Cannabis

(rINNM)

💊 Chemical information

Cáñamo Indiano; Cannab.; Cannabis Indica; Chanvre; Hanfkraut; Indian Hemp.
CAS — 8063-14-7.

Description.

Cannabis consists of the dried flowering or fruiting tops of the pistillate plant of Cannabis sativa (Cannabinaceae). In the UK cannabis is defined by law as any part of any plant of the genus Cannabis. Marihuana usually refers to a mixture of the leaves and flowering tops. Bhang, dagga, ganja, kif, and maconha are commonly used in various countries to describe similar preparations. Hashish and charas are names often applied to the resin, although in some countries hashish is applied to any cannabis preparation. A series of cannabinoids has been extracted from the plant, the most important being Δ 9 -tetrahydrocannabinol (dronabinol), Δ 8 tetrahydrocannabinol, Δ 9 -tetrahydrocannabinolic acid, cannabinol, and cannabidiol. Cannabis and cannabis preparations have also been known by the following names, many of which are ‘street names’ or slang names: 30s; 50; 420; 4.20; 4:20; 4/20; Abu-Sufian; Acapulco; Acapulco gold; Acapulco red; Ace; Afgani indica; Afghan; Afghan black; Afghanais; Afi; African; African black; African bush; Airplane; Ait makhlif; Ak-47; Al Green; Al Sharpton; Aliamba; Amsterdam; Anassa; Angola; Angolaise; Anhascha; Arathi; Arathi Highlands; Ashes; Assassin of Youth; Assyuni; Astro turf; Atshitshi; Aunt Mary; Baby; Baby belong; Baby bhang; Babysitter; Bad One; Bad seed; Bale; Bamba; Bambalacha; Bambia; Bammer; Bammies; Bammy; Bangi-Aku; Bango; Bangoo; Bangue; Banji; Bank Head Bud; Banzai Buds; Bar; Barbara Jean; Barn Man; Bash; BC bud; BC budd; BC Kindbud; Beaster; Beat N Sleep; Belyando spruce; Bergspinasie; Bhang; Bhangaku; Bheng; Biff; Bigfoot; Biggy; Birthday Cake; Black; Black bart; Black ganga; Black gold; Black gungi; Black gunion; Black Maria; Black mo; Black moat; Black powder; Black Russian; Blah; Blast; Blaze; Block; Blonde; Blonde hash; Blow; Blowhead; Blowing smoke; Blue de hue; Blue sage; Blue sky blond; Blueberry; Bo; Bob Hope; Bobby Brown; Bo-bo; Bobo bush; Bohd; Boi; Boléia; Bomb; Bombay Black; Bomb-dizzle; Bone; Boo; Boo boo bama; Boom; Bowgma-Chuff; Brass; Bread; Brick; Bristol Brown; Broccoli; Brown; Brown Frown; B-ster; Bubble gum; Bubonic Chronic; Bud; Buda; Buddha; Buddha grass; Buds; Buen; Bueno; Bullyon; Bunk; Burnie; Burrito; Bush; Butt; Butter; Butter flower; Buzzles; Cabbage; Cable; Caca; Caca de Chango; Cam red; Cam trip; Cambodian red; Can; Canadian black; Canamo; Canapa; Canappa; Cangonha; Canhama; Cann; Cannabis tea; Cannacoro; Can-Yac; Carmabis; Caroçuda; Cavite All Star; Cavite All Stars; CDs; Cereal; Cess; Cest; Chamom; Chara; Charas; Charge; Charris; Cheeba; Cheebong; Cheech and Chong; Cheeo; Cheese; Chemo; Chiba chiba; Chicago black; Chicago green; Chillums; Chippie; Chira; Chitari; Chocolate; Chocolate