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THE MERCK MANUAL:    WHAT DOES THE U.S. MILITARY’S OFFICIAL FIELD MANUAL HAVE TO SAY ABOUT CANNABIS HERB

    The Merck Manual, the U.S. military’s field guide to medicine states:

    “Chronic or periodic administration of cannabis or cannabis substances produc[es] some psychic dependence because of the desired subjective effects, but no physical dependence; there is no abstinence syndrome when the drug is discontinued.

    “Cannabis can be used on episodic but continuous basis without evidence of social or psychic dysfunction. In many users the term dependence with its obvious connotations probably is misapplied.

    “Many of the claims regarding severe biologic impact are still uncertain, but some others are not. Despite the acceptance of the ‘new’ dangers of marijuana, there is still little evidence of biologic damage even among relatively heavy users. This is true even in the areas intensively investigated, such as pulmonary, immunologic, and reproductive function. Marijuana used in the USA has a higher THC content than in the past. Many critics have incorporated this fact into warnings, but the chief opposition to the drug rests on a moral and political, and not a toxicological, foundation.”

    Merck Manual of Diagnosis and Therapy, Fifteenth Edition, 1987, Robert Berkow, M.D., Editor-in-Chief. Published by Merck Sharp and Dohme Research Laboratories Division of Merck and Co., Inc. (Pharmaceutical) Rahway, New Jersey, 1987.


CANNABIS

(Marijuana)

    Over 60 Synergistic compounds in one natural medication

    Available:

Cigarettes (350mg.-500mg. r.d.)

Concentrated cannabis oil (grass oil)

Concentrated cannabis pollen (kif)

Concentrated cannabis resin (hashish)

Description:

    Cannabis is the crude vegetable preparation of the plants Cannabis sativa L. and Cannabis Indica. The pharmacologically active components of the drug are a cannabinoids, including delta-9 trans-tetrahydrocannabinol, cannabidiol, cannabinol, tetrahydrocannabivarin and perhaps 60 other cannabinoids of varying pharmacalogical properties. Unique in both botany and pharmacological action, cannabinoids are not nitrogenous alkaloids, and their site and mode of action in the body are unknown, though they clearly modify neurotransmission in the CSN. Cannibinoids work synergistically, in that the effects of delta-9 trans-tetrahydrocannibinol in isolation, for example, are very greatly modified by its interaction in crude cannabis with Cannibidiol, which antagonizes some effects of the tetrahydrocannibinol and potentiates others. Cannabis also necessarily comprises a broad variety of non-pharmacological substances common to vegetable matter in general; however, most or all of these extraneous materials can be substantially eliminated, before the drug is ingested, by appropriate filtering devices.

Precautions:

    Cannabis is proscribed under the Uniform Controlled Dangerous Substances Act of 1972. Its possession is a felony under federal law and physicians who facilitate its use by patients are subject to prosecution under conspiracy statutes; merely advising a patient where he or she might obtain cannabis renders a physician liable to arrest. Patients who use cannabis should be advised of the risk of prosecution and imprisonment and the material health hazards posed thereby.

Contraindications:

    Persons suffering from viral or bacterial pulmonary infections should not ingest Cannabis by inhalation until the remission of the infection. Extended and regular administration to persons with emphysema and lung fibrosis may aggravate these conditions. [This claim has been disproven, see emphysema.]

Adverse Reactions:

    Idiosyncratic anxiety crises, dysphoric dissociation and depersonalization syndromes may occur in a very few patients experiencing acute onset of cannabis’s mental effects for the first time; dosage should be lowered and an attempt should be made to determine the root emotional cause of the reaction. If the reaction persists long after the drug wears off or dependably occurs with succeeding administrations, a preexisting premorbid psychotic condition may be suspected and therapy should be discontinued.

