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The Info List - Medical Cannabis


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Medical cannabis, or medical marijuana, is cannabis and cannabinoids that are recommended by doctors for their patients.[1][2] The use of cannabis as medicine has not been rigorously tested due to production restrictions and other governmental regulations.[3] Limited evidence suggests cannabis can: reduce nausea and vomiting during chemotherapy, improve appetite in people with HIV/AIDS, and reduce chronic pain and muscle spasms.[4][5][6] Short-term use increases the risk of both minor and major adverse effects.[5] Common side effects include dizziness, feeling tired, vomiting, and hallucinations.[5] Long-term effects of cannabis
Long-term effects of cannabis
are not clear.[5] Concerns include memory and cognition problems, risk of addiction, schizophrenia in young people, and the risk of children taking it by accident.[4] The Cannabis
Cannabis
plant has a history of medicinal use dating back thousands of years across many cultures.[7] The use of medical cannabis is controversial. A number of medical organizations have requested removal of cannabis from the list of Schedule I controlled substances, followed by regulatory and scientific review.[8][9] Others such as the American Academy of Pediatrics
American Academy of Pediatrics
oppose the legalization of medical cannabis.[10] Medical cannabis
Medical cannabis
can be administered through a variety of methods, including capsules, lozenges, tinctures, dermal patches, oral or dermal sprays, cannabis edibles, and vaporizing or smoking dried buds. Synthetic cannabinoids, such as dronabinol and nabilone, are available for prescription use in some countries. Countries that allow the medical use of whole-plant cannabis include Canada, Chile, Colombia, Germany, Greece, Israel, Italy, the Netherlands, Poland, Peru, and Uruguay. Australia
Australia
has passed legislation to allow the medical use of cannabis in some states. In the United States, 29 states and the District of Columbia have legalized cannabis for medical purposes, beginning with California
California
in 1996. Although cannabis remains prohibited for any use at the federal level, the Rohrabacher–Farr amendment was enacted in December 2014, limiting the ability of federal law to be enforced in states where medical cannabis has been legalized.

Contents

1 Classification 2 Medical uses

2.1 Nausea and vomiting 2.2 HIV/AIDS 2.3 Pain 2.4 Neurological problems 2.5 Posttraumatic stress disorder

3 Adverse effects

3.1 Medical use 3.2 Recreational use 3.3 Cognitive effects 3.4 Impact on psychosis 3.5 Other potential long-term effects

4 Pharmacology

4.1 Absorption 4.2 Distribution 4.3 Metabolism 4.4 Excretion

5 Administration 6 History

6.1 Ancient 6.2 Modern

7 Society and culture

7.1 Legal status

7.1.1 United States

7.2 Economics

7.2.1 Distribution 7.2.2 Insurance

7.3 Positions of medical organizations 7.4 Recreational use 7.5 Brand names

8 Research 9 See also 10 References 11 Further reading 12 External links

Classification Many different cannabis strains are collectively called medical cannabis. Since many varieties of the cannabis plant and plant derivatives all share the same name, the term medical cannabis is ambiguous and can be misunderstood. A Cannabis
Cannabis
plant includes more than 400 different chemicals, of which about 70 are cannabinoids.[11] In comparison, typical government-approved medications contain only one or two chemicals.[11] The number of active chemicals in cannabis is one reason why treatment with cannabis is difficult to classify and study.[11] A 2014 review stated that the variations in ratio of CBD-to- THC
THC
in botanical and pharmaceutical preparations determines the therapeutic vs psychoactive effects (CBD attenuates THC's psychoactive effects[12]) of cannabis products.[13] Medical uses

Cannabis
Cannabis
as illustrated in Köhler's Book of Medicinal Plants, 1897

Medical cannabis
Medical cannabis
has several potential beneficial effects.[5] Evidence is moderate that it helps in chronic pain and muscle spasms.[5] Low quality evidence suggests its use for reducing nausea during chemotherapy, improving appetite in HIV/AIDS, improving sleep, and improving tics in Tourette syndrome.[5] When usual treatments are ineffective, cannabinoids have also been recommended for anorexia, arthritis, migraine, and glaucoma.[14] It is recommended that cannabis use be stopped in pregnancy.[15] Nausea and vomiting Medical cannabis
Medical cannabis
is somewhat effective in chemotherapy-induced nausea and vomiting (CINV)[4][14] and may be a reasonable option in those who do not improve following preferential treatment.[16] Comparative studies have found cannabinoids to be more effective than some conventional antiemetics such as prochlorperazine, promethazine, and metoclopramide in controlling CINV,[17] but these are used less frequently because of side effects including dizziness, dysphoria, and hallucinations.[18][19] Long-term cannabis use may cause nausea and vomiting, a condition known as cannabinoid hyperemesis syndrome.[20] A 2016 Cochrane review said that cannabinoids were "probably effective" in treating chemotherapy-induced nausea in children, but with a high side effect profile (mainly drowsiness, dizziness, altered moods, and increased appetite). Less common side effects were "occular problems, orthostatic hypotension, muscle twitching, pruritis, vagueness, hallucinations, lightheadedness and dry mouth".[21] HIV/AIDS Evidence is lacking for both efficacy and safety of cannabis and cannabinoids in treating patients with HIV/AIDS
HIV/AIDS
or for anorexia associated with AIDS. As of 2013, current studies suffer from effects of bias, small sample size, and lack of long-term data.[22] Pain A 2017 review found moderate to high quality evidence for effectiveness of cannabis in relieving chronic pain in several conditions, particularly when inhaled.[23] Another review found tentative evidence for use of cannabis in treating peripheral neuropathy, but little evidence of benefit for other types of long term pain.[24] When cannabis is inhaled to relieve pain, blood levels of cannabinoids rise faster than when oral products are used, peaking within three minutes and attaining an analgesic effect in seven minutes.[23] A 2014 review found limited and weak evidence that smoked cannabis was effective for chronic non-cancer pain.[25] A 2015 meta-analysis found that inhaled medical cannabis was effective in reducing neuropathic pain in the short term for one in five to six patients.[26] Another 2015 review found limited evidence that medical cannabis was effective for neuropathic pain when combined with traditional analgesics.[27] A 2011 review considered cannabis to be generally safe,[28] and in palliative care, its use appears safer than opioids.[29] Neurological problems The efficacy of cannabis in treating neurological problems, including multiple sclerosis (MS), epilepsy, and movement problems, is not clear.[30] Studies of the efficacy of cannabis for treating multiple sclerosis have produced varying results. The combination of Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD) extracts give subjective relief of spasticity, though objective post-treatment assessments do not reveal significant changes.[31] Evidence also suggests that oral cannabis extract is effective for reducing patient-centered measures of spasticity.[32] A trial of cannabis is deemed to be a reasonable option if other treatments have not been effective.[4][by whom?] Its use for MS is approved in ten countries.[4][33] A 2012 review found no problems with tolerance, abuse or addiction.[34] Posttraumatic stress disorder Further information: Posttraumatic stress disorder § Cannabinoids There is tentative evidence that medical cannabis is effective at reducing posttraumatic stress disorder symptoms, but, as of 2015[update], there is insufficient evidence to confirm its effectiveness for this condition.[35] Adverse effects

