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Psychological

Effects of

Tetrahydrocannabinol
Irene E. Waskow, PhD;
James E. Olsson, PhD;
Carl Salzman, MD; and

Martin M. Katz, PhD, Chevy Chase, Md

THE

MORE widespread use of marihuaand marihuana-like drugs in the general


population and the controversy about their
possible harmful, as well as beneficial,
effects have led to an increased interest in
studying these compounds during the last
few years. At the same time, the identification of l-\g=D\1-3,4 trans-tetrahydrocannabinol (THC) as a constituent of marina

Submitted for publication July 29, 1969.

From the Special Studies Section, Psychopharmacology Research Branch, National Institute of Mental Health, Chevy Chase, Md. Dr. Olsson is currently with the Medical Office, Supreme Bench of
Baltimore, and Dr. Salzman is currently with the
Massachusetts Mental Health Center, and Harvard
Medical School, Boston. Drs. Waskow and Katz are

currently with the Clinical Research Branch, NIMH,


Chevy Chase, Md.
Read in part before the American College of
Neuropsychopharmacology, San Juan, PR, Dec 19,
1968.

Reprint requests to Clinical Research Branch,


Division of Extramural Research Programs, NIMH,
5454 Wisconsin Ave, Chevy Chase, Md (Dr.
Waskow).

huana and its synthesis by Gaoni and


Mechoulam1,2 have made possible the systematic study of this substance, which is
presumed to be the most active element in
marihuana (l-\g=D\1 is also referred to as l-\g=D\9;
l-\g=D\1 follows terpene nomenclature, which
was used by Mechoulam and Gaoni, whereas
l-\g=D\9 follows standard chemical abstracts no-

menclature).
The major aim of the present study is the
delineation of some of the psychological
effects of THC. This paper will deal primarily with the systematic measurement of
subjective reactions to the drug, and secondarily with some basic measures of cognition,
physiological response, and observed behav

ior. Future papers will report on other psy


chological effects of the drug. Previous re
search by the present investigators on the
psychological effects of lysergic acid diethylamide (LSD) and other drugs in a prison
population3 provided a background and a
procedural routine which could easily be
adapted for the study of this new drug.
Two groups of investigators46 have al
ready reported on some of the physiological
and psychological effects of the newly syn
thesized THC. In these investigations, the
subjects either knew what type of drug they
were to receive or had sufficient experience
with drugs so that they could readily identi
fy them. Since it is widely believed that the
effects of this type of drug can be greatly

influenced by a person's expectations and


past experience, it is important to study the

reactions of subjects who do not have spe


cific expectations about the drug they are
receiving. In the present study, a special
effort was made to keep expectations as
neutral as possible.
Following a pilot study, a second major

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variable was introduced into the design: one


half of the subjects in both THC and place
bo conditions were allowed to listen to music
before and after drug administration. This
music condition was included for several
reasons. Many subjects in a pilot study
tended to focus on uncomfortable physical
reactions to the drug, which seemed to inter
fere with their experiencing of other kinds of
effects. The authors considered various ways
of changing the experimental situation so
that a greater variety of effects might be
experienced. On the basis of prior studies
with this subject population, it was felt that
a change in setting would be more effective
than direct instructions or suggestions. Mu
sic was chosen as an especially relevant
setting variable, since, in our culture, mari
huana is frequently smoked in a setting
which includes music. Several pilot subjects
who were allowed to listen to music during
the onset of drug effects did seem to focus
less on physical discomfort and to experi
ence more emotional changes.
Methods
The

study

took

place

at the Patuxent Insti

tution, a treatment center in Maryland for


emotionally unstable criminal offenders. Two
previous drug studies had been conducted by
the present investigators at this institution.
The general setting and procedures of the pres

ent study were, with a few additions, essential


ly the same as in the earlier research.3
Subjects.The 32 men were paid volunteers
of at least dull-normal intelligence (average
intelligence quotient, 95) and of at least fifth
grade educational level (average tested grade
level, eighth grade). All were screened psy
chiatrically to eliminate potentially psychotic
or severely disturbed individuals; thus the sam
ple is most representative of the "normal"
segment of the prison population. All subjects
who had a history of extended use of narcotic

were also excluded, as


inmates who had participated in the two
previous drug studies. A total of seven subjects
had had some experience with marihuana,
while one half of the subjects reported no
experience with drugs whatsoever. Potential
subjects were interviewed by the project coor
dinator, were informed about the general na
ture of the experiment, and were given a free
choice of volunteering or not volunteering for
the study. Subjects were told that the purpose