Thai; Choof; Chrin; Christmas bud; Christmas tree; Chro; Chron; Chron Chron; Chronic; Chucky; Chunky; Chur ganja; Churrus; Churus; Chus; Chutras; Chutsao; Citral; Citrol; Clone; Club; Cochornis; Coconut Rabbi; Colarado cocktail; Colas; Coli; Coliflor tostao; Collie Weed; Colombian; Colombo; Columbia; Columbian; Columbus black; Compresses; Cosa; Costo; Crazy weed; Creeper; Creeper Weed; Crippy; Crown Town Brown; Crying weed; Cryppie; Cryptonie; C.S.; Cubes; Culican; Cumming Air; Cung; Curro; Cush; D Nugs; Daboa; Dacha; Dagga; Dak; Dancouver; Dan K; Dank; DarakteBang; Dark; Dawamesk; Deaf; Dew; Diamba; Diambista; Diggidy; Diggity; Dimba; Ding; Dinkie dow; Dirijo; Dirt; Dirt grass; Ditch; Ditch weed; Ditchweed; Dizz; Djamba; Djoma; Do a joint; Doctor Kissinger’s Crutch; DoggyNuggz; Doja; Dokka; Dolja; Domestic; Don jem; Don Juan; Dona Juana; Dona Juanita; Donajuanita; Doob; Doobee; Doobie; Dooko; Dope; Doradilla; Dormilona; Doshia; Double zero; Doug; Doug Funnie; Downtown brown; Dozer; Draf; Draf weed; Drag weed; Draw; Dread; Dro; Droski; Drottleneck; Dry high; Dubbe; Dube; Duby; Durban Poison; Durijo; Durog; Durong; Duros; Dustwallow Marsh; Ebenieghber; El Gallo; Electric Puha; Elephant; Elva; Endo; Erva do norte; Erva maligna; Esra; Esrar; Exotics; Fallbrook redhair; Faso; Feeling; Fêmea; Feng Shui inner tam-tam; Fine stuff; Finger; Finger lid; Fininha; Finote; Fir; Fire; Firebush; Firewood; Flack Juice; Flame; Flower; Flower tops; Fokkra; Food; Four twenty; Fraho; Frajo; Friend; Fruit; Fu; Fuma D’Angola; Fumo brabo; Fumo de caboclo; Funk; Funny stuff; Fur; Gage; Gandia; Ganga; Gange; Gangster; Ganj; Ganja; Ganjila; Garaouich; Garawiche; Garbage; Garoarsch; Gash; Gauche butt; Gauge; Gauge butt; Gauja; Gear; Gerp; Ghana; Ghanja; Giggle smoke; Giggle weed; Gnaoui; Goblet of jam; Gold; Gold star; Golden; Golden leaf; Gong; Gongo; Gonj; Good giggles; Good Goods; Good stuff; Goody-goody; Goof; Goof butt; Gorge; Gozah; Grahni Sherdool; Grain; Grand Pants; Gram; Grapefruit Hydro; Grass; Grass brownies; Grasshopper; Grata; Greefe; Green; Green buds; Green Candy; Green cheesy wham; Green Funk; Green Goblin; Green goddess; Green Jesus Love; Green paint; Green Penis; Greens; Greeter; Grefa; Grefer; Greta; Grey shields; Griefo; Griefs; Grifa; Griff; Griffa; Griffa-griffo; Griffo; Grim Creeper; Grimmy; Grolid; Guabza; Guaza; Gunga; Gungeon; Gungun; Gunja; Gunjah; Gunney; Gunney sack; Gunza; Gweeler; H; H caps; Hachiche; Haircut; Hairy Ogre; Hameni; Hamp; Hang Liu; Hanhich; Haouzi; Harm reducer; Harry Potter; Harsh; Has; Hascisc; Hash; Hash oil; Hashish; Hasis; Hasji’s; Hasjisj; Haszysz; Hawaiian; Hawaiian Black; Hawiian homegrown hay; Hax; Haxixe; Hay; Haze; Headies; Heady Nugs; Heat; Heloua; Hemp; Hen-Nab; Herb; Herba; Herbals; Herbalz: High; High-Grade; Hippie