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9
Cannabis Dependence
Key Chapter Points
• Cannabis is a genus of flowering plant that
includes three species—C. sativa, C. indica,
and C. ruderalis.
• To produce a mood-altering effect, cannabis is
used in three main forms: (1) marijuana, (2)
hashish, and (3) hash oil.
• Long-term health risks of marijuana use
include immune system effects, cardiovascular effects, respiratory effects, reproductive
effects, behavioral effects, and cancer.
• Three medicinal products are derived from marijuana: dronabinol, nabilone, and nabiximols.
• Depending on the state, patients may qualify
for treatment with medical marijuana if they
meet certain requirements.
• Cannabis indica, or “ganja,” is smoked as a
form of marijuana.
• The synthetic cannabinoids, known as Spice
or K2, are lab-synthesized liquid chemicals
that mimic the effect of THC.
• Hashish, or hash, is an extracted product from
the cannabis plant that is composed of compressed or purified preparations of glandular
resin hairs called trichomes.
• Hash oil is a resinous matrix produced by a
solvent extraction of cannabis.
• Repeated use over days to weeks induces considerable tolerance to the behavioral and psychological effects of cannabis.
• Thirty percent of those who use marijuana
may develop some degree of marijuana use
disorder.
• Acute marijuana toxicity (bad trip) results in
anxiety, agitation, difficulty with coordination,
decreased muscle strength, postural hypotension, headache, sweating, and lethargy.
Cannabis is a genus of flowering plant that
includes three species—C. sativa, C. indica, and
C. ruderalis. Cannabis sativa and Cannabis
indica products are used recreationally and as a
source of fiber. Cannabis ruderalis is a species
of Cannabis originating in Central Russia. It is
less common than the other species of Cannabis.
It has a lower tetrahydrocannabinol (THC) content than the other two, so it is rarely grown for
recreational use. Its much shorter stature (about
2 ft) limits its application for hemp production.
It is used traditionally in Russian and Mongolian
folk medicine, especially for the treatment of
depression [1].
Cannabinoids are organic substances present
in the cannabis plant. More than 60 have been
identified. The cannabis plant grows wild in
many of the tropical and temperate areas of the
world. It can be grown in almost any climate and
is increasingly cultivated indoors. It consists of a
male plant and a female plant. The male plant
produces pollen, which pollinates the flowers of
the female plant (Fig. 9.1). Once pollinated, the
© Springer International Publishing AG 2018
H.T. Milhorn, Substance Use Disorders, DOI 10.1007/978-3-319-63040-3_9
131
9 Cannabis Dependence
132
Table 9.1 Prevalence of marijuana plus hashish use in
2015 for various age ranges (%) (From [5])
Lifetime
Past year
Past month
Ages 12–17
15.70
12.60
7.00
Ages 18–25
52.70
32.20
19.80
Age 26
and older
46.00
10.40
6.50
resemble well-known foods. Some of the names
of these products are Rastateers, KeefKat,
Munchy Way, and Rasta Reese’s [4].
Prevalence of Use
Fig. 9.1 Female Cannabis sativa plant
female plant produces seeds. If the female plant
is not pollinated, the buds and flowers continue to
develop and produce tetrahydrocannabinol
(THC), which is the major psychoactive substance in the cannabis plant [2].
There were at least 2000 medicinal cannabis
products produced by over 280 manufacturers at
the turn of the century. Cannabis products were
on the shelf of every pharmacy and were widely
prescribed until medical use was prohibited in
1937 by the Marijuana Tax Act [2].
The Controlled Substances Act of 1970 classified marijuana, along with heroin and LSD, as a
Schedule I drug.
Medical marijuana was legalized in California
in 1996, and several other states have followed
suit. In addition, several states, including
California, have made recreational marijuana
legal. Such laws are in direct disagreement with
federal law prohibiting the possession of marijuana [3].
In states where marijuana has become legalized, more and more marijuana “edibles” are
seen in retail establishments. Marijuana products
include baked goods and candy that closely
Table 9.1 gives the prevalence of marijuana plus
hashish for various age ranges [5]. To produce a
mood-altering effect, cannabis is used in three
main forms: (1) marijuana, (2) hashish, and (3)
hash oil.
Marijuana
Marijuana is the most commonly used illicit drug
in the United States. It is made from the dried
flowers and leaves of the unpollinated female
Cannabis sativa plant. It is the least potent of the
three cannabis mood-altering products.
