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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5536_Библиотеки_им_академика_М_И_Перельмана.pdf
Cannabis and Amphetamines
The most famous early users in the history of cannabis were the Hindus of India and
Nepal. Soma, a drug mentioned in early Hindu texts as an intoxicating hallucinogen,
may have been a reference to cannabis. Spreading with the Indo-Aryan culture from
India outwards, cannabis was introduced to the Assyrians (Iraq/Syria), Scythians
(Eurasian steppe), and Thracians/Dacians (Greece and the Balkans) in the 3rd and
2nd millennia BCE. The shamans of the latter culture were called kapnobatai —
“those who walk on smoke/clouds.” They used burning cannabis flowers to induce
a state of trance. This practice is believed to have been inherited by Greek oracles
and worshippers, including members of the cult of Dionysus.
Early users in the history of cannabis would have also been attracted to the plant by
its positive medical properties, including the alleviation of pain, nausea, depression,
and as an agent for encouraging the appetite. Modern science has uncovered
additional benefits from cannabis, including the inhibition of cancer cell growth
and the reduction of memory impairment in the elderly. On the negative side,
cannabis use has been found to correlate with anxiety, but there is debate as to
whether its role is causative or merely correlative. There are harmful chemicals in
marijuana smoke, so patients consuming the drug for medical purposes often do
so orally or by using a vaporizer.
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After cannabis was used freely for thousands of years, a major change in the history
of cannabis came in the early 20th century, when prohibitionists in the United States
succeeded in getting the government to criminalize the drug, beginning with the
Marihuana Tax Act of 1937. This was followed up by subsequent legislation in 1951
and 1971 (the Comprehensive Drug Abuse Prevention and Control Act of 1971).
The leading figure in the criminalization of cannabis was conservative Harry Jacob
Anslinger, who linked the drug to moral decline and even spontaneous murder.
260
From the 1970s to the present, the legality of cannabis has been a contentious
issue between those arguing for the repeal of prohibition and those who wish to
uphold it.Medical marijuana is allowed in several US states, in defiance of federal
anti-marijuana laws. Extensive debates are ongoing at the state and federal levels.
Illustrated Handbook of Drugs & Alcohol Related Health Issues
Medical Uses of THC
Tetrahydrocannabinol, also known as THC, helps reduce nausea and vomiting, which
is particularly helpful to patients undergoing chemotherapy for cancer. Patients
suffering from AIDS often experience a lack of appetite, of which tetrahydrocannabinol
is also helpful in counteracting. Found in marijuana, tetrahydrocannabinol is also
sometimes used for glaucoma relief.
Obtained from the cannabis plant, marijuana is an herb frequently researched for its
medicinal use because of its high concentration of tetrahydrocannabinol. Smoking
marijuana for medicinal purposes is often debated among researchers, lawmakers
and average citizens. While THC is known to be helpful in pain management,
appetite stimulation and alleviating nausea, the amount of THC an individual inhales
by smoking marijuana is not easy to discern since the amount smoked may vary and
tetrahydrocannabinol levels cannot be properly measured. Taken in pill form, however,
medical researchers have discovered that tetrahydrocannabinol is effective in some cases.
Chemotherapy is one of the most common treatments for patients battling cancer. It
is not without side effects, however, which include extreme nausea and vomiting.
Tetrahydrocannabinol is known to help offset these effects, and doctors often
prescribe measured doses of it in pill form for this reason.
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Cannabis and Amphetamines
Patients suffering from AIDS often experience a loss of appetite, as well as extreme
weight loss. Tetrahydrocannabinol is known to stimulate the appetite, however,
which is why it is often used by AIDS patients. With the help of THC, many people
afflicted with AIDS are able to maintain a healthy weight.
THC is also believed to reduce intraocular pressure in the eyes, which may be
helpful to individuals suffering from glaucoma. Research indicates, however, that
the amount of relief it offers may not be enough to prevent permanent damage
to the optic nerves. Doctors, therefore, do not recommend tetrahydrocannabinol
as a primary treatment for glaucoma, though some do use it to complement other
treatments for this condition.