Lettuce; Hocus; Hola-wola-shupidy-doo; Home Grown; Homegrown; Hooch; Hooda; Hooter; Huile; Humboltd Green; Hursini; Hydro; Hydrophonic; Hyge; Ice Cream; Igbo; Indian boy; Indian hay; Indian hemp; Indiana ditchweed; Indiana hay; Indica; Indische-hennepkruid; Indisk hampa; Indo; Indonesian bud; Indoor; Instaga; Instagu; Intianhamppu; Intsangu; Isangu; Ish; IZM; Jamaican gold; Jamaican red; Jamaican red hair; Jane; Janjah; Janjaweed; Jatiphaladya churna; Jay smoke; Jea; Jive; Jive stick; Johnson grass; Jolly green; Jonko; Joy smoke; Juan Valdez; Juana; Juanita; Juja; Kabak; Kaff; Kajees; Kalakit; Kali; Kamonga; Kanab; Kansas Grass; Karpura rasa; Kate bush; Kawaii electric; Kaya; KB; K.B.; Kee; Keif; Kentucky blue; Key; KGB; K.G.B.; KhanhChha; Khanje; Khayf; Khif-kiff; Ki; Kief; Kif; Kif Ktami; Kiff; Kill; Killer; Killer green bud; Killer weed; Kilroy; Kilter; Kind; Kind bud; Kind-Bud; Kine-Bud; King bud; Kinnab; Kitt; Kolto; Kona gold; Kraut; Krippies; Krippy; Kronic; Kryptonite; Kumba; Kush; Kushempeng; Kutchie; Kynd; Kynd-Bud; La-LaLa; Ladies; Lakbay diva; Lakbay viva; Lamb’s bread; Lang; Laughing grass; Laughing weed; Leaf; Lebanese; Lebanese blonde; Lebanese gold; Leno; Leon Mcarthy; Leon Punders; LG; Liamba; Lianda; Light Green; Light stuff; Lima; Limbo; Lime green; Little green friends; Little smoke; L.L.; Llesca; Loaf; Lobo; Local weed; Loco; Loco Weed; Locoweed; Longbottom Leaf; Loose shank; Love nuggets; Love weed; Lows; Lubage; Lucas; Lumber; M; Macaroni; Machinery; Macon; Maconha; Maconia; Madi; Mafu; Maggie; Magic smoke; Magiyam; Majat; Makhlif; Malak; Malawi Cob; Malawi Gold; Malawi grass; Malawian gold; Malva; Manhattan silver; Manitoba Hydro; Manzul; Marachuan; Maraguango; Marajuana; Marie Jeanne; Marie-Jane; Marie-Juana; Marigongo; Marihuana; Marijuana; Marimba; Mariquita; Marley; Maroc; Marocaine; Maruamba; Mary; Mary Ann; Mary Jane; Mary and Johnny; Mary Jonas; Mary Warner; Mary Weaver; Mary-Ann; Mary-Jane; Mary-Jonas; Matekwane; Maui wauie; Maui-wowie; May Ann; Mbanje; Meck; Meconha; Meg; Meggie; Merda; Merde; Mersh; Messorole; Method; Methtical; Mex; Mexican brown; Mexican green; Mexican locoweed; Mexican red; Mezz; Mid-Grade; Middies; Middys; Midies; Mids; Mighty mite; Mint; Misari; Mister Brownstone; M.J.; Mnoana; Mo; M.O.; Modams; Mohasky; Mohasty; Momea; Momeka; Monte; Mooca; Moocah; Mooster; Moota; Mooters; Mootie; Mootos; Mor a grifa; Moragrifa; Moroc; Mota; Motah; Mother; Moto; Mr. Piff; Mu; M.U.; Muggie; Muggle; Muggles; Mulatinha; Mull; Mundyadi vatika; Murphy; Musty Marty; Muta; Mutah; Mutha; Nail; Namba; Nederweed; Nederwiet; Neihe; Nigra; Nordle; Northern lights; N’rama; Ntsangu; Nug; Nugget; Nuggets; Nuggs; Nugglets; Nwonkaka; Oboy; O.J.; Old Toby; Oleo; Olja; Ooh-Wee; Orange Cat; Oregano; Out-Do; Owl; Ozone; Paca lolo; Pack; Pack a bowl; Pakaloco; Pakalolo; Paki black; Pakistani