chapter6 - CHAPTER 6 ALL AROUNDERS CHAPTER OVERVIEW Drugs...

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Unformatted text preview: CHAPTER 6 ALL AROUNDERS CHAPTER OVERVIEW Drugs such as marijuana, LSD, ketamine, PCP, MDMA (ecstasy), psilocybin mushrooms, and peyote (mescaline) are the most commonly used psychedelic (hallucinogenic) drugs. They cause intensified and mixed-up sensations, as well as illusions, delusions, and hallucinations. Many of them also cause stimu- lation and impaired judgment and reasoning. This chapter summarizes the history, pharmacology, epidemiology, and the physical/psychological effects of various psychedelic drugs. It also examines the history, epidemiology, botany, pharmacology, and compulsive qualities of the drug along with an examination of the medical marijuana controversy, which includes the 1999 special report to the President on the drug. I. HIST OR Y II. CLASSIFICA T ION III. GENERAL EFFECTS A. ASSESSING THE EFFECTS 1. Physical & Mental Effects 2. Illusions, Delusions, & Hallucinations IV. LSD, PSILOCYBIN 48 SHORT CHAPTER OUTLINE 4. Foxy (5-methoxy-N, N- A. KETAMINE diisopropyltryptamine [5-Me- B_ PCP DIPT]) & AMT (alphamemyltrypmne) C. SAL 'VIA DIVINORUM 5. Yage (salvrnonn A) K PEYOTE, MDMA, & OTHER D. AMANITA MUSHROOMS PHENYLALKYLAMINE 13- DEXTROMETHORPHAN PSYCHEDELICS (Robitussin DM®, Romilar®, A. PEYOTE (mescaline) & other cough syrups) 1. Effects F. NUTMEG & MACE MUSHROOMS, & OTHER INDOLE PS Y CHEDELI CS A. LSD (LYSERGIC ACID DIETHYLAMIDE) 1. History (also see Chapter I) 2. Epidemiology 3. Manufacture of LSD 4. Pharmacology 5. Physical Effects 6. Mental Effects 7. Bad Trips (acute anxiety reactions) 8. Mental Illness & LSD 9. Dependence B. “MAGIC MUSHROOMS” (psilocybin & psilocin) 1. Pharmacology 2. Effects C. OTHER INDOLE PSYCHEDELICS 1. Ibogaine 2. Morning Glory Seeds (ololiuqui) 3. DMT (dirnethyltryptamine) B. PSYCHO-STIMULANTS (MDA, MDMA, 2C-B, PMA, 2C-T-7, 2C-T-2, ET AL.) & CLUB DRUGS VIII. MARIJUANA & OTHER CANNABINOLS A. HISTORY OF USE l. MDMA (ecstasy, rave, 1“ EPIDEMIOLOGY “XTC,” “X,” “Adam,” “E,” et C. BOTANY a1.) 1. Species 2. Parties, Raves, & Music Clubs 2, Sinsemjlla & Other Forms of 3. Nexus (2C-B or 4-bromo-2,5- Marijuana dimethoxy phenylethylamine) 3, Growers 4. STP (DOM) (2.5-dimeth0xy- D. PHARMACOLOGY 4'methylamphetamme) 1. Marijuana Receptors & 5- PMA (4'MA 0r Neurotransmitters Parmethoxymphe‘amine) E. SHORT-TERM EFFECTS 6. 2C-T-7 & 2C-T-2 . 1. Phys1cal Effects VI. BELLADONNA & OTHER 2. Mental Effects ANTICHOLINERGIC F. LONG-TERM EFFECTS PS Y CHEDELI CS 1 . Respiratory Problems A. BELLADONNA, HENBANE, 2. Immune System MANDRAKE, & D ATURA 3. Learning & Emotional (jimsonweed, thornapple) Maturation VIL KETAMINE, PCP, & 4. Acute Mental Effects OTHER PS Y CHEDELI CS G. TOLERANCE, H. MARIJUANA (Cannabis) & OFFICE OF NATIONAL WITHDRAWAL, & THE LAW DRUG CONTROL POLICY ADDICTION 1. Marijuana, Driving, & Drug 1. Conclusions of the Report 1. Tolerance Testing 2. Recommendations of the 2. Withdrawal 2. Medical Use of Marijuana Report 3. Addiction 1. 1999 REPORT FROM THE 4. Is Marijuana a Gateway INSTITUTE OF Drug? MEDICINE TO THE EXTENDED CHAPTER OUTLINE I. HISTORY Psychedelic plants and fimgi have probably been used since the origin of man. More than 4,000 plants have psychedelic (hallucinogenic) proper- ties. The purpose of using hallucinogens is to alter one’s consciousness and perception of reality rather than to induce a rush. For this reason they are rarely injected. Today the majority of these drugs are grown and used in the Americas, Europe, and Africa, the major exception being marijuana which is grown in most countries. Hundreds of primitive tribes in the Americas, such as the Aztecs and Toltecs in the past and the Kiowas and Huich— ols in the present, have used peyote, psilocybin mushrooms, yage, marijuana, and morning glory seeds among other hallucinogens for religious, so- cial, ceremonial, and medical rites. Other than marijuana, psychedelics in the ’60s and ’7OS were and continue to be the most popular among young White users. (p. 227) II. CLASSIFICA TION Uppers stimulate the body and downers depress it. All arounders usually act as stimulants and occa- sionally as depressants but mostly psychedelics dramatically alter the user’s perception and create a world in which reason takes a back seat to inten- sified sensations by creating illusions, delusions, and hallucinations. The five main classes of psy- chedelics are indole psychedelics (LSD, psilocybin mushrooms), phenylalkylamines (peyote, MDMA [ecstasy]), anticholinergics (belladonna, datura), those in a class by themselves (ketamine, PCP, Salvia divinorum), and the cannabinols found in Cannabis (marijuana) plants. (p. 228) III. GENERAL EFFECTS A. Assessing the effects. The effects of many psy- chedelics are dependent on the amount in- gested, experience with the drug, the basic emotional makeup of the user, the mood and mental state at the time of use, any preexisting mental illnesses, and the surroundings in which the drug is