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{{short description|Cannabis sativa L. (marijuana; hemp) used medicinally}}
{{About|the medical uses of cannabis|general drug information|Cannabis (drug)|other uses|Cannabis (disambiguation)}}
{{other uses of|Cannabis}}
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{{redirect|Medical marijuana|the company|Medical Marijuana, Inc.}}
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]'' purchased at a medical cannabis dispensary]]
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<!-- Definition and uses -->
'''Medical cannabis''' refers to the parts of the herb ] used as a form of medicine or ], or to synthetic forms of specific ] such as ] (delta-9-tetrahydrocannabinol) as a form of medicine. The ] has been used as a medicine over an extensive period of time.<ref name="Amar2006">{{cite journal |doi=10.1016/j.jep.2006.02.001 |title=Cannabinoids in medicine: A review of their therapeutic potential |year=2006 |last1=Ben Amar |first1=Mohamed |journal=Journal of Ethnopharmacology |volume=105 |pages=1–25 |pmid=16540272 |issue=1–2}}</ref> Cannabis is one of the ] of ],<ref name="Wong">{{Cite book|last=Wong |first=Ming |year=1976 |title=La Médecine chinoise par les plantes |publisher=Tchou |location=Paris |oclc=2646789}}{{Page needed|date=August 2010}}</ref> and is prescribed for a broad range of indications.
'''Medical cannabis''', '''medicinal cannabis''' or '''medical marijuana''' ('''MMJ''') refers to ] and ]s that are ] by ]s for their patients.<ref>{{cite journal | vauthors = Murnion B | title = Medicinal cannabis | journal = Australian Prescriber | volume = 38 | issue = 6 | pages = 212–15 | date = December 2015 | pmid = 26843715 | pmc = 4674028 | doi = 10.18773/austprescr.2015.072 }}</ref><ref>{{cite web |title= What is medical marijuana? |url= https://www.drugabuse.gov/publications/drugfacts/marijuana-medicine |website= National Institute of Drug Abuse |access-date= 19 April 2016 |date= July 2015 |quote= The term medical marijuana refers to using the whole unprocessed marijuana plant or its basic extracts to treat a disease or symptom. |archive-date= 17 April 2016 |archive-url= https://web.archive.org/web/20160417154854/https://www.drugabuse.gov/publications/drugfacts/marijuana-medicine |url-status= live }}</ref><ref>{{Cite journal |last1=Sarris |first1=Jerome |last2=Sinclair |first2=Justin |last3=Karamacoska |first3=Diana |last4=Davidson |first4=Maggie |last5=Firth |first5=Joseph |date=2020-01-16 |title=Medicinal cannabis for psychiatric disorders: a clinically-focused systematic review |journal=BMC Psychiatry |language=en |volume=20 |issue=1 |page=24 |doi=10.1186/s12888-019-2409-8 |doi-access=free |issn=1471-244X |pmc=6966847 |pmid=31948424}}</ref><ref>{{Cite journal |last=O'Brien |first=Kylie |date=2019-06-01 |title=Medicinal Cannabis: Issues of evidence |url=https://www.sciencedirect.com/science/article/pii/S1876382019300216 |journal=European Journal of Integrative Medicine |volume=28 |pages=114–120 |doi=10.1016/j.eujim.2019.05.009 |issn=1876-3820}}</ref> The use of cannabis as medicine has a long history, but has not been as rigorously tested as other medicinal plants due to legal and governmental restrictions, resulting in limited ] to define the safety and efficacy of using cannabis to treat diseases.<ref>{{cite journal | title = Release the strains | journal = Nature Medicine | volume = 21 | issue = 9 | page = 963 | date = September 2015 | pmid = 26340110 | doi = 10.1038/nm.3946 | doi-access = free }}</ref>


Preliminary evidence has indicated that cannabis might reduce ] and ]ing during ] and reduce ] and ]s.<ref name=Borgelt2013 /><ref name=JAMA2015 /> Regarding non-inhaled cannabis or cannabinoids, a 2021 review found that it provided little relief against chronic pain and sleep disturbance, and caused several transient ]s, such as cognitive impairment, ], and ].<ref name="wang2021">{{cite journal | last1=Wang | first1=Li | last2=Hong | first2=Patrick J | last3=May | first3=Curtis | last4=Rehman | first4=Yasir | last5=Oparin | first5=Yvgeniy | last6=Hong | first6=Chris J | last7=Hong | first7=Brian Y | last8=AminiLari | first8=Mahmood | last9=Gallo | first9=Lucas | title=Medical cannabis or cannabinoids for chronic non-cancer and cancer related pain: a systematic review and meta-analysis of randomised clinical trials | journal=BMJ | volume=374 | date=2021-09-09 | pages=n1034 | issn=1756-1833 | pmid=34497047 | doi=10.1136/bmj.n1034 | url=https://www.bmj.com/content/374/bmj.n1034 | doi-access=free | access-date=9 September 2021 | archive-date=9 September 2021 | archive-url=https://web.archive.org/web/20210909220904/https://www.bmj.com/content/374/bmj.n1034 | url-status=live }}</ref>


<!-- Side effects -->
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Short-term use increases the risk of minor and major adverse effects.<ref name=JAMA2015 /> Common side effects include ], feeling tired, vomiting, and ]s.<ref name=JAMA2015 /> Long-term effects of cannabis are not clear.<ref name=JAMA2015 /> Concerns include memory and cognition problems, risk of addiction, ] in young people, and the risk of children taking it by accident.<ref name=Borgelt2013 />
= INTRO NOTE ON FDA =========================
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| Many in-good-faith editors have attempted to add an intro sentence
| on the FDA's official stance. HOWEVER, be aware that this
| page is focused on the scientific conclusions of countries
| WORLDWIDE, not just the US. Including information on just one
| country would therefore be giving undue weight in the lead.
|
= Thank you! ================================
-->== Strains ==<!-- linked to Template:Cannabis -->
]


Many cultures have used cannabis for therapeutic purposes for thousands of years.<ref name=BenAmar2006>{{cite journal | vauthors = Ben Amar M | title = Cannabinoids in medicine: A review of their therapeutic potential | journal = Journal of Ethnopharmacology | volume = 105 | issue = 1–2 | pages = 1–25 | date = April 2006 | pmid = 16540272 | doi = 10.1016/j.jep.2006.02.001 | type = Review | citeseerx = 10.1.1.180.308 }}</ref> Some American medical organizations have requested removal of cannabis from the list of ]s maintained by the United States federal government, followed by regulatory and scientific review.<ref name="ANA" /><ref name="AAFP" /> Others oppose its legalization, such as the ].<ref name="AAP" />
The ] ''Cannabis'' contains two species which produce useful amounts of psychoactive cannabinoids. '']'' produces a higher level of ] (abbreviated CBD) relative to ] (the primary psychoactive component in medical and recreational cannabis). '']'', on the other hand, produces a higher level of THC relative to CBD.<ref>{{cite web |title=What are the differences between Cannabis indica and Cannabis sativa, and how do they vary in their potential medical utility? |publisher=ProCon.org |url=http://medicalmarijuana.procon.org/view.answers.php?questionID=000638}}</ref>


Medical cannabis can be administered through various methods, including ], ]s, ]s, ]es, oral or dermal sprays, ]s, and ] or ]. Synthetic cannabinoids are available for prescription use in some countries, such as ] and ]. Countries that ] include Argentina, Australia, Canada, Chile, Colombia, Germany, Greece, Israel, Italy, the Netherlands, Peru, Poland, Portugal, Spain, and Uruguay. In the United States, 38 states and the District of Columbia have legalized cannabis for medical purposes, beginning with the passage of California's ] in 1996.<ref name="NCSL" /> Although cannabis remains prohibited for any use at the federal level, the ] was enacted in December 2014, limiting the ability of federal law to be enforced in states where medical cannabis has been legalized.
Medical use of ''sativa'' is associated with a cerebral high, and many patients experience stimulating effects. For this reason, ''sativa'' is often used for daytime treatment. It may cause more of a euphoric, "high" sensation, and tends to stimulate hunger, making it potentially useful to patients with ]s or ]. ''Sativa'' also exhibits a higher tendency to induce ] and ], so patients prone to these effects may limit treatment with pure ''sativa'', or choose hybrid strains.<ref>{{cite journal |doi=10.1192/bjp.178.2.116 |title=Psychiatric effects of cannabis |year=2001 |last1=Johns |first1=A. |journal=The British Journal of Psychiatry |volume=178 |issue=2 |pages=116}}</ref>
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== Classification ==
''Cannabis indica'' is associated with sedative effects and is often preferred for night time use, including for treatment of insomnia.<ref name="Joy-Watson-Benson"/> ''Indica'' is also associated with a more "stoned" or meditative sensation than the euphoric, stimulating effects of ''sativa'', possibly because of a higher CBD-to-THC ratio.<ref>{{cite web |url=http://www.growery.org/3032/Indica-Sativa-Whats-the-difference |title=Indica? Sativa? What's the difference? |publisher=Growery |accessdate=2011-02-17}}</ref>


In the U.S., the ] defines medical cannabis as "using the whole, unprocessed marijuana plant or its basic extracts to treat symptoms of illness and other conditions".<ref name=nida>{{cite web |publisher= National Institute on Drug Abuse |date= July 2019 |title= Marijuana as Medicine |url= https://www.drugabuse.gov/publications/drugfacts/marijuana-medicine |access-date= 19 April 2016 |archive-date= 17 April 2016 |archive-url= https://web.archive.org/web/20160417154854/https://www.drugabuse.gov/publications/drugfacts/marijuana-medicine |url-status= live }}</ref>
Many strains of cannabis are currently cultivated for medical use, including strains of both species in varying potencies, as well as hybrid strains designed to incorporate the benefits of both species. Hybrids commonly available can be heavily dominated by either ''Cannabis sativa'' or ''Cannabis indica'', or relatively balanced, such as so-called "50/50" strains.


A cannabis plant includes more than 400 different chemicals, of which about 70 are ]s.<ref name="Consumer Reports April 2016">{{cite web |author1 = Consumer Reports |title = Up in Smoke: Does Medical Marijuana Work? |url = http://www.consumerreports.org/medical-marijuana/does-medical-marijuana-work/ |website = Consumer Reports |access-date = 24 May 2016 |date = 28 April 2016 |archive-date = 14 March 2021 |archive-url = https://web.archive.org/web/20210314045548/https://www.consumerreports.org/medical-marijuana/does-medical-marijuana-work/ |url-status = live }}</ref> In comparison, typical government-approved medications contain only one or two chemicals.<ref name="Consumer Reports April 2016" /> The number of active chemicals in cannabis is one reason why treatment with cannabis is difficult to classify and study.<ref name="Consumer Reports April 2016" />
''Cannabis'' strains with relatively high CBD-to-THC ratios, usually ''indica''-dominant strains, are less likely to induce ]. This may be due to CBD's ]ic effects at the ], compared to THC's ] effect. CBD is also a ] agonist, which may also contribute to an ] effect.<ref name="Joy-Watson-Benson">{{cite book |title=Marijuana and Medicine: Assessing The Science Base |author=J.E. Joy, S. J. Watson, Jr., and J.A. Benson, Jr, |location=Washington D.C |publisher=] |year=1999 |isbn=0-585-05800-8 |url=http://books.nap.edu/html/marimed/}}</ref> This likely means the high concentrations of CBD found in ''Cannabis indica'' mitigate the ] effect of THC significantly.<ref name="Joy-Watson-Benson"/>


A 2014 review stated that the variations in ratio of CBD-to-THC in botanical and pharmaceutical preparations determines the therapeutic vs psychoactive effects (CBD attenuates THC's psychoactive effects<ref name="Schubart et al.2014">{{cite journal | vauthors = Schubart CD, Sommer IE, Fusar-Poli P, de Witte L, Kahn RS, Boks MP | title = Cannabidiol as a potential treatment for psychosis | journal = European Neuropsychopharmacology | volume = 24 | issue = 1 | pages = 51–64 | date = January 2014 | pmid = 24309088 | doi = 10.1016/j.euroneuro.2013.11.002 | s2cid = 13197304 | url = http://cannabisclinicians.org/wp-content/uploads/2013/12/CBD-psychosis-2013.pdf | access-date = 9 July 2016 | archive-date = 20 October 2018 | archive-url = https://web.archive.org/web/20181020210452/http://cannabisclinicians.org/wp-content/uploads/2013/12/CBD-psychosis-2013.pdf }}</ref>) of cannabis products.<ref name="ReferenceA">{{cite journal | vauthors = Koppel BS, Brust JC, Fife T, Bronstein J, Youssof S, Gronseth G, Gloss D | title = Systematic review: efficacy and safety of medical marijuana in selected neurologic disorders: report of the Guideline Development Subcommittee of the American Academy of Neurology | journal = Neurology | volume = 82 | issue = 17 | pages = 1556–1563 | date = April 2014 | pmid = 24778283 | pmc = 4011465 | doi = 10.1212/WNL.0000000000000363 }}</ref>
== Use ==
Medical marijuana is typically classified as an illegal drug in most countries and the US Food and Drug Agency (FDA) applies the schedule VI category from the Controlled Substances Act (FDA.gov). However, a number of governments, including the U.S. Federal Government, allow treatment with one or more specific low doses of synthetic ] for one or more disorders. In addition to the potential for negative effects, medical marijuana can be used to treat people that are suffering from cancer, AIDS, and chronic pain. Research studies show that medical marijuana is helpful to people who experience chronic non-cancer pain, vomiting and nausea caused by chemotherapy. The drug can also help with treating symptoms of AIDS patients and muscle spasms related to multiple sclerosis. As of 2011, the use of medical marijuana is legalized in 16 U.S. states but still illegal by federal law.<ref>{{cite journal |doi=10.12659/MSM.882116 |title=Medical marijuana: Medical necessity versus political agenda |year=2011 |last1=Clark |first1=Peter A. |last2=Capuzzi |first2=Kevin |last3=Fick |first3=Cameron |journal=Medical Science Monitor |volume=17 |issue=12 |pages=RA249–61 |pmid=22129912 |pmc=3628147}}</ref>


