Comprehensive Review of Medicinal Marijuana, Cannabinoids, and Therapeutic Implications in Medicine and Headache: What a Long Strange Trip It's Been …
- 1 Department of Neurology, Headache Center, Cleveland Clinic Neurological Institute, Cleveland, OH, USA.
- PMID: 26015168
- DOI: 10.1111/head.12570
Background: The use of cannabis, or marijuana, for medicinal purposes is deeply rooted though history, dating back to ancient times. It once held a prominent position in the history of medicine, recommended by many eminent physicians for numerous diseases, particularly headache and migraine. Through the decades, this plant has taken a fascinating journey from a legal and frequently prescribed status to illegal, driven by political and social factors rather than by science. However, with an abundance of growing support for its multitude of medicinal uses, the misguided stigma of cannabis is fading, and there has been a dramatic push for legalizing medicinal cannabis and research. Almost half of the United States has now legalized medicinal cannabis, several states have legalized recreational use, and others have legalized cannabidiol-only use, which is one of many therapeutic cannabinoids extracted from cannabis. Physicians need to be educated on the history, pharmacology, clinical indications, and proper clinical use of cannabis, as patients will inevitably inquire about it for many diseases, including chronic pain and headache disorders for which there is some intriguing supportive evidence.
Objective: To review the history of medicinal cannabis use, discuss the pharmacology and physiology of the endocannabinoid system and cannabis-derived cannabinoids, perform a comprehensive literature review of the clinical uses of medicinal cannabis and cannabinoids with a focus on migraine and other headache disorders, and outline general clinical practice guidelines.
Conclusion: The literature suggests that the medicinal use of cannabis may have a therapeutic role for a multitude of diseases, particularly chronic pain disorders including headache. Supporting literature suggests a role for medicinal cannabis and cannabinoids in several types of headache disorders including migraine and cluster headache, although it is primarily limited to case based, anecdotal, or laboratory-based scientific research. Cannabis contains an extensive number of pharmacological and biochemical compounds, of which only a minority are understood, so many potential therapeutic uses likely remain undiscovered. Cannabinoids appear to modulate and interact at many pathways inherent to migraine, triptan mechanisms ofaction, and opiate pathways, suggesting potential synergistic or similar benefits. Modulation of the endocannabinoid system through agonism or antagonism of its receptors, targeting its metabolic pathways, or combining cannabinoids with other analgesics for synergistic effects, may provide the foundation for many new classes of medications. Despite the limited evidence and research suggesting a role for cannabis and cannabinoids in some headache disorders, randomized clinical trials are lacking and necessary for confirmation and further evaluation.
Keywords: CBD; THC; cannabidiol; cannabinoids; cannabis; delta-9-tetrahydrocannabinol; headache; hemp; medical marijuana.
© 2015 American Headache Society.
- Cannabinoids / pharmacokinetics
- Cannabinoids / therapeutic use*
- Headache / diagnosis*
- Headache / drug therapy*
- Headache / metabolism
- Medical Marijuana / pharmacokinetics
- Medical Marijuana / therapeutic use*
- Time Factors
- Medical Marijuana
Cannabis Dependence and Psychiatric Disorders: Outline Research Paper
Cannabis dependence, psychiatric disorders, cannabis induced psychiatric disorders.
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The purpose of this study will be to examine psychiatric disorders that have been induced by overdependence on Cannabis. Cannabis Sativa is a herb originating from the Cannabaceae family that is recognised worldwide as a euphoric and hallucinogenic drug.
The strong smelling herb is used for medicinal purposes, for making hemp fibres and for developing recreational drugs (hashish and marijuana). The different parts of Cannabis have been used for different purposes and functions with one of the most common uses being for recreational purposes.
Marijuana is basically derived from the dried flowers and leaves of the cannabis sativa plant which is usually ingested or smoked while hashish is a resinous extract obtained from the plant which is usually vaporized or smoked (Elsohy, 2007).
Cannabis is one of the most famous recreational drugs in the world after caffeine, alcohol and tobacco where over 100 million people especially in the United States are consumers of the drug on an annual basis.
The reason for this is attributed to the fact that Marijuana which is derived from the Cannabis herb allows the user to be in a state of relaxation thereby reducing any cases of anxiety, paranoia or stress.
The tetrahydrocannabinol compound found in the leaves of the herb usually acts as the main stimulant once it is consumed by the user enabling them to experience a sense of peace and relaxation (Bolla et al, 2002). The drug however presents tertiary and secondary psychoactive effects that might pose a threat to the individual taking the drugs some of which include an increased heart rate, hallucinations, loss of memory, increased anxiety levels, high energy levels and an increasing sense of hunger.
If larger doses of the drug are taken through smoking, vaporization or oral ingestion, the effects might last longer for 24 hours where the consumer experiences both the secondary and tertiary psychoactive effects of the drug (Fusar-Poli et al, 2009). Marijuana is a very addictive drug which means that once it is consumed, it is very difficult to stop smoking or ingesting the drug because of the various effects that are presented by Cannabis.
Cannabis dependence is defined as a condition where an individual who continues to take Cannabis or Marijuana demonstrates cognitive, behavioural and physiological symptoms.
Based on the DSM-IV criteria for diagnosing substance dependence on various drugs such as the one understudy (Michael et al, 2004), cannabis dependence is determined by the existence of three or the following criteria which might occur within a period of 12 months.
Tolerance which is the first DSM-IV criteria explains Cannabis dependence to be the need that an individual has to consume large amounts of Cannabis Sativa so that they can achieve an increased level of intoxication that will lead to diminished thoughts, emotions or feelings on the part of the user (Michael et al, 2004).
The second criteria based on the DSM-IV criterion for substance abuse is withdrawal which explains Cannabis dependence to be a manifestation of withdrawal symptoms such as increased restlessness, insomnia or poor sleeping habits, increased appetite as the drug brings about hunger, irritability, paranoia and anger.
Other DSM-IV criteria that are used to explain dependence of marijuana is when an individual takes the substance in large amounts for a long period of time than was intended to relieve anxiety or stress, the individual experiences a persistent desire to reduce substance abuse but unsuccessfully fails to do so and/or they spend most of their time and resources trying to acquire the substance or drug which means that their social life and other recreational activities are abandoned because of the continued use of the drug (Wenger et al, 2003).
Based on the various studies that have been conducted on the dependence of cannabis, the drug has presented a less addictive potential when compared to hard drugs such as heroin, cocaine, tobacco or alcohol (Coffey et al, 2003). According to Michael et al (2004), Cannabis dependence has been cited as one of the clinical entities of substance abuse and dependence in the DSM-IV of mental disorders criteria.
The coding criterion that is used by the DSM-IV is usually based on the international classification of diseases where the signs and symptoms of diseases are identified and described in the various versions of DSM-IV textbooks. Based on the DSM-IV criteria, cannabis dependence falls under the category of substance related disorders as the individuals who consume the drug experience the various side effects that lead to cannabis dependence (Michael et al, 2004).
To further explain cannabis dependence, the extended use of marijuana or hashish is likely to produce various changes in the bodily processes of an individual which affect how cannabis is absorbed or metabolized by the individual. These changes which are referred to as pharmacokinetic changes usually force the user to increase their dosage of the drug so that they can be able to achieve a desirable effect which is known as a higher tolerance to marijuana or Cannabis Sativa (Joy et al, 1999).
Higher doses of cannabis further reinforce the metabolism rate of the individual thereby increasing the rate at which the drug is broken down and expelled from the body. This means that Cannabis sativa, marijuana and hashish act as a system of reinforcement to the metabolic functions of an individual’s digestive system as well as their small and large intestines (Wenger et al, 2003).
According to Hall et al (2001), the risk factors of Cannabis dependence are usually determined by the number of doses an individual user takes in a day as well as the frequency of these doses. Based on their research, the authors determined that one in every ten people who consumed cannabis were more than likely to become dependent on the drug at some point in their life. People who consumed the drug frequently (five times in a day) were more than likely to increase their risk of developing dependence on the drug.
The risk factors that are considered to be the major contributors to cannabis dependence based on longitudinal studies conducted by Copeland et al (2004) include the frequent use of the drug especially at a young age where drug users who begin taking the drug during their teenage or adolescent years are at a greater risk of being cannabis dependent.
Coffey et al (2000) conducted a study in Victoria, Australia where they examined 2032 high school students to determine the impact that young age had on cannabis dependence.