taken. (p. 228) 1. Physical & mental effects. LSD and other hallucinogens stimulate the sympathetic nervous system causing a rise in pulse rate and blood pressure. Many psychedelics can trigger sweating, palpitations, or nausea. Generally psychedelics interfere with dopa- mine, norepinephrine, acetylcholine, anan- damide, alpha psychosin, and especially se- rotonin. The stimulation of the brainstem can overload the sensory pathways making the user acutely aware of all sensation. Dis— ruption of visual and auditory centers can confuse perception. The mixing of the senses is known as “synesthesia.” (p. 230) 2. Illusions, delusions, & hallucinations. An illusion is a mistaken perception of an exter- nal stimulus. A delusion is a mistaken idea that is not swayed by reason or other power- ful evidence. A hallucination is a sensory experience that doesn’t come from external stimuli. With LSD and most psychedelics, illusions and delusions are the primary expe- riences. With mescaline, psilocybin, and PCP, hallucinations are the primary experi— ences. (p. 230) IV. LSD, PSILOCYBIN MUSHROOMS, & OTHER INDOLE PS Y CHEDELI CS A. LSD (lysergic acid diethylamide) 1. History. LSD is a synthesized form of the ergot fungus toxin that infects rye and other grasses. It was responsible for many out- breaks of ergot poisoning (ergotism) and thousands of deaths over the centuries when people accidentally ate the infected grain, 49 50 particularly in parts of Europe and Russia. There are two types of ergotism: gangre- nous ergotism (also known as “St. An- thony’s Fire”) marked by fever, hallucina- tions, and rotting away of gangrenous ex— tremities of the body and convulsive ergot- ism marked by visual and auditory halluci- nations, vomiting, diarrhea, convulsions, etc. LSD was first extracted in 1938 by Dr. Al- bert Hoffman. In the 1950s, LSD was inves- tigated as a therapy for mental illness and alcoholism and as a key to exploring thought processes. In the 1960s LSD-25 was popu- larized by Harvard psychologists Drs. Timothy Leary and Richard Alpert and by Ken Kesey, author of One Flew Over the Cuckoo’s Nest. LSD was made illegal in 1966. (p. 230) . Epidemiology. Younger and younger Americans were using LSD in the early 1990s but those numbers dropped by the early 2000s possibly due to the increasing popularity of MDMA (ecstasy). In the 1960s “acidheads” were usually in their early 20s and many were searching for a quasi relig- ious experience. In the 2000s most younger teenagers say they just want to get high or augment the effects of ecstasy and other drugs. Standard drug testing usually does not test for LSD because doses are so small it is almost impossible to detect. (p. 231) . Manufacture of LSD takes place primarily in northern California, mostly in the Bay area, although there is some secondary manufacture in the Pacific Northwest and recently the Midwest. The production of LSD is tedious and involves volatile and dangerous chemicals. The end product of the initial synthesis, crystalline LSD, is dis- solved in alcohol and drops of the solution are put on blotter paper and chewed or swallowed. (p. 232) . Pharmacology. LSD is remarkable for its potency. Doses as low as 25 micrograms or 25 millionths of a gram can cause mental changes. Effects appear 15 minutes to 1 hour after ingestion and last 6—8 hours. The usual dose is 150—300 micrograms. Tolerance de- velops rapidly to the psychedelic effects but is lost rapidly after cessation of use, usually within a few days. Withdrawal after LSD use is usually more mental and emotional than physical—a psychedelic hangover. (p. 232) . Physical Effects. LSD can cause a rise in heart rate and blood pressure, a higher body temperature, dizziness, dilated pupils, and some sweating, much like amphetamines. Users see light trails (an aftereffect known as a “trailing phenomena”). (p. 233) . Mental effects. LSD overloads the brain- stem causing sensory distortions (seeing sounds, feeling smells, or hearing colors [synesthesia]), dreaminess, depersonaliza- tion, altered mood, and impaired concentra- tion and motivation. One of the greatest dangers of LSD is the loss of judgment and impaired reasoning. (p. 233) . Bad trips (acute anxiety reactions). Be- cause LSD affects the emotional center of the brain and distorts reality, some users, particularly first—time users who take it without supportive experienced users around them, are subject to the extremes of euphoria and panic. (p. 233) . Mental illness and LSD. Proponents of psychotherapeutic use of LSD claim that drug-stimulated insights afford some users a shortcut to the extended process of psycho- therapy in which uncovering traumas and conflicts from the subconscious helps to heal the patient. Opponents say the dangerous side effects of LSD more than outweigh any benefits. The popular picture of someone using LSD just one time and becoming per- manently psychotic is incorrect. It is a very unusual occurrence. However in people with a preexisting mental illness or instability, LSD