American medical hashish

Medical use There is insufficient data to draw strong conclusions about the safety of medical cannabis.[36] Typically, adverse effects of medical cannabis use are not serious.[4] These include: tiredness, dizziness, cardiovascular, psychoactive effects, and increased appetite. Tolerance to these effects develops over a period of days or weeks. The amount of cannabis normally used for medicinal purposes is not believed to cause any permanent cognitive impairment in adults, though long-term treatment in adolescents should be weighed carefully as they are more susceptible to these impairments. Withdrawal symptoms are rarely a problem with controlled medical administration of cannabinoids. The ability to drive vehicles or to operate machinery may be impaired until a tolerance is developed.[16] Although supporters of medical cannabis say that it is safe,[36] further research is required to assess the long-term safety of its use.[18][37] Recreational use See also: Long-term effects of cannabis Tetrahydrocannabinol
Tetrahydrocannabinol
(THC), the principal psychoactive constituent of the cannabis plant, has low toxicity while the LD50 (dose of THC needed to kill 50% of tested rodents) is high. Acute effects may include anxiety and panic, impaired attention, and memory (while intoxicated), an increased risk of psychotic symptoms, and possibly increased risk of accidents if a person drives a motor vehicle while intoxicated.[38] Psychotic episodes are well-documented and typically resolve within minutes or hours. There have been few reports of symptoms lasting longer.[39][40] According to the United States
United States
Department of Health and Human Services, there were 455,000 emergency room visits associated with cannabis use in 2011. These statistics include visits in which the patient was treated for a condition induced by or related to recent cannabis use. The drug use must be "implicated" in the emergency department visit, but does not need to be the direct cause of the visit. Most of the illicit drug emergency room visits involved multiple drugs.[41] In 129,000 cases, cannabis was the only implicated drug.[42][43] Effects of chronic use may include bronchitis, a cannabis dependence syndrome, and subtle impairments of attention and memory. These deficits persist while chronically intoxicated.[38] Compared to non-smokers, people who smoked cannabis regularly in adolescence exhibit reduced connectivity in specific brain regions associated with memory, learning, alertness, and executive function.[43] One study suggested that sustained heavy, daily, adolescent onset cannabis use over decades is associated with a decline in IQ by age 38, with no effects found in those who initiated cannabis use later, or in those who ceased use earlier in adulthood.[44] There has been a limited amount of studies that have looked at the effects of smoking cannabis on the respiratory system.[45] Chronic heavy marijuana smoking is associated with coughing, production of sputum, wheezing, coughing, and other symptoms of chronic bronchitis.[38] Regular cannabis use has not been shown to cause significant abnormalities in lung function.[46] Cannabis
Cannabis
smoke contains thousands of organic and inorganic chemical compounds. This tar is chemically similar to that found in tobacco smoke,[47] and over fifty known carcinogens have been identified in cannabis smoke,[48] including; nitrosamines, reactive aldehydes, and polycylic hydrocarbons, including benz[a]pyrene.[49] Light and moderate use of cannabis is not believed to increase risk of lung or upper airway cancer. Evidence for causing these cancers is mixed concerning heavy, long-term use. In general there are far lower risks of pulmonary complications for regular cannabis smokers when compared with those of tobacco.[46] Combustion products are not present when using a vaporizer, consuming THC
THC
in pill form, or consuming cannabis edibles. There is serious suspicion among cardiologists, spurring research but falling short of definitive proof, that cannabis use has the potential to contribute to cardiovascular disease.[50] Cannabis
Cannabis
is believed to be an aggravating factor in rare cases of arteritis, a serious condition that in some cases leads to amputation. Because 97% of case-reports also smoked tobacco, a formal association with cannabis could not be made. If cannabis arteritis turns out to be a distinct clinical entity, it might be the consequence of vasoconstrictor activity observed from delta-8- THC
THC
and delta-9-THC.[51] Other serious cardiovascular events including myocardial infarction, stroke, sudden cardiac death, and cardiomyopathy have been reported to be temporally associated with cannabis use. Research in these events is complicated because cannabis is often used in conjunction with tobacco, and drugs such as alcohol and cocaine.[52] These putative effects can be taken in context of a wide range of cardiovascular phenomena regulated by the endocannabinoid system and an overall role of cannabis in causing decreased peripheral resistance and increased cardiac output, which potentially could pose a threat to those with cardiovascular disease.[53] Cannabis
Cannabis
usually causes no tolerance or withdrawal symptoms except in heavy users. In a survey of heavy users 42.4% experienced withdrawal symptoms when they tried to quit marijuana such as craving, irritability, boredom, anxiety and sleep disturbances.[54] About 9% of those who experiment with marijuana eventually become dependent. The rate goes up to one in six among those who begin use as adolescents, and one-quarter to one-half of those who use it daily according to a NIDA review.[43] A 2013 review estimates daily use is associated with a 10-20% rate of dependence.[4] The highest risk of cannabis dependence is found in those with a history of poor academic achievement, deviant behavior in childhood and adolescence, rebelliousness, poor parental relationships, or a parental history of drug and alcohol problems.[55] A 2013 literature review found that exposure to marijuana had biologically-based physical, mental, behavioral and social health consequences and was "associated with diseases of the liver (particularly with co-existing hepatitis C), lungs, heart, and vasculature".[56] Cognitive effects A 2011 systematic review evaluated published studies of the acute and long-term cognitive effects of cannabis. THC
THC
intoxication is well established to impair cognitive functioning on an acute basis, including effects on the ability to plan, organize, solve problems, make decisions, and control impulses. The extent of this impact may be greater in novice users, and paradoxically, those habituated to high-level ingestion may have reduced cognition during withdrawal. Studies of long-term effects on cognition have provided conflicting results, with some studies finding no difference between long-term abstainers and never-users and others finding long-term deficits. The discrepancies between studies may reflect greater long-term effects among heavier users relative to occasional users, and greater duration of effect among those with heavy use as adolescents compared to later in life.[57] A second systematic review focused on neuroimaging studies found little evidence supporting an effect of cannabis use on brain structure and function.[58] A 2003 meta-analysis concluded that any long-term cognitive effects were relatively modest in magnitude and limited to certain aspects of learning and memory.[59] Impact on psychosis Exposure to THC
THC
can cause acute transient psychotic symptoms in healthy individuals and people with schizophrenia.[12] A 2007 meta analysis concluded that cannabis use reduced the average age of onset of psychosis by 2.7 years relative to non-cannabis use.[60] A 2005 meta analysis concluded that adolescent use of cannabis increases the risk of psychosis, and that the risk is dose-related.[61] A 2004 literature review on the subject concluded that cannabis use is associated with a two-fold increase in the risk of psychosis, but that cannabis use is "neither necessary nor sufficient" to cause psychosis.[62] A French review from 2009 came to a conclusion that cannabis use, particularly that before age 15, was a factor in the development of schizophrenic disorders.[63] Some studies have suggested that cannabis users have a greater risk of developing psychosis than non-users. This risk is most pronounced in cases with an existing risk of psychotic disorder.[64][65] A 2005 paper from the Dunedin study suggested an increased risk in the development of psychosis linked to polymorphisms in the COMT gene.[66] However, a more recent study cast doubt on the proposed connection between this gene and the effects of cannabis on the development of psychosis.[67] A 2008 German review reported that cannabis was a causal factor in some cases of schizophrenia and stressed the need for better education among the public due to increasingly relaxed access to cannabis.[68] Other potential long-term effects A 2008 National Institutes of Health
National Institutes of Health
study of 19 chronic heavy marijuana users with cardiac and cerebral abnormalities (averaging 28 g to 272 g (1 to 9+ oz) weekly) and 24 controls found elevated levels of apolipoprotein C-III (apoC-III) in the chronic smokers.[69] An increase in apoC-III levels induces the development of hypertriglyceridemia. Pharmacology The genus Cannabis
Cannabis
contains two species which produce useful amounts of psychoactive cannabinoids: Cannabis
Cannabis
indica and Cannabis
Cannabis
sativa, which are listed as Schedule I medicinal plants in the US;[4] a third species, Cannabis
Cannabis
ruderalis, has few psychogenic properties.[4] Cannabis
Cannabis
contains more than 460 compounds;[7] at least 80 of these are cannabinoids[70][71] – chemical compounds that interact with cannabinoid receptors in the brain.[4] As of 2012, more than 20 cannabinoids were being studied by the U.S. FDA.[72] The most psychoactive cannabinoid found in the cannabis plant is tetrahydrocannabinol (or delta-9-tetrahydrocannabinol, commonly known as THC).[7] Other cannabinoids include delta-8-tetrahydrocannabinol, cannabidiol (CBD), cannabinol (CBN), cannabicyclol (CBL), cannabichromene (CBC) and cannabigerol (CBG); they have less psychotropic effects than THC, but may play a role in the overall effect of cannabis.[7] The most studied are THC, CBD and CBN.[56] CB1 and CB2 are the primary cannabinoid receptors responsible for several of the effects of cannabinoids, although other receptors may play a role as well. Both belong to a group of receptors called G protein-coupled receptors (GPCRs). CB1 receptors are found in very high levels in the brain and are thought to be responsible for psychoactive effects.[73] CB2 receptors are found peripherally throughout the body and are thought to modulate pain and inflammation.[74] Absorption Cannabinoid
Cannabinoid
absorption is dependent on its route of administration. Smoking is by far the most common form of administration. Inhalation of the smoke quickly and efficiently delivers the drug from the lungs to the brain. Smoked THC
THC
has a bioavailability of approximately 25% and a rapid time to peak plasma levels of 6 to 10 minutes. Bioavailability varies between individuals depending on the number, duration and spacing of puffs, hold time, and inhalation volume.[75] Inhaled and vaporized THC
THC
have similar absorption profiles to smoked THC, with a bioavailability ranging from 10 to 35%. Oral administration has the lowest bioavailability of approximately 6%, variable absorption depending on the vehicle used, and the longest time to peak plasma levels (2 to 6 hours) compared to smoked or vaporized THC.[76] Similar to THC, CBD has poor oral bioavailability, approximately 6%. The low bioavailability is largely attributed to significant first-pass metabolism in the liver and erratic absorption from the gastrointestinal tract. However, oral administration of CBD has a faster time to peak concentrations (2 hours) than THC.[76] Due to the poor bioavailability of oral preparations, alternative routes of administration have been studied, including sublingual and rectal. These alternative formulations maximize bioavailability and reduce first-pass metabolism. Sublingual administration in rabbits yielded bioavailability of 16% and time to peak concentration of 4 hours.[77] Rectal administration in monkeys doubled bioavailability to 13.5% and achieved peak blood concentrations within 1 to 8 hours after administration.[75] Distribution Like cannabinoid absorption, distribution is also dependent on route of administration. Smoking and inhalation of vaporized cannabis have better absorption than do other routes of administration, and therefore also have more predictable distribution.[75][78] THC
THC
is highly protein bound once absorbed, with only 3% found unbound in the plasma. It distributes rapidly to highly vascularized organs such as the heart, lungs, liver, spleen, and kidneys, as well as to various glands. Low levels can be detected in the brain, testes, and unborn fetuses, all of which are protected from systemic circulation via barriers.[79] THC
THC
further distributes into fatty tissues a few days after administration due to its high lipophilicity, and is found deposited in the spleen and fat after redistribution.[78][80][81] Metabolism

