Cannabis

Scientific classification
Kingdom: Plantae
Division: Magnoliophyta
Class: Magnoliopsida
Order: Rosales
Family: Cannabaceae
Genus: Cannabis L.
Species
Cannabis sativa L.[1]
Cannabis indica Lam. (putative)[1]
Cannabis ruderalis Janisch. (putative)

Cannabis (Cán-na-bis) is a genus of flowering plants that includes three putative species, Cannabis sativa,[1] Cannabis indica,[1] and Cannabis
ruderalis. These three taxa are indigenous to Central Asia, and South Asia.[2] Cannabis has long been used for fibre (hemp), for medicinal
purposes, and as a recreational drug. Industrial hemp products are made from Cannabis plants selected to produce an abundance of fiber and
minimal levels of THC (Δ9- tetrahydrocannabinol), a psychoactive molecule that produces the "high" associated with marijuana. The
psychoactive product consists of dried flowers and leaves of plants selected to produce high levels of THC. Various extracts including hashish
and hash oil are also produced from the plant.[3]

Etymology

The word cannabis is from Greek κάνναβις (kánnabis) (see Latin cannabis),[4] which was originally Scythian or Thracian.[5] It is related to the
Persian kanab, the English canvas and possibly even to the English hemp (Old English hænep).[5] In Hebrew, the word is ‫בֹוס‬ ַ [qanːa'boːs].
ּ ‫קַּנ‬
Old Akkadian qunnabtu, Neo-Assyrian and Neo-Babylonian qunnabu were used to refer to the plant meaning "a way to produce smoke."[6][7][8]

Description

Cannabis is an annual, dioecious, flowering herb. The leaves are palmately compound or digitate, with serrate leaflets.[9] The first pair of
leaves usually have a single leaflet, the number gradually increasing up to a maximum of about thirteen leaflets per leaf (usually seven or
nine), depending on variety and growing conditions. At the top of a flowering plant, this number again diminishes to a single leaflet per leaf.
The lower leaf pairs usually occur in an opposite leaf arrangement and the upper leaf pairs in an alternate arrangement on the main stem of a
mature plant.

Cannabis normally has imperfect flowers, with staminate "male" and pistillate "female" flowers occurring on separate plants.[10] It is not
unusual, however, for individual plants to bear both male and female flowers.[11] Although monoecious plants are often referred to as
"hermaphrodites," true hermaphrodites (which are less common) bear staminate and pistillate structures on individual flowers, whereas
monoecious plants bear male and female flowers at different locations on the same plant. Male flowers are normally borne on loose panicles,
and female flowers are borne on racemes.[12] "At a very early period the Chinese recognized the Cannabis plant as dioecious,"[13] and the (ca.
3rd century BCE) Erya dictionary defined xi 枲 "male cannabis" and fu 莩 (or ju 苴) "female cannabis".[14]

All known strains of Cannabis are wind-pollinated[15] and produce "seeds" that are technically called achenes.[16] Most strains of Cannabis are
short day plants,[15] with the possible exception of C. sativa subsp. sativa var. spontanea (= C. ruderalis), which is commonly described as
"auto-flowering" and may be day-neutral.

Cannabis, like many organisms, is diploid, having a chromosome complement of 2n=20, although polyploid individuals have been artificially
produced.[17] The plant is believed to have originated in the mountainous regions northwest of the Himalayas. It is also known as hemp,
although this term is often used to refer only to varieties of Cannabis cultivated for non-drug use. Cannabis plants produce a group of
chemicals called cannabinoids, which produce mental and physical effects when consumed. Cannabinoids, terpenoids, and other compounds
are secreted by glandular trichomes that occur most abundantly on the floral calyxes and bracts of female plants.[18] As a drug it usually comes
in the form of dried flower buds (marijuana), resin (hashish), or various extracts collectively known as hashish oil.[3] In the early 20th century, it
became illegal in most of the world to cultivate or possess Cannabis for drug purposes.

The genus Cannabis was formerly placed in the Nettle (Urticaceae) or Mulberry (Moraceae) family, but is now considered along with hops
(Humulus sp.) to belong to the Hemp family (Cannabaceae).[19] Recent phylogenetic studies based on cpDNA restriction site analysis and
gene sequencing strongly suggest that the Cannabaceae arose from within the Celtidaceae clade, and that the two families should be merged
to form a single monophyletic group.[20][21]

Various types of Cannabis have been described, and classified as species, subspecies, or varieties:[22]

• plants cultivated for fiber and seed production, described as low-intoxicant, non-drug, or fiber types.
• plants cultivated for drug production, described as high-intoxicant or drug types.
• escaped or wild forms of either of the above types.

Cannabis plants produce a unique family of terpeno-phenolic compounds called cannabinoids, which produce the "high" one experiences from
smoking marijuana. The two cannabinoids usually produced in greatest abundance are cannabidiol (CBD) and/or Δ9-tetrahydrocannabinol
(THC), but only THC is psychoactive. Since the early 1970s, Cannabis plants have been categorized by their chemical phenotype or
"chemotype," based on the overall amount of THC produced, and on the ratio of THC to CBD.[23] Although overall cannabinoid production is
influenced by environmental factors, the THC/CBD ratio is genetically determined and remains fixed throughout the life of a plant.[24] Non-drug
plants produce relatively low levels of THC and high levels of CBD, while drug plants produce high levels of THC and low levels of CBD. When
plants of these two chemotypes cross-pollinate, the plants in the first filial (F1) generation have an intermediate chemotype and produce similar
amounts of CBD and THC. Female plants of this chemotype may produce enough THC to be utilized for drug production.[23][25]

Whether the drug and non-drug, cultivated and wild types of Cannabis constitute a single, highly variable species, or the genus is polytypic
with more than one species, has been a subject of debate for well over two centuries. This is a contentious issue because there is no
universally accepted definition of a species.[26] One widely applied criterion for species recognition is that species are "groups of actually or
potentially interbreeding natural populations which are reproductively isolated from other such groups."[27] Populations that are physiologically
capable of interbreeding, but morphologically or genetically divergent and isolated by geography or ecology, are sometimes considered to be
separate species.[27] Physiological barriers to reproduction are not known to occur within Cannabis, and plants from widely divergent sources
are interfertile.[17] However, physical barriers to gene exchange (such as the Himalayan mountain range) might have enabled Cannabis gene
pools to diverge before the onset of human intervention, resulting in speciation.[28] It remains controversial whether sufficient morphological
and genetic divergence occurs within the genus as a result of geographical or ecological isolation to justify recognition of more than one
species.[29][30][31]

Early classifications

The Cannabis genus was first classified using the "modern" system of taxonomic nomenclature by Carolus Linnaeus in 1753, who devised the
system still in use for the naming of species.[32] He considered the genus to be monotypic, having just a single species that he named
Cannabis sativa L. (L. stands for Linnaeus, and indicates the authority who first named the species). Linnaeus was familiar with European
hemp, which was widely cultivated at the time. In 1785, noted evolutionary biologist Jean-Baptiste de Lamarck published a description of a
second species of Cannabis, which he named Cannabis indica Lam.[33] Lamarck based his description of the newly named species on plant
specimens collected in India. He described C. indica as having poorer fiber quality than C. sativa, but greater utility as an inebriant. Additional
Cannabis species were proposed in the 19th century, including strains from China and Vietnam (Indo-China) assigned the names Cannabis
chinensis Delile, and Cannabis gigantea Delile ex Vilmorin.[34] However, many taxonomists found these putative species difficult to distinguish.
In the early 20th century, the single-species concept was still widely accepted, except in the Soviet Union where Cannabis continued to be the
subject of active taxonomic study. The name Cannabis indica was listed in various Pharmacopoeias, and was widely used to designate
Cannabis suitable for the manufacture of medicinal preparations.[35]

20th Century

In 1924, Russian botanist D.E. Janichevsky concluded that ruderal Cannabis in central Russia is either a variety of C. sativa or a separate
species, and proposed C. sativa L. var. ruderalis Janisch. and Cannabis ruderalis Janisch. as alternative names.[22] In 1929, renowned plant
explorer Nikolai Vavilov assigned wild or feral populations of Cannabis in Afghanistan to C. indica Lam. var. kafiristanica Vav., and ruderal
populations in Europe to C. sativa L. var. spontanea Vav.[25][34] In 1940, Russian botanists Serebriakova and Sizov proposed a complex
classification in which they also recognized C. sativa and C. indica as separate species. Within C. sativa they recognized two subspecies: C.
sativa L. subsp. culta Serebr. (consisting of cultivated plants), and C. sativa L. subsp. spontanea (Vav.) Serebr. (consisting of wild or feral
plants). Serebriakova and Sizov split the two C. sativa subspecies into 13 varieties, including four distinct groups within subspecies culta.
However, they did not divide C. indica into subspecies or varieties.[22][36] This excessive splitting of C. sativa proved too unwieldy, and never
gained many adherents.

In the 1970s, the taxonomic classification of Cannabis took on added significance in North America. Laws prohibiting Cannabis in the United
States and Canada specifically named products of C. sativa as prohibited materials. Enterprising attorneys for the defense in a few drug busts
argued that the seized Cannabis material may not have been C. sativa, and was therefore not prohibited by law. Attorneys on both sides
recruited botanists to provide expert testimony. Among those testifying for the prosecution was Dr. Ernest Small, while Dr. Richard E. Schultes
and others testified for the defense. The botanists engaged in heated debate (outside of court), and both camps impugned the other's integrity.
[29][30]
The defense attorneys were not often successful in winning their case, because the intent of the law was clear.[37]

In 1976, Canadian botanist Ernest Small[38] and American taxonomist Arthur Cronquist published a taxonomic revision that recognizes a single
species of Cannabis with two subspecies: C. sativa L. subsp. sativa, and C. sativa L. subsp. indica (Lam.) Small & Cronq.[34] The authors
hypothesized that the two subspecies diverged primarily as a result of human selection; C. sativa subsp. sativa was presumably selected for
traits that enhance fiber or seed production, whereas C. sativa subsp. indica was primarily selected for drug production. Within these two
subspecies, Small and Cronquist described C. sativa L. subsp. sativa var. spontanea Vav. as a wild or escaped variety of low-intoxicant
Cannabis, and C. sativa subsp. indica var. kafiristanica (Vav.) Small & Cronq. as a wild or escaped variety of the high-intoxicant type. This
classification was based on several factors including interfertility, chromosome uniformity, chemotype, and numerical analysis of phenotypic
characters.[23][34][39]

Professors William Emboden, Loran Anderson, and Harvard botanist Richard E. Schultes and coworkers also conducted taxonomic studies of
Cannabis in the 1970s, and concluded that stable morphological differences exist that support recognition of at least three species, C. sativa,
C. indica, and C. ruderalis.[40][41][42][43] For Schultes, this was a reversal of his previous interpretation that Cannabis is monotypic, with only a
single species.[44] According to Schultes' and Anderson's descriptions, C. sativa is tall and laxly branched with relatively narrow leaflets, C.
indica is shorter, conical in shape, and has relatively wide leaflets, and C. ruderalis is short, branchless, and grows wild in central Asia. This
taxonomic interpretation was embraced by Cannabis aficionados who commonly distinguish narrow-leafed "sativa" drug strains from wide-
leafed "indica" drug strains.[45]

Continuing research

Molecular analytical techniques developed in the late 20th century are being applied to questions of taxonomic classification. This has resulted
in many reclassifications based on evolutionary systematics. Several studies of Random Amplified Polymorphic DNA (RAPD) and other types
of genetic markers have been conducted on drug and fiber strains of Cannabis, primarily for plant breeding and forensic purposes.[46][47][48][49][50]
Dutch Cannabis researcher E.P.M. de Meijer and coworkers described some of their RAPD studies as showing an "extremely high" degree of
genetic polymorphism between and within populations, suggesting a high degree of potential variation for selection, even in heavily selected
hemp cultivars.[24] They also commented that these analyses confirm the continuity of the Cannabis gene pool throughout the studied
accessions, and provide further confirmation that the genus comprises a single species, although theirs was not a systematic study per se.

Karl W. Hillig, a graduate student in the laboratory of long-time Cannabis researcher Paul G. Mahlberg[51] at Indiana University, conducted a
systematic investigation of genetic, morphological, and chemotaxonomic variation among 157 Cannabis accessions of known geographic
origin, including fiber, drug, and feral populations. In 2004, Hillig and Mahlberg published a chemotaxomic analysis of cannabinoid variation in
their Cannabis germplasm collection. They used gas chromatography to determine cannabinoid content and to infer allele frequencies of the
gene that controls CBD and THC production within the studied populations, and concluded that the patterns of cannabinoid variation support
recognition of C. sativa and C. indica as separate species, but not C. ruderalis.[25] The authors assigned fiber/seed landraces and feral
populations from Europe, central Asia, and Asia Minor to C. sativa. Narrow-leaflet and wide-leaflet drug accessions, southern and eastern
Asian hemp accessions, and feral Himalayan populations were assigned to C. indica. In 2005, Hillig published a genetic analysis of the same
set of accessions (this paper was the first in the series, but was delayed in publication), and proposed a three-species classification,
recognizing C. sativa, C. indica, and (tentatively) C. ruderalis.[28] In his doctoral dissertation published the same year, Hillig stated that principal
components analysis of phenotypic (morphological) traits failed to differentiate the putative species, but that canonical variates analysis
resulted in a high degree of discrimination of the putative species and infraspecific taxa.[52] Another paper in the series on chemotaxonomic
variation in the terpenoid content of the essential oil of Cannabis revealed that several wide-leaflet drug strains in the collection had relatively
high levels of certain sesquiterpene alcohols, including guaiol and isomers of eudesmol, that set them apart from the other putative taxa.[53]
Hillig concluded that the patterns of genetic, morphological, and chemotaxonomic variation support recognition of C. sativa and C. indica as
separate species. He also concluded there is little support to treat C. ruderalis as a separate species from C. sativa at this time, but more
research on wild and weedy populations is needed because they were underrepresented in their collection.

In September 2005, New Scientist reported that researchers at the Canberra Institute of Technology had identified a new type of Cannabis
based on analysis of mitochondrial and chloroplast DNA.[54] The New Scientist story, which was picked up by many news agencies and web
sites, indicated that the research was to be published in the journal Forensic Science International. When the article was finally published,
there was no mention of "Rasta."[55]

Popular usage

The scientific debate regarding taxonomy has had little effect on the terminology in widespread use among cultivators and users of drug-type
Cannabis. Cannabis aficionados recognize three distinct types based on such factors as morphology, native range, aroma, and subjective
psychoactive characteristics. "Sativa" is the term used to describe the most widespread variety, which is usually tall, laxly branched, and found
in warm lowland regions. "Indica" is used to designate shorter, bushier plants adapted to cooler climates and highland environments.
"Ruderalis" is the term used to describe the short plants that grow wild in Europe and central Asia.

Breeders, seed companies, and cultivators of drug type Cannabis often describe the ancestry or gross phenotypic characteristics of cultivars
by categorizing them as "pure indica," "mostly indica," "indica/sativa," "mostly sativa", or "pure sativa."

On of the most popular and potent sativas in Africa is Malawi Gold, locally know as Chamba. It is internationally renowed for its potency and
its flavor.

Reproduction

Breeding systems

Cannabis is predominantly dioecious,[15][56] although many monoecious varieties have been described.[57] Subdioecy (the occurrence of
monoecious individuals and dioecious individuals within the same population) is widespread.[58][59][60] Many populations have been described as
sexually labile.[48][61][62]

As a result of intensive selection in cultivation, Cannabis exhibits many sexual phenotypes that can be described in terms of the ratio of female
to male flowers occurring in the individual, or typical in the cultivar.[63] Dioecious varieties are preferred for drug production, where typically the
female flowers are used. Dioecious varieties are also preferred for textile fiber production, whereas monoecious varieties are preferred for pulp
and paper production. It has been suggested that the presence of monoecy can be used to differentiate licit crops of monoecious hemp from
illicit drug crops.[58] However, the so-called "sativa" drug strains often produce monoecious individuals, probably as a result of inbreeding.

