II. Class

  1. Relaxant, Euphoriant, and Hallucinogen (high doses)
  2. Federal Schedule I Agent
    1. Medical use is permitted in more than half U.S. States (and D.C.)
    2. Recreational use has been approved by Colorado and Washington legislatures

III. Pharmacology: Marijuana (THC)

  1. Derived naturally from hemp, Cannabis sativa
  2. Smoked or eaten (e.g. "Hash Brownies")
  3. Classic hash is dried Marijuana with 70% THC content
  4. Street Names
    1. Pot, Grass, Tea
    2. Dagga, Kif
    3. Joint, Reefer
    4. Weed, Dope
  5. Pharmacokinetics: THC
    1. Delta-9-Tetrahydrocannabinol (THC)
    2. THC (5-20 mg): 2-4 hour duration
    3. Long half life

IV. Pharmacology: Hemp Oil

  1. Background
    1. Pulverized Marijuana placed for 8 minutes in PVC pipe filled with butane and capped at each end
    2. Results in 90% THC solution (honey oil) or wax (after exposure to rubbing Alcohol)
    3. Production associated with explosions and fires (related to use of butane)
  2. Street Names
    1. Honey Oil
      1. Concentrated THC in Butane solvent
      2. Smoked (or placed on a Cigarette)
    2. Wax
      1. Solidified honey oil (after exposure to rubbing Alcohol)
      2. Similar appearance to honeycomb or ear wax
      3. Smoked
  3. References
    1. Nordt and Swadron in Herbert (2014) EM: Rap 14(6):6

V. Pathophysiology

  1. Similar to highly addictive "hard" drugs or Opioids
    1. Results in Dopamine release
    2. Blocked by Naloxone
  2. Marijuana considered a gateway drug
    1. Use may lead to Opiate Abuse
  3. References
    1. Tanda (1997) Science 276:2048-50 [PubMed]

VI. Pharmacokinetics

  1. Smoking Marijuana
    1. Bioavailability: 20-50%
    2. Onset: Rapid
    3. Duration: 4 hours
  2. Edible maijuana
    1. Bioavailability: 4-12%
    2. Onset: 1-2 hours
    3. Peaks: 2-6 hours
    4. Duration: Up to 12 hours
    5. Lower serum concentration than if smoked

VII. Indications: Medical Marijuana

  1. Anti-emetic (especially Chemotherapy related)
    1. Most established use
    2. Consider dronabinol (Marinol) or Nabilone (Cesamet) instead
    3. However, Cannabinoid Hyperemesis Syndrome may result with increased, sustained use
  2. AIDS anorexia
    1. Consider Nabilone (Cesamet) instead
  3. Neuropathic pain
  4. Multiple Sclerosis related spasticity and pain
  5. Intractable Seizure Disorder
    1. Consider cannabidiol (CBD) instead

VIII. Symptoms

  1. Acute Effects
    1. Euphoria
    2. Relaxed inhibitions
    3. Increased appetite
    4. Decreased alertness
    5. Disoriented behavior
  2. Chronic Use: Amotivational syndrome
    1. Aimless
    2. Uncommunicative

IX. Signs

  1. Cardiopulmonary findings
    1. Tachycardia
    2. Hypertension
    3. Tachypnea
  2. Miscellaneous findings
    1. Conjunctival Injection
    2. Dry Mouth
    3. Decreased coordination

X. Adverse Effects

  1. General
    1. Dizziness
    2. Dry Mouth
    3. Fatigue
    4. Drowsiness
    5. Cognitive Impairment
    6. Respiratory symptoms (when smoked)
  2. Withdrawal (for the 9% of users who are dependent)
    1. Anorexia
    2. Insomnia
    3. Anxiety
    4. Depressed Mood or dysphoria
    5. Irritability
  3. Toxicity
    1. Dysphoria
    2. Sinus Tachycardia
    3. Orthostatic Hypotension
    4. May increase Myocardial Infarction risk
  4. May precipitate psychiatric illness
    1. Latent Schizophrenia
    2. Anxiety Disorder
    3. Dysphoria
    4. Paranoia

XI. Drug Interactions

  1. CNS Depressants (increased Sedation, Dizziness)
    1. Opioids
    2. Benzodiazepines
  2. Antithrombotics
    1. Increased bleeding risk