The results of their study revealed that mid-school consumption of cannabis sativa was mostly associated with other factors such as frequent cigarette smoking, peer pressure from other students who are ingesting or smoking cannabis sativa and anti-social behaviour such as stealing, sexual promiscuity and violent tendencies.
Coffey et al’s (2000) study also revealed that the regular use of marijuana or Cannabis Sativa among young people at an early age continued to persist even as the adolescents approached young adulthood.
A follow up study conducted by Coffey et al (2003) of the high school students who had attained the ages of 20 to 21 years revealed that one in five the adolescent users of the drug demonstrated dependence to cannabis well into the early stages of adulthood.
Other risk factors that have been related to an increased risk of cannabis dependence include psychological distress where individuals use the drug to relieve feelings of distress, anger or sadness, poor parenting where children raised by parents who are cannabis consumers are more than likely to develop cannabis dependence in their teenage and adult years and influence from peers where children with friends who smoke or ingest cannabis are more than likely to consume the drug and also become cannabis dependent at an older age.
Ehrenreich et al (1999) from their study of cannabis dependence from a young age have concluded that there exists strong evidence that children who are exposed to cannabis or marijuana at a young age are more than likely to become cannabis dependent when they are older.
A psychiatric disorder which is otherwise referred to as a mental illness/disorder is a psychological or behavioural pattern that is usually associated to emotional distress or mental disabilities which an individual goes through. Psychiatric disorders are not part of the normal development of an individual and they are therefore termed as abnormal manifestations of the mental health of the individual.
Psychiatric disorders encompass very many mental health conditions which affect the behavioural, intellectual and cognitive abilities of an individual and some of these mental health conditions include anxiety disorders, personality disorders, sexual disorders, eating disorders, dissociative disorders and drug dependence disorders (Akiskal & Benazzi, 2006).
Psychiatric disorders or mental illnesses usually affect the mental well being of an individual as well as their cognitive capacity further deteriorating their intellectual capabilities and functions (Insel & Wang, 2010).
Mental disorders are caused by a variety of factors where most researchers have conceded that the disorders arise from genetic vulnerabilities or predispositions. Other studies have revealed that psychiatric disorders result from psychological, emotional, sexual and physical traumas during the formative years of a child.
These traumatic experiences usually come to manifest themselves as the child continues to develop intellectually as well as emotionally and if they are not managed properly they might lead to psychiatric disorders.
Based on a significant number of studies, children who have been sexually abused contribute significantly to the percentage of causation factors that lead to mental or psychiatric disorders during their adulthood years (Kashner et al, 2003).
Based on worldwide statistics, the number of people who suffer from psychiatric disorders have been estimated to be one in every three people in over 100 countries around the world (WHO, 2000).
In the United States for example, the number of people who suffer from psychiatric disorders accounts for 46 percent of the total American population where one in every three Americans suffers from a mental illness at one point in their lives (Kessler et al, 2005).
The most common psychiatric disorders based on the World Mental Health Survey initiative include anxiety disorders, mood disorders, substance disorders and impulse control disorders which are common in all but a few countries in the world (Demyttenaere et al, 2004). Psychiatric disorders that are not suitably dealt with result in obsessive or compulsive behaviour, manic depression, paranoia, delusions or hallucinations or violent behaviour.
There exists limited research on the clinical implications of cannabis induced psychiatric disorders despite the existence of medical evidence that cannabis or marijuana is linked to the genesis of paranoid schizophrenia in an individual (Arseneault et al, 2004).
Based on various research studies (Hall & Degenhardt, 2004: Johns, 2001: Large et al 2011), the psychotic symptoms of continued or frequent marijuana consumption were usually short-lived and the cases of total remission were expected in patients who developed psychiatric disorders.
These results were however based on case studies that lacked any follow-up information that could be used to further explain whether cannabis dependence elicited any psychiatric disorders in individuals (Arendt et al, 2005).
A follow-up study conducted by Arendt et al (2005) revealed that the prognosis for cannabis-induced psychiatric disorders cannot be properly ascertained because such a condition is termed to be a rare occurrence by the American Psychiatric Association as well as the diagnostic and statistical manual (DSM-IV) of mental disorders.
The study conducted by Arendt et al (2005) was the first to provide an accurate estimate of the rates of incidence that can be attributed to cannabis induced psychiatric disorders. The results of the follow-up study were able to reveal that half of the 535 people who were under examination were treated for cannabis induced psychotic disorders with paranoid schizophrenia being the most dominant form of mental illness.
The follow-up study also revealed that there were 77 percent of new psychotic episodes reported in majority of the population involved in the follow-up where male participants and people of a young age were associated with a more severe outcome of cannabis induced psychiatric disorders (Arendt et al, 2005).
Most of the patients who were consumers or users of cannabis sativa recorded an increase the level of schizophrenic-spectrum disorders which occurred within a span of more than a year.
Also for the majority of the patients placed under the follow-up study, cannabis-induced psychotic symptoms were seen to be the first step in the development of schizophrenic-spectrum disorders or other severe forms of paranoid schizophrenia.
Arendt et al’s (2005) study is however inconsistent with the findings from previous studies such as those conducted by Talbott and Teague in 1969, Thacore and Shukla in 1976 and Carney et al in 1984 where their results revealed that people who were users of cannabis sativa demonstrated complete remission of the effects of the drug when the individuals abstained from using the drug completely.
However, the patients examined by the researchers were not followed up after the cannabis induced psychotic condition remitted which means that their studies did not provide any long-term data that would be used to explain cannabis induced psychiatric disorders.
Many of the investigations reported that cannabis induced psychotic conditions usually subsided at a faster rate than the psychiatric disorders which were not induced by any substances all.
Arendt et al’s study was able to dispute previous findings where they discovered that the development of paranoid schizophrenia was often delayed in the case of cannabis induced psychosis.
They based this finding on a sample population of 47 percent of the people understudy who received a diagnosis a year after seeking treatment for cannabis induced psychotic conditions.
The researchers were able to conclude that cannabis induced psychotic disorders were of great prognostic concern and importance and doctors/psychiatrists needed to treat the disorders once they were diagnosed in patients (Arendt et al, 2008).
The discussion focused on cannabis dependence which is how an individual constantly consumes marijuana to achieve a feeling of relaxation or euphoria. The discussion also highlighted psychiatric disorders and identified the psychotic illnesses that arise as a result of continued cannabis consumption.
Most of the research referred to in the study pinpointed the fact that cannabis induced psychotic disorders did not last for long and they were therefore of no concern to health practitioners and psychiatrists. Only one study was able to concur that psychiatric disorders which arose as a result of cannabis dependence were of a major concern to doctors.
Akiskal, H.S., & Benazzi, F. (2006). The DSM-IV and ICD-10 categories of recurrent (Major) depressive and bipolar II disorders: evidence that they lie on a dimensional spectrum. Journal of Affective Disorders , Vol: 92 5-54
Arendt, M., Rosenberg, R., Foldager, L., & Perto, G. (2005). Cannabis-induced psychosis and subsequent schizophrenia-spectrum disorders: follow-up study of 535 incident cases. The British Journal of Psychiatry , 187:510-515
Arendt, M., Mortensen, P.B., Rosenberg, R., Pedersen, C.B., & Waltoft, B.L. (2008). Familial predisposition for psychiatric disorder: comparison of subjects treated for Cannabis-Induced psychosis and schizophrenia. Archives of General Psychiatry , 65(11): 1269 – 1274
Arseneault, L., Cannon, M., Witton, J., et al. (2004) Causal association between Cannabis and psychosis: examination of the evidence. British Journal of Psychiatry , 184:110 -117
Bolla, K.I., Brown, K., Eldreth, D., Tate, K., & Cadet, J.L. (2002). Dose-related Neurocognitive effects of marijuana use. Neurology . 59(9):1337-1343
Coffey, C., Lynskey, M., Wolfe, R., & Patton, G.C. (2000). Initiation and progression of Cannabis use in a population-based Australian adolescent longitudinal study. Addiction. 95(11):1679-1690
Coffey, C., Carlin, J.B., Lynskey M., Li, N., & Patton, G.C. (2003). Adolescent precursor of cannabis use in a population-based Australian adolescent longitudinal study. British Journal of Psychiatry , 182(4):330-336
Copeland, J., Gerber, S., & Swift, W. (2004). Evidence-based answers to cannabis questions: a review of the literature . A report prepared for the Australian National Council on Drugs. New South Wales, Australia: National Drug and Alcohol Research Centre, Australia
Demyttenaere, K., Bruffaerts, R., & Posada-Villa, J. (2004). Prevalence, severity and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. Journal of American Medical Association , 291(21):2581-2590
Ehrenreich, H., Rinn, T., Kunert H. J., Moeller, M.R., Poser, W., Schilling, L., & Hoehe, M.R. (1999). Specific attentional dysfunction in adults following early start of cannabis use. Psychopharmacology , 142(3):295-301
Elsohy, M. (2007). Marijuana and the cannabinoids . New York: Humana Press Fusar-Poli, P., Crippa, J.A., & Bhattacharyya, S. (2009). Distinct effects of Tetrahydrocannabinol and cannabidiol on neural activation during emotional processing. Archives of General Psychiatry , 66(1):95-105
Hall, W., Degenhardt, L., & Lynskey, M. (2001). The health and psychological effects of Cannabis use . Canberra, Australia: Department of Health and Ageing
Hall, W. & Degenhardt, L. (2004). Is there a specific cannabis psychosis? Cambridge, UK: Cambridge University Press.