Marijuana is also believed by some to be helpful in treating certain neurological
disorders, psychological disorders and other painful conditions, such as nerve
damage. Anecdotal evidence exists which suggests that marijuana is useful in the
treatment of anxiety disorders and other conditions, such as ulcerative colitis.
Research has been performed to determine whether it is effective in treating these
and other conditions, but results have not produced clear evidence for marijuana’s
effectiveness in other treatments.
In the United States, the Food and Drug Administration advises that THC only be
used when other medicines are not helpful in treating pain, nausea, vomiting and
loss of appetite. When tetrahydrocannabinol is prescribed, doctors typically only
allow patients small amounts of the substance and only do so for a limited time.
This is because long-term use leads to addiction and other possible side effects,
such as psychosis.
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Medical Marijuana License
A medical marijuana license is a form of legal documentation that allows anyone
with proper medical papers to purchase and use medicinal marijuana. Medical
cannabis, or marijuana, is not legal in every country. Limited use of medicinal
marijuana is legal in Canada, Austria, Germany, the Netherlands, Spain, Finland,
Israel, and Portugal. Some states within the United States allow the legal purchase
of medicinal marijuana.
Each aforementioned country’s government plays a large part in the growth, purchase,
and distribution of medicinal marijuana. Regardless of particular laws surrounding
legal cannabis usage, almost all countries require citizens to obtain a medical
marijuana license prior to purchase or use of the plant.
To gain a medical marijuana license, one must be ill in some manner. Therefore,
each person who wishes to obtain a license must speak with a medical doctor prior
to purchasing marijuana from a legal seller. There are many different ailments that
may qualify for a medical marijuana license. Both mental and physical illnesses
can result in the distribution of a license according to government regulations.
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Studies have shown that marijuana can ease many illness-related symptoms caused
by Alzheimer’s, diabetes, attention deficit disorder, asthma, depression, skin tumors,
sleep apnea, breast cancer, HIV/AIDS, and many other ailments. People who are
facing end-stage diseases are also often granted a legal license.
Illustrated Handbook of Drugs & Alcohol Related Health Issues
There are many different methods available for using medicinal cannabis. Taking
capsules, smoking, drinking, and eating marijuana are all ways that patients can
reap the benefits of this drug. While smoking marijuana is the preferred method
by many patients, there is some controversy surrounding this type of consumption.
Many doctors and scientists argue that smoking anything is not beneficial. This
theory is based upon the fact that cigarettes often cause lung cancer due to smoke
inhalation amongst other things. Also, some argue that smoking any kind of drug is
not an effective way to distribute a drug evenly throughout the body, since smoke
cannot be controlled.
Contrastingly, there are many people around the globe that are pushing for the
legalization of medicinal marijuana. These proponents of medical cannabis base
their arguments upon numerous studies that show the positive effects of this drug.
Still, the world is largely split over the legalization of marijuana.
If you happen to live in a country or state that allows the legal consumption of
medicinal marijuana, you must speak with a recognized medical doctor prior to
obtaining a medical marijuana license. Once an license has been issued, you can
only purchase this drug from legal government distribution centers.
Cannabis and Amphetamines
263
Marijuana
Marijuana, also known as cannabis, is an annual plant that is grown worldwide
for its fibers, which are used to make hemp fabric; its seeds, which are used for
birdseed; and its buds, which can be smoked for recreational and/or medicinal
purposes. The plants are usually between 1 and 5 feet (0.3 to 1.5 m) tall and can
thrive in a variety of climates given adequate light, including indoor “grow rooms.”
The plant is thought to have originated in Central Asia, near present-day Tibet.
Evidence of marijuana’s use and cultivation stretches back to 10,000 BC, represented
by charred seeds found in a ritual brazier in Romania. It is estimated that about
4% of the world’s adults use it annually and 0.6% use it daily. This translates to
about 264 and 40 million people respectively.
Much of marijuana’s fame and controversy comes from its use as a psychoactive drug.
As a drug, marijuana has many names Ganga, weed, trees, etc. In many countries, it
is expensive because its use as a drug is either illegal or tightly regulated. In many
other countries, however, like Mexico, Canada, the Netherlands, Spain, Australia,
Russia, Iran, France, and Italy, the plant is either legal or nominally illegal but the
penalties for its use are rarely enforced in practice. This makes it less expensive
and more widely available.
