Medical cannabis, or medical marijuana, is cannabis and cannabinoids
that are recommended by doctors for their patients. The use of
cannabis as medicine has not been rigorously tested due to production
restrictions and other governmental regulations. Limited evidence
suggests cannabis can: reduce nausea and vomiting during chemotherapy,
improve appetite in people with HIV/AIDS, and reduce chronic pain and
Short-term use increases the risk of both minor and major adverse
effects. Common side effects include dizziness, feeling tired,
vomiting, and hallucinations.
Long-term effects of cannabis
Long-term effects of cannabis are not
clear. Concerns include memory and cognition problems, risk of
addiction, schizophrenia in young people, and the risk of children
taking it by accident.
Cannabis plant has a history of medicinal use dating back
thousands of years across many cultures. 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. Others
such as the
American Academy of Pediatrics
American Academy of Pediatrics oppose the legalization of
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
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,
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
2 Medical uses
2.1 Nausea and vomiting
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
7 Society and culture
7.1 Legal status
7.1.1 United States
7.3 Positions of medical organizations
7.4 Recreational use
7.5 Brand names
9 See also
11 Further reading
12 External links
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 plant includes more
than 400 different chemicals, of which about 70 are cannabinoids.
In comparison, typical government-approved medications contain only
one or two chemicals. The number of active chemicals in cannabis
is one reason why treatment with cannabis is difficult to classify and
A 2014 review stated that the variations in ratio of CBD-to-
botanical and pharmaceutical preparations determines the therapeutic
vs psychoactive effects (CBD attenuates THC's psychoactive
effects) of cannabis products.
Cannabis as illustrated in Köhler's Book of Medicinal Plants, 1897
Medical cannabis has several potential beneficial effects. Evidence
is moderate that it helps in chronic pain and muscle spasms. Low
quality evidence suggests its use for reducing nausea during
chemotherapy, improving appetite in HIV/AIDS, improving sleep, and
improving tics in Tourette syndrome. When usual treatments are
ineffective, cannabinoids have also been recommended for anorexia,
arthritis, migraine, and glaucoma.
It is recommended that cannabis use be stopped in pregnancy.
Nausea and vomiting
Medical cannabis is somewhat effective in chemotherapy-induced nausea
and vomiting (CINV) and may be a reasonable option in those who
do not improve following preferential treatment. Comparative
studies have found cannabinoids to be more effective than some
conventional antiemetics such as prochlorperazine, promethazine, and
metoclopramide in controlling CINV, but these are used less
frequently because of side effects including dizziness, dysphoria, and
hallucinations. Long-term cannabis use may cause nausea and
vomiting, a condition known as cannabinoid hyperemesis syndrome.
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".
Evidence is lacking for both efficacy and safety of cannabis and
cannabinoids in treating patients with
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.
A 2017 review found moderate to high quality evidence for
effectiveness of cannabis in relieving chronic pain in several
conditions, particularly when inhaled. Another review found
tentative evidence for use of cannabis in treating peripheral
neuropathy, but little evidence of benefit for other types of long
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. A 2014
review found limited and weak evidence that smoked cannabis was
effective for chronic non-cancer pain. 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. Another
2015 review found limited evidence that medical cannabis was effective
for neuropathic pain when combined with traditional analgesics.
A 2011 review considered cannabis to be generally safe, and in
palliative care, its use appears safer than opioids.
The efficacy of cannabis in treating neurological problems, including
multiple sclerosis (MS), epilepsy, and movement problems, is not
clear. 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. Evidence also
suggests that oral cannabis extract is effective for reducing
patient-centered measures of spasticity. A trial of cannabis is
deemed to be a reasonable option if other treatments have not been
effective.[by whom?] Its use for MS is approved in ten
countries. A 2012 review found no problems with tolerance,
abuse or addiction.
Posttraumatic stress disorder
Further information: Posttraumatic stress disorder
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.
American medical hashish
There is insufficient data to draw strong conclusions about the safety
of medical cannabis. Typically, adverse effects of medical
cannabis use are not serious. 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. Although
supporters of medical cannabis say that it is safe, further
research is required to assess the long-term safety of its
See also: Long-term effects of cannabis
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. Psychotic episodes are well-documented and typically
resolve within minutes or hours. There have been few reports of
symptoms lasting longer.
According to the
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. In 129,000 cases, cannabis was the only implicated
Effects of chronic use may include bronchitis, a cannabis dependence
syndrome, and subtle impairments of attention and memory. These
deficits persist while chronically intoxicated. 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. 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.
There has been a limited amount of studies that have looked at the
effects of smoking cannabis on the respiratory system. Chronic
heavy marijuana smoking is associated with coughing, production of
sputum, wheezing, coughing, and other symptoms of chronic
bronchitis. Regular cannabis use has not been shown to cause
significant abnormalities in lung function.
Cannabis smoke contains thousands of organic and inorganic chemical
compounds. This tar is chemically similar to that found in tobacco
smoke, and over fifty known carcinogens have been identified in
cannabis smoke, including; nitrosamines, reactive aldehydes, and
polycylic hydrocarbons, including benz[a]pyrene. 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. Combustion products are not present when
using a vaporizer, consuming
THC in pill form, or consuming cannabis
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.
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 and delta-9-THC. 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. 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
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. 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. A 2013 review estimates daily use is associated with
a 10-20% rate of dependence. 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.
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
A 2011 systematic review evaluated published studies of the acute and
long-term cognitive effects of cannabis.
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. A second systematic review focused on neuroimaging
studies found little evidence supporting an effect of cannabis use on
brain structure and function. 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.
Impact on psychosis
THC can cause acute transient psychotic symptoms in
healthy individuals and people with schizophrenia.
