Marijuana

What is Marijuana

Marijuana is a term used to describe preparations derived from dried leaves and flowers of the Cannabis sativa or hemp plant.

The Cannabis sativa plant contains over 500 different compounds, approximately 100 of which are referred to as cannabinoids.

Cannabinoids are further classified into 3 subcategories: phytocannabinoids [e.g., delta-9-tetrahydrocannabinol (delta-9-THC), cannabidiol (CBD), cannabigerol (CBG), cannabichromene (CBC), cannabinol (CBN)]; endocannabinoids [e.g., arachidonylethanolamine (AEA) or anandamide, 2-arachidonylglycerol (2-AG)]; and synthetic cannabinoids.

These cannabinoids produce a variety of pharmacologic effects when ingested, chewed, or smoked; with delta-9-THC being the cannabinoid primarily responsible for the psychoactive properties of marijuana.

Marijuana is classified under the Federal Controlled Substance Act as a Schedule I botanical product. Despite being a Schedule I product, the FDA has approved 3 oral medications that contain active ingredients known to be present in botanical marijuana [e.g., Marinol (dronabinol, a synthetic form of delta-9-THC), Cesamet (nabilone), and Epidiolex (CBD)]. Further, the 2018 Farm Bill removed products derived from the hemp or Cannabis sativa plant from Schedule I status ONLY IF the cannabinoids produced by the plant contain no more than 0.3% delta-9-THC.

The federal Farm Bill does not affect state cannabis laws, which in many cases, conflict with federal laws. A majority of states and the District of Columbia have enacted laws to remove state-level criminal penalties for marijuana possession and use in patients with approved medical conditions.

The accepted medical conditions for which marijuana may be used vary from state to state; contact the specific state for their approved medical marijuana indication list and criteria for approved use.

Many states require patient registration, and county and city laws may also impact legal possession and use.

Approved state indications may include treatment of nausea or vomiting due to cancer (chemotherapy or radiotherapy) or HIV infection (e.g., due to medication treatment), glaucoma, muscle spasticity (multiple sclerosis, Crohn’s disease, or damage to spinal cord), seizures (epilepsy), chronic pain, peripheral neuropathy, arthritis, cachexia or wasting syndromes (e.g., AIDS/HIV), anorexia nervosa, migraine, hepatitis C, amyotrophic lateral sclerosis (Lou Gehrig’s disease), muscular dystrophy, nail-patella syndrome, post-traumatic stress disorder, agitation associated with Alzheimer’s disease, palliative care (e.g., hospice care or terminal illness resulting in less than 12 months of life), and serious or rare medical conditions for which the use of medical marijuana is beneficial.

Indications

  1. anorexia
  2. cachexia
  3. chemotherapy-induced nausea/vomiting
  4. glaucoma
  5. neuropathic pain
  6. spasticity
  7. Tourette’s syndrome
  8. tremor

For the treatment of chemotherapy-induced nausea/vomiting

Side Effects

  1. anemia
  2. anxiety
  3. appetite stimulation
  4. arrhythmia exacerbation
  5. ataxia
  6. blepharospasm
  7. bronchial secretions
  8. chest pressure syndrome
  9. confusion
  10. conjunctival hyperemia
  11. constipation
  12. cough
  13. depression
  14. diarrhea
  15. diplopia
  16. dizziness
  17. drowsiness
  18. dysarthria
  19. dysphoria
  20. dyspnea
  21. emotional lability
  22. euphoria
  23. fatigue
  24. fever
  25. growth inhibition
  26. gynecomastia
  27. hallucinations
  28. headache
  29. hypertension
  30. impaired cognition
  31. impotence (erectile dysfunction)
  32. infertility
  33. libido decrease
  34. menstrual irregularity
  35. myocardial infarction
  36. nausea
  37. nystagmus
  38. oligospermia
  39. orthostatic hypotension
  40. paranoia
  41. paresthesias
  42. peripheral vasodilation
  43. photophobia
  44. physiological dependence
  45. psychological dependence
  46. restlessness
  47. secondary malignancy
  48. stroke
  49. teratogenesis
  50. testicular atrophy
  51. tolerance
  52. tremor
  53. vomiting
  54. weakness
  55. weight gain
  56. wheezing
  57. withdrawal
  58. xerostomia

NOTE: Marijuana has not been approved by the FDA for any indication; no product is commercially available.

Monitoring Parameters

  • urinalysis

Contraindications

  • abrupt discontinuation
  • asthma
  • breast-feeding
  • cardiac arrhythmias
  • cardiac disease
  • children
  • chronic obstructive pulmonary disease (COPD)
  • driving or operating machinery
  • emphysema
  • GI disease
  • hypertension
  • infants
  • influenza
  • lung cancer
  • myocardial infarction
  • neonates
  • orthostatic hypotension
  • pregnancy
  • pulmonary disease
  • reproductive risk
  • respiratory infection
  • stroke

Interactions

No information is available regarding drug interactions associated with Marijuana

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