Lester Grinspoon

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.

Cannabis in palliative medicine: improving care and reducing opioid-related morbidity.

Unlike hospice, long-term drug safety is an important issue in palliative medicine. Opioids may produce significant morbidity. Cannabis is a safer alternative with broad applicability for palliative care. Yet the Drug Enforcement Agency (DEA) classifies cannabis as Schedule I (dangerous, without medical uses). Dronabinol, a Schedule III prescription drug, is 100% tetrahydrocannabinol (THC), the most psychoactive ingredient in cannabis. Cannabis contains 20% THC or less but has other therapeutic cannabinoids, all working together to produce therapeutic effects. As palliative medicine grows, so does the need to reclassify cannabis. This article provides an evidence-based overview and comparison of cannabis and opioids. Using this foundation, an argument is made for reclassifying cannabis in the context of improving palliative care and reducing opioid-related morbidity.

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.

Medical marihuana in a time of prohibition

Abstract As the medical virtues of cannabis become increasingly clear, the question of how to make it available to patients becomes increasingly urgent. Conventional routes to medical legitimacy—the process by which pharmaceutical companies satisfy government requirements for a new medicine—are inappropriate because of the unique history and properties of this substance. Its full medical potential cannot be realized as long as present prohibition laws are enforced. For medical as well as other reasons, cannabis should be available to the public under restrictions similar to those governing alcohol. Although early changes in the law are unfortunately unlikely, increasing public understanding of the medical usefulness of cannabis may lead to changes in enforcement patterns that bring the 60 year reign of prohibition to a de facto conclusion.

The behavioral effects of nicotinamide adenine dinucleotide in chronic schizophrenia

SummaryTwo grams of NAD were administered orally to ten chronic schizophrenic patients for twenty-one days. Five of the patients were also receiving thioridazine. There was no gross clinical improvement noted in any of the patients despite the fact that related experiments suggested that the NAD was absorbed. In those patients who were not also receiving phenothiazines there was a distinct tendency towards increased hostility, aggressiveness and irritability beginning one week after the initiation of NAD treatment and lasting for nearly two weeks after the NAD was discontinued.

Pharmacotherapy combined with other treatment methods

Summary This paper attempts to review reports on combinations of drugs and other modalities. The following tentative impressions appear warranted: 1. Combined ECT and drugs: Anti-depressants may maintain post-ECT improvement in mood, but no decided advantage obtains from its use during a course of ECT treatment. Combination of reserpine and ECT may be dangerous. Phenothiazines may have beneficial effects as a tranquilizer, but synergism with ECT remains doubtful. 2. Combined occupational therapy and drugs: Apparently drugs make it possible for many inaccessible patients to participate meaningfully in social interaction and to learn new skills. 3. Combined psychotherapy and drugs: Various drugs are alleged to hasten or facilitate individual psychotherapy; however, where anxiety is reduced it is also reported that patients stop working in psychotherapy and become complacent. Individualization and special attention to drug dosage may optimize usefulness of drugs in this context. In group therapy, tranquilizers appear to facilitate interaction and enhance the group process.

On the pharmaceuticalization of marijuana

Abstract Given the very limited toxicity of marijuana and the growing appreciation of its therapeutic value, it will undoubtedly find increasing application as a medicine in the coming years. But there is uncertainty about the forms in which it will be made available. Governments are hesitant to approve it because of concern about its use for nonmedical purposes and the difficulties of distributing as a medicine a substance that is already easily available. An alternative is the development of commercial cannabis pharmaceuticals that can be regulated and controlled. But pharmaceutical firms will be reluctant to invest the necessary money if they believe they cannot compete successfully with marijuana. Some of these products may have advantages over whole smoked or ingested marijuana, but most will not, and they will all be quite expensive. Ultimately, we can anticipate two medical distribution networks, a legal one for cannabinoid pharmaceuticals and an illegal one for street or homegrown marijuana.

The Future of Medical Marijuana

The medical value of marijuana is becoming increasingly clear, as it proves to be a remarkably versatile, safe, and inexpensive drug. Arrangements now being proposed for making cannabis constituents medically available include quasi-legal buyers clubs, restrictive classification as a prescription drug, the isolation of individual cannabinoids, and the manufacture of synthetic analogs. Careful analysis potentially of this inexpensive drug shows that all these proposals are unworkable. Furthermore, cannabis has so many beneficial uses that the strictly medical ones should not be singled out for approval, and its medical potential cannot be fully realized as long as its use for any other purpose is prohibited. Therefore cannabis should be made available under laws similar to those now applied to alcohol.

Abnormalities in Skin Potential Fluctuations During the Sleep of Acute Schizophrenic Patients

&NA; Spontaneous skin potential fluctuations (SPF) were recorded during the sleep of 8 acute schizophrenic patients and 6 normal volunteers. While in normals the SPFs decreased during rapid eye movement (REM) sleep and were most numerous during Stages III and IV, the acute schizophrenics had the greatest number of SPFs during REM sleep and waking, and fewest during Stages III and IV sleep. It is hypothesized that this effect represents a lack of normal control during REM sleep in the acute schizophrenic patients. It may be related to the recently reported failure of acute schizophrenics to have post‐REM‐deprivation supranormal levels of REM seen in normals. It is also possibly connected to a hypothesized serotonergic REM system.