== Medical uses ==
]
]
Studies have shown several well-documented beneficial effects of cannabis.<ref name="Aggarwal-May–June-2009">{{Cite journal |pmid=19662925 |laysummary=http://blogs.sfweekly.com/thesnitch/2009/09/chronic_city_summing_up_the_ev.php |laysource=] |laydate=15 September 2009 |year=2009 |last1=Aggarwal |first1=SK |last2=Carter |first2=GT |last3=Sullivan |first3=MD |last4=Zumbrunnen |first4=C |last5=Morrill |first5=R |last6=Mayer |first6=JD |title=Medicinal use of cannabis in the United States: Historical perspectives, current trends, and future directions |volume=5 |issue=3 |pages=153–68 |journal=Journal of opioid management}}</ref><ref name="cannabis-med1">{{cite web|url=http://www.cannabis-med.org/meeting/Cologne2009/reader.pdf |title=IACM 5th Conference on Cannabinoids in Medicine |publisher=International Association for Cannabis as Medicine |format=PDF |accessdate=2011-07-28}}</ref><ref>{{Cite book |editor1-first=Janet E. |editor1-last=Joy |editor2-first=Stanley J. |editor2-last=Watson |editor3-first=John A. |editor3-last=Benson |year=1999 |title=Marijuana and Medicine: Assessing the Science Base |url=http://www.nap.edu/openbook.php?isbn=0309071550 |page= |publisher=] |location=Washington, D.C. |isbn=978-0-309-07155-0 |oclc=246585475}}</ref><ref name="medmjscience1"/> Among these are: The amelioration of nausea and vomiting, stimulation of hunger in ] and AIDS patients, lowered intraocular eye pressure (shown to be effective for treating ]), as well as gastrointestinal illness. The drug also produces antibacterial effects<ref>. cannabismd.net. Retrieved on 2013-04-17.</ref> and is one of the best known ].<ref>. Canadamedicalmarijuana.com. Retrieved on 2013-04-17.</ref> On the National Cancer Institute website, the ] (NIH) stated that cannabinoids found in marijuana appear to have significant analgesic and anti-inflammatory effects, antitumor effects, and anticancer effects, including the treatment of breast and lung cancer.<ref>{{cite web|title=Cannabis and Cannabinoids (PDQ®)|url=http://www.cancer.gov/cancertopics/pdq/cam/cannabis/healthprofessional/page4|work=National Cancer Institute at the National Institutes of Health|publisher=NIH…Turning Discovery Into Health®|accessdate=24 August 2013|date=2 August 2013}}</ref> The anti-cancer effect is due to the presence of cannabidiol (CBD) in the plant, an anti-cancer agent that does not cause euphoria.<ref>{{cite news|title=Pot compound seen as tool against cancer|url=http://www.sfgate.com/health/article/Pot-compound-seen-as-tool-against-cancer-3875562.php|accessdate=24 August 2013|newspaper=San Francisco Chronicle|date=18 September 2012|author=Victoria Colliver}}</ref>


Overall, research into the health effects of medical cannabis has been of low quality and it is not clear whether it is a useful treatment for any condition, or whether harms outweigh any benefit.<ref name=pratt>{{cite journal |vauthors=Pratt M, Stevens A, Thuku M, Butler C, Skidmore B, Wieland LS, Clemons M, Kanji S, Hutton B |title=Benefits and harms of medical cannabis: a scoping review of systematic reviews |journal=Syst Rev |volume=8 |issue=1 |page=320 |date=December 2019 |pmid=31823819 |pmc=6905063 |doi=10.1186/s13643-019-1243-x |type=Systematic review |doi-access=free }}</ref> There is no consistent evidence that it helps with ] and ].<ref name=pratt />
Sanjay Gupta, a neurosurgeon and chief medical correspondent for the ] media network, published an essay on the CNN website in August 2013 in which he apologizes for his previous hardline stance against cannabis. In 2009 Gupta wrote a ''Time'' magazine article entitled "Why I would Vote No to Pot" but stated in his 2013 piece that "... I was too dismissive of the loud chorus of patients whose symptoms improved on cannabis." His CNN article is entitled "Why I changed my mind on weed" and was written after an extensive period of research. Gupta explains that cannabis has "very legitimate medical applications" and is sometimes "the only thing that works," and, as part of his apology, states, "We have been terribly and systematically misled for nearly 70 years in the United States, and I apologize for my own role in that."<ref>{{cite news|title=CNN's Dr. Sanjay Gupta finds ample evidence of benefits of medical marijuana|url=http://www.bradenton.com/2013/08/16/4663379/cnns-dr-sanjay-gupta-finds-ample.html|accessdate=24 August 2013|newspaper=Bradenton Herald|date=16 August 2013|author=BRADENTON HERALD EDITORIAL}}</ref>


Low quality evidence suggests its use for reducing ] during ], improving appetite in ], improving sleep, and improving ]s in ].<ref name=JAMA2015>{{cite journal | vauthors = 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 | title = Cannabinoids for Medical Use: A Systematic Review and Meta-analysis | journal = JAMA | volume = 313 | issue = 24 | pages = 2456–73 | date = 23 June 2015 | pmid = 26103030 | doi = 10.1001/jama.2015.6358 | doi-access = free | hdl = 10757/558499 | hdl-access = free }}</ref> When usual treatments are ineffective, ]s have also been recommended for ], ], ],<ref name="Sachs et al. 2015" /> and ].<ref name="Distillations">{{cite web |title=Sex(ism), Drugs, and Migraines: Distillations Podcast and Transcript, Episode 237 |date=15 January 2019 |url=https://www.sciencehistory.org/distillations/podcast/sexism-drugs-and-migraines |website=Distillations |publisher=] |access-date=28 August 2019 |archive-date=14 March 2021 |archive-url=https://web.archive.org/web/20210314045616/https://www.sciencehistory.org/distillations/podcast/sexism-drugs-and-migraines |url-status=live }}</ref>
There are several methods for ], including ] or smoking dried buds, drinking, or eating extracts, and taking capsules. The comparable efficacy of these methods was the subject of an investigative study<ref name="medmjscience1">{{cite web |url=http://www.nih.gov/news/medmarijuana/MedicalMarijuana.htm |title=Workshop on the Medical Utility of Marijuana |publisher=] |year=1997 |accessdate=26 April 2009}}</ref> conducted by the ].


It is unclear whether American states might be able to mitigate the adverse effects of the ] by prescribing medical cannabis as an alternative pain management drug.<ref>{{cite journal |last1=Gilson |first1=Aaron M. |last2=LeBaron |first2=Virginia T. |last3=Vyas |first3=Marianne Beare |title=The use of cannabis in response to the opioid crisis: A review of the literature |journal=Nursing Outlook |date=1 January 2018 |volume=66 |issue=1 |pages=56–65 |pmid=28993073 |doi=10.1016/j.outlook.2017.08.012 |issn=0029-6554}}</ref>
While utilizing cannabis for recreational purposes is illegal in many parts of the world, many countries are beginning to consider varying levels of decriminalization for medical usage, including Canada, Austria, Germany, Switzerland, the Netherlands, Czech Republic, Spain, Israel, Italy, Finland, and Portugal. Synthetic cannabinoids are available as prescription drugs in some countries. Examples are ] (The United States and Canada) and ] (Canada, Mexico, the United Kingdom, and the United States).{{Citation needed|date=August 2013}}


Cannabis should not be used in ].<ref>{{cite journal | author = American College of Obstetricians Gynecologists Committee on Obstetric Practice | title = Committee Opinion No. 637: Marijuana Use During Pregnancy and Lactation | journal = Obstetrics and Gynecology | volume = 126 | issue = 1 | pages = 234–38 | date = July 2015 | pmid = 26241291 | doi = 10.1097/01.AOG.0000467192.89321.a6 }}</ref>
In the U.S., federal legislation outlaws the use of all herb parts from cannabis; states that have approved use of medical cannabis are in conflict with federal law. The ] ruled in '']'' and '']'' that the federal government has a right to regulate and criminalize cannabis, even for medical purposes. A person can therefore be prosecuted for a cannabis-related crime even if it is legal medical use according to state laws. The U.S. federal government, through the ] (NIDA), continues to provide medical cannabis to four patients who participated in the ].<ref>{{cite journal|title=The Sixth National Clinical Conference on Cannabis Therapeutics: A Report on the 2010 Conference |author=Mark Mathew Braunstein |url=http://www.markbraunstein.org/articles/braunstein-cannabis-conference.pdf |year=2010 |publisher=Treating Yourself |issue= 23, 2010 |quote=He is one of only four remaining patients whose cannabis is still provided by the federal government under its now disbanded Investigational New Drug (IND) program.}}</ref> NIDA claims this is done for "compassionate purposes" and the U.S. federal government still maintains that medical marijuana is not an effective or desirable treatment for any medical condition, despite significant contrary evidence.{{Citation needed|date=August 2013}}


== Clinical applications == === Insomnia ===
Research analyzing data from the National Health and Nutrition Examination Survey (NHANES) did not find significant differences in sleep duration between cannabis users and non-users. This suggests that while some individuals may perceive benefits from cannabis use in terms of sleep, it may not significantly change overall sleep patterns across the general population.<ref>{{Cite journal |last1=Diep |first1=Calvin |last2=Tian |first2=Chenchen |last3=Vachhani |first3=Kathak |last4=Won |first4=Christine |last5=Wijeysundera |first5=Duminda N. |last6=Clarke |first6=Hance |last7=Singh |first7=Mandeep |last8=Ladha |first8=Karim S. |date=2021-11-24 |title=Recent cannabis use and nightly sleep duration in adults: a population analysis of the NHANES from 2005 to 2018 |url=https://rapm.bmj.com/content/early/2021/11/24/rapm-2021-103161 |journal=Regional Anesthesia & Pain Medicine |volume=47 |issue=2 |pages=100–104 |language=en |doi=10.1136/rapm-2021-103161 |issn=1098-7339 |pmid=34873024}}</ref>
]


A review of literature up to 2018 indicates that cannabidiol (CBD) may have therapeutic potential for the treatment of insomnia. CBD, a non-psychoactive component of cannabis, is of particular interest due to its potential to influence sleep without the psychoactive effects associated with tetrahydrocannabinol (THC).<ref>{{Cite journal |last1=Walsh |first1=Jennifer H |last2=Maddison |first2=Kathleen J |last3=Rankin |first3=Tim |last4=Murray |first4=Kevin |last5=McArdle |first5=Nigel |last6=Ree |first6=Melissa J |last7=Hillman |first7=David R |last8=Eastwood |first8=Peter R |date=2021-11-12 |title=Treating insomnia symptoms with medicinal cannabis: a randomized, crossover trial of the efficacy of a cannabinoid medicine compared with placebo |journal=SLEEP |language=en |volume=44 |issue=11 |doi=10.1093/sleep/zsab149 |issn=0161-8105 |pmc=8598183 |pmid=34115851}}</ref>
A 2002 review of ] by Franjo Grotenhermen states that medical cannabis has established effects in the treatment of nausea, vomiting, ], unintentional ], ], and ]. Other "relatively well-confirmed" effects were in the treatment of "], painful conditions, especially ], ]s, ], <nowiki></nowiki> ]".<ref name="groten">{{Cite book|last=Grotenhermen |first=Franjo |chapter=Review of Therapeutic Effects |chapterurl=http://books.google.com/books?id=JvIyVk2IL_sC&pg=PA123 |title=Cannabis and Cannabinoids: Pharmacology, Toxicology and Therapeutic Potential |publisher=] |location=New York City |year=2002 |isbn=978-0-7890-1508-2 |page=124}}</ref>


=== Nausea and vomiting ===
Preliminary findings indicate that cannabis-based drugs could prove useful in treating ], ], ]s, ], and related conditions.<ref name="cecd">{{Cite journal |pmid=15159679 |year=2004 |last1=Russo |first1=EB |title=Clinical endocannabinoid deficiency (CECD): Can this concept explain therapeutic benefits of cannabis in migraine, fibromyalgia, irritable bowel syndrome and other treatment-resistant conditions? |volume=25 |issue=1–2 |pages=31–9 |journal=Neuro endocrinology letters}}</ref>
Medical cannabis is somewhat effective in ] (CINV)<ref name=Borgelt2013 /><ref name="Sachs et al. 2015">{{cite journal | vauthors = Sachs J, McGlade E, Yurgelun-Todd D | title = Safety and Toxicology of Cannabinoids | journal = Neurotherapeutics | volume = 12 | issue = 4 | pages = 735–46 | date = October 2015 | pmid = 26269228 | pmc = 4604177 | doi = 10.1007/s13311-015-0380-8 }}</ref> and may be a reasonable option in those who do not improve following preferential treatment.<ref name=Grotenhermen2012 /> Comparative studies have found cannabinoids to be more effective than some conventional antiemetics such as ], ], and ] in controlling CINV,<ref name=Bowels2012>{{cite journal | vauthors = Bowles DW, O'Bryant CL, Camidge DR, Jimeno A | title = The intersection between cannabis and cancer in the United States | journal = Critical Reviews in Oncology/Hematology | volume = 83 | issue = 1 | pages = 1–10 | date = July 2012 | pmid = 22019199 | doi = 10.1016/j.critrevonc.2011.09.008 | type = Review }}</ref> but these are used less frequently because of side effects including dizziness, dysphoria, and hallucinations.<ref name=Wang2008>{{cite journal | vauthors = Wang T, Collet JP, Shapiro S, Ware MA | title = Adverse effects of medical cannabinoids: a systematic review | journal = CMAJ | volume = 178 | issue = 13 | pages = 1669–78 | date = June 2008 | pmid = 18559804 | pmc = 2413308 | doi = 10.1503/cmaj.071178 | type = Review }}</ref><ref name=Jordan2007>{{cite journal | vauthors = Jordan K, Sippel C, Schmoll HJ | title = Guidelines for antiemetic treatment of chemotherapy-induced nausea and vomiting: past, present, and future recommendations | journal = The Oncologist | volume = 12 | issue = 9 | pages = 1143–50 | date = September 2007 | pmid = 17914084 | doi = 10.1634/theoncologist.12-9-1143 | s2cid = 17612434 | type = Review | url = http://pdfs.semanticscholar.org/d98c/026bda42b4b6ea1b0286d1893b362b46cca4.pdf | archive-url = https://web.archive.org/web/20190307023741/http://pdfs.semanticscholar.org/d98c/026bda42b4b6ea1b0286d1893b362b46cca4.pdf | archive-date = 2019-03-07 }}</ref> Long-term cannabis use may cause nausea and vomiting, a condition known as ] (CHS).<ref name=Nicolson2012>{{cite journal | vauthors = Nicolson SE, Denysenko L, Mulcare JL, Vito JP, Chabon B | title = Cannabinoid hyperemesis syndrome: a case series and review of previous reports | journal = Psychosomatics | volume = 53 | issue = 3 | pages = 212–19 | date = May–Jun 2012 | pmid = 22480624 | doi = 10.1016/j.psym.2012.01.003 | type = Review, case series }}</ref>


