by Chris Conrad
Researchers have found neither impairment nor improvement in objective visual acuity or in the perception of light brightness, testing both naive and experienced users at smoked doses of four to six mg THC.9 Other studies demonstrated that there was no effect on depth perception, duration of after-image, or visual motor coordination tests. Conventional wisdom once held that cannabis dilated the pupils and some early studies had reported enlarged pupils and a sluggish reaction to light.10 However, when pupil diameter was systematically measured, researchers found no dilation at doses up to 70 mg. To the contrary, sophisticated instrumentation has demonstrated a slight but consistent pupillary constriction within five minutes of smoking.11 A preservation of normal light responsiveness is common, followed in a few hours by a depression of pupillary responsiveness to nearby stimulation, possibly representing fatigue or sleepiness. One study identified a consistent increase in glare recovery time, which persisted for several hours but was not dose related.12 Further tests revealed that this was not related to change in illumination threshold or pupil size.
This extra sensitivity to light, which manifests itself in dark settings, may explain the mechanism behind another possible benefit attributed to cannabis use: improved night vision. M. E. West of the University of the West Indies in Kingston, Jamaica, observed that local fishermen who smoke cannabis or drink an alcoholic beverage made with the stems and leaves of the plant have “an uncanny ability to see in the dark.”13 However, factors such as practice and familiarity with the situation cannot be fully discounted in this observation.
The only eye anomaly that has been established as a pattern among long-term, heavy cannabis users is a slight yellow discoloration of the eye caused by permanent congestion of the transverse ciliary vessels, as observed in the cannabis culture of India.14 This probably has to do with the ongoing dehydration of the eye. The use of lubricating eye drops may help to mitigate this effect. A few patients have experienced rare and peculiar responses, not all of which are desirable. There are anecdotal reports of swollen eyelids, drooping upper eyelids, hyper-sensitivity to light, and rapid, involuntary eye movements.15 Such responses are quite rare, and stop when their consumption of cannabis is discontinued.
A recommended remedy for headaches due to tired or weak eyes combines cannabis tincture with that of nucis vomicus taken several times per day.16 Cannabis also acts as a nervous sedative in exophthalmic goiter. This is a protrusion of one or both eyeballs exposing an unusually large amount of the front of the eye, resulting in a staring appearance. It is usually caused by thyrotoxicosis, an over-active and swollen thyroid gland that is often a result of iodine deficiency, disease, or the side-effect of some drug. This is an example of how an effect experienced as a negative by one user—droopy eyelids—may compensate for a condition and be perceived as a benefit by another patient.
It all depends on how you look at it.
Chapter 8
Eating and Digestion
Hemp crosses paths with the human gastronomic system in four ways. First, its seed is used as a primary food source, and the seed oil can be pressed out to be added to food as a dietary supplement. Second, it is possible to eat the resinous foliage of marijuana and take advantage of its medicinal benefits without smoking. Third, smoked cannabis helps soothe the stomach and prevents vomiting. And fourth, cannabis may change the very nature of the relationship an individual patient has with food.
This last effect is one of the most important benefits of medical marijuana, yet one that is rarely taken seriously. It’s called “the munchies” in the vernacular. That term covers a wide range of effects that have led to countless jokes about marijuana smokers. You take a few puffs. Your mouth begins to dry out a bit, making you want to consume something to moisten your palate. Next comes almost a craving for food, or at least an insatiable curiosity as to what might be available to eat, if you did feel like eating something. After that comes the experimental appetite, in which something you ordinarily would not eat suddenly becomes very appealing . . . or at least worth giving another chance. And once the eating begins, you find a new world of tastes and flavors that triggers a fantastic appreciation of food and unleashes a voracious desire to consume more and more, until someone finally has to pry the peanut butter jar out of your hands at two in the morning.
