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Abstract

Cannabis- An Easement- a Proposed Unique Drug Category

Tod H. Mikuriya

Cannabis has been categorized in contradictory and diverse ways since antiquity and subject to political context. The Controlled Substances Act of 1970 classifies cannabis as an hallucinogen with high potential for abuse with no medical value. When cannabis was available for prescriptive use from the mid 1840’s through 1938 it was classified as hypnotic, sedative, and narcotic. Medical literaturature and clinical observation suggests that an apt classification or categorization is easement for low dose cannabis effects. The author proposes the addition of easement to drug classifications and categories of action of cannabis drugs.

Acknowledgement: Classic Pharmaceuticals

 Cannabis- An Easement- a Unique Drug Category

  Tod H. Mikuriya, M.D.

Contemporary categorization of cannabis as a psychotropic drug has been largely incorrect. The Controlled Substances Act classifies Marihuana as a hallucinogen with high potential for abuse, lack of accepted safety and no medicinal use.[i] Jaffe in his classification of pharmacological agents commonly used for subjective purposes correctly puts cannabinoids in its own undefined class.[ii] Morgan classifies cannabis as a hallucinogen in the Merck Manual 17^th Edition in 1999 in the section on drug use and dependence.[iii] On the other hand, the 1899 Merck’s Manual categorizes cannabis as hypnotic/sedative.[iv] (Long before marijuana became a popular illegal drug)

The term Easement most aptly characterizes the unique medicinal effects of cannabis.

Easement while usually associated with legal terminology, dealing with property in Webster’s 3^rd New Unabridged Dictionary, but the first meaning is “An act or means of easing or relieving (as from pain, discomfort, or burdens)[v]

Roget’s Thesaurus: includes easment under relief: 834. Relief; deliverance &c. 689; easment, softening, mitigation, palliation &c. 174; soothing, lullaby, cradle song, berceuse, solace, consolation, comfort, encouragement. Lenitive, restorative &c (remedy) 689. Repair, refection, refocillation, refreshment, regalement, relief &c.[vi] (Peter Mark Roget was a British physician and fellow of the Royal Society who began a compilation and classification of words in 1805. He published the first edition of the Thesarus in 1853.)

Roget’s II Thesaurus adjective synonyms for ease are: lax, let up, loosen, relax, slack, slacken, untighten Nouns Comfortable, Easygoing, Tolerant, Wanton, Smooth, Prosperous, Amiable, Gradual, Laid-back, and Prosperity”. [vii]

Roget’s International Thesaurus lists easment under 120 RELIEF: Nouns 1 relief, easement, easing, ease; relaxation, relaxing or easing of tension, decompression, slackening; reduction, diminishment, diminution, lessening, abatement, remission; remedy 86; alleviation, mitigation, palliation, softening, assuagement, allayment, defusing, appeasement, mollification, subduement; soothing, salving, anodyne; lulling.[viii]

Brittanica World Language Vol 1 noun: 1 Freedom from pain, agitation, or perplexity. Verb: 1. To relieve the mental or physical pain or oppression of; comfort.  2. To make less painful or oppressive: This will ease your pain. 3. To lessen the pressure, weight, tension, etc. Easement : 2. Relief,  3. Anything that gives ease or relief. [ix]

Neither Dorland’s[x] nor Steadman’s Medical Dictionaries, however, list ease or easement.[xi] The Physicians Desk Reference likewise omits this therapeutic category.[xii]

Cannabis’ properties are unique and distinctly different from other categories of drugs. Subjective descriptions of the therapeutic properties by persons who have discovered the utility of the drug for the management of a wide range of chronic diseases both mental and physical.

While most would characterize and categorize cannabis’ therapeutic actions as sedative, anxiolytic, and analgesic; the power of the drug to alleviate depression is, perhaps, as an important psychotherapeutic property. But it goes beyond localized symptoms

Confronted by mental disorders that have diverse causes and ways of expression, depression and anxiety vary significantly in severity, expression, and manifestation. For some, cannabis is a lifeline to sanity and functionality.

Cannabis calms agitation, anger, and mania. Painful, disruptive, and frequently incapacitating symptoms are brought under control with minimal side effects and rapid relief when inhaled. Cannabis promotes sleep and permits relief from wakefulness without hangover.

Cannabis relaxes both smooth and skeletal muscles. Obsessive and mood driven cognitive patterns relax and put into emotional perspective. Appetite and bowel normalcy is restored, cognition is reconnected with somatic and affective awareness. Control of the sympathetic nervous system dominance in favor of the parasympathetic or vegetative nervous system affects both CNS and somatic system states. Unlike sedatives, opioids, anxiolytic, stimulant, or antidepressants, cannabis is free from unwanted effects by an order of magnitude.

19th Century Clinical Literature

Clendinning in 1843 after clinical trials with the hemp drugs utilized by O’Shaughnessy in 1839 in India stated:

 “Looking at disease abstractly, I should say that no indications exceed in importance the two following, vis:-

1.      The alleviation of acute pain, whether neuralgic, spasmodic, or inflammatory in its origin; and

2.      The securing adequate daily rest in sleep by procuring, artificially if necessary, a suspension at least of any morbid actions or conditionss that might militate against refreshing repose. Almost all the suffering, and great part of the danger of sickness may be referred to uneasy sensations of one sort or other, the irritated nervous tissues reacting throughout the economy on the nurtrient functions, deranging the elementary affinities in the blood, undermining the organic powers, and ultimately ruining the general health. Looking again at disease as we see it in clinical practice, there are no medicinal substances of more interest or importance in its treatment than such as fitted to fulfil these two indications.”[xiii]

In 1845 J.J. Moreau de Tours, a French psychiatrist utilized cannabis in the treatment of depression described the drug's effects:[xiv]

"It seems that nothing can hurt you in this peace of mind, that you are inaccessible to sadness.”