black; Panama cut; Panama gold; Panama red; Pappa C’s funky space boots; Parsley; Passa; Pasta; Pasto; Pat; Pétard; Peinka; Penek; Penka; Philip Drummond; Philly blunts; Piff; Pin; Pine; Pito; Pizza; Platters; Plow; Pocket rocket; Pod; Poison; Poke; Poke Smot; Politics; Po-Pa; Porro; Pot; Potlikker; Potten bush; P.R.; Pretendica; Pretendo; Pretinha; Pretties; Pretty Ladies; Puff; Purp; Purple; Purple haze; Purple Urple; Purps; Quarter moon; Queen Ann’s lace; Rafe; Rafi; Rafo; Ragweed; Railroad weed; Rainy day woman; Rangood; Rasta Plant; Rasta weed; RB; Red bud; Red cross; Red dirt; Red oil; Red seal; Redge; Reef; Reefer; Reggies; Reggiwegs; Regs; Regular; Relish; Resin; R.G.B.; Riamba; Righteous bush; Rip; RIP; Roacha; Rocky; Rongony; Root; Rope; Rora; Rosa Maria; Rose Maria; Rose Marie; Rose-Marie; Rough stuff; Rube; Rubia; Ruderalis; Rugs; Sabsi; Sadda; Salad; Salt and pepper; Santa Marta; Sasfras; Sativa; Schwag; Schwagg; Schwamp; Scissors; Scraps; Scrapes; Scrub; Seeds; Sen; Sense; Sensemilia; Sensi; Sess; Sezz; Shake; Sheeba; Sheebz; Shit; Shmagma; Shrimp; Shrubs; Shwig; Shwiggity Shwag; Shwag; Shwuggets; Siddhi; Siddi; Sighirma; Sins; Sinse; Sinsemilla; Sizzla; Skunk; Skunkweed; Sky; Smokage; Smoke; Smoke a bowl; Smoke Canada; Smoochywoochypoochy; Snop; Soap bar; Soles; Soñadora; Soruma; Soul Flower; Soussi; Speed boat; Splim; Square mackerel; Stack; Stank; Stank-a-dank; Stash; Stems; Stick; Sticks; Sticky; Sticky Black; Sticky brown; Sticky Icky; Sticky Icky Icky; Stink weed; Stinkweed; Stinky; Stoney weed; Stress; Striijj; Stuff; Subji; Sugar weed; Summitates cannabis; SupaDank; Super grass; Super pot; Supergrass; Suruma; Swag; Swamp Grass; Swazi Gold; SWED; Sweet Leaf; Sweet Lucy; T; Tablete; Tack; Tahgalim; Tai Alon; Taima; Takkouri; Takrouri; Tea; Tedrika; Teloeut; Tempel; Temple; Temple balls; Teriaki; Texas pot; Texas Red; Texas tea; Tex-mex; Thai Sticks; That Shit; THC; The Dank; The Peeping Jesus; The Pig Farmer’s laptop; The Shit That Killed Elvis; The Wizard; Thirteen; Thumb; Thump! Thump! Thump!; Tia; Tical; Tijuana; Time; Time Machine’s Glory; TJ; Tochi; Toke; Torch; Towels; Transkei; Trauma; Trees; Triple A; Tronadora; Trupence bag; Turtle; Tustin; Tweed; Tweeds; Twenty Twen Twen; Tweny Bag; Umya; Unotque; Urumogi; Utilities; Vipe; Viper’s weed; Wacky Baccy; Wacky Backy; Wacky Tabacky; Wacky terbacky; Wacky tobaccky; Wacky weed; Wag; Wake and Bake; Wasch; Weasel feed; Wee; Weed; Weed tea; Weed tear; Wewe; Whack; Whackatabacky; Wheat; White Rhino; White Russian; White Widow; Whitehaired lady; Woo blunts; Woodle; Woof; Wooz; Wooze; X; Yaa; Yamba; Yandi; Yarndi; Yeah; Yeh; Yellow submarine; Yen pop; Yerba; Yerhia; Yesca; Yesco; Yeska; Ying; Yoda; Yoruba; Yum Yum; Zacate chino; Zacatecas purple; Zambi; Zani; Zerouali; Ziele konopi indyjskich; Zig Zag man; Zol; Zoot.

