Addiction in the Courtroom [Guest Post]

Forensic psychology and the paradox of addiction.

Allison Gamble says she has been a curious student of psychology since high school. Though her studies ultimately led her to writing and editing, she keeps her understanding of the mind close at hand in the weird world of internet marketing.

The paradox of addiction presents a legal conundrum when it comes to determining the extent of a defendant’s guilt in criminal court. Although addiction is generally considered a mental health condition, it does not lie within the parameters that typically define mental illness in the courts. Though defense lawyers may present addiction as a mitigating factor--in some cases influencing the jury to vote for a lesser conviction--addiction does not excuse the defendant from being legally responsible for the crime.

Forensic psychology is a field that weaves together psychology and the criminal justice system. Oftentimes these insights prove useful for determining legal guilt or innocence. For example, if a defendant is found not guilty by reason of insanity, it is likely due to the work of a forensic psychologist. However, when it comes to crimes involving addictive behavior, forensic psychology is faced with paradoxical truths regarding addiction, and the relationship between addiction and responsibility for one’s actions.

A commonly held view of addiction is that it is a disease marked by lack of control. An alcoholic cannot stop himself from drinking. Likewise, a drug addict will do things no one in their right mind would ever do just to get the next high. All of these people may thoroughly regret their behavior when the high wears off, but that does not stop them from doing it again. Indeed, they often cannot stop without help.

Paradoxically, however, addiction is all about choice. A crucial part of treatment for addiction requires the addict to take full responsibility for his or her behavior. Addicts must recognize that their addictive behavior is, on some level, a choice, and that they can choose differently. It is not clear to what extent biology plays a role in starting an addiction. Social and emotional factors also play parts, both in forming an addiction and in continuing it.

This creates a huge gray area when an addict commits a crime related to his or her addiction. Did the person have control over their behavior? Is the addiction itself a choice, or something the addict can’t help any more than they could help catching the flu? Especially in cases where the addiction itself is a crime, such as compulsive shoplifting or narcotic use, these questions are crucial in determining the defendant’s responsibility for the crime and an appropriate sentence. Generally if these questions can be answered at all, the answer is often both yes and no, and the legal system often reflects this dichotomy: People convicted of addiction-related crimes may be ordered into treatment as part of their sentences. In some cases, especially for crimes not involving violence or repeat offenses, criminal charges are dropped if the defendant agrees to treatment. However, a defendant being treated for addiction may also be sentenced to jail time, probation, fines, community service, and/or restitution, especially if the crime involved violence or property damage. Since addiction is both under and outside of the addict’s control, someone who commits an addiction-related crime should be both held responsible and offered treatment.

Graphics Credit: http://diaryofasmartchick.com/

Are E-Cigarettes a Good Idea or a Bad Idea?

A group of nicotine researchers argue for an alternative.

Electronic cigarettes are here to stay. If you're not familiar with them, e-cigarettes are designed to look exactly like conventional cigarettes, but they use batteries to convert liquid nicotine into a fine, heated mist that is absorbed by the lungs. Last summer, even though the FDA insisted on referring to e-cigarettes as “untested drug delivery systems,” Dr. Neal Benowitz of the University of California in San Francisco--a prominent nicotine researcher for many years--called e-cigarettes “an advancement that the field has been waiting for.” And recently, Dr. Michael Siegel of the Boston University School of Public Health wrote: “Few, if any, chemicals at levels detected in electronic cigarettes raise serious health concerns.” Furthermore, Dr. Siegel took a swipe at the opposition: “The FDA and major anti-smoking groups keep saying that we don’t know anything about what is in electronic cigarettes. The truth is, we know a lot more about what is in electronic cigarettes than regular cigarettes.”

Harm reduction advocates are ecstatic. But do e-cigarettes simply reduce harm by eliminating combustion by-products--or do they perpetuate nicotine addiction, frustrate the efforts of smoking cessation experts, and give false hope to smokers that they can have their cake and eat it, too?

Dr. Siegel conducted a survey of e-cigarette users and found that 66% reported a reduction in the number of cigarettes smoked at the six-month point. “Of respondents who were not smoking at 6 months, 34.3% were not using e-cigarettes or any nicotine-containing products at the time.” Pretty impressive--although Siegel himself refers to the findings as “suggestive, not definitive”--and seemingly a giant leap forward for harm reduction.