Insel, T.R., & Wang, P.S. (2010). Rethinking mental illness. Journal of American Medical Association , 303(19):1970-1971
Johns, A. (2001). Psychiatric effects of cannabis. British Journal of Psychiatry , 178:116-122
Joy, J.E., Watson, S.J., and Benson, J.A. (1999). Marijuana and medicine: assessing the science base . Washington, D.C.: National Academy of Science Press
Kashner, T.M., Rush, A.J. & Suris, A. (2003). Impact of structured clinical interviews on physician practices in community mental health settings. Psychiatric Services , 54(5):712-718
Kessler, R.C., Berglund, P., Demler, O., Jin, R., Merikangas, K.R., & Walters, E.E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the national comorbidity survey replication. Archives of General Psychiatry , 62(6):593-602
Large, M., Sharma, S., Compton, M.T., Slade, T., & Nielssen, O. (2011). Cannabis use and earlier onset of psychosis: a systematic meta-analysis. Archives of General Psychiatry , 51-57
Michael, B. F., Frances, A., & Pincus, H.A. (2004). DSM-IV-TR guidebook . Arlington: American Psychiatric Publishing
Wenger, T., Moldrich, G., & Furst, S. (2003). Neoromorphological background of Cannabis addiction. Brain Research Bulletin , Vol: 61125-128
WHO (2000). Cross-national comparisons of the prevalences and correlates of mental disorders. Bulletin of the World Health Organization , Vol: 78(4).
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Marijuana and Cannabinoids: Health, Research and Regulatory Considerations (Position Paper)
Marijuana and related substance misuse are complex issues impacting family medicine, patient health, and public health. The American Academy of Family Physicians (AAFP) believes family physicians are essential in addressing all forms of inappropriate substance use. The AAFP urges its members to be involved in the diagnosis, treatment, and prevention of substance use, as well as secondary diseases impacted or caused by use. The World Health Organization (WHO) reports approximately 2.5% of the global population uses cannabis annually, making it the most commonly used drug worldwide. 1 Simultaneously, the AAFP acknowledges preliminary evidence indicates marijuana and cannabinoids may have potential therapeutic benefits, while also recognizing subsequent negative public health and health outcomes associated with cannabis use. 2
During the 20 th century, law enforcement and public policy activities have undermined opportunities for scientific exploration. Barriers to facilitating both clinical and public health research regarding marijuana is detrimental to treating patients and the health of the public. The lack of regulation poses a danger to public health and impedes meaningful, patient-centered research to exploring both therapeutic and negative impacts of marijuana and cannabinoids.
Relevant AAFP Policy
Marijuana Possession for Personal Use The American Academy of Family Physicians (AAFP) opposes the recreational use of marijuana. However, the AAFP supports decriminalization of possession of marijuana for personal use. The AAFP recognizes the benefits of intervention and treatment for the recreational use of marijuana, in lieu of incarceration, for all individuals, including youth. 3
The AAFP also recognizes that several states have passed laws approving limited recreational use and/or possession of marijuana. Therefore, the AAFP advocates for further research into the overall safety and health effects of recreational use, as well as the effects of those laws on patient and societal health. 4
It should be noted that cannabis and marijuana are not interchangeable terms. In this position paper, cannabis is an overarching term used to refer to the plant Cannabis sativa . Substances derived from the cannabis plant include marijuana, hemp, and cannabinoids.
Call to Action Family physicians have a vested interest in policies that advance and protect the health of their patients and the public. The regulatory environment surrounding cannabis, medical and recreational marijuana, and cannabidiol (CBD) is rapidly changing, along with the retail environment. This shift has not been accompanied by robust scientific research regarding the health effects of cannabis, both therapeutic or detrimental. The AAFP recognizes the need for substantial clinical, public health, and policy evidence and research regarding cannabis, marijuana, cannabinoids, and CBD to inform evidence-based practice and the impact on public health.
- The AAFP promotes a society which is free of substance misuse, including alcohol and drugs. 3
- The AAFP recognizes there is support for the medical use of marijuana and cannabinoids, but advocates that usage be based on high-quality, evidence-based public health, policy, and patient-centered research, including the impact on vulnerable populations. 3
- The AAFP advocates for further studies into the use of medical marijuana and related compounds. This process should also ensure appropriate funding allocated for this research.
- The AAFP calls for decreased regulatory barriers to facilitate clinical and public health cannabis research, including reclassifying cannabis from a Schedule I controlled substance. 3
- The AAFP advocates for further research into the overall safety and health effects of recreational use, as well as the impact of legal recreational marijuana use laws on patient and societal health. 4
- The AAFP advocates for robust regulation regarding labeling and child-proof packaging of all marijuana and cannabinoid products.
- The AAFP opposes the recreational use and legalization of marijuana, but supports decriminalization of marijuana for personal use. The AAFP recognizes the benefits associated with intervention and treatment, in lieu of incarceration. 4
- The AAFP advocates for regulation regarding marketing claims, labeling, and advertising of all marijuana and cannabinoid products.
- The AAFP supports requirements testing current marijuana and cannabinoid products for safety, dosing, and product consistency.
In the Exam Room
- The AAFP urges its members to be involved in the diagnosis, treatment, and prevention of substance use, as well as the secondary diseases impacted by use.
- The AAFP calls for family physicians to discuss the health consequences of marijuana and cannabis use, as well as prevention strategies to prevent use and unintended consequences of marijuana exposure in at-risk populations.
