Jump to content

Medical cannabis

Page semi-protected
From Wikipedia, the free encyclopedia
For other uses of "Cannabis", seeCannabis (disambiguation).
"Medical marijuana" redirects here. For the company, seeMedical Marijuana, Inc.

Part of a series on
Cannabis
Cannabis
Chemistry
  • Semi-synthetic cannabinoids
Pharmacology
Consumption
Economics
Effects
Forms
Law
Variants
  • Genus
  • Species
Related

Medical cannabis,medicinal cannabisormedical marijuana(MMJ) refers tocannabis productsandcannabinoid moleculesthat areprescribedbyphysiciansfor their patients.[1][2][3][4]The use of cannabis as medicine has a long history, but has not been as rigorously tested as other medicinal plants due to legal and governmental restrictions, resulting in limitedclinical researchto define the safety and efficacy of using cannabis to treat diseases.[5]

Preliminary evidence has indicated that cannabis might reducenauseaandvomitingduringchemotherapyand reducechronic painandmuscle spasms.[6][7]Regarding non-inhaled cannabis or cannabinoids, a 2021 review found that it provided little relief against chronic pain and sleep disturbance, and caused several transientadverse effects,such as cognitive impairment,nausea,anddrowsiness.[8]

Short-term use increases the risk of minor and major adverse effects.[7]Common side effects includedizziness,feeling tired, vomiting, andhallucinations.[7]Long-term effects of cannabis are not clear.[7]Concerns include memory and cognition problems, risk of addiction,schizophreniain young people, and the risk of children taking it by accident.[6]

Many cultures have used cannabis for therapeutic purposes for thousands of years.[9]Some American medical organizations have requested removal of cannabis from the list ofSchedule I controlled substancesmaintained by the United States federal government, followed by regulatory and scientific review.[10][11]Others oppose its legalization, such as theAmerican Academy of Pediatrics.[12]

Medical cannabis can be administered through various methods, includingcapsules,lozenges,tinctures,dermal patches,oral or dermal sprays,cannabis edibles,andvaporizingorsmoking dried buds.Synthetic cannabinoids are available for prescription use in some countries, such assynthetic delta-9-THCandnabilone.Countries thatallow the medical use of whole-plant cannabisinclude Argentina, Australia, Canada, Chile, Colombia, Germany, Greece, Israel, Italy, the Netherlands, Peru, Poland, Portugal, Spain, and Uruguay. In the United States, 38 states and the District of Columbia have legalized cannabis for medical purposes, beginning with the passage of California'sProposition 215in 1996.[13]Although cannabis remains prohibited for any use at the federal level, theRohrabacher–Farr amendmentwas enacted in December 2014, limiting the ability of federal law to be enforced in states where medical cannabis has been legalized.

Classification

In the U.S., theNational Institute on Drug Abusedefines medical cannabis as "using the whole, unprocessed marijuana plant or its basic extracts to treat symptoms of illness and other conditions".[14]

A cannabis plant includes more than 400 different chemicals, of which about 70 arecannabinoids.[15]In comparison, typical government-approved medications contain only one or two chemicals.[15]The number of active chemicals in cannabis is one reason why treatment with cannabis is difficult to classify and study.[15]

A 2014 review stated that the variations in ratio of CBD-to-THC in botanical and pharmaceutical preparations determines the therapeutic vs psychoactive effects (CBD attenuates THC's psychoactive effects[16]) of cannabis products.[17]

Medical uses

Cannabisas illustrated in Köhler'sBook of Medicinal Plants,1897

Overall, research into the health effects of medical cannabis has been of low quality and it is not clear whether it is a useful treatment for any condition, or whether harms outweigh any benefit.[18]There is no consistent evidence that it helps withchronic painandmuscle spasms.[18]

Low quality evidence suggests its use for reducingnauseaduringchemotherapy,improving appetite inHIV/AIDS,improving sleep, and improvingticsinTourette syndrome.[7]When usual treatments are ineffective,cannabinoidshave also been recommended foranorexia,arthritis,glaucoma,[19]andmigraine.[20]

It is unclear whether American states might be able to mitigate the adverse effects of theopioid epidemicby prescribing medical cannabis as an alternative pain management drug.[21]

Cannabis should not be used inpregnancy.[22]

Insomnia

Research analyzing data from the National Health and Nutrition Examination Survey (NHANES) did not find significant differences in sleep duration between cannabis users and non-users. This suggests that while some individuals may perceive benefits from cannabis use in terms of sleep, it may not significantly change overall sleep patterns across the general population.[23]

A review of literature up to 2018 indicates that cannabidiol (CBD) may have therapeutic potential for the treatment of insomnia. CBD, a non-psychoactive component of cannabis, is of particular interest due to its potential to influence sleep without the psychoactive effects associated with tetrahydrocannabinol (THC).[24]

Nausea and vomiting

Medical cannabis is somewhat effective inchemotherapy-induced nausea and vomiting(CINV)[6][19]and may be a reasonable option in those who do not improve following preferential treatment.[25]Comparative studies have found cannabinoids to be more effective than some conventional antiemetics such asprochlorperazine,promethazine,andmetoclopramidein controlling CINV,[26]but these are used less frequently because of side effects including dizziness, dysphoria, and hallucinations.[27][28]Long-term cannabis use may cause nausea and vomiting, a condition known ascannabinoid hyperemesis syndrome(CHS).[29]

A 2016Cochrane reviewsaid that cannabinoids were "probably effective" in treating chemotherapy-induced nausea in children, but with a high side-effect profile (mainly drowsiness, dizziness, altered moods, and increased appetite). Less common side effects were "ocular problems, orthostatic hypotension, muscle twitching, pruritus, vagueness, hallucinations, lightheadedness and dry mouth".[30]

HIV/AIDS

Evidence is lacking for both efficacy and safety of cannabis and cannabinoids in treating patients withHIV/AIDSor foranorexiaassociated with AIDS. As of 2013, current studies suffer from the effects of bias, small sample size, and lack of long-term data.[31]

Pain

A 2021 review found little effect of using non-inhaled cannabis to relieve chronic pain.[8]According to a 2019 systematic review, there have been inconsistent results of using cannabis for neuropathic pain, spasms associated withmultiple sclerosisand pain fromrheumaticdisorders, but was not effective treating chronic cancer pain. The authors state that additionalrandomized controlled trialsof different cannabis products are necessary to make conclusive recommendations.[18]

When cannabis is inhaled to relieve pain, blood levels of cannabinoids rise faster than when oral products are used, peaking within three minutes and attaining an analgesic effect in seven minutes.[32]

A 2011 review considered cannabis to be generally safe,[33]and it appears safer thanopioidsin palliative care.[34]

A 2022 review concluded the pain relief experienced after using medical cannabis is due to theplacebo effect,especially given widespread media attention that sets the expectation for pain relief.[35]

Neurological conditions

Cannabis' efficacy is not clear in treating neurological problems, includingmultiple sclerosis(MS) and movement problems.[17]Evidence also suggests that oral cannabis extract is effective for reducing patient-centered measures of spasticity.[17]A trial of cannabis is deemed to be a reasonable option if other treatments have not been effective.[6][by whom?]Its use for MS is approved in ten countries.[6][36][conflicted source?]A 2012 review found no problems with tolerance, abuse, or addiction.[37]In the United States,cannabidiol,one of the cannabinoids found in the marijuana plant, has been approved for treating two severe forms of epilepsy,Lennox-Gastaut syndromeandDravet syndrome.[38]

Mental health

Further information:Cannabis use and traumaandPosttraumatic stress disorder § Cannabinoids

A 2019 systematic review found that there is a lack of evidence that cannabinoids are effective in treatingdepressiveoranxiety disorders,attention-deficit hyperactivity disorder(ADHD),Tourette syndrome,post-traumatic stress disorder,orpsychosis.[39]

Research indicates that cannabis, particularly CBD, may have anxiolytic (anxiety-reducing) effects. A study found that CBD significantly reduced anxiety during a simulated public speaking test for individuals with social anxiety disorder. However, the relationship between cannabis use and anxiety symptoms is complex, and while some users report relief, the overall evidence from observational studies and clinical trials remains inconclusive. Cannabis is often used by people to cope with anxiety, yet the efficacy and safety of cannabis for treating anxiety disorders is yet to be researched.[40][41]

Cannabis use, especially at high doses, is associated with a higher risk of psychosis, particularly in individuals with a genetic predisposition to psychotic disorders like schizophrenia. Some studies have shown that cannabis can trigger a temporary psychotic episode, which may increase the risk of developing a psychotic disorder later.[42]

The impact of cannabis on depression is less clear. Some studies suggest a potential increase in depression risk among adolescents who use cannabis, though findings are inconsistent across studies.[42]