can aggravate those conditions into more severe mental disturbances, e. g., hallu- cinogen persisting perceptual disorder (HPPD) that consists of mental flashbacks of sensations or of a bad trip a user had while under the influence of LSD. These can hap- pen several months or even years after ces- sation of use. Although flashbacks appear to be similar to a posttraumatic stress disorder (PTSD), medications like sertraline, Cloni- dine®, and naltrexone may be useful in treating this problem. (p. 233) . Dependence. Since LSD generally does not produce compulsive use, it is not considered addictive. Larger numbers of trips by users are probably due to a psychological rather than a physical dependence. (p. 234) B. “Magic mushrooms” (psilocybin and psilo- cin). Psilocybin and psilocin are the active in— gredients in a number of mushrooms found in Mexico, the United States, South America, Southeast Asia, and Europe. They were espe- cially important to Indian cultures in Mexico and some other areas in the pre-Colombian Americas and were used in ceremonies dating as far back as 1000 BC During these ceremo- nies the mushrooms induce visions that report- edly helped treat illnesses, solve problems, or get in contact with the spirit world. (p. 234) l. Pharmacology. Psilocybin and psilocin are found in about 75 different species of mush- rooms. Both wild and cultivated mushrooms vary greatly in strength, so a single potent mushroom might have as much psilocybin as 10 weak ones. The chemical structure of psilocybin is similar to that of LSD. (p. 235) 2. Effects. Most mushrooms containing psilo- cybin cause nausea and other physical symptoms. Psychedelic effects follow in- cluding visceral sensations, changes in sight, hearing, taste, and touch, and altered states of consciousness. The major danger in “’shroom” harvesting is mistaking poison— ous mushrooms for those containing psilo- cybin. (p. 235) C. Other indole psychedelics l. Ibogaine is a long-acting psychedelic in high doses and a stimulant in low doses. Its use is generally limited to native cultures in western and central Africa. There has been research into the use of ibogaine to treat heroin or cocaine addiction. (p. 235) 2. Morning glory seeds (ololiuqui) contain an LSD-like substance (lysergic acid amide) which is about one-tenth as potent as LSD. Morning glory seeds are sold commercially but to prevent misuse they are dipped in a toxic, vomit-inducing substance. (p. 235) 3. DMT (dimethyltryptamine) is a psyche- delic substance similar to psilocin. South American tribes have used it for at least 400 years preparing it from several different plants as a snuff. They blow it into each other’s noses through a hollow reed and then dance, hallucinate, and sing. A synthetic form can be made in basement laboratories. DMT causes intense visual rather than auditory hallucinations, intoxication, and often a loss of awareness of surroundings lasting 30—60 minutes. The short duration of action gave rise to the nickname “business- man’s special” since one can get high and sober up during lunch. (p. 236) 4. Foxy (5-methoxy-N, N- diisopropyltryptamine [5—Me-DIPT]) & AMT (alphamethyltryptamine). These two psychedelic tryptamines appeared in the early 2000s while they were still not listed as scheduled drugs. However, they have been prosecuted under the federal drug- analogue statute. The effects include hallu- cinations, euphoria, empathy, visual and auditory disturbances (illusions), and emo- tional distress. Effects also include nausea, vomiting, and diarrhea. (p. 236) 5. Yage is made from an Amazonian vine and causes intense vomiting, diarrhea, and then a dreamlike condition that usually lasts up to 10 hours. (p. 236) V. PE YOTE, MDMA, & OTHER PHENYLALKYLAMINE PS Y CHEDELI CS This class is chemically related to adrenaline and amphetamine although many of the effects are quite different. The phenylalkylamines take several hours longer to reach their peak than ampheta- mines or indole psychedelics like LSD. (p. 236) A. Peyote (mescaline). Mescaline is the active component of the peyote cactus and the San Pedro cactus. It is used by Native American people in religious ceremonies though its his- tory goes back to pre-Columbian times. The Spanish tried to stamp it out. In 1990 the US. Supreme Court ruled that the use of peyote during religious ceremonies is not protected by the Constitution and that states can ban it. For this reason many ceremonies by the Native American Church of North America which use peyote are held in secret. (p. 237) 1. Effects. Peyote is derived from the tops (“buttons”) of the peyote cactus cut at ground level. They can be used fresh or dried. The effects last approximately 12 hours and are very similar to LSD with em- phasis on colorful visions. (p. 237) 51 B. 52 Psycho-stimulants (MDA, MDMA, 2C-B, PMA, 2C-T-7, 2C-T-2, et al.) & club drugs are laboratory variations of the amphetamine molecule. Often called designer psychedelics or psycho-stimulants, they are chemically defined as phenylethylamine