Medical Admissions Criteria
Tod H. Mikuriya, M.D.
Because of the vacuum of clinical knowledge about the therapeutic
applications of cannabis caused by marijuana prohibition a widespread
condition of ignorance exists. While it is acknowledged that
there exists a range of illnesses on the dimension of seriousness
objectively, there is none to the person afflicted who is seeking
relief. Exclusion because the condition does not appear on a
list developed by a group of non-medical politicians or bureaucrats
merely perpetuate this clinical ignorance. Therefore the medical
criteria are to be inclusive limited only by contemporary classifications
Persons shall have a verified specific diagnosis by a licensed
physician that is included within the latest revision of the
International Classification of Diseases ICD-9. Or the Diagnostic
Statistical Manual DSM-IV vague statements about conditions,
disorders, or syndromes without specific information or not recognized
by either ICD-9 or DSM-IV are not acceptable.
Mental Disorders Admissions Protocol
Since the inception of cannabis buyers clubs some have expressed
concern about the possibility of adverse effects on individuals
suffering from emotional or mental disorders.
In clinical interviews I have conducted with members and patients
in my psychiatric practice it is my impression that while many
definitely benefit from cannabis there are others for whom use
of cannabis is contraindicated.
The buyers cooperative procedures seek to both address these
concerns and study more fully the effects of cannabis on emotional
and mental disorders.
All persons seeking membership in the cooperative for treatment
of conditions listed in DSM-IV or emotional or mental conditions
listed in ICD-9 shall be reviewed by mental health professional
after verification by intake staff.
Individuals in whom the use of cannabis is or has been problematic
shall be excluded. This group includes persons suffering from
cannabis related disorders.
Additionally, other emotional and mental conditions may be
worsened by the use of cannabis. Some persons are involved in
treatment requiring abstinence from cannabis especially those
involved in twelve step recovery programs.
Cases where verification or suitability for the program is
in dispute shall be reviewed by a panel of volunteer psychiatrists
who will make final determination.
Adverse Effects of Cannabis
As with any drug, cannabis is a tool. There will always be
individuals that experience adverse consequences from any drug
use. The abuse of cannabis had been recognized for millennia.
These problems were described by O'Shaughnessey
during his observations in India in 1839, which included
references in the Persian medical literature. With widespread
non medical use of the drug for the past thirty years, psychiatrists
have developed classifications of cannabis presented in the latest
Diagnostic and Statistical Manual, Revision IV (DSM-IV).
Overdose is most common by the oral route since the time from
taking the drug until the experience of effects begin is from
one to three or more hours. Inexperienced and ignorant first
time users will have an unforgettable experience.
The effects of overdose have been numerously described in
general, clinical, and scientific literature. Cannabis overdose
comprises the majority of listings in the Surgeon General's list,
19th century precursor of the Indicus Medicus. American
literary accounts in books: Fitz
Hugh Ludlow's Hashish
Eater and an
essay on Hashish by Victor Robinson, M.D., are expressly
devoted to cannabis. Descriptions of experience with the drug
as part of travel to areas of indigenous use may be found in
English and European literature over the past three centuries.
Scientific and medical descriptions of effects of cannabis overdose
have been numerous extensive. Before and after its removal in
The effects of overdose are from the stimulation and sedation
of the central nervous system. Stimulation with a flooding of
ideas and images that are vivid and rapidly changing. Attention
and concentration are markedly impaired. Time perception is significantly
altered with minutes seeming like hours. There may be distortion
of spatial perception. Secondary physical effects, aside from
a speeding up of the heart rate is generally no more than that
associated with mild to moderate exercise.
- Recent use of cannabis.
- Clinically significant maladaptive behavior or psychological
changes (e.g. impaired motor coordination, euphoria, anxiety,
sensation of slowed time, impaired judgment, social withdrawal)
that developed during, or shortly after, cannabis use.
- Two (or more) of the following signs, developing within 2
hours of cannabis use: (1) conjunctivae injection (2) increased
appetite (3) dry mouth (4) tachycardia. The symptoms are not
due to a general medical condition and are not better accounted
for by another mental disorder.
- Specify if:
With Perceptual Disturbances: This specifier may be noted when
hallucinations with intact reality testing or auditory, visual,
or tactile illusions occur in the absence of delirium. Intact
reality testing means that the person knows that the hallucinations
are induced by the substance and do not represent external reality.