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When smoked, marijuana gives the user a “high,” a mild feeling of elation, pleasure,
and wonder. The onset is rapid, taking about 2 to 5 minutes, and lasts for about 30
minutes to three or four hours, depending on the dose. Being high on marijuana
changes the way people interpret sounds and color, making auditory and visual
experiences more stimulating and intense. This is why its use was been intensely
promoted by music fans in the 1960s and 70s, and it continues to be used frequently
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at rock concerts. Using it gives the user a soothing sensation that diminishes the
pain of diseases like cancer and AIDS.
Besides the positive aspect, marijuana has some downsides. It may cause a slight
feeling of paranoia in the user, which may exacerbate pre-existing paranoia derived
from using an illegal drug in the first place. It causes lethargy and poor motor
coordination, meaning that operating heavy machinery or driving under the influence
is inadvisable. In some countries, using or possessing it is illegal, meaning that
being caught with it can lead to fines or jail time. In some countries and areas,
like Hong Kong for instance, the plant is so illegal that growing or distributing it
can lead to life imprisonment.
Illustrated Handbook of Drugs & Alcohol Related Health Issues
What are the Facts about Smoking Marijuana?
In much of the world, smoking marijuana has become a criminal act and has a
reputation as a dangerous drug. The facts concerning smoking marijuana sometimes
paint a different picture of the drug; while it can be a health hazard for many
people, recent research contends that it can be useful as a medical treatment as
well. It is important to keep in mind, however, that smoking marijuana is still illegal
in many countries, despite what research or public opinion may dictate.
Citation: http://images.wisegeek.com/girl-with-marijuana.jpg
Cannabis and Amphetamines
Smoking marijuana can cause a psychoactive experience: that is, the drug can alter the
brain’s function, changing mood, thought processes, cognition, and behavior. It does
so because marijuana contains a chemical compound called tetrahydrocannabinol,
or THC for short. While smoking marijuana is today considered illegal in much of
the world, the drug has been around for centuries and has even been considered
a function of religious importance in some cultures. Marijuana has only relatively
recently become an illegal substance, not to mention a social taboo.
The effects of smoking marijuana are hotly debated. Some research suggests that
smoking marijuana can increase the risk of stroke, cause addiction and lead to
other more dangerous drugs. Other research suggests that marijuana can actually
aid patients in extreme pain. Marijuana is known to increase appetite in patients
undergoing chemotherapy, and it can also decrease stomach pain. It has been
known to be extremely helpful to glaucoma patients because it lowers the pressure
on the eyes. In some parts of the United States, marijuana has been legalized for
medical purposes; in other parts of the world, the drug has been legalized for both
medical and recreational purposes.
Marijuana must be inhaled or otherwise ingested in order to have any effect on
the human body. Smoking marijuana is not the only method of taking in the drug.
Vaporizers heat the plant to a certain degree, such that the active ingredients
evaporate. The vapor can then be inhaled. Other ways of taking in marijuana
include ingesting it orally, though the plant would still need to be heated to a
certain degree to activate the key ingredients.
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The marijuana plant is indigenous to south and central Asia and has been in use
there for centuries. The plant can be harvested and used to make different versions
of drugs, each with different strengths and dangers. Other versions of drugs made
from the marijuana plant include hashish, which is a concentrated resin made
from the female plants. The effects are similar to marijuana, but hashish is more
concentrated and usually much stronger.
266
Illustrated Handbook of Drugs & Alcohol Related Health Issues
PHARMACOLOGY
Cannabis sativa contains over 400 chemical substances about 60 are responsible for its
unique effects. The principal psychoactive ingredient is delta-9-tetrahydrocannabinol
(THC). THC is largely responsible for the person feeling ‘stoned’ with changes in
mood, thoughts, perceptions and motor skills when intoxicated. THC is lipophilic
and rapidly taken up by fatty tissue. This results in a slow elimination of metabolites.
THC content varies greatly (from 0.5–12%), depending on genetic and environmental
factors and the method of preparation.
