Marijuana Abuse

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Basics

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.
  • 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

  • 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
  • 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

-- To view the remaining sections of this topic, please or --

Basics

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.
  • 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

  • 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
  • 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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