Mechanisms of sex determination

Cannabis has been described as having one of the most complicated mechanisms of sex determination among the dioecious plants.[63] Many
models have been proposed to explain sex determination in Cannabis.

Based on studies of sex reversal in hemp, it was first reported by K. Hirata in 1924 that an XY sex-determination system is present.[61] At the
time, the XY system was the only known system of sex determination. The X:A system was first described in Drosophila spp in 1925.[64] Soon
thereafter, Schaffner disputed Hirata's interpretation,[65] and published results from his own studies of sex reversal in hemp, concluding that an
X:A system was in use and that furthermore sex was strongly influenced by environmental conditions.[62]

Since then, many different types of sex determination systems have been discovered, particularly in plants.[56] Dioecy is relatively uncommon
in the plant kingdom, and a very low percentage of dioecious plant species have been determined to use the XY system. In most cases where
the XY system is found it is believed to have evolved recently and independently.[66]

Since the 1920s, a number of sex determination models have been proposed for Cannabis. Ainsworth describes sex determination in the
genus as using "an X/autosome dosage type".[56]

The question of whether heteromorphic sex chromosomes are indeed present is most conveniently answered if such chromosomes were
clearly visible in a karyotype. Cannabis was one of the first plant species to be karyotyped; however, this was in a period when karyotype
preparation was primitive by modern standards (see History of Cytogenetics). Heteromorphic sex chromosomes were reported to occur in
staminate individuals of dioecious "Kentucky" hemp, but were not found in pistillate individuals of the same variety. Dioecious "Kentucky"
hemp was assumed to use an XY mechanism. Heterosomes were not observed in analyzed individuals of monoecious "Kentucky" hemp, nor
in an unidentified German cultivar. These varieties were assumed to have sex chromosome composition XX.[67] According to other
researchers, no modern karyotype of Cannabis had been published as of 1996.[68] Proponents of the XY system state that Y chromosome is
slightly larger than the X, but difficult to differentiate cytologically.[69]

More recently, Sakamoto and various co-authors[70][71] have used RAPD to isolate several genetic marker sequences that they name Male-
Associated DNA in Cannabis (MADC), and which they interpret as indirect evidence of a male chromosome. Several other research groups
have reported identification of male-associated markers using RAPD and AFLP.[24][48][72] Ainsworth commented on these findings, stating,

"It is not surprising that male-associated markers are relatively abundant. In dioecious plants where sex chromosomes have not been
identified, markers for maleness indicate either the presence of sex chromosomes which have not been distinguished by cytological methods
or that the marker is tightly linked to a gene involved in sex determination.[56]"

Environmental sex determination is known to occur in a variety of species.[73] Many researchers have suggested that sex in Cannabis is
determined or strongly influenced by environmental factors.[62] Ainsworth reviews that treatment with auxin and ethylene have feminizing
effects, and that treatment with cytokinins and gibberellins have masculinizing effects.[56] It has been reported that sex can be reversed in
Cannabis using chemical treatment.[74] A PCR-based method for the detection of female-associated DNA polymorphisms by genotyping has
been developed.[75]

Industrial and personal uses

Cannabis is used for a wide variety of purposes.

Hemp
Main article: Hemp

Hemp is the natural, durable soft fiber from the stalk of Cannabis sativa plants that grow upwards of 20 feet tall. Cannabis plants used for
hemp production are not valued for recreational uses as the plants that are cultivated for hemp produce minimal levels of THC, analogous to
attempting to get drunk from low-alcohol beer. Cannabis plants intended for any drug cultivation cannot be hidden in a hemp field either, as
the size and height of each are significantly different.[76]

Hemp producers sell hemp seeds as a health food, as they are rich in heart-healthy, essential fatty acids, amino acids (both essential and
nonessential), vitamins and minerals. Hemp "milk" is a milk substitute also made from hemp seeds that is both dairy and gluten-free.[77]

Hemp is fairly easy to grow and matures very fast compared to many crops, most notably trees used for paper. Compared to cotton for
clothing, hemp cloth is known to be of superior strength and longer-lasting. The fibers may also be used to form cordage for industrial-strength
ropes. Hemp plants also require little pesticides and herbicides due to its height, density and foliage. This also makes the hemp plant
environmentally very friendly.

Hemp can be utilized for 25,000 very durable textile products,[76] ranging from paper and clothing to biofuels (from the oils found in the seeds),
medicines and construction material. Hemp has been used by many civilizations, from China to Europe (and later North America) for the last
12,000 years of history.[76][78]

Recreational use

Comparison of physical harm and dependence regarding various drugs.[79]

Cannabis is a popular recreational drug around the world, only behind alcohol, caffeine and tobacco. In the United States alone, it is believed
that over 100 million Americans have tried Cannabis, with 25 million Americans using it within the past year.[80]

The psychoactive effects of Cannabis are known to have a biphasic nature. Primary psychoactive effects include a state of relaxation, and to a
lesser degree, euphoria from its main psychoactive compound, tetrahydrocannabinol. Secondary psychoactive effects, such as a facility for
philosophical thinking; introspection and metacognition have been reported, amongst cases of anxiety and paranoia.[81] Finally, the tertiary
psychoactive effects of the drug cannabis, can include an increase in heart rate and hunger, believed to be caused by 11-Hydroxy-THC, a
psychoactive metabolite of THC produced in the liver.

Normal cognition is restored after approximately three hours for larger doses via a smoking pipe, bong or vaporizer.[81] However, if a large
amount is taken orally the effects may last much longer. After 24 hours to a few days, minuscule psychoactive effects may be felt, depending
on dosage, frequency and tolerance to the drug.

Various forms of the drug cannabis exist, including extracts such as hashish and hash oil[3] which, due to appearance, are more susceptible to
adulterants when left unregulated.

The plant Cannabis sativa is known to cause more of a "high" by stimulating hunger and by producing a rather more comedic, or energetic
feeling. Conversely, the Cannabis indica plant is known to cause more of a "stoned" type of feeling, possibly due to a higher CBD to THC ratio.
[82]

Cannabidiol (CBD), which has no psychotropic effects by itself[83] (although sometimes showing a small stimulant effect, similar to caffeine),
[citation needed]
attenuates, or reduces[84] the higher anxiety levels caused by THC alone.[85]

According to the UK medical journal The Lancet, Cannabis has a lower rate of dependence compared to both nicotine and alcohol.[86]
However, everyday use of Cannabis can in some cases, be correlated with some psychological withdrawal symptoms such as irritability, and
insomnia[81] and evidence could suggest that if a user experiences stress, the likeliness of getting a panic attack increases due to an increase
of THC metabolites.[87][88] However, any Cannabis withdrawal symptoms are typically mild and are never life-threatening.[86]

Medical use

A synthetic form of the main psychoactive cannabinoid in Cannabis, Δ9-tetrahydrocannabinol (THC), is used as a treatment for a wide range of
medical conditions.[89]
In the United States, although the Food and Drug Administration (FDA) does acknowledge that "there has been considerable interest in its use
for the treatment of a number of conditions, including glaucoma, AIDS wasting, neuropathic pain, treatment of spasticity associated with
multiple sclerosis, and chemotherapy-induced nausea," the agency has not approved "medical marijuana". There are currently 2 oral forms of
cannabis (cannabinoids) available by prescription in the United States for nausea and vomiting associated with cancer chemotherapy:
dronabinol (Marinol) and nabilone (Cesamet). Dronabinol is also approved for the treatment of anorexia associated with AIDS.[90] The FDA
does facilitate scientific investigations into the medical uses of cannabinoids.[91]

In a collection of writings on medical marijuana by 45 researchers, a literature review on the medicinal uses of Cannabis and cannabinoids
concluded that established uses include easing of nausea and vomiting, anorexia, and weight loss; "well-confirmed effect" was found in the
treatment of spasticity, painful conditions (i.e. neurogenic pain), movement disorders, asthma, and glaucoma. Reported but "less-confirmed"
effects included treatment of allergies, inflammation, infection, epilepsy, depression, bipolar disorders, anxiety disorder, dependency and
withdrawal. Basic level research was being carried out at the time on autoimmune disease, cancer, neuroprotection, fever, disorders of blood
pressure.[92]

Clinical trials conducted by the American Marijuana Policy Project, have shown the efficacy of cannabis as a treatment for cancer and AIDS
patients, who often suffer from clinical depression, and from nausea and resulting weight loss due to chemotherapy and other aggressive
treatments.[93] A synthetic version of the cannabinoid THC named dronabinol has been shown to relieve symptoms of anorexia and reduce
agitation in elderly Alzheimer's patients.[94] Dronabinol has been approved for use with anorexia in patients with HIV/AIDS and chemotherapy-
related nausea. This drug, while demonstrating the effectiveness of Cannabis at combating several disorders, is more expensive and less
available than whole cannabis and has not been shown to be effective or safe.[95]

Glaucoma, a condition of increased pressure within the eyeball causing gradual loss of sight, can be treated with medical marijuana to
decrease this intraocular pressure. There has been debate for 25 years on the subject. Some studies have shown a reduction of IOP in
glaucoma patients who smoke cannabis,[96] but the effects are generally short-lived. There exists some concern over its use since it can also
decrease blood flow to the optic nerve. Marijuana lowers IOP by acting on a cannabinoid receptor on the ciliary body called the CB receptor.[97]
Although Cannabis may not be the best therapeutic choice for glaucoma patients, it may lead researchers to more effective treatments. A
promising study shows that agents targeted to ocular CB receptors can reduce IOP in glaucoma patients who have failed other therapies.[98]

Medical cannabis is also used for analgesia, or pain relief. It is also reported to be beneficial for treating certain neurological illnesses such as
epilepsy, and bipolar disorder.[99] Case reports have found that Cannabis can relieve tics in people with obsessive compulsive disorder and
Tourette syndrome. Patients treated with tetrahydrocannabinol, the main psychoactive chemical found in Cannabis, reported a significant
decrease in both motor and vocal tics, some of 50% or more.[100][101][102] Some decrease in obsessive-compulsive behavior was also found.[100] A
recent study has also concluded that cannabinoids found in Cannabis might have the ability to prevent Alzheimer's disease.[103] THC has been
shown to reduce arterial blockages.[104]

Another potential use for medical cannabis is movement disorders. Cannabis is frequently reported to reduce the muscle spasms associated
with multiple sclerosis; this has been acknowledged by the Institute of Medicine, but it noted that these abundant anecdotal reports are not
well-supported by clinical data. Evidence from animal studies suggests that there is a possible role for cannabinoids in the treatment of certain
types of epileptic seizures.[105] A synthetic version of the major active compound in Cannabis, THC, is available in capsule form as the
prescription drug dronabinol (Marinol) in many countries. The prescription drug Sativex, an extract of cannabis administered as a sublingual
spray, has been approved in Canada for the treatment of multiple sclerosis.[106]

Cannabis was manufactured and sold by U.S. pharmaceutical companies from the 1880s through the 1930s, but the lack of documented
information on the frequency and effectiveness of its use makes it difficult to evaluate its medicinal value in these forms. Cannabis was listed
in the 1929–1930 Physicians' Catalog of the Pharmaceutical and Biological Products of Parke, Davis & Company as an active ingredient in ten
products for cough, colic, neuralgia, cholera mordus and other medical conditions, as well as a "narcotic, analgesic, and sedative."[107] The
1929–1930 Physicians' Catalog also lists compund medications containing cannabis that in some cases were apparently formulated by
medical doctors, in its "Pills and Tablets" section[108]

As cannabis is further legalized for medicinal use, it is possible that some of the foregoing compound medicines, whose formulas have been
copied exactly as published, may be scientifically tested to determine whether they are effective medications. Writing in the Canadian Medical
Association Journal, smoking cannabis from a pipe may significantly relieve chronic pain in patients with damaged nerves.[109]

Religious use

Cannabis is first referred to in Hindu Vedas between 2000 and 1400 BCE, in the Atharvaveda. By the 10th century CE, it has been suggested
that it was referred to by some in India as "food of the gods".[110] Cannabis use eventually became a ritual part of the Hindu festival of Holi. In
Buddhism, cannabis is genereally regarded as an intoxicant and therefore a hindrance to development of meditation and clear awareness.
Shamanic use of Cannabis in China has been dated to at least 1000 BCE.[111] In ancient Germanic culture, Cannabis was associated with the
Norse love goddess, Freya.[112][113] An anointing oil mentioned in Exodus is, by some translators, said to contain Cannabis.[114] Sufis have used
Cannabis in a spiritual context since the 13th century CE.[115]

In modern times the Rastafari movement has embraced Cannabis as a sacrament.[116] Elders of the modern religious movement known as the
Ethiopian Zion Coptic Church consider Cannabis to be the Eucharist, claiming it as an oral tradition from Ethiopia dating back to the time of
Christ, even though the movement was founded in the United States in 1975 and has no ties to either Ethiopia or the Coptic Church.[117] Like
the Rastafari, some modern Gnostic Christian sects have asserted that Cannabis is the Tree of Life.[118][119] Other organized religions founded
in the 20th century that treat Cannabis as a sacrament are the THC Ministry,[120] the Way of Infinite Harmony, Cantheism,[121] the Cannabis
Assembly[122] and the Church of Cognizance.
 Cannabis (drug)

Cannabis, also known as marijuana[2] (sometimes spelled "marihuana"[3]) among many other names,a[›] refers to any number of preparations
of the Cannabis plant intended for use as a psychoactive drug. The word marijuana comes from the Mexican Spanish mariguana.[4] According
to the United Nations, cannabis "is the most widely used illicit substance in the world."[5]

The typical herbal form of cannabis consists of the flowers and subtending leaves and stalks of mature pistillate of female plants. The resinous
form of the drug is known as hashish (or merely as 'hash').[6]

The major psychoactive chemical compound in cannabis is Δ9-tetrahydrocannabinol (commonly abbreviated as THC). At least 66 other
cannabinoids are also present in cannabis, including cannabidiol (CBD), cannabinol (CBN) and tetrahydrocannabivarin (THCV) among many
others, which are believed to result in different effects from those of THC alone.[7]

Cannabis use has been found to have occurred as long ago as the third millennium B.C.[8] In modern times, the drug has been used for
recreational, religious or spiritual, and medicinal purposes. The UN estimated that in 2004 about 4% of the world's adult population (162
million people) use cannabis annually, and about 0.6% (22.5 million) use it on a daily basis.[9] The possession, use, or sale of cannabis
preparations containing psychoactive cannabinoids became illegal in most parts of the world in the early 20th century. Since then, some
countries have intensified the enforcement of cannabis prohibition, while others have reduced it.

