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An Easement- a Proposed Unique Drug Category
has been categorized in contradictory and diverse ways since antiquity and
subject to political context. The Controlled Substances Act of 1970 classifies
cannabis as an hallucinogen with high potential for abuse with no medical
value. When cannabis was available for prescriptive use from the mid 1840’s
through 1938 it was classified as hypnotic, sedative, and narcotic. Medical
literaturature and clinical observation suggests that an apt classification
or categorization is easement for low dose cannabis effects. The author proposes
the addition of easement to drug classifications and categories of action
of cannabis drugs.
Acknowledgement: Classic Pharmaceuticals
An Easement- a Unique Drug Category
H. Mikuriya, M.D.
of cannabis as a psychotropic drug has been largely incorrect. The Controlled
Substances Act classifies Marihuana as a hallucinogen with high potential
for abuse, lack of accepted safety and no medicinal use.[i] Jaffe
in his classification of pharmacological agents commonly used for subjective
purposes correctly puts cannabinoids in its own undefined class.[ii] Morgan
classifies cannabis as a hallucinogen in the Merck Manual 17th Edition
in 1999 in the section on drug use and dependence.[iii] On
the other hand, the 1899 Merck’s Manual categorizes cannabis as hypnotic/sedative.[iv] (Long before marijuana
became a popular illegal drug)
The term Easement
most aptly characterizes the unique medicinal effects of cannabis.
usually associated with legal terminology, dealing with property in Webster’s
3rd New Unabridged Dictionary, but the first meaning is “An act
or means of easing or relieving (as from pain, discomfort, or burdens)[v]
includes easment under relief: 834. Relief; deliverance &c. 689; easment,
softening, mitigation, palliation &c. 174; soothing, lullaby, cradle
song, berceuse, solace, consolation, comfort, encouragement. Lenitive, restorative &c
(remedy) 689. Repair, refection, refocillation, refreshment, regalement,
relief &c.[vi] (Peter
Mark Roget was a British physician and fellow of the Royal Society who began
a compilation and classification of words in 1805. He published the first
edition of the Thesarus in 1853.)
Roget’s II Thesaurus
adjective synonyms for ease are: lax, let up, loosen, relax, slack, slacken,
untighten Nouns Comfortable, Easygoing, Tolerant, Wanton, Smooth, Prosperous,
Amiable, Gradual, Laid-back, and Prosperity”. [vii]
Thesaurus lists easment under 120 RELIEF: Nouns 1 relief, easement, easing,
ease; relaxation, relaxing or easing of tension, decompression, slackening;
reduction, diminishment, diminution, lessening, abatement, remission; remedy
86; alleviation, mitigation, palliation, softening, assuagement, allayment,
defusing, appeasement, mollification, subduement; soothing, salving, anodyne;
Language Vol 1 noun: 1 Freedom from pain, agitation, or perplexity. Verb:
1. To relieve the mental or physical pain or oppression of; comfort. 2. To make less painful or oppressive: This will ease your
pain. 3. To lessen the pressure, weight, tension, etc. Easement : 2. Relief, 3. Anything that gives ease or relief. [ix]
Neither Dorland’s[x] nor
Steadman’s Medical Dictionaries, however, list ease or easement.[xi] The
Physicians Desk Reference likewise omits this therapeutic category.[xii]
are unique and distinctly different from other categories of drugs. Subjective
descriptions of the therapeutic properties by persons who have discovered
the utility of the drug for the management of a wide range of chronic diseases
both mental and physical.
most would characterize and categorize cannabis’ therapeutic actions as sedative,
anxiolytic, and analgesic; the power of the drug to alleviate depression
is, perhaps, as an important psychotherapeutic property. But it goes beyond
mental disorders that have diverse causes and ways of expression, depression
and anxiety vary significantly in severity, expression, and manifestation.
For some, cannabis is a lifeline to sanity and functionality.
agitation, anger, and mania. Painful, disruptive, and frequently incapacitating
symptoms are brought under control with minimal side effects and rapid relief
when inhaled. Cannabis promotes sleep and permits relief from wakefulness
both smooth and skeletal muscles. Obsessive and mood driven cognitive patterns
relax and put into emotional perspective. Appetite and bowel normalcy is
restored, cognition is reconnected with somatic and affective awareness.
Control of the sympathetic nervous system dominance in favor of the parasympathetic
or vegetative nervous system affects both CNS and somatic system states.