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. A 2005 meta analysis concluded that adolescent use of
cannabis increases the risk of psychosis, and that the risk is
dose-related. 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. 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.
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. A 2005
paper from the Dunedin study suggested an increased risk in the
development of psychosis linked to polymorphisms in the COMT gene.
However, a more recent study cast doubt on the proposed connection
between this gene and the effects of cannabis on the development of
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.
Other potential long-term effects
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. An increase in apoC-III levels induces the development of
Cannabis contains two species which produce useful amounts
of psychoactive cannabinoids:
Cannabis indica and
which are listed as Schedule I medicinal plants in the US; a third
Cannabis ruderalis, has few psychogenic properties.
Cannabis contains more than 460 compounds; at least 80 of these are
cannabinoids – chemical compounds that interact with
cannabinoid receptors in the brain. As of 2012, more than 20
cannabinoids were being studied by the U.S. FDA.
The most psychoactive cannabinoid found in the cannabis plant is
tetrahydrocannabinol (or delta-9-tetrahydrocannabinol, commonly known
as THC). 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. The most studied are THC, CBD and CBN.
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. CB2 receptors are found peripherally
throughout the body and are thought to modulate pain and
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 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.
Inhaled and vaporized
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
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.
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. Rectal administration in monkeys doubled bioavailability to
13.5% and achieved peak blood concentrations within 1 to 8 hours after
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.
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
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.
THC to 11-COOH-THC
Delta-9-THC is the primary molecule responsible for the effects of
Delta-9-THC is metabolized in the liver and turns into
THC is the first metabolic product in this
Delta-9-THC and 11-OH-
THC are psychoactive. The
THC into 11-OH-
THC plays a part in the heightened
psychoactive effects of edible cannabis.
THC is metabolized in the liver into 11-COOH-THC, which is
the second metabolic product of THC. 11-COOH-
THC is not
Ingestion of edible cannabis products lead to a slower onset of effect
than the inhalation of it because the
THC travels to the liver first
through the blood before it travels to the rest of the body. Inhaled
cannabis can result in
THC going directly to the brain, where it then
travels from the brain back to the liver in recirculation for
metabolism. Eventually, both routes of metabolism result in the
metabolism of psychoactive
THC to inactive 11-COOH-THC.
Due to the large propensity of
THC and CBD being hepatically
metabolized, a majority of their metabolites are excreted via feces
than in the urine.
THC is hydroxylated into 11-OH-
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. The
terminal half-life is approximately 25–36 hours.
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.
Similar to delta-9-THC, a majority of CBD is excreted in feces and
some in the urine. The terminal half-life is approximately 18–32
Illustrating various forms of medicinal cannabis
Smoking is the means of administration of cannabis for many
consumers, and the most common method of medical cannabis
consumption in the US as of 2013. 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. The
potential for adverse effects from smoke inhalation makes smoking a
less viable option than oral preparations.
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.
Cannabinoid medicines are available in pill form (dronabinol and
nabilone) and liquid extracts formulated into an oromucosal spray
(nabiximols). 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
THC and contributes further to the variability of plasma
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. 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."
Main article: History of medical cannabis
Cannabis, called má 麻 (meaning "hemp; cannabis; numbness") or
dàmá 大麻 (with "big; great") in Chinese, was used in
fiber starting about 10,000 years ago. The botanist Hui-lin Li
wrote that in China, "The use of
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." 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,
Cannabis is one of the 50 "fundamental"
herbs in traditional Chinese medicine.
Ebers Papyrus (c. 1550 BCE) from
Ancient Egypt describes medical
cannabis. The ancient Egyptians used hemp (cannabis) in
suppositories for relieving the pain of hemorrhoids.
Surviving texts from ancient
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.
Ancient Greeks used cannabis to dress wounds and sores on their
horses, and in humans, dried leaves of cannabis were used to treat
nose bleeds, and cannabis seeds were used to expel tapeworms.
In the medieval Islamic world, Arabic physicians made use of the
diuretic, antiemetic, antiepileptic, anti-inflammatory, analgesic and
antipyretic properties of
Cannabis sativa, and used it extensively as
medication from the 8th to 18th centuries.
An Irish physician, William Brooke O'Shaughnessy, is credited with
introducing cannabis to Western medicine. O'Shaughnessy discovered
cannabis in the 1830s while living abroad in India, where he conducted
numerous experiments investigating its medical utility. Noting in
particular its analgesic and anticonvulsant effects, O'Shaughnessy
England with a supply of cannabis in 1842, after which its
use spread through Europe and the United States.
entered into the
United States Pharmacopeia in 1850.
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. 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.
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. 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
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. In 1996,
California became the first U.S. state to
legalize medical cannabis in defiance of federal law. In 2001,
Canada became the first country to adopt a system regulating the
medical use of cannabis.
The use of cannabis, at least as fiber, has been shown to go back at
least 10,000 years in Taiwan. "Dà má" (
Pinyin pronunciation) is the
Chinese expression for cannabis, the first character meaning "big" and
the second character meaning "hemp".
Cannabis indica fluid extract, American Druggists Syndicate, pre-1937.
An advertisement for cannabis americana distributed by a pharmacist in
New York in 1917
Ebers Papyrus (c. 1550 BCE) from
Ancient Egypt has a prescription
for medical marijuana applied directly for inflammation.
Society and culture
Legality of cannabis
Legality of cannabis by country
Worldwide laws on cannabis possession for medical purposes as of 2017.