History

The use of cannabis, at least as fiber, has been shown to go back at least 10,000 years in Taiwan.[10] Má (Pinyin pronunciation), the Chinese
expression for hemp, is a pictograph of two plants under a shelter.[11]

Cannabis is indigenous to Central and South Asia.[12] Evidence of the inhalation of cannabis smoke can be found in the 3rd millennium B.C.,
as indicated by charred cannabis seeds found in a ritual brazier at an ancient burial site in present day Romania.[8] Cannabis is also known to
have been used by the ancient Hindus and Nihang Sikhs of India and Nepal thousands of years ago. The herb was called ganjika in Sanskrit
(गाजा/গঁাজা ganja in modern Indic languages).[13][14] The ancient drug soma, mentioned in the Vedas, was sometimes associated with cannabis.[15]

Cannabis was also known to the ancient Assyrians, who discovered its psychoactive properties through the Aryans.[16] Using it in some
religious ceremonies, they called it qunubu (meaning "way to produce smoke"), a probable origin of the modern word "cannabis".[17] Cannabis
was also introduced by the Aryans to the Scythians and Thracians/Dacians, whose shamans (the kapnobatai—"those who walk on
smoke/clouds") burned cannabis flowers to induce a state of trance.[18] Members of the cult of Dionysus, believed to have originated in Thrace
(Bulgaria, Greece and Turkey), are also thought to have inhaled cannabis smoke. In 2003, a leather basket filled with cannabis leaf fragments
and seeds was found next to a 2,500- to 2,800-year-old mummified shaman in the northwestern Xinjiang Uygur Autonomous Region of China.
[19][20]

Cannabis has an ancient history of ritual use and is found in pharmacological cults around the world. Hemp seeds discovered by
archaeologists at Pazyryk suggest early ceremonial practices like eating by the Scythians occurred during the 5th to 2nd century B.C.,
confirming previous historical reports by Herodotus.[21] One writer has claimed that cannabis was used as a religious sacrament by ancient
Jews and early Christians[6][22] due to the similarity between the Hebrew word "qannabbos" ("cannabis") and the Hebrew phrase "qené bósem"
("aromatic cane"). It was used by Muslims in various Sufi orders as early as the Mamluk period, for example by the Qalandars.[23]

A study published in the South African Journal of Science showed that "pipes dug up from the garden of Shakespeare's home in Stratford
upon Avon contain traces of cannabis."[24] The chemical analysis was carried out after researchers hypothesized that the "noted weed"
mentioned in Sonnet 76 and the "journey in my head" from Sonnet 27 could be references to cannabis and the use thereof.[25]

Cannabis was criminalized in various countries beginning in the early 20th century. It was outlawed in South Africa in 1911, in Jamaica (then a
British colony) in 1913, and in the United Kingdom and New Zealand in the 1920s.[26] Canada criminalized marijuana in the Opium and Drug
Act of 1923, before any reports of use of the drug in Canada. In 1925 a compromise was made at an international conference in Haag about
the International Opium Convention that banned exportation of "Indian hemp" to countries that had prohibited its use, and requiring importing
countries to issue certificates approving the importation and stating that the shipment was required "exclusively for medical or scientific
purposes". It also required parties to "exercise an effective control of such a nature as to prevent the illicit international traffic in Indian hemp
and especially in the resin".[27] In the United States the first restrictions for sale of cannabis came in 1906 (in District of Columbia).[28] In 1937,
the Marijuana Transfer Tax Act was passed, and prohibited the production of hemp in addition to marijuana. The reasons that hemp was also
included in this law are disputed. The Federal Bureau of Narcotics agents reported that fields with hemp were also used as a source for
marijuana dealers. Other authors claim have claimed that it was passed in order to destroy the hemp industry,[29][30][31] largely as an effort of
businessmen Andrew Mellon, Randolph Hearst, and the Du Pont family.[29][31] With the invention of the decorticator, hemp became a very
cheap substitute for the paper pulp that was used in the newspaper industry.[29][32] Hearst felt that this was a threat to his extensive timber
holdings. Mellon, Secretary of the Treasury and the wealthiest man in America, had invested heavily in the Du Pont families new synthetic
fiber, nylon, which was also being outcompeted by hemp.[29]

Forms

Natural herbal form

The terms cannabis or marijuana generally refer to the dried flowers and subtending leaves and stems of the female cannabis plant. This is
the most widely consumed form, containing 3% to 22% THC.[33][34] In contrast, cannabis strains used to produce industrial hemp contain less
than 1% THC and are thus not valued for recreational use.[35]

Concentrated THC

Kief
Main article: Kief
Kief is a powder, rich in trichomes, which can be sifted from the leaves and flowers of cannabis plants and either consumed in powder form or
compressed to produce cakes of hashish.[36]

Hashish

Hashish (also spelled hasheesh, hashisha, or simply hash) is a concentrated resin produced from the flowers of the female cannabis plant.
Hash can often be more potent than marijuana and can be smoked or chewed.[37] It varies in color from black to golden brown depending upon
purity.

Hash oil

Hash oil, or "butane honey oil" (BHO), is a mix of essential oils and resins extracted from mature cannabis foliage through the use of various
solvents. It has a high proportion of cannabinoids (ranging from 40 to 90%).[38] and is used in a variety of cannabis foods.

Documentaries such as Run From the Cure, Cured: A Cannabis Story, and the book Live Free or Die by Shona Banda relate experiences with
the medicine.

Residue (resin)

Because of THC's adhesive properties, a sticky residue, most commonly known as "resin", builds up inside utensils used to smoke cannabis.
It has tar-like properties but still contains THC as well as other cannabinoids. This buildup has some of the psychoactive properties of
cannabis but is more difficult to smoke without discomfort caused to throat and lungs. This tar may also contain CBN, which is a breakdown
product of THC. Cannabis users typically only smoke residue when cannabis is unavailable. Glass pipes may be water-steamed at a low
temperature prior to scraping in order to make the residue easier to remove.[39] Alcohol is an effective solvent for cleaning residue from
paraphernalia.

Potency

According to the United Nations Office on Drugs and Crime (UNODC), "the amount of THC present in a cannabis sample is generally used as
a measure of cannabis potency."[40] The three main forms of cannabis products are the herb (marijuana), resin (hashish), and oil (hash oil).
The UNODC states that marijuana often contains 5% THC content, resin "can contain up to 20% THC content", and that "Cannabis oil may
contain more than 60% THC content."[40]

A scientific study published in 2000 in the Journal of Forensic Sciences (JFS) found that the potency (THC content) of confiscated cannabis in
the United States (US) rose from "approximately 3.3% in 1983 and 1984", to "4.47% in 1997". It also concluded that "other major cannabinoids
(i.e., CBD, CBN, and CBC)" (other chemicals in cannabis) "showed no significant change in their concentration over the years".[41] More recent
research undertaken at the University of Mississippi's Potency Monitoring Project[42] has found that average THC levels in cannabis samples
between 1975 and 2007 have increased from 4% in 1983 to 9.6% in 2007.

Australia's National Cannabis Prevention and Information Centre (NCPIC) states that the buds (flowers) of the female cannabis plant contain
the highest concentration of THC, followed by the leaves. The stalks and seeds have "much lower THC levels".[43] The UN states that the
leaves can contain ten times less THC than the buds, and the stalks one hundred times less THC.[40]

After revisions to cannabis rescheduling in the UK, the government moved cannabis back from a class C to a class B drug. A purported
reason was the appearance of high potency cannabis. They believe skunk accounts for between 70 and 80% of samples seized by police [44]
(despite the fact that skunk can sometimes be incorrectly mistaken for all types of female herbal cannabis).[45]

It is noted that one of the earliest strains of skunk to appear was that of "SKUNK #1", which has been inbred since 1978,[46] but high potency
herbal cannabis has been around even longer.

According to the "Talk to FRANK" (UK) website:

Recently, there has been an increased availability of strong herbal cannabis, containing on average 2-3 times the amount of the active
compound, tetrahydrocannabinol or THC, as compared to the traditional imported ‘weed’. This strong cannabis includes:‘sinsemilla’ (a bud
grown in the absence of male plants and which has no seeds); ‘homegrown’; ‘skunk’, which has a characteristic strong smell; and imported
‘netherweed’...

...it may not be possible to tell whether a particular sample of 'skunk' or ‘homegrown’ or ‘sinsemilla’ will have a higher potency than an equal
amount of traditional herbal cannabis.

Of course, "homegrown", "netherweed" and "sinsemilla" are not always "strong", and not every strain of cannabis with a "characteristic strong
smell" can be accurately named "skunk". "Traditional herbal cannabis" or "weed", has on the whole, always been subjectively "strong".

While commentators have warned that greater cannabis "strength" could represent a health risk, others have noted that users readily learn to
compensate by downsizing their dosage, thus benefiting from reductions in smoking side-hazards such as heat shock or carbon monoxide.

Adulterants
Adulterants in cannabis are less common than in other recreational drugs[citation needed]. Chalk (in the Netherlands) and glass particles (in the UK)
have been used at times to make cannabis appear to be higher quality.[48][49][50] Increasing the weight of hashish products in Germany with lead
caused lead intoxication in at least 29 users.[51] In the Netherlands two chemical analogs of Sildenafil (Viagra) were found in adulterated
marijuana.[52]

• "Soap-Bar": according to both the "Talk to FRANK" website and the UKCIA website, "perhaps the most common type
of cannabis found in the UK" can contain turpentine, tranquillizers, boot polish, henna and animal faeces - amongst several other things.[47][53]
One small study of five "soap-bar" samples seized by UK Customs in 2001 found huge adulteration by many toxic substances, including soil,
glue, engine oil and animal faeces.[54]

Routes of administration

A 700 mg cannabis cigarette, or "joint". Temperatures can reach 700°C., destroying cannabinoids but causing "drug effects" attributed to the
cannabis.

A narrow, screened single-toke utensil, such as the midwakh (shown here), kiseru or sebsi, permits "vaporizing" a 25-mg. low-temperature
serving of pre-sifted herb, minimizing combustion to protect economy and health.

Cannabis is consumed in many different ways, most of which involve inhaling smoke from pipes, bongs (small pipes with water chambers),
paper-wrapped joints or tobacco-leaf-wrapped blunts.

Cannabis has also been used as an active ingredient in tablets, extracts, tinctures and compound medicines that were professionally
formulated, manufactured, and sold to physicians and hospitals, as discussed below in 'Medical use'.

Vaporizer

A vaporizer heats herbal cannabis to 365–410 °F (185–210 °C), causing the active ingredients to evaporate into a gas without burning the
plant material (the boiling point of THC is 390.4 °F (199.1 °C) at 760 mmHg pressure).[55] A lower proportion of toxic chemicals is released than
by smoking, depending on the design of the vaporizer and the temperature at which it is set. This method of consuming cannabis produces
markedly different effects than smoking due to the flash points of different cannabinoids; for example, CBN has a flash point of 212.7 °C
(414.9 °F)[56] and would normally be present in smoke but might not be present in vapor.

As another alternative to smoking, cannabis may be consumed orally. However, the cannabis or its extract must be sufficiently heated or
dehydrated to cause decarboxylation of its most abundant cannabinoid, tetrahydrocannabinolic acid (THCA), into psychoactive THC.[57]

Cannabinoids can be leached from cannabis plant matter using high-proof spirits (often grain alcohol) to create a tincture, often referred to as
Green Dragon.

Cannabis can also be consumed as a tea. THC is lipophilic and only slightly water soluble (with a solubility of 2.8 mg per liter),[58] so tea is
made by first adding a saturated fat to hot water (i.e. cream or any milk except skim) with a small amount of cannabis, green or black tea
leaves and honey or sugar, steeped for approximately 5 minutes.

Effects

Cannabis has psychoactive and physiological effects when consumed. The minimum amount of THC required to have a perceptible
psychoactive effect is about 10 micrograms per kilogram of body weight.[59] Aside from a subjective change in perception and, most notably,
mood, the most common short-term physical and neurological effects include increased heart rate, lowered blood pressure, impairment of
short-term episodic memory, working memory, psychomotor coordination, and concentration.[60] Long-term effects are less clear.[61][62]

Classification

While many drugs clearly fall into the category of either stimulant, depressant, or hallucinogen, cannabis exhibits a mix of all properties,
perhaps leaning the most towards hallucinogenic or psychedelic properties, though with other effects quite pronounced as well. Though THC
is typically considered the primary active component of the cannabis plant, various scientific studies have suggested that certain other
cannabinoids like CBD may also play a significant role in its psychoactive effects.[10][63][64]

Medical use
Cannabis used medically does have several well-documented beneficial effects. Among these are: the amelioration of nausea and vomiting,
stimulation of hunger in chemotherapy and AIDS patients, lowered intraocular eye pressure (shown to be effective for treating glaucoma), as
well as general analgesic effects (pain reliever).b[›]

Cannabis was manufactured and sold by U.S. pharmaceutical companies from the 1880s through the 1930s, but the lack of documented
information on the frequency and effectiveness of its use makes it difficult to evaluate its medicinal value. Cannabis in the form of a tincture
and a fluid extract is documented in a 1929-30 Parke Davis & Co catalog,[65] and is listed as an active ingredient in ten products for cough,
colic, neuralgia, cholera mordus and other medical conditions, as well as a "narcotic, analgesic, and sedative". The catalog also lists
compound medications containing cannabis that in some cases were apparently formulated by medical doctors, in its Pills and Tablets section.

As cannabis is further legalized for medicinal use, it is possible that some of the foregoing compound medicines, whose formulas have been
copied exactly as published, may be scientifically tested to determine whether they are effective medications.

Less confirmed individual studies also have been conducted indicating cannabis to be beneficial to a gamut of conditions running from multiple
sclerosis to depression. Synthesized cannabinoids are also sold as prescription drugs, including Marinol (dronabinol in the United States and
Germany) and Cesamet (nabilone in Canada, Mexico, The United States and The United Kingdom).b[›]

Currently, the U.S. Food and Drug Administration (FDA) has not approved smoked marijuana for any condition or disease in the United States,
largely because good quality scientific evidence for its use from U.S. studies is lacking; however, a major barrier to acquiring the necessary
evidence is the lack of federal funding for this kind of research.[66] Regardless, thirteen states have legalized cannabis for medical use.[67][68]
Canada, Spain, The Netherlands and Austria have also legalized cannabis for medicinal use.[69][70]

Long-term effects

The smoking of cannabis is the most harmful method of consumption, as the inhalation of smoke from organic materials can cause various
health problems.[71]

By comparison, studies on the vaporization of cannabis found that subjects were "only 40% as likely to report respiratory symptoms as users
who do not vaporize, even when age, sex, cigarette use, and amount of cannabis consumed are controlled."[72] Another study found vaporizers
to be "a safe and effective cannabinoid delivery system."[73][74]

Cannabis is ranked one of the least harmful drugs by a study published in the UK medical journal, The Lancet.[75]

While a study in New Zealand of 79 lung-cancer patients suggested daily cannabis smokers have a 5.7 times higher risk of lung cancer than
non-users,[76] another study of 2252 people in Los Angeles failed to find a correlation between the smoking of cannabis and lung, head or neck
cancers.[77] Some studies have also found that moderate cannabis use may protect against head and neck cancers,[78] as well as lung cancer.
[79]
Some studies have shown that cannabidiol may also be useful in treating breast cancer.[80] These effects have been attributed to the well
documented anti-tumoral properties of cannabinoids, specifically tetrahydrocannabinol (THC) and cannabidiol.

