Uses Drugs of Abuse—Origins and Effects - Cannabis
Cannabis plants are usually smoked in the form of loosely rolled cigarettes ("joints") or in various kinds of pipes. The effects are felt within minutes, usually peaking in ten to thirty minutes and lingering for two to three hours. Low doses induce restlessness and an increasing sense of well-being, followed by a dreamy state of relaxation and, frequently, hunger. Changes in sensory perception—a more vivid sense of sight, smell, touch, taste, and hearing—may occur, with subtle alterations in thought formation and expression. Drugs made from the cannabis plant are widely distributed on the U.S. black market.
Marijuana
Marijuana is a tobacco-like substance produced by drying the leaves and flowery top of the cannabis plant. (See Figure 2.5.) Its potency varies considerably, depending on how much of the chemical THC (delta-9-tetrahydrocannabinol) is present. The National Drug Intelligence Center estimates that wild U.S.
FIGURE 2.5
Budding cannabis plant.
The most potent form of marijuana is sinsemilla (Spanish for "without seed"), which comes from the unpollinated female cannabis plant and can contain up to 17% THC. Another potent form, Southeast Asian "Thai stick" (marijuana buds bound into short sections of bamboo), is not often found in the United States.
Marijuana is grown illegally throughout the United States, both indoors and out. Growers generally try to achieve the highest possible THC content in order to produce the greatest possible effect. It is thought that most marijuana smoked in the United States is grown in the United States, much of it in the Midwest using sophisticated hydroponic techniques (growing the plants in water instead of soil). Street names for marijuana include "pot," "grass," "weed," "Mary Jane," and "reefer."
USE AND EFFECTS.
Every survey the federal government conducts on drug use indicates that marijuana is by far the most extensively used illicit drug in the United States. During the 1960s and 1970s it was as common at many parties as beer and wine. In 2003 an estimated 96.6 million Americans—more than a third of the population age twelve and over—had tried marijuana at some point in their life, according to results from the National Survey on Drug Use and Health, conducted annually by the Substance Abuse and Mental Health Services Administration.
Extensive research by NIDA uncovered the effect that THC has on the hippocampus, a part of the brain that is crucial for learning, memory, and the integration of sensory experiences with emotions and motivation. Many feel that these studies, when taken together, may explain the euphoria and memory loss induced by marijuana, as well as provide definitive proof of the drug's toxic effect on brain cells.
Scientists at UCLA's Jonsson Comprehensive Cancer Center found in 1997 that smoking one to three marijuana cigarettes produces the same lung damage and potential cancer risk as smoking five times as many cigarettes. And NIDA, as shown on their Web site (http://www.nida.nih.gov/pdf/monographs/download44.html), reported as far back as 1984 that marijuana adversely affects reproductive function in both males and females.
The immediate physical effects of marijuana include a faster heartbeat (by as much as 50%), bloodshot eyes, and a dry mouth and throat. It can reduce short-term memory, alter one's sense of time, and reduce concentration and coordination. Some users experience light-headedness and giddiness, while others feel depressed and sad. Many users have also reported experiencing severe anxiety attacks.
Although symptoms usually disappear in about four to six hours, it takes about three days for 50% of the drug to be broken down and eliminated from the body. It takes three weeks to completely excrete the THC from one marijuana cigarette. If a user smokes two joints a week, it takes months for all traces of the THC to disappear from the body.
SUPPORT FOR PATIENT USE.
In the past marijuana has been used to treat glaucoma and several neurological disorders. However, an Institute of Medicine (IOM) report concluded that the drug was not useful in glaucoma treatment because its effects were short-lived (Janet E. Joy, Stanley J. Watson, Jr., and John A. Benson, Jr., Marijuana and Medicine: Assessing the Science Base, National Academies Press, 1999). The report also indicated that marijuana was ineffective in treating patients suffering from Parkinson's or Huntington's diseases. According to one of the principal investigators for the IOM, John Benson, Jr., the medical effects of marijuana are generally modest, and only patients who do not respond well to other medications should use it. Marijuana appears to be useful in treating conditions such as chemotherapy-induced nausea or the wasting caused by AIDS. It may also help relieve muscle spasms associated with multiple sclerosis.
In May 1991 nearly half of all cancer specialists who responded to an unofficial Harvard University survey said that they would prescribe marijuana for some of their patients if the drug were legal. A somewhat smaller percentage said that despite the drug's illegal status, they had already recommended it to patients as a means of enhancing appetite and relieving chemotherapy-related nausea.
As noted at the beginning of this chapter, one of the criteria used by the DEA in classifying drugs is whether there is a "currently accepted medical use in treatment in the United States." In 1988 Francis Young, the administrative judge of the DEA, noted that marijuana "in its natural form, is one of the safest therapeutically active substances known to man" and recommended that physicians be authorized to use it. The DEA refused to relax the restrictions.
In 1991 the Massachusetts Supreme Court, in Massachusetts v. Hutchins (49 CRL 1442), ruled that society's interest in preventing illegal drug use out-weighed a patient's "medical necessity" to use marijuana. The defendant, who began growing his own marijuana when he was unable to get government approval to use the drug to relieve the pain of his chronic illness, had been charged with possession and cultivation of the cannabis plant.