Unlike sedatives, opioids, anxiolytic, stimulant, or antidepressants, cannabis
is free from unwanted effects by an order of magnitude.
Century Clinical Literature
1. The alleviation of acute pain, whether neuralgic, spasmodic, or inflammatory in its origin; and
securing adequate daily rest in sleep by procuring, artificially if necessary,
a suspension at least of any morbid actions or conditionss that might militate
against refreshing repose. Almost all the suffering, and great part of the
danger of sickness may be referred to uneasy sensations of one sort or other,
the irritated nervous tissues reacting throughout the economy on the nurtrient
functions, deranging the elementary affinities in the blood, undermining
the organic powers, and ultimately ruining the general health. Looking again
at disease as we see it in clinical practice, there are no medicinal substances
of more interest or importance in its treatment than such as fitted to fulfil
these two indications.”[xiii]
"It seems that nothing can hurt you in this peace of mind, that you are inaccessible to sadness.”
Moreau’s collaborator wrote in 1848: I am convinced that this plant (already
useful to man, who uses it for clothing and makes rope from it, which helps
him navigate the seas) can comfort him in his suffering, that I join my feeble
voice to those of these hard-working and dedicated medical travelers, that
I call Cannabis to the attention of observers and workers alike.”[xv]
The Indian Hemp
Drugs Commission in 1894[xvi] reviewed
medical literature, testimony by both indigenous medical practitioners and
Western trained physicians and described cannabis to be used as a tonic to
increase stamina. In cultures and societies such as India or Nepal it is
recognized that cannabis cools the passions as compared with alcohol which
heats or inflames them. Moslem cultures refer to a cannabis induced placid
dreamy state as “el kif”[xvii]
Clinical aspects of modulating emotional response and psychopathologic
conditions: EEG effects
emotional reactivity and intensity while increasing introspection as evidenced
by the slowing of the EEG after initial speeding up[xviii]. In
EEG biofeedback utilizing bilateral channels the author has observed bursts
of theta (4-7 Hz) in a background of high frequency beta (20 – 22 Hz) in
patients experiencing agitation or anxiety. These episodic intrusions of
theta corresponded to distraction or loss of train of thought. The unique
easment effects of cannabis relieves agitation that decreases or eliminates
these disturbances in cognition. Obsessive and pressured thinking give way
to focussed cognition.
With ADD there
is sub beta fixation with inability to speed up the EEG which has the psychophysical
concomitance of “spaciness”, poor short term memory, poor retention, poor
frustration tolerance, poor tolerance of noise,
difficulty with crowds, and groups.
loosened associations when in relaxed circumstances. Alpha (8 –13 Hz), a
relaxed open focus cognitive state with a more holistic apperception.
reactivity is smoothed out, worries are less pressing. Of significance is
the enhanced affective control with salutary effects on cognition. Decreased
obsessive and paranoid ideation driven by affect are relieved. Increased
psychophysical awareness and pattern recognition enhances a sense of ease.
Cannabis relieves the sensation of being “all clenched up”. The relief of
musculoskeletal and visceral tension restores a sense of control. When certain
localized pain causes both discomfort and detachment with pain affected part
assuming a life of its own. Cannabis, at a low inhaled dose, “reconnects” psychophysical
awareness. This change in subjective perspective appears to be part of the
unique psychopharmacologic mechanisms of cannabis.
and acute mild short term memory impairment relieve obsessive ideation and
other cognitive distraction. The anxiety relief diminishes obsessive and
ruminative thinking. Short term memory impairment makes “holding thoughts” more
difficult with relief. Obsessive ideation of both neurotic and psychotic
etiologies are relieved.
control through both immediate relief and salutary effects on vegetative
functioning in circadian sleep rhythms, quality of sleep, and improvement
of appetite, digestion, and bowel function.
combination of psychic and somatic components that depend on set, setting,
personality, as well as the physical or organic factors determine the severity
and nature of pain. Individual and interactions with others also frequently
play significant roles. Mood is affected by injury or damage. Mood affects
the perception of physical dysfunction. Fatigue increases the vulnerability
to pain and decreases resistance to perception of pain. Perception of pain
is changed by cannabis.
suggested in 1887 a possible mechanism of cannabis’ analgesic properties:
the time that this remarkable drug is relieving pain a very curious psychical
condition manifests itself; namely, that the diminution of pain seems to
be due to its fading away in the distance, so that the pain becomes less
and less, just as the pain in a delelicate ear would grow less and less
as a beaten drum was carried farther and farther out of the range of hearing.
