Cannabis sativa from Vienna Dioscurides, c. 512 CE
There is still much about the effects of cannabis* on the mind and body that is not understood, despite currently being used by something like 200 million people worldwide.
To fill gaps in the knowledge, one of the biggest studies into cannabis use ever undertaken is happening right now at Kings College in London. Called Cannabis and Me it is aimed at the whole adult population of London, not just smokers, focussing on “understanding the wider impact of cannabis use on the physical and mental health of cannabis users.” Data from the study is already being used in research and providing quite surprising results. Organisers are asking people to take part, as there is still a long way to go.
I had my first experiences with cannabis as a teenager and started smoking habitually as I began working in recording studios and touring with bands in my early 20s. It was the late 80s and at that time smoking cannabis was regarded as simply part of the job. This wasn’t just peer pressure or a culture of indulgence, (although both played their part), cannabis has a number of effects that can seem beneficial to musicians. Perhaps the most important, especially for the studio, is that music sounds different when you’re stoned. Subtleties and details become more apparent. One way of describing this I’ve heard is that the sound begins to “glow”. Even small doses have an effect on concentration and sensitivity to content.
In 1971, psychologist Charles Tart conducted a study of the effects of cannabis. He assembled 150 cannabis users for a few months, gave them cannabis and asked them to smoke their normal amount. He then gave them psychological tests and asked them to describe what the drug was doing for them at different times. The results were published in his seminal book On Being Stoned. Among the data collected is a list of effects he found that deal directly with the experience of music and sound. Mildly stoned people reported perceiving a “more subtle quality” to sound. When they got moderately stoned they started to get a greater understanding of the lyrics of songs, and then finally when they were strongly stoned they found that they could perceive greater spacial separation between sounds when listening to music. Not only are these peculiarly precise and almost technical effects, they also clearly demonstrate some of the heightened sensitivities required in music production and performance. The last effect especially points to the characteristics in styles of music often made by and for cannabis users, dub reggae being the most obvious.
Other effects are more physical. Cannabis is particularly popular with drummers and percussionists. It relaxes the body which helps wth time-keeping especially when playing regular rhythms in cycles. The effects on memory and learning also help people to settle in to a groove, maintaining the familiar rather than tackling new ideas and material. Even seasoned cannabis smokers experience this looping effect when reading in particular. The relaxing quality of cannabis contributes to what a friend of mine who lived in Amsterdam once described as the “look” of stoned people — he could tell if people were stoned from metres away. This effect on posture and movement seems to assist with the physicalities of playing music that emphasises cycles and grooves.
To begin to understand the close relationship between music and narcotics in general I spoke to Dr. Russell Newcombe, one of the UK’s leading researchers and consultants on drug use and drug policy.
“The main thing to start with would be neurotransmitters. Music and drugs both effect the brain’s neurotransmitters and therefore our subjective experience.” The link is deep in the very function of our brains.
Neurotransmitters are chemicals released at the end of a nerve fibre by the arrival of a nerve impulse and then cause the transfer of the impulse to another nerve fibre. They are vital players in the way our nervous systems work. There are well over 100 different neurotransmitters each with very specific functions. For example dopamine is our “pleasure and reward chemical”, serotonin "our mood chemical, producing a happier mood and a greater sense of closeness and sympathy with people”, and noradrenaline is “the energy chemical”.
“Music effects neurotransmitters related to pleasure like dopamine and serotonin, in the same way as the things they were developed for: survival behaviours like eating and sex which stimulate our neurotransmitters. As we evolved to become more complex animals we extrapolated this to other things in the environment, and eventually music. Research clearly shows that music does stimulate the same neurotransmitters as drugs.”
But there is a difference:
“Music can raise dopamine within normal levels as food and sex do. Drugs can raise neurotransmitters to artificially high levels, way beyond what would occur normally. If you’re on a certain drug, some kinds of music will sound better because the drug is taking you higher”.
For example cocaine lifts 2 neurotransmitters: dopamine and noradrenaline. Consequently people’s experiences of cocaine are very homogenous and direct: pleasure from the dopamine release, coupled with increased mental and physical energy, improved memory and control of language (not forgetting an ego boost) from the noradrenaline. If cannabis is well suited to musicians, I could imagine that cocaine might be very popular with other professions that favour those qualities, perhaps even politics…
Cannabis on the other hand effects a “cascade” of neurotransmitters in a mechanism that is only recently becoming understood: “I don’t think there’s any of the top 12 neurotransmitters that aren’t effected by cannabis.”
I contacted Dr. Marta Di Forti, leader of the Cannabis and Me research team, a leading academic and clinician working in the field of cannabis and psychology, who also runs the Cannabis Clinic for Patients with Psychosis (CCP) at the Maudsley hospital in South London.