XII. Management: Toxicity

  1. See Synthetic Cannabinoid (e.g. K2, JWH, Spice)
  2. Usually no specific treatment needed
  3. Benzodiazepines for severe reactions
  4. Toxicity may be related to polysubstance abuse (consider other Drugs of Abuse combined with THC)
  5. Marijuana Intoxication in children may present with greater CNS depression
  6. Toxicity may be associated with masking agent Overdose
    1. Some THC users have Overdosed on Niacin (Vitamin B3) in attempt to mask the Urine Drug Screen (UDS)
    2. No evidence Niacin actually masks THC in the urine, but this has resulted in emergency department visits
      1. Mittal (2007) Ann Emerg Med 50:587-590 [PubMed]
  7. Legalized Marijuana in 4 U.S. States (CO, OR, WA, AL) as of 2015 has been associated with increased ED visits
    1. Increased cyclic Vomiting (2x) and accidental childhood Poisonings
    2. Kim (2016) Ann Emerg Med 68(1): 71-5 [PubMed]

XIII. Complications

  1. Emergency
    1. Myocardial Infarction
    2. Acute Kidney Injury
    3. Seizure
  2. Longterm effects from excessive and persistent use
    1. Cannabinoid Hyperemesis Syndrome
    2. Neuropsychological decline in older adults

XIV. References

  1. (2017) Presc Lett 24(9): 51
  2. (2012) Presc Lett 20(2): 11
  3. Fontes (2014) Crit Dec Emerg Med 28(1): 14-24
  4. Mason (2016) EM:Rap 16(8): 5

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Ontology: Hashish (C0018613)

Concepts Substance (T167)
MSH D002188
SnomedCT 228999003
English Cannabis resin - non-pharmac, Hashishs, hashish, marijuana resin, Cannabis resin - non-pharmaceutical, Marijuana resin, Marihuana resin, Cannabis resin - non-pharmaceutical (substance), Hashish
Czech hašiš
Portuguese Haxixe
Spanish Hachis, resina de Cannabis - uso no farmacéutico (sustancia), resina de Cannabis - uso no farmacéutico
German Haschisch
Italian Hashish
French Hachisch, Haschich, Hachich
Norwegian Hasj
Dutch Hasjiesj

Ontology: Marihuana (C0024808)

Definition (NCI) Any part of, or extract from, the female hemp plant Cannabis sativa. Marijuana contains cannabinoids, substances with hallucinogenic, psychoactive, and addictive properties. This agent has potential use for treating cancer pain and cachexia. (NCI04)
Definition (NCI_NCI-GLOSS) The dried leaves and flowering tops of the Cannabis sativa plant, or an extract from the plant. Marijuana is being studied in the treatment of nausea and vomiting caused by chemotherapy or opiate drugs, such as morphine sulfate. Marijuana is also being studied in the treatment of pain.
Definition (PDQ) Any part of, or extract from, the female hemp plant Cannabis sativa. Marijuana contains cannabinoids, substances with hallucinogenic, psychoactive, and addictive properties. This agent has potential use for treating cancer pain and cachexia. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=269131&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=269131&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C26659" NCI Thesaurus)
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D002188
SnomedCT 228997001, 398705004
English Marihuana, Marijuana, cannabinols in any form, marijuana in any form, Cannabis, Marijuanas, Marihuanas, MARIJUANA [VA Product], marihuana, marijuana, cannabis, MARIJUANA
Czech marihuana
German Marihuana
Italian Marihuana, Marijuana
French Marie-jeanne, Marijuana, Marihuana
Norwegian Marihuana
Spanish marihuana, Marihuana
Dutch Marihuana
Portuguese Maconha

Ontology: Tetrahydrocannabinol (C0039663)