Metabolism of THC
THC
to 11-COOH-THC

Delta-9-THC
Delta-9-THC
is the primary molecule responsible for the effects of cannabis. Delta-9-THC
Delta-9-THC
is metabolized in the liver and turns into 11-OH-THC.[82] 11-OH- THC
THC
is the first metabolic product in this pathway. Both Delta-9-THC
Delta-9-THC
and 11-OH- THC
THC
are psychoactive. The metabolism of THC
THC
into 11-OH- THC
THC
plays a part in the heightened psychoactive effects of edible cannabis.[83] Next, 11-OH- THC
THC
is metabolized in the liver into 11-COOH-THC, which is the second metabolic product of THC.[84] 11-COOH- THC
THC
is not psychoactive.[82] Ingestion of edible cannabis products lead to a slower onset of effect than the inhalation of it because the THC
THC
travels to the liver first through the blood before it travels to the rest of the body. Inhaled cannabis can result in THC
THC
going directly to the brain, where it then travels from the brain back to the liver in recirculation for metabolism.[82] Eventually, both routes of metabolism result in the metabolism of psychoactive THC
THC
to inactive 11-COOH-THC. Excretion Due to the large propensity of THC
THC
and CBD being hepatically metabolized, a majority of their metabolites are excreted via feces than in the urine.[76] After delta-9- THC
THC
is hydroxylated into 11-OH- THC
THC
via CYP2C9, CYP2C19, and CYP3A4, it undergoes phase II metabolism into more than 30 metabolites. A majority of these metabolites are products of glucuronidation. Approximately 65% is excreted in feces and 25% in the urine, while the remaining 10% is excreted by other means.[76] The terminal half-life is approximately 25–36 hours.[85] CBD is hydroxylated by P450 liver enzymes into 7-OH-CBD. Its metabolites are products of primarily CYP2C19 and CYP3A4 activity, with potential activity of CYP1A1, CYP1A2, CYP2C9, and CYP2D6.[86] Similar to delta-9-THC, a majority of CBD is excreted in feces and some in the urine.[76] The terminal half-life is approximately 18–32 hours.[87] Administration

Illustrating various forms of medicinal cannabis

Smoking is the means of administration of cannabis for many consumers,[88] and the most common method of medical cannabis consumption in the US as of 2013.[4] It is difficult to predict the pharmacological response to cannabis because concentration of cannabinoids varies widely as there are different ways of preparing cannabis for consumption (smoked, applied as oils, eaten, infused into other foods, or drunk) and a lack of production controls.[4] The potential for adverse effects from smoke inhalation makes smoking a less viable option than oral preparations.[88] Cannabis
Cannabis
vaporizers have gained popularity because of the perception among users that less harmful chemicals are ingested when components are inhaled via aerosol rather than smoke.[4] Cannabinoid
Cannabinoid
medicines are available in pill form (dronabinol and nabilone) and liquid extracts formulated into an oromucosal spray (nabiximols).[4] Oral preparations are "problematic due to the uptake of cannabinoids into fatty tissue, from which they are released slowly, and the significant first-pass liver metabolism, which breaks down Δ9 THC
THC
and contributes further to the variability of plasma concentrations".[88] The US Food and Drug Administration
Food and Drug Administration
(FDA) has not approved smoked cannabis for any condition or disease as it deems evidence is lacking concerning safety and efficacy of cannabis for medical use.[89] The FDA issued a 2006 advisory against smoked medical cannabis stating: "marijuana has a high potential for abuse, has no currently accepted medical use in treatment in the United States, and has a lack of accepted safety for use under medical supervision."[89] History Main article: History of medical cannabis Ancient Cannabis, called má 麻 (meaning "hemp; cannabis; numbness") or dàmá 大麻 (with "big; great") in Chinese, was used in Taiwan
Taiwan
for fiber starting about 10,000 years ago.[90] The botanist Hui-lin Li wrote that in China, "The use of Cannabis
Cannabis
in medicine was probably a very early development. Since ancient humans used hemp seed as food, it was quite natural for them to also discover the medicinal properties of the plant."[91] Emperor Shen-Nung, who was also a pharmacologist, wrote a book on treatment methods in 2737 BCE that included the medical benefits of cannabis. He recommended the substance for many ailments, including constipation, gout, rheumatism, and absent-mindedness.[92] Cannabis
Cannabis
is one of the 50 "fundamental" herbs in traditional Chinese medicine.[93] The Ebers Papyrus
Ebers Papyrus
(c. 1550 BCE) from Ancient Egypt
Ancient Egypt
describes medical cannabis.[94] The ancient Egyptians used hemp (cannabis) in suppositories for relieving the pain of hemorrhoids.[95] Surviving texts from ancient India
India
confirm that cannabis' psychoactive properties were recognized, and doctors used it for treating a variety of illnesses and ailments, including insomnia, headaches, gastrointestinal disorders, and pain, including during childbirth.[96] The Ancient Greeks
Ancient Greeks
used cannabis to dress wounds and sores on their horses,[97] and in humans, dried leaves of cannabis were used to treat nose bleeds, and cannabis seeds were used to expel tapeworms.[97] In the medieval Islamic world, Arabic physicians made use of the diuretic, antiemetic, antiepileptic, anti-inflammatory, analgesic and antipyretic properties of Cannabis
Cannabis
sativa, and used it extensively as medication from the 8th to 18th centuries.[98] Modern An Irish physician, William Brooke O'Shaughnessy, is credited with introducing cannabis to Western medicine.[99] O'Shaughnessy discovered cannabis in the 1830s while living abroad in India, where he conducted numerous experiments investigating its medical utility.[100] Noting in particular its analgesic and anticonvulsant effects, O'Shaughnessy returned to England
England
with a supply of cannabis in 1842, after which its use spread through Europe and the United States.[101] Cannabis
Cannabis
was entered into the United States
United States
Pharmacopeia in 1850.[100] The use of cannabis in medicine began to decline by the end of the 19th century, due to difficulty in controlling dosages and the rise in popularity of synthetic and opium-derived drugs.[101] Also, the advent of the hypodermic syringe allowed these drugs to be injected for immediate effect, in contrast to cannabis which is not water-soluble and therefore cannot be injected.[101] In the United States, the medical use of cannabis further declined with the passage of the Marihuana Tax Act of 1937, which imposed new regulations and fees on physicians prescribing cannabis.[102] Cannabis was removed from the U.S. Pharmacopeia in 1941, and officially banned for any use with the passage of the Controlled Substances Act
Controlled Substances Act
of 1970.[101] Cannabis
Cannabis
began to attract renewed interest as medicine in the 1970s and 1980s, in particular due to its use by cancer and AIDS patients who reported relief from the effects of chemotherapy and wasting syndrome.[103] In 1996, California
California
became the first U.S. state to legalize medical cannabis in defiance of federal law.[104] In 2001, Canada
Canada
became the first country to adopt a system regulating the medical use of cannabis.[105]