Cannabis use has been assessed by several studies to be correlated with the development of anxiety, psychosis, and depression.[81][82] A 2007
meta-analysis estimated that cannabis use is statistically associated, in a dose-dependent manner, to an increased risk in the development of
psychotic disorders, including schizophrenia.[83] No causal mechanism has been proven, however, and the meaning of the correlation and its
direction is a subject of debate that has not been resolved in the scientific community. Some studies assess that the causality is more likely to
involve a path from cannabis use to psychotic symptoms rather than a path from psychotic symptoms to cannabis use,[84] while other studies
assess the opposite direction of the causality, or hold cannabis to only form parts of a "causal constellation", while not inflicting mental health
problems that would not have occurred in the absence of the cannabis use.[85][86]

Though cannabis use has at times been associated with stroke, there is no firmly established link, and potential mechanisms are unknown.[87]
Similarly, there is no established relationship between cannabis use and heart disease, including exacerbation of cases of existing heart
disease.[88] Though some fMRI studies have shown changes in neurological function in long term heavy cannabis users, no long term
behavioral effects after abstinence have been linked to these changes.[89]

Detection of use

THC and its major (inactive) metabolite, THC-COOH, can be quantitated in blood, urine, hair, oral fluid or sweat using chromatographic
techniques as part of a drug use testing program or a forensic investigation of a traffic or other criminal offense. The concentrations obtained
from such analyses can often be helpful in distinguishing active use from passive exposure, prescription use from illicit use, elapsed time since
use, and extent or duration of use. These tests cannot, however, distinguish authorized cannabis smoking for medical purposes from
unauthorized recreational smoking.[90] Commercial cannabinoid immunoassays, often employed as the initial screening method when testing
physiological specimens for marijuana presence, have different degrees of cross-reactivity with THC and its metabolites. Urine contains
predominantly THC-COOH, while hair, oral fluid and sweat contain primarily THC. Blood may contain both substances, with the relative
amounts dependent on the recency and extent of usage.[90][91][92][93]

The Duquenois-Levine test is commonly used as a screening test in the field, but it cannot definitively confirm the presence of marijuana, as a
large range of substances have been shown to give false positives. Despite this, it is common in the United States for prosecutors to seek
plea bargains on the basis of positive D-L tests, claiming them definitive, or even to seek conviction without the use of gas chromatography
confirmation, which can only be done in the lab.[94]

Gateway drug theory

Some claim that trying cannabis increases the probability that users will eventually use "harder" drugs. This hypothesis has been one of the
central pillars of anti-cannabis drug policy in the United States,[95] though the validity and implications of these hypotheses are highly debated.
[96]
Studies have shown that tobacco smoking is a better predictor of concurrent illicit hard drug use than smoking cannabis.[97]

No widely accepted study has ever demonstrated a cause-and-effect relationship between the use of cannabis and the later use of harder
drugs like heroin and cocaine. However, the prevalence of tobacco cigarette advertising and the practice of mixing tobacco and cannabis
together in a single large joint, common in Europe, are believed to be cofactors in promoting nicotine dependency among young persons
investigating cannabis.[98]

A 2005 comprehensive review of the literature on the cannabis gateway hypothesis found that pre-existing traits may predispose users to
addiction in general, the availability of multiple drugs in a given setting confounds predictive patterns in their usage, and drug sub-cultures are
more influential than cannabis itself. The study called for further research on "social context, individual characteristics, and drug effects" to
discover the actual relationships between cannabis and the use of other drugs.[99]

A new user of cannabis who feels there is a difference between anti-drug information and their own experiences will apply this distrust to
public information about other, more powerful drugs. Some studies state that while there is no proof for this gateway hypothesis, young
cannabis users should still be considered as a risk group for intervention programs.[100] Other findings indicate that hard drug users are likely to
be "poly-drug" users, and that interventions must address the use of multiple drugs instead of a single hard drug.[101]

Another gateway hypothesis is that while cannabis is not as harmful or addictive as other drugs, a gateway effect may be detected as a result
of the "common factors" involved with using any illegal drug. Because of its illegal status, cannabis users are more likely to be in situations
which allow them to become acquainted with people who use and sell other illegal drugs.[102][103] By this argument, some studies have shown
that alcohol and tobacco may be regarded as gateway drugs.[97] However, a more parsimonious explanation could be that cannabis is simply
more readily available (and at an earlier age) than illegal hard drugs, and alcohol/tobacco are in turn easier to obtain earlier than cannabis
(though the reverse may be true in some areas), thus leading to the "gateway sequence" in those people who are most likely to experiment
with any drug offered.[96]

A 2010 study published in the Journal of Health and Social Behavior found that the main factors in users moving on to other drugs were age,
wealth, unemployment status, and psychological stress. The study found there is no "gateway theory" and that drug use is more closely tied to
a person's life situation, although marijuana users are more likely to use other drugs.[104]

Legal status

Since the beginning of the 20th century, most countries have enacted laws against the cultivation, possession or transfer of cannabis. These
laws have impacted adversely on the cannabis plant's cultivation for non-recreational purposes, but there are many regions where, under
certain circumstances, handling of cannabis is legal or licensed. Many jurisdictions have lessened the penalties for possession of small
quantities of cannabis, so that it is punished by confiscation and sometimes a fine, rather than imprisonment, focusing more on those who
traffic the drug on the black market.

In some areas where cannabis use has been historically tolerated, some new restrictions have been put in place, such as the closing of
cannabis coffee shops near the borders of the Netherlands,[105] closing of coffee shops near secondary schools in the Netherlands and
crackdowns on "Pusher Street" in Christiania, Copenhagen in 2004.[106][107]

Some jurisdictions use free voluntary treatment programs and/or mandatory treatment programs for frequent known users. Simple possession
can carry long prison terms in some countries, particularly in East Asia, where the sale of cannabis may lead to a sentence of life in prison or
even execution. More recently however, many political parties, non-profit organizations and causes based on the legalization of medical
cannabis and/or legalizing the plant entirely (with some restrictions) have emerged.

Price

The price or street value of cannabis varies strongly by region and area. In addition, some dealers may sell potent buds at a higher price.[108]

In the United States, cannabis is overall the #4 value crop, and is #1 or #2 in many states including California, New York and Florida,
averaging $3,000/lb.[109][110] It is believed to generate an estimated $36 billion market.[111] Most of the money is spent not on growing and
producing but on smuggling the supply to buyers. The United Nations Office on Drugs and Crime claims in its 2008 World Drug Report that
typical U.S. retail prices are 10-15 dollars per gram (approximately $290 to $430 per ounce). Street prices in North America are known to
range from about $150 to $250 per ounce, depending on quality.[112]

The European Monitoring Centre for Drugs and Drug Addiction reports that typical retail prices in Europe for cannabis varies from 2€ to 14€
per gram, with a majority of European countries reporting prices in the range 4–10€.[113] In the United Kingdom, a cannabis plant has an
approximate street value of £300,[114] but retails to the end-user at about £160/oz.

Truth serum

Cannabis was used as a truth serum by the Office of Strategic Services (OSS), a US government intelligence agency formed during World
War II. In the early 1940s, it was the most effective truth drug developed at the OSS labs at St. Elizabeths Hospital; it caused a subject "to be
loquacious and free in his impartation of information."[115]

In May 1943, Major George Hunter White, head of OSS counter-intelligence operations in the US, arranged a meeting with Augusto Del
Gracio, an enforcer for gangster Lucky Luciano. Del Gracio was given cigarettes spiked with THC concentrate from cannabis, and
subsequently talked openly about Luciano's heroin operation. On a second occasion the dosage was increased such that Del Gracio passed
out for two hours.[115]

Breeding and cultivation

It is often claimed by growers and breeders of herbal cannabis that advances in breeding and cultivation techniques have increased the
potency of cannabis since the late 1960s and early '70s, when THC was first discovered and understood. However, potent seedless marijuana
such as "Thai sticks" were already available at that time. Sinsemilla (Spanish for "without seed") is the dried, seedless inflorescences of
female cannabis plants. Because THC production drops off once pollination occurs, the male plants (which produce little THC themselves) are
eliminated before they shed pollen to prevent pollination. Advanced cultivation techniques such as hydroponics, cloning, high-intensity artificial
lighting, and the sea of green method are frequently employed as a response (in part) to prohibition enforcement efforts that make outdoor
cultivation more risky. These intensive horticultural techniques have made it possible to grow strains with fewer seeds and higher potency. It is
often cited that the average levels of THC in cannabis sold in United States rose dramatically between the 1970s and 2000, but such
statements are likely skewed because of undue weight given to much more expensive and potent, but less prevalent samples.[116]

"Skunk" refers to several named strains of potent cannabis, grown through selective breeding and often hydroponics. It is a cross-breed of
Cannabis sativa and C. indica (although other strains of this mix exist in abundance). Skunk cannabis potency ranges usually from 6% to 15%
and rarely as high as 20%. The average THC level in coffee shops in the Netherlands is about 18–19%.[117]

A Dutch double-blind, randomized, placebo-controlled, cross-over study examining male volunteers aged 18–45 years with a self-reported
history of regular cannabis use concluded that smoking of cannabis with high THC levels (marijuana with 9–23% THC), as currently sold in
coffee shops in the Netherlands, may lead to higher THC blood-serum concentrations. This is reflected by an increase of the occurrence of
impaired psychomotor skills, particularly among younger or inexperienced cannabis smokers, who do not adapt their smoking style to the
higher THC content.[118] High THC concentrations in cannabis was associated with a dose-related increase of physical effects (such as
increase of heart rate, and decrease of blood pressure) and psychomotor effects (such as reacting more slowly, being less concentrated,
making more mistakes during performance testing, having less motor control, and experiencing drowsiness). It was also observed during the
study that the effects from a single joint at times lasted for more than eight hours. Reaction times remained impaired five hours after smoking,
when the THC serum concentrations were significantly reduced, but still present. The researchers suggested that THC may accumulate in
blood-serum when cannabis is smoked several times per day.

Another study showed that consumption of 15 mg of Δ9-THC resulted in no impairment in performance of implicit memory tasks occurring over
a three-trial selective reminding task after two hours. In several tasks, Δ9-THC increased both speed and error rates, reflecting “riskier” speed–
accuracy trade-offs.[119]

What is cannabis?

• Cannabis sativa, also known as hemp, is a species of the Cannabinaceae family of plants.
• Cannabis is also known as Ganja, grass, Hashish, Hemp, Indian hemp, marijuana, Pot, reefer, weed.
• Cannabis contains the chemical compound THC (delta-9 tetrahydrocannabinol), which is believed to be responsible
for most of the characteristic psychoactive effects of cannabis.
• The dried leaves and flowers of the cannabis plant are known as marijuana, which can be smoked (through a pipe or
bong or hand-rolled into a joint) or taken orally with food (baked in cookies).
• The resinous secretions of the plant are known as hashish, which can be smoked or eaten.
• The fiber of the cannabis plant is cultivated as industrial hemp with uses in textile manufacturing.

Important information about cannabis

• Do not drive, operate machinery, or perform other hazardous activities while using cannabis. It may cause dizziness,
drowsiness, and impaired judgment.
• Do not drink alcohol while using cannabis. Alcohol will increase dizziness, drowsiness, and impaired judgment.
• Cannabis may increase the effects of other drugs that cause drowsiness, including antidepressants, alcohol,
antihistamines, sedatives (used to treat insomnia), pain relievers, anxiety medicines, seizure medicines, and muscle relaxants.
• Cannabis is a Schedule 1 drug under the Controlled Substances Act.

What are the effects of cannabis?

• The effects experienced by the cannabis user are variable and will depend upon the dose, method of administration,
prior experience, any concurrent drug use, personal expectations, mood state and the social environment in which the drug is used.
• Effects of cannabis include:
o an altered state of consciousness. The user may feel "high", very happy, euphoric, relaxed, sociable and
uninhibited.
o distorted perceptions of time and space. The user may feel more sensitive to things around them, and may
also experience a more vivid sense of taste, sight, smell and hearing.
o increased pulse and heart rate, bloodshot eyes, dilated pupils, and often increased appetite.
o impaired coordination and concentration, making activities such as driving a car or operating machinery
difficult and dangerous.
o negative experiences, such as anxiousness, panic, self-consciousness and paranoid thoughts.
• People who use large quantities of cannabis may become sedated or disoriented and may experience toxic
psychosis - not knowing who they are, where they are, or what time it is. High doses may also cause fluctuating emotions, fragmentary
thoughts, paranoia, panic attacks, hallucinations and feelings of unreality.
• The effects of cannabis are felt within minutes, reach their peak in 10 to 30 minutes, and may linger for two or three
hours. THC is highly lipid soluble and can be stored in fat cells potentially for several months. The stored THC is released very slowly, and
unevenly, back into the bloodstream.

Medical uses

• While cannabis remains a Schedule 1 substance, research has resulted in development and marketing of dronabinol
and nabilone which are synthetic cannabinoid products.
•
o Marinol (dronabinol) is used for the control of nausea and vomiting caused by chemotherapeutic agents
used in the treatment of cancer and to stimulate appetite in AIDS patients.
o Cesamet (nabilone) is used for the control of nausea and vomiting caused by chemotherapeutic agents used
in the treatment of cancer.

Cannabis side effects

• Long term effects of heavy use can include:
•
o irritation to the lungs, risk of developing chronic bronchitis and an increased risk of developing cancer of the
respiratory tract (more likely to do with smoking).
o exacerbation of pre-existing cardiovascular disease, as cannabis use significantly raises the heart rate.
o decreased concentration levels, reduced short-term memory and difficulties with thinking and learning
(resolved if cannabis use stops).
o decreased sex drive in some people. Chronic use can lower sperm count in males and lead to irregular
periods in females (resolved if cannabis use stops).
o dependence on cannabis - compulsive need to use the drug, coupled with problems associated with chronic
drug use.

What should I avoid when using cannabis?

• Do not drive, operate machinery, or perform other hazardous activities while using cannabis. Cannabis may cause
dizziness, drowsiness, and impaired judgment.
• Do not drink alcohol while using cannabis. Alcohol will increase dizziness, drowsiness, and impaired judgment.
• Cannabis may increase the effects of other drugs that cause drowsiness, including antidepressants, alcohol,
antihistamines, sedatives (used to treat insomnia), pain relievers, anxiety medicines, seizure medicines, and muscle relaxants.
• Do not use cannabis if you are pregnant or could become pregnant. There is some evidence that women who smoke
cannabis during the time of conception or while pregnant may increase the risk of their child being born with birth defects. Pregnant women
who continue to smoke cannabis are probably at greater risk of giving birth to low birthweight babies.
• Do not use cannabis if you are breast-feeding a baby.

What happens if I overdose?

• Seek emergency medical attention.

• Symptoms of overdose include fatigue, lack of coordination, paranoia and psychosis.

What other drugs will affect cannabis?

• Cannabis may increase the effects of other drugs that cause drowsiness, including antidepressants, alcohol,
antihistamines, sedatives (used to treat insomnia), pain relievers, anxiety medicines, seizure medicines, and muscle relaxants.
• For more information on Drug Interactions, please visit the Drugs.com Drug Interactions Checker.

Cannabis

Cannabis sativa L., the hemp plant, grows wild throughout most of the tropic and temperate regions of the world. Prior to the advent of
synthetic fibers, the cannabis plant was cultivated for the tough fiber of its stem. In the United States, cannabis is legitimately grown only for
scientific research.

Cannabis contains chemicals called cannabinoids that are unique to the cannabis plant. Among the cannabinoids synthesized by the plant are
cannabinol, cannabidiol, cannabinolidic acids, cannabigerol, cannabichromene, and several isomers of tetrahydrocannabinol. One of these,
delta-9-tetrahydrocannabinol (THC), is believed to be responsible for most of the characteristic psychoactive effects of cannabis. Research
has resulted in development and marketing of the dronabinol (synthetic THC) product, Marinol®, for the control of nausea and vomiting
caused by chemotheraputic agents used in the treatment of cancer and to stimulate appetite in AIDS patients. Marinol® was rescheduled in
1999 and placed in Schedule III of the CSA.

Cannabis products are usually smoked. Their effects are felt within minutes, reach their peak in 10 to 30 minutes, and may linger for two or
three hours. The effects experienced often depend upon the experience and expectations of the individual user, as well as the activity of the
drug itself. Low doses tend to induce a sense of well-being and a dreamy state of relaxation, which may be accompanied by a more vivid
sense of sight, smell, taste, and hearing, as well as by subtle alterations in thought formation and expression. This state of intoxication may
not be noticeable to an observer. However; driving, occupational, or household accidents may result from a distortion of time and space
relationships and impaired coordination. Stronger doses intensify reactions. The individual may experience shifting sensory imagery, rapidly
fluctuating emotions, fragmentary thoughts with disturbing associations, an altered sense of self- identity, impaired memory, and a dulling of
attention despite an illusion of heightened insight. High doses may result in image distortion, a loss of personal identity, fantasies, and
hallucinations.