However, even though they have dramatically altered the harm reduction landscape, e-cigarettes will not change anything for smokers who are attempting to completely quit using nicotine. When they inhale their last e-cigarette mist, several hours later they will begin to suffer the same withdrawal pains as regular cigarette smokers: “Irritability, craving, depression, anxiety, cognitive and attention deficits, sleep disturbances, and increased appetite,” as NIDA summarizes it. Current smokers are keenly interested in the new products, partly because of health concerns, and partly, it seems safe to venture, because a new generation of nicotine-based products like e-cigarettes “will enable them to put off the need to quit smoking,” as Dr. Dorothy Hatsukami, director of the Tobacco Use Research Center at the University of Minnesota, has asserted.

Harm reduction advocates for the electronic cigarette often make it sound like once the smoker is only inhaling nicotine, his or her problems are solved. But nicotine, of course, is the addictive part. Nicotinic receptors are present in moderate to high density in the brain areas containing dopamine cell bodies--the ventral tegmental area and the nucleus accumbens—the same pattern as almost every other addictive drug.

Even that part wouldn’t be a problem if addiction to nicotine were utterly benign. But it isn’t--although you wouldn’t know it from the pro-electronic cigarette propaganda. Nicotine in the blood is correlated with increases in arterial vasoconstriction, and is strongly suspected of playing a role in arteriosclerosis and other cardiovascular diseases. Nicotine increases LDL cholesterol, causes brochoconstriction, and has been implicated in the origin of lung tumors. There are also strong suggestions of links between nicotine and low birth weights in newborns.

So, it’s important not to kid ourselves about the hazards of nicotine, even though it may also be a medicine under certain conditions, like many other addictive drugs. Nicotine, you may recall, found industrial use as a farm crop insecticide. A poison, in other words. Nonetheless, what nicotine is NOT linked to certainly matters as well. Nicotine does not cause chronic obstructive pulmonary diseases, like emphysema—a huge plus. Nicotine won’t worsen asthma, as cigarettes do. And in the form of the electronic cigarette, it won’t cause secondhand smoke—another major plus for the e-cig.

There is another approach to regulating the harm caused by cigarettes. A group of scientists has been calling for a major effort at reducing the amount of nicotine in cigarettes so that, over time, a non-addictive level of nicotine would be reached--and cigarettes would no longer be addictive. Study after study has shown that if such were the case, about 80 to 90% of smokers would quit. And teens who experimented with truly low-nicotine cigarettes wouldn’t get hooked—unlike the “light” cigarette scandal, where the supposedly safer cigarettes may actually have turned out to be more dangerous because they forced smokers to smoke more in order to get the desired effect. Dr. Hatsukami and five other prominent nicotine experts contend that extremely low-nicotine cigarettes do not cause smokers to smoke more, “because it is harder to compensate for very low nicotine intake,” according to Hatsukami. Especially if there are no high-nicotine alternatives for sale—legally, at least. Mitch Zeller, who along with Hatsukami, co-chairs the National Cancer Institute’s Tobacco Harm Reduction Network, painted this picture: “Imagine a world where the only cigarettes that kids could experiment with would neither create nor sustain addiction."

Nonsense, counters Dr. Gilbert Ross of the American Council on Science and Health. “Asserting that smokers won’t smoke more cigarettes to get the nicotine they crave is a fairy tale,” he said. “The likely result is a major increase in cigarette-related diseases.”

These are the competing visions of our nicotine-addicted future. In one scenario, smokers stay addicted to nicotine, with its accompanying heath risks and all the other negative aspects of being addicted. But the immediate harm to their health is lessened due to fewer inhaled carcinogens, and they don’t create secondhand smoke. In the opposing scenario, smokers continue to smoke, and society continues to deal with secondhand smoke through no-smoking policies, while medical research agencies, under government mandate, oversee the gradual reduction of nicotine in cigarettes to a level below what is needed for addiction.

The optimistic thought here is that either of these approaches would bring much-needed improvement to the semi-controlled anarchy and hypocrisy of the current situation.

Photo Credit: http://whyquit.com 

Let’s Get Cellular: Meth Metabolism

Speedy fruit flies metabolize glucose differently.

