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there appears to be cross-tolerance between cannabinoids and alcohol.

'Amotivational syndrome'. This term dignifies an imprecisely characterised state, ranging from a feeling of unease and sense of not being fully effective, up to a gross lethargy, with social passivity and deterioration. It is difficult to assess, when personal traits and intellectual rejection of technological civilisation are also taken into account. Yet the reversibility of the state, its association with cannabinoid use, and its recognition by cannabis users make it impossible to ignore. (Escalation theory, seep. 171.)

Cannabinoids and skilled tasks, e.g. car driving. General performance in both motor and psychological tests deteriorates, more in naive than in experienced subjects. Effects may be similar to alcohol, but experiments in which the subjects are unaware that they are being tested (and so do not compensate voluntarily) are difficult to do, as with alcohol. Some scientists claim the effects are negligible but this view has been 'put in proper perspective' by a commentator42 who asked how these scientists 'would feel if told that the pilot of their international jet taking them to a psychologists' conference, was just having a reefer or two before opening up the controls'.

Other effects. Cannabis smoked or taken by mouth produces reddening of the eyeballs (probably the forerunner of the general dilatation of blood vessels and fall of blood pressure with higher doses), unsteadiness (particularly for precise movements), and tachycardia. The smoke produces the usual smoker's cough and delivers much more tar than tobacco cigarettes; the tar from reefer cigarettes is as carcinogenic in animal experiments as cigarette tobacco tar. Increase in appetite is commonly experienced.

Cannabinoids are teratogenic in animals, but effect in humans is unproved, although there is impaired fetal growth with repeated use.

A therapeutic role has been suggested for cannabinoids in a variety of conditions including chronic

42 Dr G Milner.

pain, migraine headaches, muscle spasticity in multiple sclerosis or spinal cord injury, movement disorders, appetite stimulation in AIDS patients and nausea and vomiting. One systematic review concluded that cannabinoids were no more effective that codeine for acute or chronic pain although most of the trials were conducted in the 1970s.43 A further review concluded that cannabinoids protected against nausea and vomiting induced by chemotherapy but the studies were conducted mainly in the 1980s, i.e. before the introduction of the (highly effective) serotonin receptor antagonists.44 Clinical trials now in progress will clarify the value of individual cannabinoids in such conditions, their profile of adverse effects and comparison with other drug and non-drug therapies.

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