THE COURTS UPHOLD THE DEA ON MARIJUANA RESCHEDULING.
Over the past two decades a number of legal attempts have been made to get marijuana rescheduled from Schedule I, the most restrictive classification, to a less restrictive schedule. The first petition was filed in 1972 and reached the Court of Appeals of the District of Columbia four times: National Organization for the Reform of Marijuana Laws v. Ingersoll (497 F.2d 654, 1974), National Organization for the Reform of Marijuana Laws v. Drug Enforcement Administration (559 F.2d 735, 1977), National Organization for the Reform of Marijuana Laws v. Drug Enforcement Administration & Department of Health, Education and Welfare (No. 79-1660, 1980), and Alliance for Cannabis Therapeutics and The National Organization for the Reform of Marijuana Laws v. Drug Enforcement Administration (930 F.2d 936, 1991). All of these petitions failed.
In another attempt, Alliance for Cannabis Therapeutics and Drug Policy Foundation v. Drug Enforcement Administration (15 F.3d 1131, 1994), the petitioners claimed that the DEA had failed to recognize that "marijuana is misclassified because it has been shown to serve various medicinal purposes … marijuana alleviates some side effects of chemotherapy in cancer patients, aids in the treatment of glaucoma and eye diseases, and reduces muscle spasticity in patients suffering from multiple sclerosis and other maladies of the central nervous system" (Schaffer Library of Drug Policy, http://www.druglibrary.org/schaffer/hemp/medical/court_ruling.htm).
In support of their case, the petitioners submitted affidavits and testimonials from a number of patients and doctors who said marijuana had been helpful in treatment. The Food and Drug Administration (FDA) claimed that the testimonials were not scientific proof and that no scientific study had shown that marijuana was useful in medical treatment.
The FDA claimed that, when questioned under oath, each witness supporting the rescheduling of marijuana "admitted he was basing his opinion on anecdotal evidence, on stories he heard from patients, and on his impressions about the drug." The appeals court agreed with the FDA that "only rigorous scientific proof can satisfy" the requirements needed to change marijuana's rating and let the FDA's position stand.
THE MEDICAL USE OF MARIJUANA—A POLITICAL ISSUE OR A SCIENTIFIC ISSUE?
In 1997 the White House Office of National Drug Control Policy (ONDCP) made an effort to take the issue out of the political arena and place it in the scientific arena. The ONDCP asked the Institute of Medicine (IOM), a private, nonprofit organization that provides health-policy advice to Congress, to review the scientific evidence on the potential health benefits and risks of marijuana. Following an eighteen-month study, the investigators concluded that "the future of cannabinoid drugs lies not in smoked marijuana, but in chemically defined drugsthatacton … humanphysiology" (Institute of Medicine, "Marijuana and Medicine: Assessing the Science Base," Washington, DC: National Academy Press, 1999). Rigorous clinical trials, along with the development of new delivery mechanisms for the drug, were among the recommendations of the IOM's report.
Yet the debate continued in the political arena. By the late 1990s voters in nine states—Alaska, Arizona, California, Colorado, Hawaii, Maine, Nevada, Oregon, and Washington—had approved initiatives intended to make marijuana legal for medical purposes. However, the initiatives were ineffective. The federal government threatened to prosecute doctors who wrote prescriptions for marijuana. In 1997 a group of doctors sued to prevent the federal government from revoking doctors' registrations, and a federal judge permanently enjoined the federal government from doing so in September 2000.
Patients, though, found it increasingly difficult to obtain the drug, especially since the federal government started closing down "buyers' clubs," or organizations that distribute medical marijuana to seriously ill patients who wouldn't be able to obtain it otherwise. Debate continued as federal prosecutors went up against the Oakland Cannabis Buyers Cooperative, a nonprofit organization that provides marijuana to doctor-approved patients. Though its operations were legal under California law, the federal government ordered an injunction against its operation. A new defense, that of "medical necessity," came out of the legal wrangling, and the Ninth Circuit Court of Appeals upheld the defense. But in 2001 the Supreme Court ruled that there is no "medical necessity" exception to drug laws since Schedule I states there is "no currently accepted medical use in treatment in the United States" for marijuana. This ruling, though it did not overrule state laws, did allow federal prosecutors to continue enforcing federal drug laws.
Hashish
Hashish is made from the THC-rich resinous material of the cannabis plant. This resin is collected, dried, and compressed into a variety of forms, including balls, cakes, and sticks. Pieces are then broken off and smoked. Most hashish comes from the Middle East, North Africa, Pakistan, and Afghanistan. According to the DEA, the THC content of hashish in the United States hovered around 6% during the 1990s. Demand in this country is limited.
Hash Oil
Despite the name, hash oil is not directly related to hashish. It is produced by extracting the cannabinoids from the cannabis plant with a solvent. The color and odor of hash oil depend on the solvent used. Most recently, seized hash oil has ranged from amber to dark brown with about 15% THC. In terms of effect, a drop or two of hash oil on a cigarette is equal to a single joint of marijuana.
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