Three drugs that come from cannabis--marijuana, hashish, and hashish oil--are distributed on the U.S. illicit market. Having no currently
accepted medical use in treatment in the United States, they remain under Schedule I of the CSA. Today, cannabis is illicitly cultivated, both
indoors and out, to maximize its THC content, thereby producing the greatest possible psychoactive effect.

STREET TERM DEFINITION

3750 Marijuana and crack rolled in a joint

420 Marijuana use

51 Combination of crack cocaine with marijuana or tobacco

A-bomb Marijuana cigarette with heroin or opium

Acapulco gold Marijuana from S.W. Mexico; marijuana

Acapulco red Marijuana

Ace Marijuana cigarette; PCP

Afgani indica Marijuana

African Marijuana
African black Marijuana

African bush Marijuana

African woodbine Marijuana cigarette

Airhead Marijuana user

Airplane Marijuana

Alice B. Toklas Marijuana brownie

Amp Amphetamine; marijuana dipped in formaldehyde or embalming fluid, sometimes laced with PCP and smoked

Amp joint Marijuana cigarette laced with some form of narcotic

Angola Marijuana

Are you anywhere? Do you use marijuana?

Ashes Marijuana

Assassin of Youth Marijuana

Astro turf Marijuana

Atom bomb Marijuana mixed with heroin

Atshitshi Marijuana

Aunt Mary Marijuana

B Amount of marijuana to fill a matchbox

B-40 Cigar laced with marijuana and dipped in malt liquor

Baby Marijuana

Baby bhang Marijuana

Babysitter Marijuana

Bad seed Marijuana combined with peyote; heroin

Bag Container for drugs; a package of drugs, usually marijuana or heroin; a person's favorite drug

Baker Person who smokes marijuana

Bale Marijuana

Bamba Marijuana

Bambalacha Marijuana

Bammies A poor quality of marijuana

Bammy Marijuana

Banano Marijuana or tobacco cigarettes laced with cocaine

Bar Marijuana

Bash Marijuana

Basuco (Spanish) Cocaine; Coca paste residue sprinkled on regular or marijuna cigarette

Bazooka Cocaine; combination of crack and marijuana; crack and tobacco combined in a joint; coca paste and marijuana

BC bud Marijuana from British Columbia; synonymous with any high-grade marijuana from Canada

Beedies Cigarettes from India (resemble marijuana joints/vehicle for other drugs)

Belyando spruce Marijuana

Bhang Marijuana, Indian term

Bite one's lips To smoke marijuana

Black Marijuana; opium; methamphetamine

Black bart Marijuana

Black ganga Marijuana resin

Black gold High potency marijuana

Black gungi Marijuana from India

Black gunion Marijuana

Black mo/black moat Highly potent marijuana

Black mote Marijuana mixed with honey

Black rock Crack Cocaine

Blanket Marijuana cigarette

Blast Cocaine; Smoke crack; Marijuana; smoke marijuana or crack

Blast a joint To smoke marijuana

Blast a roach To smoke marijuana

Blast a stick To smoke marijuana

Blaxing Smoking marijuana

Blazing Smoking marijuana

Block Marijuana

Blonde Marijuana

Blow Cocaine; to inhale cocaine; to smoke marijuana; to inject heroin

Blow a stick To smoke marijuana

Blow one's roof To smoke marijuana

Blowing smoke Marijuana

Blue de hue Marijuana from Vietnam

Blue sage Marijuana

Blue sky blond High potency marijuna from Colombia

Blunt Marijuana inside a cigar; cocaine and marijuana inside a cigar

Bo Marijuana

Bo-bo Marijuana

Bobo bush Marijuana

Bogart a joint Salivate on a marijuana cigarette; refuse to share

Bohd Marijuana; PCP

Bomb Crack; heroin; large marijuana cigarette; high potency heroin

Bomber Marijuana cigarette

Bone Marijuana; $50 piece of crack; high purity heroin

Bong Pipe used to smoke marijuana

Boo Marijuana; methamphetamine

Boo boo bama Marijuana

Boom Marijuana

Boot the gong To smoke marijuana

Brick Crack Cocaine; cocaine; marijuana; 1 kilogram of marijuana

Broccoli Marijuana

Brown Marijuana; heroin; methamphetamine

Bubble gum Cocaine; crack cocaine; marijuana from Tennessee

Bud Marijuana

Buda Marijuana; a high-grade marijuana joint filled with crack

Buddha Potent marijuana spiked with opium

Bullyon Marijuana

Burn one To smoke marijuana

Burnie Marijuana

Bush Marijuana; cocaine; PCP

Butter Marijuana; crack

Butter flower Marijuana

C.S. Marijuana

Cam trip High potency marijuana

Cambodian red/Cam red Marijuana from Cambodia

Can Marijuana; 1 ounce

Canade Heroin/marijuana combination

Canadian black Marijuana

Canamo Marijuana

Canappa Marijuana

Cancelled stick Marijuana cigarette

Candy blunt Blunts dipped in cough syrup

Candy sticks Marijuana cigarettes laced with powdered cocaine

Cannabis tea Marijuana

Carmabis Marijuana

Cartucho (Spanish) Package of marijuana cigarettes

Catnip Marijuana cigarette

Caviar Combination of cocaine and marijuana; Crack Cocaine

Cavite all star Marijuana

Cest Marijuana

Champagne Combination of cocaine and marijuana

Charas Marijuana from India

Charge Marijuana

Chase To smoke cocaine; to smoke marijuana

Cheeba Marijuana

Cheeo Marijuana

Chemo Marijuana

Chiba chiba High potency marijuana from Colombia

Chicago black Marijuana, term from Chicago

Chicago green Marijuana

Chiefing To smoke marijuana

Chillum An object used to smoke opium, hashish, and marijuana

Chips Tobacco or marijuana cigarettes laced with PCP

Chira Marijuana

Chocolate Marijuana; opium; amphetamine

Chocolate Thai Marijuana

Christmas bud Marijuana

Christmas tree Marijuana; amphetamine; methamphetamine; depressant

Chronic Marijuana; marijuana mixed with crack

Chunky Marijuana

Churus Marijuana

Citrol High potency marijuana, from Nepal

Clam bake Sitting inside a car or other small, enclosed space and smoking marijuana

Clicker Crack mixed with PCP; marijuana dipped in formaldehyde and smoked

Clickums A marijuana cigarette laced with PCP.

Climb Marijuana cigarette

Cochornis Marijuana

Cocktail Combination of crack and marijuana; cigarette laced with cocaine or crack; partially smoked marijuana cigarette inserted in regular cigarette; to smoke
cocaine in a cigarette

Cocoa puff To smoke cocaine and marijuana

Colas Marijuana

Coli Marijuana

Coliflor tostao (Spanish) Marijuana

Colombian Marijuana

Colorado cocktail Marijuana

Columbus black Marijuana

Cosa (Spanish) Marijuana

Crack back Marijuana and crack

Crack bash Combination of crack cocaine and marijuana

Crazy weed Marijuana

Cripple Marijuana cigarette

Crying weed Marijuana

Cryppie Marijuana

Cryptonie Marijuana

Cubes Marijuana tablets; crack cocaine

Culican High potency marijuana from Mexico

Dagga Marijuana from South Africa

Dank Marijuana; the practice of lacing cigarettes with formaldehyde

Dawamesk Marijuana

Dew Marijuana
Diablito (Spanish) Combination of crack cocaine and marijuana in a joint

Diambista Marijuana

Dimba Marijuana from West Africa

Ding Marijuana

Dinkie dow Marijuana

Dipped joints Marijuana combined with PCP and formaldehyde

Dips Marijuana joints dipped in PCP (phencyclidine)

Dirt grass Inferior quality marijuana

Dirties Marijuana cigarettes with powder cocaine added to them

Dirty joints Combination of crack cocaine and marijuana

Ditch Marijuana

Ditch weed Inferior quality marijuana

Djamba Marijuana

Do a joint Marijuana

Dody Marijuana

Domestic Locally grown marijuana

Don jem Marijuana

Don Juan Marijuana

Dona Juana (Spanish) Marijuana

Dona Juanita (Spanish) Marijuana

Donk Marijuana/PCP combination

Doob Marijuana

Doobee Marijuana

Doobie/dubbe/duby Marijuana

Dope Marijuana; heroin; any other drug

Dope smoke To smoke marijuana

Doradilla Marijuana

Draf Marijuana; ecstasy, with cocaine

Draf weed Marijuana

Drag weed Marijuana

Dry high Marijuana

Dube Marijuana

Duby Marijuana

Durong Marijuana

Duros (Spanish) Marijuana

Dust Marijuana mixed with various chemicals; cocaine; heroin; PCP

Dust blunt Marijuana/PCP combination

Dusting Adding PCP, heroin, or another drug to marijuana; Using inhalants

Earth Marijuana cigarette

El diablito (Spanish) Cocaine, marijuana, heroin and PCP

El diablo (Spanish) Cocaine, marijuana and heroin

El Gallo ("rooster") Marijuana

Elephant Marijuana; PCP

Endo Marijuana

Esra Marijuana

Fallbrook redhair Marijuana, term from Fallbrook, CA

Fatty Marijuana cigarette

Feed bag Container for marijuana

Feeling Marijuana

Fiend Someone who smokes marijuana alone

Fine stuff Marijuana

Finger Marijuana cigarette

Finger lid Marijuana

Fir Marijuana

Fire it up To smoke marijuana

Firewood Marijuana

Flower Marijuana

Flower tops Marijuana

Fly Mexican airlines To smoke marijuana

Fraho/frajo Marijuana

Frios (Spanish) Marijuana laced with PCP

Fry Marijuana cigarettes dipped in embalming fluid, sometimes also laced with PCP; Crack Cocaine

Fry daddy Crack and marijuana; cigarette laced with crack; marijuana joint laced with crack

Fry sticks Marijuana cigarettes dipped in embalming fluid, sometimes also laced with PCP

Fu Marijuana

Fuel Marijuana mixed with insecticides; PCP

Fuma D'Angola (Portugese) Marijuana

Gage/gauge Marijuana

Gange Marijuana

Gangster Marijuana; person who uses or manufactures methamphetamine

Ganja Marijuana; term from Jamaica

Ganoobies State of being stoned and laughing uncontrollably

Garbage Inferior quality marijuana; low quality heroin

Gash Marijuana

Gasper Marijuana cigarette

Gasper stick Marijuana cigarette

Gauge butt Marijuana

Geek Crack mixed with marijuana

Geek-joints Cigarettes or cigars filled with tobacco and crack; a marijuana cigarette laced with crack or powdered cocaine

Get a gage up To smoke marijuana

Get high To smoke marijuana

Get the wind To smoke marijuana

Ghana Marijuana

Giggle smoke Marijuana

Giggle weed Marijuana

Gimmie Crack and marijuana; marijuana joint laced with crack

Go loco To smoke marijuana

Goblet of jam Marijuana

Gold Marijuana; Crack Cocaine; heroin

Gold star Marijuana

Golden Marijuana

Golden leaf Very high quality marijuana

Gong Marijuana; opium

Gonj Marijuana

Good butt Marijuana cigarette

Good giggles Marijuana

Good stuff High potency drug, especially marijuana

Goody-goody Marijuana

Goof butt Marijuana cigarette

Gorge Marijuana

Grass Marijuana

Grass brownies Marijuana

Grasshopper Marijuana

Grata Marijuana

Greek Combination of marijuana and powder cocaine

Green Inferior quality marijuana; ketamine; PCP

Green buds Marijuana

Green goddess Marijuana

Greens Marijuana

Greeter Marijuana

Gremmies Combination of cocaine and marijuana

Greta Marijuana

Griefo Marijuana

Griefs Marijuana

Grifa (Spanish) Marijuana

Griff Marijuana

Griffa Marijuana

Griffo Marijuana

Grow(s) Marijuana growing operations (indoor and outdoor)

Gunga Marijuana

Gungeon Marijuana

Gungun Marijuana

Gunja Marijuana

Gyve Marijuana cigarette

Haircut Marijuana

Hanhich Marijuana

Happy cigarette Marijuana cigarette

Happy stick Marijuana and PCP combination

Harsh Marijuana

Has Marijuana

Hawaiian Very high potency marijuana

Hawaiian Black Marijuana

Hawaiian homegrown hay Marijuana

Hay Marijuana

Hay butt Marijuana cigarette

Herb Marijuana

Herb and Al Marijuana and alcohol

Herba Marijuana

Hit To smoke marijuana; marijuana cigarette; Crack Cocaine

Hit the hay To smoke marijuana

Hocus Marijuana; opium

Homegrown Marijuana

Honey blunts Marijuana cigars sealed with honey

Hooch Marijuana

Hooter Cocaine; marijuana

Hot stick Marijuana cigarette

Hydro Amphetamine; high quality methamphetamine; marijuana; methylenedioxymethamphetamine (MDMA); marijuana grown in water (hydroponic)

Hydrogrows Indoor marijuana growing operations

Illies Marijuana dipped in PCP

Illing Marijuana dipped in PCP

Illy Marijuana cigarettes soaked in embalming fluid and dried

Indian boy Marijuana

Indian hay Marijuana from India

Indian hemp Marijuana

Indica Species of cannabis, found in hot climate, grows 3.5 to 4 feet

Indo Marijuana term from Northern CA

Indonesian bud Marijuana; opium

Instaga Marijuana

Instagu Marijuana
J Marijuana cigarette

Jamaican gold Marijuana

Jamaican red hair Marijuana

Jane Marijuana

Jay Marijuana cigarette

Jay smoke Marijuana

Jefferson airplane Used match cut in half to hold a partially smoked marijuana cigarette

Jim Jones Marijuana laced with cocaine and PCP

Jive Marijuana; heroin; drugs

Jive stick Marijuana

Joint Marijuana cigarette

Jolly green Marijuana

Joy smoke Marijuana

Joy stick Marijuana cigarette; marijuana and PCP combination

Ju-ju Marijuana cigarette

Juan Valdez (Spanish) Marijuana

Juanita (Spanish) Marijuana

Juice joint Marijuana cigarette sprinkled with crack

Juja Marijuana

Jumbos Large vials of crack sold on the streets; marijuana mixed with crack

K2/Spice Olive-colored plant material sold as incense laced with synthetic cannabinoid mimicking compounds (most notably HU-210 and JWH-018)

Kabak Marijuana; Turkish marijuana

Kaff Very potent marijuana from Morocco, Lebanon and other Arab/Middle Eastern countries

Kalakit Marijuana

Kali Marijuana

Kansas Grass Marijuana

Kate bush Marijuana

Kawaii electric Marijuana

Kaya Marijuana

KB Marijuana

Kee Marijuana

Kentucky blue Marijuana

Key Marijuana

KGB (killer green bud) Marijuana

Khayf Very potent marijuana from Morocco, Lebanon and other Arab/Middle Eastern countries

Ki Marijuana

Kick stick Marijuana cigarette

Kief Very potent marijuana from Morocco, Lebanon and other Arab/Middle Eastern countries

Kiff Marijuana cigarette; very potent marijuana from Morocco, Lebanon and other Arab/Middle Eastern countries

