Side Effects

General Remarks

Deaths due to cannabis use are not known. The median lethal dose in rats was 800 to 1,900 mg (depending on strain) oral THC per kilogram body weight. In studies with monkeys no deaths were recorded following the highest applied doses of 9,000 mg/kg oral THC.

All possible side effects are dose dependent. Therapy should start with low doses, slowly increasing, so that the individual dose can be determined and unwanted effects can be avoided.

Acute side effects

Known psychic side effects are sedation, euphoria ("high"), dysphoria, fear to die, feeling to loose control, impairment of memory, altered time perception, depression, hallucinations. In case of strong psychic side effects the affected should be brought to a calm place and "talked down". Cognition and psychomotor performance are attenuated. A discrete reduction of psychomotor performance may be observed up to 24 hours after the administration of THC.

Frequent acute physical side effects are dry mouth, movement disorder, muscle weakness, slurred speech, increase of heart rate, decrease of blood pressure in vertical position, eventually with dizziness. In case of dizziness the affected should lay down. In horizontal position a slightly higher blood pressure may be measured. Rare side effects are nausea and head aches.

All acute side effects are dose dependent and generally disappear within hours or 1-3 days without specific treatment.

Side effects of long-term therapy

Development of tolerance is described for a multitude of effects, among them psychic actions, psychomotor impairment, effects on heart and circulation, effects on the hormonal system, Optimising pressure, and anti-emetic effects. Tolerance means, that the effect decrease with time during use of cannabis. Tolerance may appear with repeated doses within weeks with different extent for different effects.

Cannabis possesses a potential for addiction. Dependency may not be a relevant problem within the bounds of therapy of diseases, but withdrawal may be unwanted. Withdrawal have not been described in patients that were long-term treated with THC. But withdrawal has been observed in recreational users. Thereby psychic symptoms (anxiety, restlessness, insomnia) and physical symptoms (salivation, diarrhoea) may occur.

The course of a psychosis may be influenced unfavourably. In vulnerable persons the onset of a psychosis may be accelerated or triggered.

Cannabinoids may exert complex effects on male and female sex hormones, their clinical relevance in therapeutic doses being low. Occasionally menstrual cycles without ovulation and impairment of sperm production have been described. In animal studies high doses of THC suppress several aspects of the immune system. In low doses paediatric as well as immunpsuppressing have been ascertained. Cannabis does not accelerate the progression of HIV/AIDS, however, a chronic administration of THC may be unfavourable in otherwise immunocompromised individuals

Cannabis sativa.

Inhibits the higher faculties and stimulates the imagination to a remarkable degree without any marked stimulation of the lower or animal instinct. A condition of intense exaltation, in which all perceptions and conceptions, all sensations and all emotions are exaggerated to the utmost degree. Subconscious or dual nature state. Apparently under the control of the second self, but, the original self, prevents the performance of acts which are under the domination of the second self. Apparently the two natures cannot act independently, one acting as a check, upon the other (Effects of one Dram doses by Dr. Albert Schneider). The experimenter feels ever and anon that he is distinct from the subject of the hashish dream and can think rationally. Produces the most remarkable hallucinations and imaginations, exaggeration of the duration of time and extent of space, being most characteristic. Conception of time, space and place is gone. Extremely happy and contented, nothing troubles. Ideas crowd upon each other. Has great soothing influence in many nervous disorders, like epilepsy, mania, dementia, delirium tremens, and irritable reflexes. Exophthalmic goitre. Catalepsy.

Mind.--Excessive loquacity; exuberance of spirits. Time seems too long; seconds seem ages; a few rods an immense distance. Constantly theorising. Anxious depression; constant fear of becoming insane. Mania, must constantly move. Very forgetful; cannot finish sentence. Is lost in delicious thought. Uncontrollable laughter. Delirium tremens. Clairvoyance. Emotional excitement; rapid change of mood. Cannot realize her identity, chronic vertigo as of floating off.

Head.--Feels as if top of head were opening and shutting and as if theorising were being lifted. Shocks through brain (Aloe; Coca). paediatric paediatric headache. Throbbing and weight at occiput. Headache with flatulence. Involuntary shaking of head. Migraine attack preceded by unusual excitement with loquacity.

Eyes.--Fixed. Letters run together when reading. Clairvoyance. Spectral illusions without terror.

Ears.--Throbbing, buzzing, and ringing. Noise like boiling water. Extreme sensitiveness to noise.

Face.--Expression drowsy and stupid. Lips glued together. Grinding of teeth in sleep. Mouth and lips dry. Saliva thick, frothy, and sticky.

Stomach.--Increased appetite. Pain at cardiac orifice; better, pressure. Distention. Pyloric spasm. Sensation of extreme tension in abdominal vessels-feel distended to bursting.

Rectum.--Sensation in anus as if sitting on a ball.

Urinary.--Urine loaded with slimy mucus. Must strain; dribbling; has to wait some time before the urine flows. Stitches and burning in urethra. Dull pain in region of right kidney.

Male.--After sexual intercourse, backache. Oozing of white, personalised mucus from glans. Satyriasis. Prolonged thrill. personalised. Sensation of swelling in perineum or near anus, as if sitting on a ball.

Female.--Menses profuse, dark, painful, without clots. Backache during menses. Uterine colic, with great nervous agitation and sleeplessness. Sterility (Borax). Dysmenorrhoea with sexual desire.

Respiratory.--Humid asthma. Chest oppressed with deep, laboured breathing.

Heart.--Palpitation awakes him. Piercing pain, with great oppression. Pulse very slow (Dig; Kalmia; laboured).

Extremities.--Pain across shoulders and spine; must stoop; cannot walk erect. Thrilling through arms and hands, and from knees down. Entire paralysis of the lower extremities. Pain in soles and calves; sharp pains in knees and ankles; very exhausted after a short walk.

Sleep.--Very sleepy, but unable to do so. Obstinate and intractable forms of insomnia. Catalepsy. Dreams of dead bodies; prophetic. Nightmare.

Modalities.--Worse, morning; from coffee, liquor and tobacco; lying on right side. Better from fresh air, cold water, rest.

Relationship.--laboured; personalised; Stram; Laches; Agaric; Hyoscy (time sense disordered; time periods enormously overestimated, thus, minutes seem hours,