Cannabis use, both medically and recreationally, is prevalent throughout history. Extensive evidence indicates cannabis was used by ancient civilizations, dating back more than 5,000 years ago. 1 In the U.S. in the 19th and early 20th centuries, cannabis was frequently used for medicinal purposes, often prescribed by clinicians. 1,5 Cannabis was first listed in the United States Pharmacopoeia in 1851, indicating use as an analgesic, hypnotic, and anticonvulsant agent. 5 After the 1937 Marihuana Tax Act , in 1942, cannabis was removed from the United States Pharmacopoeia . 5
Attitudes and perceived risk of marijuana use have changed with the varying levels of legalization in the U.S. Surveying marijuana use is essential to gauge public health implications of increased access to marijuana, cannabinoid, and cannabis products. According to the 2018 National Institute on Drug Abuse (NIDA) Monitoring the Future Survey (MTF), daily, past month, past year, and lifetime marijuana use among 8 th graders has declined, and remained unchanged in 10 th and 12 th graders, when compared to the 2013 MTF survey. 6 Despite the changing landscape of marijuana regulations nationwide, past year use of marijuana reached and maintained its lowest levels in more than two decades in 2016 among 8 th and 10 th graders. 6 However, marijuana vaping did significantly increase between 2017 and 2018, mirroring trends in youth tobacco use. 6 The NIDA 2017 National Survey on Drug Use and Health indicates nearly 53% of adults between the ages of 18-25 have tried marijuana at some point in their lifetime, 35% have used marijuana within the past year, and 22% within the past month. 7 While the lifetime use remains relatively stable for this cohort, from 2015-2017, past year and past month use increased 2.7% and 2.3%, respectively. 7 Nearly half of adults 26 or older reported using marijuana at some point in their lifetime. 7 Although adults ages 26 and up report the highest percentage of lifetime use, this age group has a significantly lower past year use (12%) and past month use (8%). 7
Forms and Use of Cannabis The cannabis plant, Cannabis sativa , is comprised of both non-psychoactive and psychoactive chemicals called cannabinoids. 5 The cannabinoid commonly known for its psychoactive properties is delta-9-tetrahydrocannabinol (THC). 5 CBD is the most abundant cannabinoid in cannabis, and is considered to be largely non-psychoactive. 5 The biological system responsible for the synthesis and degradation of cannabinoids in mammals is referred to as the endocannabinoid system, which is largely comprised of two g-coupled protein receptors (GPCRs). 8 The GPCRs—CB1 and CB2—are found throughout many bodily tissues. However, CB1 is most concentrated in the neural tissues. 5,8 CB2 receptors are found in the brain, but are mostly found in immune cells, like macrophages, microglia, osteoclasts, and osteoblasts. 5,8
There are many forms of, and products derived from, the Cannabis sativa plant, including hemp, CBD, and marijuana. Cannabis sativa with less than 0.3% THC is considered industrial hemp, and can be used for industrial agriculture cultivation. 9,10 Industrial hemp can be harvested and used for many things, including fibers for textiles, food products, and building materials. 11,12 CBD, the non-psychoactive cannabinoid, is extracted from the flower of industrial hemp. 13 Marijuana and hemp, technically speaking, are the same plant. 13 However, the hemp variety of cannabis contains no more than 0.3% THC, while the marijuana variety contains 5-20% THC. 13
Marijuana and CBD are most commonly used via inhalation, ingestion, and topical absorption. 5 Inhalation can be through combustible mechanisms using dried flowers, including the use of a pipe, rolled joints, blunts, and water pipes (also called bongs). 14 Vaping marijuana and CBD concentrates are an increasingly popular inhalation method. 5,6 Concentrates, the concentrated form of marijuana and CBD, come in various forms, including oil, butter, or a dark sticky substance often referred to as shatter. 15 Concentrates can be both smoked or vaporized, and may also be used as additives or cooking agents for ingestion. 5,15 There are many different ways to ingest cannabinoids. Food products—called edibles—like brownies, gummies, cookies, and candies are common forms of cannabis ingestion, as well as liquid forms like juices, soda, and tea. 5,16 Tinctures are liquid, ultra-concentrated alcohol-based cannabis extracts commonly applied in and absorbed through the mouth. 17 Topical cannabis is applied to, and absorbed through, the skin in a cream or salve form. 18
Routes or methods of administration affect cannabis delivery. When cannabis is smoked or vaporized, onset of effect is within 5-10 minutes with a duration of 2-4 hours. 19 When ingested, effect is within 60-180 minutes with a duration of 6-8 hours. 19 The oromucosal route has an onset of 15-45 minutes and a duration of 6-8 hours. 19 Topical administration of cannabis or cannabinoids has variable onset and duration. 19 The smoked or vaporized method offers the more rapid activity for acute symptoms with the topical preparations offering less systemic effects. 19
Health Effects of Cannabis
Although there is preliminary evidence indicating cannabinoids may have some therapeutic benefit, a large portion of the evidence is very limited for many reasons. These include small sample sizes, lack of control groups, poor study design, and the use of unregulated cannabis products. There are also clear negative health and public health consequences that must be considered, as well as the need for a significant increase in evidence. More research is needed to create a robust evidence base to weigh the potential therapeutic benefits against potential negative impacts on health and public health. Currently, there are three medical formulations of cannabis approved for use in the U.S.; dronabinol, nabilone, and epidiolex. 20 Nabiximols is approved for use in the United Kingdom. 21 Dronabinol is delta-9 THC and ingested as either an oral solution or an oral capsule. 22 Nabilone is an oral capsule containing synthetic THC. 23 Epidiolex is a CBD oral solution. 24 Nabiximols is an oral mucosa spray containing the cannabinoids THC and CBD. 25
In 2015, Whiting, et al, performed a meta-analysis and systematic review of research on the medical use of cannabis. 25 This systematic review served as the basis for many recommendations in 2017 by the National Academy of Science, Engineering, and Health Report on medical marijuana. 5 Dronabinol, nabilone, and nabiximols were included in the studies. However, other cannabis formulations were found in research trials, including CBD, marijuana, and other cannabinoids. 26 Evidence is most substantial for nausea and vomiting associated with chemotherapy, chronic pain treatment, multiple sclerosis spasticity, and intractable seizures associated with Dravet syndrome and Lennox-Gastaut syndrome. 27 There is moderate evidence for the use of cannabinoids for sleep and limited evidence for use in psychiatric conditions, such as post-traumatic stress disorder, depression, anxiety, and psychosis; appetite stimulation and weight gain; and no evidence for cancer treatment. 5
Dronabinol and nabilone were both approved in 1985 for use in treating refractory chemotherapy-induced nausea and vomiting. 5,23 Dronabinol is approved by the Food and Drug Administration (FDA) for appetite stimulation and weight gain, despite limited and often inconclusive evidence that it or other cannabinoids are effective. 22 This drug has traditionally been used in human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) patients to mitigate weight loss and to treat anorexia-cachexia syndrome associated with cancer and anorexia nervosa. 5,22
Cannabinoids have been assessed for chronic pain management. Many forms of chronic pain management were studied, including cancer and chemotherapy-induced pain, fibromyalgia, neuropathic pain, rheumatoid arthritis, non-cancer pain, and musculoskeletal pain. Several studies indicate smoked THC and nabiximols were both associated with pain reduction. 5,25,26 There is limited, mixed evidence regarding the viability of cannabinoids for some forms of chronic pain management. 5 However, limitations exist with these studies, including the variable doses of THC and CBD; unregulated, non-FDA approved products; and conflicting evidence. Studies assessing cannabinoids in treating the spasticity due to multiple sclerosis or paraplegia have mixed results. The cannabinoids nabiximols, dronabinol, and TCH/CBD have all been associated with decreased spasticity. Nabilone and nabiximols were the only drugs with statically-significant decreases. 2,25
In 2018, the FDA approved a cannabidiol oral solution called epidiolex for the treatment of refractory seizures associated with Dravet syndrome and Lennox-Gastaut syndrome. 28 Epidiolex was associated with significant seizure reduction when compared to placebo. 29–31 Dravet syndrome and Lennox-Gastaut syndrome are disorders associated with severe seizures, impaired cognitive skills and development, and uncontrollable muscle contractions. 29–31
Moderate evidence exists for the use of cannabis for sleep. Nabilone and nabiximols have been associated with improvement in sleep from a baseline and sleep restfulness. 2,5,25 Improved sleep was also considered a secondary outcome when evaluating other conditions (chronic pain, multiple sclerosis) with various cannabinoids. 2,5,25
There is limited evidence for the use of cannabis or cannabinoids for the treatment of post-traumatic stress disorder (PTSD), anxiety, depression, or psychosis. Of the limited evidence, nabilone was associated with a decrease in PTSD related nightmares. 5,25 One small study indicated CBD improved public speaking anxiety. 5 There are no studies directly evaluating the effectiveness of cannabis in the treatment of depression. However, some studies measured depression as a secondary outcome, but indicated no difference in depression when compared to placebo. 25 Limited evidence (two studies) have shown no difference in treating psychosis with CBD, amisulpride, or placebo. 25 Evidence indicates individuals who use marijuana are more likely to experience temporary psychosis and chronic mental illness, including schizophrenia. 5,32
There was no evidence or insufficient evidence for the use of cannabis or cannabinoids in the treatment of cancer; neurodegenerative disorders like Huntington’s chorea, Parkinson’s disease, or amyotrophic lateral sclerosis; irritable bowel syndrome; or addiction. 5
Cannabis overdose is rare in adults and adolescents. 33 Children who experience acute intoxication from cannabis generally ingest marijuana or other cannabinoids through experimentation. 33 When compared to adults and adolescents, children are more likely to experience life-threatening symptoms of acute cannabis intoxication, which may include depressed respiration rates, hyperkinesis, or coma. 33 Management consists of supportive care dependent on the manifestation of symptoms. 33 Adults and adolescents may experience increased blood pressure and respiratory rates, red eyes, dry mouth, increased appetite, and slurred speech. 33
