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49 Med. Sci. & L. 1 (2009)

handle is hein.journals/mdsclw49 and id is 1 raw text is: Lader: Addiction and the pharmacology of cannabis: implications for medicine and the law 1 Addiction and the pharmacology of cannabis: implications for medicine and the law Malcolm Lader, OBE LLB DSc PhD FRCPsych FMedSci Emeritus Professor of Clinical Psychopharmacology, Institute of Psychiatry, King's College, Denmark Hill, London SE5 8AF Correspondence: Email: m.lader@iop.kc/.ac.uk ABSTRACT The topic of drug addiction or misuse of drugs has numerous far-reaching ramifications into areas such as neuroscience, medicine and therapeutics, toxicology, epidemiology, national and international economics and politics, and the law. The general principles of drug addiction are first summarised. A recurring and intrinsic problem is lack of adequate characterisation of the independ- ent variable, namely the drug taken. Secondly, it is not feasible to allocate subjects randomly to treat- ments. Thirdly, the heterogeneity of different forms of addiction precludes facile generalisations. A problem drug user is anyone who experiences social, psychological, physical, or legal problems related to intoxication, and/or regular excessive con- sumption, and/or dependence as a consequence of their use of drugs (UK Advisory Council on Misuse of Drugs, 1982) Cannabis is a genus of flowering plants whose prod- ucts are used as recreational drugs. Claims have been made for a range of therapeutic properties. Its two main active principles are A9 - tetrahydro- cannabinol (THC) and cannabidiol (CBD). These compounds have contrasting pharmacological prop- erties. THC is suspected of causing psychotic phe- nomena, but CBD seems more sedative and may even be antipsychotic. The past use of cannabis, par- ticularly the concentrations of THC and CBD, can be monitored with hair analysis. Recent studies involving the administration of THC and CBD to human subjects are reviewed. Suggestions are made for further research into the pharmacology and toxicology of CBD. Such data may also point to a more rational evidence-based approach to the legal control of cannabis prepara- tions. INTRODUCTION The topic of drug addiction or misuse of drugs is a complex one. Primarily a branch of pharmacology, it has numerous far-reaching ramifications into areas such as neuroscience, medicine and therapeutics, toxicology, epi- demiology, international economic and politi- cal policies, and the law. The last is a particu- lar concern as drug misuse has primary legislation such as the Misuse of Drugs Act 1971 and the Drugs Act 2005, and attendant legislation such as the Drug Regulations. It elicits high media concern, not always well- informed. Medical views encompass a range of opinion from drug misuse being another form of medical disorder to a dismissal of the topic as self-inflicted damage that should not be condoned, certainly discouraged, and on which treatment facilities should not be squandered. In particular, its legal aspects spawn an astonishing range of lay opinions from the draconian 'lock-'em-all-up' brigade to those who advocate partial or total decriminalisa- tion and emphasis on treatment and regard the drug regulatory legislation as being an un- justified limitation on personal liberty. Scientific and not-so-scientific publications in this area run to many thousands, and any commentator must be selective. I have chosen to explore the pharmacology of the third most commonly used psychotropic substance, cannabis (tobacco and alcohol are the com- monest). As with other aspects of drug misuse, the pharmacology can be dauntingly complex, especially with plant products. I shall concen- trate on a common constituent, cannabidiol (CBD), an important substance whose study has been largely eclipsed by the main psycho- active constituent, A9 - tetrahydrocannabinol (THC). The questions that I shall address

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