The use of cannabis, at least as fiber, has been shown to go back at least 10,000 years in Taiwan. "Dà má" ( Pinyin
Pinyin
pronunciation) is the Chinese expression for cannabis, the first character meaning "big" and the second character meaning "hemp".

Cannabis
Cannabis
indica fluid extract, American Druggists Syndicate, pre-1937.

An advertisement for cannabis americana distributed by a pharmacist in New York in 1917

The Ebers Papyrus
Ebers Papyrus
(c. 1550 BCE) from Ancient Egypt
Ancient Egypt
has a prescription for medical marijuana applied directly for inflammation.

Society and culture Legal status See also: Legality of cannabis
Legality of cannabis
by country

Worldwide laws on cannabis possession for medical purposes as of 2017.   Legal or essentially legal   Decriminalized   Illegal but often unenforced   Illegal   No information

Countries that have legalized the medical use of cannabis include Canada,[106] Chile,[106] Colombia,[106] Croatia,[107] Cyprus,[108] Czech Republic,[106] Jamaica,[106] Finland,[109] Germany,[110] Greece,[111] Israel,[112] Italy,[113] Macedonia,[114] the Netherlands,[106] Poland,[115] Peru,[116] Romania,[117] and Uruguay[106] Other countries have more restrictive laws allowing for the use of specific cannabinoids only, such as France
France
and the United Kingdom which have approved the use of Sativex.[118] Countries with more relaxed laws include Uruguay,[106] the Netherlands,[106] and Spain,[119] where cannabis can be obtained without need for a prescription. In Mexico, THC
THC
content of medical cannabis is limited to one percent.[120] The same limit applies in Switzerland, but no prescription is required to purchase.[121] In the United States[122] and Australia,[123] the legality of medical cannabis varies by state. Cannabis
Cannabis
is in Schedule IV of the United Nations' Single Convention on Narcotic Drugs, making it subject to special restrictions. Article 2 provides for the following, in reference to Schedule IV drugs:

A Party shall, if in its opinion the prevailing conditions in its country render it the most appropriate means of protecting the public health and welfare, prohibit the production, manufacture, export and import of, trade in, possession or use of any such drug except for amounts which may be necessary for medical and scientific research only, including clinical trials therewith to be conducted under or subject to the direct supervision and control of the Party.[124]

The convention thus allows countries to outlaw cannabis for all non-research purposes but lets nations choose to allow use for medical and scientific purposes if they believe total prohibition is not the most appropriate means of protecting health and welfare. The convention requires that states that permit the production or use of medical cannabis must operate a licensing system for all cultivators, manufacturers, and distributors and ensure that the total cannabis market of the state shall not exceed that required "for medical and scientific purposes."[124] United States See also: Medical cannabis
Medical cannabis
in the United States As of April 2017, 29 states and the District of Columbia have legalized the medical use of cannabis, and another 17 have passed laws allowing the use of CBD products.[122] Cannabis
Cannabis
remains illegal at the federal level by way of the Controlled Substances Act, under which cannabis is classified as a Schedule I drug with a high potential for abuse and no accepted medical use. In December 2014, however, the Rohrabacher–Farr amendment was signed into law, prohibiting the Justice Department from prosecuting individuals acting in accordance with state medical cannabis laws.[125] Economics Distribution

Medical marijuana dispensary

The method of obtaining medical cannabis varies by region and by legislation. In the US, most consumers grow their own or buy it from marijuana dispensaries in the 29 states and the District of Columbia that permit the use of medical cannabis.[4][126] Marijuana
Marijuana
vending machines for selling or dispensing cannabis are in use in the United States and are planned to be used in Canada.[127] In 2014, the startup Meadow began offering on-demand delivery of medical marijuana in the San Francisco Bay Area, through their mobile app.[128] Insurance In the United States, health insurance companies may not pay for a medical marijuana prescription as the Food and Drug Administration must approve any substance for medicinal purposes. Before this can happen, the FDA must first permit the study of the medical benefits and drawbacks of the substance, which it has not done since it was placed on Schedule I of the Controlled Substances Act
Controlled Substances Act
in 1970. Therefore, all expenses incurred fulfilling a medical marijuana prescription will possibly be incurred as out-of-pocket.[129] However, the New Mexico
Mexico
Court of Appeals has ruled that workers' compensation insurance must pay for prescribed marijuana as part of the state's Medical Cannabis
Cannabis
Program.[130] Positions of medical organizations Medical organizations that have issued statements in support of allowing access to medical cannabis include the American Nurses Association,[8] American Public Health Association,[131] American Medical Student Association,[132] National Multiple Sclerosis Society,[133] Epilepsy Foundation,[134] and Leukemia & Lymphoma Society.[135] Organizations that have issued statements in opposition to the legalization of medical cannabis include the American Academy of Pediatrics,[10] American Psychiatric Association,[136] and American Society of Addiction
Addiction
Medicine.[137] However, the AAP also supports rescheduling for the purpose of facilitating research.[10] The American Medical Association[138] and American College of Physicians[139] do not take a position on the legalization of medical cannabis, but have called for the Schedule I classification of cannabis to be reviewed. The American Academy of Family Physicians similarly does not take a position, but does support rescheduling in order to facilitate research.[9] The American Cancer Society[140] and American Psychological Association[141] have noted the obstacles that exist for conducting research on cannabis, and have called on the federal government to better enable scientific study of the drug. Recreational use The authors of a report on a 2011 survey of medical cannabis users say that critics have suggested that some users "game the system" to obtain medical cannabis ostensibly for treatment of a condition, but then use it for nonmedical purposes – though the truth of this claim is hard to measure.[142] The report authors suggested rather that medical cannabis users occupied a "continuum" between medical and nonmedical use.[142] Brand names In the US, the FDA has approved two oral cannabinoids for use as medicine: dronabinol and nabilone.[4] Dronabinol, synthetic THC, is listed as Schedule II.[143] Nabilone, a synthetic cannabinoid, is also Schedule II, indicating high potential for side effects and addiction.[72] Both received approval for sale in the US in 1985, under the brand names Marinol and Cesamet.[144] Nabiximols, an oromucosal spray derived from two strains of Cannabis
Cannabis
sativa and containing THC
THC
and CBD,[72] is not approved in the United States, but is approved in several European countries, Canada, and New Zealand as of 2013.[4] As of 2018, medical marijuana in Canada
Canada
is being legally distributed to registered patients in bud, drops and capsule forms by such companies as Canopy Growth Corp. and Aurora Cannabis.

