Marijuana Abuse
Basics
Description
Description
- Worldwide, marijuana is the most commonly abused Schedule I substance
- Illegal under Federal Law
- Legalized in 9 states and the District of Columbia
- Allowed for medical purposes in 29 states and the District of Columbia
- In states with medical marijuana laws, illicit use of marijuana increased significantly
- Adolescent daily use is on the rise
- AKA: Pot, weed, grass, ganja, blunt, hashish
- Tobacco-like preparations of the leaves and flowers of the plant Cannabis sativa
- Active ingredients are:
- Trans-19–tetrahydrocannabinol (19–THC)
- Psychoactive effects mediated by the partial activation of CB1 receptor in the brain
- Cannabidiol (CBD)
- CBD is nonpsychotropic, making CBD derivatives of therapeutic interest in areas such as Alzheimer's, epilepsy, anxiety, psychosis, inflammatory processes, cancer, pain management, etc.
- Trans-19–tetrahydrocannabinol (19–THC)
- Metabolism: Highly lipophilic so elimination half-life is long at 25–36 hours
- Metabolism via hepatic cytochrome oxidases, CUP2C9 and 3A4, ultimately excreted via feces (65%) and urine (20%)
- Conclusive or substantial evidence that cannabis:
- Effectively treats chronic pain in adults
- Is an effective anti-emetic for chemotherapy-induced nausea and vomiting
- Leads to increased risk of MVCs
- Leads to lower birth weight of infants
- Leads to higher risk for development of schizophrenia or other psychoses with highest risk in frequent users
- Earlier age of use is a risk factor for developing chronic cannabis use
- Moderate evidence that cannabis:
- Leads to development of substance dependence or a substance abuse disorder
- Leads to increased incidence of suicide ideation and suicide attempts
- Leads to impairment in learning, memory, and attention
Etiology
Etiology
- Inhaled
- Rolled in paper
- Vaporization devices
- AKA “juuling” or “juling”
- Often very potent
- Water pipes (bongs)
- Hookahs
- Dabbing
- Hash oil extracted from marijuana plant is extracted into wax form
- Smoked with a pipe
- Very potent
- Ingested
- Tinctures
- Fast acting
- Alcohol is usual solvent
- Drops are placed under tongue
- Ingestible oils
- Can be eaten or swallowed in the form of a capsule
- Edibles
- Any food that contains cannabis
- Longer onset
- Often cause full-body, psychoactive effects
- Often infused into ingredients high in fat
- Butter, olive oil
- Drinkables
- Beverages infused with marijuana or oils
- Tinctures
- Topical
- Minimal neurologic effects
- Snorting (THC crystals)
- Synthetic Cannabinoids (SCB):
- Widely available via the internet despite increasing legal restrictions
- Major complications include cardiovascular events (myocardial infarction, ischemic stroke and emboli), acute kidney injury (AKI), generalized tonic-clonic seizures, psychiatric presentations (including first episode psychosis, paranoia, self-harm/suicide ideation) and hyperemesis
- Most common symptoms are tachycardia, agitation, and nausea requiring only symptomatic care
- Studies indicate that in contrast to partial agonist properties of Δ(9)-THC typically observed in vitro, SCBs act as full CB1 and CB2 receptor agonists both in cellular assays and animal studies
- Wet
- Marijuana cigarette (joint) dipped in phencyclidine (PCP) and/or formaldehyde
- Symptoms include hallucinations, disorientation, impaired coordination, paranoia, sexual disinhibition, severe aggression, violent behavior, visual disturbances, respiratory failure, seizures, hyperemesis
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Citation
Schaider, Jeffrey J., et al., editors. "Marijuana Abuse." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307741/1.3/Marijuana_Abuse.
Marijuana Abuse. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307741/1.3/Marijuana_Abuse. Accessed October 4, 2024.
Marijuana Abuse. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307741/1.3/Marijuana_Abuse
Marijuana Abuse [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2024 October 04]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307741/1.3/Marijuana_Abuse.
* Article titles in AMA citation format should be in sentence-case
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