condition is probably associated with the other well known symptom produced
from the drug; namely, the prologation of time.”[xix]
patients medicating with cannabis for pain indicate the perception of pain
is changed. Paradoxically, for some, pain becomes more tolerated it is perceived
as being “owned” and actually part of the person instead of a process with
an existence and life of its own. Cannabis appears to connect the localized
discomfort. The awareness change relieves the sense of separateness and out
of control quality of the discomfort. The fear diminishes as the perception
of separateness of the pain source is altered. A sense of control is restored
through this integration.
caused by the feeling of an inner disintegration is eased without the sedation,
constipation, anorexia, and itching from opioid use is avoided. Cannabis
both integrates and mobilizes afffect from the easement of cannabis which
is distinct from other sedatives or analgesics.
safety and freedom from annoying or incapacitating effects of other drugs
used for symptom management in chronic illness cannot be overstated. The
relief of depression and anxiety from cannabis is a significant aspect of
the analgesic effects of the drug.
This complex pharmacologic spectrum of actions defies semantic constraints of categorization as narcotic, hallucinogen, or sedative. Easement would appear to be a more precise description based upon ethnographic, medical, pharmaceutical liturature, and clinical observations of low and appropriate therapeutic inhaled or oral cannabis.
properties apply for chronic conditions and experienced users and not for
acute effects in naieve subjects, nor oral overdose. For the latter, hallucinogen
therapeutic mechanisms of cannabis afford opportunities for studying mind
body connections to better understand the human complex interplay of set,
setting, personality with cannabis in the management of chronic illness.
characterizations are important in shaping not only personal experience but
institutional policy as well.
March 1, 2001
Code 21:811(d) Comprehensive Drug
Abuse Prevention and Control Act of 1970, Public Law 91-513, October
J Chapt 23 Drug Addiction and Drug Abuse P. 541, Goodman and Gilman’s
The Pharmacological basis of Therapeutics 7th Edition, MacMillan
NY 1985 1839 pp.
JP Drug Use and Dependence Chapter 195, The Merck Manual 17th Edition
Merck Research Laboratories Whitehouse Station, NJ 1999 2833 pp. P
1899 Manual Merck & Co. NY 192pp (Reprinted with the 1999 Centennial
of Words and Phrases Roget, P.M., Roget, J.L. and Roget, S.R. Grosset & Dunlap,
New York 1853, 1947 ed
II The New Thesaurus Houghton Mifflin, Boston 1998 (unpaginated)
International Thesaurus 5th Edition, Chapman, R Ed Harper Collins New York 1992 Unpaginated
[ix] Brittanica World Language Vol 1 Funk & Wagnalls Co. NY 1959 1029 pp.P. 397
Illustrated Medical Dictionary 24th Edition WB Saunders
Company Philadelphia 1965 1724 pp.
Medical Dictionary Illustrated 22nd Edition Williams & Wilkins
Company, Baltimore 1973 1533 pp P 390
Desk Reference PDR 54 Edition 2000 Medical Economics, Montvale, NJ
3355 pp. Supplement A 383 pp.
J Observations on the Medicinal Properties of the Cannabis Sativa of
India Med.Chirg. Trans. London 26:188 –210 1843
JJ Hashish and Mental Illness Ed Peters, H & Nahas GG Translated
by Barnett, GJ Raven Press New York 1973 245 pp p 28
E Sur le haschich. Journal de Pharmacie et de Chimie Vol
13: 427-441 1848 (Quoted by Siegel, RK and Hirshman, AE Edmond DeCourtive
and the First Thesis on Hashish: A Historical Note and Translation.
Journal of Psychoactive Drugs Vol. 23(1) Jan – Mar 1991 85-86
Hemp Drugs Commission, Simla, India 1894
GM Daru and Bhang- Cultural Factors in the Choice of Intoxicant Quart
J of Studies on Alcohol V15,No 2 June 1954 220-237
J, Dornbush R, Feldstein S, Clare G, Zaks A, Fink M, and Freedman AM
Marihurana, EEG, and Behavior Ann NY Acad Sci 191:206-215 1971
[xix] Hare, H.A. A system of Practical Therapeutics, Lee Brothers and Co. Philadelphia, 1892 Vol. 3