Pharmacopoeias.

In Chin. and Jpn.

💊 Dependence

Prolonged heavy use of cannabis may lead to tolerance and psychological dependence but the existence of physical dependence remains somewhat controversial. Reported withdrawal symptoms have included anorexia, agitation, apprehension, aggression, anxiety, insomnia, irritability, restlessness, fever, sweating, tremor, dysphoria, rhinorrhoea, headache, and nausea. Symptoms of withdrawal have been reported in neonates born to mothers who used cannabis during pregnancy, and have included jitteriness and tremulousness, crying, and disturbances in sleep and response to light occurring up to 30 days after birth.
1. Smith NT. A review of the published literature into cannabis withdrawal symptoms in human users. Addiction 2002; 97: 621–32.
2. Budney AJ, Moore BA. Development and consequences of cannabis dependence. J Clin Pharmacol 2002; 42 (11 suppl): 28S–33S
3. Haney M. Effects of smoked marijuana in healthy and HIV+ marijuana smokers. J Clin Pharmacol 2002; 42 (11 suppl): 34S–40S
4. Haney M. The marijuana withdrawal syndrome: diagnosis and treatment. Curr Psychiatry Rep 2005; 7: 360–6
5. Nordstrom BR, Levin FR. Treatment of cannabis use disorders: a review of the literature. Am J Addict 2007; 16: 331–42
6. Budney AJ, et al. Marijuana dependence and its treatment. Addict Sci Clin Pract 2007; 4: 4–16
7. Benyamina A, et al. Pharmacotherapy and psychotherapy in cannabis withdrawal and dependence. Expert Rev Neurother 2008; 8: 479–91.

💊 Adverse Effects, Treatment, and Precautions

Cannabis is widely abused for its psychological effects and the most important psychoactive cannabinoid is Δ9-tetrahydrocannabinol. The toxicity of cannabis is dose-related and when used recreationally depends to a large extent on the experience of the user and degree of tolerance. The effects may also be affected by CNS depressants taken at the same time. The psychological effects produced by low doses of cannabis include calmness, euphoria, relaxation, drowsiness, a feeling of well-being, heightened sensory awareness, and alterations in perception of time, space, colour, or sound. Sedation may occur some time later after the initial effects. Anxiety or panic reactions may also occur at low doses. As the level of intoxication increases, the user may experience feelings of depersonalisation, disorientation, decreased inhibition, altered mood, memory impairment, and difficulty in maintaining attention. Symptoms of heavy intoxication include incoordination, ataxia, skeletal muscle jerks, and slurred speech. Distrust, dysphoria, poor concentration, slowed reaction times, lethargy, and sedation may also occur. Fear, panic attacks in apprehensive patients, hallucinations, and transient paranoia or psychosis have also been reported. Cannabis additionally affects several physiological body systems and symptoms of intoxication include tachycardia, palpitations, paroxysmal atrial fibrillation, and orthostatic hypotension; life-threatening ventricular tachycardia may occur after large doses. Decrease in intra-ocular pressure, conjunctival injection, cough, dry mouth, increased appetite, and reduced bowel motility have also been reported. The toxicity of cannabis is increased with intravenous use. Gastrointestinal disturbances have been reported including nausea and vomiting, abdominal pain, and diarrhoea. Other symptoms include headache, rigors, fever, dyspnoea, cardiovascular irregularities, jaundice, shock, disseminated intravascular coagulation, renal impairment, and death. Ingestion of cannabis by children is potentially fatal. Mydriasis, hypotonia, hyporeflexia, ataxia, hypothermia, tachycardia, respiratory depression, drowsiness, stupor, and coma have been reported. Chronic use of cannabis has been reported to reduce resistance to infection, produce persistent neurotoxicity, and the carcinogens present in cannabis smoke potentially increase the risk of cancer. However, there is little conclusive evidence for the long-term effects of cannabis. Cannabis has been presumed to affect driving because of slowed reaction times, effects on cognition, and perceptual alterations, although there is no conclusive evidence to this effect, and it has not been possible to correlate cannabis blood concentration with specific levels of impaired driving performance. The risks of gastrointestinal decontamination following ingestion of cannabis may outweigh the benefits if the patient is drowsy or agitated. However, activated charcoal has been recommended within one hour of ingestion of a potentially toxic dose. Ipecacuanha given within 30 to 90 minutes of ingestion has been used as an alternative. Treatment of an overdose or acute toxicity following ingestion or inhalation of cannabis products is symptomatic and supportive. Adults often require little more than reassurance as clinical toxicity is rarely serious and recovery usually occurs spontaneously within several hours. Patients should be monitored for 6 hours after intravenous injection of cannabis products. Children should also be observed for 6 hours after ingestion. Agitated patients may require sedation with diazepam; lorazepam or midazolam have also been used. Haloperidol or ziprasidone are alternatives to benzodiazepines.
1. Johnson BA. Psychopharmacological effects of cannabis. Br J Hosp Med 1990; 43: 114–22
2. American Academy of Pediatrics. Marijuana: a continuing concern for pediatricians. Pediatrics 1991; 88: 1070–2
3. Wills S. Cannabis and cocaine. Pharm J 1993; 251: 483–5
4. Hall W, Solowij N. Adverse effects of cannabis. Lancet 1998; 352: 1611–16
5. Ashton CH. Adverse effects of cannabis and cannabinoids. Br J Anaesth 1999; 83: 637–49
6. Ashton CH. Pharmacology and effects of cannabis: a brief review. Br J Psychiatry 2001; 178: 101–6.