Generic medication Brand name(s) Country Licensed indications

Nabilone Cesamet U.S., Canada Antiemetic (treatment of nausea or vomiting) associated with chemotherapy that has failed to respond adequately to conventional therapy[4]

Dronabinol Marinol

Syndros U.S. Anorexia associated with AIDS–related weight loss[4]

Nabiximols Sativex Canada, New Zealand, eight European countries as of 2013 Limited treatment for spasticity and neuropathic pain associated with multiple sclerosis and intractable cancer pain.[4]

As an antiemetic, these medications are usually used when conventional treatment for nausea and vomiting associated with cancer chemotherapy fail to work.[4] Nabiximols
Nabiximols
is used for treatment of spasticity associated with MS when other therapies have not worked, and when an initial trial demonstrates "meaningful improvement".[4] Trials for FDA approval in the US are underway.[4] It is also approved in several European countries for overactive bladder and vomiting.[72] When sold under the trade name Sativex
Sativex
as a mouth spray, the prescribed daily dose in Sweden delivers a maximum of 32.4 mg of THC
THC
and 30 mg of CBD; mild to moderate dizziness is common during the first few weeks.[145] Relative to inhaled consumption, peak concentration of oral THC
THC
is delayed, and it may be difficult to determine optimal dosage because of variability in patient absorption.[4] In 1964, Albert Lockhart and Manley West began studying the health effects of traditional cannabis use in Jamaican communities. They developed, and in 1987 gained permission to market, the pharmaceutical "Canasol", one of the first cannabis extracts.[146] Research Main article: Medical cannabis
Medical cannabis
research Medical cannabis research includes any medical research on using cannabis as a treatment for any medical condition. For reasons including increased popular support of cannabis use, a trend of cannabis legalization, and the perception of medical usefulness, more scientists are doing medical cannabis research. Medical cannabis
Medical cannabis
is unusually broad as a treatment for many conditions, each of which has its own state of research. Similarly, various countries conduct and respond to medical cannabis research in different ways. See also

Cannabis
Cannabis
portal Medicine portal

Charlotte's Web cannabis strain Chinese herbology Medical cannabis
Medical cannabis
in the United States Tilden's Extract

References

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and Medicine -- Assessing the Science Base" (PDF). Washington, D.C.: National Academy Press.  ^ "History of Marijuana
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as Medicine – 2900 BC to Present". ProCon.org. Retrieved 27 July 2017.  ^ "Marijuana's journey to legal health treatment: the Canadian experience". CBC News. 17 August 2009. Retrieved 27 July 2017.  ^ a b c d e f g h i Williams, Sean (15 May 2016). "10 Countries (Aside From the U.S.) Where Some Form of Medical Marijuana
Marijuana
Is Legal". The Motley Fool. Retrieved 5 November 2017.  ^ Veselica, Lajla (15 October 2015). " Croatia
Croatia
legalises marijuana for medical use". Yahoo News. AFP. Retrieved 4 November 2017.  ^ " Cyprus
Cyprus
begins to distribute medical cannabis". InCyprus. 22 May 2017. Retrieved 11 November 2017.  ^ "Legal status of cannabis in Finland
Finland
– An overview". Sensi Seeds. Retrieved 4 November 2017.  ^ Senthilingam, Meera (6 March 2017). " Germany
Germany
joins the global experiment on marijuana legalization". CNN. Retrieved 4 November 2017.  ^ Revesz, Rachael (3 July 2017). " Greece
Greece
legalises marijuana for medical purposes". The Independent. Retrieved 4 November 2017.  ^ Schwartz, Yardena (24 August 2017). "How the Booming Israeli Weed Industry Is Changing American Pot". Rolling Stone. Retrieved 4 November 2017.  ^ Samuels, Gabriel (26 July 2016). "Italian army aims to produce 'the best-quality' medical marijuana after finding current batches deficient". The Independent. Retrieved 4 November 2017.  ^ Marusic, Sinisa Jakov (1 June 2016). "Macedonia Allows Medical Marijuana
Marijuana
in Pharmacies". Balkan Insight. Retrieved 4 November 2017.  ^ "Medical use of cannabis officially legal in Poland". Radio Poland. PAP. 11 February 2017. Retrieved 4 November 2017.  ^ Collyns, Dan (20 October 2017). " Peru
Peru
legalises medical marijuana in move spurred by mother's home lab". The Guardian. Retrieved 4 November 2017.  ^ Gates, Sara (15 October 2013). " Romania
Romania
To Allow Medicinal Use Of Marijuana
Marijuana
Derivatives, But Drug Remains Illegal". HuffPost. Retrieved 4 November 2017.  ^ " Sativex
Sativex
(delta-9-tetrahydrocannabinol and cannabidiol)". GW Pharmaceuticals. Retrieved 5 November 2017.  ^ Cedar, Ali (25 August 2015). "Exploring the Cannabis
Cannabis
Clubs of Southern Spain, Europe's New Weed Destination". Vice. Retrieved 5 November 2017.  ^ Janikian, Michelle (14 September 2017). "Legal Pot In Mexico: Everything You Need to Know". Rolling Stone. Retrieved 5 November 2017.  ^ Depetris, Marina; Miller, John (21 March 2017). "Swiss cannabis entrepreneurs develop craving for low-potency pot". Reuters. Retrieved 5 November 2017.  ^ a b "State Medical Marijuana
Marijuana
Laws". National Conference of State Legislatures. Retrieved 9 July 2017.  ^ Collett, Michael (22 February 2017). "Who can get medicinal marijuana?". ABC News. Retrieved 6 November 2017.  ^ a b "Single Convention on Narcotic Drugs, 1961 As amended by the 1972 Protocol" (PDF). International Narcotics Control Board. United Nations. 13 March 1961. pp. 2–3. Retrieved 17 August 2009.  ^ Ingraham, Christopher (13 June 2017). "Jeff Sessions personally asked Congress to let him prosecute medical-marijuana providers". The Washington Post. Retrieved 9 July 2017.  ^ Timothy B. Wheeler (11 October 2014). "Medical marijuana fees stir debate in Maryland". The Baltimore Sun. Retrieved 12 October 2014.  ^ Blackwell, Tom (16 October 2013). "The pot vending machine's first foreign market? Canada, of course, 'a seed for the rest of the world'". National Post. Retrieved 4 December 2013.  ^ "Uber-For-Weed Startup Meadow Lights Up In San Francisco". TechCrunch. AOL. 14 October 2014. Retrieved 22 January 2016.  ^ Clark, Tonya Body (10 February 2015). "The Medical Marijuana Debate". Compliance Corner. Wolters Kluwer Financial Services. Retrieved 26 February 2015.  ^ Peters, Joey (29 June 2015). "Court: Employer can't block workers' comp for medical marijuana". NM Political Report. Retrieved 30 June 2015.  ^ "Resolution on Medical Marijuana". druglibrary.org. Retrieved 30 July 2017.  ^ "House of Delegates 2017, Resolution: A8" (PDF). amsa.org. American Medical Student Association. Retrieved 30 July 2017.  ^ "Medical Marijuana
Marijuana
(Cannabis) FAQs". National Multiple Sclerosis Society. Retrieved 30 July 2017.  ^ Gattone, Philip M.; Lammert, Warreb (20 February 2014). "Epilepsy Foundation Calls for Increased Medical Marijuana
Marijuana
Access and Research" (Press release). Washington, D.C.: Epilepsy Foundation. Retrieved 30 July 2017.  ^ "Medical Marijuana
Marijuana
Use and Research" (PDF). maps.org. Leukemia & Lymphoma Society. Retrieved 30 July 2017.  ^ "Position Statement on Marijuana
Marijuana
as Medicine" (PDF). American Psychiatric Association. Retrieved 30 July 2017.  ^ "Public Policy Statement on Marijuana, Cannabinoids and Legalization" (PDF). American Society of Addiction
Addiction
Medicine. 21 September 2015.  ^ Use of Cannabis
Cannabis
for Medicinal Purposes (PDF), American Medical Association, 2009  ^ Supporting Research into the Therapeutic Role of Marijuana
Marijuana
(PDF), American College of Physicians, February 2016  ^ " Marijuana
Marijuana
and Cancer". American Cancer Society. Retrieved 12 July 2017.  ^ " Marijuana
Marijuana
research: Overcoming the barriers". American Psychological Association. 14 September 2017. Retrieved 9 October 2017.  ^ a b Reinarman C, Nunberg H, Lanthier F, Heddleston T (2011). "Who are medical marijuana patients? Population characteristics from nine California
California
assessment clinics". J Psychoactive Drugs (Review). 43 (2): 128–35. doi:10.1080/02791072.2011.587700. PMID 21858958.  ^ "Final Rule: Placement of FDA-Approved Products of Oral Solutions Containing Dronabinol
Dronabinol
[(-)-delta-9-trans-tetrahydrocannabinol (delta-9-THC)] in Schedule II". U.S. Department of Justice. Retrieved 2 February 2018.  ^ Clark, Amy (16 May 2006). "'New' Pot Pill For Chemo Patients". CBS News. Associated Press. Retrieved 26 July 2017.  ^ "Produkt – FASS Allmänhet". fass.se.  ^ Dr Farid F. Youssef. " Cannabis
Cannabis
Unmasked: What it is and why it does what it does". UWIToday: June 2010. http://sta.uwi.edu/uwitoday/archive/june_2010/article9.asp