Marijuana is usually smoked in hand-rolled
cigarettes (joints) or in special water pipes
(bongs). Marijuana can also be mixed into food
or brewed as tea and ingested. It also has been
used as cigars called “blunts.” It also may come
in a “wax” form that resembles lip balm. It can be
eaten or smoked [6].
revalence of Use
P
Marijuana use by 8th, 10th, and 12th graders
have held steady in the past few years following
several years of increase in the previous decade.
In 2015, 11.8% of 8th graders reported marijuana
use in the past year, and 6.5% were current users.
Among 10th graders, 25.4% had used marijuana
in the past year and 14.8% were current users.
Among 12th graders, 34.9% had used marijuana
during the prior year and 21.3% were current
Prevalence of Use
133
users. Six percent said they used marijuana daily
or nearly daily. However, teens’ perceptions of
the risks of marijuana use have steadily declined
over the past decade, possibly related to increasing public debate about legalizing or loosening
restrictions on marijuana for medicinal and recreational use [7].
Street Names
Because marijuana is such a popular drug, it has
a large number of street names. Some of the more
popular ones are:
Bud
Blunt
Chronic
Dope
Ganja
Sinsemilla
Grass
Green
Hash
Herb
Joint
Loud
Mary Jane
MJ
Pot
Reefer
Skunk
Smoke
Trees
Weed
Marijuana is commonly laced with other psychoactive substances. Some of these street names
are:
With tobacco
With PCP
With formaldehyde
(embalming fluid)
With cocaine HCl
With crack cocaine
With heroin
Kiff
Chips, donk, illies, illing,
lovelies, love leaf, killer
supergrass, wack, woolies,
zoom, fry, frios, yerba mala
Boat, loveboat, amp, drank,
clickem, ill, illy, wet,
water-water
Chronic, banano, caviar,
champagne, cocoa puff,
gremmies, lace
Chronic, bazooka, cocktail,
crack back, daddy, dirty, geek,
gimmie, juice joint, liprimo,
oolies, p-dogs, torpedo, turbo,
woolies
A-bomb
Pharmacology
Pharmacodynamics Cannabinoids exert their
effect by interaction with specific endogenous
neuronal cannabinoid receptors that are termed
CB1 receptors. These receptors have been found
in the brain and peripheral nerves. A second cannabinoid receptor, the CB2 receptor, is present in
macrophages in the spleen and in other immune
cells. The distribution of CB1 receptors includes
the cerebral cortex, limbic areas (including hip-
pocampus and amygdala), basal ganglia, cerebellum, thalamus, and brain stem. The endogenous
substance, named anandamide after the Sanskrit
word for bliss (ananda), has a high affinity for
CB1 receptors and has most of the same actions
of THC.
THC has been shown to increase the release of
dopamine from the nucleus accumbens and prefrontal cortex. This effect may be the basis of
cannabis’s reinforcing properties and the cause of
its recreational use.
It appears that there may be a whole system of
multiple cannabinoid receptors and anandamiderelated substances.
The sensations of slight euphoria, relaxation,
and amplified auditory and visual perceptions
produced by marijuana are due almost entirely to
its effect on the cannabinoid receptors in the
brain [8].
Pharmacokinetics In the United States, the content of marijuana was originally 1–2%. Selective
breeding now yields marijuana with much higher
THC concentrations. The average THC concentration in 2008 was 10.1%. The most potent marijuana is known as sinsemilla, with a THC
concentration that may be 14% or higher.
To obtain maximal effect from marijuana,
users must master a smoking technique that is
different from that used to smoke regular cigarettes. Users inhale smoke as deeply into their
lungs as possible and then hold their breath for
20–30 s to extract as much of the THC from the
smoke as possible.
Various methods of smoking marijuana include
rolling it into “joints” (marijuana cigarettes) or
“blunts” (marijuana rolled into the leaf wrap of a
hollowed-out cigar). Smoking it through a pipe,
through a water pipe (“bong”), or a vaporizer are
also common methods. While marijuana is most
often smoked, it can also be ingested.
The effects of smoking are typically felt
within a few minutes and can peak in 10–30 min.
Short-term effects from smoking generally wear
off within 2–3 h. About 50% of the THC in a
joint of herbal cannabis is inhaled; nearly all of
this is absorbed through the lungs, rapidly enters
the bloodstream, and reaches the brain within
134
seconds. Effects are perceptible within seconds
and fully apparent in a few minutes.