Breast feeding.

The American Academy of Pediatrics deprecates1 the use of cannabis as a drug of abuse by breast-feeding mothers; a published report2 indicated that cannabinoids were secreted into breast milk and absorbed by nursing infants, and while no adverse effect was reported to have occurred, some components do have a very long half-life.
1. American Academy of Pediatrics. The transfer of drugs and other chemicals into human milk. Pediatrics 2001; 108: 776–89. Correction. ibid.; 1029. Also available at: http://aappolicy.aappublications.org/cgi/content/full/ pediatrics%3b108/3/776 (accessed 06/07/04
2. Perez-Reyes M, Wall ME. Presence of delta9-tetrahydrocannabinol in human milk. N Engl J Med 1982; 307: 819–20.

Effects on the cardiovascular system.

References.
1. Jones RT. Cardiovascular system effects of marijuana. J Clin Pharmacol 2002; 42 (11 suppl): 58S–63S
2. Sidney S. Cardiovascular consequences of marijuana use. J Clin Pharmacol 2002; 42 (11 suppl): 64S–70S.

Effects on the cerebrovascular system.

References.
1. Herning RI, et al. Cerebrovascular perfusion in marijuana users during a month of monitored abstinence. Neurology 2005; 64: 488–93.

Effects on the CNS.

References to, and reviews of, the CNS effects of cannabis, including effects on cognition,1-4 anxiety and depression,5 and psychosis,6-11 including schizophrenia.12,13 Coma, reversed by flumazenil, has been reported in 2 children who had ingested cannabis.14
1. Pope HG Jr, et al. Neuropsychological performance in longterm cannabis users. Arch Gen Psychiatry 2001; 58: 909–15
2. Solowij N, et al. Cognitive functioning of long-term heavy cannabis users seeking treatment. JAMA 2002; 287: 1123–31. Correction: ibid.: 1651
3. Harrison GP Jr, et al. Cognitive measures in long-term cannabis users. J Clin Pharmacol 2002; 42 (11 suppl): 41S–47S
4. Gonzalez R, et al. Nonacute (residual) neuropsychological effects of cannabis use: a qualitative analysis and systematic review. J Clin Pharmacol 2002; 42 (11 suppl): 48S–57S
5. Patton GC, et al. Cannabis use and mental health in young people: cohort study. BMJ 2002; 325: 1195–8
6. McKay DR, Tennant CC. Is the grass greener? The link between cannabis and psychosis. Med J Aust 2000; 172: 284–6
7. Johns A. Psychiatric effects of cannabis. Br J Psychiatry 2001; 178: 116–22
8. Henquet C, et al. Prospective cohort study of cannabis use, predisposition for psychosis, and psychotic symptoms in young people. BMJ 2005; 330: 11
9. Fergusson DM, et al. Cannabis and psychosis. BMJ 2006; 332: 172–5
10. Hall W. Is cannabis use psychotogenic? Lancet 2006; 367: 193–5. Correction. ibid.; 1056
11. Moore THM, et al. Cannabis use and risk of psychotic or affective mental health outcomes: a systematic review. Lancet 2007; 370: 319–28
12. Zammit S, et al. Self reported cannabis use as a risk factor for schizophrenia in Swedish conscripts of 1969: historical cohort study. BMJ 2002; 325: 1199
13. Arseneault L, et al. Cannabis use in adolescence and risk for adult psychosis: longitudinal prospective study. BMJ 2002; 325: 1212–3
14. Rubio F, et al. Flumazenil for coma reversal in children after cannabis. Lancet 1993; 341: 1028–9.