Adverse effects

American medical hashish

Medical use

There is insufficient data to draw strong conclusions about the safety of medical cannabis.[43]Typically, adverse effects of medical cannabis use are not serious;[6]they include tiredness, dizziness, increased appetite, and cardiovascular and psychoactive effects. Other effects can include impaired short-term memory; impaired motor coordination; altered judgment; and paranoia or psychosis at high doses.[44]Tolerance to these effects develops over a period of days or weeks. The amount of cannabis normally used for medicinal purposes is not believed to cause any permanent cognitive impairment in adults, though long-term treatment in adolescents should be weighed carefully as they are more susceptible to these impairments. Withdrawal symptoms are rarely a problem with controlled medical administration of cannabinoids. The ability to drive vehicles or to operate machinery may be impaired until a tolerance is developed.[25]Although supporters of medical cannabis say that it is safe,[43]further research is required to assess the long-term safety of its use.[27][45]

Cognitive effects

Further information:long-term effects of cannabis

Recreational use of cannabis is associated with cognitive deficits, especially for those who begin to use cannabis in adolescence. As of 2021there is a lack of research into long-term cognitive effects of medical use of cannabis, but one 12-month observational study reported that "MC patients demonstrated significant improvements on measures ofexecutive functionand clinical state over the course of 12 months ".[46]

Impact on psychosis

Exposure to THC can cause acute transient psychotic symptoms in healthy individuals and people with schizophrenia.[16]

A 2007 meta analysis concluded that cannabis use reduced the average age of onset of psychosis by 2.7 years relative to non-cannabis use.[47]A 2005 meta analysis concluded that adolescent use of cannabis increases the risk of psychosis, and that the risk is dose-related.[48]A 2004 literature review on the subject concluded that cannabis use is associated with a two-fold increase in the risk of psychosis, but that cannabis use is "neither necessary nor sufficient" to cause psychosis.[49]A French review from 2009 came to a conclusion that cannabis use, particularly that before age 15, was a factor in the development of schizophrenic disorders.[50]

Pharmacology

ThegenusCannabiscontains two species which produce useful amounts of psychoactive cannabinoids:Cannabis indicaandCannabis sativa,which are listed as Schedule I medicinal plants in the US;[6]a third species,Cannabis ruderalis,has few psychogenic properties.[6]Cannabis contains more than 460 compounds;[9]at least 80 of these arecannabinoids[51][52]–chemical compoundsthat interact withcannabinoid receptorsin the brain.[6]As of 2012, more than 20 cannabinoids were being studied by the U.S. FDA.[53]

The most psychoactive cannabinoid found in the cannabis plant istetrahydrocannabinol(or delta-9-tetrahydrocannabinol, commonly known as THC).[9]Other cannabinoids includedelta-8-tetrahydrocannabinol,cannabidiol(CBD),cannabinol(CBN),cannabicyclol(CBL),cannabichromene(CBC) andcannabigerol(CBG); they have less psychotropic effects than THC, but may play a role in the overall effect of cannabis.[9]The most studied are THC, CBD and CBN.[54]

CB1 and CB2 are the primary cannabinoid receptors responsible for several of the effects of cannabinoids, although other receptors may play a role as well. Both belong to a group of receptors called G protein-coupled receptors (GPCRs). CB1 receptors are found in very high levels in the brain and are thought to be responsible for psychoactive effects.[55]CB2 receptors are found peripherally throughout the body and are thought to modulate pain and inflammation.[56]

Absorption

Cannabinoid absorption is dependent on its route of administration.

Inhaled and vaporized THC have similar absorption profiles to smoked THC, with abioavailabilityranging from 10 to 35%. Oral administration has the lowest bioavailability of approximately 6%, variable absorption depending on the vehicle used, and the longest time to peak plasma levels (2 to 6 hours) compared to smoked or vaporized THC.[57]

Similar to THC, CBD has poor oral bioavailability, approximately 6%. The low bioavailability is largely attributed to significant first-pass metabolism in the liver and erratic absorption from the gastrointestinal tract. However, oral administration of CBD has a faster time to peak concentrations (2 hours) than THC.[57]

Due to the poor bioavailability of oral preparations, alternative routes of administration have been studied, including sublingual and rectal. These alternative formulations maximize bioavailability and reduce first-pass metabolism. Sublingual administration in rabbits yielded bioavailability of 16% and time to peak concentration of 4 hours.[58]Rectal administration in monkeys doubled bioavailability to 13.5% and achieved peak blood concentrations within 1 to 8 hours after administration.[59]

Distribution

Like cannabinoid absorption, distribution is also dependent on route of administration. Smoking and inhalation of vaporized cannabis have better absorption than do other routes of administration, and therefore also have more predictable distribution.[59][60]THC is highly protein bound once absorbed, with only 3% found unbound in the plasma. It distributes rapidly to highly vascularized organs such as the heart, lungs, liver, spleen, and kidneys, as well as to various glands. Low levels can be detected in the brain, testes, and unborn fetuses, all of which are protected from systemic circulation via barriers.[61]THC further distributes into fatty tissues a few days after administration due to its high lipophilicity, and is found deposited in the spleen and fat after redistribution.[60][62][63]

Metabolism

Delta-9-THC is the primary molecule responsible for the effects of cannabis. Delta-9-THC is metabolized in the liver and turns into 11-OH-THC.[64]11-OH-THC is the first metabolic product in this pathway. Both Delta-9-THC and 11-OH-THC are psychoactive. The metabolism of THC into 11-OH-THC plays a part in the heightened psychoactive effects of edible cannabis.[65]

Next, 11-OH-THC is metabolized in the liver into 11-COOH-THC, which is the second metabolic product of THC.[66]11-COOH-THC is not psychoactive.[64]

Ingestion of edible cannabis products lead to a slower onset of effect than the inhalation of it because the THC travels to the liver first through the blood before it travels to the rest of the body. Inhaled cannabis can result in THC going directly to the brain, where it then travels from the brain back to the liver in recirculation for metabolism.[64]Eventually, both routes of metabolism result in the metabolism of psychoactive THC to inactive 11-COOH-THC.

Excretion

Due to substantial metabolism of THC and CBD, their metabolites are excreted mostly viafeces,rather than by urine.[57][67]After delta-9-THC is hydroxylated into 11-OH-THC via CYP2C9, CYP2C19, and CYP3A4, it undergoes phase II metabolism into more than 30 metabolites, a majority of which are products ofglucuronidation.Approximately 65% of THC is excreted in feces and 25% in the urine, while the remaining 10% is excreted by other means.[57]The terminal half-life of THC is 25 to 36 hours,[68]whereas for CBD it is 18 to 32 hours.[67]

CBD is hydroxylated by P450 liver enzymes into 7-OH-CBD. Its metabolites are products of primarily CYP2C19 and CYP3A4 activity, with potential activity of CYP1A1, CYP1A2, CYP2C9, and CYP2D6.[69]Similar to delta-9-THC, a majority of CBD is excreted in feces and some in the urine.[57]The terminal half-life is approximately 18–32 hours.[70]

Administration

Illustrating various forms of medicinal cannabis

Smokinghas been the means of administration of cannabis for many users, but it is not suitable for the use of cannabis as a medicine.[71]It was the most common method of medical cannabis consumption in the US as of 2013.[6]It is difficult to predict the pharmacological response to cannabis because concentration of cannabinoids varies widely, as there are different ways of preparing it for consumption (smoked, applied as oils, eaten, infused into other foods, or drunk) and a lack of production controls.[6]The potential for adverse effects from smoke inhalation makes smoking a less viable option than oral preparations.[71]Cannabis vaporizershave gained popularity because of a perception among users that fewer harmful chemicals are ingested when components are inhaled via aerosol rather than smoke.[6]Cannabinoid medicines are available in pill form (dronabinolandnabilone) and liquid extracts formulated into an oromucosal spray (nabiximols).[6]Oral preparations are "problematic due to the uptake of cannabinoids into fatty tissue, from which they are released slowly, and the significant first-pass liver metabolism, which breaks down Δ9THC and contributes further to the variability of plasma concentrations".[71]

The US Food and Drug Administration (FDA) has not approved smoked cannabis for any condition or disease, as it deems that evidence is lacking concerning safety and efficacy.[72]The FDA issued a 2006 advisory againstsmokedmedical cannabis stating: "marijuana has a high potential for abuse, has no currently accepted medical use in treatment in the United States, and has a lack of accepted safety for use under medical supervision."[72]

History

Main article:History of medical cannabis

Ancient

Cannabis, calledmáMa(meaning "hemp; cannabis; numbness" ) ordàmáĐại ma(with "big; great" ) in Chinese, was used inTaiwanfor fiber starting about 10,000 years ago.[73]The botanistHui-lin Liwrote that in China, "The use of Cannabis in medicine was probably a very early development. Since ancient humans used hemp seed as food, it was quite natural for them to also discover the medicinal properties of the plant."[74]EmperorShen-Nung,who was also a pharmacologist, wrote a book on treatment methods in 2737 BCE that included the medical benefits of cannabis. He recommended the substance for many ailments, including constipation, gout, rheumatism, and absent-mindedness.[75]Cannabis is one of the50 "fundamental" herbsintraditional Chinese medicine.[76]

TheEbers Papyrus(c. 1550 BCE) fromAncient Egyptdescribes medical cannabis.[77]The ancient Egyptians used hemp (cannabis) insuppositoriesfor relieving the pain ofhemorrhoids.[78]

Surviving texts fromancient Indiaconfirm that cannabis' psychoactive properties were recognized, and doctors used it for treating a variety of illnesses and ailments, including insomnia, headaches, gastrointestinal disorders, and pain, including during childbirth.[79]

TheAncient Greeksused cannabis to dress wounds and sores on their horses,[80]and in humans, dried leaves of cannabis were used to treat nose bleeds, and cannabis seeds were used to expel tapeworms.[80]

In themedieval Islamic world,Arabic physiciansmade use of thediuretic,antiemetic,antiepileptic,anti-inflammatory,analgesicandantipyreticproperties ofCannabis sativa,and used it extensively as medication from the 8th to 18th centuries.[81]

Landrace strains

Evolution of cultivated cannabis strains. Thecultivar,Cannabis ruderalis,still grows wild today.

