James B. Bakalar

The Use of Cannabis as a Mood Stabilizer in Bipolar Disorder: Anecdotal Evidence and the Need for Clinical Research

The authors present case histories indicating that a number of patients find cannabis (marihuana) useful in the treatment of their bipolar disorder. Some used it to treat mania, depression, or both. They stated that it was more effective than conventional drugs, or helped relieve the side effects of those drugs. One woman found that cannabis curbed her manic rages; she and her husband have worked to make it legally available as a medicine. Others described the use of cannabis as a supplement to lithium (allowing reduced consumption) or for relief of lithiums side effects. Another case illustrates the fact that medical cannabis users are in danger of arrest, especially when children are encouraged to inform on parents by some drug prevention programs. An analogy is drawn between the status of cannabis today and that of lithium in the early 1950s, when its effect on mania had been discovered but there were no controlled studies. In the case of cannabis, the law has made such studies almost impossible, and the only available evidence is anecdotal. The potential for cannabis as a treatment for bipolar disorder unfortunately can not be fully explored in the present social circumstances.

Coca and cocaine as medicines: An historical review☆

Coca has been used in folk medicine in South America for thousands of years both as a general stimulant and for more specific medical purposes. It remains one of the most commonly used medicines in some areas of Bolivia and Peru. The medical use of coca and cocaine in the industrial world has a more dramatic and varied history. Coca extract and cocaine were introduced as pancreas for a wide variety of complaints in the late 19th century. Cocaine was the first effective local anesthetic; prescription drugs, patent medicine, and soda drinks containing it were also popular. When its dangers became apparent and substitutes became available, its medical use went into decline, especially when, in the 1930s, amphetamine began to replace it for some purposes. Today its only generally accepted medical use is as a topical anesthetic in certain kinds of minor surgery and other clinical procedures. There are, however, some recent and so far uncertain signs of reviving interest in cocaine and even coca itself for other medical purposes, in research as well as in diagnosis and treatment.

ADVERSE EFFECTS OF COCAINE: SELECTED ISSUES

Until recently scientific knowledge about cocaine use and abuse was very limited, and most of it was based on studies more than fifty years old. There were no controlled experiments on human beings; even the clinical literature was sparse and affected by the limitations and prejudices of an earlier era. Recently cocaine has been gaining popularity on the street faster than any other drug, and, partly as a result, more significant work has been done on it in the last five years than in the preceding forty. This research is of several kinds: controlled experiments on human beings and animals, animal studies aimed at discovering theoretical models of psychosis, studies on medical uses, clinical reports on adverse effects and treatment, surveys and sociological reports on illicit use, chemical detection and identification studies. There have been no surprising discoveries, but we have put our knowledge on a sounder basis and filled gaps in it. And since illicit use has become so widespread, it is easier to judge the effects and dangers of cocaine as it is ordinarily used, avoiding the bias and sensationalism that often accompany insufficient information. Our emphasis will be on work done in the last five years even when the results are a confirmation or summary of knowledge familiar from earlier work.

Social and Intellectual Attitudes Toward Drug-Induced Religious Experience

This article is a comment on the ambiguity of the psychedelic experience itself and the peculiarities of the modern social response to it. I discuss three kinds of attitudes toward psychedelic religious experience and compare them with three attitudes toward religious tradition described by Peter Berger. These are, roughly, materialist reductionism, defense of the purity of an orthodox faith, and religion as personal experiences given form and meaning by traditional interpretation. The effects of psychedelic drugs are used by some to discredit both drugs and religion, by others to discredit drugs while justifying a certain definition of religion, and by still others to accept drug-taking as one mode of religious experience broadly conceived. This last attitude is the one usually taken by psychedelic drug users themselves, but it raises the difficult question of what is definably religious about personal experiences before they are given form by a doctrine, ritual, and community. In this connection I discuss the common view of psychedelic experience as a foretaste or preliminary to a more serious religious regimen.

Testing Psychotherapies and Drug Therapies: The Case of Psychedelic Drugs

The drug revolution that began 30 years ago has transformed psychiatry, but it has left little imprint on psychotherapeutic procedures themselves. Little attention has been given to the possibility of using drugs directly to enhance the process of psychotherapy — fortifying the therapeutic alliance and facilitating the production of memories, fantasies, and insights. A change may now be coming; for example, a psychiatrist known for his research on the therapeutic alliance has proposed that a “pharmacotherapy of interpersonal processes” might be considered both to study and to improve the alliance [1], The wait has been long partly because the research involved is complex and hard to perform. The theoretical bases for the two types of therapy are vastly different; these differences are reflected in the way experiments arc conducted and the results are evaluated. Reconciliation and unification will not be easy to achieve. One of the best ways to see why that is so is to examine the different significance assigned to placebo effects in drug experiments and psychotherapy studies.

Arguments for a Harmfulness Tax

A “Harmfulness Tax” is proposed as an alternative to the present unsuccessful drug prohibition policy. Both legal and currently illegal drugs would be taxed in proportion to the social cost associated with their use. In a sense, drug users would be required to buy insurance against the harm their drug use might cause to society. The scheme would be implemented in stages beginning with alcohol, tobacco and marijuana. After the program had been established in this way, it would be extended to other drugs, including cocaine. This proposal accords well with experiences gained in taxing legal drugs and with the realities of current drug use in America.