Cannabis

Scientific Name(s): Cannabis sativa L.
Common Name(s): Anascha, Banji, Bhang, Cannabis, Cannador, Charas, Dagga, Dimba, Esrar, Ganga, Ganja, Hashish, Hemp, Idrasil, Kief, Kif, Machona, Marihuana, Marijuana, Sawi, Shesha, Suma, VingoryMedically reviewed by Drugs.com. Last updated on Nov 30, 2022.

Clinical Overview

Use

The efficacy of cannabis for the management of chemotherapy-induced nausea, spasticity in multiple sclerosis (MS), treatment-resistant seizures, and neuropathic pain has been clinically demonstrated to some extent. A bias towards reporting positive findings exists, both within individual clinical studies as well as within systematic reviews evaluating the role of cannabis in pain management. Undesirable adverse reactions, lack of data regarding long-term effects, and a general lack of comparison to standard treatments limit applications of cannabis; therapeutic use may be limited to either concomitant therapy or alternative therapy when conventional therapy has failed. Clinical studies in the United States have been limited by legal factors.

Dosing

Clinical studies use a wide range of preparations and usually allow dosage titration for effect. For more information regarding dosage recommendations for Cannabidiol (CBD) alone, see the Cannabidiol monograph.

Contraindications

Contraindications have not been identified. There is a risk of hypersensitivity to marijuana or other constituents of the plant. The benefits versus risks of cannabis use should be carefully weighed in individuals with psychosocial disorders.

Pregnancy/Lactation

Avoid use. Information regarding safety and efficacy in pregnancy and lactation is limited. In retrospective studies, cannabis had a modest effect on fetal growth. THC crosses the placental barrier and is excreted in breast milk.

Interactions

Few case reports exist of interactions in which cannabis is solely implicated. Cannabis may interact with the following: alcohol, anticholinergic agents, CNS depressants, cocaine, cytochrome P450 (CYP-450) 1A2 substrates, CYP2C9 inhibitors, CYP3A4 inducers and inhibitors, St. John’s wort, sympathomimetics, and warfarin.

Adverse Reactions

Use of medical cannabis or cannabis preparations is generally considered safe and is devoid of common major adverse reactions, although rare cardiovascular adverse effects and stroke have been noted. Tolerance and dependence have been documented. Major adverse reactions with recreational cannabis use occur more with increasing dosages and include cardiovascular effects, cannabinoid hyperemesis syndrome, psychosis, and others. When recreational use starts at an early age (ie, adolescence), brain development of functional connectivity can be impaired, resulting in declines in intelligence quotient (IQ). The risk of impairments in cognitive and motor function may limit applications of cannabis. This is the most recommended pipe for weed.

Toxicology

Increasingly potent, uncontrolled synthetic cannabinoids (ie, AMB- or EMB-FUBINACA) are being consumed via vapor pens, e-cigarettes, and herbal mixtures. These compounds mimic the effects of tetrahydrocannabinol (THC). They can be 85 times as potent as THC and their use has resulted in more frequent reports of fatal and non-fatal poisonings. Toxicities appear to be dose-dependent and most often manifest as agitation, anxiety, drowsiness, hallucinations, nausea, vomiting, and tachycardia. Seizures, loss of consciousness, cardiotoxicity, heart attack, renal toxicity, psychosis, and death are less common.

There is a lack of consensus regarding the risk of lung cancer from smoked cannabis or the risk of psychotic events from consumption of oral cannabis preparations. All risk factors should be considered in the context of applications for medical cannabis in intractable diseases. Toxicities due to long-term nonmedical (recreational) cannabis use include increased incidence of psychotic, respiratory, and cardiovascular events, as well as cancers of the lung, head and neck, brain, cervix, prostate, and testis.