Killer Marijuana; PCP

Killer green bud Marijuana

Killer weed Marijuana

Killer weed (1980's) Marijuana and PCP

Kilter Marijuana

Kind Marijuana

Kind bud High quality marijuana

King bud Marijuana

Kona gold Marijuana

Krippy Marijuana

Kryptonite Crack cocaine; marijuana

Kumba Marijuana

Kush Marijuana

L.L. Marijuana
Lace Cocaine and marijuana

Lakbay diva Marijuana

Laughing grass Marijuana

Laughing weed Marijuana

Leaf Cocaine; Marijuana

Leak Marijuana/PCP combination

Leno (Spanish) Marijuana

LG (Lime Green) Marijuana

Lid 1 ounce of marijuana

Light stuff Marijuana

Lima Marijuana

Liprimo Marijuana and crack rolled in a joint

Little smoke Marijuana; LSD; psilocybin/psilocin

Llesca Marijuana

Loaf Marijuana

Lobo Marijuana

Loco (Spanish) Marijuana

Loco Weed (Spanish) Marijuana

Locoweed Marijuana

Log Marijuana cigarette; PCP

Loose shank Marijuana

Love boat Marijuana dipped in formaldehyde; PCP; blunts mixed with marijuana and heroin; blunts mixed with marijuana and PCP

Love leaf Marijuana/PCP combination

Love weed Marijuana

Loveboat PCP; combination of PCP and marijuana

Lovelies Marijuana laced with PCP

Lubage Marijuana

M Marijuana; morphine

M.J. Marijuana

M.O. Marijuana

M.U. Marijuana

Macaroni Marijuana

Macaroni and Cheese $5 pack of marijuana and a dime bag of cocaine

Machinery Marijuana

Macon Marijuana

Maconha Marijuana

Mafu (Spanish) Marijuana

Magic smoke Marijuana

Manhattan silver Marijuana

Mari Marijuana cigarette

Marimba (Spanish) Marijuana

Mary Marijuana

Mary and Johnny Marijuana

Mary Ann Marijuana

Mary Jane Marijuana

Mary Jonas Marijuana

Mary Warner Marijuana

Mary Weaver Marijuana

Matchbox 1/4 ounce of marijuana or 6 marijuana cigarettes

Maui wauie Marijuana from Hawaii

Maui-wowie Marijuana; methamphetamine

Meg Marijuana

Megg Marijuana cigarette

Meggie Marijuana

Messorole Marijuana

Mexican brown Marijuana; heroin

Mexican green Marijuana

Mexican locoweed Marijuana

Mexican red Marijuana

Mighty mezz Marijuana cigarette

Mo Marijuana; powder cocaine

Modams Marijuana

Mohasky Marijuana

Mohasty Marijuana

Monte Marijuana from South America

Mooca/moocah Marijuana

Mooster Marijuana

Moota/mutah Marijuana

Mooters Marijuana cigarette

Mootie Marijuana

Mootos Marijuana

Mor a grifa Marijuana

Mota/moto (Spanish) Marijuana

Mother Marijuana

Mow the grass To smoke marijuana

Mu Marijuana

Muggie Marijuana

Muggle Marijuana

Muggles Marijuana

Muta Marijuana

Mutha Marijuana

Nail Marijuana cigarette

Nigra Marijuana

Northern lights Marijuana from Canada

Number Marijuana cigarette

O.J. Marijuana

Oolies Marijuana cigarettes laced with crack

Ozone Marijuana, PCP and crack cigarette; marijuana cigarette; PCP

P-dogs Combination of cocaine and marijuana

P.R. Panama Red

Pack Marijuana; heroin

Pack a bowl Marijuana

Pack of rocks Marijuana cigarette

Pakaloco Marijuana ("crazy tobacco")

Pakalolo Marijuana

Pakistani black Marijuana

Panama cut Marijuana

Panama gold Marijuana

Panama red Marijuana

Panatella Large marijuana cigarette

Paper blunts Marijuana within a paper casing rather than a tobacco leaf casing

Parsley Marijuana combined with PCP

Pasto (Spanish) Marijuana

Pat Marijuana

Philly blunts Marijuana

Pin Marijuana
Pipe Crack pipe; marijuana pipe; vein into which a drug is injected; mix drugs with other substances

Pocket rocket Marijuana; marijuana cigarette

Pod Marijuana

Poke Marijuana; to smoke marijuana

Pot Marijuana

Potlikker Marijuana

Potten bush Marijuana

Premos Marijuana joints laced with crack cocaine

Prescription Marijuana cigarette

Pretendica Marijuana

Pretendo Marijuana

Primo Crack; marijuana mixed with cocaine; crack and heroin; heroin, cocaine and tobacco

Primo square A marijuana joint laced with crack

Primo turbo Combination of crack cocaine and marijuana

Puff the dragon To smoke marijuana

Purple haze LSD; crack cocaine; marijuana

Queen Ann's lace Marijuana

Ragweed Inferior quality marijuana; heroin

Railroad weed Marijuana

Rainy day woman Marijuana

Rangood Marijuana grown wild

Rasta weed Marijuana

Red bud Marijuana

Red cross Marijuana

Red dirt Marijuana

Reefer Marijuana

Reefers Marijuana cigarette

Righteous bush Marijuana

Rip Marijuana

Roach Butt of marijuana cigarette

Roach clip Holds partially smoked marijuana cigarette

Roacha Marijuana

Roasting Smoking marijuana

Rockets Marijuana cigarette

Rompums Marijuana with horse tranquilizers

Root Marijuana

Rope Marijuana; rohypnol

Rose marie Marijuana

Rough stuff Marijuana

Rubia (Spanish) Marijuana

Ruderalis Species of cannabis, found in Russia, grows 1 to 2.5 feet

Rugs Marijuana

Salad Marijuana

Salt and pepper Marijuana

Sandwich bag $40 bag of marijuana

Santa Marta (Spanish) Marijuana

Sasfras Marijuana

Sativa Species of cannabis, found in cool, damp climate, grows up to 18 feet

Schwagg Marijuana

Scissors Marijuana

Scrub Marijuana

Seeds Marijuana

Sen Marijuana
Sess Marijuana

Sezz Marijuana

Shake Marijuana; powder cocaine

Sherman stick Crack cocaine combined with marijuana in a blunt

Shotgun Inhaling marijuana smoke forced into one's mouth by another's exhaling

Siddi Marijuana

Sinse (Spanish) Marijuana

Sinsemilla Potent variety marijuana

Skunk Marijuana; heroin

Skunkweed Marijuana

Smoke Marijuana; Crack Cocaine; heroin and crack

Smoke a bowl Marijuana

Smoke Canada Marijuana

Snop Marijuana

Spark it up To smoke marijuana

Speedboat Marijuana, PCP, and crack combined and smoked

Spice/K2 Olive-colored plant material sold as incense laced with synthetic cannabinoid mimicking compounds (most notably HU-210 and JWH-018)

Spliff Large marijuana cigarette

Splim Marijuana

Splitting Rolling marijuana and cocaine into a single joint

Square mackerel Marijuana, term from Florida

Squirrel Combination of PCP and marijuana, sprinkled with cocaine and smoked; marijuana, PCP, and crack combined and smoked; LSD

Stack Marijuana

Stems Marijuana

Stick Marijuana; PCP

Sticky icky Marijuana

Stink weed Marijuana

Stoney weed Marijuana

Straw Marijuana cigarette

Sugar weed Marijuana

Super grass PCP; marijuana with PCP; marijuana

Super pot Marijuana

Swag Marijuana

Sweet Lucy Marijuana

Swishers Cigars in which tobacco is replaced with marijuana

Syrup Combination of marijuana and cough syrup

T Cocaine; Marijuana

Taima Marijuana

Takkouri Marijuana

Tea Marijuana; PCP

Tea Party To smoke marijuana

Tex-mex Marijuana

Texas pot Marijuana

Texas tea Marijuana

Thai sticks Bundles of marijuana soaked in hashish oil; marijuana buds bound on short sections of bamboo

Thirteen Marijuana

Thirty-eight Crack sprinkled on marijuana

Thumb Marijuana

Tin Container for marijuana

Tio Cocaine-laced marijuana cigarette

Toke To inhale cocaine; to smoke marijuana; marijuana

Toke up To smoke marijuana

Torch Marijuana
Torch up To smoke marijuana

Torpedo Marijuana and crack

Trauma Marijuana

Tray $3 bag of marijuana

Trees Marijuana

Triple A Marijuana from British Columbia

Trupence bag Marijuana

Turbo Marijuana and crack

Tustin Marijuana

Twist Marijuana cigarette

Twistum Marijuana cigarette

Unotque Marijuana

Up against the stem Addicted to smoking marijuana

Vega A cigar wrapping refilled with marijuana

Viper Marijuana smoker

Viper's weed Marijuana

Wac PCP on marijuana

Wacky weed Marijuana

Wake and Bake Marijuana

Water Blunts; methamphetamine; PCP; a mixture of marijuana and other substances within a cigar; Gamma hydroxybutyrate (GHB)

Water-water Marijuana cigarettes dipped in embalming fluid, sometimes also laced with PCP

Weed Marijuana; PCP

Weed tea Marijuana

Wet Blunts mixed with marijuana and PCP; methamphetamine; marijuana cigarettes soaked in PCP ("embalming fluid") and dried

Wet daddies Marijuana joints that are dipped in formaldehyde, often mixed with PCP

Wet sticks Marijuana combined with PCP and formaldehyde

Whack Crack Cocaine; heroin and PCP; Crack/PCP mixture or marijuana laced with insecticides

Whackatabacky Marijuana

Wheat Marijuana

White Russian Marijuana

White-haired lady Marijuana

Wicky Combination of powder cocaine, PCP and marijuana

Wicky stick PCP, marijuana, and crack

Wollie Rocks of crack rolled into a marijuana cigarette or in a cigar

Woo blunts Marijuana; marijuana combined with cocaine

Woola blunt Marijuana and heroin combination

Woolah Hollowed out cigar refilled with marijuana and crack

Woolas Cigarettes laced with cocaine; crack sprinkled on marijuana cigarette

Woolie Marijuana and heroin combination; marijuana and crack cocaine combination

Woolie blunt Combination of crack cocaine and marijuana

Woolies Marijuana and crack or PCP

Wooly blunts Marijuana and crack or PCP

Wooties Crack smoked in marijuana joints

X Marijuana; amphetamine; methylenedioxymethamphetamine (MDMA)

Yeh Marijuana

Yellow submarine Marijuana

Yen pop Marijuana

Yeola Marijuana and crack

Yerba (Spanish) Marijuana

Yerba mala (Spanish) PCP and marijuana

Yerhia Marijuana

Yesca Marijuana

Yesco Marijuana
Zacatecas purple Marijuana from Mexico

Zambi Marijuana

Zay A mixture of marijuana and other substances within a cigar; blunts

Zig Zag man Marijuana; LSD; marijuana rolling papers

Zol Marijuana cigarette

Zooie Holds butt of marijuana cigarette

Zoom Marijuana laced with PCP; PCP

http://www.whitehousedrugpolicy.gov/streetterms/default.asp

Cannabis Compound Abuse

Introduction

Background

Typically referred to as marijuana, cannabis has been used for medicinal purposes worldwide for thousands of years. Reports dating as early
as 2700 BC refer to carbon-dated cannabis shoots, leaves, and fruits unearthed in the Yanghqi Tombs, Turpan District in Xinjiang, China.
They are believed to have been used for ritual/medicinal purposes, given the Shamanistic identity of the entombed.

Cannabis was introduced to the Virginia colony of Jamestown in 1611 and to the Massachusetts Bay Colony in 1629. In 1619, the first
American law related to marijuana was passed—it mandated that farmers grow Indian hempseed. Although primarily used as a source of fiber,
cannabis was occasionally smoked. Cannabis began to be used medicinally and was grown by many American planters. From 1850-1942, it
was listed in the US Pharmacopoeia, the official list of recognized medical drugs . Cannabis was marketed as extract or tincture by several
pharmaceutical companies and used for ailments such as anxiety and lack of appetite.1

Marijuana was legal in the United States until 1937, when Congress passed the Marijuana Tax Act, effectively making the drug illegal.
Interestingly, the American Medical Association opposed the legislation at the time of its passage. As a result of the Comprehensive Drug
Abuse Prevention and Control Act of 1970, marijuana was classified as a Schedule I drug, defined as a category of drugs not considered
legitimate for medical use. Other Schedule I drugs include heroin, phencyclidine (PCP), and lysergic acid diethylamide (LSD).1

The medicinal use of cannabis is currently the subject of intense legal debate in the United States, yet momentum appears to be building in
support of the widespread legalization of marijuana for medicinal purposes. According to an April 2009 field poll, 56% of Californians
expressed support for legalizing marijuana and taxing sale proceeds. In October 2009, Gallup reported that 44% of Americans favored
legalization of marijuana.2

At present time, 14 states have legalized the use of marijuana for medicinal use, yet a significant paradox continues to exist between state
and federal law. Recent federal policy changes have attempted to redress these inconsistencies. In 2009, the Justice Department issued a
federal medical marijuana policy memo to the Drug Enforcement Administration (DEA), Federal Bureau of Investigation (FBI), and US
attorneys instructing prosecutors not to target medicinal marijuana patients and their providers for federal prosecution in states where
medicinal marijuana has been legalized. In the summer of 2010, the Department of Veteran Affairs issued a department directive to "formally
allow patients treated at its hospitals and clinics to use medical marijuana in states where it is legal, a policy clarification that veterans have
sought for years."3 A California voter initiative that would legalize possession and sale of marijuana, ending marijuana prohibition, has qualified
for the November 2010 ballot.

Similar to California, other states and countries have sought to decriminalize the use and possession of marijuana. In 2009, Massachusetts
passed the Massachusetts Sensible Marijuana Policy, which reduced the penalties that individuals would have to pay and eliminated the
offense from inclusion to the Criminal Offender Record Information (CORI) for minor marijuana offenses. Previously, this offense could be
punishable with a fine of up to $1,000 and a maximum of 6 months in jail.

In the Netherlands, where the distribution of marijuana has been legalized, the effect of decriminalization has had little effect on the
consumption rate of cannabis.4 In 2004, Reinarman et al looked at the consumption of marijuana rates between San Francisco and
Amsterdam to see what effect decriminalization had on these different populations.5 The results showed that the consumption habits between
the 2 populations were negligible. Little evidence has shown that the decriminalization of cannabis has changed the consumption habits of the
populations involved.6

While there is a rich history of anecdotal accounts of the benefits of marijuana and a long tradition of marijuana being used for a variety of
ailments, the scientific literature in support of medicinal uses of marijuana is less substantial. Considered to be one of the first scientifically
valid papers in support of marijuana’s medicinal benefit, in 2007, Dr. Donald Abrams and colleagues published the results of a randomized
placebo-controlled trial examining the effect of smoked cannabis on the neuropathic pain of HIV-associated sensory neuropathy and an
experimental pain model. The authors concluded that smoked cannabis effectively relieved chronic neuropathic pain in HIV-associated
sensory neuropathy and was well tolerated by patients. The pain relief was comparable to chronic neuropathic pain treated with oral drugs.7

According to Harvard Medical School's April, 2010 edition of the Harvard Mental Health Letter:8

Consensus exists that marijuana may be helpful in treating certain carefully defined medical conditions. In its comprehensive 1999 review, for
example, the Institute of Medicine (IOM) concluded that marijuana may be modestly effective for pain relief (particularly nerve pain), appetite
stimulation for people with AIDS wasting syndrome, and control of chemotherapy-related nausea and vomiting.
These widely held beliefs in the medical community supporting the medicinal benefit of marijuana contrast starkly to a limited body of clinical
research. The American Medical Association is urging the federal government to change the classification of marijuana from a Schedule I drug
to enable further clinical research on marijuana. Additionally, Harvard Mental Health Letter's authors point out that while marijuana works to
relieve pain, suppress nausea, reduce anxiety, improve mood, and act as a sedative, the evidence that marijuana may be an effective
treatment for psychiatric indications is inconclusive.8

While marijuana may have medicinal benefits, its use can lead to abuse and dependence with concurrent morbidity, including impaired
occupational and social functioning. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR)
recognizes the following 8 cannabis-associated disorders:9

1. Cannabis dependence
2. Cannabis abuse
3. Cannabis intoxication
4. Cannabis intoxication delirium
5. Cannabis-induced psychotic disorder, with delusions
6. Cannabis-induced psychotic disorder, with hallucinations
7. Cannabis-induced anxiety disorder
8. Cannabis-related disorder not otherwise specified

Case study

Mr. X, a 19-year-old single white male presents complaining of apathy, lack of motivation, and an increasing sense of social isolation. He tried
marijuana for the first time at age 15, when he was a junior in high school and quickly started smoking on a daily basis. He would spend nights
and then days with friends, getting "stoned," experiencing the "giggles" and relishing the inevitable "munchies." He quickly noticed that
smoking marijuana seemed to quell feelings of anxiety he experienced in social settings. Having graduated from high school a year earlier, he
describes unfulfilled plans to attend college, which were foiled by his inability to submit the requisite applications. He describes half-hearted
attempts to secure employment and now resides in the basement of his parent's house, supported by them. He describes a typical day in the
following fashion:

Upon waking, usually in the late morning, he invariably takes a bong hit or smokes a joint, to "get going." Then he spends a significant amount
of time preparing breakfast — he feels the marijuana heightens his culinary senses and he takes great joy in cooking and preparing a large
meal.