A 2016 ] 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 "ocular problems, orthostatic hypotension, muscle twitching, pruritus, vagueness, hallucinations, lightheadedness and dry mouth".<ref>{{cite journal | vauthors = Phillips RS, Friend AJ, Gibson F, Houghton E, Gopaul S, Craig JV, Pizer B | title = Antiemetic medication for prevention and treatment of chemotherapy-induced nausea and vomiting in childhood | journal = The Cochrane Database of Systematic Reviews | volume = 2016 | pages = CD007786 | date = February 2016 | issue = 2 | pmid = 26836199 | doi = 10.1002/14651858.CD007786.pub3 | pmc = 7073407 | url = http://eprints.whiterose.ac.uk/95658/1/Phillips_et_al_2016_The_Cochrane_library.sup_2.pdf | access-date = 23 September 2019 | archive-date = 30 June 2021 | archive-url = https://web.archive.org/web/20210630071713/https://eprints.whiterose.ac.uk/95658/1/Phillips_et_al_2016_The_Cochrane_library.sup_2.pdf | url-status = live }}</ref>
Medical cannabis has also been found to relieve certain symptoms of ]<ref name="ms">{{Cite journal |doi=10.1016/S0140-6736(03)14738-1 |title=Cannabinoids for treatment of spasticity and other symptoms related to multiple sclerosis (CAMS study): Multicentre randomised placebo-controlled trial |year=2003 |last1=Zajicek |first1=John |last2=Fox |first2=Patrick |last3=Sanders |first3=Hilary |last4=Wright |first4=David |last5=Vickery |first5=Jane |last6=Nunn |first6=Andrew |last7=Thompson |first7=Alan |journal=The Lancet |volume=362 |issue=9395 |pages=1517}}</ref> and ]<ref name="spinal">{{cite web |title=Spinal Cord Injury and Disease |url=http://web.archive.org/web/20070825002916/http://www.medicalmarijuanainformation.com/therapeuticuses/patientGroups.php?groupID=19 |work=Therapeutic Uses of Marijuana |publisher=Medical Marijuana Information Resource Centre |accessdate=9 August 2009}}</ref><ref>{{cite journal |doi=10.1007/BF02190083 |title=Delta-9-tetrahydrocannabinol shows antispastic and analgesic effects in a single case double-blind trial |year=1990 |last1=Maurer |first1=M. |last2=Henn |first2=V. |last3=Dittrich |first3=A. |last4=Hofmann |first4=A. |journal=European Archives of Psychiatry and Clinical Neuroscience |volume=240 |pages=1–4 |pmid=2175265 |issue=1}}</ref><ref>{{cite journal |doi=10.1097/00045391-199510000-00012 |title=Treatment of Spasticity in Spinal Cord Injury with Dronabinol, A Tetrahydrocannabinol Derivative |year=1995 |last1=Kogel |first1=Robert W. |last2=Johnson |first2=Paul B. |last3=Chintam |first3=Rani |last4=Robinson |first4=Charles J. |last5=Nemchausky |first5=Bernard A. |journal=American Journal of Therapeutics |volume=2 |issue=10 |pages=799–805 |pmid=11854790}}</ref><ref>{{cite journal |doi=10.1038/sj.sc.3101982 |title=The treatment of spasticity with Δ9-tetrahydrocannabinol in persons with spinal cord injury |year=2006 |last1=Hagenbach |first1=U |last2=Luz |first2=S |last3=Ghafoor |first3=N |last4=Berger |first4=J M |last5=Grotenhermen |first5=F |last6=Brenneisen |first6=R |last7=Mäder |first7=M |journal=Spinal Cord |volume=45 |issue=8 |pages=551–62 |pmid=17043680}}</ref><ref name=Mack/> by exhibiting ] and ] properties as well as stimulating appetite.

Other studies state that cannabis or cannabinoids may be useful in treating ],<ref name="alchy">{{Cite journal|author=Thanos PK, Dimitrakakis ES, Rice O, Gifford A, Volkow ND |title=Ethanol self-administration and ethanol conditioned place preference are reduced in mice lacking cannabinoid CB1 receptors |journal=Behavioural Brain Research |volume=164 |issue=2 |pages=206–13 |year=2005 |pmid=16140402 |doi=10.1016/j.bbr.2005.06.021}}</ref> ],<ref>{{Cite journal|author=Carter GT, Rosen BS |title=Marijuana in the management of amyotrophic lateral sclerosis |journal=The American Journal of Hospice & Palliative Care |volume=18 |issue=4 |pages=264–70 |year=2001 |pmid=11467101 |doi=10.1177/104990910101800411 }}</ref><ref>{{Cite journal|author=Weydt P, Hong S, Witting A, Möller T, Stella N, Kliot M |title=Cannabinol delays symptom onset in SOD1 (G93A) transgenic mice without affecting survival |journal=Amyotrophic Lateral Sclerosis and Other Motor Neuron Disorders |volume=6 |issue=3 |pages=182–4 |year=2005 |pmid=16183560 |doi=10.1080/14660820510030149 }}</ref> ]-induced ],<ref name="arthritis">{{Cite journal|author=Malfait AM |title=The nonpsychoactive cannabis constituent cannabidiol is an oral anti-arthritic therapeutic in murine collagen-induced arthritis |journal=Proceedings of the National Academy of Sciences of the United States of America |volume=97 |issue=17 |pages=9561–6 |year=2000 |pmid=10920191 |pmc=16904 |doi=10.1073/pnas.160105897 |author2=Gallily R |author3=Sumariwalla PF |last4=Malik |first4=AS |last5=Andreakos |first5=E |last6=Mechoulam |first6=R |last7=Feldmann |first7=M |bibcode = 2000PNAS...97.9561M }}</ref> ],<ref>{{Cite journal|author=Tashkin DP, Shapiro BJ, Lee YE, Harper CE |title=Effects of smoked marijuana in experimentally induced asthma |journal=The American Review of Respiratory Disease |volume=112 |issue=3 |pages=377–86 |year=1975 |pmid=1099949 |url=http://www.druglibrary.org/schaffer/hemp/medical/tashkin/tashkin1.htm}}</ref> ],<ref>{{Cite journal|title=Cannabis may help keep arteries clear |date=16 April 2005 |doi=10.1038/nature03389 |laysummary=http://www.newscientist.com/article/mg18624956.000-cannabis-may-help-keep-arteries-clear.html|laysource=New Scientist |journal=Nature |volume=434 |pmid=15815632 |author=Steffens S |issue=7034 |pages=782–6 |author2=Veillard NR |author3=Arnaud C |last4=Pelli |first4=Graziano |last5=Burger |first5=Fabienne |last6=Staub |first6=Christian |last7=Zimmer |first7=Andreas |last8=Frossard |first8=Jean-Louis |last9=Mach |first9=François |bibcode = 2005Natur.434..782S|first10=F }}</ref> ],<ref name="bi">{{Cite journal|author=Grinspoon L, Bakalar JB |title=The use of cannabis as a mood stabilizer in bipolar disorder: anecdotal evidence and the need for clinical research |journal=Journal of Psychoactive Drugs |volume=30 |issue=2 |pages=171–7 |year=1998 |pmid=9692379 |url=http://www.ukcia.org/research/TheUseofCannabisasaMoodStabilizerinBipolarDisorder.html|doi=10.1080/02791072.1998.10399687}}</ref><ref>{{Cite journal|author=Ashton CH, Moore PB, Gallagher P, Young AH |title=Cannabinoids in bipolar affective disorder: a review and discussion of their therapeutic potential |journal=Journal of Psychopharmacology |volume=19 |issue=3 |pages=293–300 |year=2005 |pmid=15888515 |doi=10.1177/0269881105051541}}</ref> ],<ref>{{Cite journal|author=Patsos HA |title=The endogenous cannabinoid, anandamide, induces cell death in colorectal carcinoma cells: a possible role for cyclooxygenase 2 |journal=Gut |volume=54 |issue=12 |pages=1741–50 |year=2005 |pmid=16099783 |pmc=1774787 |doi=10.1136/gut.2005.073403|author2=Hicks DJ|author3=Dobson RR|last4=Greenhough|first4=A|last5=Woodman|first5=N|last6=Lane|first6=JD|last7=Williams|first7=AC|last8=Paraskeva|first8=C}}</ref> ]-associated ],<ref>{{cite journal |last=Abrams |first=D.I., MD |coauthors=Jay, C.A., MD |title=Cannabis in painful HIV-Associated Sensory Neuropathy |journal=Neurology |year=2007 |volume=68 |issue=7 |pages=515–521 |url=http://www.neurology.org/content/68/7/515.abstract |accessdate=2/3/2011 |doi=10.1212/01.wnl.0000253187.66183.9c |pmid=17296917}}</ref>
],<ref name="depression">{{Cite journal|author=Bambico FR, Katz N, Debonnel G, Gobbi G |title=Cannabinoids elicit antidepressant-like behavior and activate serotonergic neurons through the medial prefrontal cortex |journal=The Journal of Neuroscience |volume=27 |issue=43 |pages=11700–11 |year=2007 |pmid=17959812 |doi=10.1523/JNEUROSCI.1636-07.2007 |laysummary=http://www.foxnews.com/story/0,2933,304996,00.html |laysource=] |laydate=25 October 2007}}</ref><ref name="DoiaddbehMissing">{{cite journal |doi=10.1016/j.addbeh.2005.05.052 |title=Decreased depression in marijuana users |year=2006 |last1=Denson |first1=Thomas F. |last2=Earleywine |first2=Mitchell |journal=Addictive Behaviors |volume=31 |issue=4 |pages=738–42 |pmid=15964704}}</ref><ref name="Zhang_etal">{{cite journal |doi=10.1172/JCI25509 |title=Cannabinoids promote embryonic and adult hippocampus neurogenesis and produce anxiolytic- and antidepressant-like effects |year=2005 |last1=Jiang |first1=W. |journal=Journal of Clinical Investigation |volume=115 |issue=11 |pages=3104–16 |pmid=16224541 |last2=Zhang |first2=Y |last3=Xiao |first3=L |last4=Van Cleemput |first4=J |last5=Ji |first5=SP |last6=Bai |first6=G |last7=Zhang |first7=X |pmc=1253627}}</ref><ref>{{cite journal |doi=10.2353/ajpath.2006.050500 |title=Neuroprotective and Blood-Retinal Barrier-Preserving Effects of Cannabidiol in Experimental Diabetes |year=2006 |last1=El-Remessy |first1=Azza B. |last2=Al-Shabrawey |first2=Mohamed |last3=Khalifa |first3=Yousuf |last4=Tsai |first4=Nai-Tse |last5=Caldwell |first5=Ruth B. |last6=Liou |first6=Gregory I. |journal=The American Journal of Pathology |volume=168 |pages=235–44 |pmid=16400026 |issue=1 |pmc=1592672}}</ref> ],<ref>{{cite journal |doi=10.1002/mds.1280 |title=Randomised, double-blind, placebo-controlled trial to assess the potential of cannabinoid receptor stimulation in the treatment of dystonia |year=2002 |last1=Fox |first1=Susan H. |last2=Kellett |first2=Mark |last3=Moore |first3=A. Peter |last4=Crossman |first4=Alan R. |last5=Brotchie |first5=Jonathan M. |journal=Movement Disorders |volume=17 |pages=145–9 |pmid=11835452 |issue=1}}</ref> ],<ref name="ep">{{cite news|url=http://www.telegraph.co.uk/science/science-news/8440303/Cannabis-could-be-used-to-treat-epilepsy.html |title=Cannabis could be used to treat epilepsy |work=The Daily Telegraph |date=10 April 2011 |accessdate=2011-04-20 |first=Richard |last=Gray}}</ref><ref>{{cite journal |doi=10.1126/science.1088208 |title=CB1 Cannabinoid Receptors and On-Demand Defense Against Excitotoxicity |year=2003 |last1=Marsicano |first1=G. |journal=Science |volume=302 |issue=5642 |pages=84–8 |pmid=14526074 |last2=Goodenough |first2=S |last3=Monory |first3=K |last4=Hermann |first4=H |last5=Eder |first5=M |last6=Cannich |first6=A |last7=Azad |first7=SC |last8=Cascio |first8=MG |last9=Gutiérrez |first9=SO |last10=Van Der Stelt |first10=M |last11=López-Rodriguez |first11=ML |last12=Casanova |first12=E |last13=Schütz |first13=G |last14=Zieglgänsberger |first14=W |last15=Di Marzo |first15=V |last16=Behl |first16=C |last17=Lutz |first17=B}}</ref><ref>{{Cite journal|author=Bacci A, Huguenard JR, Prince DA |title=Long-lasting self-inhibition of neocortical interneurons mediated by endocannabinoids |journal=Nature |volume=431 |issue=7006 |pages=312–6 |year=2004 |pmid=15372034 |doi=10.1038/nature02913 |laysummary=http://www.sciencedaily.com/releases/2004/09/040916102315.htm |laysource=] |laydate=16 September 2004|bibcode = 2004Natur.431..312B }}</ref> ]s,<ref>{{Cite journal|author=Di Carlo G, Izzo AA |title=Cannabinoids for gastrointestinal diseases: potential therapeutic applications |journal=Expert Opinion on Investigational Drugs |volume=12 |issue=1 |pages=39–49 |year=2003 |pmid=12517253 |doi=10.1517/13543784.12.1.39}}</ref> ]s,<ref>{{Cite journal|author=Lorente M |title=Amphiregulin is a factor for resistance of glioma cells to cannabinoid-induced apoptosis |journal=Glia |volume= 57|issue= 13|pages=1374–85 |year=2009 |pmid=19229996 |doi=10.1002/glia.20856|author2=Carracedo A|author3=Torres S|last4=Natali|first4=Francesco|last5=Egia|first5=Ainara|last6=Hernández-Tiedra|first6=Sonia|last7=Salazar|first7=María|last8=Blázquez|first8=Cristina|last9=Guzmán|first9=Manuel|first10=Guillermo}}</ref><ref>{{Cite journal|author=Ramer R, Hinz B |title=Inhibition of cancer cell invasion by cannabinoids via increased expression of tissue inhibitor of matrix metalloproteinases-1 |journal=Journal of the National Cancer Institute |volume=100 |issue=1 |pages=59–69 |year=2008 |pmid=18159069 |doi=10.1093/jnci/djm268}}</ref> ],<ref>{{Cite journal|author=Sylvestre DL, Clements BJ, Malibu Y |title=Cannabis use improves retention and virological outcomes in patients treated for hepatitis C |journal=European Journal of Gastroenterology & Hepatology |volume=18 |issue=10 |pages=1057–63 |year=2006 |pmid=16957511 |doi=10.1097/01.meg.0000216934.22114.51}}</ref> ],<ref>{{cite journal |pmid=19228180 |year=2009 |last1=Iuvone |first1=T |last2=Esposito |first2=G |last3=De Filippis |first3=D |last4=Scuderi |first4=C |last5=Steardo |first5=L |title=Cannabidiol: A promising drug for neurodegenerative disorders? |volume=15 |issue=1 |pages=65–75 |doi=10.1111/j.1755-5949.2008.00065.x |journal=CNS neuroscience & therapeutics}}</ref><ref>{{cite journal |pmid=20590577 |year=2010 |last1=Scotter |first1=EL |last2=Goodfellow |first2=CE |last3=Graham |first3=ES |last4=Dragunow |first4=M |last5=Glass |first5=M |title=Neuroprotective potential of CB1 receptor agonists in an in vitro model of Huntington's disease |volume=160 |issue=3 |pages=747–61 |doi=10.1111/j.1476-5381.2010.00773.x |pmc=2931573 |journal=British journal of pharmacology}}</ref> ],<ref>{{Cite journal|author=Powles T |title=Cannabis-induced cytotoxicity in leukemic cell lines: the role of the cannabinoid receptors and the MAPK pathway |journal=Blood |volume=105 |issue=3 |pages=1214–21 |year=2005 |pmid=15454482 |doi=10.1182/blood-2004-03-1182 |author2=te Poele R|author3=Shamash J|last4=Chaplin|first4=T|last5=Propper|first5=D|last6=Joel|first6=S|last7=Oliver|first7=T|last8=Liu|first8=WM}}</ref> ],<ref>{{Cite journal|author=Casanova ML |title=Inhibition of skin tumor growth and angiogenesis in vivo by activation of cannabinoid receptors |journal=The Journal of Clinical Investigation |volume=111 |issue=1 |pages=43–50 |year=2003 |pmid=12511587 |pmc=151833 |doi=10.1172/JCI16116 |author2=Blázquez C|author3=Martínez-Palacio J|last4=Villanueva|first4=Concepción|last5=Fernández-Aceñero|first5=M. Jesús|last6=Huffman|first6=John W.|last7=Jorcano|first7=José L.|last8=Guzmán|first8=Manuel}}</ref> ] (MRSA),<ref>{{Cite journal|author=Appendino G, Gibbons S, Giana A, Pagani A, Grassi G, Stavri M, Smith E, Rahman MM |title=Antibacterial Cannabinoids from ''Cannabis sativa'': A Structure—Activity Study |journal=J Nat Prod |volume=71 |issue=8 |pages=1427–30 |year=2008|pmid=18681481 |doi=10.1021/np8002673 |laysummary=http://www.webmd.com/news/20080904/marijuana-chemicals-may-fight-mrsa |laysource=] |laydate=4 September 2008}}</ref> ],<ref>{{Cite journal|author=Kreitzer AC, Malenka RC |title=Endocannabinoid-mediated rescue of striatal LTD and motor deficits in Parkinson's disease models |journal=Nature |volume=445 |issue=7128 |pages=643–7 |year=2005 |pmid=17287809 |doi=10.1038/nature05506 |laysummary=http://med.stanford.edu/news_releases/2007/february/malenka.html |laysource=] |laydate=7 February 2007}}</ref> ],<ref>{{Cite journal|author=Szepietowski JC, Szepietowski T, Reich A |title=Efficacy and tolerance of the cream containing structured physiological lipids with endocannabinoids in the treatment of uremic pruritus: a preliminary study |journal=Acta Dermatovenerologica Croatica |volume=13 |issue=2 |pages=97–103 |year=2005 |pmid=16324422}}</ref><ref>{{Cite journal|author=Bergasa NV |title=The pruritus of cholestasis |journal=Journal of Hepatology |volume=43 |issue=6 |pages=1078–88 |year=2005 |pmid=16253381 |doi=10.1016/j.jhep.2005.09.004}}</ref> ] (PTSD),<ref>{{Cite journal|author=Ganon-Elazar E, Akirav I|title=Cannabinoid receptor activation in the basolateral amygdala blocks the effects of stress on the conditioning and extinction of inhibitory avoidance|journal=J. Neurosci|volume=29|issue=36|pages=11078–88|pmid=19741114 |year=2009|laysummary=http://psychcentral.com/news/2009/11/05/medical-marijuana-for-ptsd/9359.html|laysource=PsychCentral|laydate=5 November 2009|doi=10.1523/JNEUROSCI.1223-09.2009}}</ref> ],<ref>{{cite journal |pmid=17157480 |year=2007 |last1=Wilkinson |first1=JD |last2=Williamson |first2=EM |title=Cannabinoids inhibit human keratinocyte proliferation through a non-CB1/CB2 mechanism and have a potential therapeutic value in the treatment of psoriasis |volume=45 |issue=2 |pages=87–92 |doi=10.1016/j.jdermsci.2006.10.009 |journal=Journal of dermatological science}}</ref> ],<ref>{{cite journal |pmid=16173972 |year=2005 |last1=Howard |first1=J |last2=Anie |first2=KA |last3=Holdcroft |first3=A |last4=Korn |first4=S |last5=Davies |first5=SC |title=Cannabis use in sickle cell disease: A questionnaire study |volume=131 |issue=1 |pages=123–8 |doi=10.1111/j.1365-2141.2005.05723.x |journal=British journal of haematology}}</ref> ],<ref>{{Cite journal|author=Carley DW, Paviovic S, Janelidze M, Radulovacki M |title=Functional role for cannabinoids in respiratory stability during sleep |journal=Sleep |volume=25 |issue=4 |pages=391–8 |year=2002 |pmid=12071539 |url=http://www.scholaruniverse.com/ncbi-linkout?id=12071539 }}</ref> and ].<ref>Grotenhermen, Russo (2002) "Review of Therapeutic Effects." Chapter 11, p. 128 in ''Cannabis and Cannabinoids: Pharmacology, Toxicology, and Therapeutic Potential'', Routledge, ISBN 0789015080.</ref> Controlled research on treating ] with a synthetic version of ] called (]), showed the patients taking the pill had a beneficial response without serious adverse effects;<ref name=SingerBehavior>{{cite journal |author = Singer HS |year = 2005 |title = Tourette's syndrome: from behaviour to biology |journal = Lancet Neurol |volume = 4 |issue = 3 | pages = 149–59 |pmid = 15721825 |doi=10.1016/S1474-4422(05)01012-4}}</ref> other studies have shown that cannabis "has no effects on tics and increases the individuals inner tension".<ref>{{cite journal|journal = Brain: a journal of neurology|pmid = 10686169|volume=123 |title = Tourette syndrome, associated conditions and the complexities of treatment|year=2000|pages=425–62|author=Robertson MM|doi=10.1093/brain/123.3.425|issue = 3}}</ref> Case reports found that cannabis helped reduce ]s, but validation of these results requires longer, controlled studies on larger samples.<ref>{{cite journal|pmid = 3235704|volume=8|issue=6|journal = Journal of Clinical Psychopharmacology|year=1988|title = Marijuana and Tourette's syndrome|pages=444–5|author=Sandyk R, Awerbuch G|doi=10.1097/00004714-198812000-00021}}</ref><ref>{{cite journal|pmid = 9465342|volume=68|issue=12|journal = Der Nervenarzt|year=1997|title = Gilles de la Tourette syndrome. Effect of nicotine, alcohol and marihuana on clinical symptoms|pages=985–9|author=Müller-Vahl KR, Kolbe H, Dengler R}}</ref>

