For personal use. Only reproduce with permission from The Lancet Publishing Group.

CannabisJonathon Green Pavilion Books, 2002£20, 256 ppISBN 1 86205 479 7

“Why would a neurology journal want to review yet anotherbook on cannabis?”, I asked myself, despite the acadenic-grey bound volume, boldly emblazoned CANNABIS ingold, and containing both enticing images and entrancingtidbits of cannabis culture, hashish history, and marijuanamedicine (not forgetting the pot policy and reefer recipes).The ultimate coffee-table cannabis text. “Pass the brownsugar, thanks.”

But if it were coffee-time and Cannabis was on the table,which neurologists would try it?Fascinating to many would be thedecade-long voyage of discoveryinto our endogenous canna-binoid system. But JonathonGreen only briefly hits onanandamide, the brain’s “blissmolecule”, and the science ofcannabinoids, in sparse detailsspread throughout the book.What he does offer is a vividaccount of the historical andcurrent uses of the plant and itsproducts, including a helpful A-to-Z list of proposed medicinalbenefits.

Though clearly Cannabis wasnever intended for academics, Icould imagine many neurologiststaking a peek or two, beingamong the specialists most likelyto encounter people using thedrug therapeutically—for spasms,insomnia, multiple sclerosis, etc.The claims of benefits derived from the plant or itsconstituents has placed neurologists in the invidiousposition of being aware of a potential tool for palliation thatis illegal, and in the middle of a legal and political debateabout the place for the drug’s remedicalisation based on ascience that hasn’t caught up yet.

As Green suggests, use of cannabis and its extracts hasperhaps never been higher, though he does not ask why. Arewe re-evaluating its usefulness or is prohibition failing?Perhaps modern life means people need more analgesicsand anaesthetics to get through the daily grind. Or anevolutionary argument I heard suggests that the plantwould continue to adapt for human use, exploiting its nicheas fibre, therapy, and intoxicant, to ensure furthercultivation. But maybe that’s just the dope talking. Likeother aspects of the book, Green’s treatment of wider issuesis superficial, but he does admit he partakes regularly(though not with tobacco, anymore).

Another cup? How many readers lost interest when theyrealised the author is a self-confessed “midnight toker”

(Green, I mean, although there was this one time as areckless preclinical student in India . . .)? And how many arereading on, wondering if Cannabis could give them or theirwaiting rooms more street cred? Although the bookcontains too little on the potential harms of some methodsof administration to make Cannabis “safe” to leave in mostwaiting rooms, to my mind, Green does relay a valid view ofglobal cannabis culture, rendering the personal experienceof intoxication through the testimony of great thinkers,reputed artists, and historians who have attempted tocapture the essence. Phew! Light the incense!

No need then for me to recount my quarter. But I didn’tinhale. And I do believe every clinician needs to beacquainted with the basic uses and misuses of all commondrugs, including weeds, but the reality is that they aren’t.

For example, the story I heardfirst-hand of a young lad who—when stopped incidentally bythe police—emptied hispockets to discover, among theloose change and fluff, a largepiece of hash (cannabis resin).Which he promptly ate (I guessthe theory goes that possessionis illegal in the UK whereasingestion is not). What wasmost surprising, he said, wasthe reaction of the casualtydoctor when the officers tookhim to hospital. “She didn’tseem to know anything about it[cannabis] or what it would doto me. She kept asking me whatI had taken”, he recalled. “I wasjust lying there, fighting to keepawake, so paranoid that if I fellasleep they would try to pumpmy stomach.”

I hope most neurologistsare more seasoned, through patients’, if not, personalexperience. Though chance would predict that a fewneurologists are or have been secret “tokers”, since cannabisuse continues to be widespread among all groups, evenotherwise upstanding professionals. Tabloid reports of a“roach” (from “cockroach”, not an insect, but a name forthe end of a ‘joint’—La Cucuracha was an infamousMexican marijuana-smoking cockroach) in the UKgovernment Cabinet offices may attest that dopeheadsabound at the highest levels.

For potheads and spliff-junkies, Green’s book seems agood bible, giving the lowdown on making a “bong”, howto “back-roll” to use less paper, tips to grow-your-own, andclassic recipes for hash brownies and bhang lassi. Whichreminds me of my own personal research . . . “Anothercoffee? Yes, why not. I forgot what I was telling you.”Kelly Morris

On page 291 of this issue, David Baker and coauthors review thetherapeutic potential of cannabinoids and the cannabinoid system.

THE LANCET Neurology Vol 2 May 2003 http://neurology.thelancet.com 319

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