Following breakfast he retires back to his room in the basement and spends the next several hours playing video games online. When he
senses that he is slowing down and feeling sleepy, he’ll smoke more marijuana because it gives him more energy and improves his mood.

He’ll typically break from his immersion in the online gaming world for a late lunch, repeating his earlier efforts associated with breakfast.
Occasionally, he’ll go to the local park to play basketball with the kids that are still in high school. Previously a successful athlete in high
school, he feels like he’s lost a step and his reflexes on the court aren’t as quick as they used to be.

He has taken to selling a baseball card collection he painstakingly acquired when he was younger to raise money to pay for his marijuana and
as that collection has dwindled he has started to grow marijuana in his basement. He describes his first efforts as generating a meager plant
that bears a resemblance to the sad Christmas tree from Charlie Brown.

He doesn’t understand why he no longer has a girlfriend or why it has become difficult to meet new girls. He seems perplexed by his last
girlfriend's complaints that he had become boring and it seemed like he was "letting life pass him by." He reports that his parents seem to be
growing increasingly frustrated with him and reports arguing with them over his marijuana use — they identify it as a problem, he disagrees.
He no longer goes out at night and instead spends most of his time smoking, playing video games alone in his room in the basement.

He denies any difficulty sleeping, although he doesn’t remember dreaming anymore and can’t remember the last dream he had. He reports
some cognitive difficulties associated with decreased ability to concentrate and some short-term memory problems. He reports feeling
occasionally irritable when too much time passes in between smoking and feels that marijuana makes him less irritable. He is interested in
being more social, more engaged and feeling like he is achieving his goals but seems unable to explain why he can’t accomplish what he sets
out to.

He does not seem to appreciate that his heavy and chronic marijuana use is a significant cause of his symptoms. He indicates that overall he
enjoys smoking marijuana and believes it makes it easier for him to enjoy his days, which have become more difficult lately as he appreciates
the stark difference between the quality of life he is enjoying compared to his peers who are now working or attending college.

Pathophysiology

Cannabis contains several pharmacologically active substances, including delta-9-tetrahydrocannabinol (THC) and cannabidiol.

The major psychoactive component of marijuana is tetrahydrocannabinol (THC).

Pyrolysis of marijuana releases more than 100 substances that are subsequently inhaled with the smoke. 1-trans -delta-9-THC is thought to
be the ingredient most responsible for the central nervous system effects of marijuana.

Another increasingly important constituent is cannabidiol. It is the constituent thought now to reduce many of the undesirable effects of THC; it
significantly reduces the anxiety and psychotic-like symptoms that can be associated with THC. It is currently under investigation for use as an
anxiolytic and antipsychotic. Double-blinded tests on volunteers have demonstrated its usefulness as an anxiolytic in anxiogenic test
situations. Animal and human studies also suggest that it has a pharmacologic profile similar to atypical antipsychotics; as such, cannabis is
being considered as an alternative effective treatment for schizophrenia.10 However, THC has been more extensively studied; therefore, much
of our understanding of the physiological changes induced by marijuana is predicated on the binding and metabolism of THC.

Smoking is the most common and efficient means of ingestion, with the dose being titrated by the user through varying the depth and
frequency of inhalation; thus, the delivery mechanism poses a challenge for cannabis as a medication. THC can also be extracted by fat-
containing foods or dissolved in oil for pharmaceutical purposes.

Synthetic cannabinoids exist that are more potent and somewhat more water soluble. Currently, 2 medications containing synthetic THC are
FDA approved.

• Dronabinol (Marinol): This drug is indicated for the treatment of anorexia associated with weight loss in patients with
AIDS and nausea and vomiting associated with cancer chemotherapy in patients who have failed to respond adequately to conventional
antiemetic treatments.
• Nabilone (Cesamet): This drug is indicated for the treatment of nausea and vomiting associated with cancer
chemotherapy in patients who have failed to respond adequately to conventional antiemetic treatments.

After intake, THC undergoes metabolism to an inactive metabolite (8-11-DiOH-THC) and also to a highly active metabolite (11-OH-delta-9-
THC). The half-life of THC is approximately 4 hours. The long life of the active metabolite is explained by the incorporation of the compound in
lipid storage depots and similar storage sites in muscle tissue. Thirty to 60% of THC, in all forms, is excreted in feces; the remaining amount is
excreted in urine.

Delta-9-THC is believed to exert all of its effects on the brain via the cannabinoid 1 (CB1) receptor. High densities of CB1 receptors are found
in the cerebral cortex (especially frontal), basal ganglia, cerebellum, anterior cingulate cortex, and hippocampus. They are relatively absent in
the brainstem nuclei. Stimulation of these receptors causes monoamine and amino acid neurotransmitters to be released. Endogenous
ligands for CB1 receptors include anandamide and 2-arachidonylglycerol—the endocannabinoids.

Frequency

United States

• Marijuana remains the most commonly used illicit drug, with 14.6 million persons reporting use in the past month.11
• The National Institute on Drug Abuse reported in January 2010 that while historically drug use, including marijuana,
has declined since the 1990s among 8th, 10th, and 12th graders, the prevalence rates of marijuana use in 2009 were the same as they were
5 years prior.12
• Throughout their lifetime, approximately 9% of the American adult population has met criteria for a cannabis use
disorder.13

International

An estimated 65 million European adults have used marijuana at least once and it is widely accepted that it is the most frequently used illicit
substance in Western countries.14

Mortality/Morbidity

Cannabis consumption has never directly resulted in mortality and no fatalities have been documented that identify cannabis consumption as
the etiologic agent. However, cannabis consumption has been associated with multifactorial deaths, including marijuana-related accidents and
deaths attributed to abuse of alcohol and other illicit substances.15

Studies using simulated driving and flying situations have shown that the use of cannabis has a profound effect on estimations of time and
distance and causes impairment of attention and short-term memory. These effects are still discernible 24-48 hours after use of the drug. A
linear relationship is noted between level of impairment and serum/saliva THC level in tasks necessary for driving, such as perceptual motor
control, motor impulsivity, and cognitive function.

Cannabis dependence is associated with morbidity, including impaired occupational and social functioning. Cannabis use can be comorbid
with the presence of other psychiatric disorders, characterized by a disordered thought process, perceptual disturbances, or symptoms of
anxiety. When marijuana is believed to be the etiologic agent, clinicians may diagnose a cannabis-induced disorder.

Psychotic symptoms represent a significant morbidity associated with cannabis use in select patients. While cannabis and the development of
psychosis have been linked, this link is not without considerable controversy and understandably there are differing perspectives on whether
this relationship is indeed causal, temporal, or coincidental. Given marijuana's clinical benefits, some have argued that patients diagnosed with
psychotic disorders gravitate toward self-medicating with marijuana for these effects while others have advanced the view that marijuana can
help precipitate the onset of psychosis in those who are genetically vulnerable. A recent study examining this controversial topic concluded
that marijuana use can play a "catalytic role" in the onset of psychosis as demonstrated by cannabis use being associated with an association
of an earlier age at on onset of psychosis treatment. Unfortunately, this study is not without limitations.16

Another recent article examining this topic observed patients over 10 years and reached some similar conclusions. This study appears to
provide additional evidence supporting the hypothesis that cannabis use is associated with an earlier age of onset of psychosis. However, the
authors' findings complicate the debate further regarding the potential role of cannabis as an etiologic agent versus its use as self-medication
by patients with psychotic symptoms. The authors note that there is a bidirectional relationship between psychosis and cannabis use;
cannabis exposure predicted psychosis severity and those with more sever psychotic symptoms were more likely to use cannabis in the
future.17

Race

Given how widespread cannabis use is globally, across cultures, race is not a significant risk factor associated with cannabis use nor does it
represent a useful criteria for identifying acute or chronic marijuana users. However, a recent study in California demonstrated a significant
disparity in arrest rates for users of marijuana based on race. According to the report, from 2004-2008, in Sacramento and San Francisco
Counties, black residents were arrested for marijuana possession 4 times as often as white residents. In Los Angeles County, the disparity
was more than 3 to 1.18
Sex

Being male increases the odds of reporting past month cannabis use (10.2% vs 6.1% in 2005).11

Age

Use, abuse, and dependence on marijuana tends to cut across demographics, including age.

Clinical

History

Per the DSM-IV-TR, the cannabis-related disorders are divided into 2 main categories: cannabis use disorders and cannabis-induced
disorders.

When soliciting information related to marijuana use, both acutely and chronically, clinicians are advised to keep the following diagnostic
criteria in mind.

Cannabis intoxication

Cannabis intoxication, a cannabis-induced disorder coded as 292.89, is defined by the DSM-IV-TR, as the following:

• Recent use of cannabis

• Clinically significant maladaptive behavioral or psychological changes (eg, impaired motor coordination, euphoria,
anxiety, sensation of slowed time, impaired judgment, social withdrawal) that developed during, or shortly after, cannabis use
• At least 2 of the following signs, developing within 2 hours of cannabis use:
o Conjunctival injection
o Increased appetite
o Dry mouth
o Tachycardia
• Symptoms not due to a general medical condition and not better accounted for by another mental disorder

Clinicians are instructed to specify if this is occurring with perceptual disturbances. This specifier may be noted when hallucinations with intact
reality testing or auditory, visual, or tactile illusions occur in the absence of a delirium. Intact reality testing means that the person knows that
the hallucinations are induced by the substance and do not represent external reality. When hallucinations occur in the absence of intact
reality testing, a diagnosis of substance-induced psychotic disorder, with hallucinations, should be considered.

Cannabis abuse

Cannabis abuse, a cannabis use disorder coded as 305.20, is defined by the DSM-IV-TR as the following:

• A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by at
least 1 of the following, occurring within a 12-month period:
o Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home (eg,
repeated absences or poor work performance related to substance use; substance-related absences, suspension, or expulsions from school;
neglect of children or household)
o Recurrent substance use in situations in which it is physically hazardous (eg, driving an automobile or
operating a machine)
o Recurrent substance-related legal problems (eg, arrests for substance-related disorderly conduct)
o Continued substance use despite having persistent or recurrent social or interpersonal problems caused or
exacerbated by the effects of the substance (eg, arguments with spouse about consequences of intoxication, physical fights)
• The symptoms have never met the criteria for substance dependence for this class of substance

Cannabis dependence

Cannabis dependence, a cannabis use disorder coded as 304.30, is defined by the DSM-IV-TR as the following:

A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by at least 3 of the following,
occurring at any time in the same 12-month period:

• Tolerance, as defined by either of the following:

o A need for markedly increased amounts of the substance to achieve intoxication or desired effect
o Markedly diminished effect with continued use of the same amount of the substance
• Withdrawal, as manifested by either of the following:
o The characteristic withdrawal syndrome for the substance (Refer to Substance withdrawal.)
o The same (or closely related) substance taken to relieve or avoid withdrawal symptoms
• The substance is often taken in larger amounts or over a longer period than was intended.
• There is a persistent desire or unsuccessful efforts to cut down or control substance use.
• A great deal of time is spent in activities necessary to obtain the substance (eg, visiting multiple doctors or driving
long distances), use the substance (eg, chain-smoking), or recover from its effects.
• Important social, occupational, or recreational activities are given up or reduced because of substance use.
• The substance use is continued despite knowledge of having a persistent or recurrent physical or psychological
problem that is likely to have been caused or exacerbated by the substance (eg, current marijuana use despite recognition of marijuana-
induced apathy).
Clinicians are instructed to specify the following:

• With physiological dependence - Evidence of tolerance or withdrawal

• Without physiological dependence - No evidence of tolerance or withdrawal

The DSM-IV-TR defines substance withdrawal as the following:

• The development of a substance-specific syndrome due to the cessation of (or reduction in) substance use that has
been heavy and prolonged.
• The substance-specific syndrome causes clinically significant distress or impairment in social, occupational, or other
important areas of functioning.
• The symptoms are not due to a general medical condition and are not better accounted for by another mental
disorder.

Compared to other illicit substances with clearly defined withdrawal states and associated symptoms, the definition of a cannabis withdrawal
syndrome (CWS) has remained controversial. As no evidence is available of increasing tolerance associated with cannabis use, making the
diagnosis of cannabis dependence with physiological dependence has remained controversial, if not impossible. Although prior studies have
attempted to illustrate the existence of CWS, these studies have had significant limitations. And until recently there has been a dearth of any
prospective studies assessing the occurrence of CWS. Recently, however, a prospective study focused on assessing the course of CWS
symptoms among patients dependent on cannabis who were seeking detoxification. This study seems to support evidence of a clinically
relevant CWS that the authors qualify as "only expected in a subgroup of cannabis-dependent patients."19

The authors identify the following commonly observed symptoms associated with CWS:

• Anger
• Aggression
• Anxiety
• Decreased appetite
• Weight loss
• Irritability
• Restlessness
• Sleep difficulty

Although less commonly reported and occurring less frequently, the following symptoms have been reported as well:

• Depressed mood
• Stomach pain
• Physical discomfort
• Tremor
• Sweating

These symptoms are believed to occur following a 24-hour period of abstinence, peaking at day 3 following abstinence and lasting 1-2
weeks.19,20

Unexpectedly, the authors reported that there was a weak association between the number of endorsed DSM-IV-TR dependence criteria and
the likelihood of development of CWS. The authors recommended subgrouping cannabis-dependent patients undergoing detoxification into
those with no or only very mild CWS and those with moderate-to-strong CWS. Risk factors that seemed to predict which subgroup patients
could be classified by, included recent cannabis intake and last amount of cannabis consumed prior to hospitalization, with patients reporting
recent and more cannabis consumption before hospitalization, as more likely to report symptoms of CWS.19

Cannabis intoxication delirium

Cannabis intoxication delirium, a cannabis-induced disorder coded as 292.81, is defined by the DSM-IV-TR as follows:

• Disturbance of consciousness (ie, reduced clarity of awareness of the environment) with reduced ability to focus,
sustain, or shift attention
• A change in cognition (such as memory deficit, disorientation, language disturbance) or the development of a
perceptual disturbance that is not better accounted for by a preexisting established or evolving dementia
• Disturbance developing over a short period of time (usually hours to days) and tending to fluctuate during the course
of the day
• Evidence from the history, physical examination, or laboratory findings either of the following:
o The symptoms in the first 2 criterion developed during substance intoxication.
o Medication use is etiologically related to the disturbance. (The diagnosis should be recorded as substance-
induced delirium if related to medication use.)