We know from the work of Nora Volkow and others that meth abusers have chronically low levels of dopamine D2 receptors in their brains. But what is going on in the rest of the body when methamphetamine addiction is running full force? A study of meth-crazed fruit flies, just published at PLoS ONE by researchers at the University of Illinois, Purdue, and elsewhere, took a whole-body approach, tracing the meth-induced cascade of chemical reactions wherever they found it. Most drug research in animal models concentrates on changes in the brain.  But this study was looking elsewhere, for changes caused by meth and evidenced along common metabolic pathways. They found that meth exposure had striking effects on insect molecular pathways associated with “energy generation, sugar metabolism, sperm cell formation, cell structure, hormones, skeletal muscle and cardiac muscles.”  In other words—and no secret here—speed impacts aging, sexual behavior and cardiovascular health. But how, exactly?

The administration of methamphetamine to Drosophilia melanogaster—a fruit fly with one of the most studies genotypes in history—causes changes in the way certain genes and proteins are expressed. Some of the changes might hold for human users, as well:

-- Meth dysregulates calcium and iron homeostasis.

-- Meth inhibits something called ETC—the mitochondrial electron transport chain. This causes changes in proteins and reduced enzyme activity that, among other things, has been known to make bees more aggressive.

-- Meth alters peptides related to chronic heart failure in humans. The researchers observed that “concentrations of numerous muscle-associated proteins changed in response to METH exposure.”

-- Meth causes various sexual dysfunctions in man and animal, including inhibited sperm motility. Some of the changes in fruit flies caused by meth involved genes known to control sperm maturation. Altogether, the team identified seven meth-responsive genes and proteins associated with male reproductive functions.

-- Meth also caused changes “in whole organism sugar levels” in the fruit flies. Using gas chromatography/mass spectrometry technology, researchers observed decreased levels of trehalose, the primary form of blood sugar in insects. This could reflect “either higher metabolic rates resulting from a METH-induced increase in physical activity or increased carbohydrate consumption resulting from increased glycolysis…. Interestingly, human METH addicts often imbibe large amounts of sugary soft drinks; such dietary studies in Drosophilia lead us to question whether sugar intake in humans helps to alleviate the toxic effects of METH.”

-- “METH impacts pathways associated with hypoxia and/or the Warburg effect, pathways in which cellular energy is predominantly produced by glycolysis rather than by oxidative respiration.” Short version: The Warburg effect is associated with the aberrant energy metabolism characteristic of cancer cells. This certainly doesn’t mean we can conclude that speed causes cancer, but it is one more piece of evidence confirming the notion that methamphetamine’s range of potentially damaging side effects is simply too high to justify. We can argue the merits of legalizing marijuana, but no one who studies meth seriously has ever suggested legalization of this pernicious substance.

Professor Barry Pittendrigh of the University of Illinois, a member of the study team, said: “One could almost call meth a perfect storm toxin because it does so much damage to so many different tissues in the body.”

Sun, L., Li, H., Seufferheld, M., Walters, K., Margam, V., Jannasch, A., Diaz, N., Riley, C., Sun, W., Li, Y., Muir, W., Xie, J., Wu, J., Zhang, F., Chen, J., Barker, E., Adamec, J., & Pittendrigh, B. (2011). Systems-Scale Analysis Reveals Pathways Involved in Cellular Response to Methamphetamine PLoS ONE, 6 (4) DOI: 10.1371/journal.pone.0018215

So, Like, We’re Watching the LSD Episode of The Fringe...

Lysergic Acid Diethylamide

So this guy I know? Like really, really well? He’s over at my place and we’re watching The Fringe on TV and smoking a bowl, excuse me, we’re vaping a bowl, he’s an older guy and all concerned with his health and shit. So we’re watching the Lysergic Acid Diethylamide episode of The Fringe, and Walter’s rapping away like a drunken monkey as usual, and they’re hardly underway before my friend is jumping up off the couch and saying no, that’s not what LSD was like…. I said how would I know, and anyway the clothes in those Sixties photos always looked so bad, they must have looked even worse when you were tripping on that stuff. The closest thing I’ve ever had to a psychedelic experience was that time that guy slipped a roofie in my Mimosa. But I digress. My friend says no, no, see, when you took acid, you didn’t suddenly get hurled into somebody else’s consciousness, which in this case seems to resemble some crowded city out of Inception, with your tripping buddy perched on a bus, waving at you. That’s just not fucking how it went. So then he pauses, gets kind of sheepish, says, well, actually, that did happen once, but that’s not the point. And then blah blah happened. And everybody could read everybody else’s mind. And from then on everything was blah blah blah. And peace reigned forevermore. Okay, that’s not fair, he’s really just complaining that they aren’t telling it straight, about how LSD really feels, and what you really see and shit. This notion about taking drugs and ending up in cities full of people wearing black clothing really cracked him up. So I go, when was the last time you took a walk down Lake Street and saw somebody wearing some other color? But he loved the black guy who accidentally dosed himself and then started comparing his stick of red licorice to Bernini's spiral altar at St. Peter's. But car chases? Elevators? The Twin Towers, for God’s sake? Where are the colors, the tracers, the melting edges, the fractal glow of a universe in constant motion? Or something like that. My friend wants to know how they thought they were going to get away with it. Turning it all into a cartoon. And not just any cartoon, but that awful rotoscoping shit that made him seasick when we rented “A Scanner Darkly.”  Like they thought nobody who had ever taken the stuff was going to watch their crappy show, anyway? Whatever. But I thought that last part was cool, the cartoon guys were running to catch a giant purple blimp, like an episode of the Teenage Mutant Ninja Turtles—and chased by zombies!  And more car chases! Too cool! And my friend is laughing, and then he says yeah, well, something like that happened to him once, too….