To many people, however, being able to hold down food and get proper nutrition is no joking matter. When there is no appetite or desire to eat, there is less intake of raw materials for the body to rebuild damaged systems. When a patient can’t hold food down, they can’t eat properly. And if you don’t eat, you die. It’s that simple. Resinous cannabis stimulates the appetite and helps patients with debilitating conditions eat and thereby gain weight, giving them the strength they need to combat disease or infection, and to effect a recovery. Cannabis and its extracts have demonstrated clinical utility in treating persons with anorexia nervosa, as well as the wasting syndrome associated with tuberculosis, AIDS, and cancer. The herb has also proven useful in settling the stomachs of people with problems such as motion sickness. Its euphoric effect also raises a patient’s spirits, improving overall chances of survival and recovery.
This use of cannabis is well established in the classical literature and in folk remedy, although controlled studies of the effect are still lacking due to bureaucratic interference in doing the necessary research. The following patient’s case history goes back to the days before marijuana prohibition began. “As a child about six years old I had developed a severe nausea from some form of germ or virus. My mother took me to see a Finnish doctor in New York. He prepared some herbs in a container, lit them, and with a towel draped over my head I was told to breathe in the smoke. As I remember, it cleared up the nausea and I recovered soon thereafter. This took place about 1933, and I understood it to be an old practice in Finland. It wasn’t until one day I surprised my kids smoking ‘pot’ that I recognized that smell. There should be references to that medical use in Finland and other European countries.”
Of course, such traditional references do exist,1 but many of the health problems for which cannabis has proven most effective are relatively new, such as cancer and AIDS.
COPING WITH LIFE DURING CANCER
Cancer is an environmentally-caused disease in which the body’s natural defense systems are overridden and possibly turned against the patient. Normal cells have growth restraints; cancer cells do not. The resulting development of uncontrolled tissue growths, called tumors, can become malignant and spread through various body systems. These invaders grow at a rapid and painful rate, squeezing out healthy tissues, causing intense pain, and interfering with normal functioning of the body. In most cases, cancer is an age-related phenomenon, so personal risk increases with the individual’s age. Over the coming years, cancer will strike an estimated one out of five Americans and affect three out of four families. About a hundred million Americans now living will develop cancer, and in many cases this will prove terminal. There is, as yet, no cure for cancer. That is why it is important to put the disease into remission in a way that allows a high degree of comfort and normalcy. Cannabis helps make living with cancer easier and more dignified.
My father, Robert Conrad, was one of the unlucky ones. He died of cancer on Christmas Eve of 1994. During his final illness, he was kept at a Veterans Administration hospital in upstate New York, where the doctors gave him a variety of opiates and other pharmaceuticals. These hard drugs were able to control most of his pain, but he suffered a variety of side effects including constipation, lack of appetite, upset stomach, irritability, restlessness, insomnia, confusion, and what he called a “mental fog” that made his conversations disjointed and occasionally incoherent. A fiercely independent man, he was distressed to find himself confined to a wheelchair and hospital bed. We discussed some of the data that showed cannabis could help relieve most of his symptoms. He was interested. “I’ll gladly be the guinea pig to test the stuff out,” he remarked. “What have I got to lose?”
His physician, however, refused even to seriously discuss the use of cannabis as an adjunct to treatment. When my father found out I had mentioned it to his doctor, he became afraid to use the herb, lest it be reported to the police. He continued to deteriorate. I visited him at a picnic table under a large tree growing on the hospital grounds, discussing life and memories. When he was in exceptional misery, I again suggested cannabis. He refused, and warned me not to take any more risks for him. I still remember one of the last conversations I had with him, when he took me by the arm and looked into my eyes with intense inner pain and desperation. “It’s just not right,” he told me. “No one should have to go through this. Promise me something, Chris. Promise you’ll do something to legalize medical marijuana, and make sure no one else has to suffer like this.” When I agreed, he squeezed my arm and nodded his approval. I returned to California. Soon after that he took a turn for the worse, and did not recover. I never saw my dad alive again after that day.
