Marijuana: still a "signal of misunderstanding".

This article reviews four decades of my professional experience with marijuana, including: 1) my treatment of marijuana-dependent patients, particularly adolescents; 2) my research on the general effects and medical uses of the government-grown marijuana and of oral tetrahydrocannabinol (Marinol); and 3) my social policy experiences, both nationally and internationally, as a member of the National Commission on Marijuana Drug Abuse. The article emphasizes the mythology, morality, and misunderstanding that clouds so much of the thinking about marijuana in general and its medical utility in particular.

Interactive teaching, medical students, and substance abuse : university and community come together in a new endeavor.

The authors present an innovative approach for providing freshman and sophomore medical students with their initial exposure to the problems of alcohol and other drug abuse. Students in small interactive group seminars teach each other about the major areas of substance abuse: treatment, prevention/education, research, and law enforcement. They are aided by group moderators, by resource professionals, and by recovery teachers as they make field trips, attend 12-step meetings, and get background material. They utilize audiovisuals, role-plays, and programmed patients in a report/debate format. Effects of this seminar on their attitudes have been measured and are presented.

The drug abusing adolescent: clinical issues.

Clinical intervention with adolescent substance abusers is a complex issue. Disputes remain regarding the precise nature of the disorder. Treatment of the adolescent is complicated by the normal development tasks of this age, particularly denial of possible consequences and adoption of attendant risk-taking behaviors. Treatment begins with a complete drug history and must not neglect the adolescent's family and other support system. The mental health professional, especially the psychiatrist, can make a unique contribution in this area, despite the "bad press" he has so often received by the rest of the (treatment) community.

Delta-9-THC in the treatment of spasticity associated with multiple sclerosis.

Marijuana is reported to decrease spasticity in patients with multiple sclerosis. This is a double blind, placebo controlled, crossover clinical trial of delta-9-THC in 13 subjects with clinical multiple sclerosis and spasticity. Subjects received escalating doses of THC in the range of 2.5-15 mg., five days of THC and five days of placebo in randomized order, divided by a two-day washout period. Subjective ratings of spasticity and side effects were completed and semiquantitative neurological examinations were performed. At doses greater than 7.5 mg there was significant improvement in patient ratings of spasticity compared to placebo. These positive findings in a treatment failure population suggest a role for THC in the treatment of spasticity in multiple sclerosis.

Therapeutic issues of marijuana and THC (tetrahydrocannabinol).

This article summarizes current knowledge about the medicinal value of cannabis and its principal psychoactive ingredient, delta 9-tetrahydrocannabinol (THC), particularly in the control of nausea and vomiting, in glaucoma, and in reduction of spasticity in multiple sclerosis. The major issues in the controversy about marijuana and medicine, primarily moral and ethical, are discussed.

THC or Compazine for the cancer chemotherapy patient--the UCLA study. Part II: Patient drug preference.

Factors influencing preference for THC vs. Compazine (prochlorperazine) as an antiemetic agent during cancer chemotherapy were studied in 139 patients who received both medications in a double-blind randomized crossover design trial. Nausea reduction was the main determinant of preference. THC preference was associated with more, rather than fewer, drug-related side effects than Compazine, particularly sedation. Patients who reported being anxious or depressed did not experience accentuation of their mood states with either regime. Mood effects, nausea reduction, incidence of side effects, and drug preference were the same in patients under and over 50 years of age. Patients with a history of illicit drug use reported fewer side effects from THC, but reported no difference in drug preference or nausea reduction compared to those patients without a history of illicit use.

Tetrahydrocannabinol vs. prochlorperazine. The effects of two antiemetics on patients undergoing radiotherapy.

The authors tested the effectiveness of orally administered delta-9-tetrahydrocannabinol (THC) as compared to prochlorperazine for the alleviation of symptoms, such as vomiting and nausea, experienced by patients receiving radiotherapy. The test subjects rated the severity of their illness, as well as the extent of their subsequent moods, their level of concentration, their amount of physical activity, and their desire for social interaction. They chose the drug they preferred and recorded its side effects. The use of THC was slightly more beneficial than the use of prochlorperazine.

Cannabis and cancer chemotherapy: a comparison of oral delta-9-THC and prochlorperazine.