Photo Credit:http://clatl.com/

Medical Cigarettes

Is it “Inhumane” to Take Cigarettes Away from Schizophrenics?

In an article for Brain Blogger a couple of years ago, I looked into the astonishing fact that, as a typical study of in-patient smoking among schizophrenics in Britain revealed, about 80-90% of the patients diagnosed with schizophrenia were cigarette smokers. Given that the running rate in the general population hovers around 20-25% on average, this is really quite amazing. It seems clear that nicotine is doing something for a schizophrenic that makes cigarettes into a form of self-medication that almost all schizophrenics apparently discover at one time or another.

A review of relevant studies through 1999, undertaken by Lyon and published in Psychiatric Services, shows unequivocally that schizophrenic smokers are self-medicating to improve processing of auditory stimuli and to reduce many of the cognitive symptoms of the disease. “Neurobiological factors provide the strongest explanation for the link between smoking and schizophrenia,” Lyons writes, “because a direct neurochemical interaction can be demonstrated.” According to Lyon, “Several studies have reported that smokers require higher levels of antipsychotics than nonsmokers. Smoking can lower the blood levels of some antipsychotics by as much as 50%…. For example, Ziedonis and associates found that the average antipsychotic dosage for smokers in their sample was 590 mg in chlorpromazine equivalents compared with 375 mg for nonsmokers.”

In particular, smoking seems to help quell auditory and visual hallucinations. The process known as “sensory gating” refers to lower response levels to repeated auditory stimuli. A schizophrenic’s response to a second stimulus is greater than a normal person’s, and this is also impacted by cigarettes. Sensory gating may be involved in the auditory hallucinations common to schizophrenics. Receptors for nicotine are involved in sensory gating, and several studies have shown that sensory gating among schizophrenics is markedly improved after smoking.

There is an additional reason why smoking is an issue of importance for health professionals. Dr. Bill Yates at Brain Posts recently examined a small study by Michael Allen and colleagues in the American Journal of Psychiatry in which 40 schizophrenic patients were admitted to a psychiatric emergency service, where they were given standard antipsychotic therapy. In addition, the researchers randomly assigned either a 21mg nicotine patch or a placebo patch to the subjects upon admission. As Dr. Yates summarized the results:

--Nicotine patches reduced agitation by 33% in the first four hours and 23% at 24 hours. And the reduction was greater than with either the antipsychotic alone, or in conjunction with the placebo patch.

--Subjects with lower nicotine dependence scores tended to show the most response compared to placebo.

--The effect of nicotine replacement on agitation reduction approached the level seen with standard antipsychotic therapy.

As Yates notes, this finding is “pretty dramatic.” It seems to show that acute nicotine withdrawal only makes the situation worse in a clinical setting. The study authors also argue that stronger patches combined with nicotine gum might quell agitation more quickly and effectively. “Encouraging patients with psychotic disorders and mood disorders to quit smoking is an important general health strategy,” Dr. Yates writes. “However, this study suggests that attempting this during an acute psychotic break is probably counter productive and may be inhumane.”

Photo Credit:http://drugabuse.gov/

Drug Czar Kerlikowske Interviewed in Foreign Policy Magazine

Drug War goes international in a big way.

Gil Kerlikowske, Director of the Office of National Drug Control Policy--a.k.a. the Drug Czar--finds himself in a curious position. Kerlikowske can be forgiven for feeling a little like J. Edgar Hoover, when the FBI director found that domestic security at home seemed to require some rather active investigations into Cubans and other Communists abroad. Kerlikowske is now riding a horse he never had much say in buying. The U.S. is in the midst of launching a new international drug strategy consisting of “interlocking plans” in Central and South America aimed at “transnational criminal groups.”

