA 10/6/99


Source: Tod H. Mikuriya, M.D.

 

[tszasz4u]

Sorry, but looking through my Libertarian glasses, I see a lot of defining of terms on the State's terms! Who is to define for me that I am "suffering" from dependency or addiction; that contracting HIV was because of the "victims" being in the throes of addiction; but another battle casuality in this war on drugs. What about a free-market in clean syringes and needles? And who decides for all of us, as to what drug, and in what manner, we might ingest same? Perhaps I digress.
As I see it, the legalizer and medicalizer is very much onboard the pathologizing of "inappropriate" drug use, and sees the state's role as both prosecutor and drug therapist; Talk about ambivalence! So good drug=therapeutically, legally sanctioned. I will let the reader fill in the blanks on how "bad" drugs are construed by the medical-statists and drug socialists.

The regard I have for the wisdom and sagacity of the above "groupings", I also reserve for the do-gooder, mental health zealots and priestly caste of lesser clergy, who are quick to dispense with the sacraments of good mental health. And drug "habits" are just that, whether it be a life-time of prescription Zoloft, or, a joint or two a night. There is ceremony and ritual in every drug, once ingested. The drug itself, say bag of smack on the table, is inert. However, try having some dried plant material in your pocket, and see what happens to this dried, vegatative material! This is the nature of scapegoating drugs, its "users" and "pushers."
The war on drugs is a sacraficial offering, justified by the mantle of medicine and science, as communicated by a Therapeutic state; and we are its children; sometimes beaten, often cajoled, always subsumed by the "collective good."
Whether one is talking of some six million children, who, for no other reason than the "failure" to flourish in the classroom (read: non-conformity to the institution's programmatic requirements), are drugged and made docile. And who furnishes the justification and rationale for this mass drugging? What exigency and expediency is being met? Drugging children to conform; our war on drugs; coerced and unwanted drug treatment, often with involuntary psychiatric meddling ; prescription laws, etc., are all therapeutically inspired and justified laws. Well, for one, I cannot, in good conscience find such political acts of the state against one's person. Chacun soi.
There is little difference between, say, a Republican and a Liberal Democrat, when it comes to drugs as "dangerous", after all, the state has very well set the drug miseducation curricula in our public schools for generations already. And what better way of developing a child's civic consciousness than that of a state-sanctioned, anti-drug catechism? It is not the business to educate our young, and to be honest and forthright, especially about something as damning to the body politic as drug use. Let us remember that the Constitution strongly implies, in letter and spirit, through the First Amendment, no established church. And what of state and medicine? It might be assumed that medicine (psychiatry) is indeed a sort of established church. I urge you, reader, to ponder this assertion, in light of our present age.
I very much am aware why marijuana, with its powerful symbolic capital, would have been co-opted by the legalization-medicalization lobby: medical-statists and chemical socialists in sheeps clothing. I will not cry wolf.

I have, for years now, proposed to friends, acquaintances, family and stranger, that perhaps there is a more reasonable solution; one that addresses the nexus of this whole debate over legalization or no,and it this. Who are those groups and individuals who are pushing to have marijauna legalized, and, what are the short-term and long term political and social motives? What are the politics that animate this legalization debate? Who is enfranchised, or disenfranchised, in this move to legislate "favorably", for the greatest good for the greatest number?
If many a advocacy and lobby group are animated by an appeal to state sanction for a strict set of (medical) uses, then, I think civil rights will be served provisionally and differentially; not to mention the coming into being of a greater bureaucratic-centralized presence into that of the personal and private; there go a few Constitutional Amendments out the window.
If one makes one's bed, one sleeps in it. Or better yet, if one goes to bed with dogs with fleas, one should expect to wake up with fleas. The ship of fools is set to depart.

 

[tszasz4u]

"Many of each group have come to realize that cannabis is less toxic or harmful than alcohol, opiods, and other psychotropics in their continuing struggles with indelible memories and their physiologic concomitants. Cannabis is used to relieve depression, decrease emotional overreactivity, and sleep deficit."

To borrow from George Orwell, this piece of medical "insight" is but therapeutic doublespeak. Why must this discussion, over the right to medicate (or re-create),and to purchase drugs in a free market, be couched in such therapeutic and medico-legal terms? Unless, of course, one accepts drug proscription as an ongoing quasi-religious crusade of our secular age; and "unsanctioned" drugs and its "user" as the heretic. I would submit that this appeal to, and reference of, matters medical, is the very root of the state's medical monopoly! True freedom, to ingest, is anterior to all laws that have been enacted to subvert and deny! The medical-statist and Therapeutic zealots abound, and are all too quick to frame drug use in its conventional terms, as that between good and bad drug, and "proper" and "improper" drug use. But I say, what of the responsibility that freedom assumes? Should this not, too, be accorded the use of drugs...all drugs?

 

[tszasz4u]

"Methadone maintenance programs, available since the 1970’s, remain heavily bureaucratized and functionally rationed." Thomas Szasz has aptly likened methadone "treatment" for heroine addiction as that of treating a whiskey drunk with scotch.

 

[sinbad]

Agreed, always believed there to be some two-faced ness (can't spell the other word) in treating heroin with methodone.
Overall guess, as I'm sure some learned soul knows the facts and will spent countless minutes cuting & pasting to show such knowledge, addiction is based on the indivual.
being on pain meds for pain, using bud for pain is the same thing. If the person would be addictied to tv, food, wine, women of song they'll be-the tv, food, wine and that the good Lord women aren't evil. Well some are evil, I take that back-met many a "itchy" ones in both sexes though.
Smoked in my teens, went into service-tried everything and this works. Fight the fight, but be right.