Further reading

Iversen, Leslie L. (2000). The Science of Marijuana. Oxford University Press. ISBN 0-19-513123-1.  2009 Conference on Cannabinoids in Medicine, International Association for Cannabis
Cannabis
as Medicine "The Health Effects of Cannabis
Cannabis
and Cannabinoids: The Current State of Evidence and Recommendations for Research". nationalacademies.org. Washington, DC: National Academies of Sciences, Engineering, and Medicine: The National Academies Press. 2017. doi:10.17226/24625.  "References on Multiple Sclerosis and Marijuana". Schaffer Library of Drug Policy. Retrieved 18 December 2013.  Wujastyk, Dominik (12 September 2001). " Cannabis
Cannabis
in Traditional Indian Herbal
Herbal
Medicine" (PDF). Archived from the original (PDF) on 10 November 2005. Retrieved 23 September 2009. 

External links

Wikimedia Commons has media related to Medical cannabis.

Medical cannabis
Medical cannabis
at Curlie (based on DMOZ), links to websites about medical cannabis Information on Cannabis
Cannabis
and Cannabinoids from the U.S. National Cancer Institute Information on cannabis (marihuana, marijuana) and the cannabinoids from Health Canada The Center for Medicinal Cannabis
Cannabis
Research of the University of California Medical Marijuana
Marijuana
– a 2014–2015 three-part CNN
CNN
documentary produced by Sanjay Gupta

v t e

Cannabis
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indica ruderalis sativa Difference between C. indica and C. sativa

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Effects

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Culture

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Pro-Cannabis organizations

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Major legal reforms

UK: Return to class B Uruguay: Law No. 19172 US:

Decriminalization of non-medical use Rescheduling per the Controlled Substances Act

Politicians and parties

Cannabis
Cannabis
political parties List of British politicians who have acknowledged cannabis use List of US politicians who have acknowledged cannabis use

Legal cases

ADPF 187 Gonzales v. Raich Ker v. California Kyllo v. United States
United States
(thermal imaging) Leary v. United States

Category Portal

Articles related to medical cannibis

v t e

Ancient anaesthesia

Plants / animals

Aconitum
Aconitum
(aconite) Atropa belladonna
Atropa belladonna
(belladonna) Cannabis

medical use

Castoreum Coca Conium
Conium
(hemlock) Datura innoxia
Datura innoxia
(thorn-apple) Datura metel
Datura metel
(devil's trumpet) Hyoscyamus niger
Hyoscyamus niger
(henbane) Lactucarium Mandragora officinarum
Mandragora officinarum
(mandrake) Opium Saussurea
Saussurea
(saw-wort) Willow

People

Abulcasis Avenzoar Avicenna Celsus Dioscorides Galen Hippocrates Rhazes Sabuncuoğlu Sushrutha Theophrastus Zhang

Compounds

Aconitine Atropine Cocaine Coniine Hyoscine Δ9-THC Hyoscyamine Morphine Salicylate

v t e

Cannabinoid
Cannabinoid
receptor modulators

Receptor (ligands)

CB1

Agonists (abridged; see here for more): 2-AG 2-AGE (noladin ether) 11-Hydroxy-THC α-Amyrin β-Amyrin AB-CHMINACA AM-1172 AM-1220 AM-1221 AM-1235 AM-2201 AM-2232 Anandamide Arvanil AZ-11713908 Cannabinol CB-13 CP 47,497 CP 55,940 Dimethylheptylpyran DEA ECG EGCG Epicatechin Gallocatechol
Gallocatechol
(gallocatechin) Honokiol HU-210 JWH-007 JWH-015 JWH-018 JWH-073 Kavain L-759,633 Levonantradol Menabitan Nabilone Nabitan NADA O-1812 Oleamide Pravadoline Serinolamide A THC
THC
(dronabinol) UR-144 WIN 55,212-2 Yangonin

Antagonists: AM-251 AM-6545 Cannabidiol Cannabigerol Drinabant Falcarinol
Falcarinol
(carotatoxin) Hemopressin Ibipinabant LY-320,135 MK-9470 NESS-0327 O-2050 Otenabant PF-514273 PipISB Rimonabant Rosonabant Surinabant Taranabant THCV TM-38837 VCHSR Virodhamine

Antibodies: Brizantin (Бризантин) Dietressa (Диетресса)

Unknown/unsorted: MAFP

CB2

Agonists: 2-AG 2-AGE (noladin ether) 3,3'-Diindolylmethane 4-O-Methylhonokiol α-Amyrin β-Amyrin A-796,260 A-834,735 A-836,339 AM-1172 AM-1221 AM-1235 AM-1241 AM-2232 Anandamide AZ-11713908 Cannabinol Caryophyllene CB-13 CBS-0550 CP-55,940 GW-405,833
GW-405,833
(L-768,242) GW-842,166X HU-308 JTE 7-31 JWH-007 JWH-015 JWH-018 JWH-73 JWH-133 L-759,633 L-759,656 Magnolol MDA-19 Nabitan NADA PF-03550096 S-444,823 SER-601 Serinolamide A UR-144 Tedalinab THC
THC
(dronabinol) THCV Tetrahydromagnolol Virodhamine

Antagonists: 4-O-Methylhonokiol AM-630 BML-190 Cannabidiol Honokiol JTE-907 SR-144,528 WIN 54,461 WIN 56,098

NAGly (GPR18)

Agonists: Abnormal cannabidiol ACPA AM251 Anandamide Cannabidiol NADGly THC
THC
(dronabinol) O-1602

Antagonists: CID-85469571 O-1918

GPR55

Agonists: 2-AGE (noladin ether) 2-ALPI Abnormal cannabidiol AM-251 CID1011163 CID1252842 CID1792579 CP 55,940 GSK-494581A Lysophosphatidylinositol ML-184 ML-185 ML-186 O-1602 Oleoylethanolamide Palmitoylethanolamide THC
THC
(dronabinol)

