Cannabis: Acute negative reactions

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Acute negative reactions

The use of cannabis, like any other substance, can cause “acute negative reactions”, that is, physical or mental disorders related to the administration of a single dose. They must be distinguished from “chronic negative reactions”, which derive from the prolonged use of the substance and generally have a permanent character, affecting the psychophysical state of the consumer even outside periods of intoxication.

In this chapter we will describe the most typical acute negative reactions, the possible aggravating factors, the statistical incidence of the phenomenon and a hypothesis will be drawn on the mechanism by which the reactions themselves materialize.

Negative physical reactions

According to Blum, the main negative physical effects of cannabis (compared to those of acute alcohol intoxication) would consist of:

– Nausea and headache (21% of cases for cannabis, 89% for alcohol);
– Insomnia (2% for cannabis, 4% for alcohol)

The Canadian commission report describes all possible physical ailments (without going into “how often”):

– Tachycardia, gastrointestinal disturbances (nausea, vomiting, diarrhea, constipation), headache, cramps, dizziness, fainting, numbness, lack of coordination, ataxia, tremors.

According to the US commission report, the most common effects are:

dizziness, nausea, motor uncoordination, tachycardia.

According to a Berke-Hernton study (1974) the most frequent effects would be:

– Nausea (found at least once by 18.2% of consumers)
– Malaise and vomiting (11.9%)
– Dizziness (11.3%)
– Headache (4.8%)
– Fatigue (3.8%)
– Tendency to pass out (3.4%)
– Sense of heaviness (2.9%)
– Sense of cold (2.7%)

Negative psychic reactions

In the context of psychological reactions, Kaplan has identified the most typical negative effects of the phenomena of:

a) Anguish, b) Depression, c) Paranoia

They would happen due to the particular emotional sensitivity caused by the substance, the distortion of temporal perception, the loss of control over mental processes.

Blum thus determined the statistical incidence of the main negative psychic effects of cannabis compared to those of alcohol:

– Emotional disorders (15% for cannabis, 11% for alcohol)
– Thought disorders (9% cannabis, 21% alcohol)
– Learning disorders (2% cannabis, 5% alcohol)
– Hallucinations (8% cannabis, 1% alcohol)
– Sexual difficulties (1% cannabis, 6% alcohol)

According to Grinspoon the most frequent negative effects are: a) Panic, b) Paranoia, c) Depression.

Psychosis, usually associated with excessive doses or oral ingestion of the substance, is rare.

The US commission believes that the perception distortions typical of cannabis (perception of time and subjectivity) can cause: a) Panic, b) Loss of control, c) Depersonalisation; these phenomena would more easily arise in rigidly structured personalities.

Regarding the negative psychic effects, the Canadian commission cites Becker’s hypothesis that the most frequent disorder is anxiety, mainly due to the lack of familiarity with the effects of the substance; anxiety would be increased by any therapeutic intervention that determines a psychiatrizing interpretation of the malaise in the subject, where the only effective intervention consists in the “redefinition” of the effects, that is, an aid in interpreting the overall effects of the substance.

According to the NIDA report, the most frequent negative reaction consists of panic and anguish, and is due to an exaggeration of the typical effects of the substance; the reaction is more common in inexperienced consumers and wears off in a few hours without the need for any special treatment. Another common effect is a feeling of paranoia, light and short-lived.

A study carried out in Costa Rica finds that the negative reaction most frequently reported by consumers is a feeling of panic (called “white death”), which is not attributed by traditional medicine to excessive dosage, but to the psychophysical state of the subject; the “white death” is treated with water and sugar and rapidly regresses.

Another disturbance detected by the same research (very rarely) is the “flash back”, that is, the reproduction of the symptoms of intoxication after some time; no cases of acute psychosis or acute toxic psychosis were found.

An overall picture of the negative psychic effects, can be formed from the testimony of 150 consumers, Also Tart classified the different negative effects (which, on the other hand, are not all intrinsically undesirable) into four categories of frequency: characteristic effects, common, not frequent, rare:

Characteristic effects

“Thoughts take off and are not easy to be caught”

Common effects

“Impossibility of thinking clearly; escape of thoughts “
“Less efficient mind to solve problems”
“Less accurate work”

Not so frequent effects

“Impossibility to return to a normal state”
“Paranoid feelings towards companions”
“Worsening of memory”

Rare effects

“Sense of being possessed by a hostile force”
“Muted Sounds”
“Fear of losing control and let go”

According to Tart, a typical negative effect is what is called “freak out” or “emotional crisis”, ie the fact that the “consumer is temporarily overwhelmed by intense negative emotions”.

