INTOXicA,ri(N V.IITH-.C-9 Preliminar,/ Descrieflon Of The Reaction Definition. Intoxication with C-9 refers to the sum tol'al of mental and physical changes induced by Ingestion of this drug and Is characterized by slow onset after oral Ingestion, prolonged persistence of symptoms, conjunctival injection, pseudo2pfosis, tachycardia at rest, postural fachycardia and hypofension, and subjective symptoms which occur Include drowsiness mixed with a ppr-e -hens-ion, dryness of the mouth, difficulty in thinking and concentrating' variable changes In moods and a feeling of increased sensory perception. ys ical Pr Ph ooer ies. C-9 is 2an oily resin. It is soluble in organic solvents including ethyl alcohol, but is Insoluble in water. Alcoholic solutions of the drug are stable for at least 8 ironfhs* Method of Administration. Because of the drugs insol:ubilify In water, methods of administration are limited. The drug is ef f e.c t. I. ve orally an-d may be given in food., coffee2, soft dri:nks, or aico,@olic@ drinks. It Is also when dria-,-4 e-% -N and smoked, although the effects are generally milder and less consistent after smoking as compared with oral'ingesf'ion. Dosac The p IC resent descripf ion is based on doses (tofa.1 of 0.5 to 2.5 mg. of the drug orally. Def-inite cardiovascular et'fects can be defected in doses of 0.5 mg. Definite subjective effect's are reported with dozes of I mg. or more& At I mg. level, the ef fect s are us ua Ily regarded as pleasant by experienced marihuana users* With the higher doses, subjective effec s become S- agreeable even to experienced addlci's.. With doses of 2 mg. or more., tardlovaicular effects become very prominent and fain,'Ing -may occur on standing. Time Cours2e. Following oral ingestion both cardiovascular and subjective effects appear about one and one-half to two hours after a@ministration of the drug. Maxt mum effect Is reached four or five hours after the drug Is given. The peak effects is maintained to about the 16th hour following administration of the drug. Some effects may persist as long as 24 to 48 hours after administration. In ge2neral, the larger the dose of C-9 that Is given the longer symptoms persist. Subjective Sy-,lpfoms. During the height of the C-9 reaction (4.-16 hours) the following symptoms, which are listed by orgarv systems, have been reported. The list does not Include all symptoms that have been ment.loned but only those that are frequently reported. Special Senses. 2 Vision* (1) Blurring of vision. (2) Change in spatial perception. (3) Occasionally, elementary hallucinations (colored I I hts, patterns, etc.).on closing the eyes* Taste. (1) Increased acuity of taste. 121 Dry taste. Touch* 0 (1) Numbness of one or more extremitizs. (hot or cold feelings on the @-kin). (2) Pares@hesla Smel I No symptoms reported in this area. Gas-f-rointesf Ina I. (1) Dryness of-the mouth (2).Decreased salivation. (3) Dryness of the throa.f. (4) Increased appetite (consistently reported). (5) Nausea and vomi2t Ing (on ly with the larger doses Cardiovascular. (I') Dizziness (2) Palpitation (3) Weakntss and fatigue (4) Fainting on standing Res,o i.ra t IL (1) Sense of choki-ng (2) Air hunger 2 Renal No symptoms. reported. Neuromuscular (1) Dizziness (2) Blurring of vision (3) Paresthesta (4) Drovisiness (5) Sweating (6) Vveakness Mental Reaction. Ideation. Ideation Is reported as being impaired. Patients 9 ha ve. d 1 f@f I c u@l f yin th inking, ind it hard to concentrate, and are bothered by attempts to carry out' set k'asks. IVood. klood varies. Ind I vid@ua Is who are not habl@uate'd to marihuana or who dislike the effects of the drug, are depressed by C-9* They become fearful, and frequently refuse to take the drug again. Unpleasant effects are accentuat ed by nausea and vomiting, fainfnesso dlzztness, and weakness orv' standing. In e.xperienced.marihuana users, effects on mood.vary with the situation'. If patients are observed In small social groups and not Intensively ex2amined there Ts astrong tendency for elation to appear. The patients laugh, giggle, tell point- less. jokes, play records, and gtnerall'y-.be'have ir. A silly fashion. Under,conditions of Intensive examination, tendency is for pa-fients to withdraw, and act ina guarded fashion though they remain quiet and cooperative. When doses of 2-2' mg. are givens experienced marlhuana users become fearful and- somewhat withdrawn. They state that they are afraid of going too high' and that they wi I I be unable to a come down*ff Affect usually'ls approoria.te to the situation- and the stimuli being received. Stream and Content of Thought_. No gross impairment of a2bstract thin?