Effects on the eyes.

A report of persistent visual abnormalities in a patient after discontinuation of heavy abuse of cannabis.1 No organic cause for the effects, which were accompanied by less persistent mental changes, could be found.
1. Laffi GL, Safran AB. Persistent visual changes following hashish consumption. Br J Ophthalmol 1993; 77: 601–2.

Effects on the lungs.

References.
1. Tashkin DR, et al. Respiratory and immunologic consequences of marijuana smoking. J Clin Pharmacol 2002; 42 (11 suppl): 71S–81S
2. Aldington S, et al. Effects of cannabis on pulmonary structure, function and symptoms. Thorax 2007; 62: 1058–63. Correction. ibid. 2008; 63: 385.

Hyperthermia.

Life-threatening hyperthermia was reported1in a 24-year-old man who went jogging after smoking cannabis.
1. Walter FG, et al. Marijuana and hyperthermia. J Toxicol Clin Toxic ol 1996; 34: 217–21.

Peripheral vascular disease.

References.
1. Combemale P, et al. Cannabis arteritis. Br J Dermatol 2005; 152: 166–9.

Pregnancy.

Cannabis has effects on sperm and can alter reproductive hormonal systems. Infants born to mothers exposed to cannabis during pregnancy tend to have a lower birth-weight1,2and may suffer from increased excitation in the postnatal period.3
1. Zuckerman B, et al. Effects of maternal marijuana and cocaine use on fetal growth. N Engl J Med 1989; 320: 762–8
2. Frank DA, et al. Neonatal body proportionality and body composition after in utero exposure to cocaine and marijuana. J Pediatr 1990; 117: 622–6
3. Silverman S. Interaction of drug-abusing mother, fetus, types of drugs examined in numerous studies. JAMA 1989; 261: 1689, 1693.

💊 Interactions

Cannabis and alcohol have additive effects. The sedative effects of cannabis may be potentiated by other CNS depressants. Additive antimuscarinic effects, for example tachycardia, may occur with drugs such as tricyclic antidepressants. Cannabis induces microsomal enzymes and therefore interactions with a wide range of drugs that are metabolised by these enzymes might be expected.

Disulfiram.

Limited evidence indicates that use of disulfiram with cannabis may produce a hypomanic state.1
1. Lacoursiere RB, Swatek R. Adverse interaction between disulfiram and marijuana: a case report. Am J Psychiatry 1983; 140: 243–4.

💊 Pharmacokinetics

Time to onset and duration of effects of cannabis vary with factors such as route of administration and the user’s experience. The active principles of cannabis are readily absorbed from the lungs. Systemic bioavailability of Δ9-tetrahydrocannabinol from smoked cannabis generally ranges between about 10 and 35%, with regular users achieving a higher efficiency. This produces an effect within minutes, reaches a peak in about 30 minutes, and lasts for about 3 to 4 hours. The pharmacokinetics of cannabis following injection are similar to smoking. Δ9-Tetrahydrocannabinol absorption may be slow and erratic from the gastrointestinal tract, and extensive first-pass liver metabolism reduces the systemic bioavailability to less than 20% with high interindividual variation. Effects peak in about 1 to 4 hours and last for up to 6 hours. Δ9-Tetrahydrocannabinol is lipophilic and becomes widely distributed in the body. Plasma protein binding is about 97 to 99%. Δ9-Tetrahydrocannabinol is extensively metabolised in the liver via the cytochrome P450 isoenzyme CYP2C subfamily, primarily to the active 11-hydroxy derivative. Within 72 hours of an oral dose, 10 to 15% is excreted in the urine mainly as conjugates and metabolites, and 35 to 50% in faeces mainly as unconjugated metabolites. About 80 to 90% of a dose is excreted within 5 days after ingestion. Duration of detectability of urinary metabolites varies greatly and can be several weeks for heavy chronic users. Cannabis crosses the placenta and is distributed into breast milk.
1. Grotenhermen F. Pharmacokinetics and pharmacodynamics of cannabinoids. Clin Pharmacokinet 2003; 42: 327–60.