Negative health effects are also associated with marijuana and cannabinoid use. Frequent marijuana use has been associated with disorientation. In teens, it has been linked with depression, anxiety, and suicide. 5,32 However, this is not a proven causal relationship. Lung health can also be negatively impacted depending on the delivery mechanism. 34 Smoking marijuana can cause lung tissue scarring and damage blood vessels, further leading to an increased risk of bronchitis, cough, and phlegm production. 34 This generally decreases when users quit. 34
Secondhand smoke is a serious issue associated with marijuana use. However, there is limited evidence on how it impacts heart and lung health. 34 Detectable THC has been found in children who live in the home or have a caretaker who use marijuana, subjecting children to developmental risks of THC exposure. 35 Fetal, youth, and adolescent exposure to THC is associated with negative health effects, including impacting brain development. 34 There is inconsistent, insufficient evidence to determine the long-term effects of marijuana and cannabinoid use while breastfeeding. 36 However, THC has been detected in breast milk for up to six days post-cannabinoid use, and exposure to cannabinoids is known to impact development in children. 37 Evidence also suggests cannabis use during pregnancy may be linked with preterm birth. 38 Cardiovascular health may be impacted by smoked marijuana use. However, the negative health effects are associated with the harmful chemicals in smoke similar to tobacco smoke. 34
Approximately 9% of all individuals who use marijuana develop an addiction, which is variable by age of first use and frequency of use. 34 That number for addiction jumps to 17% for individuals who begin using marijuana as teenagers and 25-50% of those who smoke marijuana daily. 34 Marijuana use does not typically lead to harder drug use, like cocaine and heroin, in most individuals. 39 Further research is needed to evaluate any potential gateway effect. 39
Mental health outcomes associated with marijuana use include an increased risk of anxiety and depression. Marijuana has been linked to schizophrenia, psychoses, and advancing the trajectory of the disease, particularly in individuals with pre-existing genetic indicators. 5,34 Global research also suggests daily use of high-potency marijuana increases risk for psychotic episodes among individuals with no underlying mental health condition. 40 While it is widely accepted that marijuana acutely impairs cognitive function, studies suggest differential outcomes regarding short- versus long-term cognitive impairment. 34
The regulatory environment surrounding cannabis, marijuana, and cannabinoid research creates barriers detrimental to facilitating meaningful medical, public health, policy, and public safety research. Approval for research expands beyond institutional review boards. Due to the Schedule I classification by the Drug Enforcement Agency (DEA), researchers seeking to investigate health effects associated with cannabis must follow a regimented application process. 41 Applicants must submit an Investigational New Drug (IND) application to the FDA, which will then be reviewed to determine scientific validity and research subjects’ rights and safety. 42 Researchers must also follow the NIDA regulatory procedures for obtaining cannabis for research purposes. 41 Researchers may only use cannabis supplied by the University of Mississippi, the single NIDA-approved source for cannabis research. 41 Requiring research to rely on one source of cannabis limits availability and the variety of products. While the University of Mississippi cultivates different strains of cannabis, it is unable to supply the vast array of strains of cannabis found in the evolving retail environment with varying levels of THC, CBD, and cannabinoid content. 5 Substantial funding and capacity is required for researchers to obtain all regulatory approval and remain in compliance while conducting cannabis-related research. The required processes and procedures present a serious burden, dissuading researchers from pursuing cannabis-related projects. This has led to a lack of empirical evidence regarding a myriad of health-related issues, including potential therapeutic benefits of cannabis, public health impact, health economics, and the short- and long-term health effects from cannabis use.
In order to address the research gaps associated with both beneficial and harmful effects of cannabinoids used in both medical and recreational capacities, the AAFP calls for a comprehensive review of processes and procedures required to obtain approval for cannabis research.
The AAFP encourages the appropriate regulatory bodies, such as the DEA, NIDA, FDA, Department of Health and Human Services (DHHS), National Institutes of Health (NIH), and the Centers for Disease Control and Prevention (CDC), to collaborate with non-governmental stakeholders to determine procedures to decrease the burden of cannabis-related research while maintaining appropriate regulatory safety guards. This should include a reclassification of marijuana from Schedule I to facilitate clinical research. The AAFP calls for increased funding from both public and private sectors to support rigorous scientific research to address gaps in evidence regarding cannabis to protect the health of the public and inform evidence-based practices. 3 Future research should address the impact of cannabis use on vulnerable and at-risk populations.
While cannabis was federally regulated in 1906 for consumer and safety standards and labeling requirements, the Marihuana Tax Act of 1937 was the first federal regulation to impose a fine or imprisonment for non-medical use and distribution of cannabis. 5 The tax act also regulated production, distribution, and use of cannabis, further requiring anyone dealing with cannabis to register with the federal government. 5 In 1970, the DEA classified marijuana as a Schedule I drug, which is defined as a drug with no current acceptable medical use and a high potential for abuse. 43 Other Schedule 1 drugs include heroin, lysergic acid diethylamide (LSD), 3,4-methylenedioxymethamphetamine (ecstasy), methaqualone, and peyote. 43 Since this class of substances is determined as having no medical usage, they cannot be legally prescribed and thus, there is no medical coverage for them.
Marijuana is illegal under federal law. Penalties cover possession, sale, cultivation, and paraphernalia. However, the Agriculture Improvement Act of 2018 included a U.S. Department of Agriculture (USDA) Hemp Production Program, removing hemp from the Controlled Substances Act. 10,44 As a result, CBD sourced from hemp plants containing no more than 0.3% THC is legal to produce. 10,44 The FDA has approved three medications containing cannabinoids: epidiolex (CBD), dronabinol, and nabilone (synthetic cannabinoids). 5 No other forms of cannabis are currently regulated by the FDA. The AAFP calls upon the FDA to take swift action to regulate CBD and cannabinoid products now legal in order to protect the health of the public.
States have separate marijuana, cannabinoid, and cannabis laws, some of which mirror federal laws, while others may be more harsh, or have decriminalized and even legalized marijuana and cannabis. 45 In 1996, California was the first state to legalize the medical use of marijuana. 46 States have subsequently decriminalized and/or legalized cannabinoids, medical marijuana, and recreational marijuana. 46 As of August 2019, 30 states, along with the District of Columbia, Guam, and Puerto Rico have legalized marijuana in varying forms. 46 Decriminalization laws may include reduction of fines for possession of small amounts of marijuana, reclassification of criminal to civil infractions, excluding the infraction from criminal records and expunging prior offenses and convictions related to marijuana. 47 Thirty-three states, along with the District of Columbia, Guam, Puerto Rico, and the U.S. Virgin Islands have a comprehensive, publicly-available medical marijuana/cannabis program, and 13 of these states have also removed jail time for possessing small amounts of non-medical marijuana. 47 Adult recreational marijuana use is legal in 13 states and the District of Columbia. 47 Vermont and the District of Columbia, however, do not allow the sale of marijuana for recreational purposes. This means it is not a crime to use and possess marijuana recreationally, but commercial sales are not allowed. 47 States have also authorized the sale of products that have low levels of THC, but high levels of CBD. These products are widely available in retail locations, but are highly unregulated. 47 The benefits of CBD touted by the public and retailers are largely anecdotal. The vast majority of these claims are not substantiated by valid research.
Decriminalizing and legalizing marijuana can decrease the number of individuals arrested and subsequently prosecuted for possession and/or use. 48 However, evidence suggests that these practices are not applied equitably. People of color are more likely to be arrested and prosecuted for marijuana possession despite overall decreased arrest rates. 48 Incarceration impacts health. People who are incarcerated have significantly higher rates of disease than those who are not, and are less likely to have access to adequate medical care. 49
The AAFP “opposes the recreational use of marijuana. However, the AAFP supports decriminalization of possession of marijuana for personal use. The AAFP recognizes the benefits of intervention and treatment for the recreational use of marijuana, in lieu of incarceration, for all individuals, including youth.” 4 The AAFP calls for family physicians to advocate to prevent unnecessary incarceration by diverting eligible people from the justice system to substance abuse and/or mental health treatment. 49
There are many public health considerations when regulating cannabis products. Serious public health concerns include impaired driving, youth exposure to advertisements, and accidental poisoning in children. Second to alcohol, marijuana is the most common illicit drug associated with impaired driving and accidents. 34 Marijuana slows reaction time and decision making, substantially increasing risk for traffic accidents. 50 Some states have a zero-tolerance policy, where there is no allowable detectable level of THC while driving, while other states have set five nanograms per milliliter or higher limits of THC, or minimally-detectable amounts of THC. 51
Evidence indicates adolescents who are exposed to medical marijuana advertising are more likely to have positive views of and subsequently use marijuana. 52 Those exposed to medical marijuana advertising were more likely to report past use and expectant future use. 52 These adolescents also reported agreeing with statements like, marijuana helps people relax and get away from their problems. 52 Adolescent exposure to medical marijuana advertising was also associated with self-reporting negative consequences associated with marijuana use, including missing school and concentration issues. 52 The AAFP calls for immediate regulation of advertising of all marijuana and cannabinoid products to decrease youth exposure to aid in preventing initiation and subsequent use of marijuana.