The emotional crisis would be mainly linked to three factors:

a) pre-existing emotional problems;

b) The amplification of emotions typically caused by the substance;

c) The anxiety provoked in the less expert consumers by the lack of knowledge of the overall effects of the substance

The concept of “emotional crisis” is covered more in depth by Berke – Hernton, according to whom there are two main negative emotions: a) fear b) depression

“Fear is the main negative emotion that interferes with the pleasant effects associated with cannabis use.” There are different levels of fear. At the lowest level there is a slight anxiety, which is typical of novice users. There follows a sense of panic, intense as “Intense and unpleasant anticipation of a danger”, which is linked to changes in the perception of internal and external reality, and becomes concrete in the fear of not being able to return to the normal state, of not communicating with others , in other words to go crazy.

More serious is paranoia, that is, the feeling of being persecuted; it would be determined by an unconscious refusal of the experience with drugs, and by a projection of the refusal on other people.

Another component of the paranoia of being persecuted would be the unconscious sense of guilt of consumers, enhanced by the objective situation of illegality and social censorship to which consumers themselves are subject to in our culture.At a higher level, although very rare, there is a real acute toxic psychosis known as “freak out”: anguish, paranoia, hallucinations, mental confusion.

Depression essentially depends on pre-existing negative emotional conditions in the subject, or linked to environmental circumstances; in both cases, negative emotions are enhanced by cannabis. The depression would stem from the fact that the consumer rejects the drug experience, and ends up projecting this aggressive charge on himself (instead of on other people, as in the case of paranoia).

Influence of complementary factors

We have seen how the subjective and objective methods and circumstances of use (that is, what we have called “complementary factors”) are considered of often decisive importance in determining the negative psychic reactions when using cannabis. It will therefore be interesting to analyze how each of the complementary factors affects the phenomenon and to what extent.

A) Method of use

The method of administration greatly affects the risk of suffering adverse or negative effects. The oral intake is certainly a possible aggravating factor, because: a) the effect, is not experienced immediately as when the substance is smoked, it is difficult to “calibrate” by the consumer, and therefore a super-dosage is easy and can happen; b) the quantity of active substance, generally mixed with other (sweet) ingredients, cannot be controlled by the consumer; c) the effect of the ingested substance is on considerably longer than that which occurs for inhalation.

Dosage is obviously essential. Negative reactions are very often linked to overdosing. The dosage is linked to the quality of the substance, as different types of plants and parts of the plant also correspond to very different quantities and different types of active ingredient.

B) Personality

It is difficult to assess to what extent the rigidly structured personality (that is, with particularly deep-rooted “cultural influences”) can affect the onset of negative reactions. There is indeed reason to believe that subjects of this type have no need to experiment with cannabis; on the other hand, conscious or unconscious resistances generally manage to cancel the effects of the substance, simply by not recognizing them, not using them, and in extreme cases forgetting about them.

If this resistance line does not hold, anguish and paranoia can be experienced through the mechanism described by Berke-Hernton. The existence of psychotic traits is considered by many to be an element of risk for the onset of psychosis, which would however be short-lived. As for the influence of neurotic traits of the consumer personality, and given the enormous variety of situations that can be defined with this term, a possible correlation between this type of personality and the onset of negative reactions is not yet clear.

C) Psychophysical conditions

As with any other substance, the existence of particular physical conditions can increase the risk of negative reactions. It has been seen that the use of tobacco and alcohol, and the state of pregnancy, have been indicated by Berke-Hernton as predisposing factors for the onset of negative somatic reactions.

In particular, the simultaneous use of alcohol and cannabis (very frequent, for the social circumstances in which the use of cannabis takes place in the context of our culture) has been indicated by many researchers as an aggravating factor for the driving ability of motor vehicles.

It has been mentioned how pre-existing emotional conditions can influence negative reactions, in particular the determinism of depressive phenomena. On the other hand, cannabis has always been used as a sedative and euphoric inducer in oriental medicine: it would therefore be incorrect to automatically count a state of depression among the contraindications to the use of cannabis.