DeCourtive, Moreau’s collaborator wrote in 1848: I am convinced that this plant (already useful to man, who uses it for clothing and makes rope from it, which helps him navigate the seas) can comfort him in his suffering, that I join my feeble voice to those of these hard-working and dedicated medical travelers, that I call Cannabis to the attention of observers and workers alike.”[xv]

The Indian Hemp Drugs Commission in 1894[xvi] reviewed medical literature, testimony by both indigenous medical practitioners and Western trained physicians and described cannabis to be used as a tonic to increase stamina. In cultures and societies such as India or Nepal it is recognized that cannabis cools the passions as compared with alcohol which heats or inflames them. Moslem cultures refer to a cannabis induced placid dreamy state as “el kif”[xvii]

Clinical aspects of modulating emotional response and psychopathologic conditions: EEG effects

Cannabis decreases emotional reactivity and intensity while increasing introspection as evidenced by the slowing of the EEG after initial speeding up[xviii].  In EEG biofeedback utilizing bilateral channels the author has observed bursts of theta (4-7 Hz) in a background of high frequency beta (20 – 22 Hz) in patients experiencing agitation or anxiety. These episodic intrusions of theta corresponded to distraction or loss of train of thought. The unique easment effects of cannabis relieves agitation that decreases or eliminates these disturbances in cognition. Obsessive and pressured thinking give way to focussed cognition.

With ADD there is sub beta fixation with inability to speed up the EEG which has the psychophysical concomitance of “spaciness”, poor short term memory, poor retention, poor frustration tolerance, poor tolerance of  noise, difficulty with crowds, and groups.

Introspective loosened associations when in relaxed circumstances. Alpha (8 –13 Hz), a relaxed open focus cognitive state with a more holistic apperception.

Emotional reactivity is smoothed out, worries are less pressing. Of significance is the enhanced affective control with salutary effects on cognition. Decreased obsessive and paranoid ideation driven by affect are relieved. Increased psychophysical awareness and pattern recognition enhances a sense of ease. Cannabis relieves the sensation of being “all clenched up”. The relief of musculoskeletal and visceral tension restores a sense of control. When certain localized pain causes both discomfort and detachment with pain affected part assuming a life of its own. Cannabis, at a low inhaled dose, “reconnects” psychophysical awareness. This change in subjective perspective appears to be part of the unique psychopharmacologic mechanisms of cannabis.

Anxiety relief and acute mild short term memory impairment relieve obsessive ideation  and other cognitive distraction. The anxiety relief diminishes obsessive and ruminative thinking. Short term memory impairment makes “holding thoughts” more difficult with relief. Obsessive ideation of both neurotic and psychotic etiologies are relieved.

Emotional control through both immediate relief and salutary effects on vegetative functioning in circadian sleep rhythms, quality of sleep, and improvement of appetite, digestion, and bowel function.

Pain

A combination of psychic and somatic components that depend on set, setting, personality, as well as the physical or organic factors determine the severity and nature of pain. Individual and interactions with others also frequently play significant roles. Mood is affected by injury or damage. Mood affects the perception of physical dysfunction. Fatigue increases the vulnerability to pain and decreases resistance to perception of pain. Perception of pain is changed by cannabis.

Hare suggested in 1887 a possible mechanism of cannabis’ analgesic properties:

 “During the time that this remarkable drug is relieving pain a very curious psychical condition manifests itself; namely, that the diminution of pain seems to be due to its fading away in the distance, so that the pain becomes less and less, just as the pain in a delelicate ear would grow less and less as a beaten drum was carried farther and farther out of the range of hearing.

This condition is probably associated with the other well known symptom produced from the drug; namely, the prologation of time.”[xix]

Interviews with patients medicating with cannabis for pain indicate the perception of pain is changed. Paradoxically, for some, pain becomes more tolerated it is perceived as being “owned” and actually part of the person instead of a process with an existence and life of its own. Cannabis appears to connect the localized discomfort. The awareness change relieves the sense of separateness and out of control quality of the discomfort. The fear diminishes as the perception of separateness of the pain source is altered. A sense of control is restored through this integration.

The immobility caused by the feeling of an inner disintegration is eased without the sedation, constipation, anorexia, and itching from opioid use is avoided. Cannabis both integrates and mobilizes afffect from the easement of cannabis which is distinct from other sedatives or analgesics.

The comparative safety and freedom from annoying or incapacitating effects of other drugs used for symptom management in chronic illness cannot be overstated. The relief of depression and anxiety from cannabis is a significant aspect of the analgesic effects of the drug.

This complex pharmacologic spectrum of actions defies semantic constraints of categorization as narcotic, hallucinogen, or sedative. Easement would appear to be a more precise description based upon ethnographic, medical, pharmaceutical liturature, and clinical observations of low and appropriate therapeutic inhaled or oral cannabis.

These therapeutic properties apply for chronic conditions and experienced users and not for acute effects in naieve subjects, nor oral overdose. For the latter, hallucinogen might apply.

The therapeutic mechanisms of cannabis afford opportunities for studying mind body connections to better understand the human complex interplay of set, setting, personality with cannabis in the management of chronic illness.

Semantic characterizations are important in shaping not only personal experience but institutional policy as well.

THM

March 1, 2001

Berkeley