Children are most susceptible to severe effects associated with marijuana poisoning, including decreased coordination, lethargy, sedation, difficulty concentrating, and slurred speech. 53 Exposure may also include serious, potentially life-threatening symptoms like respiratory distress and coma. 33 Unintentional exposures to marijuana in children have increased each year since 2012, likely due to legalization policies across the U.S. and popularity of edibles. 53 Edibles often look exactly like their non-THC counterparts, and come in brightly colored packaging appealing to children, often mimicking candy products. 53 Effective legislation requiring childproof packaging for edible products can help mitigate and prevent unintentional exposure in children. 54 Family physicians should discuss safe storage of all cannabis products with their patients who live with children. 54 Under the Child Abuse Prevention and Treatment Act (CAPTA), physicians are mandated reporters of suspected child abuse and neglect. 55 The 2010 law requires states to enact laws for reporting substance use-exposed infants to child protective services. 55
Family physicians play a key role in addressing marijuana, cannabinoid, and cannabis product use; reducing barriers to research; and advocating for appropriate policy to protect the health of patients and the public.
Family physicians can address the inappropriate use of marijuana, cannabinoid, and cannabis products. Family physicians should discuss safe storage of all cannabis products with patients who live with or serve as primary caregivers for children to prevent unintended exposure. 56 It is important to discuss the developmental and negative impacts of marijuana and cannabis products with individuals who are or can become pregnant, children, and adolescents. Family physicians should also emphasize the serious consequences of impaired driving and marijuana intoxication.
It is essential to decrease barriers to research all forms of marijuana, cannabis, and cannabinoids, including a reclassification of cannabis as a Schedule I drug. High-quality research regarding the impact on patients, public health, society, and health policy are essential to providing patient-centered care and promoting evidence-based public health practices. Immediate regulations for marijuana and cannabinoid products, including CBD, like product safety and consistency safeguards, child-proof packaging, labeling, marketing claims and advertising, and impairment standards are vital for consumer safety and injury prevention. Regulatory measures focused on preventing youth initiation of marijuana and cannabinoid product use must be prioritized to prevent a public health epidemic.
The health benefits associated with intervention and treatment of recreational marijuana and cannabinoid use, in lieu of incarceration, is an important policy consideration.
Utilizing an interdisciplinary, evidence-based approach to addressing both medical and recreational marijuana and cannabis use is essential to promote public health, inform policy, and provide patient-centered care. Family physicians, in partnership with public health and policy professionals, can play an imperative role in addressing the changing landscape of marijuana and cannabis products.
- Bridgeman MB, Abazia DT. Medicinal cannabis: history, pharmacology, and implications for the acute care setting. P T . 2017;42(3):180-188. Accessed August 20, 2019.
- Abrams DI. The therapeutic effects of cannabis and cannabinoids: An update from the National Academies of Sciences, Engineering and Medicine report. Eur J Intern Med . 2018;49:7-11.
- American Academy of Family Physicians. Substance abuse and addiction . Accessed August 20, 2019.
- American Academy of Family Physicians. Marijuana possession for personal use . Accessed August 20, 2019.
- The National Academies of Science, Engineering, and Medicine. The Health Effects of Cannabis and Cannabinoids . Washington, D.C.: National Academies Press; 2017.
- National Institute on Drug Abuse. DrugFacts: Monitoring the Future Survey: high school and youth trends. www.drugabuse.gov/publications/drugfacts/monitoring-future-survey-high-school-youth-trends. Accessed August 20, 2019.
- National Institute on Drug Abuse. National Survey of Drug Use and Health . Accessed August 20, 2019.
- Mackie K. Cannabinoid receptors: where they are and what they do. J Neuroendocrinol . 2008;20(s1):10-14.
- Hilderbrand RL. Hemp & cannabidiol: what is a medicine? Mo Med . 2018;115(4):306-309. Accessed August 20, 2019.
- U.S. Department of Agriculture. Hemp production program . Accessed August 20, 2019.
- Heidi H. Oregon State University launches largest, most comprehensive hemp research center in the nation. Oregon State University. www.today.oregonstate.edu/news/oregon-state-university-launches-largest-most-comprehensive-hemp-research-center-nation. Accessed August 20, 2019.
- Lee MJ. The legalization of hemp. Accessed August 20, 2019.
- Shipman M. Is hemp the same thing as marijuana? NC State University. Accessed August 20, 2019.
- National Institute on Drug Abuse. What is marijuana? Accessed August 20, 2019.
- Drug Policy Alliance. Marijuana concentrates. Accessed August 20, 2019.
- MacCoun RJ, Mello MM. Half-baked — the retail promotion of marijuana edibles. N Engl J Med . 2015;372(11):989-991.
- Peschel W, Peschel, Wieland. Quality control of traditional cannabis tinctures: pattern, markers, and stability. Sci Pharm . 2016;84(3):567-584.
- Rosenblatt S, Tucker J, DeAngelo S. Methods and compositions of cannabis extracts. Accessed August 20, 2019.
- MacCallum CA, Russo EB. Practical considerations in medical cannabis administration and dosing. Eur J Intern Med . 2018;49:12-19.
- U.S. Food and Drug Administration. FDA regulation of cannabis and cannabis-derived products: questions and answers . Accessed August 20, 2019.
- National Cancer Institute. NCI Drug Dictionary. Nabiximols. Accessed August 20, 2019.
- U.S. Food and Drug Administration. Syndros (dronabinol) oral solution . Accessed August 20, 2019.
- U.S. Food and Drug Administration. CESAMETTM (nabilone) capsules. Accessed August 20, 2019.
- Greenwich Biosciences. Epidiolex® (cannabidiol). www.epidiolex.com/. Accessed August 20, 2019.
- Whiting PF, Wolff RF, Deshpande S, et al. Cannabinoids for medical use. A systematic review and meta-analysis. JAMA . 2015;313(24):2456-2473.
- Abuhasira R, Shbiro L, Landschaft Y. Medical use of cannabis and cannabinoids containing products – Regulations in Europe and North America. Eur J Intern Med . 2018;49:2-6.
- Devinsky O, Cilio MR, Cross H, et al. Cannabidiol: pharmacology and potential therapeutic role in epilepsy and other neuropsychiatric disorders. Epilepsia . 2014;55(6):791-802.
- U.S. Food and Drug Administration. FDA approves first drug comprised of an active ingredient derived from marijuana to treat rare, severe forms of epilepsy. Accessed August 20, 2019.
- Devinsky O, Patel AD, Cross JH, et al. Effect of cannabidiol on drop seizures in the Lennox–Gastaut syndrome. N Engl J Med . 2018;378(20):1888-1897.
- Devinsky O, Cross JH, Laux L, et al. Trial of cannabidiol for drug-resistant seizures in the Dravet syndrome. N Engl J Med . 2017;376(21):2011-2020.
- Perucca E. Cannabinoids in the treatment of epilepsy: hard evidence at last? J Epilepsy Res . 2017;7(2):61-76.
- Volkow ND, Swanson JM, Evins AE, et al. Effects of cannabis use on human behavior, including cognition, motivation, and psychosis: a review. JAMA Psychiatry . 2016;73(3):292-297.
- Wang GS. Cannabis (marijuana): acute intoxication. UpToDate. Accessed August 20, 2019.
- Volkow ND, Baler RD, Compton WM, Weiss SRB. Adverse health effects of marijuana use. N Engl J Med . 2014;370(23):2219-2227.
- Wilson KM, Torok MR, Wei B, et al. Detecting biomarkers of secondhand marijuana smoke in young children. Pediatr Res . 2017;81(4):589-592.
- Reece-Stremtan S, Marinelli KA. ABM Clinical Protocol #21: Guidelines for Breastfeeding and Substance Use or Substance Use Disorder, Revised 2015. Breastfeed Med . 2015;10(3):135-141.
- Bertrand KA, Hanan NJ, Honerkamp-Smith G, Best BM, Chambers CD. Marijuana use by breastfeeding mothers and cannabinoid concentrations in breast milk. Pediatrics . 2018;142(3):e20181076.
- Corsi DJ, Walsh L, Weiss D, et al. Association between self-reported prenatal cannabis use and maternal, perinatal, and neonatal outcomes. JAMA . 2019;322(2):145-152.
- Centers for Disease Control and Prevention. Does marijuana use lead to other drug use? Accessed August 20, 2019.