-Ning occurs* So far as one can ascertain, there Is no abnormal thought content. Paranoid Ideas have not been prominent in our experience. -y. Like n-ood, psyidhomo for a.cf I vi f y Psvchomofor Activit varies -eiifh the situation and'with the 4 Individuals. In social situations, oufg;oing individuals are prone to laugh, dance'. giggle and crack many jokes. Patients usually remain defac.@ed from, f.he situati,on. They tend to laugh quietly at the outgoing individuals& When the situation is not social, tendenc y is for all types of patients to withdraw to their rooms and take naps. Hallucinations and Delusions. Hallucinations and delusions have not ye+ been observed. Occasionally elementary hallucinations, lights, patterns and2'co'lorings on closing fhe eyes, have been reported. General Characteristics of C-9 Reaction. Although the @mental e@fects Induced by C-9 seems somewhat vague, they are -deftnitety marihuana-like and are so identified by experienced tublects who are well acquainted with the effects of marihuana. Suc2h patients state that the chief differences are slow onset a(ad Long persistence of the reaction. Essentially the druq seems to Induce a mental state characterized by a peculiar mixture of pleasant sedation plus apprehension and anxiety which has no - -------------- definite basis. A sensation of being light or floatinq Is frequently re2ported. Distortion of ti'me sense Is often men.'Ioned.; time seems to pass more slowly. Some-difficulty In vision is present. This is usually described as consisting of slight blurring of vision plus spatial dts@ort'ton. Distances o.-dinaelly ar>,oear to be greater; distortion in form, shape or color is 3unusual. in addition., there is a sense of heighte'ned sensory 'tion---,all things took bet'ler, feet befter and fasl'e percep betterg In th-e proper situation there Is diminuflon in ego controls which, though not as great as seen i-ilth large amount's of alcohol, results tn@somewhat silly, uninhibited behavior.' 't a t' they are able to enjoy music more., to The.patients 9 e appreciate taste of food more highly, and-to appreciate colors and so on more.than they would without the drug. Although the test situation has precluded any direct observations on sexual -driv2e all patients consistently state that sexual urges would be enhanced In a proper situation. SyTptoms Induced by C-9 differs sharply In overall pattern from those induced by LSD-25. In the LSD reaction, nervousness, anxiety a.nd anorexia are prominent. In the C-9 reaction, @dr,ows-Ine-ss (although mixed with some mild apprehe..riston) and 6ti-nger are commonly reported. Atropine-like effects tdryness ----------- of the mouth etc.) are prominent with C-9 and not prominent wlfh LSD. Characteristic, vlsual-percepfual distortion, which is so prominent in the LSD reaction, is scarcel.yrmentioned bt Individuals under C.-9. Depersonalization (a feel2ing' that onets body or so part of it I's not onets own) is common with LSD,.rare under C-90 Objecftve Effects. These include: (1) Injection of the conjuncfl.vae (red eyes) (2) Pseudonto-sTs (drocpy !I..-4s r.! Ir-. ep-f a ppea ra nce 'I (3) Tachycardia (fast pu2lsel (4) Ve.ry fast pulse and marked drop In blood pressure on, standing-. No -effects of outstanding. significance have been observed on bod-y temperature, resting blood pressure, respirafory rate, or In any phase of the neurological examination. Pupils are not dilated.- -There is no gross motor ataxia and no g.ross- c-hancle.on sensory :z examina.tiono No laboratory evidence of damage to the I iver, ktdriey or hemopoictic system has been observed affer single doses.- of the drug. Cardlovascviar Effects. The cardiovascular effects of C-9 are.also Induced by the members of the marihuana group (marihuana Itself and parahcxyl compounds). They cons2ist essentially of fachycardia and postural hypotenst@n. These effects are evident In two-@hours. and may be present 24 to 48 hours la-ter. They may be present for 24 to 48 hours- after the ingestion of doses of 2 -to,2*5 mg* The cardiovascular effects are most evident on quiet standing. The resting pulse rate and.pulse rate after one and two minutes standing plu2s blood pressure af'tcr one and two minutes standing are very useful Indicators of the drugts effects. Variations. As is the case with all drugs,, the degree of effect obtained with a given dose of C-9 varies from Individual to,individual. In some pafienfs, intense menfa-I effect& plus cardiovascular effects%, resulting in fainting on stand!.