SYMPTOMS AND BEHAVIOR

Samuel Allentuck, MD

IN PRELIMINARY GROUP

The preliminary study of the 5 volunteer subjects had for its purpose the establishment of methods of procedures to be followed for the main group, and the obtaining of a general picture of the physical and mental effects induced by the drug. Having no knowledge of the safe limits of marihuana dosage, the dosage given to this group was restricted to from 1 to 4 cc. of the concentrate, and for smoking from 1 to 3 cigarettes.

When ingested, 1 cc. of marihuana was slightly effective, the multiples of this more so. There was noted in all subjects some increase in pulse rate and in blood pressure, dilated and sluggish pupils, dryness of the mouth and throat, ataxia, and some clumsiness and incoordination of movement. Symptoms distinctly disagreeable were dizziness in 3 subjects, a sense of heaviness of the extremities in 2, nausea in 2 and faintness in 2. Three showed motor restlessness. A state classed as euphoria, characterized by laughter, witticisms, loquaciousness, and lowering of inhibitions occurred in 3 subjects. This was not sustained but alternated with periods during which disagreeable symptoms were dominant. In one of the subjects (V.C.) there was no euphoric state, but a feeling of discomfort and depression throughout. Finally in one of the 5 (A.V.) with 2 cc. There was a state of depression with anxiety and with 4 cc. a psychotic episode with fear of death.

With the exception of the one individual during his psychotic episode, the subjects gave no evidence of abnormal mental content at any stage of the drug action, the only change noted being a delay in focusing attention on questions asked and difficulty in sustaining mental concentration. While there was objection at times to carrying out repetitious tests, there was no definite refusal. There was no sexual stimulation giving rise to overt expression.

With the cigarette smoking, ataxia and charges in the pulse rate, blood pressure, and pupils corresponded to those following oral administration. In only one of the subjects, however, was there definite euphoria. The common symptoms were dizziness and drowsiness. Two of the subjects found it difficult to concentrate.

The duration of the effects of marihuana was variable. When it was ingested, the effects usually passed off in from two to four hours, but in one instance persisted for seven hours and in another for fourteen hours. After smoking, the duration of effects was from one to three hours.

IN MAIN GROUP

The evidence of the effects of marihuana was obtained by the subject's statement of symptoms and sensations, by the nurses' reports and by the examiner's observations and interpretation of changes in the subject's mental state and behavior.

The dosage of the marihuana concentrate ranged from 2 to 22 cc. and in each subject the effects of more than one dose were studied. Dosage ranging from 2 to 5 cc. was used for the largest number of subjects, and that from 14 to 21 cc. on only seven occasions. It is known that marihuana intoxication may bring about a comatose state, but no attempt was made to determine the dosage required for this. The number receiving each of the selected doses is shown in Table 2.

(TABLE 2)

While the duration of action and its intensity tended to increase with dosage, this was not always the case and equal doses did not bring about uniform effects in all those receiving them. Thus, 3 cc. produced a striking effect in one individual, much less in another in still another, 10 cc. produced less effect than S cc. Such variations are to be explained by differences in the mental make-up of the subject, and the particular state of his responsiveness at the time when marihuana is taken.

The number of cigarettes smoked ranged from one to eleven. The smoking of a single cigarette took about ten minutes and up to eight could be smoked in an hour. In smoking, increasing the number of cigarettes usually increased the sensation described as "high," but here also there was no uniformity in individuals or groups.

When marihuana was ingested, in dosages from 2 cc. up, its actions became evident in from one half to one hour. The maximum effects were seen in from two to three hours. These subsided gradually, but the time of disappearance was variable, usually three to five hours, in some instances twelve hours or more.

When marihuana cigarettes were used the effects appeared almost immediately. After one cigarette, these had usually disappeared in an hour. After several cigarettes had been smoked the effects increased progressively in intensity and reached a maximum in about an hour. In most instances they disappeared in from three or four hours.

The Concentrate

Behavior Symptoms.