Legal or essentially legal
Illegal but often unenforced
Countries that have legalized the medical use of cannabis include
Canada, Chile, Colombia, Croatia, Cyprus,
Czech Republic, Jamaica, Finland, Germany,
Greece, Israel, Italy, Macedonia, the
Netherlands, Poland, Peru, Romania, and
Uruguay Other countries have more restrictive laws allowing for
the use of specific cannabinoids only, such as
France and the United
Kingdom which have approved the use of Sativex. Countries with
more relaxed laws include Uruguay, the Netherlands, and
Spain, where cannabis can be obtained without need for a
prescription. In Mexico,
THC content of medical cannabis is limited to
one percent. The same limit applies in Switzerland, but no
prescription is required to purchase. In the United States
and Australia, the legality of medical cannabis varies by state.
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.
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
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.
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.
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.
machines for selling or dispensing cannabis are in use in the United
States and are planned to be used in Canada. In 2014, the startup
Meadow began offering on-demand delivery of medical marijuana in the
San Francisco Bay Area, through their mobile app.
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. However,
Mexico Court of Appeals has ruled that workers' compensation
insurance must pay for prescribed marijuana as part of the state's
Positions of medical organizations
Medical organizations that have issued statements in support of
allowing access to medical cannabis include the American Nurses
Association, American Public Health Association, American
Medical Student Association, National Multiple Sclerosis
Society, Epilepsy Foundation, and Leukemia & Lymphoma
Organizations that have issued statements in opposition to the
legalization of medical cannabis include the American Academy of
Pediatrics, American Psychiatric Association, and American
Addiction Medicine. However, the AAP also supports
rescheduling for the purpose of facilitating research.
The American Medical Association and American College of
Physicians 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. The American Cancer Society and
American Psychological Association 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.
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. The report authors suggested rather
that medical cannabis users occupied a "continuum" between medical and
In the US, the FDA has approved two oral cannabinoids for use as
medicine: dronabinol and nabilone. Dronabinol, synthetic THC, is
listed as Schedule II. Nabilone, a synthetic cannabinoid, is also
Schedule II, indicating high potential for side effects and
addiction. Both received approval for sale in the US in 1985,
under the brand names Marinol and Cesamet. Nabiximols, an
oromucosal spray derived from two strains of
Cannabis sativa and
THC and CBD, is not approved in the United States, but
is approved in several European countries, Canada, and New Zealand as
of 2013. As of 2018, medical marijuana in
Canada is being legally
distributed to registered patients in bud, drops and capsule forms by
such companies as Canopy Growth Corp. and Aurora Cannabis.
Antiemetic (treatment of nausea or vomiting) associated with
chemotherapy that has failed to respond adequately to conventional
Anorexia associated with AIDS–related weight loss
Canada, New Zealand,
eight European countries
as of 2013
Limited treatment for spasticity and neuropathic pain associated with
multiple sclerosis and intractable cancer pain.
As an antiemetic, these medications are usually used when conventional
treatment for nausea and vomiting associated with cancer chemotherapy
fail to work.
Nabiximols is used for treatment of spasticity associated with MS when
other therapies have not worked, and when an initial trial
demonstrates "meaningful improvement". Trials for FDA approval in
the US are underway. It is also approved in several European
countries for overactive bladder and vomiting. When sold under the
Sativex as a mouth spray, the prescribed daily dose in
Sweden delivers a maximum of 32.4 mg of
THC and 30 mg of
CBD; mild to moderate dizziness is common during the first few
Relative to inhaled consumption, peak concentration of oral
delayed, and it may be difficult to determine optimal dosage because
of variability in patient absorption.
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.
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 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.
Charlotte's Web cannabis strain
Medical cannabis in the United States
^ Murnion, B (December 2015). "Medicinal cannabis". Australian
prescriber. 38 (6): 212–5. doi:10.18773/austprescr.2015.072.
PMC 4674028 . PMID 26843715.
^ "What is medical marijuana?". National Institute of Drug Abuse. July
2015. Retrieved 19 April 2016. The term medical marijuana refers to
using the whole unprocessed marijuana plant or its basic extracts to
treat a disease or symptom.
^ "Release the strains". Nature Medicine. 21: 963. 4 September 2015.
doi:10.1038/nm.3946. Retrieved 8 September 2015.
^ a b c d e f g h i j k l m n o p q r s t u v w x Borgelt, LM;
Franson, KL; Nussbaum, AM; Wang, GS (February 2013). "The
pharmacologic and clinical effects of medical cannabis" (PDF).
Pharmacotherapy. 33 (2): 195–209. doi:10.1002/phar.1187.
^ a b c d e f g Whiting, PF; Wolff, RF; Deshpande, S; Di Nisio, M;
Duffy, S; Hernandez, AV; Keurentjes, JC; Lang, S; Misso, K; Ryder, S;
Schmidlkofer, S; Westwood, M; Kleijnen, J (23 June 2015).
"Cannabinoids for Medical Use: A Systematic Review and Meta-analysis".
JAMA. 313 (24): 2456–2473. doi:10.1001/jama.2015.6358.
^ Jensen, Bjorn; Chen, Jeffrey; Furnish, Tim; Wallace, Mark (1
September 2015). "Medical
Marijuana and Chronic Pain: a Review of
Basic Science and Clinical Evidence". Current Pain and Headache
Reports. 19 (10). doi:10.1007/s11916-015-0524-x.
^ a b c d Ben Amar M (2006). "Cannabinoids in medicine: a review of
their therapeutic potential". Journal of Ethnopharmacology (Review).
105 (1–2): 1–25. doi:10.1016/j.jep.2006.02.001.
^ a b Therapeutic Use of
Marijuana and Related Cannabinoids (PDF),
American Nurses Association, 2016
^ a b "
Marijuana -- AAFP Policies". aafp.org. Retrieved 30 July
^ a b c
American Academy of Pediatrics
American Academy of Pediatrics Reaffirms Opposition to
Marijuana for Recreational or Medical Use, American Academy
of Pediatrics, 26 January 2015, retrieved 30 July 2017
^ a b c Consumer Reports (28 April 2016). "Up in Smoke: Does Medical
Marijuana Work?". Consumer Reports. Retrieved 24 May 2016.