Cannabis seeds may have been used for food, rituals or religious practices in ancient Europe and China.[82]: 19–22 Harvesting the plant led to the spread of cannabis throughoutEurasiaabout 10,000 to 5,000 years ago, with further distribution to theMiddle Eastand Africa about 2,000 to 500 years ago.[82]: 18–19 Alandracestrainof cannabis developed over centuries.[83]They are cultivars of the plant that originated in one specific region.

Widely cultivated strains of cannabis, such as "Afghani" or "Hindu Kush", are indigenous to thePakistanandAfghanistanregions, while "Durban Poison" is native to Africa.[82]: 45–48 There are approximately 16 landrace strains of cannabis identified from Pakistan, Jamaica, Africa, Mexico, Central America and Asia.[84]

Modern

An Irish physician,William Brooke O'Shaughnessy,is credited with introducing cannabis to Western medicine.[85]O'Shaughnessy discovered cannabis in the 1830s while living abroad inIndia,where he conducted numerous experiments investigating the drug's medical utility (noting in particular itsanalgesicandanticonvulsanteffects).[86]He returned toEnglandwith a supply of cannabis in 1842, after which its use spread through Europe and the United States.[87]In 1845 French physicianJacques-Joseph Moreaupublished a book about the use of cannabis in psychiatry.[88]In 1850 cannabis was entered into theUnited States Pharmacopeia.[86]An anecdotal report ofCannabis indicaas a treatment fortetanusappeared inScientific Americanin 1880.[89]

The use of cannabis in medicine began to decline by the end of the 19th century, due to difficulty in controlling dosages and the rise in popularity of synthetic andopium-derived drugs.[87]Also, the advent of the hypodermicsyringeallowed these drugs to be injected for immediate effect, in contrast to cannabis which is not water-soluble and therefore cannot be injected.[87]

In the United States, the medical use of cannabis further declined with the passage of theMarihuana Tax Act of 1937,which imposed new regulations and fees on physicians prescribing cannabis.[90]Cannabis was removed from the U.S. Pharmacopeia in 1941, and officially banned for any use with the passage of theControlled Substances Actof 1970.[87]

Cannabis began to attract renewed interest as medicine in the 1970s and 1980s, in particular due to its use by cancer and AIDS patients who reported relief from the effects ofchemotherapyandwasting syndrome.[91]In 1996,Californiabecame the first U.S. state to legalize medical cannabis in defiance of federal law.[92]In 2001,Canadabecame the first country to adopt a system regulating the medical use of cannabis.[93]

  • The use of cannabis, at least as fiber, has been shown to go back at least 10,000 years in Taiwan. "Dà má" (Pinyin pronunciation) is the Chinese expression for cannabis, the first character meaning "big" and the second character meaning "hemp".
    The use of cannabis, at least as fiber, has been shown to go back at least 10,000 years inTaiwan."Dà má" (Pinyinpronunciation) is the Chinese expression for cannabis, the first character meaning "big" and the second character meaning "hemp".
  • Cannabis indica fluid extract, American Druggists Syndicate, pre-1937
    Cannabis indicafluid extract, American Druggists Syndicate, pre-1937
  • An advertisement for cannabis americana distributed by a pharmacist in New York in 1917
    An advertisement forcannabis americanadistributed by a pharmacist in New York in 1917
  • The Ebers Papyrus (c. 1550 BCE) from Ancient Egypt has a prescription for medical marijuana applied directly for inflammation.
    TheEbers Papyrus(c. 1550 BCE) from Ancient Egypt has a prescription for medical marijuana applied directly for inflammation.

Society and culture

See also:Legality of cannabis by country
Map of world medical cannabis laws
Legal status of (whole-plant) medical cannabis worldwide(onlyde jure;may not reflect actual access in these countries)
Legal as authorized by a physician
Legal for any use (no prescription required)
See alsocountries that have decriminalized or where enforcement is limited.

Countries that have legalized the medical use of cannabis includeArgentina,[94]Australia,[95]Brazil,[96]Canada,[97]Chile,[97]Colombia,[97]Costa Rica,[98]Croatia,[99]Cyprus,[100]Czech Republic,[97]Finland,[101]Germany,[102]Greece,[103]Israel,[104]Italy,[105]Jamaica,[106]Lebanon,[107]Luxembourg,[108]Malta,[109]Morocco,[110]theNetherlands,[97]New Zealand,[111]North Macedonia,[112]Panama,[113]Peru,[114]Poland,[115]Portugal,[116]Rwanda,[117]Sri Lanka,[118]Switzerland,[119]Thailand,[120]theUnited Kingdom,[121]andUruguay.[97]Other countries have more restrictive laws that allow only the use of isolated cannabinoid drugs such asSativexorEpidiolex.[122][123]Countries with the most relaxed policies include Canada,[124]the Netherlands,[97]Thailand,[125]and Uruguay,[97]where cannabis can be purchased without need for a prescription. InMexico,THC content of medical cannabis is limited to one percent.[126]In theUnited States,the legality of medical cannabis varies by state.[13]

However, in many of these countries, access may not always be possible under the same conditions.

International law

See also:Removal of cannabis and cannabis resin from Schedule IV of the Single Convention on narcotic drugs, 1961

Cannabis and its derivatives are subject to regulation under threeUnited Nationsdrug control treaties:the 1961Single Convention on Narcotic Drugs,the 1971Convention on Psychotropic Substances,and the 1988Convention Against Illicit Traffic in Narcotic Drugs and Psychotropic Substances.[127]

Cannabis and cannabis resin are classified as a Schedule I drug under the Single Convention treaty, meaning that medical use is considered "indispensible for the relief of pain and suffering" but that it is considered to be an addictive medication with risks of abuse.[128]Countries have an obligation to provide access and sufficient availability of drugs listed in Schedule I for the purposes of medical uses.[129][130]

Prior to December 2020 cannabis and cannabis resin were also included in Schedule IV, a more restrictive level of control, which is for only the most dangerous drugs such as heroin and fentanyl.[131]They were removed after an independent scientific assessment by theWorld Health Organizationin 2018-1029.

Member nations of theUN Commission on Narcotic Drugsvoted 27–25 to remove it from Schedule IV on 2 December 2020,[132]following aWorld Health Organizationrecommendation for removal in January 2019.[133][134]

United States

See also:Medical cannabis in the United States

In the United States, the use of cannabis for medical purposes is legal in 38 states, four out of five permanently inhabitedU.S. territories,and theDistrict of Columbia.[13]An additional 10 states have more restrictive laws allowing the use of low-THC products.[13]Cannabis remains illegal at the federal level under theControlled Substances Act,which classifies it as a Schedule I drug with a high potential for abuse and no accepted medical use. In December 2014, however, theRohrabacher–Farr amendmentwas signed into law, prohibiting theJustice Departmentfrom prosecuting individuals acting in accordance with state medical cannabis laws.[135]

In the US, the FDA has approved two oral cannabinoids for use as medicine in 1985:[136]dronabinol(pure delta-9-THC; brand name Marinol) andnabilone(asynthetic neocannabinoid;brand name Cesamet).[6]In the US, they are both listed as Schedule II, indicating high potential for side effects and addiction.[53][137]

Economics

Distribution

Medical marijuana dispensary in Denver, Colorado

The method of obtaining medical cannabis varies by region and by legislation. In the US, most consumers grow their own or buy it fromcannabis dispensariesin states where it is legal.[6][138]Marijuana vending machinesfor selling or dispensing cannabis are in use in the United States and are planned to be used in Canada.[139]In 2014, the startup Meadow began offering on-demand delivery of medical marijuana in the San Francisco Bay Area, through their mobile app.[140]

Almost 70% of medical cannabis is exported from the United Kingdom, according to a 2017 United Nations report, with much of the remaining amount coming from Canada and the Netherlands.[141]

