Abstract
Introduction: Cannabis has been historically classified as a hallucinogen. However, subjective cannabis effects do not typically include hallucinogen-like effects. Empirical reports of hallucinogen-like effects produced by cannabis in controlled settings, particularly among healthy research volunteers, are rare and have mostly occurred after administration of purified Δ-9 tetrahydrocannabinol (THC) rather than whole plant cannabis.Methods: The case of a healthy 30-year-old male who experienced auditory and visual hallucinations in a controlled laboratory study after inhaling vaporized cannabis that contained 25 mg THC (case dose) is presented. Ratings on the Hallucinogen Rating Scale (HRS) following the case dose are compared with HRS ratings obtained from the participant after other doses of cannabis and with archival HRS data from laboratory studies involving acute doses of cannabis, psilocybin, dextromethorphan (DXM), and salvinorin A.Results: Scores on the Volition subscale of the HRS were greater for the case dose than for the maximum dose administered in any other comparison study. Scores on the Intensity and Perception subscales were greater for the case dose than for the maximum dose of cannabis, psilocybin, or salvinorin A. Scores on the Somaesthesia subscale were greater for the case dose than for the maximum dose of DXM, salvinorin A, or cannabis. Scores on the Affect and Cognition subscales for the case dose were significantly lower than for the maximum doses of psilocybin and DXM.Conclusion: Acute cannabis exposure in a healthy adult male resulted in self-reported hallucinations that rated high in magnitude on several subscales of the HRS. However, the hallucinatory experience in this case was qualitatively different than that typically experienced by participants receiving classic and atypical hallucinogens, suggesting that the hallucinatory effects of cannabis may have a unique pharmacological mechanism of action. This type of adverse event needs to be considered in the clinical use of cannabis.
Highlights
Cannabis has been historically classified as a hallucinogen
Approach In the context of a double-blind, placebo-controlled laboratory study investigating the effects of smoked and vaporized cannabis, we present the details of an adverse reaction to inhalation of vaporized cannabis containing 25 mg THC in a healthy male research participant (H.C.)
Ratings of subjective drug effects provided by H.C. during the case dose are compared with subjective data obtained from other participants in the same study, as well as subjective effects reported by participants in separate self-administration studies that evaluated acute dose effects of oral cannabis, psilocybin,[5] DXM,[10] and salvinorin A.9,21
Summary
Cannabis has been historically classified as a hallucinogen. subjective cannabis effects do not typically include hallucinogen-like effects. The hallucinatory experience in this case was qualitatively different than that typically experienced by participants receiving classic and atypical hallucinogens, suggesting that the hallucinatory effects of cannabis may have a unique pharmacological mechanism of action. This type of adverse event needs to be considered in the clinical use of cannabis. Case reports that documented the subjective effects of cannabis[1,2] included experiences of anxiety, physiological distress, spiritual or mystical effects, and alterations to perception, awareness, and insight These case reports provided support for characterizing cannabis as a hallucinogen.[2] Currently, it is uncommon for cannabis to be categorized as a hallucinogen, but, as policy changes regarding the medicinal.
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