^ a b Schubart CD, Sommer IE, Fusar-Poli P, de Witte L, Kahn RS, Boks
MP (2014). "
Cannabidiol as a potential treatment for psychosis" (PDF).
European Neuropsychopharmacology. 24 (1): 51–64.
doi:10.1016/j.euroneuro.2013.11.002. PMID 24309088.
^ Barbara S. Koppel MD FAAN; John C.M. Brust MD FAAN; Terry Fife MD
FAAN; Jeff Bronstein MD PhD; Sarah Youssof MD; Gary Gronseth MD FAAN;
David Gloss MD (2014). "Systematic review: Efficacy and safety of
medical marijuana in selected neurologic disorders". Neurology. 82
(17): 1556–1563. doi:10.1212/WNL.0000000000000363.
PMC 4011465 . PMID 24778283.
^ a b Sachs J, McGlade E, Yurgelun-Todd D (2015). "Safety and
Toxicology of Cannabinoids". Neurotherapeutics. 12 (4): 735–746.
doi:10.1007/s13311-015-0380-8. PMC 4604177 .
^ Committee on Obstetric Practice (July 2015). "Committee Opinion No.
Marijuana Use During
Pregnancy and Lactation". Obstetrics &
Gynecology. 126 (1): 234–238.
^ a b Grotenhermen, F; Müller-Vahl, K (July 2012). "The therapeutic
potential of cannabis and cannabinoids". Deutsches Arzteblatt
international. 109 (29–30): 495–501.
doi:10.3238/arztebl.2012.0495. PMC 3442177 .
^ Bowles DW, O'Bryant CL, Camidge DR, Jimeno A (July 2012). "The
intersection between cannabis and cancer in the United States". Crit.
Rev. Oncol. Hematol. (Review). 83 (1): 1–10.
doi:10.1016/j.critrevonc.2011.09.008. PMID 22019199.
^ a b Wang T, Collet JP, Shapiro S, Ware MA (June 2008). "Adverse
effects of medical cannabinoids: a systematic review". CMAJ (Review).
178 (13): 1669–78. doi:10.1503/cmaj.071178. PMC 2413308 .
^ Jordan K, Sippel C, Schmoll HJ (September 2007). "Guidelines for
antiemetic treatment of chemotherapy-induced nausea and vomiting:
past, present, and future recommendations". Oncologist (Review). 12
(9): 1143–50. doi:10.1634/theoncologist.12-9-1143.
^ Nicolson SE, Denysenko L, Mulcare JL, et al. (May–Jun 2012).
Cannabinoid hyperemesis syndrome: a case series and review of
previous reports". Psychosomatics (Review, case series). 53 (3):
212–9. doi:10.1016/j.psym.2012.01.003. PMID 22480624.
^ Phillips, RS; Friend, AJ; Gibson, F; Houghton, E; Gopaul, S; Craig,
JV; Pizer, B (2 February 2016). "
Antiemetic medication for prevention
and treatment of chemotherapy-induced nausea and vomiting in
childhood". The Cochrane Database of Systematic Reviews. 2: CD007786.
doi:10.1002/14651858.CD007786.pub3. PMID 26836199.
^ Lutge EE, Gray A, Siegfried N (2013). "The medical use of cannabis
for reducing morbidity and mortality in patients with HIV/AIDS".
Cochrane Database Syst Rev (Review). 4: CD005175.
doi:10.1002/14651858.CD005175.pub3. PMID 23633327.
^ a b Aviram, J; Samuelly-Leichtag, G (2017). "Efficacy of
Cannabis-Based Medicines for Pain Management: A Systematic Review and
Meta-Analysis of Randomized Controlled Trials". Pain Physician. 20
(6): E755–E796. PMID 28934780.
^ Nugent, Shannon M.; Morasco, Benjamin J.; O'Neil, Maya E.; Freeman,
Michele; Low, Allison; Kondo, Karli; Elven, Camille; Zakher,
Bernadette; Motu'apuaka, Makalapua; Paynter, Robin; Kansagara, Devan
(15 August 2017). "The Effects of
Cannabis Among Adults With Chronic
Pain and an Overview of General Harms". Annals of Internal Medicine.
167 (5): 319–331. doi:10.7326/M17-0155. PMID 28806817.
^ Kahan, M; Srivastava, A; Spithoff, S; Bromley, L (December 2014).
"Prescribing smoked cannabis for chronic noncancer pain: preliminary
recommendations". Canadian Family Physician. 60 (12): 1083–90.
PMC 4264803 . PMID 25500598.
^ Andreae, MH; Carter, GM; Shaparin, N; Suslov, K; Ellis, RJ; Ware,
MA; Abrams, DI; Prasad, H; Wilsey, B; Indyk, D; Johnson, M; Sacks, HS
(8 September 2015). "Inhaled cannabis for chronic neuropathic pain: an
individual patient data meta-analysis". The Journal of Pain. 16 (12):
1221–32. doi:10.1016/j.jpain.2015.07.009. PMC 4666747 .
^ Deshpande, A; Mailis-Gagnon, A; Zoheiry, N; Lakha, SF (August 2015).
"Efficacy and adverse effects of medical marijuana for chronic
noncancer pain: Systematic review of randomized controlled trials".
Canadian Family Physician. 61 (8): e372–81. PMC 4541447 .
^ Lynch ME, Campbell F (November 2011). "Cannabinoids for treatment of
chronic non-cancer pain; a systematic review of randomized trials".
British Journal of Clinical Pharmacology (Review). 72 (5): 735–44.
doi:10.1111/j.1365-2125.2011.03970.x. PMC 3243008 .
^ Carter GT, Flanagan AM, Earleywine M, et al. (August 2011).