Insurance

In the United States, health insurance companies may not pay for a medical marijuana prescription as theFood and Drug Administrationmust approve any substance for medicinal purposes. Before this can happen, the FDA must first permit the study of the medical benefits and drawbacks of the substance, which it has not done since it was placed on Schedule I of the Controlled Substances Act in 1970. Therefore, all expenses incurred fulfilling a medical marijuana prescription will possibly be incurred as out-of-pocket.[142]However, theNew Mexico Court of Appealshas ruled thatworkers' compensationinsurance must pay for prescribed marijuana as part of the state's Medical Cannabis Program.[143]

Positions of medical organizations

Medical organizations that have issued statements in support of allowing access to medical cannabis include theAmerican Nurses Association,[10]American Public Health Association,[144]American Medical Student Association,[145]National Multiple Sclerosis Society,[146]Epilepsy Foundation,[147]andLeukemia & Lymphoma Society.[148]

Organizations that oppose the legalization of medical cannabis include theAmerican Academy of Pediatrics(AAP)[12]andAmerican Psychiatric Association.[149]However, the AAP also supports rescheduling for the purpose of facilitating research.[12]

TheAmerican Medical Association[150]andAmerican College of Physicians[151]do not take a position on the legalization of medical cannabis, but have called for the Schedule I classification to be reviewed. TheAmerican Academy of Family Physicians[11]andAmerican Society of Addiction Medicine[152]also do not take a position, but do support rescheduling to better facilitate research. TheAmerican Heart Associationsays that "many of the concerning health implications of cannabis include cardiovascular diseases" but that it supports rescheduling to allow "more nuanced... marijuana legislation and regulation" and to "reflect the existing science behind cannabis".[153]TheAmerican Cancer Society[154]andAmerican Psychological Association[155]have noted the obstacles that exist for conducting research on cannabis, and have called on the federal government to better enable scientific study of the drug.

Cancer Research UKsay that while cannabis is being studied for therapeutic potential, "claims that there is solid" proof "that cannabis or cannabinoids can cure cancer is highly misleading to patients and their families, and builds a false picture of the state of progress in this area".[156]

Nonproprietary names

There are threeInternational Nonproprietary Name(INN) granted for cannabinoids: two plant-derivedphytocannabinoidsand oneneocannabinoid:

  • Dronabinolis the INN for delta-9-THC[157][158](there is a common confusion according to which the word "dronabinol" would only refer to synthetic delta-9-THC, which is incorrect[159]).
  • Cannabidiolis also the official INN for the molecule, granted in 2017.[160]
  • Nabiloneis the INN for a synthetic cannabinoid analog (not present inCannabisplants).

Nabiximolsis the generic name (but not recognized as an INN) of a mixture of Cannabidiol and Dronabinol. Its most common form is the oromucosal spray derived from two strains ofCannabis sativaand containing THC and CBD traded under the brand name Sativex®.[53]It is not approved in the United States, but is approved in several European countries, Canada, and New Zealand as of 2013.[6]

Generic
name 		Brand
name(s) 		Country (non-exhaustive) Licensed indications
Nabilone Cesamet U.S., Canada Antiemetic(treatment of nausea or vomiting) associated with chemotherapy that has failed to respond adequately to conventional therapy[6]
Dronabinol Marinol
Syndros U.S. Anorexia associated with AIDS–related weight loss[6]
Nabiximols Sativex Canada, New Zealand,
majority of the EU[161] 		Limited treatment for spasticity and neuropathic pain associated withmultiple sclerosisand intractable cancer pain.[6]

As anantiemetic,these medications are usually used when conventional treatment for nausea and vomiting associated with cancer chemotherapy fail to work.[6]

Nabiximolsis used for treatment of spasticity associated with MS when other therapies have not worked, and when an initial trial demonstrates "meaningful improvement".[6]Trials for FDA approval in the US are underway.[6]It is also approved in several European countries for overactive bladder andvomiting.[53]When sold under the trade name Sativex as a mouth spray, the prescribed daily dose in Sweden delivers a maximum of 32.4 mg ofTHCand 30 mg ofCBD;mild to moderate dizziness is common during the first few weeks.[162]

Relative to inhaled consumption, peak concentration of oral THC is delayed, and it may be difficult to determine optimal dosage because of variability in patient absorption.[6]

In 1964, Albert Lockhart andManley Westbegan studying the health effects of traditional cannabis use inJamaicancommunities. They developed, and in 1987 gained permission to market, the pharmaceutical "Canasol", one of the first cannabis extracts.[163]

Research

Main article:Medical cannabis research

A 2022 review concluded that "oral, synthetic cannabis products with high THC-to-CBD ratios and sublingual, extracted cannabis products with comparable THC-to-CBD ratios may be associated with short-term improvements in chronic pain and increased risk for dizziness and sedation."[164]