AFP reporter Jordi Zamora wrote that “the strategy will merge a handful of existing programs, including Plan Colombia, which has received more than $6 billion in U.S. aid since it was launched in 2000, and the Merida Initiative for Mexico, for which Congress has appropriated $1.5 billion since 2008.” Kerlikowske said that the global nature of the drug threat “requires a strategic response that is also global in scope.” With various crackdowns and battles over smuggling routes, the drug trade in the region has led to thousands of deaths, and has created “complex and evolving threats” from crime syndicates,” according to Assistant Secretary of State William Brownfield.  However, “progress in Central America will only push drug traffickers elsewhere if we do not support strong institutions throughout the hemisphere,” he said.  It seems like the Office of National Drug Control Policy continues to be internationalist in scope.

With all that as background, Foreign Policy magazine spoke with Kerlikowske in search of more detail, and got some--including a strange paean to America’s ability to produce and distribute its own illegal drugs, with no help from Mexico, thank you very much. Kerlikowske seems almost to be bragging. And if he’s right, what are all those border killings about, anyway?

FP: What's your big-picture sense of the drug situation in Latin America?

GK: It used to be fairly easy to categorize countries as production countries, transit countries, or consumer countries. I think those lines have been--if not completely obliterated--generally blurred. The amount of drug use in Mexico is significant. It's also clear from my most recent trip to visit drug treatment centers in Colombia that they're concerned as well. 

FP: U.S. Ambassador Carlos Pascual was forced to leave his position in Mexico two weeks ago because of comments he made in WikiLeaks cables about the perception that the drug war in Mexico is failing and about pervasive corruption in Mexican law enforcement. Are those concerns you share?

GK: As a police officer, I can say that cynicism just comes with the territory, and it's pretty easy to adapt that kind of attitude to Mexico. I'm not overly optimistic, but I think there has been some progress and we have an administration that's courageously taking on these criminal organizations, who are now involved in so many other kinds of crimes.

FP: It does seem that there have been a number of recent scandals involving U.S.-Mexico drug partnership: the Pascual resignation, the reports of the ATF allowing cross-border gunrunning, the controversial use of drones over Mexican territory. Has that relationship become more difficult lately?

GK: In my two years of dealing with this on a closer level, I'd say these last two months are more strained than during the rest of the time I've been here, but I don't see it as a significant bump in the road or a glitch that's going to stop things.

FP: What do you say to those in Latin America who say that it’s useless to crack down on the drug trade as long as the demand persists from the United States?

GK: For one thing, we've become much better at producing drugs in the United States: hydroponic marijuana with a very high THC content -- public lands produce a lot of marijuana. And we don't get any prescription drugs smuggled in to any great extent--which, right now, are our No. 1 growing drug problem in the United States, and also methamphetamine. We're getting much better at making our own, albeit in small amounts.

FP: How do you respond to the growing number of former Latin American leaders--former Mexican President Vicente Fox, most recently--who have come out in favor of legalization or at least a radical overhaul of the current policy?

GK: Isn't it funny how people who no longer have responsibility for anyone's safety or security suddenly see the light? I think it's not a lot different from what we've heard in recent years in the United States, which is: We've had a war on drugs for 40 years and we don't see success. If we have a kid in high school, they can still get drugs or there's drugs on the street corner. So legalization must be an answer…. Heaven knows, we're not very successful with alcohol. We don't collect much in tax money to cover the costs. We certainly can't keep it out of the hands of teenagers or people who get behind the wheel. Why in heaven’s name do we think that if we legalize marijuana, we'd have a system where we could collect enough tax revenue to cover the increased health-care costs? I haven't seen that grand plan. “

Photo Credit: www.fs.fed.us

Marijuana, Vomiting, and Hot Baths

A case history of cannabinoid hyperemesis.

Cannabinoid hyperemesis, as it's known, is an extremely rare but terrifying disorder marked by severe episodic vomiting that can only be relieved by hot baths. (see earlier post). Sufferers are heavy, regular cannabis users, most of them. And hot baths? Where did THAT come from?