Cannabis in palliative medicine: improving care and reducing
opioid-related morbidity". The American journal of hospice &
palliative care (Review). 28 (5): 297–303.
doi:10.1177/1049909111402318. PMID 21444324.
^ Koppel, BS; Brust, JC; Fife, T; Bronstein, J; Youssof, S; Gronseth,
G; Gloss, D (29 April 2014). "Systematic review: efficacy and safety
of medical marijuana in selected neurologic disorders: report of the
Guideline Development Subcommittee of the American Academy of
Neurology". Neurology. 82 (17): 1556–63.
doi:10.1212/WNL.0000000000000363. PMC 4011465 .
^ Lakhan SE, Rowland M (2009). "Whole plant cannabis extracts in the
treatment of spasticity in multiple sclerosis: a systematic review".
BMC Neurology (Review). 9: 59. doi:10.1186/1471-2377-9-59.
PMC 2793241 . PMID 19961570.
^ Koppel, BS; Brust, JC; Fife, T; Bronstein, J; Youssof, S; Gronseth,
G; Gloss, D (29 April 2014). "Systematic review: efficacy and safety
of medical marijuana in selected neurologic disorders: report of the
Guideline Development Subcommittee of the American Academy of
Neurology". Neurology. 82 (17): 1556–63.
doi:10.1212/WNL.0000000000000363. PMC 4011465 .
^ [conflicted source?] Clark PA, Capuzzi K, Fick C (2011). "Medical
marijuana: Medical necessity versus political agenda". Medical Science
Monitor (Review). 17 (12): RA249–61. doi:10.12659/MSM.882116.
PMC 3628147 . PMID 22129912.
^ Oreja-Guevara, C (2012). "Treatment of spasticity in multiple
sclerosis: New perspectives regarding the use of cannabinoids".
Revista de neurologia (Review) (in Spanish). 55 (7): 421–30.
^ Yarnell S (2015). "The Use of Medicinal
Marijuana for Posttraumatic
Stress Disorder: A Review of the Current Literature". Prim Care
Companion CNS Disord (Review). 17 (3). doi:10.4088/PCC.15r01786.
PMC 4578915 . PMID 26644963.
^ a b Washington, Tabitha A.; Brown, Khalilah M.; Fanciullo, Gilbert
J. (2012). "Chapter 31: Medical Cannabis". Pain. Oxford University
Press. p. 165. ISBN 978-0-19-994274-9. Proponents of medical
cannabis site its safety, but there studies in later years that
support that smoking of marijuana is associated with risk for
dependence and that
THC alters the structures of cells in the
^ Barceloux, Donald G (2012). "Chapter 60:
L.) and synthetic cannabinoids". Medical Toxicology of Drug Abuse:
Synthesized Chemicals and Psychoactive Plants. pp. 886–931.
^ a b c W. Hall; N. Solowij (14 November 1998). "Adverse effects of
cannabis". Lancet. 352 (9140): 1611–16.
doi:10.1016/S0140-6736(98)05021-1. PMID 9843121.
Sativex Oral Mucosal Spray Public Assessment Report. Decentralized
United Kingdom Medicines and Healthcare Products
Regulatory Agency. p. 93. Retrieved 7 May 2015. There is clear
evidence that recreational cannabis can produce a transient toxic
psychosis in larger doses or in susceptible individuals, which is said
to characteristically resolve within a week or so of absence (Johns
2001). Transient psychotic episodes as a component of acute
intoxication are well-documented (Hall et al 1994)
^ D'Souza, DC; Sewell, RA; Ranganathan, M (October 2009). "Cannabis
and psychosis/schizophrenia: human studies". European archives of
psychiatry and clinical neuroscience. 259 (7): 413–31.
doi:10.1007/s00406-009-0024-2. PMC 2864503 .
^ "Drug Abuse Warning Network, 2011. National Estimates of
Drug-Related Emergency Department Visits" (PDF). U.S. Department of
Health and Human Services. 2011. Retrieved 8 May 2015.
^ a b c Volkow ND, Baler RD, Compton WM, Weiss SR (2014). "Adverse
health effects of marijuana use". N. Engl. J. Med. 370 (23):
2219–27. doi:10.1056/NEJMra1402309. PMC 4827335 .
^ Hall, W (January 2015). "What has research over the past two decades
revealed about the adverse health effects of recreational cannabis
Addiction (Abingdon, England). 110 (1): 19–35.
doi:10.1111/add.12703. PMID 25287883.
^ Stephen Maisto; Mark Galizio; Gerard Connors (2014). Drug Use and
Abuse. Cengage Learning. p. 278.
^ a b Tashkin, DP (June 2013). "Effects of marijuana smoking on the
lung". Annals of the American Thoracic Society. 10 (3): 239–47.
doi:10.1513/annalsats.201212-127fr. PMID 23802821.
^ Hashibe, Mia; Straif, Kurt; Tashkin, Donald P.; Morgenstern, Hal;
Greenland, Sander; Zhang, Zuo-Feng (April 2005). "Epidemiologic review
of marijuana use and cancer risk". Alcohol. 35 (3): 265–275.
doi:10.1016/j.alcohol.2005.04.008. PMID 16054989.
^ "Does smoking cannabis cause cancer?". Cancer Research UK. 20
September 2010. Archived from the original on 29 July 2012. Retrieved
9 January 2013.
^ Tashkin, Donald (March 1997). "Effects of marijuana on the lung and
its immune defenses". UCLA School of Medicine. Retrieved 23 June
^ A. Riecher-Rössler (2014). Comorbidity of Mental and Physical
Disorders. Karger Medical and Scientific Publishers. p. 88.
^ Cottencin O. (Dec 2010). "
Cannabis arteritis: review of the
literature". J Addict Med (Review). 4 (4): 191–6.
doi:10.1097/ADM.0b013e3181beb022. PMID 21769037.