Definition (CHV) an organic chemical extracted from Marihuana
Definition (CHV) an organic chemical extracted from Marihuana
Definition (CHV) an organic chemical extracted from Marihuana
Definition (CHV) an organic chemical extracted from Marihuana
Definition (CHV) an organic chemical extracted from Marihuana
Definition (MSH) A psychoactive compound extracted from the resin of Cannabis sativa (marihuana, hashish). The isomer delta-9-tetrahydrocannabinol (THC) is considered the most active form, producing characteristic mood and perceptual changes associated with this compound.
Definition (NCI_NCI-GLOSS) A synthetic pill form of delta-9-tetrahydrocannabinol (THC), an active ingredient in marijuana that is used to treat nausea and vomiting associated with cancer chemotherapy.
Definition (NCI) A synthetic form of delta-9-tetrahydrocannabinol, a psychoactive substance found in Cannabis sativa. Dronabinol acts directly on the appetite and vomiting control centers in the brain to stimulate appetite and prevent emesis. (NCI04)
Definition (PDQ) A synthetic form of delta-9-tetrahydrocannabinol, a psychoactive substance found in Cannabis sativa. Dronabinol acts directly on the appetite and vomiting control centers in the brain to stimulate appetite and prevent emesis. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=39707&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=39707&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C867" NCI Thesaurus)
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D013759
SnomedCT 386846008, 72024007, 108415005, 96225007
LNC LP16059-5, MTHU003348
English delta(1)-Tetrahydrocannabinol, delta(1)-THC, delta(9)-Tetrahydrocannabinol, delta(9)-THC, THC, 6H-Dibenzo(b,d)pyran-1-ol, 6a,7,8,10a-tetrahydro-6,6,9-trimethyl-3-pentyl-, (6aR-trans)-, 9 ene Tetrahydrocannabinol, 9-ene-Tetrahydrocannabinol, Delta 9-Tetrahydrocannabinol, Tetrahydrocannabinol, Synthetic delta-9-Tetrahydrocannabinol, delta-9-tetrahydrocannabinol, DELTA THC 09, dronabinol (medication), DRONABINOL, tetrahydrocannabinol (THC), Dronabinol, dronabinol, Dronabinol [Chemical/Ingredient], (-)-.DELTA.9-Tetrahydrocannabinol, tetrahydrocannabinol, delta-9-Tetrahydrocannabinol, Dronabinol (product), Dronabinol (substance), Tetrahydrocannabinol (substance), delta-9-Tetrahydrocannabinol (substance), delta 9-tetrahydrocannabinol
Swedish Tetrahydrocannabinol
Spanish delta-9-tetrahidrocannabinol (sustancia), delta-9-tetrahidrocanabinol sintético, delta-9-tetrahidrocanabinol, delta-9-tetrahidrocannabinol, delta-9-tetrahidrocanabinol (sustancia), Dronabinol, Tetrahidrocannabinol, Not Translated[Dronabinol], dronabinol (producto), dronabinol (sustancia), dronabinol, tetrahidrocanabinol (sustancia), tetrahidrocanabinol, THC, delta(9)-THC
Czech tetrahydrokanabinol
Finnish Tetrahydrokannabinoli
Italian THC, Delta(1)-THC, Delta(1)-tetraidrocannabinolo, Delta(9)-THC, Delta(9)-tetraidrocannabinolo, 9-ene-tetraidrocannabinolo, Dronabinolo, Tetraidrocannabinolo
Russian TETRAGIDROKANNABINOL, DRONABINOL, ТЕТРАГИДРОКАННАБИНОЛ, ДРОНАБИНОЛ, DELTA (9)-THC, THC
Japanese テトラヒドロカンナビノール, デルタ9THC, ドロナビノール, Δ1-3,4-trans-テトラヒドロカンナビノール
German DELTA THC 09, Delta(9)-THC, Dronabinol, THC, Tetrahydrocannabinol
Polish Tetrahydrokannabinol
French D9-THC, THC (TétraHydroCannabinol), Dronabinol, Tétrahydrocannabinol
Portuguese Not Translated[Dronabinol], Tetra-Hidrocanabinol, Dronabinol, THC, delta (9)-THC

Ontology: Cannabis (C0936079)

Definition (MSHCZE) Rod rostlin z čeledi Cannabaceae, z řádu Urticales, podtřídy Hamamelidae. Vrchní okvětní část se označuje mnoha slangovými termíny, například tráva, hulení, zelí, marihuana, hašiš, bhang a ganja. Stonek je významný zdroj konopného vlákna.
Definition (MSH) The plant genus in the Cannabaceae plant family, Urticales order, Hamamelidae subclass. The flowering tops are called many slang terms including pot, marijuana, hashish, bhang, and ganja. The stem is an important source of hemp fiber.
Definition (CSP) plant genus of the family Cannabacae and the dried flowering tops which contain hallucinogens.
Concepts Plant (T002)
MSH D002188
SnomedCT 22924007
English Cannabis, Hemp Plant, Plant, Hemp, Hemp Plants, Plants, Hemp, Cannabi, cannabis, hemp plant, Cannabis L., 1753, Cannabis (organism), Cannabis, NOS, Hemp (Cannabis)
Swedish Kannabis
Czech Cannabis, konopí
Finnish Kannabis
Italian Pianta di canapa, Cannabis
Russian MARIKHUANA, KONOPLIA, GASHISH, ГАШИШ, КОНОПЛЯ, МАРИХУАНА
Japanese マリファナ, カンナビス属, 大麻, ハッシッシュ, アサ, アサ属
Croatian MARIHUANA
Polish Konopie, Haszysz, Konopie indyjskie, Marihuana
Norwegian Cannabis, Hampplanter
Spanish Marijuana, Cannabis (organismo), Cannabis
Portuguese Cânave, Linho-Cânhamo, Cânabis, Cânhamo-da-Índia, Cânabe, Cannabis
French Cannabis
German Cannabis
Dutch Cannabis