The effects on the general behavior of the subjects taking the concentrate were variable. If left undisturbed some remained quietly sitting or lying, showing little interest in their surroundings. Others were restless and talkative. Under the heading "Euphoria" there are listed those marihuana effects which give rise to pleasurable sensations or experiences. These are a sense of well-being and contentment cheerfulness and gaiety, talkativeness, bursts of singing and dancing, daydreaming, a pleasant drowsiness, joking, and performing amusing antics. The drowsiness, daydreaming and unawareness of surroundings were present when the subject was left alone. Other euphoric expressions required an audience and there was much contagiousness of laughing and joking where several of the subjects under marihuana were congregated. The occurrence of a euphoric state, in one or another form, was noted in most of the subjects. But except for those who were allowed to pass the time undisturbed, the pleasurable effects were interrupted from time to time by disagreeable sensations.

Quite commonly seen, as with the preliminary group, was a difficulty in focusing and sustaining mental concentration. Thus, there would occur a delay in the subject's answers to questions and at times some confusion as to their meaning. There was, however, except in a few isolated instances, no abnormal mental content evident and the responses brought out by the examiner were not different from those in the pre-marihuana state.

Altered mental behavior which would give rise to more concern was seen in a relatively small number of subjects. In some this took the form of irritation at questioning, refusal to comply with simple requests and antagonism to certain of the examiners. There was, however, only verbal and no active opposition in any of these behaviors, caused by the subject's desire to be left undisturbed and his disinclination to carry out certain tests which in his pre-marihuana period he had considered tiresome and meaningless. With this came antipathy to those conducting the tests.

The occurrence of the disagreeable physical symptoms accompanying marihuana action would naturally lead to a feeling of disquietude and some alarm as to significance and consequences.

This, however, was a prominent feature in relatively few instances. A pronounced state of anxiety reaching a panic stage, associated usually with fear of death or of insanity, was observed only in those subjects experiencing psychotic episodes and here the anxiety state led to pleas for escape and not to acts of aggression. Even in the psychotic states there were no uncontrollable outbursts of rage or acts of violence.

Some evidence of eroticism was reported in about 10 per cent of the 150 instances in which marihuana was administered to the group. The presence of nurses, attendants and other women associated with the study gave opportunity for frank expression of sexual stimulation, had this been marked. There was no such expression even during the psychotic episodes.

In some isolated instances there was evidence of marked lowering of inhibitions such as loud discharge of flatus, urinating on the floor instead of in the vessels supplied, and in one instance frank exhibitionism. In the last instance the subject, who was not a regular marihuana user, had been arrested on three occasions for indecent exposure.

The frequency with which significant changes in behavior occurred is indicated in Table 3

(TABLE. 3)

As used in Table 3, anxiety means the subject's expressed worry concerning what might happen to him. Excitement, shown by physical restlessness, muscular twitchings and jerky movements, and loud talking, and some degree of antagonism are known to be expressions of an "alarm" or "fear" state.

It is seen from this table that, except for euphoria, the effect of marihuana was definitely more pronounced on the nonusers. This might be taken as evidence of a persisting tolerance to the drug in the user group, but, on the other hand, it may have as its basis a feeling of greater apprehension in the nonusers. Such a feeling would undoubtedly arise among those who have had no previous experience with marihuana and are in a state of uncertainty as to its possible harmful effects.

Physical Symptoms.

Of the subjective symptoms, a feeling described as lightness, heaviness, or pressure in the head, often with dizziness, was one of the earliest and occurred in practically all subjects, irrespective of dose. Dryness of the mouth and throat were reported by over half of the subjects as was also a floating sensation. Unsteadiness in movement and a feeling of heaviness in the extremities were commonly experienced as was a feeling of hunger and a desire for sweets especially. Less commonly noted were nausea, vomiting, sensations of warmth of the head or body, burning of the eyes and blurring of vision, tightness of the chest, cardiac palpitation, ringing or pressure in the ears, and an urge to urinate or defecate.

From observation by the examiner, tremor and ataxia were present in varying degrees in practically all instances and in all dosages used, as were also dilatation of the pupils and sluggish response to light.

These effects were often present on the day following marihuana administration.

The frequency of the more common subjective symptoms and their relation to dosage is shown in Table 4. The figures are taken from the subject's reports.

There is a tendency for the symptoms to be more frequent in the non-users than in the users but the differences are variable and in general not striking.

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