^ Thomas G (1 January 2014). "Adverse cardiovascular, cerebrovascular,
and peripheral vascular effects of marijuana inhalation: what
cardiologists need to know". Am J Cardiol. 113 (1): 187–90.
doi:10.1016/j.amjcard.2013.09.042. PMID 24176069.
^ RT Jones (2002). "Cardiovascular system effects of marijuana". J
Clin Pharmacol (Review). 42 (11 Suppl): 58S–63S.
doi:10.1002/j.1552-4604.2002.tb06004.x. PMID 12412837.
^ "Withdrawal Symptoms From Smoking Pot?". WebMD.
^ Hall, W; Degenhardt, L (17 October 2009). "Adverse health effects of
non-medical cannabis use". Lancet. 374 (9698): 1383–91.
doi:10.1016/s0140-6736(09)61037-0. PMID 19837255.
^ a b Gordon AJ, Conley JW, Gordon JM (December 2013). "Medical
consequences of marijuana use: a review of current literature". Curr
Psychiatry Rep (Review). 15 (12): 419. doi:10.1007/s11920-013-0419-7.
^ Crean RD, Crane NA, Mason BJ (March 2011). "An evidence-based review
of acute and long-term effects of cannabis use on executive cognitive
functions". J Addict Med. 5 (1): 1–8.
doi:10.1097/ADM.0b013e31820c23fa. PMC 3037578 .
^ Martín-Santos R, Fagundo AB, Crippa JA, Atakan Z, Bhattacharyya S,
Allen P, Fusar-Poli P, Borgwardt S, Seal M, Busatto GF, McGuire P
(March 2010). "Neuroimaging in cannabis use: a systematic review of
the literature". Psychol Med. 40 (3): 383–98.
doi:10.1017/S0033291709990729. PMID 19627647.
^ Grant I, Gonzalez R, Carey CL, Natarajan L, Wolfson T (2003).
"Non-acute (residual) neurocognitive effects of cannabis use: A
meta-analytic study". Journal of the International Neuropsychological
Society. 9 (5): 679–89. doi:10.1017/S1355617703950016.
PMID 12901774. Lay summary –
WebMD (1 July 2003).
^ Large M, Sharma S, Compton MT, Slade T, Nielssen O (June 2011).
Cannabis use and earlier onset of psychosis: a systematic
meta-analysis". Arch. Gen. Psychiatry. 68 (6): 555–61.
doi:10.1001/archgenpsychiatry.2011.5. PMID 21300939.
^ Semple DM, McIntosh AM, Lawrie SM (March 2005). "
Cannabis as a risk
factor for psychosis: systematic review". J. Psychopharmacol.
(Oxford). 19 (2): 187–94. doi:10.1177/0269881105049040.
^ Arseneault L, Cannon M, Witton J, Murray RM (2004). "Causal
association between cannabis and psychosis: examination of the
evidence". The British Journal of Psychiatry. 184 (2): 110–117.
doi:10.1192/bjp.184.2.110. PMID 14754822.
^ Laqueille X (2009). "Le cannabis est-il un facteur de
vulnérabilité des troubles schizophrènes?" [Is cannabis is a
vulnerability factor of schizophrenic disorders?]. Archives de
Pédiatrie. 16 (9): 1302–5. doi:10.1016/j.arcped.2009.03.016.
PMID 19640690. (Registration required (help)).
^ Moore TH, Zammit S, Lingford-Hughes A, Barnes TR, Jones PB, Burke M,
Lewis G (2007). "
Cannabis use and risk of psychotic or affective
mental health outcomes: a systematic review". The Lancet. 370 (9584):
319–28. doi:10.1016/S0140-6736(07)61162-3. PMID 17662880.
^ Henquet C, Krabbendam L, Spauwen J, Kaplan C, Lieb R, Wittchen HU,
van Os J (2005). "Prospective cohort study of cannabis use,
predisposition for psychosis, and psychotic symptoms in young people".
BMJ. 330 (7481): 11–0. doi:10.1136/bmj.38267.664086.63.
PMC 539839 . PMID 15574485.
^ Caspi A, Moffitt TE, Cannon M, McClay J, Murray R, Harrington H,
Taylor A, Arseneault L, Williams B, Braithwaite A, Poulton R, Craig IW
(2005). "Moderation of the Effect of Adolescent-Onset
Cannabis Use on
Psychosis by a Functional Polymorphism in the
Catechol-O-Methyltransferase Gene: Longitudinal Evidence of a Gene X
Environment Interaction". Biological Psychiatry. 57 (10): 1117–27.
doi:10.1016/j.biopsych.2005.01.026. PMID 15866551.
^ S. Zammit; G. Spurlock; H. Williams; N. Norton; N. Williams; M.C.
O'Donovan; M.J. Owen (2007). "Genotype effects of CHRNA7, CNR1 and
COMT in schizophrenia: interactions with tobacco and cannabis use".
The British Journal of Psychiatry. 191 (5): 402–7.
doi:10.1192/bjp.bp.107.036129. PMID 17978319. Lay summary –
^ Kawohl W, Rössler W (2008). "
Cannabis and Schizophrenia: new
findings in an old debate". Neuropsychiatrie : Klinik,
Diagnostik, Therapie und Rehabilitation : Organ der Gesellschaft
Osterreichischer Nervenarzte und Psychiater. 22 (4): 223–9.
^ Jayanthi S, Buie S, Moore S, Herning RI, Better W, Wilson NM,
Contoreggi C, Cadet JL (2008). "Heavy marijuana users show increased
serum apolipoprotein C-III levels: evidence from proteomic analyses".
Molecular Psychiatry. 15 (1): 101–112. doi:10.1038/mp.2008.50.