When marijuana is ingested, its onset of
action is within 30–60 min, and peak effects
may not occur until the second or third hour.
After oral ingestion, blood concentrations
reached are 25–30% of those obtained by smoking the drug, partly because of first-pass metabolism in the liver.
THC is rapidly converted into its active metabolite 11-hydroxy-delta-9-tetrahydrocannabinol,
which produces effects identical to the parent
compound. The active metabolite is then converted to inactive metabolites and excreted in the
feces (65%) and urine (25%). Very little unmetabolized THC is found in the urine.
Once absorbed, THC and other cannabinoids
are rapidly distributed to all other tissues at rates
dependent on the blood flow. Because they are
extremely lipid soluble, cannabinoids accumulate in fatty tissues, reaching peak concentrations
in 4–5 days. They are then slowly released back
into other body compartments, including the
brain. Because of the sequestration in fat, the tissue elimination half-life of THC is about 7 days,
and complete elimination of a single dose may
take up to 30 days. With repeated dosage, high
levels of cannabinoids can accumulate in the
body [9, 10].
Cannabis short-term effects include a burning sensation in the mouth, a dry throat, and
bloodshot eyes. It produces euphoria and altered
senses, such as seeing brighter colors. It produces muscle relaxation, slowed reflexes, an
altered sense of time, and altered cognitive
function. It decreases muscle coordination,
causes a loss of short-term and working memory, increases heart rate, and increases appetite
causing the “munchies.” It negatively affects
perception and judgment; increases chances of
risky behavior, such as unprotected sex and trying more dangerous drugs; and creates difficulty
problem solving.
Short-term pharmacological effects of marijuana are given in Table 9.2 [11]. Cardiovascular
effects of marijuana include increased heart
rate, increased systolic pressure, decreased
blood pressure while erect, and a marked red-
9 Cannabis Dependence
Table 9.2 Short-term pharmacological effects of marijuana (From Milhorn [11]. Approved with permission,
Springer)
Central nervous system
Altered perception of time (time seems to pass more
slowly)
Antiemetic effect
Anxiety
Balance difficulty
Coordination problems
Decreased reaction time
Depersonalization
Difficulty carrying out tasks requiring multiple mental
steps to reach a goal
Euphoria
Feelings of relaxation and sleepiness
Impaired perception, attention, and information
processing
Impaired psychomotor sensation
Increased hunger
Increased risk of contracting sexually transmitted
diseases
Increased sense of well-being
Keener sense of hearing
Paranoia
Psychosis
Sense of detachment
Senses of touch, taste, and smell seem to be enhanced
Short-term memory impairment
Subtle visual and auditory stimuli may take on novel
characteristics
Vivid visual imagery
Peripheral effects
Increased heart rate
Increased systolic pressure in the supine position
Decreased blood pressure in the erect position
Marked reddening of conjunctiva
Plasma volume expansion
Increased body temperature due to impaired sweating
Decreased intraocular pressure
Dry mouth and throat
Muscle weakness
Tremors
Unsteadiness
Increased deep tendon reflexes
dening of the conjunctiva due to blood vessel
dilation. Sodium retention and expanded plasma
volume occur.
Muscle weakness, tremors, unsteadiness, and
increased deep tendon reflexes occur. Intraocular
pressure is decreased and an antiemetic effect
occurs.
Marijuana is known to produce flashbacks in
previous users of lysergic acid diethylamide (LSD).
Prevalence of Use
Drugs that sometimes are mixed with marijuana
to increase its effects include phencyclidine
(PCP), opium, formaldehyde, and Raid insect
spray [12].
135
believed to increase the risk of bleeding (Ginkgo
biloba, garlic, saw palmetto) [13, 14].
Health Risks
Interactions with Other Drugs
Marijuana may increase the risk of bleeding
when taken with drugs such as aspirin, warfarin
(Coumadin), and heparin, antiplatelet drugs such
as clopidogrel (Plavix), and nonsteroidal antiinflammatory drugs such as ibuprofen (Motrin,
Advil) or naproxen (Naprosyn, Aleve).
Marijuana may increase blood sugar levels by
interacting with medications that are used for
blood sugar control. Medication adjustments
may be necessary.
Marijuana may cause low blood pressure, so
caution is advised in people taking medications
that lower blood pressure.