Antagonists: Cannabidiol CID-16020046 ML-191 ML-192 ML-193 O-1918 PSB-SB-487 PSB-SB-1202 PSB-SB-1203 Tetrahydromagnolol

GPR119

Agonists: 2-Oleoylglycerol Anandamide APD668 AR-231,453 AS-1269574 MBX-2982 N-Oleoyldopamine Oleoylethanolamide Olvanil PSN-375,963 PSN-632,408

Transporter (modulators)

eCBTs

Inhibitors: 5'-DMH-CBD AM-404 AM-1172 Arachidonoyl serotonin Arvanil Cannabidiol Guineensine LY-2183240 O-2093 OMDM-2 Paracetamol
Paracetamol
(acetaminophen) SB-FI-26 UCM-707 URB-597 VDM-11 WOBE490 WOBE491 WOBE492

Enzyme (modulators)

FAAH

Inhibitors: 4-Nonylphenylboronic acid AACOCF3 AM-404 Arachidonoyl serotonin BIA 10-2474 Biochanin A Genistein IDFP JNJ-1661010 JNJ-42165279 JZL-195 Kaempferol LY-2183240 MAFP Palmitoylisopropylamide Paracetamol
Paracetamol
(acetaminophen) PF-3845 PF-04457845 PF-750 SA-47 SA-57 TAK 21d TC-F 2 UCM710 URB-597

Activators: PDP-EA

MAGL

Inhibitors: ABX-1431 IDFP JJKK 048 JW 642 JZL-184 JZL-195 JZP-361 KML 29 MAFP MJN110 NAM Pristimerin URB-602

ABHD6

Inhibitors: JZP-169 JZP-430 KT182 KT185 KT195 KT203 LEI-106 ML294 ML295 ML296 UCM710 WWL-70

ABHD12

Inhibitors: Betulinic acid Maslinic acid MAFP Oleanolic acid Orlistat
Orlistat
(tetrahydrolipstatin) Ursolic acid

Others

Precursors: Phosphatidylethanolamine NAPE Diacylglycerol

Others: 2-PG (directly potentiates activity of 2-AG at CB1 receptor) ARN-272 (FAAH-like anandamide transporter inhibitor)

See also Receptor/signaling modulators Cannabinoids (cannabinoids by structure)

v t e

Recreational drug use

Major recreational drugs

Depressants

Barbiturates Benzodiazepines Carbamates Ethanol (alcohol)

Alcoholic drinks Beer Wine

Gabapentinoids GHB Inhalants

Medical

Nitrous oxide

Hazardous solvents

contact adhesives Gasoline nail polish remover Paint thinner

Other

Freon

Kava Nonbenzodiazepines Quinazolinones

Opioids

Buprenorphine

Suboxone Subutex

Codeine Desomorphine

Krokodil

Dextropropoxyphene

Darvocet Darvon

Fentanyl Diamorphine

Heroin

Hydrocodone Hydromorphone

Dilaudid

Methadone Mitragyna speciosa

Kratom

Morphine

Opium

Oxycodone

/paracetamol

Tramadol

Stimulants

Amphetamine Arecoline

Areca

Betel Caffeine

Coffee Energy drinks Tea

Cathinone

Khat

Cocaine

Coca Crack

Ephedrine

Ephedra

MDPV Mephedrone Methamphetamine Methylone Methylphenidate Modafinil Nicotine

Tobacco

Theobromine

Cocoa Chocolate

Entactogens

2C series 6-APB

Benzofury

AMT MDA MDMA

Ecstasy

Hallucinogens

Psychedelics

Bufotenin

Psychoactive toads Vilca Yopo

DMT

Ayahuasca

LSA LSD-25 Mescaline

Peruvian torch Peyote San Pedro

Psilocybin
Psilocybin
/ Psilocin

Psilocybin
Psilocybin
mushrooms

Dissociatives

DXM Glaucine Inhalants

Nitrous oxide alkyl nitrites poppers amyl nitrite

Ketamine MXE Muscimol

Amanita muscaria

PCP Salvinorin A

Salvia divinorum

Deliriants

Atropine
Atropine
and Scopolamine

Atropa belladonna Datura Hyoscyamus niger Mandragora officinarum

Dimenhydrinate Diphenhydramine

Cannabinoids

JWH-018 THC

Cannabis Hashish Hash oil Marijuana

Oneirogens

Calea zacatechichi Silene capensis

Club drugs

Cocaine Quaaludes MDMA
MDMA
(Ecstasy) Nitrous oxide Poppers

Drug culture

Cannabis
Cannabis
culture

420 Cannabis
Cannabis
cultivation Cannabis
Cannabis
smoking Head shop Legal history of cannabis in the United States Legality of cannabis Marijuana
Marijuana
Policy Project Medical cannabis NORML Cannabis
Cannabis
and religion Stoner film

Coffee
Coffee
culture

Coffee
Coffee
break Coffeehouse Latte art Tea
Tea
house

Drinking culture

Bartending Beer
Beer
culture Beer
Beer
festival Binge drinking Diethyl ether Drinking games Drinking song Happy hour Hip flask Nightclub Pub Pub
Pub
crawl Sommelier Sports bar Tailgate party Wine
Wine
bar Wine
Wine
tasting

Psychedelia

Psychonautics Art Drug Era Experience Literature Music Microdosing Therapy

Smoking culture

Cigarette card Fashion cigarettes Cloud-chasing Loosie Smokeasy Smoking fetishism Tobacco
Tobacco
smoking

Other

Club drug Counterculture of the 1960s Dance party Drug paraphernalia Drug tourism Entheogen Hippie Nootropic Party and play Poly drug use Rave Religion and drugs Self-medication Sex and drugs Whoonga

Drug production and trade

Drug production

Coca
Coca
production in Colombia Drug precursors Opium
Opium
production in Afghanistan Rolling meth lab

Drug trade

Illegal drug trade

Colombia

Darknet market Drug distribution

Beer
Beer
shop Cannabis
Cannabis
shop Liquor store Liquor license

Issues with drug use

Abuse Date rape drug Impaired driving Drug harmfulness

Effects of cannabis

Addiction Dependence

Prevention Opioid
Opioid
replacement therapy Rehabilitation Responsible use

Drug-related crime Fetal alcohol spectrum disorder Long-term effects of cannabis Neurotoxicity Overdose Passive smoking

of tobacco or other substances

Legality of drug use

International

1961 Narcotic Drugs 1971 Psychotropic Substances 1988 Drug Trafficking Council of the European Union decisions on designer drugs

State level

Drug policy

Decriminalization Prohibition Supply reduction

Policy reform

Demand reduction Drug Policy Alliance Harm reduction Law Enforcement Action Partnership Liberalization

Latin America

Students for Sensible Drug Policy Transform Drug Policy Foundation

Drug policy by country

Australia Canada Germany India Netherlands Portugal Slovakia Soviet Union Sweden Switzerland United States

Just Say No Office of National Drug Control Policy School district drug policies California Colorado Maryland Virginia

Other

Arguments for and against drug prohibition Capital punishment for drug trafficking Cognitive liberty Designer drug Drug court Drug possession Drug test Narc Politics of drug abuse War on Drugs

Mexican Drug War Plan Colombia Philippine Drug War

Zero tolerance

Lists of countries by...