drugs (over six months)


were

study was to investigate the physical and


psychological effects of drugs in order to gain
further knowledge about the details of their
effects. They were not specifically told what
of the

drug they might receive. Since three different


drugs had been used in the previous studies,

most inmates were already aware that a variety


of drug effects were possible. Subjects were told
that the drugs would be safe under the condi
tions of this study, and were further informed:
"Some effects may be rather mild while others
may be fairly strong. Some effects may be
pleasant while others may make you feel un
comfortable for awhile. Some of the feelings
may be different than you've had before."
Design and Procedure.Once a subject had
volunteered for the study, he was randomly
assigned to one of four conditions: THC-music,

THC-no-music, placebo-music,

or

placebo-no-

music. All THC subjects received a dose of 20


mg since an extensive series of pilot subjects,
run on various doses, had indicated that 20 mg
produced a definite response in the population
being studied while still being safe and not
interfering with the desired testing procedures.
The drug condition was double-blind, so that
neither the subject nor anyone interacting with
him knew whether drug or placebo was being
administered. It was, of course, impossible to
have the music condition administered blindly,
although the experimenters did not know until
the subject appeared for the experimental day
whether he would receive music or not.
Each subject was run on a separate day.
Upon his arrival in the experimental room at
about 7:45 AM, the subject weis given the
physiological battery of tests by a male nurse
and ate a light breakfast. The project coordina
tor talked briefly with the subject before the
predrug battery of psychological tests was ad
ministered by a psychologist at 8:30. This was
followed by a second run of physiological mea
sures. At 9:30, the psychiatrist administered the
drug orally. The THC was dissolved in 95%
ethanol (4 cc of ethanol) and weis diluted with
USP cherry syrup. The placebo consisted of
the same amount of ethanol and syrup. The
physiological procedures were repeated at spec
ified times throughout the rest of the day. The
postdrug psychological batteries began at Vf
hours and 3% hours post drug. A light lunch
was served at noon, approximately 2% hours
post drug. At about 2:45 the subject was taken
to the prison hospital, where he remained for
routine observation overnight until he was dis
charged by a psychiatrist the following morn
ing. The psychiatrist was on call throughout
the experimental day and the following night.
Subjects in the music condition were asked

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to

choose, from

records, those

among a varied

to which

selection of

they would like

to

listen and were instructed in the use of the


record player and earphones. The subject was
allowed to listen to the music both before the
drug was administered and at all times when he
was not being tested. Subjects were especially
encouraged to listen during the period after
administration of the drug and before the first
postdrug battery. All music condition subjects
listened to the records during at least part of
this time, and the majority of them listened to
the records during most of the time available to
them. In general, they seemed to enjoy the
music, especially since good records were avail
able in a number of different musical styles (eg,
soul music, country music, jazz, semiclassical).
Subjects in the no-music condition spent the
comparable time looking at magazines, playing
solitaire, or just lying on the cot. All subjects
were asked to lie down one-half hour after drug
administration, since it had been found during
the pilot phase that this diminished nauseated
reactions to the drug.
With the exception of the availability of
music, all subjects were treated in the same
manner. In the instructions given, in the atmos
phere of the room, and in the interactions of
the staff with the subjects, an attempt was
made to create a pleasant, but neutral, atmos
phere, in which specific expectations on the
subject's part would be at a minimum. The
coordinator kept in frequent touch with the
subject throughout the day and tried to main
tain a friendly, supportive relationship. The
subjects seemed fairly relaxed in the situation
and seemed willing to report what they were

experiencing.
Experimental Measures.On the experimen
tal day, a number of physiological and psycho
logical measures were obtained. The physiologi
cal measures included systolic and diastolic
blood pressure, pulse rate, and temperature
taken orally. Blood pressure and pulse rate
measures were taken in both supine and erect
positions. Pupillary size was not included, since
the pilot series revealed no changes on this
measure.