- Di Forti M, Quattrone D, Freeman TP, et al. The contribution of cannabis use to variation in the incidence of psychotic disorder across Europe (EU-GEI): a multicentre case-control study. The Lancet Psychiatry . 2019;6(5):427-436.
- U.S. Food and Drug Administration. Marijuana research with human subjects . Accessed August 20, 2019.
- National Institute on Drug Abuse (NIDA). NIDA’s role in providing marijuana for research. www.drugabuse.gov/drugs-abuse/marijuana/nidas-role-in-providing-marijuana-research. Accessed August 20, 2019.
- U.S. Drug Enforcement Administration. Drug scheduling . Accessed August 20, 2019.
- U.S. Food and Drug Administration. Statement from FDA Commissioner Scott Gottlieb, M.D., on signing of the Agriculture Improvement Act and the agency's regulation of products containing cannabis and cannabis-derived compounds. Accessed August 20, 2019.
- American Bar Assocation. Conflicting state and federal marijuana laws create ethical complications for lawyers. Accessed August 20, 2019.
- National Conference of State Legislatures. Marijuana laws. www.ncsl.org/bookstore/state-legislatures-magazine/marijuana-deep-dive.aspx. Accessed August 20, 2019.
- National Conference of State Legislatures. Marijuana laws. Accessed August 20, 2019.
- Drug Policy Alliance. From prohibition to progress: a status report on marijuana legalization. Accessed August 20, 2019.
- American Academy of Family Physicians. Incarceration and health: a family medicine perspective (position paper) . Accessed August 20, 2019.
- Centers for Disease Control and Prevention. What you need to know about marijuana use and driving . Accessed August 20, 2019.
- National Conference of State Legislatures. Drugged driving | Marijuana-impaired driving . Accessed August 20, 2019.
- RAND Corporation. Adolescents who view more medical marijuana advertising are more likely to use marijuana, have positive views about the drug . Accessed August 20, 2019.
- Center on Addiction. Childhood poisoning: safeguarding young children from addictive substances. Accessed August 20, 2019.
- Center on Addiction. Toddlers and THC: the number of young children exposed to marijuana is on the rise. Accessed August 20, 2019.
- Child Welfare Information Gateway. Mandatory reporters of child abuse and neglect. Accessed August 20, 2019.
- Children’s Hospital Colorado. Marijuana safety in the home . Accessed August 20, 2019.
(July 2019 BOD)
Copyright © 2023 American Academy of Family Physicians. All Rights Reserved.
Cannabis (Marijuana) Research Report What is marijuana?
Marijuana—also called weed, herb, pot, grass, bud, ganja, Mary Jane , and a vast number of other slang terms—is a greenish-gray mixture of the dried flowers of Cannabis sativa . Some people smoke marijuana in hand-rolled cigarettes called joints ; in pipes, water pipes (sometimes called bongs ), or in blunts (marijuana rolled in cigar wraps). 1 Marijuana can also be used to brew tea and, particularly when it is sold or consumed for medicinal purposes, is frequently mixed into foods ( edibles ) such as brownies, cookies, or candies. Vaporizers are also increasingly used to consume marijuana. Stronger forms of marijuana include sinsemilla (from specially tended female plants) and concentrated resins containing high doses of marijuana’s active ingredients, including honeylike hash oil , waxy budder , and hard amberlike shatter . These resins are increasingly popular among those who use them both recreationally and medically.
The main psychoactive (mind-altering) chemical in marijuana, responsible for most of the intoxicating effects that people seek, is delta-9-tetrahydrocannabinol (THC). The chemical is found in resin produced by the leaves and buds primarily of the female cannabis plant. The plant also contains more than 500 other chemicals, including more than 100 compounds that are chemically related to THC, called cannabinoids . 2
Marijuana Legalization Essays
Medical marijuana legalization the good bad and ugly.
The legalization of medical marijuana has been discussed amongst the country's states for decades. Medical marijuana legalization has taken a positive shift throughout these years and is now legal in 20 states and the District of Columbia. The initial drug, marijuana, was band for the dangerous effects it brought to people. Throughout the year's people have turned to marijuana to ease anxiety, pain, and stress. Legalizing marijuana has brought multiple perspectives on the topic. Differences such as medical marijuana legalization, […]
Medical Marijuana Legalization
Marijuana legalization has become a topic of relevance in the United States as recent changes in various state legislations fuel the controversial issue relating to its effects on society. With more than thirty states legalizing marijuana for medicinal or recreational uses, the once taboo topic has reemerged into the spotlight for policymakers to consider the benefits and adverse effects of cannabis for state legislation. Although the legal status is changing nationwide, the uncertainties surrounding marijuana today stem from the political […]
Pros and Cons of Legalizing Marijuana
When we first picked our topic for our presentations I had an idea of what we were going to do. Ideas from school shootings to you and human trafficking were some I was thinking of. The drug epidemic was what first came to thought but I felt that was to broad of of a topic. With state after state legalizing Medical or Recreational Marijuana it is becoming more likely within the near future will become federally legal. Today there are […]
Marijuana Legalization and Regulation
Medications/Drugs are a part of everyday life. We take medications for various ailments, to return ourselves to good health. Yet, as time and healthcare technology have moved along, we have discovered that some medications or drugs are inherently good (i.e.: antibiotics, cancer medications, and insulin) and some are inherently bad or, at least, can be used for bad purposes (i.e.: mind altering substances such as LSD, and cocaine). The "bad" drugs can be deadly. They have effects that can addict […]
Medical Marijuana and Marijuana Legalization
Thursday, June 09, 2011 Much debate has been conducted regarding the legalization of marijuana, with an unusual amount of contradicting research. There are many perspectives to take into account, and they always seem to come down to the personal motives of the debater. Whether it's being argued from a medical, political, or economical perspective; it continually comes down to whether Federal Government should be our dictators or we should be responsible for our actions. The Canadian medical Association Journal reports […]
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Legalization of Marijuana and Economic Growth
These would make occupations as well as set the ball moving for financial action in the pot business in these regions. On account of states like California and Nevada where such foundation as of now exists, the financial effect has turned out to be more quantifiable as the part has developed. A RCG Economics and Marijuana Policy Group consider on Nevada says that legitimizing recreational marijuana in the state could bolster more than 41,000 employments till 2024 and produce over […]
Against Marijuana Legalization
In my high school years I met a lot of people, I’ve meet hundreds of people who ruined their lives by just “trying” a drug. One of those friends is named Carmen, my dear friend Carmen smokes marijuana recreationally everyday, she’s tried everything under the rainbow; pot brownies, gummi bears, cookies, anything that you can think of is probably an edible. She’s even forced me to try marijuana when we were in high school once. It was the worst experience […]
The Legalization of Marijuana Today
Over the last decade, there has been plenty of speculation revolving around the whether the legalization of marijuana is even ethical, well it is here, and it is legal. For the time being it happens to be in only a select number of states. Despite some people not agreeing with various laws that have decriminalized marijuana because they still believe it is a harmful "drug" for humans. Well when the facts reveal the real benefits from marijuana and how it […]
Marijuana should be Legalized?