From all the available data, it seems that it’s possible to say that a state of light depression, in particular if caused by the lack of stimuli rather than external disturbing factors, will probably be canceled by the positive effects of the experience, while a deep depression, linked to personal or external factors of great importance, can be easily amplified by the effects of the substance, risking to precipitate a negative psychic reaction.

Familiarity with the substance seems to be another determining factor: many researchers have found that most of the negative effects occur during the first experiences. It has been seen that the anxiety of inexperienced consumers has been attributed to their difficulty in interpreting a series of unknown effects.

D) Environmental factors

The environment in which the substance is consumed has, according to almost everyone, a remarkable influence on the possible occurrence of negative effects. Experienced consumers choose the environment and above all the company of people with whom there is maximum harmony, possibly avoiding the company of non-consumers: they know that relations with the environment and with other people are felt with greater immediacy and, if they evolve in a negative way, they can influence the whole experience by directing it towards depression and paranoia.

The importance of the environment is demonstrated, among other things, by the discrepancy between the data collected on subjects analyzed in the laboratory and those reported by consumers on their experience in the usual context.

D) Social factors

The social situation of cannabis users, and in particular the state of illegality of consumption, is according to several researchers (among others Grinspoon, Zinberg-Robertson, Berke-Hernton) a determining element of negative reactions, through the dynamic described by Berke- Hernton. The argument that negative reactions are less frequent in countries where the use of the substance is not criminalized is confirmed by confirming this hypothesis.

Statistical impact

The statistical incidence of negative psychic reactions has been investigated by several researchers (Hochman-Brill and Berke-Hernton), each of whom has followed different methodologies. From the generally discordant data, it appears that only paranoia is the most frequent phenomenon. This is confirmed by the Goode investigation according to which paranoia is the main negative effect (reported by 15% of subjects), and by the Tart investigation, which includes paranoid thoughts among the “infrequent” effects.

Therapy

The negative somatic effects do not require specific therapy, but possibly symptomatic remedies. The negative psychic effects, apart from the rare cases of psychosis (which also tends to regress spontaneously) do not require real medical therapy. According to many researchers, the most effective intervention is to reassure the subject by helping him to redefine the content of the experience.

According to Hochman “the essential factor of this intervention seems to be true empathy for the experience of the substance that can only come from another consumer. Those who have a closed and severe attitude towards drugs cannot provide the assistance that is required by these exceptionally sensitive consumers “; the validity of this principle has been demonstrated by the experience of some Californian “free clinics”. The psychiatrization of the disorder can aggravate it.

Mechanism of action

Dealing with “cultural influences”, it was mentioned how they can also be considered as defensive mechanisms, through which the relationships between the individual and the environment take place in the simplest and least tiring way possible.

The voiding of the conditionings caused by cannabis can therefore, under certain conditions, expose mental activity to a mass of stimuli that are difficult to manage. This will be clearer by analyzing individually what the “primary effects” of cannabis are.

A) Detachment from the social role

The detachment from the role – of which we have highlighted the protective characteristics – is in itself a potentially destabilizing factor, insofar as it forces the individual to check and redefine himself according to subjective criteria, and to elaborate the stimuli coming from the environment in an autonomous way (and not according to the patterns dictated by the role).

The tendency to introspection can bring out removed unconscious material; if the material is felt to be dangerous, a paranoia or distress reaction may occur according to the mechanism described by Berke-Hernton. The intensification of emotion(s) is also linked to the phenomena of paranoia and depression.

B) Changing perceptions

The cancellation of the “mnemonic scheme”, depriving the sensory perceptions of the usual references, can contribute to determining a “depersonalization” (loss of identity).

C) Slowing down of time

The feeling of slowed time, depriving the conscious self of the usual temporal references (past and future), can be a factor of depersonalization. The weakening of short-term memory, and the flight of ideas that sometimes derives from it, can cause the feeling of “loss of control” which is one of the most frequently described negative effects. The slowing down of time can in itself be an aggravating element of all negative effects, to the extent that the subject perceives the experience dilated over time.