A study done by Craig Reinarman surveyed people in California who used cannabis found they did so for many reasons. Reported uses were for pain relief, muscle spasms, headaches, anxiety, nausea, vomiting, depression, cramps, panic attacks, diarrhea, and itching. Others used cannabis to improve sleep, relaxation, appetite, concentration or focus, and energy. Some patients used it to prevent medication side effects, anger, involuntary movements, and seizures, while others used it as a substitute for other prescription medications and alcohol.<ref>{{cite journal|pmid=21858958|author=Reinarman, C|year=2011|journal=Journal of Psychoactive Drugs|volume=43|issue=2|pages=128–135|title=Who Are Medical Marijuana Patients? Population Characteristics from Nine California Assessment Clinics|doi=10.1080/02791072.2011.587700|last2=Nunberg|first2=H|last3=Lanthier|first3=F|last4=Heddleston|first4=T}}</ref>

== Studies ==

=== Safety of cannabis ===
{{Main|Long-term effects of cannabis}}

<!----- this is only a summary; Please put details in the main article.----->
From ], "There are no confirmed published cases worldwide of human deaths from cannabis poisoning, and the dose of THC required to produce 50% mortality in rodents is extremely high compared with other commonly used drugs".<ref>{{cite journal |doi=10.1016/S0140-6736(98)05021-1 |title=Adverse effects of cannabis |year=1998 |last1=Hall |first1=Wayne |last2=Solowij |first2=Nadia |journal=The Lancet |volume=352 |issue=9140 |pages=1611}}</ref>

According to Associate Professor Emeritus of ] at ] ], "When cannabis regains its place in the ], a status it lost after the passage of the ], it will be seen as one of the safest drugs in that compendium".<ref name="Grinspoon-2012">{{Cite journal |last=Grinspoon |first=Lester |url=http://www.metrowestdailynews.com/opinion/x422896402/Grinspoon-Marijuana-Is-Here-to-Stay |title=Grinspoon: Marijuana is here to stay |publisher=The MetroWest Daily News |date=23 September 2012 |accessdate=2013-01-07 |postscript=<!-- Bot inserted parameter. Either remove it; or change its value to "." for the cite to end in a ".", as necessary. -->{{inconsistent citations}}}}</ref>

There are medical reports of occasional ], stroke and other cardiovascular side effects.<ref name="Jones2002">{{cite journal
| last =Jones
| first =R T
| title = Cardiovascular system effects of marijuana
| journal =Journal of Clinical Pharmacology
| volume =42
| issue =11
| pages =58–63
| year =2002
| url = http://jcp.sagepub.com/content/42/11_suppl/58S.abstract
| accessdate =31 January 2013 }}</ref> Marijuana's cardiovascular effects are not associated with serious health problems for most young, healthy users.<ref name="Jones2002"/> Researchers have reported in the ], "Marijuana use by older people, particularly those with some degree of coronary artery or cerebrovascular disease, poses greater risks due to the resulting increase in catecholamines, cardiac workload, and carboxyhemoglobin levels, and concurrent episodes of profound postural hypotension. Indeed, marijuana may be a much more common cause of myocardial infarction than is generally recognized. In day-to-day practice, a history of marijuana use is often not sought by many practitioners, and even when sought, the patient's response is not always truthful. Thus, clinicians should be more vigilant in inquiring about use of marijuana in their patients, particularly among the younger adults who may present with cardiac events in the absence of cardiovascular disease or other obvious risk factors."<ref>{{cite journal
| last =Aranya
| first =A
| coauthors = Williams, M
| title = Marijuana as a trigger of cardiovascular events: Speculation or scientific certainty?
| journal =International Journal of Cardiology
| volume =118
| issue =2
| pages =141–147
| year =2007
|doi=10.1016/j.ijcard.2006.08.001}}</ref>

A 2012 study published in ] and funded by the NIH looked at a population of over 5,115 American men and women to see whether smoked cannabis has effects on the ] similar to those from smoking tobacco. The researchers found "Occasional and low cumulative marijuana use was not associated with adverse effects on pulmonary function." Smoking an average of one joint a day for seven years, they found, did not worsen pulmonary health.<ref></ref>

Cannabis smoke contains thousands of organic and inorganic chemical compounds. This ] is chemically similar to that found in tobacco smoke or cigars.<ref>{{Cite journal |last=Gumbiner |first=Jann
|title=Does Marijuana Cause Cancer? |publisher=Psychology Today |url=http://www.psychologytoday.com/blog/the-teenage-mind/201102/does-marijuana-cause-cancer |date=17 February 2011 |accessdate=2013-01-09}}</ref> Over fifty known ]s have been identified in cannabis smoke.<ref>{{Cite journal |title=Does smoking cannabis cause cancer? |publisher=Cancer Research UK |date=20 September 2010 |url=http://cancerhelp.cancerresearchuk.org/about-cancer/cancer-questions/does-smoking-cannabis-cause-cancer |accessdate=2013-01-09}}</ref> These include nitrosamines, reactive aldehydes, and polycylic hydrocarbons, including benzpyrene.<ref>{{Cite journal |last=Tashkin |first=Donald |year=1997 |month=March |title=Effects of marijuana on the lung and its immune defenses |publisher=UCLA School of Medicine |url=http://www.ukcia.org/research/EffectsOfMarijuanaOnLungAndImmuneDefenses.php |accessdate=2012-06-23}}</ref> Marijuana smoke was listed as a cancer agent in California in 2009.<ref>{{cite web |url=http://oehha.ca.gov/prop65/prop65_list/files/p65single072012.pdf |title=Chemicals known to the state to cause cancer or reproductive toxicity |publisher=ca.gov |date=20 July 2012 |accessdate=2013-01-08}}</ref>

A 2006 study involving 1,212 incident cancer cases and 1,040 cancer-free controls found no causative link to oral, laryngeal, pharyngeal, esophageal or lung cancer when adjusting for several confounding factors including cigarette smoking and alcohol use.<ref name=Taskin-MarijuanaAndCancer>{{cite journal |pmid=17035389 |year=2006 |last1=Hashibe |first1=M |last2=Morgenstern |first2=H |last3=Cui |first3=Y |last4=Tashkin |first4=DP |last5=Zhang |first5=ZF |last6=Cozen |first6=W |last7=Mack |first7=TM |last8=Greenland |first8=S |title=Marijuana use and the risk of lung and upper aerodigestive tract cancers: Results of a population-based case-control study |volume=15 |issue=10 |pages=1829–34 |doi=10.1158/1055-9965.EPI-06-0330 |journal=Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology}}</ref>