I asked her about the effects of cannabis I’d experienced in relation to music and what she knew of the mechanisms behind them: “What is beautiful about cannabis and very interesting both conceptually and evolutionarily is that we have in our body a natural, physiological system, called the endocannabinoid system that is primed to bind with cannabis compounds. This system is extraordinary because it develops very early during gestational life.”
One of the fundamental ways in which our biochemistry works is through receptors on the surface of our cells. They sit on our cell’s membranes waiting to be activated by a particular compound which binds to the receptor. Once this has taken place it causes the cell to behave in a particular way. Our cells have two types of receptors that bind specifically with cannabinoids, compounds found primarily in the cannabis plant but also in animals. Normally these receptors, CB1 and CB2, bind with endocannabinoids, the cannabinoids we generate ourselves: “These receptors are throughout the body. CB2 is all over the place, in our lungs, liver, heart, in our immune system cells, but CB1 is more in the central nervous system and the brain.”
Anandamide was the first endocannabinoid to be discovered as recently as 1992. Named after the Sanskrit for bliss, it has an enormous impact on our brains. As Dr. Newcombe put it: “If the brain was an orchestra anandamide would be the conductor.”
The second is the rather less poetically named 2AG (short for 2-Arachidonoylglycerol). Dr. Di Forti explained further: “Our endocannabinoid system has a very important role from very early life. It’s a system that was discovered very recently; first described in 2008. The reason why it’s so important is because it’s like our central nervous system’s safety helmet. If something represents a stress to the central nervous system, you produce anandamide and 2AG.”
By way of a complex process of “retrograde control”, anandamide and 2AG stimulate the production of two further neurotransmitters: GABA and glutamate. These function as the brakes and the accelerator of our entire central nervous system, exciting the function of some parts of the brain and suppressing others by producing “a cascade of other neurotransmitters. Among these neurotransmitters is dopamine. GABA and glutamate are responsible for deciding when and how to either suppress dopamine if GABA prevails, or how much to release if glutamate prevails. The bottom line is the endocannabinoid system, via GABA and glutamate regulate dopamine transmission.”
Into this finely balanced system of physical and psychological regulation comes cannabis.
CB1 and CB2 receptors also bind to the tetrahydrocannabinol (THC) and cannabidiol (CBD) in cannabis. When we have these compounds in our systems, they effectively hijack our endocannabinoid system, releasing GABA and glutamate, slowing down some parts of the brain and accelerating others in a complex and unpredictable way. The effects can be, “All over the place”.
The complexity and variety of the effects of cannabis, ranging from therapeutic applications, through the subtle auditory effects I described, all the way up to anxiety and euphoria, are also in part due to the complexity of the drug itself: “In cannabis there are lots and lots of active ingredients and I think we are just scratching the surface. We are beginning to know a reasonable amount about THC, beginning to know more on CBD, but we know very little about everything else.” So far 144 cannabinoids have been isolated from the cannabis plant and the number is growing.
CBD functions as a muscle relaxant, producing the physical effects favoured by drummers I mentioned earlier and is also used medicinally. The NHS website is, naturally, very cautious about promoting the use of what is still an illegal substance, but nevertheless lists three conditions that patients can be prescribed medicinal cannabis for: severe forms of epilepsy; nausea caused by chemotherapy; and muscle stiffness and spasms caused by multiple sclerosis. There is one medication available on prescription, Sativex which also contains low levels of THC.
THC binds with our CB1 receptors, producing GABA and glutamate and thereby the vast majority of the psychoactive effects of the drug. Consequently, the Illicit cannabis industry is constantly working on new ways to increase the levels of THC in their product. In the most recent study from 2017 it was found that the average levels of THC in cannabis seized in England continues to increase, while levels of the largely non-psychoactive CBD are decreasing. The concentration of THC in high potency cannabis strains, now close to 30%, has remained stable, but availability has increased. THC is lipophilic: it sticks to the fat in our bodies. Urine tests can prove positive up to 30 days after ingestion and up 90 days for a hair test.
“The problem is that endocannabinoids are not up and running all the time, only if they are needed. If you use cannabis every day, which means the THC is in your system all the time, it will bombard the CB1 receptors. One of the theories is that if you then you need to switch on the endocannabinoid system because there’s something your brain needs to be protected from, the endocannabinoid system finds the THC stuck to the receptor. THC is much more powerful at binding these receptors than anandamide and 2AG, disrupting this finely tuned transmission of neurotransmitters. This is one of the theories why people experience difficulties in learning, in new memory formation and potentially psychosis.”