derivatives similar to mes- caline. The drugs can cause feelings of well- being and euphoria, some psychedelic effects, stimulatory effects, side effects, and toxicity similar to amphetamines. MDA was the first of these compounds to be widely used and abused in the ’6OS, ’70s, and early ’803 on college campuses. (p. 238) 1. MDMA (ecstasy, rave, “XTC,” “X,” “Adam,” “E,” et al.). MDMA (ecstasy) is shorter acting than MDA (4—6 hrs. vs. 10—12 hrs.). It can be swallowed, snorted, or in- jected, much like methamphetamine, though it is usually sold as a capsule, tablet, or powder. MDMA is often taken at raves be- cause users claim it creates a strong desire to move about, dance, and interact with other people. (p. 238) History. Although MDMA was first discov— ered in 1914, it wasn’t until 1969 that the first human study was published. The authors recommended it to a number of therapists to help their patients see into their emotions and repressed memories. MDMA was banned in 1998. (p. 238) Use & cost. In 2002 about 7.4% of high school seniors had used MDMA but only 2.4% used on a monthly basis. A capsule, tablet, or equivalent powder packet (75—125 mg) costs $10 to $35. A DEA report found that 30—50% of the tablets sold as MDMA at rave parties actually contain no MDMA but do contain other illicit drugs like PCP, methamphetamine, PMA, or MDA. (p. 239) Physical effects. MDMA has many stimu- lant effects similar to amphetamines. The onset of action usually consists of tightness in muscles with generalized muscle spasms, trismus (jaw muscle spasm), and bruxism (clenching of teeth) just before most of the psychic effects begin to appear. Tolerance to its mental effects develops rapidly. Included in the many serious side effects are malig- nant hypertherrnia (high body temperature), high blood pressure, and seizures. (p. 239) Mental/emotional effects. About 20 min- utes to 1 hour after ingestion and continuing for 3—4 more hours, MDMA induces feel- ings of happiness, clarity, peace, pleasure, and altered sensory perceptions without causing any depersonalization or detachment from the realities of the environment. Users also report increased nonsexual empathy for others. For the first few hours ecstasy forces nerve cells to discharge their reservoirs of serotonin into the synaptic gap. This de- pletes the vesicles after about 3 hours. It can take up to a week or more to produce a suf- ficient amount of serotonin to reexperience similar feelings. Due to this excessive stimulation, serotonin receptors also retreat into the cell membrane (down regulation) to avoid damage, causing severe depression and suicidal ideation. High-dose usage has resulted in an acute anxiety reaction (“bum trip”). (p. 240) MDMA polydrug combinations. Some of the combinations include ecstasy combined with either LSD, hydrocodone, OxyContin®, heroin, GHB, nitrous oxide, Prozac®, or even Viagra® (called “sextacy”). (p. 240) . Parties, raves, and music clubs are social or dance gatherings filled with loud com— puter—generated techno music, light shows and laser light effects, and at many, club drugs and drug paraphernalia. The drugs that have been popular at these gatherings are primarily ecstasy, nitrous oxide (laughing gas), GHB or GBL, and occasionally dex- tromethorphan, ketamine, PCP, and nexus (2C-B). The problems that occur at these gatherings include bad reactions to drugs, overheating of the body, falling injuries, passing out, and bad trips. (p. 241) . Nexus (2C-B or 4—bromo-2,5—dimethoxy phenylethylamine). The effects of 2C-B are very dependant on the amount taken—mild stimulation at low doses and intense psyche- delic experiences at high doses. (p. 241) . STP (DOM) (2,5-dimethoxy-4— methylamphetamine). STP, also called “serenity,” “tranquility,” or “peace” pill, is similar to MDA and causes a 12-hour in- toxication that is reportedly a thicker duller trip than those induced by LSD or mesca- line. (p. 241) 5. PMA (4-MA or paramethoxyampheta- mine). Recently PMA has been found in pills purporting to be ecstasy that were smuggled from Europe. After 1 hour this drug causes a sudden rise in blood pressure, distinct afterimages, and a pins-and-needles tingly feeling like a chill or hair standing on end. It can cause seizures, hypertherrnia, co- agulation of blood, and muscle damage. It has caused deaths from overdose. (p. 241) 6. 