Note: This diagnosis should be made instead of a diagnosis of substance intoxication only when the cognitive symptoms are in excess of
those usually associated with the intoxication syndrome and when the symptoms are sufficiently severe enough to warrant independent
clinical attention.

Cannabis-induced psychotic disorder

Cannabis-induced psychotic disorder, with delusions, a cannabis-induced disorder coded as 292.11 and cannabis-induced psychotic disorder,
with hallucinations, a cannabis-induced disorder coded as 292.12, are defined by the DSM-IV-TR as follows:

• Prominent hallucinations or delusions (Note: Do not include hallucinations if the person has insight that they are
substance induced.)
• Evidence from the history, physical examination, or laboratory findings of either one of the following:
o The symptoms in the first criterion developed during, or within a month of, substance intoxication or
withdrawal.
o Medication use is etiologically related to the disturbance.
• The disturbance is not better accounted for by a psychotic disorder that is not substance induced. Evidence that the
symptoms are better accounted for by a psychotic disorder that is not substance induced might include the following:
o The symptoms precede the onset of the substance use (or medication use)
o The symptoms persist for a substantial period of time (eg, about a month) after the cessation of acute
withdrawal or severe intoxication or are substantially in excess of what would be expected given the type or amount of the substance used or
the duration of use.
o Other evidence suggests the existence of an independent non-substance–induced psychotic disorder (eg, a
history of recurrent non-substance–related episodes).
• The disturbance does not occur exclusively during the course of a delirium.

Cannabis-induced anxiety disorder

Cannabis-induced anxiety disorder , categorized as a cannabis-induced disorder and coded as 292.89, is defined by the DSM-IV-TR as
follows:

• Prominent anxiety, panic attacks, or obsessions or compulsions predominate in the clinical picture.
• Evidence from the history, physical examination, or laboratory findings of either of the following:
o The symptoms in the first criterion developed during, or within 1 month of, substance intoxication or
withdrawal.
o Medication use is etiologically related to the disturbance.
• The disturbance is not better accounted for by an anxiety disorder that is not substance induced. Evidence that the
symptoms are better accounted for by an anxiety disorder that is not substance induced might include the following:
o The symptoms precede the onset of the substance use (or medication use).
o The symptoms persist for a substantial period of time (eg, about a month) after cessation of acute
withdrawal or severe intoxication or are substantially in excess of what would be expected given the type or amount of the substance used or
the duration of use.
o Other evidence suggests the existence of an independent non-substance–induced anxiety disorder (eg, a
history of recurrent non-substance–related episodes).
• The disturbance does not occur exclusively during the course of a delirium.
• The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of
functioning.

Cannabis-related disorder not otherwise specified

Cannabis-related disorder not otherwise specified, categorized as a cannabis-induced disorder and coded as 292.9, is for disorders
associated with the use of cannabis that are not classifiable as one of the disorders listed above.

Physical

A thorough mental status examination is an integral component of every patient assessment. Key mental status findings associated with
cannabis use, cannabis-induced and related disorders include the following:

• Mood: Acute use may be associated with feelings of euphoria, uncontrollable laughter, increased appetite, and
difficulty concentrating. In chronic use or withdrawal, patients may report a depressed mood characterized by apathy, lack of motivation,
irritability, loss of interest in typical activities, difficulty concentrating, and possibly isolation.
• Affect: Acutely, affect may span the spectrum from euphoric to anxious. In chronic use, affect may be constricted or
flat.
• Thought process and content: As in any mental status examination, assessing the patient for the presence of
suicidality or homicidality and taking appropriate action is critical. Patients may demonstrate flight of ideas, loose associations, and in some
cases delusions and hallucinations.
• Cognition: In both acute and chronic use, difficulty concentrating and memory impairment are common.

Physical signs and symptoms associated with cannabis use are particularly relevant to the diagnosis of cannabis intoxication. Clinicians are
advised to identify at least 2 or more of the following physical symptoms, occurring within 2 hours of cannabis use, as defined by DSM-IV-TR
criteria:

• Conjunctival injection
• Increased appetite
• Dry mouth
• Tachycardia

Additionally, patients may demonstrate physical symptoms associated with cannabis withdrawal syndrome.
Other adverse physical and psychological manifestations associated with marijuana abuse are as follows:

• Sweating
• Headaches
• Restlessness
• Forgetfulness
• Visual distortions
• Lack of concentration
• Paranoia
• Mood changes
• Perceptual changes
• Feeling impersonal
• Panic disorder
• Amotivational syndrome
• Delusions
• Psychosis

Causes

Risk factors among adolescents that may increase the likelihood for marijuana abuse include the presence of comorbid substance use and
environmental stressors including difficulty in school.

Differential Diagnoses
Alcohol-Related Psychosis Hallucinogens
Allergic and Environmental Asthma Panic Disorder
Amphetamine-Related Psychiatric Primary Hypersomnia
Disorders
Anxiety Disorders Sedative, Hypnotic, Anxiolytic Use Disorders
Atrial Tachycardia Substance-Induced Mood Disorders: Depression and Mania
Brief Psychotic Disorder Toxicity, Benzodiazepine
Delirium
Depression

Workup

Laboratory Studies

• Cannabinoids can be detected in the urine for as many as 21 days after use in persons chronically using marijuana
because these lipid soluble metabolites are slowly released from fat cells into the blood; however, 1-5 days is the normal urine-positive period.
o The primary method for urinalysis detection is enzyme immunoassay or radioimmunoassay. This method is
inexpensive, quick, and accurate.
o This is also useful for confirmation of abstinence.
o Urine samples are difficult to obtain from people who are addicted, and providing a urine sample is easily
evaded. Urine toxicology testing should be performed under supervised conditions to ensure reliability of results.
o Gas chromatography (GC) in combination with mass spectrometry (MS) and/or thin-layer chromatography
(TLC) is used to confirm positive results, especially in legal proceedings.
o With all types of tests mentioned, including TLC, false-negative results tend to be more common than false-
positive results.
• Blood samples may be used to measure quantitative levels of cannabinoids.21
o Serial monitoring of tetrahydrocannabinol (THC)-COOH to creatinine ratios can distinguish between recent
use and residual excretion.
o To assess the extent of cannabis use, determination of free and bound THC-COOH can be useful.
o Blood analysis is the preferred method of detection for interpretation of acute effects. The cannabis influence
factor (CIF) is a tool that is used to interpret concentrations of THC and its metabolites in forensic cases. Absolute driving inability has been
proposed in the case of CIF of 10 or higher. The higher the CIF, the more recent the cannabis abuse.
o Blood samples must be taken within a prescribed 8-day period, and THC-COOH concentration greater than
75 ng/mL is associated with regular consumption of cannabis. THC-COOH concentration less than 5 ng/mL is associated with occasional
consumption.
• Hair analysis is not a sensitive enough tool to detect cannabinoids.21
o THC, and the main metabolite THC-COOH, do not incorporate to a great extent into hair. TCH-COOH is not
highly bound to melanin. Hence, concentrations in hair are much lower when compared with other drugs of abuse.
o Because TCH is present in cannabis smoke, it can also be incorporated into hair simply by second-hand
exposure.
• Saliva testing is a newer technology for detection
o The presence of delta-9-THC in oral fluid is a better indication of recent use than the presence of 11-nor-
delta-9-THC-9-COOH that is detected in urine. Therefore, the probability that a user is experiencing effects is higher.
o This may prove especially useful in the monitoring of driving while under the influence.

Imaging Studies

• Although no confirmatory imaging study exists for marijuana use, pilot investigations involving neuroimaging of
marijuana smokers performing various mental tasks have revealed many differences in comparative levels of activity in many regions of the
brain with respect to controls.
• Functional MRI (fMRI) and diffusion tensor imaging (DTI) techniques demonstrate significant differences in the
magnitude and pattern of signal intensity change within the anterior cingulate and the dorsolateral prefrontal cortex while performing
standardized tasks in chronic marijuana smokers compared with healthy controls.
• Neuroimaging studies, such as CT scanning, MRI, and positron emission tomography (PET) scans, are extensively
used to study the neurobiological effects of cannabis abuse but are not clinically useful in the definitive determination of recent abuse.

Treatment

Medical Care

Acute intoxication of cannabis usually resolves unremarkably within 4-6 hours and is best managed by the following measures:
• Frequent reassurance and maintenance of a nonthreatening environment
• Minimal stimuli
• Use of a specifically assigned nurse to calm the patient
• Judicious use of benzodiazepines (BZs) when significant anxiety is present

Consultations

People who use marijuana and are suffering from biological, psychological, or social impairment from marijuana use should be evaluated and,
if necessary, treated by a psychiatrist.

• The treatment of marijuana abuse follows the general principals of substance abuse, with particular attention paid to
psychological and social aspects.
• Marijuana may be one of many drugs abused, and total abstinence from all psychoactive substances (with the
exception of caffeine) is the treatment goal.
• Interventions may include psychiatric evaluation, occupational and family assessment, and implementation of a
comprehensive treatment plan.
o Psychological issues (eg, denial, minimization, rationalization) must be confronted.
o Often, cessation of drug use and subsequent cognitive improvement result in self-motivation and changes in
the occupational and social well-being of the patient.
o Lifestyle changes, such as avoiding drug-related situations, may be encouraged.
• Identify and address low self-esteem, mood disorders, family problems, and other stresses.
• One-to-one therapy, group therapy, and even hospitalization may be necessary components of the treatment plan.
(Patients with uncomplicated marijuana use in the absence of other psychiatric or medical problems are rarely hospitalized.)

Medication

Short-term, low-dose benzodiazepines for treatment of significant anxiety associated with acute intoxication has been used. Clinicians are
advised to use caution when administering benzodiazepines for the treatment of cannabis-induced anxiety, as the anxiety will invariable
resolve with no medication over a short period of time. Drug therapies that diminish cravings for marijuana or intoxicating effects from
marijuana use are currently not available.

Anxiolytics

These agents depress all levels of CNS, which, in turn, reduces anxiety symptoms.

Lorazepam (Ativan)

Treatment of acute marijuana-associated panic or anxiety symptoms. Monitor vital signs carefully after administration. Watch for respiratory
depression, ataxia, and somnolence/excess sedation. Amnesia may follow administration. Effects usually last 5-8 h after administration.
Sedative hypnotic with short onset of effects and relatively long half-life. Increasing the action of GABA, which is a major inhibitory
neurotransmitter in the brain, may depress all levels of CNS, including limbic and reticular formation. When patient must be sedated for more
than a 24-h period, this medication is excellent.

Adult

0.5-1 mg PO/IV q3-4h prn to resolve symptoms; not to exceed 4 mg in 24 h

Pediatric

0.05 mg/kg/dose IV q4-8h

Toxicity of BZs in the CNS increases when used concurrently with alcohol, phenothiazines, barbiturates, and MAOIs

Documented hypersensitivity, preexisting CNS depression, hypotension

Pregnancy

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

Caution in renal or hepatic impairment, myasthenia gravis, organic brain syndrome, or Parkinson disease

Follow-up

Further Inpatient Care

Inpatient hospitalization for the treatment of cannabis abuse or dependence is not recommended. Additionally, inpatient treatment is not
recommended for cannabis withdrawal syndrome as CWS is only expected to occur in a subgroup of users, even among heavy, chronic
users.19

Further Outpatient Care

Follow-up care should be comprehensive and involve specialist services such as those provided by drug treatment units.
• Treatment includes behavior therapy (aimed at reducing the chances of reexposure and establishing coping
mechanisms to resist further use); family, group, and individual therapy; and periodic testing of urine to monitor abstinence.
• Narcotics Anonymous (NA) is a self-help group organized on principles similar to Alcoholics Anonymous and is useful
in helping addicts maintain abstinence.
• Adolescent drug programs usually focus on promoting communication skills and age-appropriate behaviors.

Inpatient & Outpatient Medications

Overall a dearth of empirical research has focused on the role of pharmacotherapy in the treatment of cannabis dependence. A double-
blinded trial examining the role of nefazodone dosed at 300 mg bid and bupropion-SR dosed at 150 mg bid demonstrated that neither
medications were effective at increasing abstinence or reducing withdrawal symptoms among patients seeking treatment for cannabis
dependence.22

Currently, no medications have demonstrated effectiveness in the treatment of cannabis dependence or reduction of cannabis withdrawal
symptoms. Time remains the best tincture for these patients.

Deterrence/Prevention

School-based programs and peer-led groups may be useful in primary prevention of marijuana abuse.

Voucher-based reinforcement of marijuana abstinence among individuals with serious mental illness has proven effective.
Much has been made about marijuana as a “gateway drug.” Under this theory one would expect a sequential initiation of drug use progressing
from licit substances such as alcohol and tobacco to cannabis and moving on to other illicit substances. However, a recent study conducted
across diverse countries and cohorts showed significant violations of this sequential gateway hypothesis and instead has demonstrated “that
the strength of associations between substance use progression may be driven by background prevalence rather than being wholly explained
by causal mechanisms.”23

Gateway violations, such as use of illicit substance prior to cannabis use were highest in countries with the lowest rates of prevalence of
cannabis use, with similar findings of gateway violations associated with alcohol and tobacco in countries with low prevalence rates of use for
alcohol and tobacco. Further, the risk for later development of drug dependence may be more affected by the extent of prior use of any drug
and the age of onset at which that use began. The implications of this information for drug abuse prevention would imply that prevention
efforts may be most effective not simply by targeting drugs perceived to exist earlier in the “gateway” chain, but by efforts designed to prevent
all drug use.23

As with all efforts to prevent drug abuse, straight-forward education on the risks associated with cannabis may be most effective. Given the
increasing ease of access to marijuana, its increasing prevalence of use, and changing societal views, which seem to reflect its increasing
acceptance, the scare tactics of old, which attempted to illustrate "reefer madness” may be perceived as out of touch, inaccurate, and
therefore ineffective.

Complications

Marijuana use may be complicated by comorbid substance use and medical problems as outlined.

Prognosis

As with other substance abuse conditions, relapse is common in those meeting criteria for dependence, and treatment may be necessary for
multiple episodes.

Patient Education

• American Council for Drug Education, Basic Facts About Drugs: Marijuana
• National Institute on Drug Abuse, Infofacts, Marijuana
• National Institute on Drug Abuse, Marijuana: Facts for Teens
• Office of National Drug Control Policy, Marijuana
• eMedicineHealth, Substance Abuse Center
• eMedicineHealth, Drug Dependence and Abuse and Substance Abuse
• National Institute on Drug Abuse, Parents and Teachers

Miscellaneous

Medicolegal Pitfalls

• Failure of physicians to recognize cannabis abuse is common. People who use marijuana generally have no stigmata
of marijuana abuse, and a high index of suspicion and careful urine testing may be needed to diagnose such abuse.
• Marijuana abuse may be a factor in vehicle or machinery accidents because intoxication affects coordination and
motor performance. Perform the appropriate tests for use of marijuana after these accidents.
• Cannabis intoxication may be associated with dysphoric, irritable, or aggressive mood changes. Carefully examine
patients for evidence of suicidality and homicidality, document presence or absence thereof, and manage as indicated.

Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors Robert C Daly, MB, ChB, MPH, BCh; Can
M Savasman, MD; Caroline Fisher, MD, PhD; and Lina Cassandra Vawter, MD to the development and writing of this article.