💊 Uses and Administration

Cannabis contains about 60 cannabinoids of which the main active constituent is Δ9-tetrahydrocannabinol. Two types of specific endogenous cannabinoid-binding receptors have been identified. CB1 receptors are distributed throughout the CNS and some peripheral tissues and are involved in modulation of a number of neurotransmitters, which is thought to be responsible for the clinical effects of cannabinoids. CB2 receptors are expressed mainly in immune cells and are thought to be involved in modulation of the immune system. Cannabinoid receptor agonists and antagonists have also been identified.

Therapeutic use.

Cannabis was formerly used therapeutically as a sedative or narcotic. The cannabinoid Δ9-tetrahydrocannabinol and a synthetic cannabinol are used as antiemetics in patients receiving cancer chemotherapy. Dronabinol is also used to stimulate appetite in HIV patients with cachexia. Dronabinol and cannabidiol, another cannabinoid, are used in combination in a buccal spray preparation (Sativex) as adjunctive treatment for the symptomatic relief of neuropathic pain in multiple sclerosis in adults. This same preparation is also used as adjunctive analgesic treatment in adult patients with advanced cancer who have moderate to severe pain during the highest tolerated dose of strong opioid therapy for persistent background pain. Cannabinoids are also being investigated for a number of other potential therapeutic uses, including relief of spasticity in multiple sclerosis, in spinal cord injury, and in various forms of pain, including diabetic neuropathy and other types of neuropathic pain, and pain associated with rheumatoid arthritis. Cannabis reduces intra-ocular pressure and it has been reported to be of benefit in glaucoma. Vaporisation is being investigated as a means of delivering therapeutic doses of cannabinoids.

Abuse.

Cannabis is widely abused as a psychoactive agent and has a long history of such use. The amount of Δ9-tetrahydrocannabinol in cannabis depends on its geographical source. Proportions also differ depending on the form used and have been reported as: 1 to 4% in the leaves and flowering tops, or even up to 15% in some varieties bred for a high yield of cannabinoids (socalled skunk); 5 to 12% in sinsemilla (obtained from unpollinated female plants); 3 to 6% in the dried resin (hashish); and 30 to 50% in hashish oil expressed from the pressed resin. The usual route of abuse is by smoking cigarettes containing the dried leaves and flowering parts of the plant or the more potent dried resin (hashish); inhalation using water pipes or vaporisers are alternative methods. Cannabis is also ingested in cakes or sweets. Less commonly, cannabis extract or hashish oil is injected intravenously.
1. Robson P. Therapeutic aspects of cannabis and cannabinoids. Br J Psychiatry 2001; 178: 107–15
2. Mechoulam R, et al. Cannabidiol: an overview of some pharmacological aspects. J Clin Pharmacol 2002; 42 (11 suppl): 11S–19S
3. Zajicek J, et al. Cannabinoids for treatment of spasticity and other symptoms related to multiple sclerosis (CAMS study): multicentre randomised placebo-controlled trial. Lancet 2003; 362: 1517–26
4. Killestein J, et al. Cannabinoids in multiple sclerosis: do they have a therapeutic role? Drugs 2004; 64: 1–11
5. Berman JS, et al. Efficacy of two cannabis based medicinal extracts for relief of central neuropathic pain from brachial plexus avulsion: results of a randomised controlled trial. Pain 2004; 112: 299–306
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Published February 04, 2019.