The chief psychological measure in this


study is the Subjective Drug Effects Question
naire (SDEQ), an instrument which was de
veloped during the course of the earlier studies
at this institution. (For an illustration of its
use, see Katz et al.3) The questionnaire covers
most changes in the thinking, feeling, percep
tual, and somatic areas which may occur as a
function of the effects of the major classes of
drugs. The questionnaire was designed to mini
mize the role of suggestion and to make ad-

ministration as easy and straightforward as


possible. Scales measuring different facets of sub
jective reaction were developed in the earlier
studies through the use of an empirical cluster

ing procedure. Several additional scales were


developed on a semi-empirical basis and some
were grouped on an a priori basis. (The de
velopment and format of the SDEQ will be
more fully described in a later paper.)
The SDEQ was administered at approxi
mately IV2 hours and 3% hours post drug. In
order to avoid the suggestion of particular
effects that might occur, no predrug question
naire was given. (A question may be raised

equivalence of the four groups in


state prior to drug administration.
Relevant here is the finding of no differences
pre drug on the Clyde Mood Scale,7 a measure
of subjective mood.)
Several cognitive, perceptual, and affective
measures were included in the study. The pres
ent article will report results on two cognitive
measures which are used fairly widely. These
are the Mental Control section and the Mem
ory Span section of the Wechsler Memory
Scale.8 Form I of the Mental Control section
was used before drug administration and in the
second postdrug testing, form II in the first
postdrug testing. Different forms of the Mem
ory Span test were used in each of the three
about the

subjective

testing periods.
At specified times during the day, the psy
chologist (who administered the psychological
battery) and the project coordinator (who ob
served the subject through a one-way mirror
most of the time that he

was not actually in the


with the subject) made ratings on a
standard Observation Form. This form, used in
the previous studies, was based on the format
of the Clyde Mood Scale7 and included adjec
tives to represent the various factors of that
scale, as well as some additional adjectives
judged relevant by the investigators.
Additional data obtained in the study but not
being dealt with systematically at this time,
include various personality measures; answers
by the subject to questions about his history of
drug use, his expectations about the study, and
his reactions to the drug experience; and ob
servers' descriptions of their perceptions of the
subject's drug experience at the end of the day.
room

Results

Physiological Measures.Two different

types of analysis

were

data. For

performed on the
analysis, change

physiological
scores were computed for each of the four
postdrug periods, by subtracting the scores
one

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in that period from the second predrug base fled criteria for the other subtests), and
line scores. These change scores were then separately for speed alone. The Memory
submitted to a repeated measures analysis of Span section was scored for the maximum
variance in order to evaluate differences, number of digits repeated forward and back
among the four drug-setting conditions, in ward, and their total.
the postdrug pattern for each of the mea
Analyses of covariance were performed on
sures. The second approach consisted of sep all of these scores, analyzing separately the
arate analyses of the scores in each of the scores obtained in each postdrug period,
four postdrug periods, controlling, through with predrug scores as the covariate. Signif
the use of analysis of covariance, for dif icant differences were found between the
ferences in predrug scores.
drug and placebo conditions on the accuracy
The means for each of the groups and the scores for serial addition in both the first
results of analyses are summarized in Table postdrug testing (about 2 hours post drug
1 for all measures which showed significant
< 0.05) and the second postdrug testing
drug-placebo differences. There were no sig (about 4 hours post drug < 0.01). These
nificant effects of music and no drug-music differences reflect a decrease in accuracy for
interactions. The most clear-cut effects of the drug subjects and an increase for the
the drug were on pulse rate. There are placebo subjects. These effects were espe
significant differences across the postdrug cially marked in the music condition, al
periods between drug and placebo subjects though the drug-setting interaction did not
for both supine (P < 0.05) and erect reach significance. Comparisons among the
(P < 0.01) measurements, reflecting an in four groups (using the Newman-Keuls
crease in pulse rate for the THC subjects.
procedure9) indicated that the placebo-mu
These differences hold up at 1, 2Y2, and Zx/2 sic subjects had significantly higher scores
hours post drug for supine measures and at than either of the THC groups.
The drug had no significant effect on
2%, 3Y2, and 4y2 hours post drug for erect
counting backwards, saying the alphabet, or
measures. Although peak drug responses
repeating digits forward or backward.
were generally present at the one-hour postObservations.The Observation Forms
drug period, the differences in erect mea
were scored on the six Clyde Mood Scale
sures failed to reach significance at this time
because some placebo subjects showed a factors: friendly, aggressive, clear-thinking,
sleepy, unhappy, and dizzy.7 Ebel reliabili
temporary, smaller increase in pulse rate.
There was a significant drug-period inter ties10 were computed for each of these scales
action (P < 0.05) for the erect systolic in each period. Results will not be presented
blood pressure measures. This reflected a for the aggressive scores, since they did not
pattern of increasing differences over time reach an acceptable level of reliability. The
between the THC and placebo subjects, average ratings of the two raters (the psy
with THC subjects showing a decrease in chologist and the project coordinator) were
blood pressure, which reached significance submitted to an analysis of covariance for
each scale in each postdrug period, using pre
only at 4y2 hours post drug.
A significant difference (P < 0.01) in oral drug scores as the covariate.
The THC subjects appeared more sleepy
temperature between drug and placebo sub
with
found
hour
was
one
at
post drug,
(P < 0.01) and less clear-thinking (P <
jects
THC subjects evidencing a greater drop in 0.05) to the observers than did the placebo
temperature. This drop was very small, but subjects in both postdrug periods. There
were no significant effects of music and no
extremely consistent across subjects.
Mental
Con
Measures.The
drug-music interactions.
Cognitive
trol section of the Wechsler Memory Scale
Subjective Drug Effects Questionnaire.
consists of three parts: counting backwards, Analyses of variance were carried out sep
saying the alphabet, and serial addition. arately for each of the two postdrug periods
These subtests were scored according to a on all of the empirical, semi-empirical, and
system based primarily on accuracy and a priori scales. The results of these analyses
secondarily on speed (using Wechsler's cri are presented in Tables 2 and 3. Only
teria for serial addition and slightly modi- THC-placebo differences are indicated.