When writing about drugs and how they are used, certain things are taken for
granted: an understanding that drugs have an effect, that this effect leads to tolerance,
that tolerance leads to addiction, and therefore drugs are bad. But how drugs exert
their effects is rarely explored in-depth, and this leaves a huge knowledge gap
between the scientists that are working to understand marijuana and the people
who wonder why such an effective plant needs to be studied at all. This is an effort
to at least partially redress that. It is not an extensive overview of pharmacology,
just an overview of the basics.
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Cannabis and Amphetamines
267
Getting in, getting out
Pharmacokinetics deals with the movement of drugs into, within, and out of the
body. How a drug gets into the body can have a major effect on how much of an
effect you feel, how long the effects last, and how quickly you recover. Drugs that
are ingested, for example, tend to have longer-lasting but less intense effects than
drugs that are inhaled. Drugs can also be absorbed through the skin, or injected
directly into the bloodstream. But once they are inside, all drugs will, at some
point, be processed and cleared by the liver and kidneys.
The rates at which these processes occur can vary somewhat between individuals,
but by and large these are purely chemical processes. The differences come down
to physical factors, such as body fat content—since fat absorbs some chemicals
but not others—size and weight, the amount of drug that was ingested, whether
the drug is more soluble in fat, or whether it can be bound by blood proteins, etc.
But the basic premise is that all humans, barring a genetic anomaly, operate under
the same basic rules of physiology.
Pharmacodynamics
Pharmacodynamics deals with how drugs exert their effects, and while it may start
with a question such as “How does this make you feel?” we are rapidly closing
in on the exact interactions between different drugs and different receptors, and
everything that happens afterwards. It’s common knowledge that not everybody is
affected by cannabis in the same way; that the same person may even experience
cannabis differently if he eats it as opposed to smoking it. But why is this, if
marijuana only interacts with CB1 and CB2 receptors?
Yes, that’s right: of the almost-500-active compounds found in marijuana, most of
the effects can be directly linked to the cannabinoid receptors (CB1 and CB2),
or which there are only two types in the body. And drugs can’t interact with the
body unless they are bound to a receptor, first (there are a few exceptions, such as
alcohol and cyanide, which are small enough to pass through the cell membranes).
CB1 is found all over the body, but it’s most highly-concentrated in nervous tissue.
CB2 is found primarily in immune cells—and there’s still a substantial amount of
confusion as to what role it plays there.
Making matters even more confusing is that different compounds can elicit different
reactions from the same receptor: a drug can either be an agonist (as THC is for
CB1), activating a certain signaling pathway that ultimately results in the user
getting high; or an antagonist, which prevents any signaling from happening. There
is also what is known as inverse agonism, where a compound activates a signaling
pathway that has the exact opposite effects of an agonist; rather than merely keeping
it “off” as an antagonist does, it actively prevents the receptor from turning “on”.
It is believed, although it has yet to be proven, that CBD, the other major active
compound in marijuana, acts in this way.
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Illustrated Handbook of Drugs & Alcohol Related Health Issues
So the effects of smoking a joint not only come down to the relative percentages
of THC and CBD in the plant, but also how it is delivered, whether you are a
man or a woman, and the balance of agonist and reverse-agonist effects in the
individual cells—and the interactions with other neural pathways that may or may
not be activated at the same time. It is no wonder that the claims of marijuana’s
medical usefulness are so varied, and no wonder that it is taking so long to sift
through them.
Beyond THC and CBD
Given the shortcomings of plant-based medicine—the inconsistency of the product
from batch to batch, plant to plant—it’s should come as no surprise that pharmaceutical
companies are looking for alternatives to THC. Many compounds have been created
in the lab that are CB1 and CB2 agonists or antagonists, but so far only rimonabant
has made it to market—for a grand total of two years before it was withdrawn over
concerns for the patients’ psychiatric health. Rimonabant was intended to be an
anti-obesity drug, as its main effect was curbing appetite, but it was never approved
for use by the FDA, and only saw limited utility in Europe.
Part of the issue is with the basic biology of the endocannabinoid system itself.
Unlike, say, cocaine, where the reward center that get acitivated are well-defined, the
endocannabinoid system is global, and frequently interacts with other neurotransmitter
systems. People with a particular variance in their serotinergic system, for instance,
may be more prone to anxiety when they are given a CB1 antagonist. There is also
some evidence that suggest that rimonabant could be used to curb nicotine addiction.