2C-T-7 & 2C-T-2 induce delirium, heighten sensitivity, and increase awareness in the user. They can also cause dangerous cardio- vascular effects and death when taken in high doses. (p. 242) VI. BELLADONNA & OTHER A. AN T I CH OLINER GI C PS YCHEDELI CS Belladonna, henbane, mandrake, & datura (jimsonweed, thornapple). From ancient times through the Middle Ages and the Renais- sance, these plants, which contain scopolamine, hyoscyamine, and atropine, have been used in magic ceremonies, sorcery, witchcraft (black mass), and religious rituals. They’ve also been used as a poison, to mimic insanity, and even as a beauty aid by women to dilate pupils and make the eyes more striking. One of the effects of these drugs is to block acetylcholine recep- tors. These drugs can speed up the heart, create an intense thirst, and raise the body temperature to dangerous levels. Anticholinergics also cre- ate some hallucinations, a separation from real- ity, and a deep sleep for up to 48 hours. Syn- thetic anticholinergics like Cogentin® and Ar- tane® are used to treat the side effects of anti- psychotic drugs and Parkinson’s disease symp- toms. These are diverted from legal sources and then abused. (p. 242) VII. KETAMINE, PCP, & OTHER A. PS YCHEDELI CS Ketamine. The effects of ketamine, a disso- ciative general anesthetic used in human and veterinary medical procedures, are very similar to PCP. Both share the same receptor sites in the brain although they have different dura— tions of action; PCP lasts longer than keta- mine. When diverted from medical and dental supplies, it can be crystallized by a microwave oven heating process to make crystals that are then smoked in a cocaine freebase pipe or ground up and snorted. The full psychedelic experience, known as “being in a K-hole,” is described as an out-of-body near-death en- counter with depersonalization, hallucinations, delirium, and occasionally bizarre or mystical experiences. Ketamine’s toxic side effect in- clude respiratory depression, increased heart rate and blood pressure, belligerent behavior, convulsions, and in a few cases, coma. Major effects last for only about an hour or less while PCP effects last for several hours. In 1999, it was classified as a Schedule III drug. (p. 242) . PCP, also called “angel dust,” “peep,” “KJ,” “Shermans,” or “ozone,” is often misrepre— sented as THC, mescaline, or psilocybin. Originally produced as an anesthetic for hu- mans, now the only supplies are illegal ones. PCP can be smoked, snorted, swallowed, or injected. It acts like ketamine described above, only for a longer duration of time. A low dose of PCP will last 1—2 hours, a moderate dose 4— 6 hours, but the effects of a large dose can last up to 48 hours. There is a high frequency of bad trips associated with it as well as blackouts as with date rape drugs like Rohypnol®. (p. 245) . Salvia Divinorum (salvinorin A). Commonly referred to as “sage” or “diviner’s sage,” Sal- via divinorum is a psychedelic plant whose ef— fects have been likened to PCP. It has been used by shamans and curanderas (medicine men and women) in Mexico for centuries to induce a trance-like state in order to search for the cause of a patient’s illness. It can be chewed or smoked causing dreamlike halluci- nations, occasional delirium, and out-of-body sensations (short acting). Salvinorin A is thought to be the key psychoactive ingredient. It is not understood how it works in the brain and no receptor sites have yet been identified. It is currently legal (2003) but is being consid- ered for scheduling as a controlled substance. (p. 245) . Amanita mushrooms. Although many mem- bers of this family of mushrooms are deadly, the Amanita muscaria (fly agaric) and the Amanita pantherina (panther mushroom) have been used as psychedelics for many centuries. They can cause dreamy intoxication, halluci- 53 nations, delirious excitement, and toxic side ef- fects as well. The active ingredients are ibotenic acid and the alkaloid muscimole, sub— stances that resemble GABA. In ancient sacred writings in India dating back to 1500 BC, these mushrooms are referred to as the god Soma. (p. 245) E. Dextromethorphan (Robitussin DM®, Ro- milar®, & other cough syrups) is a nonpre- scription opioid cough suppressant available in many cold and cough medications. The effects of an excess dose can be euphoria, dissociation of mind and body, auditory and visual halluci- nations, and a loss of coordination. Anecdotally users say that a very high dose (300—600 mg with effects lasting 6—8 hours) is somewhat similar to LSD or “magic mushrooms.” Alcohol is found in many of the OTC cold and cough medications, so the combined effects are of a drunken deliriant. (p. 246) F. Nutmeg & mace, both from the nutmeg tree, cause varied effects from a mild floating sensa- tion to a full-blown delirium. So much has to be consumed (about 20 grams) that the user is left with a bad hangover and a severely upset stom- ach. The active chemicals are variants of MDA. Since the side effects are so nauseating, abuse is extremely rare outside of prisons. (p. 246) VIII. MARIJUANA & OTHER CANNABINOLS The Cannabis or hemp plant, also called “mari- juana,” produces fibers to make rope, cloth, roof- ing materials, and floor coverings. It grows edible seeds (akenes), it has an oil that is used as a fuel and lubricant, it contains a number of active ingre- dients that have been used to treat illnesses, and it produces a psychedelic resin that can alter con- sciousness. (p. 246) A. History of use. The relationship between Cannabis and man has existed for at least 10,000 years. From its origin in China or cen- tral Asia, hemp cultivation has spread to al- most every country in