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Table

1.Physiological

Measures

Differentiating

THC and Placebo

Significance

Means

Postdrug
Measures

Predrug

Pulse rate

Groups

Period*
3

Levels

Postdrug Periodt
4

12

Across all

Periods!

Drug

Erect

THC

81.3

96.1

87.6

86.4

89.6

NS

0.01

0.01

0.01

0.01

Placebo
THC

77.8

Supine

63.1

82.6
68.6

68.6
64.0

71.0
65.6

74.5
65.5

0.05

0.01

0.01

NS

0.05

Placebo

60.0

60.0

55.5

56.8

57.8

112.9

110.3

107.1

104.0

105.8

NS

NS

NS

0.05

NS

0.01

NS

NS

NS

NS

Systolic

blood

pressure

Erect

THC

111.4

110.4

108.4

109.5

113.3

THC

98.0

97.6

97.6

97.8

97.8

Placebo

97.8

97.7

97.6

97.8

97.7

Placebo
Oral temperature

periodswere: period 1,1 hourpostdrug; period 2, 2V4 hours postdrug; period 3,


3V4 hours post drug; period 4, 41/2 hours post drug.
are
levels
indicated
for the THC-placebo differences in separate analyses of covariance for each
t Significance
postdrug period, with predrug scores as the covariate.
Significance levels are indicated for the THC-placebo difference in a repeated measures analysis of variance
of change scores.
S A significant (P<0.05) drug-x period interaction was obtained in this analysis.
*

The approximate times of these

significant effects of the mu


condition, and only one significant drugsetting interaction. The following summary
of subjective effects is based on the dif
ferences between THC and placebo subjects
on scales of the SDEQ, with emphasis on
those items which were most responsible for
the differences found.
THC produced considerable somatic dis
comfort, with subjects feeling stuffy and
There

were no

sic

sluggish, with legs numb and eyes strained


(scale 12) ; tense and unsteady, with less

control of their bodies (scale 3). The dis


comfort experienced was expressed in their
higher scores on all subscales of a "dysphoria" scale, and probably also by the large
number of somatic symptoms reported.
Other changes in feeling state included sub
jects' reports of feeling dizzy and weird
(scale 4), as if they were floating, dream
like, and dopey (scale 7). An item analysis
indicated that subjects also reported feeling
"high" as well as sleepy. In other realms of
functioning, THC subjects felt that their
thinking was fuzzy, their movements slow,
and that they were losing their sense of time

