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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