See also

References

  1. ^Murnion B (December 2015)."Medicinal cannabis".Australian Prescriber.38(6): 212–15.doi:10.18773/austprescr.2015.072.PMC4674028.PMID26843715.
  2. ^"What is medical marijuana?".National Institute of Drug Abuse.July 2015.Archivedfrom the original on 17 April 2016.Retrieved19 April2016.The term medical marijuana refers to using the whole unprocessed marijuana plant or its basic extracts to treat a disease or symptom.
  3. ^Sarris J, Sinclair J, Karamacoska D, Davidson M, Firth J (16 January 2020)."Medicinal cannabis for psychiatric disorders: a clinically-focused systematic review".BMC Psychiatry.20(1): 24.doi:10.1186/s12888-019-2409-8.ISSN1471-244X.PMC6966847.PMID31948424.
  4. ^O'Brien K (1 June 2019)."Medicinal Cannabis: Issues of evidence".European Journal of Integrative Medicine.28:114–120.doi:10.1016/j.eujim.2019.05.009.ISSN1876-3820.
  5. ^"Release the strains".Nature Medicine.21(9): 963. September 2015.doi:10.1038/nm.3946.PMID26340110.
  6. ^abcdefghijklmnopqrstuvwBorgelt LM, Franson KL, Nussbaum AM, Wang GS (February 2013)."The pharmacologic and clinical effects of medical cannabis"(PDF).Pharmacotherapy.33(2): 195–209.doi:10.1002/phar.1187.PMID23386598.S2CID8503107.Archived(PDF)from the original on 28 August 2021.Retrieved11 November2017.
  7. ^abcdeWhiting PF, Wolff RF, Deshpande S, Di Nisio M, Duffy S, Hernandez AV, et al. (23 June 2015)."Cannabinoids for Medical Use: A Systematic Review and Meta-analysis".JAMA.313(24): 2456–73.doi:10.1001/jama.2015.6358.hdl:10757/558499.PMID26103030.
  8. ^abWang L, Hong PJ, May C, Rehman Y, Oparin Y, Hong CJ, et al. (9 September 2021)."Medical cannabis or cannabinoids for chronic non-cancer and cancer related pain: a systematic review and meta-analysis of randomised clinical trials".BMJ.374:n1034.doi:10.1136/bmj.n1034.ISSN1756-1833.PMID34497047.Archivedfrom the original on 9 September 2021.Retrieved9 September2021.
  9. ^abcdBen Amar M (April 2006). "Cannabinoids in medicine: A review of their therapeutic potential".Journal of Ethnopharmacology(Review).105(1–2): 1–25.CiteSeerX10.1.1.180.308.doi:10.1016/j.jep.2006.02.001.PMID16540272.
  10. ^abTherapeutic Use of Marijuana and Related Cannabinoids(PDF),American Nurses Association, 2016,archived(PDF)from the original on 21 September 2020,retrieved13 May2018
  11. ^ab"AAFP Releases Marijuana, Cannabinoids Position Paper".American Academy of Family Physicians.20 September 2019.Archivedfrom the original on 28 September 2019.Retrieved6 October2019.
  12. ^abcAmerican Academy of Pediatrics Reaffirms Opposition to Legalizing Marijuana for Recreational or Medical Use,American Academy of Pediatrics, 26 January 2015, archived fromthe originalon 26 April 2018,retrieved30 July2017
  13. ^abcd"State Medical Marijuana Laws".National Conference of State Legislatures.12 September 2022.Archivedfrom the original on 11 December 2018.Retrieved6 October2022.
  14. ^"Marijuana as Medicine".National Institute on Drug Abuse. July 2019.Archivedfrom the original on 17 April 2016.Retrieved19 April2016.
  15. ^abcConsumer Reports (28 April 2016)."Up in Smoke: Does Medical Marijuana Work?".Consumer Reports.Archivedfrom the original on 14 March 2021.Retrieved24 May2016.
  16. ^abSchubart CD, Sommer IE, Fusar-Poli P, de Witte L, Kahn RS, Boks MP (January 2014)."Cannabidiol as a potential treatment for psychosis"(PDF).European Neuropsychopharmacology.24(1): 51–64.doi:10.1016/j.euroneuro.2013.11.002.PMID24309088.S2CID13197304.Archived fromthe original(PDF)on 20 October 2018.Retrieved9 July2016.
  17. ^abcKoppel BS, Brust JC, Fife T, Bronstein J, Youssof S, Gronseth G, et al. (April 2014)."Systematic review: efficacy and safety of medical marijuana in selected neurologic disorders: report of the Guideline Development Subcommittee of the American Academy of Neurology".Neurology.82(17): 1556–1563.doi:10.1212/WNL.0000000000000363.PMC4011465.PMID24778283.
  18. ^abcPratt M, Stevens A, Thuku M, Butler C, Skidmore B, Wieland LS, et al. (December 2019)."Benefits and harms of medical cannabis: a scoping review of systematic reviews".Syst Rev(Systematic review).8(1): 320.doi:10.1186/s13643-019-1243-x.PMC6905063.PMID31823819.
  19. ^abSachs J, McGlade E, Yurgelun-Todd D (October 2015)."Safety and Toxicology of Cannabinoids".Neurotherapeutics.12(4): 735–46.doi:10.1007/s13311-015-0380-8.PMC4604177.PMID26269228.
  20. ^"Sex(ism), Drugs, and Migraines: Distillations Podcast and Transcript, Episode 237".Distillations.Science History Institute.15 January 2019.Archivedfrom the original on 14 March 2021.Retrieved28 August2019.
  21. ^Gilson AM, LeBaron VT, Vyas MB (1 January 2018). "The use of cannabis in response to the opioid crisis: A review of the literature".Nursing Outlook.66(1): 56–65.doi:10.1016/j.outlook.2017.08.012.ISSN0029-6554.PMID28993073.
  22. ^American College of Obstetricians Gynecologists Committee on Obstetric Practice (July 2015). "Committee Opinion No. 637: Marijuana Use During Pregnancy and Lactation".Obstetrics and Gynecology.126(1): 234–38.doi:10.1097/01.AOG.0000467192.89321.a6.PMID26241291.
  23. ^Diep C, Tian C, Vachhani K, Won C, Wijeysundera DN, Clarke H, et al. (24 November 2021)."Recent cannabis use and nightly sleep duration in adults: a population analysis of the NHANES from 2005 to 2018".Regional Anesthesia & Pain Medicine.47(2): 100–104.doi:10.1136/rapm-2021-103161.ISSN1098-7339.PMID34873024.
  24. ^Walsh JH, Maddison KJ, Rankin T, Murray K, McArdle N, Ree MJ, et al. (12 November 2021)."Treating insomnia symptoms with medicinal cannabis: a randomized, crossover trial of the efficacy of a cannabinoid medicine compared with placebo".SLEEP.44(11).doi:10.1093/sleep/zsab149.ISSN0161-8105.PMC8598183.PMID34115851.
  25. ^abGrotenhermen F, Müller-Vahl K (July 2012)."The therapeutic potential of cannabis and cannabinoids".Deutsches Ärzteblatt International.109(29–30): 495–501.doi:10.3238/arztebl.2012.0495.PMC3442177.PMID23008748.
  26. ^Bowles DW, O'Bryant CL, Camidge DR, Jimeno A (July 2012). "The intersection between cannabis and cancer in the United States".Critical Reviews in Oncology/Hematology(Review).83(1): 1–10.doi:10.1016/j.critrevonc.2011.09.008.PMID22019199.
  27. ^abWang T, Collet JP, Shapiro S, Ware MA (June 2008)."Adverse effects of medical cannabinoids: a systematic review".CMAJ(Review).178(13): 1669–78.doi:10.1503/cmaj.071178.PMC2413308.PMID18559804.
  28. ^Jordan K, Sippel C, Schmoll HJ (September 2007)."Guidelines for antiemetic treatment of chemotherapy-induced nausea and vomiting: past, present, and future recommendations"(PDF).The Oncologist(Review).12(9): 1143–50.doi:10.1634/theoncologist.12-9-1143.PMID17914084.S2CID17612434.Archived fromthe original(PDF)on 7 March 2019.
  29. ^Nicolson SE, Denysenko L, Mulcare JL, Vito JP, Chabon B (May–June 2012). "Cannabinoid hyperemesis syndrome: a case series and review of previous reports".Psychosomatics(Review, case series).53(3): 212–19.doi:10.1016/j.psym.2012.01.003.PMID22480624.
  30. ^Phillips RS, Friend AJ, Gibson F, Houghton E, Gopaul S, Craig JV, et al. (February 2016)."Antiemetic medication for prevention and treatment of chemotherapy-induced nausea and vomiting in childhood"(PDF).The Cochrane Database of Systematic Reviews.2016(2): CD007786.doi:10.1002/14651858.CD007786.pub3.PMC7073407.PMID26836199.Archived(PDF)from the original on 30 June 2021.Retrieved23 September2019.
  31. ^Lutge EE, Gray A, Siegfried N (April 2013). "The medical use of cannabis for reducing morbidity and mortality in patients with HIV/AIDS".The Cochrane Database of Systematic Reviews(Review).4(4): CD005175.doi:10.1002/14651858.CD005175.pub3.PMID23633327.
  32. ^Aviram J, Samuelly-Leichtag G (September 2017)."Efficacy of Cannabis-Based Medicines for Pain Management: A Systematic Review and Meta-Analysis of Randomized Controlled Trials".Pain Physician.20(6): E755–96.doi:10.36076/ppj.20.5.E755.PMID28934780.Archivedfrom the original on 30 June 2021.Retrieved12 January2018.
  33. ^Lynch ME, Campbell F (November 2011)."Cannabinoids for treatment of chronic non-cancer pain; a systematic review of randomized trials".British Journal of Clinical Pharmacology(Review).72(5): 735–44.doi:10.1111/j.1365-2125.2011.03970.x.PMC3243008.PMID21426373.
  34. ^Carter GT, Flanagan AM, Earleywine M, Abrams DI, Aggarwal SK, Grinspoon L (August 2011). "Cannabis in palliative medicine: improving care and reducing opioid-related morbidity".The American Journal of Hospice & Palliative Care(Review).28(5): 297–303.doi:10.1177/1049909111402318.PMID21444324.S2CID19980960.