Regarding the relative safety of cannabis, former US ] chief administrative law judge Judge Francis Young said:
:"There is no record in the extensive medical literature describing a proven, documented cannabis-induced fatality. ... Despite long history of use and the extraordinarily high numbers of social smokers, there are simply no credible medical reports to suggest that consuming marijuana has caused a single death. In practical terms, marijuana cannot induce a lethal response as a result of drug-related toxicity. ... Marijuana's ] is impossible to quantify because it is so high. ... Marijuana, in its natural form, is one of the safest therapeutically active substances known to man."<ref>. Druglibrary.org (1988-09-06). Retrieved on 2013-04-17.</ref>{{reliable source|date=April 2013}}

===Pain relief===
The effectiveness of cannabis as an ] has been the subject of numerous studies. ] doctors found that the brain on THC showed reduced response to pain, suggesting that the drug may help patients endure pain. Brain scans showed reduced activity in two centers of the brain where pain is registered: The mid-] and the right ]. However, cannabis did not block the sensation of pain like ]-based pain killers.<ref>{{Cite web |url=http://news.discovery.com/earth/cannabis-chemical-chills-out-reaction-to-pain-121221.html |title=Marijuana chemical chills out brain's pain threshold |publisher=News.discovery.com |date=21 December 2012 |accessdate=2013-01-07 |postscript=<!-- Bot inserted parameter. Either remove it; or change its value to "." for the cite to end in a ".", as necessary. -->{{inconsistent citations}}}}</ref> The researchers also found a great degree of variation among individual reports of pain relief.<ref>{{Cite web |last=Pedersen |first=Traci |url=http://psychcentral.com/news/2012/12/29/marijuana-pain-relief-varies-among-users/49770.html |title=Marijuana pain relief varies among users |publisher=Psychcentral.com |date=29 December 2012 |accessdate=2013-01-07 |postscript=<!-- Bot inserted parameter. Either remove it; or change its value to "." for the cite to end in a ".", as necessary. -->{{inconsistent citations}}}}</ref>

According to Stuart Silverman, M.D., a ] at ], "Historically and anecdotally, marijuana has been used as a painkiller".<ref>{{Cite journal |author=Anne Harding |url=http://www.cnn.com/2010/HEALTH/02/22/medical.marijuana/index.html |title=Medical marijuana may help fibromyalgia pain |publisher=CNN |date=22 February 2010 |accessdate=2013-01-07 |postscript=<!-- Bot inserted parameter. Either remove it; or change its value to "." for the cite to end in a ".", as necessary. -->{{inconsistent citations}}}}</ref> A Canadian study showed cannabis can reduce "nerve pain" from surgical complications or injuries. The study's twenty-one subjects suffered from ] and patients who smoked cannabis with a 9.4% THC content reported less pain than those patients who smoked the placebo. Improved quality of sleep and reduced anxiety were other reported benefits.<ref>{{Cite web |last=Goodwin |first=Jenifer |url=http://usatoday30.usatoday.com/yourlife/health/medical/2010-09-05-marijuana-pain_N.htm |title=Marijuana may relieve nerve pain when other drugs don't |work=USA Today |date=3 September 2010 |accessdate=2013-01-07 |postscript=<!-- Bot inserted parameter. Either remove it; or change its value to "." for the cite to end in a ".", as necessary. -->{{inconsistent citations}}}}</ref> Igor Grant, psychiatrist and director of the Center for Medicinal Cannabis Research at the ], has stated, "There is good evidence now that cannabinoids may be either an adjunct or a first-line treatment". Grant explained further that not everyone experienced pain relief, but the percentage of people who did was comparable to those who said that they experienced relief from other medications commonly prescribed for neuropathic pain (the subject of his study), such as ].<ref>{{Cite web |url=http://www.huffingtonpost.com/2010/02/18/marijuana-provides-pain-r_n_466993.html |title=Marijuana provides pain relief, new study says |work=Huffington Post |date=18 February 2010 |accessdate=2013-01-07 |postscript=<!-- Bot inserted parameter. Either remove it; or change its value to "." for the cite to end in a ".", as necessary. -->{{inconsistent citations}}}}</ref>

A small-scale ] study found that patients with chronic pain may experience greater relief if ] were added to an opiate-only treatment regime. The findings further suggested that combination therapy could result in reduced opiate dosages.<ref>{{Cite web |last=Kim |first=Leland |url=http://www.ucsf.edu/news/2011/12/11077/ucsf-study-finds-medical-marijuana-could-help-patients-reduce-pain-opiates |title=UCSF study finds medical marijuana could help patients reduce pain with opiates |publisher=ucsf.edu |date=6 December 2011 |accessdate=2013-01-07 |postscript=<!-- Bot inserted parameter. Either remove it; or change its value to "." for the cite to end in a ".", as necessary. -->{{inconsistent citations}}}}</ref> The College of Physicians and Surgeons at Columbia University, U.S. published a study in the ''Neuropsychopharmacology'' journal in 2013 that is based on research that was conducted with fifteen males and fifteen females who smoked marijuana every day. The study's subjects were exposed to either a placebo, inhaled marijuana, or dronabinol, a pill that contains cannabis' psychoactive ingredient. Participants were monitored to ensure that they had not smoked in the time period immediately prior to the tests and did not have other drugs (including alcohol) in their systems. The researchers concluded that "Dronabinol administration decreased pain sensitivity and increased pain tolerance that peaked later and lasted longer relative to smoked marijuana", thereby providing evidence that the pill form was superior to smoked cannabis in terms of pain relief efficacy. However, the Columbia researchers further stated, "A primary caveat of the current findings is that the study population consisted of daily marijuana smokers; this study limitation should be considered when interpreting the findings and placing them within the context of the potential therapeutic feasibility of cannabinoids ."<ref>{{cite web|title=Study of daily users shows marijuana pills trump smoked marijuana for pain relief|url=http://theconversation.com/study-of-daily-users-shows-marijuana-pills-trump-smoked-marijuana-for-pain-relief-13664?utm_medium=email&utm_campaign=Latest+from+The+Conversation+for+24+April+2013&utm_content=Latest+from+The+Conversation+for+24+April+2013+CID_62b60f5e455b9427d023336690a13f46&utm_source=campaign_monitor&utm_term=Study%20of%20daily%20users%20shows%20marijuana%20pills%20trump%20smoked%20marijuana%20for%20pain%20relief|work=The Conversation Australia|publisher=The Conversation Media Group|accessdate=24 April 2013|author=Sunanda Creagh|date=23|month=April|year=2013}}</ref>

=== Antiemetic ===
Several studies have established the ] effects of cannabinoids in the treatment of ] (CINV).<ref name=Grotenhermen-2012>{{cite journal |first1=Franjo |last1=Grotenhermen |first2=Kirsten |last2=Müller-Vahl |title=The Therapeutic Potential of Cannabis and Cannabinoids |journal=Deutsches Ärzteblatt International |pmid=23008748 |year=2012 |volume=109 |issue=29–30 |pages=495–501 |doi=10.3238/arztebl.2012.0495 |pmc=3442177}}</ref> Comparative studies have found cannabinoids to be more effective than some conventional anti emetics such as ], ], and ] in controlling CINV.<ref name=Bowels-2012>{{cite journal |doi=10.1016/j.critrevonc.2011.09.008 |title=The intersection between cannabis and cancer in the United States |year=2012 |last1=Bowles |first1=Daniel W. |last2=o’Bryant |first2=Cindy L. |last3=Camidge |first3=D. Ross |last4=Jimeno |first4=Antonio |journal=Critical Reviews in Oncology/Hematology |volume=83 |pages=1}}</ref> Their use is generally limited by the high incidence of side effects, such as dizziness, dysphoria, and hallucinations.<ref name=Wang-2008>{{cite journal |doi=10.1503/cmaj.071178 |title=Adverse effects of medical cannabinoids: A systematic review |year=2008 |last1=Wang |first1=T. |last2=Collet |first2=J.-P. |last3=Shapiro |first3=S. |last4=Ware |first4=M. A. |journal=Canadian Medical Association Journal |volume=178 |issue=13 |pages=1669–78 |pmid=18559804 |pmc=2413308}}</ref><ref name=Jordan.2007>{{cite journal |doi=10.1634/theoncologist.12-9-1143 |title=Guidelines for Antiemetic Treatment of Chemotherapy-Induced Nausea and Vomiting: Past, Present, and Future Recommendations |year=2007 |last1=Jordan |first1=K. |last2=Sippel |first2=C. |last3=Schmoll |first3=H.-J. |journal=The Oncologist |volume=12 |issue=9 |pages=1143–50 |pmid=17914084}}</ref> Cannabinoids are considered reserve medications in the treatment of nausea and vomiting induced by ].<ref name=Grotenhermen-2012 />

=== Glaucoma ===
]

In ], cannabis and THC have been shown to reduce intra-ocular pressure (IOP) by an average of 24% in people with normal IOP who have visual-field changes. In studies of healthy adults and glaucoma patients, IOP was reduced by an average of 25% after smoking a cannabis "cigarette" that contained approximately 2% THC—a reduction as good as that observed with most other medications available today, according to a review by the ].<ref>{{Cite book |editor1-first=Janet E. |editor1-last=Joy |editor2-first=Stanley J. |editor2-last=Watson |editor3-first=John A. |editor3-last=Benson |year=1999 |title=Marijuana and Medicine: Assessing the Science Base |url=http://www.nap.edu/openbook.php?record_id=6376&page=173 |publisher=] |location=Washington, D.C. |isbn=978-0-309-07155-0 |oclc=246585475}}</ref>

In a separate study, the use of cannabis and glaucoma was tested and found that the duration of smoked or ingested cannabis or other cannabinoids is very short, averaging 3 to 3.5 hours. Their results showed that for cannabis to be a viable therapy, the patient would have to take in cannabis in some form every 3 hours. They said that for ideal glaucoma treatment it would take two times a day at most for compliance purposes from patients.<ref>{{cite journal |author=Kaufman, Paul. |year=1998 |title=Marijuana and Glaucoma |journal=Archives of Ophthalmology |volume=116 |issue=11 |pages=1512–13 |url=http://archopht.jamanetwork.com/article.aspx?volume=116&issue=11&page=1512 |doi=10.1001/archopht.116.11.1512}}</ref> Due to these limitations, the American Glaucoma Society, in a statement in 2009, did not recommend marijuana yet as a viable glaucoma treatment, even if it expressed hope that "marijuana or related compounds could protect the optic nerve not only through IOP lowering but also through a neuroprotective mechanism."<ref name=ags2009>{{cite web|last=Henry Jampel|title=POSITION STATEMENT ON Marijuana and the Treatment of Glaucoma|url=http://www.americanglaucomasociety.net/patients/position_statements/marijuana_glaucoma|publisher=American Glaucoma Society|accessdate=13 August 2013}}</ref>

=== Spasticity in multiple sclerosis ===
]

A review of six ] of a combination of ] and ] extracts for the treatment of ] (MS) related muscle spasticity reported, "Although there was variation in the outcome measures reported in these studies, a trend of reduced spasticity in treated patients was noted." The authors postulated that "cannabinoids may provide neuroprotective and anti-inflammatory benefits in MS."<ref name=Lakhan>{{cite journal |author = Lakhan SE, Rowland M |year = 2009 |title = Whole plant cannabis extracts in the treatment of spasticity in multiple sclerosis: a systematic review |journal = BMC Neurology |volume = 9 |page = 59 |pmid = 19961570 |pmc = 2793241 |doi=10.1186/1471-2377-9-59}}</ref> A small study done on whether or not cannabis could be used to control tremors of MS patients was conducted. The study found that there was no noticeable difference of the tremors in the patients. Although there was no difference in the tremors, the patients felt as if their symptoms had lessened and their quality of life had improved. The researchers concluded that the mood enhancing or cognitive effects that cannabis has on the brain could have given the patients the effect that their tremors were getting better.<ref name="De-Vries 2010 2454–2462"/><ref name="AMAnews"/>

=== Alzheimer's disease ===
Research done by the ] in California shows that the active ingredient in marijuana, ], prevents the formation of deposits in the brain associated with ]. THC was found to prevent an enzyme called ] from accelerating the formation of "Alzheimer plaques" in the brain more effectively than commercially marketed drugs. THC is also more effective at blocking clumps of protein that can inhibit memory and cognition in Alzheimer's patients, as reported in ].<ref name="alz">{{Cite journal|author=Eubanks LM |title=A Molecular Link Between the Active Component of Marijuana and Alzheimer's Disease Pathology |journal=Molecular Pharmaceutics |volume=3 |issue=6 |pages=773–7 |year=2006 |pmid=17140265 |pmc=2562334 |doi=10.1021/mp060066m |author2=Rogers CJ |author3=Beuscher AE |last4=Koob |first4=George F. |last5=Olson |first5=Arthur J. |last6=Dickerson |first6=Tobin J. |last7=Janda |first7=Kim D.}}</ref> Cannabinoids can also potentially prevent or slow the progression of Alzheimer's disease by reducing ] phosphorylation, ], and neuroinflammation.<ref name=Campbell>{{cite journal |doi=10.1038/sj.bjp.0707446 |title=Alzheimer's disease; taking the edge off with cannabinoids? |year=2009 |last1=Campbell |first1=V A |last2=Gowran |first2=A |journal=British Journal of Pharmacology |volume=152 |issue=5 |pages=655–62 |pmid=17828287 |pmc=2190031}}</ref>

According to an article in BBC News, “Marijuana May Block Alzheimer’s”, a 2005 Study conducted by The Alzheimer’s Research Trust, it may be possible to make drugs that act only on CR2 ... they might mimic the positive effects of cannabinoids without the damaging ones of marijuana.<ref name="Alzheimer's Research Trust"></ref> The same researchers also stated that this is still a fairly new field of research and it is not east to produce such precise drugs. The Alzheimer’s Research Trust also stated that there is also no evidence yet that cannabinoid-based drugs can slow the decline in human Alzheimer's patients.<ref name="Alzheimer's Research Trust"/> Medical Marijuana is generally recognized that as well as providing a 'high,' long-term use of marijuana can also lead to depression in many individuals.<ref></ref>

A 2012 review from the ''Philosophical Transactions of a Royal Society B'' suggested that activating the cannabinoid system may trigger an "] cleanse" in the brain by removing damaged cells and improving the efficiency of the ]. The review found cannabinoids may slow decline in age and disease-related cognitive functioning.<ref>Szalavitz, Maia. (2012-10-29) . Healthland.time.com. Retrieved on 2013-04-17.</ref><ref>. Rstb.royalsocietypublishing.org (2012-12-05). Retrieved on 2013-04-17.</ref>

