Subjective Experience

Mood alteration tends to be in the direction of euphoria, and hilarity, apparently occasioned by practically nothing, is common. Inappropriateness of affect is frequently exhibited, and some degree of delusional thinking may lead the user to become apparently exaggeratedly or unwarrantedly suspicious. For example, he may start to worry about hidden listeners, concealed implications of questions, people's motives, and may even become unduly worried that the vice squad might be about. This may to a certain extent be the result of greater perceptual acuity; if an individual is more aware than usual, of a person some distance away, he might infer that the person has some special interest in him, and approaching footsteps in a corridor might sound unnaturally loud, the sinister implications being obvious.

A certain amount of depersonalisation may be experienced. (e.g. The user may feel as though he is observing himself rather as if he is an actor in a film he is watching.) Some aspects of the experience may be sufficiently unusual as to be disturbing, and may lead to mild anxiety, especially in the case of a naive user. There may also be a certain amount of depression or fatigue as the effects of the drug are wearing off.

Marihuana tends to result in increased passivity. Users are less inclined to engage in activities than to be spectators, (except, perhaps, from the more traditional ones such as making love, or playing jazz.) Inhibitions may be lessened to some extent, but this (as many of the effects) is very dependent on the immediate setting, and there is a continuity with the non-drugged personality and behaviour of the person concerned.

Disturbances in thought processes may be experienced, such as difficulty in immediate recall, multiplication of associations, disconnected thought sequences, and time perception may be altered. Reality contact is never totally relinquished it seems, and though users sometimes seem to be 'far away'. Ames found that they can still be stimulated to respond appropriately and directly to questions and other external stimuli.

True hallucinations appear to be rare, though vivid images when the eyes are closed may be 'seen', and visual and auditory distortions and illusions are common. Changes in perspective, and greater intensity and duration of after-images may be experienced. The user may become more aware and more fascinated by his own body, as well as by external stimuli, especially works of art. Intensification of bodily sensations may result in some exceptionally pleasurable sexual experience, but it may be that there is an unusual lack of interest in sexual activity.

There appear to be few long term physical effects of marihuana use, and none have been demonstrated in the West. An early Indian study (Chopras, 1939, cited by Murphy, and McGlothlin and West.) indicates that conjunctivitis may follow heavy prolonged use, and possibly bronchitis, although Murphy comments that this "is presumably due to the crude smoked material as much as to the specific drugs." 'Asthma has also been suggested. However this condition is partly psychosomatic and the Chopras themselves do not believe it is a consequence of marihuana smoking.)

There appear to be few long term physical effects of marihuana use, and none have been demonstrated in the West. An early Indian study (by the Chopras in 1939, cited by Murphy and by McGlothlin and West) indicates that conjunctivitis may follow heavy and prolonged use, and possibly bronchitis, although Murphy comments that this "is presumably due to the crude smoked material as much as to the specific drugs." (Asthma has also been suggested. However, this condition is partly psychosomatic, and the Chopras themselves did not believe that it is a consequence of marihuana smoking.)

Some potentially unpleasant psychological reactions have been mentioned. Many experiences especially novel or unexpected ones, may become the basis for anxiety. Bad reactions are generally transient or are dealt with by supportive friends, and rarely lead to psychiatric treatment. An experienced user said of a novice who had become frightened by a particularly marked effect, "She's dragged because she's high like that. I'd give anything to get that high myself. I haven't been that high for years." (Quoted by Becker.)

Recently Keeler (1967) has reported 11 cases of 'adverse reactions' to marihuana from amongst student or former student users These included anxiety and panic reactions, depression, confusion and disorientation, depersonalisation, and paranoid phenomena during the drug reaction. Disregarding the problems of giving satisfactory clinical definitions of 'adverse reaction', we can at least note that these are not well-defined clinical syndromes. Two, (disorientation and depersonalisation), have in fact been defined by other users as pleasurable. And all but two of the eleven persons interviewed considered that the benefits of cannabis by far outweighed the negative aspects, and intended to continue use of the drug. These reactions were all temporary, and do not seem to have been particularly severe.

Murphy has summarised much of the (international) evidence pertaining to marihuana and serious mental illness. The problem of the 'marihuana psychoses' was one that worried early investigators. However, as far back as 1942, Allentuck and Bowman state that "a characteristic cannabis psychoses does not exist. Marihuana will not produce a psychosis de nova in a well-integrated, stable person." (cited by Murphy.) More recent work has tended to confirm this general impression. Murphy concluded that, as far as it is possible to estimate, the incidence of major mental disorders among marihuana users is not greater than in the general population.

Becker has pointed out that concern over a drug must be seen in a cultural context. It is most pronounced when the drug is new (whether or not there is actually any danger). Marihuana was first used to any extent in the U.S. around the 1920's and 30's, and there were a number of reports about this time on marihuana induced psychoses. The reports declined in number in the 30's, and Becker found none indexed in Psychological Abstracts or the cumulative Index Medicus after 1940, (Reported in Trans-Action, March 1968, pp7-8.)

In assessing reports of 'bad' reactions, it must be remembered that the population of users may be very large, so that individual 'risk' cannot be determined with any certainty, though it would appear to be very slight. A drug reaction depends very much on the personality of the user and the setting, as well as on the drug itself. The contributions of the first two factors must be adequately controlled if the specific contribution of the drug is to be assessed. A person who is given to anxiety or hallucinations, for example, is probably more likely to experience a bad reaction. (It has been claimed occasionally that the mentally unstable are disproportionately attracted to marihuana. It is to be expected that such people would cope less ably with a disturbingly novel experience.) Furthermore many drug users are multiple drug users. In such cases it is impossible to assign to the action of a particular drug, a disturbance which is not concurrent with, or immediately subsequent to, the use of that drug.

Briefly, one must consider the history of the individual concerned before marihuana use, before the bad reaction, and after it. It must be decided just what personality changes, if any, have occurred, and just what constitutes a 'bad' reaction. In any case it must be remembered that there appear surprisingly few reports of adverse reactions in literature, and those that do appear almost invariably involve merely temporary disturbances, generally limited to the few hours of the pharmacological drug reaction itself, and rarely require hospitalisation.