Marijuana may interfere with the way the
body processes certain drugs using the liver’s
cytochrome P450 enzyme system. As a result, the
levels of these drugs may increase in the blood
and may cause increased effects or potentially
serious adverse reactions.
Marijuana may increase the amount of drowsiness caused by benzodiazepines such as lorazepam (Ativan) or diazepam (Valium), barbiturates
such as phenobarbital, narcotics such as hydrocodone, some antidepressants, and alcohol. In addition, marijuana may adversely affect the immune
system.
Marijuana may interfere with agents that treat
lung disorders, heart disorders, nausea or vomiting, nervous system disorders, psychiatric disorders, HIV, skin disorders, stomach disorders,
cancer, and seizures.
Moderate interaction occurs with disulfiram
(Antabuse), causing agitation, trouble sleeping,
and irritability. Fluoxetine (Prozac) also interacts with marijuana. Taking marijuana with
fluoxetine may cause a hypomanic state, consisting of irritability, nervousness, jitteriness,
and excitability.
Marijuana may increase the risk of bleeding
when taken with herbs and supplements that are
Long-term health risks of marijuana use include
immune system effects, cardiovascular effects,
respiratory effects, reproductive effects, behavioral effects, and cancer. Marijuana use also puts
users at risk for various types of accidents.
Coinciding with the increasing rates of cannabis use due to medical marijuana has been the
recognition of a new clinical condition known as
cannabinoid hyperemesis syndrome. This syndrome is characterized by cyclic episodes of nausea and vomiting and abdominal pain. Despite
the well-established antiemetic properties of
marijuana, there is increasing evidence of its paradoxical effects on the gastrointestinal tract and
central nervous system.
The clinical course of cannabinoid hyperemesis syndrome consists of three phases: (1) prodromal, (2) hyperemetic, and (3) recovery phase.
The hyperemetic phase usually ceases within
48 h after cessation of use, and treatment involves
supportive therapy with fluid resuscitation and
antiemetic medications. Patients often demonstrate the learned behavior of frequent hot bathing, which produces temporary cessation of
nausea, vomiting, and abdominal pain [15, 16].
Marijuana affects the immune, cardiovascular,
respiratory, and reproductive systems. It also has
psychiatric/behavioral effects and can cause cancer. Motor vehicle accidents occur under the
influence of marijuana [17].
Immune System
Long-term cannabis use can impair the immune
system’s ability to fight off microbial and viral
infections. Both animal and human studies have
shown that marijuana impairs the ability of
T-cells in the lungs’ immune defense system to
fight off some infections [18].
Cardiovascular System
Users with preexisting coronary artery disease
or cerebrovascular disease may experience
136
myocardial infarctions, congestive heart failure,
or stroke. Peripheral vasodilatation causes postural hypotension, which may lead to dizziness
or syncope. Cannabis arteritis is a very rare
peripheral vascular disease similar to Buerger’s
disease [18].
Respiratory System
The amount of tar in a marijuana cigarette is
three times the amount in a tobacco cigarette,
with one-third greater deposition in the respiratory tract. Chronic cannabis use is associated
with bronchoconstriction, pharyngitis, sinusitis,
bronchitis, squamous metaplasia of the tracheobronchial epithelium, and emphysema.
Several case reports suggest a link between
cannabis smoking and cancer of the oropharynx
and tongue, nasal and sinus epithelium, and
larynx.
Some illegally obtained marijuana is contaminated with Aspergillus species, which can cause
invasive pulmonary aspergillosis in immunocompromised users.
Smoking marijuana may increase the risk of
opportunistic infections among those who are
HIV positive, although it does not seem to effect
the development of AIDS or lower white cell
counts [18, 19].
Reproductive System
High doses of THC cause a drop in testosterone
level, decreased sperm production, and compromised sperm motility and viability.
THC alters the normal ovulatory cycle by
decreasing follicle-stimulating hormone, luteinizing hormone, and prolactin secretion. It crosses
the placenta and impairs placental development,
fetal nourishment, and placental gas exchange.
For this reason, it is implicated in low birth
weight, growth restriction, preeclampsia, spontaneous miscarriage, and stillbirth. It also accumulates in breast milk.
Children of chronic users (greater than five
joints per week) were found to have lower verbal
and memory scores at age 2 years [18].