  35. ^Filip Gedin, Sebastian Blomé, Moa Pontén, Maria Lalouni, Jens Fust, Andreé Raquette, et al. (28 November 2022)."Placebo Response and Media Attention in Randomized Clinical Trials Assessing Cannabis-Based Therapies for PainA Systematic Review and Meta-analysis".JAMA Network Open.5(11): e2243848.doi:10.1001/jamanetworkopen.2022.43848.PMC9706362.PMID36441553.
  36. ^Clark PA, Capuzzi K, Fick C (December 2011)."Medical marijuana: medical necessity versus political agenda".Medical Science Monitor(Review).17(12): RA249–61.doi:10.12659/MSM.882116.PMC3628147.PMID22129912.
  37. ^Oreja-Guevara C (October 2012). "[Treatment of spasticity in multiple sclerosis: new perspectives regarding the use of cannabinoids]".Revista de Neurología(Review) (in Spanish).55(7): 421–30.PMID23011861.
  38. ^Commissioner Oo (10 June 2019)."FDA and Marijuana".FDA.Archivedfrom the original on 16 November 2019.Retrieved16 December2019.
  39. ^Black N, Stockings E, Campbell G, Tran LT, Zagic D, Hall WD, et al. (2019)."Cannabinoids for the treatment of mental disorders and symptoms of mental disorders: a systematic review and meta-analysis".Lancet Psychiatry(Systematic review & meta-analysis).6(12): 995–1010.doi:10.1016/S2215-0366(19)30401-8.PMC6949116.PMID31672337.
  40. ^"Anxiety and Cannabis: A Review of Recent Research".Medical Cannabis Research Center.10 April 2023.Retrieved9 April2024.
  41. ^Sarris J, Sinclair J, Karamacoska D, Davidson M, Firth J (16 January 2020)."Medicinal cannabis for psychiatric disorders: a clinically-focused systematic review".BMC Psychiatry.20(1): 24.doi:10.1186/s12888-019-2409-8.ISSN1471-244X.PMC6966847.PMID31948424.
  42. ^abAbuse NI (8 May 2023)."Is there a link between marijuana use and psychiatric disorders? | National Institute on Drug Abuse (NIDA)".nida.nih.gov.Retrieved9 April2024.
  43. ^abWashington TA, Brown KM, Fanciullo GJ (2012). "Chapter 31: Medical Cannabis".Pain.Oxford University Press. p. 165.ISBN978-0-19-994274-9.Proponents of medical cannabis site its safety, but there studies in later years that support that smoking of marijuana is associated with risk for dependence and that THC alters the structures of cells in the brain
  44. ^Gage SH, Hickman M, Zammit S (April 2016)."Association Between Cannabis and Psychosis: Epidemiologic Evidence".Biological Psychiatry.79(7): 549–56.doi:10.1016/j.biopsych.2015.08.001.hdl:1983/b8fb2d3b-5a55-4d07-97c0-1650b0ffc05d.PMID26386480.S2CID1055335.Archivedfrom the original on 26 February 2020.Retrieved11 March2020.
  45. ^Barceloux DG (2012)."Chapter 60: Marijuana (Cannabis sativaL.) and synthetic cannabinoids ".Medical Toxicology of Drug Abuse: Synthesized Chemicals and Psychoactive Plants.John Wiley & Sons. pp. 886–931.ISBN978-0-471-72760-6.Archivedfrom the original on 13 January 2023.Retrieved20 December2015.
  46. ^Sagar KA, Dahlgren MK, Lambros AM, Smith RT, El-Abboud C, Gruber SA (2021)."An Observational, Longitudinal Study of Cognition in Medical Cannabis Patients over the Course of 12 Months of Treatment: Preliminary Results".Journal of the International Neuropsychological Society.27(6): 648–60.doi:10.1017/S1355617721000114.ISSN1355-6177.PMID34261553.S2CID235824932.
  47. ^Large M, Sharma S, Compton MT, Slade T, Nielssen O (June 2011)."Cannabis use and earlier onset of psychosis: a systematic meta-analysis".Archives of General Psychiatry.68(6): 555–61.doi:10.1001/archgenpsychiatry.2011.5.PMID21300939.
  48. ^Semple DM, McIntosh AM, Lawrie SM (March 2005). "Cannabis as a risk factor for psychosis: systematic review".Journal of Psychopharmacology.19(2): 187–94.doi:10.1177/0269881105049040.PMID15871146.S2CID44651274.
  49. ^Arseneault L, Cannon M, Witton J, Murray RM (February 2004)."Causal association between cannabis and psychosis: examination of the evidence".The British Journal of Psychiatry.184(2): 110–17.doi:10.1192/bjp.184.2.110.PMID14754822.
  50. ^Laqueille X (September 2009). "[Is cannabis a vulnerability factor in schizophrenic disorders]" [Is cannabis is a vulnerability factor of schizophrenic disorders?].Archives de Pédiatrie.16(9): 1302–05.doi:10.1016/j.arcped.2009.03.016.PMID19640690.
  51. ^Downer EJ, Campbell VA (January 2010). "Phytocannabinoids, CNS cells and development: a dead issue?".Drug and Alcohol Review(Review).29(1): 91–98.doi:10.1111/j.1465-3362.2009.00102.x.PMID20078688.
  52. ^Burns TL, Ineck JR (February 2006). "Cannabinoid analgesia as a potential new therapeutic option in the treatment of chronic pain".The Annals of Pharmacotherapy(Review).40(2): 251–60.doi:10.1345/aph.1G217.PMID16449552.S2CID6858360.
  53. ^abcdSvrakic DM, Lustman PJ, Mallya A, Lynn TA, Finney R, Svrakic NM (2012)."Legalization, decriminalization & medicinal use of cannabis: a scientific and public health perspective".Missouri Medicine(Review).109(2): 90–98.PMC6181739.PMID22675784.
  54. ^Gordon AJ, Conley JW, Gordon JM (December 2013)."Medical consequences of marijuana use: a review of current literature".Current Psychiatry Reports(Review).15(12): 419.doi:10.1007/s11920-013-0419-7.PMID24234874.S2CID29063282.Archivedfrom the original on 7 August 2019.Retrieved12 July2019.
  55. ^Mackie K (May 2008)."Cannabinoid receptors: where they are and what they do".Journal of Neuroendocrinology.20(Suppl 1): 10–14.doi:10.1111/j.1365-2826.2008.01671.x.PMID18426493.S2CID20161611.
  56. ^Whiteside GT, Lee GP, Valenzano KJ (2007). "The role of the cannabinoid CB2 receptor in pain transmission and therapeutic potential of small molecule CB2 receptor agonists".Current Medicinal Chemistry.14(8): 917–36.doi:10.2174/092986707780363023.PMID17430144.
  57. ^abcdeGaston TE, Friedman D (May 2017). "Pharmacology of cannabinoids in the treatment of epilepsy".Epilepsy & Behavior.Cannabinoids and Epilepsy.70(Pt B): 313–18.doi:10.1016/j.yebeh.2016.11.016.PMID28087250.S2CID3929024.
  58. ^Mannila J, Järvinen T, Järvinen K, Tervonen J, Jarho P (March 2006). "Sublingual administration of Delta9-tetrahydrocannabinol/beta-cyclodextrin complex increases the bioavailability of Delta9-tetrahydrocannabinol in rabbits".Life Sciences.78(17): 1911–14.doi:10.1016/j.lfs.2005.08.025.PMID16266727.
  59. ^abHuestis MA (August 2007)."Human cannabinoid pharmacokinetics".Chemistry & Biodiversity.4(8): 1770–804.doi:10.1002/cbdv.200790152.PMC2689518.PMID17712819.
  60. ^abBadowski ME (September 2017)."A review of oral cannabinoids and medical marijuana for the treatment of chemotherapy-induced nausea and vomiting: a focus on pharmacokinetic variability and pharmacodynamics".Cancer Chemotherapy and Pharmacology.80(3): 441–49.doi:10.1007/s00280-017-3387-5.PMC5573753.PMID28780725.
  61. ^Nahas GG (April 2001). "The pharmacokinetics of THC in fat and brain: resulting functional responses to marihuana smoking".Human Psychopharmacology.16(3): 247–55.doi:10.1002/hup.258.PMID12404577.S2CID30513770.
  62. ^Bridgeman MB, Abazia DT (March 2017)."Medicinal Cannabis: History, Pharmacology, And Implications for the Acute Care Setting".P & T.42(3): 180–88.PMC5312634.PMID28250701.
  63. ^Nahas GG, Sutin KM, Harvey DJ, Agurell S (1999).Marihuana and Medicine.Springer Science & Business Media.ISBN978-1-59259-710-9.Archivedfrom the original on 13 January 2023.Retrieved20 September2020.
  64. ^abc"Human Metabolism of THC".Sapiensoup Blog.21 December 2016.Archivedfrom the original on 26 June 2021.Retrieved1 November2017.
  65. ^"11-Hydroxy-THC - Increased Potency That Explains the Effect of Edibles? – Prof of Pot".profofpot.com.2 July 2016. Archived fromthe originalon 28 June 2021.Retrieved1 November2017.
  66. ^"Toxicology Litigation Support: Marijuana".consultox.com.Archivedfrom the original on 26 June 2021.Retrieved1 November2017.
  67. ^abDevinsky O, Cilio MR, Cross H, Fernandez-Ruiz J, French J, Hill C, et al. (June 2014)."Cannabidiol: pharmacology and potential therapeutic role in epilepsy and other neuropsychiatric disorders".Epilepsia.55(6): 791–802.doi:10.1111/epi.12631.PMC4707667.PMID24854329.
  68. ^Grotenhermen F (1 April 2003). "Pharmacokinetics and pharmacodynamics of cannabinoids".Clinical Pharmacokinetics.42(4): 327–60.doi:10.2165/00003088-200342040-00003.PMID12648025.S2CID25623600.
  69. ^Zendulka O, Dovrtělová G, Nosková K, Turjap M, Šulcová A, Hanuš L, et al. (29 February 2016)."Cannabinoids and Cytochrome P450 Interactions".Current Drug Metabolism.17(3): 206–226.doi:10.2174/1389200217666151210142051.PMID26651971.Archivedfrom the original on 3 July 2021.Retrieved1 November2017.
  70. ^Ohlsson A, Lindgren JE, Andersson S, Agurell S, Gillespie H, Hollister LE (February 1986). "Single-dose kinetics of deuterium-labelled cannabidiol in man after smoking and intravenous administration".Biomedical & Environmental Mass Spectrometry.13(2): 77–83.doi:10.1002/bms.1200130206.PMID2937482.
