A single case report has described an interaction between cannabis and disulfiram (Lacoursiere and Swatek, 1983). A 28 year old man taking disulfiram 250 mg daily exhibited signs of hypomania following the smoking of cannabis. He likened this to the effects of amphetamine. He was hyperactive, euphoric and suffered from pressure of speech, irritability and insomnia. He had used cannabis prior to commencing disulfiram and had not experienced adverse reactions. Furthermore, when disulfiram was discontinued he resumed cannabis use with no ill effects. Several months later, however, the patient was prescribed disulfiram again and, although free from adverse effects initially, he again developed hypomanic symptoms upon smoking cannabis during disulfiram treatment.
This interaction has not been reported to affect other patients receiving disulfiram and cannabis concurrently. Rosenberg et al. (1978) investigated the ability of the combination to induce alcoholics to enter or remain in treatment; no cases of hypomania were described. The patient described above had a long history of substance abuse and he may have abused other substances and not disclosed them to the authors of the case report. Alternatively, the cannabis that he used may have been adulterated with other street drugs.
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