I have witnessed first hand people suffering from psychosis due to heavy use of cannabis. Psychosis is not thinking your partner’s mates don’t like you or spending a little too long lingering over conspiracy theories on YouTube. This is a condition that can lead to self-harm and suicide: “We’re not talking about transient intoxication experience but people who develop persistent distortion of thinking and perception which reaches a threshold that requires clinical attention.”
The author, pre-cessation
Due to my experiences in music, Dr. Di Forti invited me to join her weekly online peer group sessions. Covering a wide variety of aspects of cannabis use and mental health, from the social effects of legalisation, to dissociation, and the odd quiz, they are attended by up to 40 people from across all of society, most of whom have at some point been tipped into psychosis by cannabis use. Some are still users, others are struggling with stopping, others on hospital wards with psychosis. Chatty, well-informed and touchingly supportive of each other, they have harrowing stories to tell. For example one member told how his psychosis lead him to believe that birdsong was telling him to self-harm, or that random events were informing him of his direct responsibility for natural disasters and deaths. He felt he had a duty to smoke cannabis despite the crippling impact it was having on his life. Others tell how something as innocuous as getting hold of a little cash could result in a relapse in to psychosis. Once in a while a member will be clearly suffering and the support from the rest of the group is fantastic and practical: take a shower to help with the anxiety, stay strong it’ll pass, be proud of the weeks you were clean etc. Each session starts with a piece of music, sometimes referring to the personal experience or struggle of someone in the group, sometimes motivational. It seems even from the hospital ward the link between music and cannabis remains strong.
By contrast I know people who seem to sail through life fully functioning despite permanently high doses of THC in their system. What are the chances of developing psychosis and ending up in A&E and who is at risk? Why are some people seemingly immune?
“Studies consistently show that if you use cannabis, specifically in your teens, but more importantly if you become a daily user and if you have access to a type of cannabis with a concentration of THC that’s 10% or above, your chances of developing psychosis would be multiplied by 5.4.”
A daily smoker of cannabis with 10% or more THC (pretty much all of it these days) is over five times more likely to suffer psychosis than a non-smoker. Or as a member of the peer group put it, one in seven daily smokers will experience psychosis at some point.
"What I want to make clear is that psychotic disorder is not a single cause condition. We think about people who have other risk factors and where cannabis represents what pushes them over the threshold. For the majority of people, it’s cannabis together with trauma, with a family history of psychotic disorder, with other drugs like stimulants, with obstetric complication.”
Obstetric complication?
“Yes! With their own birth. Hypoxia at birth is the single main link to later risk of psychosis. All these risk factors have an impact, migration too. All the risk factors associated with psychosis are related to an increased propensity to synthesise and release dopamine in an excessive way, not in a functional way. The problem is that dopamine is the neurotransmitter of many functions but pleasure is the most important. So this is why banning things that increase dopamine always seems extraordinarily unfair because dopamine is what gives us reward and pleasure.”
In 1997 I co-produced the eponymous, MOBO-winning first album by Sunship with pianist Ceri Evans. At the time Ceri was a practicing Sufi and his drug intake consisted of nothing more than tea and cigs. As we were working so closely together I decided that I wouldn’t smoke weed in the studio. The constant presence of cannabis in my body, brain and environment was beginning to make me uncomfortable anyway, so I embraced the opportunity. As work began I felt a tragic loss of joy and involvement in the music. It felt meaningless. All those lights that would go on in my THC infused brain whenever I touched the mixing desk resolutely refused to illuminate. Nevertheless Ceri was happy with the progress we were making so I soldiered on, going through the motions. After about two weeks something peculiar happened: all the involvement, joy and meaning came back, but without the downsides that cannabis inevitably brings with it. As I described it to a friend at the time it was like “I was stoned again but without having a nervous breakdown whenever the phone rang”. Since then I’ve had no interest in smoking cannabis. Whenever I have, it has made me miserable, anxious and uncomfortable, switching off more lights than it ever switched on. It’s as if my endocannabinoid system can now do the job of making my music “glow” better than THC. It could be my brain needed to be “taught” these avenues of perception by the years of weed smoking but I could well be kidding myself. I may have been able to achieve all the psychedelic soundworlds I have in my career without ever skinning-up.
Experiences like mine are of value in identifying some of the mechanisms behind the multiple and unpredictable effects of cannabis. So little is known, although as Dr. Di Forti tantalisingly points out:
“The auditory cortex receives synapses from areas of the brain which are controlled by neurons which have lots of CB1 receptors.”
This is why research studies like Cannabis and Me are so important to identify who cannabis is helping, who it is harming and how. Whatever your experience, be it ecstatically positive, terrifyingly negative, therapeutically beneficial or completely abstinent, please take part.
[* I use the term cannabis not marijuana, a Mexican word adopted by prohibitionists in 1930s US to emphasise the drug’s foreignness and to stigmatise non-white users.]