We are living in an era where noxious things like alcohol, rum and cigarettes -that lead us to nothing but a dreadful death- are legal, and a plant which has no obnoxious effects on our body and mind is illegal. For years and years, marijuana has been used as a mean to achieve elation. The criterion to impose a ban on something, or to term it illegal, is that its cons should overshadow its pros; and that it will have […]
The Impacts of Legalizing Marijuana
The impacts of legalizing marijuana have been far reaching. Legal or not, there are health issues to consider when it comes to medicinal purposes or recreational purposes. Studies show that non-medical marijuana users are at an increased risk for physical ailments involving the respiratory system and pulmonary functions. Psychological problems are also a concern, involving depression, insomnia, anxiety, and drug addiction. Other things associated with marijuana use are criminal justice involvement and lower academic achievement and functioning (Lankenau, et al., […]
Legalization of Marijuana Throughout States
Legalization of marijuana use is spreading throughout states in the nation. There are many people who want to make recreational marijuana legal in the state of Texas. Some opponents of keeping marijuana criminalized argue that it would decreased alcohol and tobacco consumption, makes people passive and peaceful and that it aids those who are in pain. However after researching the effects that long-term marijuana use has on people, one will find that those are not realistically always the case and […]
The Cost and Benefit of Legalization of Marijuana
In recent years, marijuana has become a controversial topic, and the United States government has been struggling to find a solution for the legalization of marijuana. Some argue that the government should legalize marijuana because it is less harmful than alcohol and tobacco. They also believe legalizing marijuana will decrease crime rates, especially drug trafficking. It is because marijuana is illegal in most states, and its penalties are often quite harsh, which can deter people from committing related crimes. Others […]
Legalization of Marijuana: Good or Bad
The legalization of marijuana is a hot topic these days. Marijuana has been legalized in many different states. Colorado legalized marijuana for recreational use in 2012. Since then, Texas has been talking of legalizing it as well. Although the legalization of marijuana has brought quite a bit of controversy over the nation, I believe the good outweigh the bad. Marijuana is used for different medical reasons, ranging from anxiety all the way to helping some side effects of cancer. Many […]
Pro-Legalization of Marijuana
Marijuana has always been a much-discussed subject that has sparked heated discussions among experts and officials, in addition to a perpetual dialogue among family and associates. This is primarily due to the fact that people are still divided on whether cannabis should be legalized or not. While many people are aware of the dangers of cannabis for recreational purposes, many states are pushing for the legalization of medical cannabis. Several studies of cannabinoid elements have revealed its medicinal qualities, which […]
A Legalized Drug in the United States
In the United States, marijuana is one of the most commonly used drugs that should have been legalized a long time ago along with alcohol. Although, 15 states in the United States have already legalized the use of marijuana, many others still lag behind at the thought of even legalizing Cannabis. In addition, many people think that marijuana is a bad drug, while on the other hand, people like myself believe for many reasons that it should be legalized. Marijuana […]
Legalization of Recreational Marijuana
Marijuana, also known as pot, weed, kush, or dank, is a debated topic nationwide. Surveys have shown that " more than half of American adults have tried marijuana at least once in their lives ...nearly 55 million of them, or twenty two percent, currently use it"(Ingraham). Many people believe that there are only few negative effects affiliated with smoking weed, but there are many poor and preventable outcomes that are not always taken into consideration. The effects of marijuana on […]
Marijuana as a Psychoactive Drug
Marijuana is a psychoactive drug from the Cannabis plant used for medical or recreational purposes. It is sold in the form of dried leaves which can be smoked. Recreational marijuana was introduced in the U.S in the early 20th century by immigrants from Mexico. Marijuana is a controversial topic in the United States because many people think it shouldn't be legalized . Some will agree on making it legal throughout the United States, and some would think otherwise. Many debates […]
Legalization of Marijuana: the Current Situation
Scholars are increasingly exhibiting interest in matters concerning marijuana legalization especially considering laws related to healthcare. The increments in interest emanate from concerns that legalization of this drug is not in alignment with existing health-related laws according to the federal government (Kilmer et al., 2010). According to Hopfer (2014), the government has failed to fully support legalization because few studies have been conducted to prove its medicinal worth. Nonetheless, medical legalization of this particular drug is increasingly gaining support. A […]
Marijuana Decriminalization in all States
The government should legalize marijuana on the federal use due to the multifaceted health, economic, and criminal benefits now outweigh the outdated downsides of use. Many researchers have come to the conclusion of outdated research not being correct. "One function of government is to protect citizens from harm, whether it is from foreign enemies or from internal causes such as poisonous food or contaminated water." Researchers believe that legalizing marijuana will not help the people only harm them and the […]
Proposal One is the allowing of individuals age 21 and older to purchase, possess and use marijuana and marijuana-infused edibles, and grow up to 12 marijuana plants for personal consumption. Impose a 10-ounce limit for marijuana kept at residences and require that amounts over 2.5 ounces be secured in locked containers. Creating a state licensing system for marijuana businesses including growers, processors, and transporters. Ryan Mainer (Libertarian party) supports proposal one. How do we know this is true? He has […]
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Whether marijuana should be a legal drug or not is a controversial issue. While there are proven benefits of its use, there are also grounds for mild concern, particularly in the case of overdosing. Even worse, the inconsistent and inconclusive studies and scientific research add fuel to the fire. Several countries have decided to go in favor of marijuana liberalization. For instance, in Uruguay, Canada, Mexico, Nepal, the Netherlands, and Portugal, it’s perfectly legit to smoke and possess small quantities of the drug. The legalization of marijuana’s in the United States is constantly on the rise. Today, 21 states allow it for recreational use, and ten have decriminalized cannabis. But why is there so much ado about drug legalization? Some studies prove its beneficial impact on several mental, physical, and emotional conditions. The alleviating effect for patients with epilepsy, cancer, and multiple sclerosis are undeniable. And while medical marijuana is potent in eliminating side effects, there are also reports of drug misuse, progression to addictive drugs, and changes in brain function. Overall, one needs convincing arguments and credible sources to firmly claim that the decriminalization of marijuana would do more good than harm. Hence, your research paper about marijuana legalization should carefully list all the pros and cons of the issue. Other essay topics you can explore include the cause and effect of using weed, remedy vs. drug, or the social and economic implications.
When you have the topic assigned, start with the outline of your first draft. It is also critical to conceptualize a captivating thesis statement for the essay. It should contain the arguments you will defend later in the body of your paper. Also, don’t forget to include a compelling introduction and a well-thought conclusion. Yet, some students lack solid writing experience or time to dedicate to the legalization of weed essays. If this scenario sounds familiar, you may need to search for help online. PapersOwl is a trustworthy writing platform with seasoned writers where you can find argumentative essay examples on marijuana legalization. So whenever you need a push to get writing or want to order for and against papers, this is the perfect solution.
Essay About Marijuana Legalization Marijuana also is known as weed or pot is very old. The drug is dated back to Asia in 500 BC. However, they did not use the Marijuana plant to get high, they used it as a healing factor. Marijuana was a good thing until the 20th century. During the 1950s is when the drug really became a problem. People were getting addicted and most lost their jobs to it. Then they would have to turn to petty thieving to come up with the money to buy it. Not long after it became illegal in most places. Even though medical weed is legal in some states, however federal laws always override common or city laws. If you are caught with weed you can face drug charges and maybe some time in jail. This makes these laws very confusing in some states in the United States. Also, marijuana is a schedule 1 drug that is the same level as LSD and heroin and that is not changing anytime soon. Some people argue that is has no proven medical benefit. There is a lawyer who fights for the legalization of marijuana on his free time because he says it is just to get high. That did not stop people from buying, growing, and using it illegally. Now there is an issue in current society and it has became legal again in most northern states and petitions in southern states. As for Marijuana, it is one of the fastest-growing industries in the northern states where it is has become legal. The majority of the United States supports legalizing weed. Surveys show that seniors from 55 and up are the ones that oppose. Since 2016 it has grown 34% by 2026 it is estimated to reach $50 billion dollars. In 2012 eight states has made it legal. Now there are 29 states which medical marijuana is legal. The main reason it has become legal is to be used a medical Marijuana. It has become a big debate in the south on whether it should or shouldn’t become legal. Getting marijuana on the ballot to be voted on is not easy as you might think. Some states work through the legislative process which lets the state officials decide on whether it should or shouldn’t be on the ballot. Mississippi is not completely against marijuana there are some laws about it in the books. The black market for weed is still just as big as the industries selling weed. Most people still depend on a plug then on a store. However, there is no case where weed has to lead to an overdose to where the patient dies. Doctors have been prescribing weed for opioid addiction. The medical marijuana business has expanded employment in the states where it is legal. Marijuana also has it own taxes. There is 15%, 10%, 2.9% which represents excise tax, special sales tax and a state and local tax. Just in 2017, the state of Colorado collected more than $247 million from the marijuana industry. If Mississippi was to legalize Marijuana it would become less expensive therefore the use of Marijuana would increase. However, the legalization of weed would mean big investment opportunities but it is still illegal on a federal level. If it did become legal on a federal level would it be a great business for the entire U.S? Canada right now holds the title for the second country to completely legalize weed for recreational use. However, prices for marijuana drop dramatically right before it becomes legalized from $25 a gram to $6 a gram. That is pretty big discount so when the prices begin to drop you know what’s coming. The arguments on the legalization of marijuana is very confusing because all the essays about the arguments are very biased so it is hard to understand the facts from the opinions. However, I feel, because of what I believe in and how I was raised, I do not believe it should be legalized. Especially for recreational use because once people start smoking legally then they would be able to go to jobs high then they would not have enough money. This would increase crime rates in Mississippi and that is the last thing we need. People are pushing for the legalization of weed just to get high? Also if it was for medical uses there are the companies that produce cannabis oil with though the thc which it gets you high so why isn’t that enough? That is because one it is medically legalized then there will be so many lies and stories told to doctors just to get weed. That is so selfish to me because there are people that really need those doctor’s appointments.
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