Among the worst experiences many cancer patients cite are the terrible side effects of the most common nonsurgical treatments—radiation and chemotherapy. The problem is that these powerful therapies not only damage cancer tissues but affect healthy tissues as well, leaving the patient in a painful and debilitated state. The treatments often cause reactions that lead to uncontrollable vomiting, which forces all the food out of a patient’s belly and may still continue for hours afterward with convulsive “dry heaves” that leave the patient crumpled on the floor in pain. As the duration of the treatment becomes longer, the cumulative effect can be devastating. While using powerful pain killers, the patient will often lose the ability to eat or rest properly, which can bring on another group of health and psychological problems, or even make the difference between life and death. Some patients discontinue the treatment because they cannot stand its physical toll.
Cannabis boosts patients’ spirits, helps them to eat and combat the excessive weight loss of wasting syndrome, and is also a potent antiemetic. Just a few puffs of a marijuana cigarette can drastically reduce or even completely eliminate the gut-wrenching nausea triggered by chemotherapy and radiation treatments.2 Some of this benefit may stem from the resin’s antispasmodic effect, which suppresses the gag reflex and relaxes abdominal muscle spasms. Whatever the mechanism it follows, studies on cancer patients who smoked cannabis under medical supervision in New Mexico, California, Michigan, New York, Georgia, and Tennessee found that cannabis often reduced nausea and vomiting when all available prescription drugs failed to work.3 A majority of cancer specialists from around the country who responded to a 1991 Harvard University survey agreed that doctors should be allowed to prescribe natural cannabis for their patients.4 Smoking is an extremely effective delivery system, preferred by patients and doctors alike.5 A survey of cancer patients undergoing chemotherapy found that most of them said that smoked marijuana was much more effective in controlling nausea than synthetic THC pills. Smoked cannabis is also less expensive and more practical since, unlike a pill, it cannot be vomited up. It is also less likely than THC to cause unpleasant side effects, because the compounds in natural cannabis that act as buffers, such as cannabidiol, are not included in the pill.
James Cox was first introduced to marijuana following two operations for testicular cancer that had metastasized to his stomach. He found that smoking it helped him cope with the pain, nausea, and eating disorders resulting from not only his cancer, but also his chemotherapy and radiation treatments, and it helped restore his appetite. He was also prescribed Demerol, which, in combination with cannabis, relieved the chronic pain due to nerve damage in his stomach and other organs. James was on the pharmaceutical for fifteen years and became addicted. By increasing his cannabis intake he was able to get off the Demerol and regain control of his life. Police twice found his Missouri marijuana garden, confiscated his medicine, and, the second time, the courts locked him away. Deprived of cannabis, James’s health problems returned with a vengeance. He found himself unable to eat, and his health quickly deteriorated. His weight plunged to dangerous levels. “Since I have been incarcerated and deprived of its use I have lived in constant discomfort and I feel this is a direct result of not having the medical benefits of marijuana. My stomach deteriorated to the point to where I could not eat anything due to incurable bleeding ulcers,” James wrote. It took two major stomach surgeries for James to be able to put on weight again and return to the level he had maintained through his previous regular use of cannabis.6 He is still denied access to medical marijuana.
Cannabis extracts have been directly applied to tumors to shrink their size and possibly stop them from spreading.7 However, currently cannabis is only being used as an adjunct to the conventional treatments that are offered.