  71. ^abcCurtis A, Clarke CE, Rickards HE (October 2009)."Cannabinoids for Tourette's Syndrome".The Cochrane Database of Systematic Reviews(Review).2009(4): CD006565.doi:10.1002/14651858.CD006565.pub2.PMC7387115.PMID19821373.
  72. ^ab"Inter-agency advisory regarding claims that smoked marijuana is a medicine"(Press release). fda.gov. 20 April 2006.Archivedfrom the original on 13 October 2012.Retrieved24 December2012.
  73. ^Abel EL (1980)."Cannabis in the Ancient World".Marihuana: the first twelve thousand years.New York City: Plenum Publishers.ISBN978-0-306-40496-2.Archivedfrom the original on 28 June 2021.Retrieved29 October2008.[page needed]
  74. ^Li, Hui-Lin (1974). "An Archaeological and Historical Account of Cannabis in China",Economic Botany28.4:437–48, p. 444.
  75. ^Bloomquist E (1971).Marijuana: The Second Trip.California: Glencoe Press.
  76. ^Wong M (1976).La Médecine chinoise par les plantes.Paris: Tchou.OCLC2646789.[page needed]
  77. ^[unreliable source?]"The Ebers Papyrus The Oldest (confirmed) Written Prescriptions For Medical Marihuana era 1,550 BC".onlinepot.org. Archived fromthe originalon 4 March 2016.Retrieved10 June2008.
  78. ^Pain S (15 December 2007)."The Pharaoh's pharmacists".New Scientist.Reed Business Information Ltd.Archivedfrom the original on 21 May 2008.Retrieved4 September2017.
  79. ^Touw M (1981). "The religious and medicinal uses of Cannabis in China, India and Tibet".Journal of Psychoactive Drugs.13(1): 23–34.doi:10.1080/02791072.1981.10471447.PMID7024492.
  80. ^abButrica JL (2002)."The Medical Use of Cannabis Among the Greeks and Romans"(PDF).Journal of Cannabis Therapeutics.2(2): 51–70.doi:10.1300/J175v02n02_04.Archived fromthe original(PDF)on 11 November 2014.Retrieved8 November2014.
  81. ^Lozano I (2001). "The Therapeutic Use of Cannabis sativa (L.) in Arabic Medicine".Journal of Cannabis Therapeutics.1:63–70.CiteSeerX10.1.1.550.1717.doi:10.1300/J175v01n01_05.
  82. ^abcHolland, Julie, ed. (2010).The Pot Book: A Complete Guide to Cannabis.New York: Simon and Schuster.ISBN978-1-59477-898-8.Archivedfrom the original on 13 January 2023.Retrieved22 April2018.
  83. ^Evert RF, Eichhorn SE (2013).Raven Biology of Plants(8th ed.). New York: W. H. Freeman and Company. pp. 213–17.ISBN978-1-4292-1961-7.
  84. ^Evert RF, Eichhorn SE (2013).Raven Biology of Plants(8th ed.). New York: W.H. Freeman and Company. pp. 501–04.ISBN978-1-4292-1961-7.
  85. ^Alison Mack, Janet Joy (2000).Marijuana As Medicine?: The Science Beyond the Controversy.National Academies Press. pp. 15–.ISBN978-0-309-06531-3.Archivedfrom the original on 13 January 2023.Retrieved20 December2015.
  86. ^abBooth M (2005).Cannabis: A History.New York: St. Martin's Press.ISBN978-0-312-42494-7.
  87. ^abcdGrinspoon L, Bakalar J (1997).Marihuana, the Forbidden Medicine(Revised and expanded ed.). Yale University Press.ISBN978-0-300-07086-6.
  88. ^Hans Bangen:Geschichte der medikamentösen Therapie der Schizophrenie.Berlin 1992, p. 22.
  89. ^Scientific American, "Successful Treatment of Tetanus".Munn & Company. 10 July 1880. p. 25.Archivedfrom the original on 12 January 2023.Retrieved5 June2021.
  90. ^Pacula RP (February 2002)."State Medical Marijuana Laws: Understanding the Laws and Their Limitations"(PDF).Journal of Public Health Policy.23(4): 413–39.CiteSeerX10.1.1.202.2274.doi:10.2307/3343240.JSTOR3343240.PMID12532682.S2CID13389317.Archived(PDF)from the original on 2 March 2021.Retrieved20 March2018.
  91. ^Joy JE, Watson SJ, Benson JA (1999)."Marijuana and Medicine – Assessing the Science Base"(PDF).Washington, D.C.: National Academy Press. Archived fromthe original(PDF)on 23 January 2018.Retrieved28 July2017.
  92. ^"History of Marijuana as Medicine – 2900 BC to Present".ProCon.org.Archivedfrom the original on 15 July 2017.Retrieved27 July2017.
  93. ^"Marijuana's journey to legal health treatment: the Canadian experience".CBC News.17 August 2009.Archivedfrom the original on 14 June 2017.Retrieved27 July2017.
  94. ^Politi D (12 November 2020)."Argentina to Allow Medicinal Marijuana to Be Grown at Home".The New York Times.Archivedfrom the original on 23 January 2023.Retrieved22 January2023.
  95. ^Jolly W (28 February 2018)."Medicinal Marijuana Legal In Australia".Canstar.Archivedfrom the original on 17 July 2018.Retrieved16 July2018.
  96. ^Ponieman N (3 December 2019)."Brazil Regulates Sale Of Medical Marijuana Products".Benzinga.Archivedfrom the original on 14 March 2021.Retrieved10 December2019.
  97. ^abcdefghWilliams S (15 May 2016)."10 Countries (Aside From the U.S.) Where Some Form of Medical Marijuana Is Legal".The Motley Fool.Archivedfrom the original on 11 November 2017.Retrieved5 November2017.
  98. ^"Costa Rica legalizes medicinal marijuana use, hemp growing".Associated Press.2 March 2022.Archivedfrom the original on 7 March 2022.Retrieved22 January2023.
  99. ^Veselica L (15 October 2015)."Croatia legalises marijuana for medical use".Yahoo News.AFP. Archived fromthe originalon 14 March 2021.Retrieved4 November2017.
  100. ^"Cyprus begins to distribute medical cannabis".InCyprus.22 May 2017. Archived fromthe originalon 9 June 2017.Retrieved11 November2017.
  101. ^"Legal status of cannabis in Finland – An overview".Sensi Seeds.Archivedfrom the original on 14 March 2021.Retrieved4 November2017.
  102. ^Senthilingam M (6 March 2017)."Germany joins the global experiment on marijuana legalization".CNN.com.Archivedfrom the original on 14 March 2021.Retrieved4 November2017.
  103. ^Revesz R (3 July 2017)."Greece legalises marijuana for medical purposes".The Independent.Archivedfrom the original on 12 May 2022.Retrieved4 November2017.
  104. ^Schwartz Y (24 August 2017)."How the Booming Israeli Weed Industry Is Changing American Pot".Rollingstone.com.Archivedfrom the original on 4 November 2017.Retrieved4 November2017.
  105. ^Samuels G (26 July 2016)."Italian army aims to produce" the best-quality "medical marijuana after finding current batches deficient".The Independent.Archivedfrom the original on 12 May 2022.Retrieved4 November2017.
  106. ^Bud M (19 March 2018)."Jamaica's Kaya Farms Becomes First Medical Marijuana Dispensary To Open".marijuana.com.Archivedfrom the original on 14 March 2021.Retrieved16 July2018.
  107. ^"Lebanon Legalizes Cannabis Farming for Medicinal Use".The New York Times.Reuters. 21 April 2020.Archivedfrom the original on 23 April 2020.Retrieved25 April2020.
  108. ^Pritchard H (29 June 2018)."Cannabis for medical use legalised in Luxembourg".Luxembourg Times.Archivedfrom the original on 29 June 2018.Retrieved8 July2018.
  109. ^Pace M (27 March 2018)."Malta has officially legalised medical cannabis".Malta Today.Archivedfrom the original on 1 July 2021.Retrieved24 August2018.
  110. ^"Morocco: Bill to legalise cannabis enters into force".Middle East Monitor.31 July 2021.Archivedfrom the original on 11 August 2021.Retrieved22 January2023.
  111. ^Ainge Roy E (11 December 2018)."New Zealand passes laws to make medical marijuana widely available".The Guardian.Archivedfrom the original on 13 January 2019.Retrieved20 January2019.
  112. ^Marusic SJ (1 June 2016)."Macedonia Allows Medical Marijuana in Pharmacies".Balkan Insight.Archivedfrom the original on 31 October 2017.Retrieved4 November2017.
  113. ^"El gobierno de Panamá legalizó el uso medicinal y terapéutico del cannabis".Infobae.14 October 2021.Archivedfrom the original on 17 October 2021.Retrieved22 January2023.
  114. ^Collyns D (20 October 2017)."Peru legalises medical marijuana in move spurred by mother's home lab".The Guardian.Archivedfrom the original on 3 July 2018.Retrieved4 November2017.
  115. ^"Medical use of cannabis officially legal in Poland".Radio Poland.PAP. 11 February 2017. Archived fromthe originalon 14 March 2021.Retrieved4 November2017.
  116. ^Lamers M (21 June 2018)."Portugal passes medical cannabis law, opens domestic market".Marijuana Business Daily.Archivedfrom the original on 5 September 2019.Retrieved24 August2018.
  117. ^Mwai C (29 June 2021)."10 things to know after Rwanda gives the green light for medical marijuana".The New Times.Archivedfrom the original on 23 January 2023.Retrieved22 January2023.
  118. ^South Asia Regional Profile(PDF),United Nations Office on Drugs and Crime, 15 September 2005,archived(PDF)from the original on 23 September 2020,retrieved2 February2019
  119. ^"Switzerland to legalise medicinal cannabis from Monday".The Local.28 July 2022. Archived fromthe originalon 9 August 2022.Retrieved22 January2023.