    Raw cannabis contains significant levels of mutagenic hydrocarbon condensates, toxins that irritate pharyngo-laryngeal, bronchial and alveolar tissues; water-soluble cytotoxins exist in cannabis that inhibit the bactericidal activity of ciliated esophageal cells. While none of these effects poses any material hazard to patients free from pulmonary dysfunction or disease, the use of smoking devices that both filter and cool the smoke is recommended over cigarettes for therapeutic administration. Oral administration of Cannabis has shown considerable effectiveness, particularly with glaucoma and antiemesis; but the physician cannot determine the dosage dependably when cannabis is eaten, since the drug is absorbed very unevenly through the G.I. tract and it decarboxylation there by HCl may alter its psychic and physiological effects in ways not yet adequately studied. The minimal untoward effects of cannabis upon lung function and tissue renders inhalation of its smoke a superior route of administration for therapeutic purposes; the patient is able to self-titrate the dosage, inhalation by inhalation, until the precise therapeutic effect is achieved.

    Tachycardia, showing a pulse-rate increase of 30 to 60 percent, dependably occurs during the drug’s onset in patients previously unexposed to cannabis; this usually persists 30 to 45 minutes. The rise and decline in heart action is smooth and uniform. Cannabis-induced tachycardia may render the drug inadvisable for use with patients who are receive Digitalis in cardiac therapy.

    Cannabis commonly promotes lassitude and drowsiness and has been shown to significantly prolong reaction time in human subjects. Patients receiving it should be advised not to drive or operate heavy machinery.

Drug Interactions:

    While the site and nature of cannabis’s mental effects in the CSN are largely unknown, it appears to raise the free levels of serotonin in the intersynactic gap probably by blocking it reuptake into the presynaptic neuron. Thus it appears to intensify and facilitate the effects of tricyclic antidepressants by promoting a higher intersynaptic ratio of serotonin to norepinephrine and dopamine. Its interaction with monamine oxidase inhibitors is similarly felicitous, since both medications work to raise free sertonin levels. With benzodiazepenes, it has been suggested that cannabis may exert some yet-determined influence on the brain hormone GABA (gamma-aminobutyric acid) to facilitate the penetration of benzodiazepene metabolites into the brain tissue and to potentiate their anxiety relieving action there. (Note: By itself, cannabis is not an antidepressant but a potentiator of moods. As an adjunct to antidepressant therapy, it should be employed only by physicians as part of a broad program of personal counseling.)

    Cannabis has no adverse reactions with any other drug. Suspicion exists, however, that in the liver cannabis metabolites may react with alcohol metabolites to promote an unwholesome modification of both drugs’ psychotropic effects.

Dosage and Administration

    Psychophysiological responses to cannabis are greatly dependent on the individual patient’s experience with the drug: After an initial period of three to five weeks of regular administration, a subject will exhibit a measure of habituation to some acute effects such as euphoria and tachycardia, while other effects, such as intraocular pressure reduction and antimesis, will remain constant. Therefore it is advisable in most cases to have the patient determine the dosage for himself until the desired therapeutic effect is realized. Inhaling cannabis smoke is the most dependable known way to accomplish this.

    Due to the nature of cannabis as a crude vegetable material, a standard uniform dose is virtually impossible to establish. The erratic provenance of street cannabis, which can originate from anywhere in the world, complicates it even further. Cannabis grown in Northern latitudes, as a rule, will generally produce pronounced sedative effect and its physical effects will typically be muted though prolonged. Equatorial cultivars of cannabis by contrast, may exert a decided tonic effect with immediate and conspicuous physical effects of relatively brief duration per single dose. Of the cannabis cultivars most widely available on the street market to patients in the United States, the commonest commercial Colombian cultivar — “Santa Marta Gold” — probably has the most dependable uniform effect per dose.

Usage in pregnancy:

    Cannabis has no proven teratogenic properties. Due to the illegal status of the drug, however, no longitudinal epidemiological statistics are available in this regard. The United States Department of Health, Education and Welfare has imposed an arbitrary cannabis-testing ban on all women “who are or may become pregnant,” rendering it impossible to scientifically investigate the influence on this or any other health concerns unique to women. The antemetic properties of cannabis have been widely exploited by pregnant women to counteract morning nausea, but until more is known of its precise action in the body, it should not be recommended for regular use during pregnancy. Recent research has suggested that all psychtropic drugs may exert some measure of subtle teratogeny, and there is no substantive reason to believe that cannabis escapes this category.

(Reprinted from High Times, July, 1980.)

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