=== Breast cancer ===
According to a 2007 and a 2010 study at the ] Research Institute, ] (CBD) stops breast cancer from spreading throughout the body by downregulating a gene called ].<ref name=pmid18025276>{{Cite journal|author=McAllister SD, Christian RT, Horowitz MP, Garcia A, Desprez PY |title=Cannabidiol as a novel inhibitor of Id-1 gene expression in aggressive breast cancer cells |journal=Molecular Cancer Therapeutics |volume=6 |issue=11 |pages=2921–7 |year=2007 |pmid=18025276 |doi=10.1158/1535-7163.MCT-07-0371 |laysummary=http://news.bbc.co.uk/2/hi/health/7098340.stm |laysource=] |laydate=19 November 2007}}</ref><ref name=PMC3410650>{{cite journal |title=Pathways mediating the effects of cannabidiol on the reduction of breast cancer cell proliferation, invasion, and metastasis |journal=Breast Cancer Res Treat. |volume=129 |issue=1 |pages=37–47 |date=22 September 2010 |pmc=3410650 |pmid=20859676 |doi=10.1007/s10549-010-1177-4 |author=McAllister SD, Murase R, Christian RT, ''et al.''}}</ref> This may provide a non-toxic alternative to ] while achieving the same results without the painful and unpleasant ]. The research team says that CBD works by blocking the activity of a gene called ], which is believed to be responsible for a process called ], which is the aggressive spread of cancer cells away from the original tumor site.<ref name=pmid18025276/><ref name=PMC3410650/> According to findings released by the team in 2012, when the particularly aggressive ] cells (which contain high levels of ID1 and account for 15% of breast cancers) were exposed to CBD, they "not only stopped acting 'crazy' but also returned to a healthy normal state". ] are currently in development.<ref>{{Cite web |url=http://www.dailymail.co.uk/health/article-2206056/Cannabis-compound-stop-breast-cancer-spreading.html |title=Cannabis compound could stop breast cancer from spreading |author=Claire Bates |work=Daily Mail |date=20 September 2012 |accessdate=2012-12-25 |postscript=<!-- Bot inserted parameter. Either remove it; or change its value to "." for the cite to end in a ".", as necessary. -->{{inconsistent citations}}}}</ref> Dr Sean McAllister, study co-leader, commented:<ref>{{Cite web |url=http://www.sfgate.com/health/article/Pot-compound-seen-as-tool-against-cancer-3875562.php |title=Pot compound seen as tool against cancer |author=Victoria Colliver |work=San Francisco Chronicle |date=18 September 2012 |accessdate=2012-12-25 |postscript=<!-- Bot inserted parameter. Either remove it; or change its value to "." for the cite to end in a ".", as necessary. -->{{inconsistent citations}}}}</ref>

:"The preclinical trial data is very strong, and there's no toxicity. There's really a lot of research to move ahead with and to get people excited".


=== HIV/AIDS === === HIV/AIDS ===
Evidence is lacking for both efficacy and safety of cannabis and cannabinoids in treating patients with ] or for ] associated with AIDS. As of 2013, current studies suffer from the effects of bias, small sample size, and lack of long-term data.<ref name=Lutge2013>{{cite journal | vauthors = Lutge EE, Gray A, Siegfried N | title = The medical use of cannabis for reducing morbidity and mortality in patients with HIV/AIDS | journal = The Cochrane Database of Systematic Reviews | volume = 4 | issue = 4 | pages = CD005175 | date = April 2013 | pmid = 23633327 | doi = 10.1002/14651858.CD005175.pub3 | type = Review }}</ref>
Investigators at ] published clinical trial data in 2007 showing that ] patients who inhaled cannabis four times daily experienced substantial increases in food intake with little evidence of discomfort and no impairment of cognitive performance. They concluded that smoked cannabis has a clear medical benefit in HIV-positive patients.<ref name=Haney>{{Cite journal|author=Haney M |title=Dronabinol and marijuana in HIV-positive marijuana smokers. Caloric intake, mood, and sleep |journal=Journal of Acquired Immune Deficiency Syndromes |volume=45 |issue=5 |pages=545–54 |year=2007 |pmid=17589370 |doi=10.1097/QAI.0b013e31811ed205|author2=Gunderson EW|author3=Rabkin J|last4=Hart|first4=Carl L|last5=Vosburg|first5=Suzanne K|last6=Comer|first6=Sandra D|last7=Foltin|first7=Richard W}}</ref><ref>{{Cite journal|author=Abrams DI |title=Short-term effects of cannabinoids in patients with HIV-1 infection: a randomized, placebo-controlled clinical trial |journal=Annals of Internal Medicine |volume=139 |issue=4 |pages=258–66 |year=2003 |pmid=12965981 |last12=Mitchell |first12=TF |last13=Mulligan |first13=K |first14=P |first15=JM |first16=M|author2=Hilton JF |author3=Leiser RJ |last4=Bacchetti |last5=Mccune |last6=Schambelan |first4=SB |first5=TA |first6=FT |last7=Benowitz |first7=NL |last8=Bredt |first8=BM |last9=Kosel |first9=B|doi=10.7326/0003-4819-139-4-200308190-00008|first10=JA|first11=SG }}</ref> In another study in 2008, researchers at the ] found that marijuana significantly reduces HIV-related ] when added to a patient's already-prescribed pain management regimen and may be an "effective option for pain relief" in those whose pain is not controlled with current medications. Mood disturbance, physical disability, and quality of life all improved significantly during study treatment.<ref name=Ellis>{{Cite journal |author=Ellis RJ |title=Smoked Medicinal Cannabis for Neuropathic Pain in HIV: A Randomized, Crossover Clinical Trial |journal=Neuropsychopharmacology |volume=34 |issue=3 |pages=672–80 |year=2009 |pmid=18688212 |doi=10.1038/npp.2008.120 |pmc=3066045 |author2=Toperoff W |author3=Vaida F |last4=Van Den Brande |first4=Geoffrey |last5=Gonzales |first5=James|last6=Gouaux|first6=Ben |last7=Bentley |first7=Heather |last8=Atkinson |first8=J Hampton}}</ref> Despite management with opioids and other pain modifying therapies, neuropathic pain continues to reduce the quality of life and daily functioning in HIV-infected individuals. Cannabinoid receptors in the central and peripheral nervous systems have been shown to modulate pain perception. No serious adverse effects were reported, according to the study published by the ].<ref>{{Cite journal|author=Abrams DI |title=Cannabis in painful HIV-associated sensory neuropathy: a randomized placebo-controlled trial |journal=Neurology |volume=68 |issue=7 |pages=515–21 |year=2007 |pmid=17296917 |doi=10.1212/01.wnl.0000253187.66183.9c|author2=Jay CA|author3=Shade SB|last4=Vizoso|first4=H.|last5=Reda|first5=H.|last6=Press|first6=S.|last7=Kelly|first7=M. E.|last8=Rowbotham|first8=M. C.|last9=Petersen|first9=K. L.}}</ref> A study examining the effectiveness of different drugs for HIV associated neuropathic pain found that smoked ] was one of only three drugs that showed evidence of efficacy.<ref>{{cite journal |author=Phillips TJ, Cherry CL, Cox S, Marshall SJ, Rice AS |title=Pharmacological Treatment of Painful HIV-Associated Sensory Neuropathy: A Systematic Review and Meta-Analysis of Randomised Controlled Trials |journal=PLoS ONE |volume=5 |issue=12 |pages=e14433 |year=2010 |pmid=21203440 |pmc=3010990 |doi=10.1371/journal.pone.0014433 |editor1-last=Pai |editor1-first=Nitika Pant|bibcode = 2010PLoSO...514433P }}</ref>


=== Brain cancer === === Pain ===
A 2021 review found little effect of using non-inhaled cannabis to relieve chronic pain.<ref name=wang2021/> According to a 2019 systematic review, there have been inconsistent results of using cannabis for neuropathic pain, spasms associated with ] and pain from ] disorders, but was not effective treating chronic cancer pain. The authors state that additional ] of different cannabis products are necessary to make conclusive recommendations.<ref name=pratt/>
A study by ] found the chemicals in cannabis promote the death of ] cells by essentially helping them feed upon themselves in a process called ]. The research team discovered that cannabinoids such as THC had anticancer effects in mice with human brain cancer cells and in people with brain tumors. When mice with the human brain cancer cells received the THC, the tumor shrank. Using ] to analyze brain tissue taken both before and after a 26-to 30-day THC treatment regimen, the researchers found that THC eliminated cancer cells while leaving healthy cells intact.<ref name=pmid19425170>{{Cite journal|author=Salazar M |title=Cannabinoid action induces autophagy-mediated cell death through stimulation of ER stress in human glioma cells |journal=The Journal of Clinical Investigation |volume=119 |issue=5 |pages=1359–72 |year=2009|pmid=19425170 |pmc=2673842 |doi=10.1172/JCI37948 |laysummary=http://health.usnews.com/health-news/family-health/cancer/articles/2009/04/01/active-ingredient-in-marijuana-kills-brain-cancer |laysource=] |laydate=1 April 2009 |last12=Fimia |first12=GM |last13=Piacentini |first13=M |first14=F |first15=PP |first16=L |first17=JL |first18=M |first19=P |last20=Velasco |first20=G|author2=Carracedo A|author3=Salanueva IJ |last4=Cecconi |last5=Pandolfi |last6=González-Feria |last7=Iovanna |last8=Guzmán |last9=Boya |first4=Sonia |first5=Mar |first6=Ainara |first7=Patricia |first8=Cristina |first9=Sofía|first10=Stephane|first11=Jonathan}}</ref> The patients did not have any toxic effects from the treatment; previous studies of THC for the treatment of cancer have also found the therapy to be well tolerated.<ref name=pmid19425170/>


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.<ref name="aviram">{{cite journal | vauthors = Aviram J, Samuelly-Leichtag G | title = Efficacy of Cannabis-Based Medicines for Pain Management: A Systematic Review and Meta-Analysis of Randomized Controlled Trials | journal = Pain Physician | volume = 20 | issue = 6 | pages = E755–96 | date = September 2017 | doi = 10.36076/ppj.20.5.E755 | pmid = 28934780 | url = http://www.painphysicianjournal.com/current/pdf?article=NDYwNA%3D%3D&journal=107 | doi-access = free | access-date = 12 January 2018 | archive-date = 30 June 2021 | archive-url = https://web.archive.org/web/20210630092212/https://www.painphysicianjournal.com/current/pdf?article=NDYwNA%3D%3D&journal=107 | url-status = live }}</ref>
=== Opioid dependence ===
Injections of THC eliminate dependence on opiates in stressed rats, according to a research team at the Laboratory for Physiopathology of Diseases of the Central Nervous System (France) in the journal ''Neuropsychopharmacology''.<ref name=pmid19553915>{{Cite journal |author=Morel LJ, Giros B, Daugé V |title=Adolescent Exposure to Chronic Delta-9-Tetrahydrocannabinol Blocks Opiate Dependence in Maternally Deprived Rats |journal=Neuropsychopharmacology |volume= 34|issue= 11|pages= 2469–76|year=2009 |pmid=19553915 |doi=10.1038/npp.2009.70 |laysummary=http://www.physorg.com/news166196260.html |laysource=] |laydate=7 July 2009}}</ref> Deprived of their mothers at birth, rats become hypersensitive to the rewarding effect of morphine and heroin (substances belonging to the opiate family), and rapidly become dependent. When these rats were administered THC, they no longer developed typical morphine-dependent behavior. In the ], a region of the brain involved in drug dependence, the production of endogenous ] was restored under THC, whereas it diminished in rats stressed from birth which had not received THC. Researchers believe the findings could lead to therapeutic alternatives to existing substitution treatments.<ref name=pmid19553915/>


A 2011 review considered cannabis to be generally safe,<ref name=Lyn2011>{{cite journal | vauthors = Lynch ME, Campbell F | title = Cannabinoids for treatment of chronic non-cancer pain; a systematic review of randomized trials | journal = British Journal of Clinical Pharmacology | volume = 72 | issue = 5 | pages = 735–44 | date = November 2011 | pmid = 21426373 | pmc = 3243008 | doi = 10.1111/j.1365-2125.2011.03970.x | type = Review }}</ref> and it appears safer than ]s in palliative care.<ref name=Carter2011>{{cite journal | vauthors = Carter GT, Flanagan AM, Earleywine M, Abrams DI, Aggarwal SK, Grinspoon L | title = Cannabis in palliative medicine: improving care and reducing opioid-related morbidity | journal = The American Journal of Hospice & Palliative Care | volume = 28 | issue = 5 | pages = 297–303 | date = August 2011 | pmid = 21444324 | doi = 10.1177/1049909111402318 | s2cid = 19980960 | type = Review }}</ref>
In humans, drug treatment subjects who use cannabis intermittently are found to be more likely to adhere to treatment for opioid dependence.<ref name=Intermittent>{{Cite journal|title=Intermittent Marijuana Use Is Associated with Improved Retention in Naltrexone Treatment for Opiate-Dependence |journal=The American Journal on Addictions |volume=18 |issue=4 |pages=301–8 |year=2009 |pmid=19444734 |doi=10.1080/10550490902927785 |pmc=2753886|last1=Raby|first1=Wilfrid Noel|last2=Carpenter|first2=Kenneth M.|last3=Rothenberg|first3=Jami|last4=Brooks|first4=Adam C.|last5=Jiang|first5=Huiping|last6=Sullivan|first6=Maria|last7=Bisaga|first7=Adam|last8=Comer|first8=Sandra|last9=Nunes|first9=Edward V.}}</ref> Historically, similar findings were reported by Edward Birch, who, in 1889, reported success in treating opiate and chloral addiction with cannabis.<ref name=Mikuriya>{{Cite journal|author=Mikuriya TH |title=Marijuana in medicine: past, present and future |journal=California Medicine |volume=110 |issue=1 |pages=34–40 |year=1969 |pmid=4883504 |pmc=1503422}}</ref>