The syndrome was first brought to wider attention last year by the anonymous biomedical researcher who calls himself Drugmonkey, who documented cases of hyperemesis that had been reported in Australia and New Zealand, as well as Omaha and Boston in the U.S. "There were two striking similarities across all these cases," Drugmonkey reported. "The first is that patients had discovered on their own that taking a hot bath or shower alleviated their symptoms. So afflicted individuals were taking multiple hot showers or baths per day to obtain symptom relief. The second similarity is, as you will have guessed, they were all cannabis users."

The reports haven't stopped. This summer, an intriguing account appeared on the official blog of New York University's Division of General Internal Medicine, where med students offered a formal definition: "A clinical syndrome characterized by intractable vomiting and abdominal pain associated with the unusual learned behavior of compulsive hot water bathing, occurring in the setting of long-term heavy marijuana use."

Still skeptical? I received this heartfelt comment on my original post a few days ago:

Listen, doubters. My son has this. He has been cyclical vomiting and spending hours in boiling hot baths since last Autumn. It's getting worse and he has lost a hell of a lot of weight. He is 21 and an addicted, heavy cannabis user who started at 15. He has tried cutting down but every other joint of weed brings on the obsession. He refuses to co operate with medical staff who try to treat him.
He has been taken to numerous hospitals as an emergency for non-stop vomiting and begs medical staff to let him sit in a very hot bath. They try the best anti-vomiting drugs instead, to no effect, and then some let him go in a hot shower for an hour plus. He always ends up on a drip and as soon as he feels well enough, discharges himself, often the same day.

At the weekend he went to a sports event in the city with friends, realised on the way he was going to have an episode, so left friends and made his way into a hotel room and locked himself in. Police were called and got him out of a boiling hot bath against his will. Cue vomiting attack so bad police called an ambulance. Once again discharged himself from hospital, demanding drip be removed or he would do it himself. Has sat in bath at house he shares with girlfriend for at least 12 hours today, she tells me. She says water is so hot she has no idea how he bears it.

He says he has no pain in stomach, just a sensation that drives his head mad and he KNOWS it will not go, or the vomiting stop, until he gets in boiling hot bath and stays there. He has even done this while abroad on holiday and ended up on a drip before being flown home.

All of this is true. A mother.

I was intrigued, and discussed this briefly with the mother, who lives in the U.K. She added a number of details in an email exchange, and agreed to let me publish her comments:

“I am a mother in the UK whose son definitely has this, but is not officially diagnosed as he ‘escapes’ medical attention by discharging himself from various hospitals.

When it happens he is desperate to get in a hot bath. He lives with his girlfriend. I only realised what the hell was really going on when she insisted on telling me, and have since been regularly involved in the hospitals saga.

When I discovered the truth I put ‘cannabis’ ‘vomiting’ and ‘hot baths’ ‘showers’ in google and up came a perfect description of what my son does.

I am trying to get him to agree to go for counselling and psychiatric help as he has reached the stage where this obsessive vomiting and bathing is wrecking his life. But every time he gets a little better he believes he can ‘control it’ which is not the case at all.

Yes – we end up in the hospitals and the first young emergency doctor who has ever smoked a joint and/or thinks he knows everything, tells G “Oh no it can’t be that, cannabis stops vomiting, not starts it.” Of course, they have never heard of this condition and just think he is being irrational because of the constant need to vomit. They are sure it is food poisoning or some kind of spasm and take basic blood tests.

They find nothing, insist on giving him the best anti-sickness drugs usually for cancer patients and so on…, saying “this will definitely stop it” and still he vomits. He is not in pain, just rapidly dehydrating and panicking and complaining of a weird sensation in his stomach. He tells them “I know it’s in my head doing this” and desperately demands to get in a bath. Even when he has arrived at hospital because police found him in a boiling hot bath, this makes no sense to the medics who only give in when none of their drugs work. He then immediately stops vomiting but is petrified of getting out of the bath. Eventually, when he says it is under control, he agrees to get out, and is put on a drip. Approx an hour later, while the doctors are planning follow-up procedures like scans and more complex blood tests etc, he starts an argument with a nurse, insists the drip is removed and phones a friend to collect him, avoiding seeking a lift from me if he can. The over-pressed doctors here (the British system is like a cattle market) are left mystified and move onto the next emergency in their pile up of admissions. And so it goes on, and will do, until G accepts even the odd joint can set him off.”
----

Researchers speculate that it has something to do with CB-1 cannabinoid receptors in the intestinal nerve plexus--but nobody really knows for sure. Low doses of THC might be anti-emetic, whereas in certain people, the high concentrations produced by long-term use could have the opposite effect.