PMC 2797551 . PMID 18475272. Lay summary –
^ Downer EJ, Campbell VA (January 2010). "Phytocannabinoids, CNS cells
and development: a dead issue?". Drug
Alcohol Rev (Review). 29 (1):
^ Burns TL, Ineck JR (2006). "
Cannabinoid analgesia as a potential new
therapeutic option in the treatment of chronic pain". The Annals of
Pharmacotherapy (Review). 40 (2): 251–260. doi:10.1345/aph.1G217.
^ a b c d Svrakic DM, Lustman PJ, Mallya A, Lynn TA, Finney R, Svrakic
NM (2012). "Legalization, decriminalization & medicinal use of
cannabis: a scientific and public health perspective". Mo Med
(Review). 109 (2): 90–8. PMID 22675784.
^ Mackie, K. (May 2008). "
Cannabinoid receptors: where they are and
what they do". Journal of Neuroendocrinology. 20 Suppl 1: 10–14.
doi:10.1111/j.1365-2826.2008.01671.x. ISSN 1365-2826.
^ Whiteside, G. T.; Lee, G. P.; Valenzano, K. J. (2007). "The role of
the cannabinoid CB2 receptor in pain transmission and therapeutic
potential of small molecule CB2 receptor agonists". Current Medicinal
Chemistry. 14 (8): 917–936. doi:10.2174/092986707780363023.
ISSN 0929-8673. PMID 17430144.
^ a b c Huestis, Marilyn A. (August 2007). "Human Cannabinoid
Pharmacokinetics". Chemistry & Biodiversity. 4 (8): 1770–1804.
doi:10.1002/cbdv.200790152. ISSN 1612-1872. PMC 2689518 .
^ a b c d e Gaston, Tyler E.; Friedman, Daniel (2017-05-01).
"Pharmacology of cannabinoids in the treatment of epilepsy". Epilepsy
& Behavior. Cannabinoids and Epilepsy. 70 (Part B): 313–318.
^ Mannila, Janne; Järvinen, Tomi; Järvinen, Kristiina; Tervonen,
Jussi; Jarho, Pekka (2006-03-20). "Sublingual administration of
Δ9-tetrahydrocannabinol/β-cyclodextrin complex increases the
bioavailability of Δ9-tetrahydrocannabinol in rabbits". Life
Sciences. 78 (17): 1911–1914. doi:10.1016/j.lfs.2005.08.025.
^ a b Badowski, Melissa E. (2017). "A review of oral cannabinoids and
medical marijuana for the treatment of chemotherapy-induced nausea and
vomiting: a focus on pharmacokinetic variability and
Chemotherapy and Pharmacology. 80 (3):
441–449. doi:10.1007/s00280-017-3387-5. ISSN 0344-5704.
PMC 5573753 . PMID 28780725.
^ Nahas, Gabriel G. (2001-04-01). "The pharmacokinetics of
THC in fat
and brain: resulting functional responses to marihuana smoking". Human
Psychopharmacology: Clinical and Experimental. 16 (3): 247–255.
doi:10.1002/hup.258. ISSN 1099-1077.
^ Bridgeman, Mary Barna; Abazia, Daniel T. (March 2017). "Medicinal
Cannabis: History, Pharmacology, And Implications for the Acute Care
Setting". Pharmacy and Therapeutics. 42 (3): 180–188.
ISSN 1052-1372. PMC 5312634 . PMID 28250701.
^ Nahas, Gabriel G.; Sutin, Kenneth M.; Harvey, David J.; Agurell,
Stig (1999-04-05). Marihuana and Medicine. Springer Science &
Business Media. ISBN 9781592597109.
^ a b c "Human Metabolism of THC". Sapiensoup Blog. 2016-12-21.
THC - Increased Potency That Explains the Effect of
Edibles? - Prof of Pot". profofpot.com. Retrieved 2017-11-01.
^ "Toxicology Litigation Support: Marijuana". consultox.com. Retrieved
^ Grotenhermen, Franjo (2003-04-01). "Pharmacokinetics and
Pharmacodynamics of Cannabinoids". Clinical Pharmacokinetics. 42 (4):
^ Juřica, Ondřej Zendulka, Gabriela Dovrtělová, Kristýna
Nosková, Miroslav Turjap, Alexandra Šulcová, Lumír Hanuš and Jan
(2016-02-29). "Cannabinoids and Cytochrome P450 Interactions". Current
Drug Metabolism. 17 (3).
^ Ohlsson, Agneta; Lindgren, Jan-Erik; Andersson, Susanne; Agurell,
Stig; Gillespie, Hampton; Hollister, Leo E. (1986-02-01). "Single-dose
kinetics of deuterium-labelled cannabidiol in man after smoking and
intravenous administration". Biological Mass Spectrometry. 13 (2):
77–83. doi:10.1002/bms.1200130206. ISSN 1096-9888.
^ a b c Curtis A, Clarke CE, Rickards HE (2009). "Cannabinoids for
Tourette's Syndrome". Cochrane Database Syst Rev (Review) (4):
CD006565. doi:10.1002/14651858.CD006565.pub2. PMID 19821373.
(Subscription required (help)).
^ a b "Inter-agency advisory regarding claims that smoked marijuana is
a medicine" (Press release). fda.gov. 20 April 2006. Retrieved 24
^ Abel, Ernest L. (1980). "
Cannabis in the Ancient World". Marihuana:
the first twelve thousand years. New York City: Plenum Publishers.
ISBN 978-0-306-40496-2. Retrieved 18 December
2013. [page needed]
^ Li, Hui-Lin (1974). "An Archaeological and Historical Account of
Cannabis in China", Economic Botany 28.4:437–448, p. 444.