A 2022 review concluded the pain relief experienced after using medical cannabis is due to the ], especially given widespread media attention that sets the expectation for pain relief.<ref>{{cite journal |journal=JAMA Network Open |date=November 28, 2022 |title=Placebo Response and Media Attention in Randomized Clinical Trials Assessing Cannabis-Based Therapies for PainA Systematic Review and Meta-analysis |author1=Filip Gedin |author2=Sebastian Blomé |author3=Moa Pontén |author4=Maria Lalouni |author5=Jens Fust |author6=Andreé Raquette |author7=Viktor Vadenmark Lundquist |author8=William H. Thompson |author9=Karin Jensen |volume=5 |issue=11 |pages=e2243848 |doi=10.1001/jamanetworkopen.2022.43848 |pmid=36441553 |pmc=9706362 |doi-access=free }}</ref>
=== Controlling ALS symptoms ===
The potential role of cannabis in treating symptoms of ] (or Lou Gehrig's Disease) has been the subject of recent research. A survey was conducted on 131 people suffering from ALS. The survey asked if the subjects had used cannabis in the last 12 months to control some of their symptoms. Of the 131 subjects, 13 had used the drug in some form to control symptoms. The survey found that cannabis was moderately effective in reducing symptoms of appetite loss, depression, pain, spasticity, drooling and weakness, and the longest relief reported was for depression. The pattern of symptom relief was consistent with those reported by people with other conditions, including ] (Amtmann et al. 2004).<ref name="De-Vries 2010 2454–2462">{{cite journal |doi=10.1111/j.1365-2702.2010.03274.x |title=Cannabis use in palliative care - an examination of the evidence and the implications for nurses |year=2010 |last1=Green |first1=Anita J |last2=De-Vries |first2=Kay |journal=Journal of Clinical Nursing |volume=19 |issue=17–18 |pages=2454–62 |pmid=20920073}}</ref>


===Crohn's Disease=== ===Neurological conditions===
Cannabis' efficacy is not clear in treating neurological problems, including ] (MS) and movement problems.<ref name="ReferenceA"/> Evidence also suggests that oral cannabis extract is effective for reducing patient-centered measures of spasticity.<ref name="ReferenceA"/> A trial of cannabis is deemed to be a reasonable option if other treatments have not been effective.<ref name=Borgelt2013 />{{By whom|date=April 2017}} Its use for MS is approved in ten countries.<ref name=Borgelt2013 /><ref name=Clark2011>{{cite journal | vauthors = Clark PA, Capuzzi K, Fick C | title = Medical marijuana: medical necessity versus political agenda | journal = Medical Science Monitor | volume = 17 | issue = 12 | pages = RA249–61 | date = December 2011 | pmid = 22129912 | pmc = 3628147 | doi = 10.12659/MSM.882116 | type = Review }}</ref>{{COI source|date=December 2013}} A 2012 review found no problems with tolerance, abuse, or addiction.<ref>{{cite journal | vauthors = Oreja-Guevara C | title = | language = es | journal = Revista de Neurología | volume = 55 | issue = 7 | pages = 421–30 | date = October 2012 | pmid = 23011861 | type = Review }}</ref> In the United States, ], one of the cannabinoids found in the marijuana plant, has been approved for treating two severe forms of epilepsy, ] and ].<ref name=":4">{{Cite journal|last=Commissioner|first=Office of the|date=2019-06-10|title=FDA and Marijuana|url=https://www.fda.gov/news-events/public-health-focus/fda-and-marijuana|journal=FDA|language=en|access-date=16 December 2019|archive-date=16 November 2019|archive-url=https://web.archive.org/web/20191116160049/https://www.fda.gov/news-events/public-health-focus/fda-and-marijuana|url-status=live}}</ref>
A study published on May 6, 2013 in the journal ''Clinical Gastroenterology and Hepatology'' revealed that subjects with Crohn's Disease experienced benefits from inhaled cannabis use. At the completion of the study's treatment period, ten out of the eleven patients that received cannabis treatment displayed substantial improvements in disease-related symptoms, while five of these patients experienced complete remission. The study's authors wrote: "... all patients in the study group expressed strong satisfaction with their treatment and improvement in their daily function." The study was small, but was designed as a ], the gold standard for a clinical trial.<ref>{{cite web|title=Study: Cannabis Helps Manage Symptoms of Crohn's Disease|url=http://www.truthonpot.com/2013/05/20/study-cannabis-helps-manage-symptoms-of-crohns-disease/|work=TruthOnPot.com|publisher=TruthOnPot.com|accessdate=11 June 2013|author=TruthOnPot.com|date=20 May 2013}}</ref><ref>{{cite journal|last=Naftali|first=Timna|title=Cannabis Induces a Clinical Response in Patients with Crohn's Disease: a Prospective Placebo-Controlled Study|date=6|year=2013|month=May|doi=10.1016/j.cgh.2013.04.034|url=http://www.cghjournal.org/article/PIIS1542356513006046/abstract?rss=yes|publisher=Elsevier Inc|first2=Lihi|first3=Iris|first4=Ephraim Philip|first5=Fabiana|first6=Fred Meir|journal=Clinical Gastroenterology and Hepatology|volume=11|issue=10|pages=1276–1280.e1|pmid=23648372}}</ref>


===Diabetes=== === Mental health ===
{{Further|Cannabis use and trauma|Posttraumatic stress disorder#Cannabinoids}}
A study published on May 16, 2013 in the ] revealed that regular ] use is associated with better glucose control. They found that current ] users had significantly lower fasting ] and were less likely to be insulin resistant, even after excluding patients with a diagnosis of ]. Participants who reported using ] in the past month had lower levels of fasting ] and ] and higher levels of ]. These associations were weaker among those who reported using ] at least once, but not in the past thirty days, suggesting that the impact of marijuana use on ] and ] exists during periods of recent use. The Study there were al<ref>{{cite journal |doi=10.1016/j.amjmed.2013.03.002 |title=The Impact of Marijuana Use on Glucose, Insulin, and Insulin Resistance among US Adults |year=2013 |last1=Penner |first1=Elizabeth A. |last2=Buettner |first2=Hannah |last3=Mittleman |first3=Murray A. |journal=The American Journal of Medicine |volume=126 |issue=7 |pages=583–9 |pmid=23684393}}</ref>


A 2019 systematic review found that there is a lack of evidence that cannabinoids are effective in treating ] or ]s, ] (ADHD), ], ], or ].<ref name=black>{{cite journal |vauthors=Black N, Stockings E, Campbell G, Tran LT, Zagic D, Hall WD, Farrell M, Degenhardt L |title=Cannabinoids for the treatment of mental disorders and symptoms of mental disorders: a systematic review and meta-analysis |journal=Lancet Psychiatry |volume=6 |issue=12 |pages=995–1010 |date=2019 |pmid=31672337 |doi=10.1016/S2215-0366(19)30401-8 |pmc=6949116 |type=Systematic review & meta-analysis}}</ref>
== Medicinal compounds ==
Cannabis contains 483 compounds. At least 80 of these are ]s,<ref>{{cite journal |author = Downer EJ, Campbell VA |year = 2010 |title = Phytocannabinoids, CNS cells and development: A dead issue? |journal = Drug and Alcohol Review |volume = 29 |issue = 1 | pages = 91–98 |pmid = 20078688 |doi=10.1111/j.1465-3362.2009.00102.x}}</ref><ref>{{cite journal |author = Burns TL, Ineck JR |year = 2006 |title = Cannabinoid analgesia as a potential new therapeutic option in the treatment of chronic pain |journal = The Annals of Pharmacotherapy |volume = 40 |issue = 2 | pages = 251–260 |pmid = 16449552 |doi=10.1345/aph.1G217}}</ref> which are the basis for medical and scientific use of cannabis. This presents the research problem of isolating the effect of specific compounds and taking account of the interaction of these compounds.<ref name="Researchers buzzing">{{Cite news |first=David |last=Kohn |url=http://www.sfgate.com/health/article/Researchers-buzzing-about-marijuana-derived-2638240.php |title=Researchers buzzing about marijuana-derived medicines |work=] |date=5 November 2004 |accessdate=26 April 2009}}</ref> Cannabinoids can serve as appetite stimulants, ]s, ]s, and have some ] effects.<ref name="Amar2006" /> Six important cannabinoids found in the cannabis plant are tetrahydrocannabinol, ], cannabidiol, cannabinol, β-caryophyllene, and cannabigerol.


Research indicates that cannabis, particularly CBD, may have anxiolytic (anxiety-reducing) effects. A study found that CBD significantly reduced anxiety during a simulated public speaking test for individuals with social anxiety disorder. However, the relationship between cannabis use and anxiety symptoms is complex, and while some users report relief, the overall evidence from observational studies and clinical trials remains inconclusive. Cannabis is often used by people to cope with anxiety, yet the efficacy and safety of cannabis for treating anxiety disorders is yet to be researched.<ref>{{Cite web |date=2023-04-10 |title=Anxiety and Cannabis: A Review of Recent Research |url=https://drexel.edu/cannabis-research/research/research-highlights/2023/April/anxiety_cannabis_fact_sheet/ |access-date=2024-04-09 |website=Medical Cannabis Research Center |language=en}}</ref><ref>{{Cite journal |last1=Sarris |first1=Jerome |last2=Sinclair |first2=Justin |last3=Karamacoska |first3=Diana |last4=Davidson |first4=Maggie |last5=Firth |first5=Joseph |date=2020-01-16 |title=Medicinal cannabis for psychiatric disorders: a clinically-focused systematic review |journal=BMC Psychiatry |volume=20 |issue=1 |page=24 |doi=10.1186/s12888-019-2409-8 |doi-access=free |issn=1471-244X |pmc=6966847 |pmid=31948424}}</ref>
=== Tetrahydrocannabinol ===
{{Main|Tetrahydrocannabinol}}
] (THC)]]


Cannabis use, especially at high doses, is associated with a higher risk of psychosis, particularly in individuals with a genetic predisposition to psychotic disorders like schizophrenia. Some studies have shown that cannabis can trigger a temporary psychotic episode, which may increase the risk of developing a psychotic disorder later.<ref name=":5">{{Cite web |last=Abuse |first=National Institute on Drug |date=2023-05-08 |title=Is there a link between marijuana use and psychiatric disorders? {{!}} National Institute on Drug Abuse (NIDA) |url=https://nida.nih.gov/publications/research-reports/marijuana/there-link-between-marijuana-use-psychiatric-disorders |access-date=2024-04-09 |website=nida.nih.gov |language=en}}</ref>
Tetrahydrocannabinol (THC) is the primary compound responsible for the psychoactive effects of cannabis. The compound is a mild analgesic, and cellular research has shown the compound has antioxidant activity.<ref>{{cite journal |author=Hampson AJ, Grimaldi M, Axelrod J, Wink D. |url=http://www.pnas.org/content/95/14/8268.long |title=Cannabidiol and (−)Δ9-tetrahydrocannabinol are neuroprotective antioxidants |journal=PNAS |volume=95 |pages=8268–73 |pmid=9653176 |date=July 1998 |accessdate=15 May 2011 |issue=14 |pmc=20965 |doi=10.1073/pnas.95.14.8268 |bibcode=1998PNAS...95.8268H}}</ref> ] is believed to interact with parts of the brain normally controlled by the ] cannabinoid ], ].<ref name="pmid1470919">{{Cite journal |author = Devane WA, Hanus L, Breuer A, Pertwee RG, Stevenson LA, Griffin G, Gibson D, Mandelbaum A, Etinger A, Mechoulam R |title = Isolation and structure of a brain constituent that binds to the cannabinoid receptor |journal = Science |volume = 258 |issue = 5090 |pages = 1946–1949 |year = 1992 |pmid = 1470919 |doi = 10.1126/science.1470919|bibcode = 1992Sci...258.1946D }}</ref><ref name="isbn0-12-551460-3">{{Cite book| author = Mechoulam R, Fride E|editor = Pertwee RG|title = Cannabinoid receptors|publisher = Academic Press|location = Boston|year = 1995|pages = 233–258|chapter = The unpaved road to the endogenous brain cannabinoid ligands, the anandamides|isbn = 0-12-551460-3}}</ref> Anandamide is believed to play a role in pain sensation, memory, and sleep.


The impact of cannabis on depression is less clear. Some studies suggest a potential increase in depression risk among adolescents who use cannabis, though findings are inconsistent across studies.<ref name=":5" />
=== Cannabidiol ===
{{Main|Cannabidiol}}
] has been shown to relieve ]s, ], ], cough, congestion and nausea, and it inhibits ] growth.<ref name=Mechoulam2007/>]]


== Adverse effects ==
] (CBD) is a major constituent of medical cannabis. CBD represents up to 40% of ]s of medical cannabis.<ref name="Grlie_1976">{{Cite journal |last=Grlic |first=Ljubiša |title =A comparative study on some chemical and biological characteristics of various samples of cannabis resin |url=http://www.unodc.org/unodc/en/data-and-analysis/bulletin/bulletin_1962-01-01_3_page005.html|journal=Bulletin on Narcotics |volume=14 |pages=37–46 |year=1976}}</ref> Cannabidiol has been shown to relieve ], ], ], cough, congestion and nausea, and it inhibits ] growth.<ref name=Mechoulam2007>{{cite journal |doi=10.1002/cbdv.200790147 |title=Cannabidiol – Recent Advances |year=2007 |last1=Mechoulam |first1=Raphael |last2=Peters |first2=Maximilian |last3=Murillo-Rodriguez |first3=Eric |last4=Hanuš |first4=Lumír O. |journal=Chemistry & Biodiversity |volume=4 |issue=8 |pages=1678}}</ref> Recent studies have shown cannabidiol to be as effective as ] in treating ]<ref>{{Cite journal |doi=10.1590/S0100-879X2006000400001 |title=Cannabidiol, a Cannabis sativa constituent, as an antipsychotic drug |year=2006 |last1=Zuardi |first1=A.W. |last2=Crippa |first2=J.A.S. |last3=Hallak |first3=J.E.C. |last4=Moreira |first4=F.A. |last5=Guimarães |first5=F.S. |journal=Brazilian Journal of Medical and Biological Research |volume=39 |issue=4 |pages=421–9 |pmid=16612464}}</ref> and psychosis.<ref>{{cite journal |pmid=23108553 |year=2012 |last1=Campos |first1=AC |last2=Moreira |first2=FA |last3=Gomes |first3=FV |last4=Del Bel |first4=EA |last5=Guimaraes |first5=FS |title=Multiple mechanisms involved in the large-spectrum therapeutic potential of cannabidiol in psychiatric disorders |volume=367 |issue=1607 |pages=3364–78 |doi=10.1098/rstb.2011.0389 |pmc=3481531 |journal=Philosophical transactions of the Royal Society of London. Series B, Biological sciences}}</ref> Because cannabidiol relieves the aforementioned symptoms, cannabis strains with a high amount of CBD may benefit people with ], frequent ] and ].<ref name=Lakhan/><ref name=Mechoulam2007/><ref>{{cite journal |pmid=3235704 |year=1988 |last1=Sandyk |first1=R |last2=Awerbuch |first2=G |title=Marijuana and Tourette's syndrome |volume=8 |issue=6 |pages=444–5 |journal=Journal of clinical psychopharmacology |doi=10.1097/00004714-198812000-00021}}</ref>
]