Alcohol
Alcohol
legality

Alcohol
Alcohol
consumption

Anabolic steroid legality Cannabis
Cannabis
legality

Annual use Lifetime use

Cigarette consumption Cocaine
Cocaine
legality

Cocaine
Cocaine
use

Methamphetamine
Methamphetamine
legality Opiates use Psilocybin
Psilocybin
mushrooms legality Salvia legality

v t e

Hypnotics/sedatives (N05C)

GABAA

Alcohols

2M2B Chloralodol Ethanol (alcohol) Ethchlorvynol Methylpentynol Trichloroethanol

Barbiturates

Allobarbital Amobarbital Aprobarbital Barbital Butabarbital Butobarbital Cyclobarbital Ethallobarbital Heptabarb Hexobarbital Mephobarbital Methohexital Narcobarbital Pentobarbital Phenallymal Phenobarbital Propylbarbital Proxibarbal Reposal Secobarbital Talbutal Thiamylal Thiopental Thiotetrabarbital Vinbarbital Vinylbital

Benzodiazepines

Brotizolam Cinolazepam Climazolam Doxefazepam Estazolam Flunitrazepam Flurazepam Flutoprazepam Lorazepam Loprazolam Lormetazepam Midazolam Nimetazepam Nitrazepam Phenazepam Quazepam Temazepam Triazolam

Carbamates

Carisoprodol Emylcamate Ethinamate Hexapropymate Meprobamate Methocarbamol Phenprobamate Procymate Tybamate

Imidazoles

Etomidate Metomidate Propoxate

Monoureides

Acecarbromal Apronal
Apronal
(apronalide) Bromisoval Capuride Carbromal Ectylurea

Neuroactive steroids

Acebrochol Allopregnanolone Alphadolone Alphaxolone Eltanolone Hydroxydione Minaxolone Progesterone

Nonbenzodiazepines

Eszopiclone Indiplon Lirequinil Necopidem Pazinaclone Saripidem Suproclone Suriclone Zaleplon Zolpidem Zopiclone

Phenols

Propofol

Piperidinediones

Glutethimide Methyprylon Pyrithyldione Piperidione

Quinazolinones

Afloqualone Cloroqualone Diproqualone Etaqualone Mebroqualone Mecloqualone Methaqualone Methylmethaqualone Nitromethaqualone

Others

Acetophenone Acetylglycinamide chloral hydrate Bromide compounds

Lithium bromide Potassium bromide Sodium bromide

Centalun Chloral betaine Chloral hydrate Chloralose Clomethiazole Dichloralphenazone Gaboxadol Kavalactones Loreclezole Paraldehyde Petrichloral Sulfonylalkanes

Sulfonmethane
Sulfonmethane
(sulfonal) Tetronal Trional

Triclofos Sesquiterpene

Isovaleramide Isovaleric acid Valerenic acid

GABAB

1,4-Butanediol 4-Fluorophenibut Aceburic acid Baclofen GABOB GHB (sodium oxybate) GBL GVL Phenibut Tolibut

H1

Antihistamines

Captodiame Cyproheptadine Diphenhydramine Doxylamine Hydroxyzine Methapyrilene Perlapine Pheniramine Promethazine Propiomazine

Antidepressants

Serotonin antagonists and reuptake inhibitors

Etoperidone Nefazodone Trazodone

Tricyclic antidepressants

Amitriptyline Doxepin Trimipramine, etc.

Tetracyclic antidepressants

Mianserin Mirtazapine, etc.

Antipsychotics

Typical antipsychotics

Chlorpromazine Thioridazine, etc.

Atypical antipsychotics

Olanzapine Quetiapine Risperidone, etc.

α2-Adrenergic

Clonidine Detomidine Dexmedetomidine Lofexidine Medetomidine Romifidine Tizanidine Xylazine

5-HT2A

Antidepressants

Trazodone Tricyclic antidepressants

Amitriptyline Doxepin Trimipramine, etc.

Tetracyclic antidepressants

Mianserin Mirtazapine, etc.

Antipsychotics

Typical antipsychotics

Chlorpromazine Thioridazine, etc.

Atypical antipsychotics

Olanzapine Quetiapine Risperidone, etc.

Others

Niaprazine

Melatonin

Agomelatine Melatonin Ramelteon Tasimelteon

Orexin

Almorexant Filorexant Suvorexant

α2δ VDCC

Gabapentin Gabapentin
Gabapentin
enacarbil Mirogabalin Phenibut Pregabalin

Others

Cannabidiol

Cannabis

Chlorophenylalkyldiols

Fenpentadiol Metaglycodol Phenaglycodol

Diethylpropanediol Evoxine Fenadiazole Guaifenesin-related muscle relaxants

Chlorphenesin Mephenesin Mephenoxalone Metaxalone Methocarbamol

Opioids (e.g., morphine) Passion flower Scopolamine Trazodone UMB68 Valnoctamide

v t e

Medicinal herbs and fungi

Herbs

Alfalfa Aloe vera Anise Asthma-plant Astragalus Cannabis

medical use

Caraway Cardamom Chamomile Chaparral Fenugreek Feverfew Flaxseed Ginger Ginkgo Ginseng Goldenseal Lemon balm Liquorice Marigold Marsh-mallow Neem Opium
Opium
poppy Oregano Peppermint Purple coneflower Rosemary Sage Star anise Summer savory Tea
Tea
tree oil Thyme Turmeric Umckaloabo Valerian Verbena White willow Yarrow Za'atar

Fungi

Almond mushroom Chaga mushroom Echigoshirayukidake Lingzhi mushroom Maitake Meshima Morel mushroom Shiitake

Regional practices

Chinese herbology Indian herbology Islamic herbology Japanese herbology Korean herbology

Related subjects

Alternative medicine Doctrine of signatures Herb garden Herbal Herbal
Herbal
tea Herbalism Homeopathy Medicinal plants

List of plants used in herbalism

v t e

Psychoactive substance-related disorder (F10–F19, 291–292; 303–305)

General

SID

Substance intoxication / Drug overdose Withdrawal Substance-induced psychosis

SUD

Substance abuse
Substance abuse
/ Substance use disorder
Substance use disorder
/ Substance-related disorders Physical dependence / Psychological dependence / Substance dependence

Alcohol

SID

Neurological disorders

Alcoholic hallucinosis Alcohol
Alcohol
withdrawal Fetal alcohol spectrum disorder
Fetal alcohol spectrum disorder
(FASD) Fetal alcohol syndrome
Fetal alcohol syndrome
(FAS) Korsakoff's syndrome Korsakoff's psychosis Wernicke–Korsakoff syndrome Wernicke's encephalopathy

Digestive system

Alcoholic hepatitis Alcoholic liver disease Auto-brewery syndrome

Nervous system

Alcohol-related dementia Alcoholic hallucinosis Hangover

Cardiovascular system

Alcoholic cardiomyopathy Alcohol
Alcohol
flush reaction

SUD

Alcoholism
Alcoholism
(alcohol use disorder) Binge drinking

Caffeine

SID

Effect of caffeine on memory Caffeine-induced sleep disorder

SUD

Caffeine
Caffeine
dependence

Cannabis

SID

Effects of cannabis Long-term effects of cannabis

SUD

Cannabis
Cannabis
dependence

Cocaine

SID

Cocaine
Cocaine
intoxication

SUD

Cocaine
Cocaine
dependence

Hallucinogen

SID

Hallucinogen
Hallucinogen
persisting perception disorder

Opioids

SID

Opioid
Opioid
overdose

SUD

Opioid
Opioid
use disorder

Sedative / hypnotic

benzodiazepine: SID

Benzodiazepine
Benzodiazepine
overdose Benzodiazepine
Benzodiazepine
withdrawal

SUD

Benzodiazepine
Benzodiazepine
use disorder Benzodiazepine
Benzodiazepine
dependence

barbiturate: SID

Barbiturate
Barbiturate
overdose

SUD

Barbiturate
Barbiturate
dependence

Stimulants

SID

Stimulant
Stimulant
psychosis

SUD

Amphetamine
Amphetamine
dependence

Tobacco

SID

Nicotine
Nicotine
poisoning Nicotine
Nicotine
withdrawal

SUD

Nicotine
Nicotine
dependence

Volatile solvent

Inhalant
Inhalant
abuse: Toluene toxicity

Poly drug use

SID

Combined drug intoxication

SUD

Polysu

.