A possible increased risk of nonlymphoblastic
leukemia, rhabdomyosarcoma, and astrocytoma
9 Cannabis Dependence
exists in children whose mothers use cannabis
during their pregnancies.
Psychiatric/Behavioral
Long-term use of marijuana also can lead to a
series of attitude and personality changes known
as “amotivational syndrome.” This syndrome is
characterized by a diminished ability to carry out
long-term plans, a sense of apathy, decreased
attention to appearance and behavior, and
decreased ability to concentrate for long periods
of time. These changes can also include poor
performance in school. Long-term marijuana use
has been shown to cause a decline in IQ of up to
eight points.
Marijuana use can cause relationship problems and antisocial behavior, such as lying and
stealing money. It leads to lower life satisfaction,
financial difficulties, and a greater chance of
being unemployed.
Marijuana use has been shown to increase the
risk of schizophrenia two fold in vulnerable individuals [18].
Cancer
Marijuana smoke contains some of the same
cancer-causing compounds as tobacco, usually in
higher concentrations. Someone who smokes five
joints per day may be taking in as many cancercausing chemicals as someone who smokes a full
pack of cigarettes every day.
Cancer of the respiratory tract and lungs may
be promoted by marijuana smoke, since it contains irritants and carcinogens. Tobacco smoke
and marijuana smoke may work together to
change the tissues that line the respiratory tract.
Marijuana smoking could contribute to early
development of head and neck cancer in some
people. Smoking marijuana has been linked to
testicular cancer [20].
Accidents
Marijuana is the most common illegal drug
reported in motor vehicle accidents. Fatal crashes
involving marijuana use tripled during the previous decade. Marijuana also has been involved in
other types of accidents [18, 21].
Synthetic Cannabinoids
137
Medical Use
Cannabis indica
ronabinol, Nabilone, and Nabiximols
D
Three medicinal products are derived from
marijuana:
dronabinol,
nabilone,
and
nabiximols.
The synthetic THC product dronabinol
(Marinol) is for the control of nausea and vomiting caused by chemotherapeutic agents and for
stimulating the appetite of AIDS patients. A DEA
Schedule II drug, dronabinol, is supplied as a 2.5,
5, and 10 mg capsule.
Originally cultivated in the United States,
Cannabis indica, or “ganja,” is smoked as a form
of marijuana. C. indica plants are short, dense
plants, with broader, darker green leaves than the
Cannabis sativa plant.
The plant is commonly referred to as “skunk”
(for the pungent odor it produces while growing),
northern lights, early girl, and many other names.
Nabilone (Cesamet) is used to treat severe nausea
and vomiting caused by chemotherapy. Nabilone
is a man-made drug similar to the natural substances found in marijuana. It works by decreasing the signals in the brain that lead to nausea and
vomiting.
Nabiximols (Sativex) is used to treat spasticity
caused by multiple sclerosis. It is composed of
two compounds found in marijuana—THC and
cannabidiol (CBD)—which isn’t psychoactive.
The drug, delivered through a vaporizer, is
approved in 25 countries but isn’t available in the
United States [22].
Medical Marijuana
Although several states have decriminalized marijuana, it remains an illegal substance under federal law. Depending on the state, patients may
qualify for treatment with medical marijuana if
they meet certain requirements and have one of
the following conditions [23]:
•
•
•
•
•
•
•
•
•
•
Amyotrophic lateral sclerosis (ALS)
Anorexia due to HIV/AIDS
Chronic pain
Crohn’s disease
Epilepsy or seizures
Glaucoma, although the American Academy
of Ophthalmology doesn’t recommend medical marijuana
Multiple sclerosis or severe muscle spasms
Nausea, vomiting, or severe wasting associated with cancer treatment
Terminal illness
Tourette syndrome
Cannabis indica and Cannabis sativa produce
two greatly different effects. C. sativa produces a
“high” effect, while C. indica produces a more
relaxed, “stoned” effect.
Cannabis indica contains a higher amount of THC
than Cannabis sativa, causing the psychological
effects to be heightened [24].
Synthetic Cannabinoids
Spice
The synthetic cannabinoids, known as Spice or
K2, are lab-synthesized liquid chemicals that
mimic the effect of THC. The chemical ingredients of Spice are sprayed onto dried plant material, which consists of chopped up herbs in a
mixture of colors including beige, cream red, and
brown. The final product looks like colored marijuana or tobacco.