(scale 6). Perceptual changes experienced


most significant in the visual area (eg,

were

eyesight blurred, seeing images with eyes


closed). Like LSD subjects in a previous
study,3 the THC subjects reported more

contradictory experiences occurring at the


same time or in succession. (A significant
drug-music interaction indicated that the
difference between drug and placebo sub
jects on scale 3 was present only in the
music condition. Comparisons among the

four groups revealed that the THC-music


subjects had significantly [< 0.05] higher
scores than the placebo-music subjects, with
no other significant differences among the
four groups. This interaction is hard to in
terpret because there are different patterns
of effects for different items in this scale.
Several core somatic items [body unsteady,
body tense, less control of body] are clearly
responsive to THC in both music and nomusic conditions, while others show a more
varied pattern.)
The effects that differentiated the THC
from the placebo subjects persisted, for the
most part, through both testing periods
(about IV2 and 3Y2 hours post drug). In
some instances (eg, total responses and
dreamlike, floating state), differences be
came significant only when placebo effects
diminished later in the day. On most scales,
there were slight decreases in THC effects
from the first to the second postdrug testing,
with the exception of an increase in the
sluggish, stuffy feelings, and a slight in
crease for the THC no-music subjects in

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Table 2.Results of

1.

Analyses

Scale (No. of Items)


Improved cognition and
accelerated

of Variance of SDEQ:

1V4

hr Post

Drug

Empirical Scales*
3V2

hr Post

Drug

psychomotor

activity (12)
2. Relaxation and

with

more

well-being,

control (12)

jitteriness,
(11)
4. Silly, weird, dizzy, excited
state (5)
5. Increased sensitivity and
autonomie arousal (6)
6. Impaired cognition, time
sense, and psychomotor
activity (7)
7. Dream-like, floating state (4)
8. Perceptual sharpness (6)
3. Tension and

with less control

0.05

0.05

0.01

0.01

0.05

0.01

_._0.05t_

9. Detachment with unreal


quality to perception (6)

10. Dream-like,

giddy state (5)


Weak, sick feeling (6)
12. Sluggish, stuffy feeling (7)

...

0.05

11.

0.05

0.05t

0.05

0.05

13. Concerned about decreased


control (7)
14. Increased control (5)

(44)
All significance levels reported

15. LSD specific scale

for THC-placebo differences with THOplacebo.


t Results using the Mann-Whitney U test, where variances were heterogeneous at <0.01.
*

are

feelings of cognitive impairment and in the

number of somatic responses.


The summary of the subjective effects of
THC was based on the scales for which
significant differences were obtained be
tween THC and placebo groups. (In addi
tion to the analyses of individual scales,
several profile analyses were performed to
see if there were differences among the four
groups in patterns of response on selected
scales. Using a conservative test,11 no signif
icant findings were obtained.)
To describe fully the subjective effects of
this drug, it is also necessary to look at those
scales on which the THC subjects scored
fairly high though not significantly different
from placebo subjects. These effects include
feelings of relaxation and well-being (espe
cially for THC-music subjects in the first
postdrug period), total euphoria, and total
number of feeling responses. Thus, the
subjective state, for some THC subjects, in

cluded relaxed and pleasant feelings

as

well

more dysphoric (particularly somatic


dysphoric) elements.
Although consideration of these additional
scales results in a more complete picture of
the subjective effects of THC, it still does
not produce a description of the subjective
state of an individual subject. There was no
single "typical" response to THC in this
study. An informal breakdown of the reac
tions of the 16 THC subjects indicates that
six had an especially strong reaction, includ
ing high scores on the dream-like, floating
as

scale. Four of these had a fair amount of


somatic discomfort along with feelings of
relaxation and some elation. The other two
(both on music) experienced relaxation and
euphoria with little somatic discomfort. In
four additional subjects, strong feelings of
physical discomfort predominated, although
in one of these there was also brief euphoric
excitement. The other six subjects had mild
er responses, with all but one experiencing
some feelings of dizziness, relaxation, and
drowsiness.

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Table 3.Results of Analyses of Variance of SDEQ:


Semi-empirical and A Priori Scales*
iy2 hr Post Drug

Semi-empirical
Euphoria
Total (34)
Somatic (7)
Mood (16)
Functioning (11)
Dysphon'a
Total (47)
Somatic (18)
Mood (16)
Functioning (13)

3V2 hr Post Drug

Scales

051"

0.05

01

0.05

0.05
A Priori Scales

Total

05

(192)

Somatic (53)

01

0.05

Feeling (54)
Thinking (20)
Perception (43)
Perception of self (14)
Perception of others (14)
Unusual perception (15)
Visual changes (12)

Ob

Auditory changes (11)


Increased awareness (6)
Decreased awareness (6)
Increased control (3)
Decreased control (7)
Ambivalence
Total (75)

0.051
Same time (75)
Different times (75)
* All
significance levels reported are for THC-placebo differences, with THC > placebo.
t Results using the Mann-Whitney U test, where variances were heterogeneous at <0.01.