-I2g., may occur with doses as low as 1.5 mg. -in other Individuals receiving I .5 mgmop. or even 2.0 mgm.., very few subject ive symptoms and only mlid chanqes In pulse rate and blooct prii,-turq,@will be observed on standing. Psychos Is After C-9. So- far, no 'toxic psychosis %as occurred after inge1stion of.C-9. It is, hotiever, known that other marihuana- like drugs sometimes trigger a toxic psychosis, usually of paranoid type, in susceptible individuals. It Is very likely that when a suff I c I en t number of pa f lents have had C-9, fox IC psychoses may be reported in a,few. -'D la gno s I sAt the-. present f.ime th'ere Is no absolutely way of d lagn-os i,ng. C-9 (-or' ma r I hua no lnfoxicatio' in n -an unkno2tyn situation. The diagnosis should be suggested by the combination of conjuntival lnjec.tion eudopfosts, fachycardia, PS postural hypotension, plus fhe-,subject.ive effects of dryness of the-'mouf4 blurrintj of vision., drowsiness., change 'in time sense, spatial.,perception, and heightened auditory acuity. Negative points of Importance Include lack of neurological .changes and absence of significant effects on respiration, temperature, and resting blood prress,ulci DtfferenfTation from LSD-25 should be 'relatively easy tunles,s a@mixture of drugs Is giv2en) since pup! I'lary dilatation, accenfuafion.of tendon ref lexes and marked visual perceptval distorf-lon are not prese.nf during the C-9 reactlong Lack of pupitlary d I [a to t lo n- se rves to d I f f c re n t I a te C-'9 f rom Scopo I am 1 ne . A I co ho I -neurof and barB'Tturates Induce definite ogical changes (nysfagrlus, a tax I a I n ga I t a nd s t a f lo n,. but do no t I nducc dryn,es-s@ o,f f h c mo u t h a nd f h c c-h a'ra c f e r 1 s '--I c me n.f a I ch a,n,ges, Ca u,-@,e,d by C-9.@ The C-9 reaction is n9 li.kely tb be confused %-jlfh any of the. major ps-ychoses'* if mi hf however be confused with anx tety reactions or panic states. ACUTE I NTOX ICA T I (@tl %--71TH THE DIETHYLAt.,ilDE OF LYSERGII-.ACID (LSD-2 Definition. Acute intoxication v!ith the-"diethylamide of lysergic acid refers. to the physiological and mental changes produced by the Ingestion oT' that drug. Acute LSD infoxi- cation Is charact2erized by dilatation of the pupils, Increased systolic. and diastolic blood pressures, Increased deep fendon reT'lexes-,,decreased superficial skin ret'lexes, retention of the pupillary.reactions to light and accomo:dat.ton and absence of changes in tests of motor coordination and sensory function. In addition, t2he drug Induces a characteristic &'rain of "mental" syr,ipfo-ms which Include in rough o-rde,r o-f aoocar@an-ce., sensation p that something is happening to the individual, nerv ousness and anxiety, peculiar sensafions on the skin (electric siocksj, hot and cold sensations2 insects crawling on the skin, changzs In t.@e texture of objects (a blanke'T feels like a buft'alo robe), dift'iculty in concentrating, rapid rush of thoughts., c@annes in mood %-thics@ var@/ from great elation to severe d4pression, changes in visual perception (things and people aopear 'lo be' 2 blurred; people and objects change in size., shape and colorl, trelementary'!' %al luci,-naflons (perception of lights, colors, diagracis, patterns raoidly changin- form, shape and size which are most prominenf on closing the eyes, or going inl'o- a- darkened room), and in extreme cases, true halluci6nafions (see.ing persons or things that are not really przsenf). Despite these experiences, the subject Lnows wlio @e isy where he is@ and the dafe and@ tir,-iz* Va r l.a f io n s The dzscripillon of LSD infoxicatton set forth in the det'inition above in2cludes symptonis observed in !net!- vi.L4uals who experienced maximal effects from LSD-25. It must be borne in mind that, as is the case-with all.drugs, the effects of identical. doses of LSD vary widely in,difli"erent Ind!-vidua-is. A dose of 2 75 mcg. may Induce only slight nervous- ness In onc Individual, while another person will experience marked visual distortions and ','rue halluctnatlons. In ae same Individual, et'seci may vary, L4e2perrdlrrg- upon. environ- r.iental circumstances. At present, however, all '.-!tlc. reasons for the variations In I'@,c dzgrez of eT@T@ecil in dlf-t@'crent' individuals are not completely understood. r-TTect of dosarz. 2 As is the case with Giber druos, tl-.c larger the dose of LSD, the greater fhe effect in fl'-kz sa!nz individual 'under the sai-ne circumstances. A person who experi- ences only clid e-r'fe.-ts after having received a dose of 75 r@2lcg. of LSD -,,tould IL-?c expected ilo- experience rtio,--Ieralle to riar'&-cd effects with a dose of 125 mcg., and markzd l'o.sl-vere effects c cj'o se o T' LSD a I s2-o a T' -icc c s viifh a dose OT' 151--) to 175. -rcC.6 zl','cci's aopear -,iore ii c 11 I r-, c o u t- s c o 'f' ii-oxi--af c, n Tii c 2 "c larger doses quic'