In 2015, 3.10% of 8th graders, 4.30% of 10th
graders, and 5.20% of 12th graders reported pastyear use of synthetic marijuana.
Spice was first sold as a recreational drug in
2004 in the United Kingdom. By 2006, it had
gained a considerable hold on the market, and the
brand name Spice (along with another brand K2)
had become a generic term for all synthetic cannabis. Some synthetic cannabinoids are 100
times more potent than THC. This has resulted in
a number of significant side effects, including
hypertension, blurred vision, myocardial infarction, vomiting, severe anxiety, paranoia, seizures,
and hallucinations.
In drug tests, the chemicals in synthetic
marijuana are harder to detect than marijuana.
9 Cannabis Dependence
138
Spice is sold under a number of names, including Mojo, Scooby Snax, Black Mamba, and
Annihilation. Vaping the liquid of synthetic
marijuana using e-cigarette is a fast-rising trend.
Most Spice manufacturers do not follow high
manufacturing standards, many of the chemicals
being produced in cheap basement laboratories.
Chemical impurities carry additional, and possibly much greater, risks. Deaths have been associated with use of the drug.
Spice is often sold as potpourri, room
deodorizer, or incense, purporting to be an
innocent product for scenting rooms and usually has the warning “Not for human consumption” on the packet.
It is estimated that there are well over 200
synthetic cannabinoids sold on the street, with
about 50 of them currently listed as DEA
Schedule I drugs.
Street names for synthetic cannabis include
Spice, black mamba, K2, fake marijuana, and
sexy monkey [25–27].
Hashish
Hashish, or hash, is an extracted product from the
cannabis plant that is composed of compressed or
purified preparations of glandular resin hairs
called trichomes. It is made from the resin, which
is a secreted gum. Hashish may be solid or resinous depending on the preparation; pressed hashish is solid, whereas water-purified hashish is
often a paste-like substance with varying hardness and pliability. Its color, most commonly
light to dark brown, can vary from transparent to
yellow, tan, black, or red depending on the process and amount of solvent left over.
Hashish is usually smoked, but it also can be
added to food and eaten. It may have 20–65%
THC concentration.
The name hashish comes from an Arabic word
meaning “grass.” Massive hashish production for
international trade originated in Morocco during
the 1960s, where the cannabis plant was widely
available. Northern India has a long social tradition in the production of hashish, known locally
as charas. It is believed to be the same plant resin
that was burned in the religious ceremonies of
ancient Persia.
A 250–1000 mg ingestion of hashish can
result in obtundation within 30 min. Street
names for hashish include chocolate, hash, and
shit [28, 29].
Hash Oil
Hash oil is a resinous matrix produced by a solvent
extraction of cannabis. A wide variety of solvents
can be used for the extraction, such as chloroform,
dichloromethane, ether, naphtha, benzene, butane,
methanol, ethanol, isopropanol, and olive oil.
One pound of marijuana yields from one-tenth
to one-fifth of a pound of hash oil. It is a concentrated product with a high THC content, which
generally varies between 20% and 60%, but can
contain up to 80% THC.
Hash oil is traditionally a dark, golden hue.
Related “honey oil” is a specific type of hash oil
made from the more potent parts of the cannabis
plant.
Hash oil is usually consumed by smoking,
ingestion, or vaporization. Smoking or vaporizing hash oil is known as “dabbing” from the
English verb to daub, which means “to smear
with something adhesive.” Dabbing devices
include special kinds of water pipes (“oil rigs”)
and vaporizers similar in design to e-cigarettes.
Anxiety or panic is the most common bad reaction, occurring during or shortly after smoking
hash oil, or they can appear more gradually 1–2 h
after an oral dose. These reactions usually resolve
without medical intervention. Hash oil can cause
tightness in chest, nausea, hypotension, tachycardia, dry mouth, and lethargy. Deaths have occurred.
Flashbacks occasionally occur in which the
original drug experience (usually dysphoria) is
relieved weeks or months after use [30].
Wax is a new marijuana product that looks and
feels like lip balm and is as strong as 15–20 joints
of marijuana. The marijuana concentrate is also
referred to as butane hash oil, honey oil, budder,
dabs, and 710 (spelled upside down is oil). It is
easy to conceal in lip balm jars. It can be eaten or
smoked using a bong or an e-cigarette. It is made
Summary
from the oils of marijuana plants. Highly flammable butane gas is used to extract the THC from
the marijuana leaf and has resulted in home
explosions, injuries, and deaths [31].