In addition to the general description of


the effects of the drug, it is important to ask
whether THC appears similar to drugs like
LSD and, in fact, whether its effects are
similar to those described for marihuana. As
can be seen in Table 2 and LSD-specific
scale, which was composed of items that had
previously differentiated a small dose of
LSD from amphetamine, chlorpromazine,
and placebo, significantly differentiated
THC from placebo subjects in the present
study. The items that were most responsible
for this difference include: throat dry, lips

sensitive, body unsteady, arms or legs weak


and numb, skin dry; feeling nervous, dizzy,
as if floating as if in a dream, losing sense of
time, feeling less control of one's body and

not seem to have the


effects
reported by Isbell
psychotomimetic
et al5 and Hollister et al6 at higher doses.
THC subjects did not have high scores on
three of the SDEQ scales which had been
sensitive to LSD effects in previous studies:
detachment with unreal quality to percep
tions, unusual perceptions (overlaps with
previous scale), and concern about de
creased control. Also, some effects of THC
had not been experienced by LSD subjects
in the previous studies: LSD subjects did
not report as great sedative effects as those
experienced by THC subjects in the present
study, and they did not concentrate as much

however, THC did

on

physical symptoms.

A number of

new

items which seemed

feelings.
Thus,

particularly relevant for marihuana-like


some aspects of the reaction were
drugs were added to the SDEQ used in this
similar to those of subjects on a small dose study. In addition, many of the original
of LSD. At this fairly low dose of 20 mg, items were also relevant. Of a total of 50

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items which were classified as marihuana-re


lated (a conservative list), 18 significantly
differentiated THC from placebo subjects in
one or both periods. These items were mouth
and throat dry, head heavy, arms or legs
numb, body unsteady, movements slow, and
less control of body; eyesight worse and
blurred, eyesight clearer in the middle than
around the edges of vision, and seeing im
ages when eyes were closed; feeling sleepy,
dreamy, dizzy, high, as if floating, and as if
in a dream, thinking fuzzy, and losing sense
of time. Thus, the marihuana-like effects
experienced by the THC subjects in this
study include feelings of body heaviness,
slowness, and unsteadiness, visual changes, a
sleepy, dizzy, dreamlike state, impairment
of thinking, and alterations in time sense.
Most of these have already been described
in the results using the SDEQ scales. The
one aspect of the reaction that is not suf
ficiently clear in those results is the sedative
effect experienced by the subjects.
Comment

discussing the subjective reactions


THC, a brief look at the physiological,
cognitive, and observable changes is in order
Before

to

to see whether these are consistent with


other information about THC, marihuana,
or

both.

Physiologically, subjects responded simi


larly to those in previous studies of THC

and marihuana5812 in that the main consis


tent effect was a rise in pulse rate. Other
physiological findings were a slight drop in
temperature. This is occasionally reported in
marihuana experiments with animals,1314
but was not found by Isbell et al or Hollister
et al using THC. (Two recent reports of the
effects of THC in mice and rats1516 included
hypothermia as one of the effects of the
drug.) The drop in systolic blood pressure
was similar to that reported by Hollister,
and was found only when subjects assumed
an erect position.
On the cognitive tasks, this fairly small
dose of THC resulted in little, if any, im
pairment of functioning. Immediate mem

ory, as tested in the memory for digits for


ward and backward, was not affected, nor
were the fairly simple tasks of saying the
alphabet or counting backward. The serial-

addition task did result in a significant


THC-placebo difference, but this was large
ly due to differences within the music condi
tion. Where music was not present, there
was little difference between subjects given
THC and placebo, and the difference be
tween music groups was due more to the
superior performance of placebo-music sub
jects than to the impairment of THC-music

subjects.

The report of the Mayor's Committee on


Marihuana concluded (without benefit of
placebo controls) that "small doses cause only
slight falling off in mental ability. ,"17 The
present study suggests almost no effect on
these simple tasks due to the small dose of
THC.
The fact that observers saw the THC
subjects as more sleepy and less clear-think
ing is quite consistent with the subjects' own
reports and with previous literature on this
and related drugs.
.