^ Bloomquist, Edward (1971). Marijuana: The Second Trip. California:
^ Wong, Ming (1976). La Médecine chinoise par les plantes. Paris:
Tchou. OCLC 2646789. [page needed]
^ [unreliable source?] "The
Ebers Papyrus The Oldest (confirmed)
Written Prescriptions For Medical Marihuana era 1,550 BC".
onlinepot.org. Retrieved 10 June 2008.
^ Pain, Stephanie (15 December 2007). "The Pharaoh's pharmacists". New
Scientist. Reed Business Information Ltd.
^ Touw, Mia (1981). "The Religious and Medicinal Uses ofCannabisin
India and Tibet". Journal of Psychoactive Drugs. 13 (1):
23–34. doi:10.1080/02791072.1981.10471447. PMID 7024492.
^ a b Butrica, James L. (2002). "The Medical Use of
Cannabis Among the
Greeks and Romans" (PDF). Journal of
Cannabis Therapeutics. 2 (2):
51–70. doi:10.1300/J175v02n02_04. Retrieved 8 November 2014.
^ Lozano, Indalecio (2001). "The Therapeutic Use of
(L.) in Arabic Medicine". Journal of
Cannabis Therapeutics. 1:
^ Alison Mack; Janet Joy (7 December 2000).
Marijuana As Medicine?:
The Science Beyond the Controversy. National Academies Press.
pp. 15–. ISBN 978-0-309-06531-3.
^ a b Booth, Martin (June 2005). Cannabis: A History. New York: St.
Martin's Press. ISBN 978-0-312-42494-7.
^ a b c d Grinspoon, Lester; Bakalar, James (1997). Marihuana, the
Forbidden Medicine (Revised and expanded ed.). Yale University Press.
^ Pacula, Rosalie Piccardo (February 2002). "State Medical Marijuana
Laws: Understanding the Laws and Their Limitations" (PDF). Journal of
Public Health Policy. 23: 413. doi:10.2307/3343240.
^ Joy, Janet E.; Watson, Stanley J.; Benson, John A. (1999).
Marijuana and Medicine -- Assessing the Science Base" (PDF).
Washington, D.C.: National Academy Press.
^ "History of
Marijuana 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 Is Legal". The
Motley Fool. Retrieved 5 November 2017.
^ Veselica, Lajla (15 October 2015). "
Croatia legalises marijuana for
medical use". Yahoo News. AFP. Retrieved 4 November 2017.
Cyprus begins to distribute medical cannabis". InCyprus. 22 May
2017. Retrieved 11 November 2017.
^ "Legal status of cannabis in
Finland – An overview". Sensi Seeds.
Retrieved 4 November 2017.
^ Senthilingam, Meera (6 March 2017). "
Germany joins the global
experiment on marijuana legalization". CNN. Retrieved 4 November
^ Revesz, Rachael (3 July 2017). "
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
^ 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 in Pharmacies". Balkan Insight. Retrieved 4 November
^ "Medical use of cannabis officially legal in Poland". Radio Poland.
PAP. 11 February 2017. Retrieved 4 November 2017.
^ Collyns, Dan (20 October 2017). "
Peru legalises medical marijuana in
move spurred by mother's home lab". The Guardian. Retrieved 4 November
^ Gates, Sara (15 October 2013). "
Romania To Allow Medicinal Use Of
Marijuana Derivatives, But Drug Remains Illegal". HuffPost. Retrieved
4 November 2017.
Sativex (delta-9-tetrahydrocannabinol and cannabidiol)". GW
Pharmaceuticals. Retrieved 5 November 2017.
^ Cedar, Ali (25 August 2015). "Exploring the
Cannabis Clubs of
Southern Spain, Europe's New Weed Destination". Vice. Retrieved 5
^ Janikian, Michelle (14 September 2017). "Legal Pot In Mexico:
Everything You Need to Know". Rolling Stone. Retrieved 5 November
^ 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 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
^ 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
^ 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
^ "Resolution on Medical Marijuana". druglibrary.org. Retrieved 30
^ "House of Delegates 2017, Resolution: A8" (PDF). amsa.org. American
Medical Student Association. Retrieved 30 July 2017.
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 Access and Research"
(Press release). Washington, D.C.: Epilepsy Foundation. Retrieved 30
Marijuana Use and Research" (PDF). maps.org. Leukemia &
Lymphoma Society. Retrieved 30 July 2017.
^ "Position Statement on
Marijuana as Medicine" (PDF). American
Psychiatric Association. Retrieved 30 July 2017.
^ "Public Policy Statement on Marijuana, Cannabinoids and
Legalization" (PDF). American Society of
Addiction Medicine. 21
^ Use of
Cannabis for Medicinal Purposes (PDF), American Medical
^ Supporting Research into the Therapeutic Role of
American College of Physicians, February 2016
Marijuana and Cancer". American Cancer Society. Retrieved 12 July
Marijuana research: Overcoming the barriers". American
Psychological Association. 14 September 2017. Retrieved 9 October
^ a b Reinarman C, Nunberg H, Lanthier F, Heddleston T (2011). "Who
are medical marijuana patients? Population characteristics from nine
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
(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 Unmasked: What it is and why it does
what it does". UWIToday: June 2010.
Iversen, Leslie L. (2000). The Science of Marijuana. Oxford University
Press. ISBN 0-19-513123-1.
2009 Conference on Cannabinoids in Medicine, International Association
Cannabis as Medicine
"The Health Effects of
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.
"References on Multiple Sclerosis and Marijuana". Schaffer Library of
Drug Policy. Retrieved 18 December 2013.
Wujastyk, Dominik (12 September 2001). "
Cannabis in Traditional Indian
Herbal Medicine" (PDF). Archived from the original (PDF) on 10
November 2005. Retrieved 23 September 2009.
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