Medical cannabis, or medical marijuana, is cannabis and cannabinoids that are recommended by doctors for their patients. 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 are not clear. The Cannabis plant has a history of medicinal use dating back thousands of years across many cultures. The use of medical cannabis is controversial. 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. Medical cannabis has several potential beneficial effects.
Evidence is moderate that it helps in chronic pain and muscle spasms. It is recommended that cannabis use be stopped in pregnancy. Less common side effects were “ocular problems, orthostatic hypotension, muscle twitching, pruritis, vagueness, hallucinations, lightheadedness and dry mouth”. 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 only limited evidence for the effectiveness of cannabis in relieving chronic pain in several conditions. Another review found tentative evidence for use of cannabis in treating peripheral neuropathy, but little evidence of benefit for other types of long term pain.
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 2011 review considered cannabis to be generally safe, and in palliative care, its use appears safer than opioids. Studies of the efficacy of cannabis for treating multiple sclerosis have produced varying results. There is tentative evidence that medical cannabis is effective at reducing posttraumatic stress disorder symptoms, but, as of 2017, there is insufficient evidence to confirm its effectiveness for this condition. There is insufficient data to draw strong conclusions about the safety of medical cannabis.
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. Effects of chronic use may include bronchitis, a cannabis dependence syndrome, and subtle impairments of attention and memory. These deficits persist while chronically intoxicated. There has been a limited amount of studies that have looked at the effects of smoking cannabis on the respiratory system. Cannabis smoke contains thousands of organic and inorganic chemical compounds. 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. Cannabis usually causes no tolerance or withdrawal symptoms except in heavy users.
In a survey of heavy users 42. 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. Exposure to 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.
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. CB1 receptors are found in very high levels in the brain and are thought to be responsible for psychoactive effects. Cannabinoid absorption is dependent on its route of administration. The low bioavailability is largely attributed to significant first-pass metabolism in the liver and erratic absorption from the gastrointestinal tract. 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. Rectal administration in monkeys doubled bioavailability to 13. 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.
Delta-9-THC is the primary molecule responsible for the effects of cannabis. Delta-9-THC is metabolized in the liver and turns into 11-OH-THC. 11-OH-THC is the first metabolic product in this pathway. Both Delta-9-THC and 11-OH-THC are psychoactive. The metabolism of THC into 11-OH-THC plays a part in the heightened psychoactive effects of edible cannabis. Next, 11-OH-THC is metabolized in the liver into 11-COOH-THC, which is the second metabolic product of THC. 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.
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. After delta-9-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. 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. Smoking has been the means of administration of cannabis for many users, but smoking is not suitable for the use of cannabis as a medicine. 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.
Chinese, was used in Taiwan for fiber starting about 10,000 years ago. 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. The 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. The cultivar, Cannabis ruderalis, still grows wild today. Cannabis seeds may have been used for food, rituals or religious practices in ancient Europe and China. Harvesting the plant led to the spread of cannabis throughout Eurasia about 10,000 to 5,000 years ago, with further distribution to the Middle East and Africa about 2,000 to 500 years ago. A landrace strain of cannabis developed over centuries.
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