The subjective effects reported by THC


subjects in this study included a fair amount
of somatic discomfort, with feelings of body
heaviness and unsteadiness, experiences of
impaired cognition and altered time sense,
visual changes, and dizzy, weird, floating,
and dreamlike feelings. Subjects also report
ed feeling sleepy and "high." The greatest
difference from most reports of the effects of
marihuana and from previous studies with
THC lies in the relatively minor role played
by feelings of elation and euphoria in the
present study Some subjects did experience
such feelings, but they were an important
part of the reaction in only a few individ
uals.
There may be a number of reasons for the
relative lack of feelings of elation and eu
phoria, feelings that are usually associated
with a marihuana "high." One variable to be
considered is the population used in this

study: are prisoners likely to respond to any


drug with euphoric responses? The fact that
the elated responses described in the report
of the Mayor's Committee12 were found with
prisoner subjects would argue against the
importance of this variable. In addition, and
more significantly, a number of very euphor
ic responses occurred in this same prison
population in previous research with LSD
and amphetamine.
Another obvious question has to do with

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the relationship of THC to marihuana and


with the dose of THC used. THC may not
constitute all of the psychotropically active
material in marihuana, and some differences
in reaction may be due to differences be
tween synthetic THC and naturally-occur
ring marihuana. But marihuana-like "high"
euphoric reactions have also been reported
for THC.56 Although the results of Hollister
et al were based only on higher doses of the
drug, Isbell et al did report marihuana-like
changes, including euphoric mood changes,
at doses equivalent to and even smaller than
the present dose.
There are a number of differences be
tween these studies with THC and the pres
ent one, including the use of former drug
addicts as subjectsa particularly sophisti
cated subject populationin one previous
program of research and the absence of pla
cebo controls in another. What we consider
one of the most important differences be
tween the previous studies and the present
one lies in the expectations of the subjects.
Subjects in these previous studies of THC
either knew they were to receive a mari
huana-like drug or were so experienced with
drups that they immediately recognized the
similarity of THC to marihuana.
If the subjects in the present study had
expected to receive marihuana and had ex
pected and wanted euphoric effects, the feel
ings of being pleasantly drowsy, dreamy,
dizzy, and high (which most of the drug
subjects experienced) might well have

served as the ingredients for a more euphor


ic state.
In order to speculate along these lines, it
is necessary to look at the expectations that
the subjects reported in response to system
atic questioning before the drug was given.
Of the 16 drug subjects, the majority did not
voice specific expectations about their drug
experience. A few felt that they might get
"high," and two or three seemed fearful of

having unpleasant experiences. Over one


something about other sub
jects' reactions, including reports of head
aches, of feeling high, and of feeling noth
ing. Most subjects seemed to accept the idea
that different effects were possible.
Qualitative examination of the data does
not reveal any relationship between the ex
pectations that were present and the subjechalf had heard

tive reactions. This is not surprising, since


the subjects did not know what drug they
might receive, had few if any cues from the
experimenters, and held only mild expecta
tions about their own reactions.
Closely related to the subjects' expecta
tions is their history of drug use. Of the two
subjects on the drug who had at some time
smoked marihuana, one had a minimal reac
tion, the other a relaxed but predominantly
uncomfortable reaction. Neither identified
the drug as marihuana. The only subject
who compared his experience to one on
"hash" was a placebo subject.
Thus, it seems reasonable to conclude that
the reactions to THC in this study were not
determined to any large extent by specific
expectations about the drug and its effects.
This may partially explain the relatively
small role played by euohoric effects. Eu

phoric effects are probably more likely to


occur as a prominent feature of the reaction
to marihuana-like drugs if subjects know
what type of drug they are taking and if
they expect it to have euphoric effects.
But, even with such expectations, some
individuals may not have pleasurable reac
tions when they first take the drug. (In an
article published after the present paper was
written, Weil et al18 report little euphoria
and few other subjective marihuana-like
effects in subjects smoking marihuana for
the first time in a controlled drug study,
even though these subiects knew they were
to receive marihuana. Details of the subjec
tive effects have not yet been reported.)
Howard Becker, in his sociological analysis
of the use of marihuana, has stated that
potential marihuana users must, in order to
continue using the drug, first learn to per
ceive the effects of the drug (learn to get
"high") and then to enjoy the effects that
they have learned to experience. Pointing
out that the effects of the drug may at first
be unpleasant, he states:
The user feels dizzy, thirsty; his scalp tin

gles; he misjudges time and distances. Are


these things pleasurable? He isn't sure. If he is

to continue marihuana use, he must decide that

they are. Otherwise, getting high, while a real


enough experience, will be an unpleasant one
he would rather avoid. The effects of the drug,
when first perceived, may be physically un
the begin
pleasant or at least ambiguous
.