the world. There are a variety of species. Some Cannabis plants are better for fiber, some for food, some for medi- cations, and some for inducing psychedelic ef- fects. Because Cannabis was not specifically banned in the Koran by the Prophet Moham- med, Islamic cultures spread its use to Africa and Europe. Cannabis was widely cultivated in 54 B. C. the Americas until the nineteenth century when the end of slavery made it less profitable to harvest and process the plant. Migrant workers who worked in the United States introduced Americans to the habit of smoking marijuana for its psychoactive effects after World War I. It was banned by the Marijuana Tax Act of 1937. Presently several countries are cultivat- ing a fibrous variant of the Cannabis plant to supply pulp and fiber to make paper, textiles, and rope. In spite of restrictions, marijuana is used in some form by 200—300 million people worldwide. (p. 246) Epidemiology. In 1960 only 2% of the people in the United States had tried any illegal drug. By 2001 more than 12 million Americans (about 5% of the US. population) were using marijuana on a monthly basis, an average of 18.7 joints. Approximately 110,000 visits to emergency rooms listed marijuana as a contrib- uting factor for the trauma. About 39% of adult male arrestees and 26% of adult female arres— tees tested positive for marijuana as did 53% of juvenile male arrestees and 38% of juvenile fe- male arrestees. (p. 248) Botany. Cannabis is the botanical genus of all these plants. “Hemp” is generally used to de— scribe the Cannabis plants that are high in fiber content whereas “marijuana” is used to describe Cannabis plants high in psychoactive compo- nents. (p. 249) 1. Species. In Uppers, Downers, All Arounders, three species are designated: Cannabis sativa, the most common species; Cannabis indica, the source of most of the world’s hashish and the preferred base plant by many illegal growers of marijuana; and Cannabis ruderalis, a small thin plant that has few psychoactive components. (p. 249) 2. Sinsemilla & other forms of marijuana. The sinsemilla growing technique increases the potency of the marijuana plant. Dried marijuana buds, leaves, and flowers can be rolled into “joints” or they can be smoked in pipes. In India (and several other countries), marijuana is divided into three different strengths: bhang, the lowest potency; ganja, made for the stronger leaves and flowering tops; and charas, the concentrated resin and the most potent. When the sticky resin is pressed into cakes it is called “hashish.” Hash oil can be extracted from the plant us- ing solvents and then added to foods, smeared onto rolling paper, or dripped onto crushed marijuana leaves to enhance the psychoactive effects. (p. 250) . Growers. The majority of marijuana used in the United States comes from Mexico and Colombia but many Americans grow their own and face stiff legal penalties for doing so. The indoor growing of marijuana has led to very high-potency plants being grown all over the United States and the world. Esti- mates of the percent of marijuana that is homegrown nationwide vary from 10% to 50% of total consumption. The common unit of sale for marijuana is 1 02. (called a “lid”). At the beginning of the 2000s the street price ranged from $100 up to $400 per “lid.” (p. 251) D. Pharmacology. At last count researchers had discovered 420 chemicals in a single Cannabis plant. The most potent psychoactive chemical is called A9 tetrahydrocannabinol or THC. Due to the widespread use of the sinsemilla— growing technique, the THC concentration has increased from 1—3% in the ’60s to 4—15% since then. Actually high potency marijuana has been around for years, it just hasn’t been so readily available. (p. 251) 1. Marijuana receptors & neurotransmit- ters. In 1990 researchers found receptor sites in the brain specifically reactive to THC, implying that the brain has its own natural neurotransmitters that affect the same areas of the brain as marijuana. Two years later, researchers found anandamide, the natural neurotransmitter that fits into these receptor sites. Because there are rela- tively few receptor sites in the autonomic nervous system, it is difficult to physically overdose with marijuana. (p. 251) E. Short-term effects 1. Physical effects include physical relaxa- tion or sedation, some pain control, some cough control, bloodshot eyes, coughing from lung irritation, an increase in appetite, and a loss of muscular coordination. Other physical effects include an increased heart rate, decreased blood pressure, decreased eye pressure, increased blood flow through the mucous membranes of the eye resulting in conjunctivitis or red eye, and decreased nausea. Marijuana impairs tracking ability and causes trailing phenomenon where one sees an afterimage of a moving object. Marijuana can act as a stimulant as well as a depressant depending on the variety and amount of chemical absorbed in the brain, the setting in which it is used, and the per- sonality of the user. Marijuana