Tolerance
Repeated use over days to weeks induces considerable tolerance to the behavioral and psychological
effects of cannabis. Regular marijuana smokers
may require more potent cannabis or larger amounts
of the drug to achieve the desired effects [32].
Dependence
Thirty percent of those who use marijuana may
develop some degree of marijuana use disorder.
People who begin using marijuana before the age
of 18 are four to seven times more likely to
develop a marijuana use disorder than those who
begin smoking it in adulthood. Nine percent of
people who use marijuana will become dependent on it, rising to about 17% in those who start
using in their teens [33]. Diagnosis of cannabis
dependence is based on the DSM-5 criteria discussed in Chap. 1.
Abstinence Syndrome
On cessation of cannabis use, withdrawal symptoms may develop. Users most commonly experience cravings, irritability, mild tremor, anxiety,
and sleep disturbances. Other symptoms may
include restlessness, anorexia and weight loss,
nausea, sweating, salivation, mild hyperthermia,
and tremor [34].
Overdose
Symptoms
Acute marijuana toxicity (bad trip) results in anxiety, agitation, difficulty with coordination,
decreased muscle strength, postural hypotension,
139
headache, sweating, and lethargy. It also results
in slurred speech, confusion, amnesia, delusions,
and hallucinations.
Treatment
In 2012, there were over 450,000 emergency
department visits in the United States related
to use of marijuana. Treatment depends on the
clinical presentation, the age of the patient, and
the presence of other legal or illicit substances.
Immediate management should be supportive,
including cardiovascular and neurological
monitoring and placement in a quiet room.
Most episodes of marijuana toxicity remit
fairly quickly.
Gastric decontamination may be considered in
children with an acute ingestion less than 2 h
prior to presentation. Patients who are agitated or
present with psychosis can be treated with a benzodiazepine [18].
Summary
Cannabis is a genus of flowering plant that
includes three species—C. sativa, C. indica, and
C. ruderalis. The male plant produces pollen,
which pollinates the flowers of the female plant.
Once pollinated, the female plant produces seeds.
If the female plant is not pollinated, the buds and
flowers continue to develop and produce THC,
which is the major psychoactive substance in the
cannabis plant. To produce a mood-altering
effect, cannabis is used in three main forms: (1)
marijuana, (2) hashish, and (3) hash oil.
Long-term health risks of marijuana use
include immune system effects, cardiovascular
effects, respiratory effects, reproductive effects,
behavioral effects, and cancer.
Medical marijuana was legalized in California
in 1996, and several other states have followed
suit. Three medicinal products are derived from
marijuana: dronabinol, nabilone, and nabiximols.
Depending on the state, patients may qualify for
treatment with medical marijuana if they meet
certain requirements.
140
Cannabis indica, or “ganja,” is smoked as a form
of marijuana. The synthetic cannabinoids, known
as Spice or K2, are lab-synthesized liquid chemicals that mimic the effect of THC.
Hashish, or hash, is an extracted product from
the cannabis plant that is composed of compressed or purified preparations of glandular
resin hairs called trichomes. Hash oil is a resinous matrix produced by a solvent extraction of
cannabis.
Repeated use over days to weeks induces considerable tolerance to the behavioral and psychological effects of cannabis. Thirty percent of
those who use marijuana may develop some
degree of marijuana use disorder. People who
begin using marijuana before the age of 18 are
four to seven times more likely to develop a marijuana use disorder than adults.
Acute marijuana toxicity (bad trip) results in
anxiety, agitation, difficulty with coordination,
decreased muscle strength, postural hypotension,
headache, sweating, and lethargy.
References
1. London D. What is Cannabis Ruderalis? Marijuana.
com. http://www.marijuana.com/blog/news/2016/05/
what-is-cannabis-ruderalis. May 12, 2016.
2. O’Brien R, Cohen S. The encyclopedia of drug abuse.
New York: Facts on File; 1984.
3. Marijuana Timeline, PBS Frontline. http://www.pbs.
org/wgbh/pages/frontline/shows/dope/etc/cron.html
4. Edible marijuana creates new cautions for a safe
Halloween. McCook Gazette. http://m.mccookgazette.com/story/2355710.html. October 31, 2016.