ner

will not continue

use

unless he learns to

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redefine the sensations

as

pleasurable.19'42)
then, that many

It has been suggested,


individuals may not have

ic responses in the THC group, while reduc


ing such responses in the placebo condition.
Thus, THC-placebo differences were greater,
in some instances, in the music than in the

a euphoric "high"
experience when they first take marihuana
or marihuana-like drugs and that they may
no-music condition.
have to learn to enjoy the experience. Other
It is important to

factors may also be involved in the absence


of a "high" experience for some individuals
on their first (or even second or third)
exposure to the drug. It is possible, eg, that
physiological as well as psychological vari
ables may play a role.
There are obviously some individuals (in
cluding several in the present study) who
can have a euphoric "marihuana-like" reac
tion on their first experience with marihuana
or THC, even without their expecting this
type of effect. Why do they not have to
"learn" to enjoy the drug or become physio
logically responsive to it? It seems very
likely that personality factors, and perhaps
individual physiological differences as well,
may be related to the initial reaction of a

particular subject.
The one point that is clear, however, is
that the question of the determinants of
subjective responses to THC (or mari
huana) is an exceedingly complex one. The
foregoing discussion has touched on some of
the important variables that must be
studied: the effect of repeated administra
tion of the drug, effects of knowledge of the
drug, past experience, expectations and mo
tivation of the subjects, effects of personality

variablesand other stable individual char


acteristicsin determining initial response
to the drug, effects of setting variables, and
effects of different doses of THC, as well as
direct comparison of THC and marihuana.
One setting variable was investigated in
the present study: the presence or absence
of music. The music condition did not result
in any significant differences but some inter

esting trends

noted. Music seemed to


role
in
play greater
bringing about certain
euphoric effects than did the drug, especial
ly earlier in the day. Music subjects were,
on the whole, more relaxed and happy, felt
less sluggish and stuffy. They tended to
were

endorse items such as: feel like laughing,


feel more free, wide awake, more control of
feelings. Although its greatest effect was in
increasing a euphoric mood for all subjects,
music also seemed to increase some dysphor-

note that music did not


function as had been anticipated, ie, as a
distractor from uncomfortable somatic
effects. THC subjects on music reported as
many or more of these effects as THC sub
jects without music. On the other hand, the
music did seem to result in an increase in
feeling responses of various kinds, and thus
may have functioned to some degree as an
emotional disinhibitor. These trends under
line the importance of interpreting a setting
variable in terms of its actual, rather than
its hypothesized, function.
Music is one of many setting variables
that could have been investigated. Of special
importance for future studies would be the
investigation of variations in the social set
ting, with special attention to the role that
may be played by the presence of other
individuals who supply social stimulation
and feedback for the subject.

Conclusions

Twenty milligrams of 1- 1-3,4 trans-tetrahydrocannabinol, when administered to


prisoner subjects in a neutral, controlled
setting, resulted in a number of subjective
effects. Drug subjects, as compared to place
bo controls, tended to feel considerable so
matic discomfort, some feelings of dizziness
and weirdness, and being in a dreamlike
floating state. They also reported feeling
sleepy and "high." They felt that they were
cognitively impaired, that they had experi
enced some visual changes, and that their
time sense was altered.
Changes were also obtained on several
physiological measures, with drug subjects
showing an increased pulse rate, a slight but
consistent drop in temperature, and a small

drop in blood pressure. Several simple cogni

tive measures revealed little or no difference


due to drug per se.
Many of the subjective effects were simi
lar to those commonly attributed to mari
huana. A major difference between the
subjective effects in this study and those in
previous studies of marihuana and THC was

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comparatively minor role played by present studythe use of musicdid not


feelings of elation and euphoria in the pres result in any significant effects.
ent study. Some of the variables that might
account for this difference were considered,
Dr. Daniel Efron supplied the drug. Dr. Harold
including subject population, nature of THC Boslow, director, and the members of the Psy
as compared to natural marihuana, subject
chology and Psychiatry Departments, the Patuxent
Jessup, Md cooperated in this study.
expectations and drug history, and individ Institution,
Edna Hardy, Henri A. Lowery, Gerald Fromm,
ual differences in personality and physiolo Robert Leihy, Donald Haines, and Robert Epstein
gy. The setting variable investigated in the assisted in this study.
in the

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