also causes a small temporary disruption of the secre- tion of the male hormone testosterone. (p. 251) Mental effects. Within a few minutes, a user becomes confused and mentally sepa- rated from the environment. It produces a feeling of de'ja vu, an aloof feeling, drowsiness, and difficulty concentrating. Stronger varieties produce giddiness, in- creased alertness, and major distortions of time, color, and sound. It exaggerates mood and personality and makes smokers more empathetic to other’s feelings but also makes them more suggestible. The distortion of a sense of time is responsible for several of the perceived effects of marijuana. The effects of mental confusion, impaired judgment, and short-term mem- ory loss result in a user’s ability to perform multiple and interactive tasks. (p. 253) F. Long-term effects 1. Respiratory problems. Marijuana is ini- tially a bronchodilator. As smoking becomes chronic, so does irritation to the breathing passages resulting in increased coughing with acute and chronic bronchitis. Further- more most damage occurs in the lungs of those who smoke both cigarettes and mari- juana. Marijuana smokers destroy cilia in the breathing passages so phlegm production is increased but is not cleared as readily. The smoker has to cough to clear any mucous from the lungs. Some of the cellular changes involve the cell nucleus suggesting that ma— lignancy may be a consequence of regular marijuana smoking since some of these changes are precursors of cancer. (p. 253) . Immune system. Evidence suggests that heavy use can depresses the immune system, exposing the user to increased risks of in- fection and disease. (p. 254) 55 Learning & emotional maturation. Marijuana use has been shown to slow learning and disrupt concentration by its influence on short-term memory. Since marijuana is “the mirror that magnifies,” smoking it often exaggerates natural ten- dencies in the user. (This may be the basis of “amotivational syndrome,” a condition where heavy marijuana users have a ten- dency to avoid problems and evade mean- ingful work.) With marijuana many thoughts and feelings are internalized. Long-term marijuana smokers feel that they are thinking, feeling, and communi- cating better but often they are not. (p. 254) Acute mental effects. Smoking marijuana that is high in THC can cause acute anxi- ety or temporary psychotic reactions. Be- sides paranoia, the user believes they have severely damaged themselves or that their underlying insecurities are insurmountable. Even seasoned users who smoke very strong marijuana will experience effects similar to cocaine, amphetamine, and PCP. (p. 255) G. Tolerance, withdrawal, & addiction 56 1. Tolerance to marijuana occurs in a rapid and dramatic fashion. Marijuana persists in the body of a chronic user for up to 3 months though the major effects last only 4— 6 hours after smoking. (p. 255) . Withdrawal. There is not a rapid onset of withdrawal from marijuana since much of the THC has been retained in the brain. Only after a relatively long period of abstinence will the withdrawal effects appear. Symp- toms of marijuana withdrawal include anger, aches, pains, and chills, depression, inability to concentrate, slight tremors, sleep distur- bances, decreased appetite, sweating, and craving. Not everyone will experience all of these symptoms but everybody will experi- ence some, especially craving. In 1994 an antagonist of anandamide was discovered. By blocking those receptors, consequently blocking the action of THC, animals were thrown into major withdrawals. This proved that marijuana causes a physical depend- ence, and that it occurred more rapidly than previous thought. (p. 256) 3. Addiction. Many people smoke marijuana in a chronic compulsive way and have diffi— culty discontinuing their use. Like cocaine, heroin, alcohol, nicotine, and other addictive drugs, marijuana does have the ability to in- duce compulsive use in spite of the negative consequences it may be causing in the user’s life. (p. 256) 4. Is marijuana a gateway drug? The claim was that marijuana physically and mentally changed users so they started using heroin and cocaine. The exaggeration of this idea undermined drug education since many knew of individuals who outwardly did not seem to be so affected. Furthermore this ex- aggeration and resultant ridicule of propa- gandistic or scare films probably caused more drug abuse than it prevented. How- ever, marijuana is a gateway drug in the sense that if people smoke it, they will probably hang around others who smoke it or use other drugs, so the opportunity to ex- periment with other drugs is greater. Viewed from this perspective, it is not surprising that most users of other illicit drugs have used marijuana first but only after they be- gan using alcohol or nicotine. (p. 257) . Marijuana (Cannabis) & the law. The drug has always been popular. Internationally it is the most widely used illicit drug in countries such as Canada, Mexico, Costa Rica, Panama, Australia, and South Africa. (p. 257) 1. Marijuana, driving, & drug testing. As with alcohol, driving impairment is directly related to the amount of THC in the brain. Marijuana induces drowsiness, impairs judgment, and makes it difficult to complete complex tasks. Drug testing is being done more frequently in reckless driving cases and after accidents. However there is a scar- city of good data about the level of THC in the blood vs. the level of impairment. Fur- thermore since the elimination rate of THC varies radically compared to alcohol that has a defined rate of metabolism, THC can per- sist in the body and be detectable weeks af- ter last use. Most important, many arrested for DUI have more than one drug in their systems, including alcohol. 