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February 14, 2010

The Marijuana High: what policy wonks still don’t know

Because the population I’ve been studying since late 2001 consists entirely of Californians seeking a doctor’s approval to use pot under the terms of Proposition 215, all have experienced the marijuana “high;” itself a unique phenomenon erroneously considered by those who never experienced it as the equivalent of alcohol intoxication

As every experienced pot smoker knows, nothing could be further from the truth; although getting high and getting drunk are the expected effects of both drugs, they are very different. Both are also very common events. With the single exception of seeking a “head rush from a cigarette, getting high on “weed” and drunk on “booze,” at well under the legal age- have been rites of passage for over half of all Americans since the University of Michigan (and later the federal government) began doing their surveys of youth in the Seventies. The cannabis applicants I’ve been studying do report trying all three at about the same average ages and well before trying any other illegal agents.

Their drug initiation patterns and other data also confirm that federal drug policy officials, their critics in "reform," and most academic drug policy experts have not developed an accurate picture of human marijuana use; initially because of imposed ignorance before 1997; more recently it seems to be denial. For over 13 years Proposition 215 has been allowing something the DEA and NIDA had successfully blocked from their beginnings in 1973 and 1975 respectively: unfettered medical access to a large population of illegal drug users. That the drug was marijuana, has been especially valuable because of the (unsuspected) role it has been playing in moderating the use of more problematic agents, literally since before Nixon’s election in 1968.

Perhaps the best way to illustrate still-prevalent ignorance is to discuss the marijuana high in terms of its clinical pharmacology, rather than in the obligatory rhetoric insisted upon ever since Nixon foreclosed unbiased clinical research by rejecting the Shafer Commission's plea in 1972.

The Inhaled High

Getting high begins when the first toke is almost immediately followed by a subjective feeling described by 80% of those surveyed as “relaxation.” The immediacy with which it is experienced confirms that whatever was in the smoke had an immediate effect on the brain, which is interesting, because at least half of all applicants report they failed to get high the first time they tried and many had to try several times before they were successful. Once successful however, a high is readily produced whenever one lights up.

More tokes are taken in relatively close succession until inevitably, one fails to enhance the high. This is important because it signals a refractory period during which additional tokes will simply be a waste of money. In essence the refractory period is also a signal the user is as high as it’s possible to get on that particular strain at that tme. Since both users and strains can vary considerably, it should not be surprising that one user may get high sooner than another, or that intensity may vary. The dominant pharmacologic effect is anxiolytic; onset is rapid because the drug is smoked; dosage can be precisely titrated for the same reason. Finally, the high is evanescent; it’s over in about an hour. Another very important consideration is that the good feeling that came with the high can linger for another hour or more, depending on circumstances.

For some users, the termination of the high is an opportunity to light up again; but only if certain conditions exist: they must not be under hostile observation, they must be able to afford it, and they must be comfortable while high in the presence of “straights.” Since the normal response is the famous “paranoid’ reaction (an unpleasant feeling that straights know one is high and disapprove) how to overcome it to the point of being comfortable has to be learned. Thus some users are able to get high repeatedly throughout the day; however the refractory period guarantees that the effect is not cumulative, as it usually is with alcohol. Other than mild ataxia (a cerebellar effect) and a tendency to become hyperfocused on interesting phenomena, cognition is not impaired and is often enhanced.

As most pot users have discovered, the high produced by edibles is strikingly different than the one produced by inhalation. There are good reasons for that difference, but they haven’t been elucidated pharmacologically because “marijuana” is illegal. However 215 has allowed the differences to be recognized clinically and described in some detail. I’ll deal with the “body high” produced by edibles in another entry.

Doctor Tom

Posted by tjeffo at February 14, 2010 06:03 PM