Effects on social behaviour

Definition of “amotivational syndrome”


A fairly widespread hypothesis is that prolonged use of cannabis can lead to a permanent change in social behaviour, called amotivational syndrome. However, the real concept of this syndrome has not been sufficiently clarified.

First, there is often confusion between permanent effects and acute effects (which coincide with intoxication, and do not determine a permanent influence on behaviour).

Secondly, there is no single definition of the phenomenon, so much so that each researcher has described it in a different way.

The Canadian commission defines the amotivational syndrome as a “set of symptoms which includes apathy, inefficiency and unproductivity, and which is considered to reflect a general lack of motivation”.

Mellinger speaks of “apathy, lack of clear goals, flattening of affects and mental confusion”.

For the US commission it is a “lack of real interest in any other activity other than the use of cannabis, with the resulting lethargy, amorality, instability, and personal and” social “deterioration.

According to McGlothin-West, the use of cannabis can lead to an amotivational syndrome characterized by “development of a more passive, more introspective personality … progressive change from orderly, learning-oriented behaviour to a state of relaxed and careless wandering … lack of efficiency, decreased ability or willingness to carry out complex long-term plans, to endure frustrations, to perform routine activities, to successfully face new situations … the subjects show greater introversion, are totally involved in the present and renounce future goals; they show a strong tendency towards a regressive, childish and magical way of thinking ”.

It seems clear to us that the first two definitions, although different from each other, give an objective picture of a situation that can be considered as being pathological.

The last two, and in particular the detailed one by McGlothin-West, include in the syndrome behaviours and attitudes that can be considered as pathological only in the context of a strictly one-dimensional cultural approach: they do not give the scientific definition of a disease, but the cultural definition of a deviant behaviour. For example, the “diminished will … to perform routine activities” does not necessarily imply a lack of motivation, but motivations other than those that most routine performers accept passively.

As for the “lack of efficiency, diminished ability … to complete complex plans … to successfully face new situations”, the pathological connotation of these characteristics is clearly destined to be used one-way against those whom the dominant culture considers deviated.

If in fact the formulation had an absolute value, it could well apply to entire categories of bureaucrats, as well as to the political class. The same consideration applies to the “renunciation of future goals”: if the survival of the planet is legitimately included in these objectives, it cannot be forgotten that the very representatives of deviant cultures have denounced and denounce the risks of the policy of waste, pollution, the nuclear bomb, armaments, where the attitude of the dominant culture has always been based on providence rather than on the “future objectives” of rational planning.

To resolve this fundamental ambiguity in defining the phenomenon, it seems appropriate to differentiate two distinct aspects:

a) The lack of motivation
b) The existence of deviant reasons

Amotivational syndrome as a lack of motivation

The existence of an intense amotivational syndrome such as “lack of general reasons” has been reported by the US commission in countries where the use of cannabis is traditional, in subjects belonging to the most disadvantaged classes; however, it has been noted that:

“Poverty, deprivation and disease are the conditions in which these people were born and in which they remain, regardless of whether they use or don’t use cannabis; in this context, resignation to these living conditions does not seem to be provoked or significantly influenced by the effects of cannabis. “

Research carried out in Jamaica, on the other hand, shows that the use of cannabis, in doses much bigger than the usual ones in the West, seems to determine an increase in productivity in workers. (The same thing was reported to us by our local source in Malawi who said that workers are able to feel and have much more energy after sampling cannabis and are able, for example, to dig big holes etc. etc.) .

The “ganja” is in fact considered a stimulating substance in the culture of that country, and Jamaicans habitually smoke during work to recover energy; it should be noted that it is generally manual work, and that, unlike in free time, Jamaicans tend to limit the dosage, smoking the substance in cigarettes instead of in the pipe.

Based on this data, L. Comitas has definitely rejected the hypothesis of the amotivational syndrome with an effect of the use of cannabis. No signs of amotivational syndrome have been found in Costa Rica, Greece, India, and South Eastern Asia. A causal relationship between cannabis and amotivational syndrome was denied by the NYAS final report.

The amotivational syndrome as deviance of motivations

In western countries, the use of cannabis coincided, at least until a few years ago, with the choice of values and behaviours in opposition to the dominant culture (commonly called “alternative culture”), which sometimes imply a conflictual relationship with the school.