When hallucinations occur in the absence of intact reality testing,
a diagnosis of Substance-Induced Psychotic Disorder, with Hallucinations
should be considered.
292.81 Cannabis Intoxication Delirium
292.11 Cannabis-Induced Psychotic Disorder, With Delusions
Specify if with onset during intoxication.
292.89 Cannabis-Induced Anxiety Disorder, Specify
if: with onset during Intoxication.
Continuing or chronic use.
Use or abuse? Cannabis, like any other drug, is a tool. Properly
utilized with realistic expectations and awareness of its properties,
cannabis is a safe and effective medicine. Improperly used with
unrealistic expectations and ignorance, adverse effects may result.
The onset of unwanted effects may be obvious or insidious. The
general etiology is some emotional discomfort for which cannabis
is taken to relieve producing undesirable consequences from using
the drug itself.
Paranoia and delusional thinking are not uncommon effects
of cannabis both acute and chronically. In the acute experience
it appears to be from the perceptual distortions of space, time
and feelings of detachment.
In chronic use paranoid and delusional thinking appear to
be the consequences of the suppression of feelings, the dulling
of feelings may alienate the cannabis users from others by diminishing
empathetic capabilities. This emotional insensitivity then results
in conflict through misperception. Misperception results from
the dulling of affect that is important contextual collateral
information source. An effective relief of emotional distress
then becomes an impediment to relationships with the cannabis
user. Feelings are an integral dimension of social perception
that convey important contextual information. Cannabis, as an
effective sedative and antidepressant, has this undesirable side
effect when misused. The relief afforded by the drug may be paid
for by complications caused by avoiding dealing with the causes
of the emotional pain as well as diminished functioning while
under its influence.
Cognitive impairment by continuing or overuse of cannabis
creates a form of mild dementia that may persist for up to several
weeks after discontinuing the drug. Individuals sensitive to
the drug report a persistent ì hangoverî that diminishes
the ability to pay attention and concentrate. The onset may be
insidious, subtle, and gradual. This condition is reversible
with abstinence from cannabis.
304.30 Cannabis Dependence
A maladaptive pattern of cannabis use, leading to clinically
significant impairment or distress, as manifested by three (or
more) of the following, occurring at any time in the same 12
- tolerance, as defined by either of the following;
- a need for markedly increased amounts of the substance
to achieve intoxication or desired effect.
- markedly diminished by either of the following;
- withdrawal, as manifested by either of the following:
- the characteristic withdrawal syndrome for the substance.
- the same (or a closely related) substance is take to relieve
or avoid withdrawal symptoms.
- cannabis is often taken in larger amounts or over a longer
period than was intended.
- there is a persistent desire or unsuccessful efforts to cut
down or control cannabis use.
- a great deal of time is spent in activities necessary to
obtain cannabis (e.g. visiting multiple dealers or driving long
distances), use the substance (e.g. chain smoking) or recover
from its effects
- important social, occupational, or recreational activities
are given up or reduced because of cannabis use
- cannabis use is continued despite knowledge of having a persistent
or recurrent physical or psychological problem that is likely
to have been cause or exacerbated by the substance.
305.20 Cannabis Abuse
A. maladaptive pattern of cannabis use leading to clinically
significant impairment or distress, as manifested by one (or
more) of the following, occurring within a 12 month period:
- recurrent cannabis use resulting in a failure to fulfill
major role obligations at work, school, or home (e.g. repeated
absences or poor work performance related to substance use; cannabis
related absences, suspensions, or expulsions from school; neglect
of children or household)
- recurrent cannabis use in situations in which it is physically
hazardous ( e.g. driving an automobile or operating a machine
when impaired by cannabis use)
- recurrent cannabis related legal problems (e.g. arrests for
cannabis relate disorderly conduct)
- continued cannabis use despite having persistent or recurrent
social or interpersonal problems caused or exacerbated by the
effects of the substance (e.g. arguments with spouse about consequences
of intoxication, forgotten promises)
B. The symptoms have never met the criteria for Cannabis Dependence
for this class of substance.
232.9 Cannabis Related Disorder not Otherwise Specified
The Cannabis Related not Otherwise Specified category is for
disorders associated with the use of cannabis that are not classifiable
as one of the disorders listed above.