  120. ^Mosbergen D (25 December 2018)."Thailand Approves Medical Marijuana In Regional First".HuffPost.Archivedfrom the original on 19 January 2019.Retrieved20 January2019.
  121. ^"Medicinal cannabis products to be legalised".BBC.26 July 2018.Archivedfrom the original on 28 July 2018.Retrieved28 July2018.
  122. ^"Sativex (delta-9-tetrahydrocannabinol and cannabidiol)".GW Pharmaceuticals.Archived fromthe originalon 10 December 2017.Retrieved5 November2017.
  123. ^Medical use of cannabis and cannabinoids(PDF),European Monitoring Centre for Drugs and Drug Addiction, December 2018,archived(PDF)from the original on 28 June 2021,retrieved11 December2019
  124. ^Sapra B (20 June 2018)."Canada becomes second nation in the world to legalize marijuana".CNN.Archivedfrom the original on 12 February 2019.Retrieved3 July2018.
  125. ^Ives M (10 November 2022)."Weed Is Now Legal in Thailand. How Long Will the High Times Last?".The New York Times.Archived fromthe originalon 27 November 2022.Retrieved22 January2023.
  126. ^Janikian M (14 September 2017)."Legal Pot In Mexico: Everything You Need to Know".Rolling Stone.Archivedfrom the original on 11 November 2017.Retrieved5 November2017.
  127. ^Habibi R, Hoffman SJ (March 2018)."Legalizing Cannabis Violates the UN Drug Control Treaties, But Progressive Countries Like Canada Have Options".Ottawa Law Review.49(2).Archivedfrom the original on 28 August 2021.Retrieved8 January2021.
  128. ^"Classification of controlled drugs".European Monitoring Centre for Drugs and Drug Addiction.Archivedfrom the original on 8 January 2021.Retrieved7 January2021.
  129. ^International Narcotics Control Board(2010).Report of the International Narcotics Control Board on the Availability of Internationally Controlled Drugs: Ensuring Adequate Access for Medical and Scientific Purposes(PDF).Vienna:United Nations.
  130. ^International Centre on Human Rights and Drug Policy (University of Essex),United Nations Development Programme,Joint United Nations Programme on HIV/AIDS,Office of the United Nations High Commissioner for Human Rights,World Health Organization(2012)."Obligations arising from human rights standards: Access to controlled substances as medicines".International Guidelines on Human Rights and Drug Policy.Retrieved30 August2024.{{cite web}}:|last=has generic name (help)CS1 maint: multiple names: authors list (link)
  131. ^Kaur H (2 December 2020)."The UN removes cannabis from a list of the most dangerous substances".CNN.Archivedfrom the original on 12 December 2020.Retrieved7 January2021.
  132. ^Kwai I (2 December 2020)."U.N. Reclassifies Cannabis as a Less Dangerous Drug".The New York Times.Archivedfrom the original on 10 January 2021.Retrieved7 January2021.
  133. ^"WHO recommends rescheduling of cannabis".European Monitoring Centre for Drugs and Drug Addiction.25 March 2019.Archivedfrom the original on 28 December 2020.Retrieved7 January2021.
  134. ^Georgiou A (8 February 2019)."WHO Recommends Rescheduling Cannabis in International Law for First Time in History".Newsweek.Archivedfrom the original on 20 December 2020.Retrieved7 January2021.
  135. ^Ingraham C (13 June 2017)."Jeff Sessions personally asked Congress to let him prosecute medical-marijuana providers".The Washington Post.Archivedfrom the original on 4 July 2017.Retrieved9 July2017.
  136. ^Clark A (16 May 2006).""New" Pot Pill For Chemo Patients ".CBS News.Associated Press.Archivedfrom the original on 28 July 2017.Retrieved26 July2017.
  137. ^"Final Rule: Placement of FDA-Approved Products of Oral Solutions Containing Dronabinol [(-)-delta-9-trans-tetrahydrocannabinol (delta-9-THC)] in Schedule II".U.S. Department of Justice.Archived fromthe originalon 28 March 2018.Retrieved2 February2018.
  138. ^Timothy B. Wheeler (11 October 2014)."Medical marijuana fees stir debate in Maryland".The Baltimore Sun.Archived fromthe originalon 16 October 2014.Retrieved12 October2014.
  139. ^Blackwell, Tom (16 October 2013)."The pot vending machine's first foreign market? Canada, of course," a seed for the rest of the world "".National Post.Retrieved4 December2013.
  140. ^"Uber-For-Weed Startup Meadow Lights Up In San Francisco".TechCrunch.AOL. 14 October 2014.Archivedfrom the original on 23 January 2016.Retrieved22 January2016.
  141. ^"The UK is the world's largest producer of legal Cannabis, UN body finds".The Independent.7 March 2018.Archivedfrom the original on 12 May 2022.Retrieved7 December2020.
  142. ^Clark TB (10 February 2015)."The Medical Marijuana Debate".Compliance Corner.Wolters Kluwer Financial Services. Archived fromthe originalon 26 February 2015.Retrieved26 February2015.
  143. ^Peters J (29 June 2015)."Court: Employer can't block workers' comp for medical marijuana".NM Political Report.Archivedfrom the original on 30 June 2015.Retrieved30 June2015.
  144. ^"Resolution on Medical Marijuana".druglibrary.org.Archivedfrom the original on 19 October 2017.Retrieved30 July2017.
  145. ^"House of Delegates 2017, Resolution: A8"(PDF).amsa.org.American Medical Student Association.Archived(PDF)from the original on 1 August 2017.Retrieved30 July2017.
  146. ^"Medical Marijuana (Cannabis) FAQs".National Multiple Sclerosis Society.Archivedfrom the original on 31 July 2017.Retrieved30 July2017.
  147. ^Gattone PM, Lammert W (20 February 2014)."Epilepsy Foundation Calls for Increased Medical Marijuana Access and Research"(Press release). Washington, D.C.: Epilepsy Foundation.Archivedfrom the original on 31 July 2017.Retrieved30 July2017.
  148. ^"Medical Marijuana Use and Research"(PDF).maps.org.Leukemia & Lymphoma Society.Archived(PDF)from the original on 19 October 2017.Retrieved30 July2017.
  149. ^"Position Statement on Marijuana as Medicine"(PDF).American Psychiatric Association.Archived fromthe original(PDF)on 31 July 2017.Retrieved30 July2017.
  150. ^Use of Cannabis for Medicinal Purposes(PDF),American Medical Association, 2009, archived fromthe original(PDF)on 19 October 2017,retrieved1 July2017
  151. ^Supporting Research into the Therapeutic Role of Marijuana(PDF),American College of Physicians, February 2016,archived(PDF)from the original on 3 August 2020,retrieved1 August2017
  152. ^"ASAM Issues New Public Policy Statement on Cannabis"(Press release). Rockville, MD: American Society of Addiction Medicine. 13 October 2020. Archived fromthe originalon 8 November 2020.Retrieved1 November2020.
  153. ^American Heart Association (5 August 2020)."Medical Marijuana, Recreational Cannabis, and Cardiovascular Health".Circulation.142(10): e131–52.doi:10.1161/CIR.0000000000000883.PMID32752884.
  154. ^"Marijuana and Cancer".American Cancer Society.Archivedfrom the original on 22 June 2017.Retrieved12 July2017.
  155. ^"Marijuana research: Overcoming the barriers".American Psychological Association.14 September 2017. Archived fromthe originalon 4 October 2017.Retrieved9 October2017.
  156. ^Arney K (25 July 2012)."Cannabis, cannabinoids and cancer – the evidence so far".Cancer Research UK.Archived fromthe originalon 11 February 2014.
  157. ^World Health Organization(1984)."List of Proposed INNs No. 51"(PDF).WHO Chronicle.38(2): 6.
  158. ^World Health Organization(1984)."List of Recommended INNs No. 24"(PDF).WHO Chronicle.38(6): 4.
  159. ^Riboulet-Zemouli K (2020)."'Cannabis' ontologies I: Conceptual issues with Cannabis and cannabinoids terminology ".Drug Science, Policy and Law.6:205032452094579.doi:10.1177/2050324520945797.ISSN2050-3245.
  160. ^World Health Organization(2017)."List of Recommended INNs No. 77"(PDF).WHO Drug Information.31(1): 75.
  161. ^Abuhasira R, Shbiro L, Landschaft Y (March 2018). "Medical use of cannabis and cannabinoids containing products – Regulations in Europe and North America".European Journal of Internal Medicine.49:2–6.doi:10.1016/j.ejim.2018.01.001.PMID29329891.
  162. ^"Produkt – FASS Allmänhet".fass.se.Archivedfrom the original on 19 October 2017.Retrieved26 December2013.
  163. ^Youssef FF (June 2010)."Cannabis Unmasked: What it is and why it does what it does".UWIToday.Archivedfrom the original on 17 March 2021.Retrieved11 May2021.
  164. ^McDonagh MS, Morasco BJ, Wagner J, Ahmed AY, Fu R, Kansagara D (2022)."Cannabis-Based Products for Chronic Pain: A Systematic Review".Ann Intern Med.175(8): 1143–1153.doi:10.7326/M21-4520.PMID35667066.S2CID249433147.Archivedfrom the original on 19 February 2023.Retrieved19 February2023.

Further reading

Wikimedia Commons has media related toMedical cannabis.

,links to websites about medical cannabis

Retrieved from "https://en.wikipedia.org/w/index.php?title=Medical_cannabis&oldid=1260469716"