Delta-9-tetrahydrocannabinol (THC) and prochlorperazine (Compazine) were found to be equally efficacious in reducing nausea and vomiting associated with cancer chemotherapy across a wide range of chemotherapeutic regimens and tumor types. Both drugs were administered orally one hour before chemotherapy, then every four hours for a total of four doses. Compazine was administered in a fixed dose of 10 mg; THC was administered by body surface area (BSA): BSA less than 1.4 m2 = 7.5 mg; BSA 1.4-1.8 m2 = 10- mg; and BSA greater than 1.8 m2 = 12.5 mg. Two hundred and fourteen subjects (75% of whom had previously received Compazine with varying results) were evaluated employing a double-blind, crossover design. Additional parameters evaluated were study drug effects on appetite, food intake, mood, activity, relaxation, interaction, and concentration. There were significant drug effects with THC: less ability to concentrate (P less than 0.01), less social interaction (P less than 0.05), and less activity (P less than 0.05). There were no significant differences between the two drugs in the level of food intake or appetite. Patients of all ages did equally well on both drugs. Neither past marijuana use nor past Compazine use were related to study the drug efficacy. Those patients who correctly identified their THC cycle did better on THC versus those who could not correctly identify which antiemetic they had received (P less than 0.05). There were more drug-related effects associated with THC, but these did not reduce the patients' preference for the drug, and were associated with nausea reduction (P less than 0.05).

Bias and the cannabis researcher.

This report focuses on several aspects of the "drug" cannabis in our society: the historical notion of a chemical as a moral issue (i.e., good and evil) rather than a pharmacological one; the scientist as a human being as well as a witting or unwitting influencer of social policy; the statistical design and manipulation of research consciously or unconsciously for fame and fortune (grants); the research treatment "connection" as part of our drug abuse industrial complex, a billion dollar a year industry; and the covert governmental manipulation and distortion of cannabis (and other drug) data.

Cognition and long-term use of ganja (Cannabis).

Neuropsychological variables and urine cannabinoid metabolites were evaluated in ten subjects born, raised, and educated in the United States and having histories of heavy or prolonged use of cannabis. No impairment of cognitive function was found. Cannabinoid metabolites in excess of 50 nanograms per milliliter were present in the ten urine samples. The tetrahydrocannabinol content of cannabis exceeded 8.0%.

DAWN: Drug Abuse Warning Network or Data About Worthless Numbers?

This report presents further data about toxicologic results in 1008 "mentions" to the DAWN (Drug Abuse Warning Network) System from Los Angeles County/USC Medical Center in 1977. Details from some of the blood concentrations found in that retrospective study are presented here for the most commonly reported drugs, both alone and in combination with alcohol. The data suggests caution about inferring drug abuse trends from DAWN data is presently collected.

The Drug Abuse Warning Network (DAWN) Program. Toxicologic verification of 1,008 emergency room 'mentions'.

One thousand eight emergency room patient records from which reports were contributed to the federal Drug Abuse Warning Network (DAWN) system from the Los Angeles County/University of Southern California Medical Center in 1977 were studied. The drugs reported to DAWN for these patients were compared with the available toxicology laboratory reports for some of these same patients. The purpose was to test the validity of the data reported to DAWN. Toxologic analyses had been performed on only 528 patients (52%) of the entire sample. Eighty percent of these tested had some positive toxicology result. The DAWN reports were verified in 20% of the tested sample, found to be incorrect in 11%, and partially correct or partially incorrect in 69%. Drugs identified toxicologically had varied concentrations, some below or within therapeutic range and some at toxic levels. This study suggests that the reliability of DAWN REPORTS SHOULD BE TESTed prospectively in an unbiased definitive material study.

Screening for drug and alcohol abuse in a general medical population.

One hundred fifty consecutive, first-visit, general medical patients were simply and inexpensively screened by questionnaire, personal inquiry, and physical examination for drug and alcohol abuse. Seventeen (11.3%) currently used psychoactive drugs, excluding alcohol, and ten (6.7%) used drugs or alcohol on a daily basis to the point that the patient considered it an abuse problem. The majority of the drug and alcohol users recognized their problem on a short questionnaire that was part of a medical intake form. Almost all of the recognized abusers of drugs or alcohol subsequently entered treatment of their problem.

Coercive persuasion (brainwashing), religious cults, and deprogramming.

Psychiatric interviews and psychological testing were conducted with 50 members of former members of a variety of religious cults who contacted the authors about the issue of deprogramming. The subjects were divided into four groups: cult members who feared deprogramming, those who had returned to the cult after deprogramming, ex-cult members who had left after deprogramming, and those who had left without deprogramming. There were significant differences between these groups on length of time in the cult, perception of and resistance toward the deprogramming experience, status of parental marriage, and who became a deprogrammer. No evidence of insanity or mental illness in the legal sense was found.

Drug use and employment patterns before and during treatment.

This paper was initiated to study the effect of outcome measures as they relate to indication of treatment success. Results have shown that after the third month in treatment, drug use decreases very little. Time in treatment in significantly related to urin-analysis results during the first 3 months; that is, those clients who were to remain in treatment for longer periods were those whose average opiate use during the first 3 months were lowest. We also found that no relationship exists between pretreatment opiate use and opiate use during any evaluation time period. Analysis of employment change rate for a 1-year's period indicate that those employed at intake remain employed and those unemployed remain so. Change in opiate use during any evaluation period had no influence whatsoever on employment.