AIDS AND HIV DISORDERS
The same healing characteristics that benefit cancer patients are also utilized by thousands of patients with Acquired Immunodeficiency Syndrome (AIDS) or Human Immunodeficiency Virus (HIV). The body responds to the HIV invasion just as it responds to a burn, tumor, or surgery. It demands extra nourishment, and, if necessary, it begins to break down the protein stored in the body’s own muscles. Patients are instructed to eat enough to avoid weight loss, which occurs in 98 percent of HIV cases. To compensate they should get almost twice as much protein intake as a healthy individual.8
Many people with AIDS report improved appetite and weight gain after they begin smoking cannabis. Kenneth Jenks was a hemophiliac living in Florida who contracted AIDS through a blood transfusion and then passed it on to his wife, Barbara, before he was aware of what had happened. Both were suffering from nausea, vomiting, and appetite loss caused by AIDS or the AZT therapy. The doctor feared that Barbara would die of starvation. In early 1989 the couple learned about marijuana through a support group for people with AIDS. Desperate for anything that would help, they began to smoke cannabis. They felt better, regained some weight, and were able to stay out of the hospital for about a year before an anonymous informant sent the police to their door on March 29, 1990. The police found the two small plants the couple had been growing in order to save money. The Jenks argued medical necessity in court, and the defense was rejected, but the appeals court overturned the decision and sustained the medical necessity defense. They were placed into the Investigational New Drug (IND) program and given free government-grown marijuana. The publicity around their case led to hundreds of AIDS patients petitioning the Food and Drug Administration to be let into the program. Because of this attention, the program was terminated on June 21, 1991. Government officials have since maintained that it would be inappropriate to make a medical exception for AIDS patients to use cannabis, because they fear the risk of aspergillus mold growing on the herb and causing lung infections. Moldy cannabis should not be smoked by anyone. Any suspect cannabis should be heated in an oven for at least three minutes at 220°F. Although that will overdry the herb, it will kill any bacteria.
People with AIDS who use cannabis regularly report that the drug allows them to continue to live a more normal life with relatively few side effects. Powerful testimonials and case histories are being documented at AIDS clinics and cannabis buyers clubs across the country.
So, how does it work? Reports of increased hunger, especially for sweets, during cannabis resination have focused attention on possible changes in blood sugar level, often with contradictory results.9 Early investigators reported decreases, but later studies found slight increases, no change at all, and movement in both directions.10 L. E. Hollister found that reports of appetite stimulation and subjective hunger occurred in slightly more than half of his subjects.11 He found a significant increase in total food intake after 26 mg of THC were ingested when the subject had eaten breakfast—but not when the subject was fasting. It’s a mixed bag. While most people seem to increase their appetite by smoking cannabis, I have talked to a significant number who smoke as a way of suppressing their appetites. Once again, personal experience is the best way to determine how cannabis
works for you.
Despite all the research that has been done—or perhaps because of all the research that has been prevented12—we still know very little about the how and why of cannabis’s amazing calming-yet-stimulating effect on the human digestive system. Is it physiological or is it neurological? More research is desperately needed, but we don’t need to understand why cannabis works to know that it does work. The important thing is that these patients regain access to this resinous herb and determine with their physicians, rather than adminstrators in Washington, D.C., whether cannabis is the right medicine for them. Now there’s food for thought.
Chapter 9
Cardiovascular and Pulmonary Systems
Smoking is by far the most popular method of consuming resinous cannabis. Many people simply enjoy the flavor. They might smoke the flower as an appetizer before dinner, or use it to cleanse the palate before dessert. The smoking process is also a remarkably fast and efficient delivery system. The particles of smoke that carry the active resinous compounds are so small that they are inhaled with the breath to the depths of the lung, where the drug is instantly absorbed across the alveolar membrane into the bloodstream.
By directly introducing cannabis drugs into the heart–lung (cardio-pulmonary) interchange, you get them into the bloodstream, up through the aorta, and into the brain without being diluted or passing through the liver. Blood flows into the heart by way of the vena cava. The ventricle chamber on the right side of the heart pumps “used” blood through the pulmonary artery to the lungs, where the alveoli transfer the carbon dioxide to be exhaled, and replace it with oxygen and whatever else has been taken into the lungs. The reoxygenated blood flows back through the pulmonary veins to the left atrium, through the mitral valve and into the left ventricle chamber, which contracts and pushes the blood out through the aorta to the brain and the rest of the body. To illustrate the virtue of smoking as a delivery system, in one trial 10–15 mg of smoked THC measured a peak concentration about eight times as great as that which followed 20 mg eaten THC, and in much less time.1