On the basis of this data, some researchers have stated that there is a causal relationship between cannabis use and amotivational syndrome (understood as the development of deviant motivations), proposing school performance as an evaluation parameter: it has been argued that the use of cannabis determines a lower than average academic performance and a greater tendency to drop out of school.
This hypothesis has been denied by the US commission according to which:

“There has been no conclusive evidence that marijuana itself is responsible for school failures or dropouts although it may be one of many reasons. A lot of research has found that the majority of young people who have used marijuana have scored higher than or equal to the average. “

A survey promoted by the Canadian commission found that consumers perform slightly below average in high schools, equivalent to the average in universities; similar results have given consumers of alcohol and tobacco. A research by Goode found that: 1) from the comparison between students who are cannabis users and students who are not cannabis users, it appears that the academic performance is identical; 2) making a further distinction between light consumers (no more than once a week) it is found that light consumers report higher marks and heavy consumers lower marks than non-consumers.

Goode concludes that, since there can be no direct pharmacological action, the decrease in the performance of heavy consumers is linked to their involvement in the “drug subculture”, that is to the fact that they hang out with other consumers, with whom they develop interests that are different from those of school.

Hochman, during a research on 400 students from the University of Los Angeles, with 5 years of use, 3 or more times a week, found that consumers report slightly higher marks than non-consumers. Hochman also traced a cultural profile of cannabis users, analyzing their attitude towards a range of problems. The following data resulted:

a) sex: in the consumer group there was greater sexual activity and freedom, and a lesser tendency towards marriage

b) politics: in the consumer group there is a greater tendency towards politicalinterest (20% against 8% of non-consumers); in the event of a call to arms (at the time the war in Vietnam was underway) only 10% of consumers were willing to join the army (against 56% of non-consumers)

c) Way of life: consumers show a clear tendency to live outside the family (28% against 10% of non-consumers), to live together with other young people and to greater mobility.

According to Hochman, this data shows that consumers have a very precise cultural characterization: this would happen not only because the use of cannabis directly affects the development of certain attitudes, but above all because (a) those who chose to use this substance were already a priori less conformist than those who chose not to use it, and (b) consumers tend to hang out together and see each other, and this contributes to stimulating and strengthening certain existential and political attitudes.

Hochman’s study has, probably, a limited value at the time it was performed (1971). In fact, the same researcher said: “There is an increasingly clear impression that as the use of cannabis has spread, these differences between consumers and non-consumers tend to disappear (testimony at the assembly of the state of California, 30 March 1971).

On the other hand, the problem of students must be reconsidered in the light of the dramatic explosion of intellectual unemployment, so leaving school could be considered a realistic choice.
The 1976 NIDA report confirms that there are no differences in educational performance between consumers and non-consumers, but objects that these data could be invalidated by the possibility that a certain number of consumers will drop out of studies before having finished them regularly;

This topic seems unconvincing, because a possible leaving school and studies in general should, however, be reflected in a period of insufficient performance before becoming final.
Indeed, Mellinger’s research at the University of Berkeley has shown that moderate use of cannabis is not a significant cause of dropping out of studies or amotivational syndrome.
The relationship between cannabis use and amotivational syndrome was also denied by a laboratory experiment performed by Mendelson. To end the speech on amotivational syndrome in young people, we report the final comment of the Canadian commission:

“There is a widespread feeling that certain types of drugs negatively influence an important component of the development and functioning of our society: aggressiveness, competitiveness, possessiveness, exclusive orientation towards certain goals, willingness to exchange the present pleasure for future rewards, ability to tolerate repetitive tasks … Those who criticize modern industrial society …, and the values and attitudes that move it, say that in the end it would be good if the ancient values and attitudes were destroyed and replaced by new values. This is not a problem that can be solved with discussions. It is much better to admit frankly that there are two points of view that are difficult to reconcile…. Drug use is not the cause of this cultural conflict, it is only one aspect of it!”

In addition to students and young people in general, cannabis use affects a considerable number of adults. The U.S. commission has found the existence of numerous socially and economically established groups of marijuana users in the legal, medical, banking, educational and commercial professions, which maintain a lifestyle that is completely indistinguishable from that of their non-consumer colleagues.

The Canadian commission found that the use of cannabis among adults is increasing, and that “the attempt to differentiate adult consumers from non-consumers based on their social behavior” is impossible.

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