5. National survey on drug use and health: trends in
prevalence of various drugs for ages 12 or older, ages
12 to 17, ages 18 to 25, and ages 26 or older. National
Institute on Drug Abuse (NIDA). 2015. https://www.
drugabuse.gov/national-survey-drug-use-health
6. Marijuana. Partnership for Drug-Free Kids. 2017.
http://www.drugfree.org/drug-guide/marijuana
7. Marijuana: What is the scope of marijuana use in
the United States? National Institute on Drug Abuse
(NIDA). November, 2016.
8. Dubuc B. The brain from top to bottom. McGill
University.
http://thebrain.mcgill.ca/flash/i/
i_03/i_03_m/i_03_m_par/i_03_m_par_heroine.
html#drogues. May 2012.
9. Ashton CH. Pharmacology and effects of cannabis: a
brief review. Br J Psychiatry. 2001;178(2):101–6.
9 Cannabis Dependence
10. Schwartz RH, Hawks RL. Laboratory detection of
marijuana use. J Am Med Assoc. 1981;254:788–92.
11. Milhorn HT. Chemical dependence: diagnosis, treatment, and prevention. New York: Springer; 1990.
12. Schwartz RH. Marijuana: an overview. Pediatr Clin N
Am. 1987;34:305–17.
13. Wilford BB, editor. Major drugs of abuse. In: Drug
abuse: a guide for the primary care physician.
Chicago: American Medical Association; 1981.p.
21–84.
14. Marijuana (Cannabis Sativa). Mayo Clinic. http://
www.mayoclinic.org/drugs-supplements/marijuana/
selected-references/hrb-20059701. November 1,
2013.
15. Council on Scientific Affairs. Marijuana: its health
hazards and therapeutic potentials. JAMA. 1981;
246:1823–7.
16. Galli JA, Sawaya RA, Friedenberg FK. Cannabinoid
hyperemesis syndrome. Curr Drug Abuse Rev.
2011;4(4):241–9.
17. Morris RR. Human pulmonary pathophysiology
changes from marijuana smoking. J Forensic Sci.
1985;30:345–9.
18. Russo L. Cannabinoid poisoning. Medscape. http://
emedicine.medscape.com/article/833828-overview.
June 24, 2016.
19. Wu TC, Tashkin DP, Djahed B, Rose JE. Pulmonary
hazards of smoking marijuana as compared with
tobacco. N Engl J Med. 1988;318:347–51.
20. What are the long-term effects of marijuana?
VeryWell.
http://www.verywell.com/long-termeffects-of-marijuana-63551. July 17, 2016.
21. Thompson D. Fatal car crashes involving pot use have
tripled in U.S., study finds. WebMD. http://www.
webmd.com/mental-health/news/20140204/fatal-carcrashes-involving-pot-use-have-tripled-in-us-studyfinds#1. February 4, 2014.
22. Macaluso M. 3 prescription drugs that come from
marijuana. USA Today, March 17, 2014.
23. Medical marijuana. Mayo Clinic. http://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/
medical-marijuana/art-20137855. October 14, 2016.
24. Marijuana. Center for Substance Abuse Research
(CESAR)/University of Maryland. http://www.cesar.
umd.edu/cesar/drugs/marijuana.asp
25. Anderson, L. Synthetic marijuana – spice or K2.
Drugs.com. https://www.drugs.com/illicit/syntheticmarijuana.html
26. What are synthetic cannabinoids?. National Institute
on Drug Abuse (NIDA). November 2015.
27. Rael A. What is synthetic marijuana and how does
it compare to traditional marijuana? The Huffington
Post, September 11, 2013.
28. Hashish. MedLibrary. http://medlibrary.org/medwiki/
Hashish
29. What is Hashish? Weed Street Journal. http://www.
theweedstreetjournal.com/hashish. March 7, 2011.
30. Hash oil. WeedWiki. http://cannabis.wikia.com/wiki/
Hash_Oil. September 28, 2015.
References
31. Dangerous new marijuana product looks like lip balm,
packs big kick. Fox News/Health, August 17, 2014.
32. Hunt A, Jones RT. Tolerance and disposition of tetrahydrocannabinol in man. J Pharmacol Exp Ther.
1980;215:35–44.
141
33. Is marijuana addictive? National Institute on Drug
Abuse (NIDA). January 2017.
34. Medina J. Cannabis (marijuana) withdrawal.
PsychCentral.
https://psychcentral.com/disorders/
cannabis-marijuana-withdrawal. February 9, 2017.
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