65% of heavy drinkers use marijuana. (p. 257) 2. The medical use of marijuana. Over the centuries marijuana has been used to treat insomnia, to calm anxiety, to control head- aches, as a childbirth inducer and analgesic, to control asthma, to treat nerve pains (neu- ralgias) and migraine headaches, to treat withdrawal from opiates and alcohol, and to control spasms. Recently marijuana has been recommend for some types of glaucoma, nausea control, pain control, and to help a patient who has lost too much weight to gain it back by stimulating hunger. In some states there are marijuana buyers clubs that supply marijuana for those who are ill. Marinol® is a legal synthetic oral form of THC that is available for medical use but it is rarely pre— scribed. A major obstacle with smoking marijuana for medical purposes is the great variation in the amount of active ingredients in any given marijuana plant. (p. 258) I. 1999 Report From the Institute of Medicine to the Office of National Drug Control Pol- icy. The report, entitled Marijuana and Medi— cine: Assessing the Science Base, was commis- sioned in 1996 and released in 1999. (Since both pro— and antimarijuana forces were pre- senting the conclusions of this report in the me- dia, the authors of Uppers, Downers, All Arounders ask that you encourage your students to read the “Conclusions” section in the text and make up their own minds.) (p. 259) 1. Conclusions of the report. Pain modula- tion, control of movement, and memory im- pairment do occur. Tolerance, dependence, and withdrawal symptoms also occur but at lower levels than with other drugs such as cocaine. Marijuana does have therapeutic ef- fects but the smoking is a poor means of de- livery 2. Recommendations of the report. Research should continue into the physiological ef- fects of synthetic and plant-derived cannabi- noids and the natural function of cannabi- noids found in the body. Rapid-onset, reli- able, and safe delivery systems should be developed. Psychological effects of canna- binoids should be evaluated. Studies to de- fine health risks of smoking marijuana should be conducted. Clinical trials of marijuana use for medical purposes should be conducted under limited circumstances. (p. 260) DISCUSSION TOPICS . Have students list three possible reasons that someone would take a. MDMA, b. marijuana, c. ketamine. Then discuss the reasons they themselves might use them. . Compare the reasons that someone would take a psychedelic like LSD or marijuana instead of a drug like alcohol or methamphetamine. . Sample student attitudes towards all psyche- delics to see whether/how they differ from atti- tudes towards uppers, like cocaine, and down- ers, like alcohol. . Discuss whether the use of psychedelics for re- ligious purposes (e. g., the Native American Church’s use of peyote) should be legal. Does a church have to be mainstream or have a certain number of members to be legitimate? . Discuss specific reasons that marijuana is known as “the mirror that magnifies.” CRITICAL THINKING AND CLASS EXERCISES . Ask students to research and then discuss the issue of legalization of marijuana. This can be divided into two parts: the legalization of marijuana for medical uses and legalization for recreational uses. . Ask students what they would say to a younger relative who asks whether it’s okay to use marijuana. Discuss whether the answer would be different if the drug were LSD or heroin. . Have the students respond to the following hy- pothetical: If a nonaddictive, nontoxic, low- cost, short-term psychedelic is invented, should it be legalized? What specific effects of psy- chedelic drugs make them illegal? What might be the personal and social benefits and risks of a widely available psychedelic? . Have students respond as a father or mother might to their child who says, “I want to try marijuana and LSD like you did in the ’70s.” 57 ...
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This note was uploaded on 04/13/2008 for the course BIO 1033 taught by Professor Joel.martinez,jr.,ph.d. during the Fall '04 term at The University of Texas at San Antonio- San Antonio.

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chapter6 - CHAPTER 6 ALL AROUNDERS CHAPTER OVERVIEW Drugs...

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