===Cannabinol=== === Medical use ===
There is insufficient data to draw strong conclusions about the safety of medical cannabis.<ref name=oxpain>{{cite book |first1 = Tabitha A. |last1 = Washington |first2 = Khalilah M. |last2 = Brown |first3 = Gilbert J. |last3 = Fanciullo |title = Pain |chapter = Chapter 31: Medical Cannabis |page = 165 |year = 2012 |publisher = Oxford University Press |isbn = 978-0-19-994274-9 |quote = 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 brain }}</ref> Typically, adverse effects of medical cannabis use are not serious;<ref name=Borgelt2013>{{cite journal | vauthors = Borgelt LM, Franson KL, Nussbaum AM, Wang GS | title = The pharmacologic and clinical effects of medical cannabis | journal = Pharmacotherapy | volume = 33 | issue = 2 | pages = 195–209 | date = February 2013 | pmid = 23386598 | doi = 10.1002/phar.1187 | s2cid = 8503107 | url = https://wsma.org/doc_library/LegalResourceCenter/MedicalCannabis/Med%20Mar%20-%20Pharmacologic%20and%20Clinical%20Effects.pdf | access-date = 11 November 2017 | archive-date = 28 August 2021 | archive-url = https://web.archive.org/web/20210828161528/https://wsma.org/doc_library/LegalResourceCenter/MedicalCannabis/Med%20Mar%20-%20Pharmacologic%20and%20Clinical%20Effects.pdf | url-status = live }}</ref> they include tiredness, dizziness, increased appetite, and cardiovascular and psychoactive effects. Other effects can include impaired short-term memory; impaired motor coordination; altered judgment; and paranoia or psychosis at high doses.<ref>{{cite journal | vauthors = Gage SH, Hickman M, Zammit S | title = Association Between Cannabis and Psychosis: Epidemiologic Evidence | journal = Biological Psychiatry | volume = 79 | issue = 7 | pages = 549–56 | date = April 2016 | pmid = 26386480 | doi = 10.1016/j.biopsych.2015.08.001 | hdl = 1983/b8fb2d3b-5a55-4d07-97c0-1650b0ffc05d | s2cid = 1055335 | url = https://research-information.bris.ac.uk/en/publications/association-between-cannabis-and-psychosis(b8fb2d3b-5a55-4d07-97c0-1650b0ffc05d).html | hdl-access = free | access-date = 11 March 2020 | archive-date = 26 February 2020 | archive-url = https://web.archive.org/web/20200226185900/https://research-information.bris.ac.uk/en/publications/association-between-cannabis-and-psychosis(b8fb2d3b-5a55-4d07-97c0-1650b0ffc05d).html | url-status = live }}</ref> 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.<ref name=Grotenhermen2012>{{cite journal | vauthors = Grotenhermen F, Müller-Vahl K | title = The therapeutic potential of cannabis and cannabinoids | journal = Deutsches Ärzteblatt International | volume = 109 | issue = 29–30 | pages = 495–501 | date = July 2012 | pmid = 23008748 | pmc = 3442177 | doi = 10.3238/arztebl.2012.0495 }}</ref> Although supporters of medical cannabis say that it is safe,<ref name=oxpain /> further research is required to assess the long-term safety of its use.<ref name=Wang2008 /><ref name=barceloux866931>{{cite book |first = Donald G |last = Barceloux |title = Medical Toxicology of Drug Abuse: Synthesized Chemicals and Psychoactive Plants |chapter = Chapter 60: Marijuana (''Cannabis sativa'' L.) and synthetic cannabinoids |isbn = 978-0-471-72760-6 |year = 2012 |pages = 886–931 |publisher = John Wiley & Sons |chapter-url = https://books.google.com/books?id=OWFiVaDZnkQC&pg=PA886 |access-date = 20 December 2015 |archive-date = 13 January 2023 |archive-url = https://web.archive.org/web/20230113004526/https://books.google.com/books?id=OWFiVaDZnkQC&pg=PA886 |url-status = live }}</ref>
{{Main|Cannabinol}}
]]]


=== Cognitive effects ===
Cannabinol (CBN) is a therapeutic ] found only in trace amounts in '']'' and '']''.<ref name="pmid1221432">{{Cite journal |author = Karniol IG, Shirakawa I, Takahashi RN, Knobel E, Musty RE |title = Effects of delta-9-tetrahydrocannabinol and cannabinol in man |journal = Pharmacology |volume = 13 |issue = 6 |pages = 502–12 |year = 1975 |pmid = 1221432|doi = 10.1159/000136944}}</ref> It is mostly produced as a ], or a breakdown product, of ] (THC).<ref name="pmid1140243">{{Cite journal| author = McCallum ND, Yagen B, Levy S, Mechoulam R|title = Cannabinol: a rapidly formed metabolite of delta-1- and delta-6-tetrahydrocannabinol|journal = Experientia|volume = 31|issue = 5|pages = 520–1|year = 1975|pmid = 1140243| doi = 10.1007/BF01932433}}</ref> CBN acts as a weak ] of the ] and ] ]s, with lower ] in comparison to ].<ref name="pmid11020293">{{Cite journal| author = Mahadevan A, Siegel C, Martin BR, Abood ME, Beletskaya I, Razdan RK|title = Novel cannabinol probes for CB1 and CB2 cannabinoid receptors|journal = Journal of Medicinal Chemistry|volume = 43|issue = 20|pages = 3778–85|year = 2000|pmid = 11020293| doi = 10.1021/jm0001572}}</ref><ref name="pmid9667767">{{Cite journal| author = Petitet F, Jeantaud B, Reibaud M, Imperato A, Dubroeucq MC|title = Complex pharmacology of natural cannabinoids: evidence for partial agonist activity of delta-9-tetrahydrocannabinol and antagonist activity of cannabidiol on rat brain cannabinoid receptors|journal = Life Sciences|volume = 63|issue = 1|pages = PL1–6|year = 1998|pmid = 9667767|doi = 10.1016/S0024-3205(98)00238-0}}</ref>
{{further|long-term effects of cannabis}}
Recreational use of cannabis is associated with cognitive deficits, especially for those who begin to use cannabis in adolescence. {{as of|2021}} there is a lack of research into long-term cognitive effects of medical use of cannabis, but one 12-month observational study reported that "MC patients demonstrated significant improvements on measures of ] and clinical state over the course of 12 months".<ref>{{cite journal |last1=Sagar |first1=Kelly A. |last2=Dahlgren |first2=M. Kathryn |last3=Lambros |first3=Ashley M. |last4=Smith |first4=Rosemary T. |last5=El-Abboud |first5=Celine |last6=Gruber |first6=Staci A. |title=An Observational, Longitudinal Study of Cognition in Medical Cannabis Patients over the Course of 12 Months of Treatment: Preliminary Results |journal=Journal of the International Neuropsychological Society |date=2021 |volume=27 |issue=6 |pages=648–60 |doi=10.1017/S1355617721000114 |pmid=34261553 |s2cid=235824932 |language=en |issn=1355-6177|doi-access=free }}</ref>


=== β-Caryophyllene === === Impact on psychosis ===
Exposure to THC can cause acute transient psychotic symptoms in healthy individuals and people with schizophrenia.<ref name="Schubart et al.2014" />
{{Main|Caryophyllene}}
]]]


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.<ref>{{cite journal | vauthors = Large M, Sharma S, Compton MT, Slade T, Nielssen O | title = Cannabis use and earlier onset of psychosis: a systematic meta-analysis | journal = Archives of General Psychiatry | volume = 68 | issue = 6 | pages = 555–61 | date = June 2011 | pmid = 21300939 | doi = 10.1001/archgenpsychiatry.2011.5 | doi-access = free }}</ref> A 2005 meta analysis concluded that adolescent use of cannabis increases the risk of psychosis, and that the risk is dose-related.<ref>{{cite journal | vauthors = Semple DM, McIntosh AM, Lawrie SM | title = Cannabis as a risk factor for psychosis: systematic review | journal = Journal of Psychopharmacology | volume = 19 | issue = 2 | pages = 187–94 | date = March 2005 | pmid = 15871146 | doi = 10.1177/0269881105049040 | s2cid = 44651274 }}</ref> 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.<ref name=Arseneault2004>{{cite journal | vauthors = Arseneault L, Cannon M, Witton J, Murray RM | title = Causal association between cannabis and psychosis: examination of the evidence | journal = The British Journal of Psychiatry | volume = 184 | issue = 2 | pages = 110–17 | date = February 2004 | pmid = 14754822 | doi = 10.1192/bjp.184.2.110 | doi-access = free }}</ref> 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.<ref name="Laqueille">{{cite journal | vauthors = Laqueille X | title = | journal = Archives de Pédiatrie | volume = 16 | issue = 9 | pages = 1302–05 | date = September 2009 | pmid = 19640690 | doi = 10.1016/j.arcped.2009.03.016 | trans-title = Is cannabis is a vulnerability factor of schizophrenic disorders? }}</ref>
Part of the mechanism by which medical cannabis has been shown to reduce tissue ] is via the compound β-caryophyllene.<ref name=pmid18574142>{{Cite journal|author=Gertsch J |title=Beta-caryophyllene is a dietary cannabinoid |journal=Proceedings of the National Academy of Sciences of the United States of America |volume=105 |issue=26 |pages=9099–104 |year=2008 |pmid=18574142 |pmc=2449371 |doi=10.1073/pnas.0803601105 |author2=Leonti M |author3=Raduner S |last4=Racz |first4=I. |last5=Chen |first5=J.-Z. |last6=Xie |first6=X.-Q. |last7=Altmann |first7=K.-H. |last8=Karsak |first8=M. |last9=Zimmer |first9=A. |bibcode = 2008PNAS..105.9099G }}</ref> A cannabinoid ] called ] plays a vital part in reducing inflammation in humans and other animals.<ref name=pmid18574142/> β-Caryophyllene has been shown to be a selective activator of the CB2 receptor.<ref name=pmid18574142/> β-Caryophyllene is especially concentrated in ], which contains about 12–35% β-caryophyllene.<ref name=pmid18574142/>


=== Cannabigerol === == Pharmacology ==
The ] '']'' contains two species which produce useful amounts of psychoactive cannabinoids: '']'' and '']'', which are listed as Schedule I medicinal plants in the US;<ref name=Borgelt2013 /> a third species, '']'', has few psychogenic properties.<ref name=Borgelt2013 /> Cannabis contains more than 460 compounds;<ref name=BenAmar2006 /> at least 80 of these are ]s<ref>{{cite journal | vauthors = Downer EJ, Campbell VA | title = Phytocannabinoids, CNS cells and development: a dead issue? | journal = Drug and Alcohol Review | volume = 29 | issue = 1 | pages = 91–98 | date = January 2010 | pmid = 20078688 | doi = 10.1111/j.1465-3362.2009.00102.x | type = Review }}</ref><ref>{{cite journal | vauthors = Burns TL, Ineck JR | title = Cannabinoid analgesia as a potential new therapeutic option in the treatment of chronic pain | journal = The Annals of Pharmacotherapy | volume = 40 | issue = 2 | pages = 251–60 | date = February 2006 | pmid = 16449552 | doi = 10.1345/aph.1G217 | s2cid = 6858360 | type = Review }}</ref> – ]s that interact with ]s in the brain.<ref name=Borgelt2013 /> As of 2012, more than 20 cannabinoids were being studied by the U.S. FDA.<ref name=Svrakic2012>{{cite journal | vauthors = Svrakic DM, Lustman PJ, Mallya A, Lynn TA, Finney R, Svrakic NM | title = Legalization, decriminalization & medicinal use of cannabis: a scientific and public health perspective | journal = Missouri Medicine | volume = 109 | issue = 2 | pages = 90–98 | year = 2012 | pmid = 22675784 | pmc = 6181739 | type = Review }}</ref>
{{Main|Cannabigerol}}


The most psychoactive cannabinoid found in the cannabis plant is ] (or delta-9-tetrahydrocannabinol, commonly known as THC).<ref name=BenAmar2006 /> Other cannabinoids include ], ] (CBD), ] (CBN), ] (CBL), ] (CBC) and ] (CBG); they have less psychotropic effects than THC, but may play a role in the overall effect of cannabis.<ref name=BenAmar2006 /> The most studied are THC, CBD and CBN.<ref name=Gordon2013>{{cite journal | vauthors = Gordon AJ, Conley JW, Gordon JM | title = Medical consequences of marijuana use: a review of current literature | journal = Current Psychiatry Reports | volume = 15 | issue = 12 | page = 419 | date = December 2013 | pmid = 24234874 | doi = 10.1007/s11920-013-0419-7 | s2cid = 29063282 | type = Review | url = https://zenodo.org/record/1232874 | access-date = 12 July 2019 | archive-date = 7 August 2019 | archive-url = https://web.archive.org/web/20190807172632/https://zenodo.org/record/1232874 | url-status = live }}</ref>
Like cannabidiol, cannabigerol is not psychoactive. Cannabigerol has been shown to relieve intraocular pressure, which may be of benefit in the treatment of ].<ref>{{cite journal |pmid=1965836 |year=1990 |last1=Colasanti |first1=BK |title=A comparison of the ocular and central effects of delta 9-tetrahydrocannabinol and cannabigerol |volume=6 |issue=4 |pages=259–69 |journal=Journal of ocular pharmacology |doi=10.1089/jop.1990.6.259}}</ref><ref>{{cite journal |pmid=6499952 |year=1984 |last1=Colasanti |first1=BK |last2=Craig |first2=CR |last3=Allara |first3=RD |title=Intraocular pressure, ocular toxicity and neurotoxicity after administration of cannabinol or cannabigerol |volume=39 |issue=3 |pages=251–9 |journal=Experimental eye research |doi=10.1016/0014-4835(84)90013-7}}</ref>
<gallery perrow="5">
File:Cannabigerol.png|Cannabigerol
</gallery>


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.<ref>{{cite journal | vauthors = Mackie K | title = Cannabinoid receptors: where they are and what they do | journal = Journal of Neuroendocrinology | volume = 20 | pages = 10–14 | date = May 2008 | issue = Suppl 1 | pmid = 18426493 | doi = 10.1111/j.1365-2826.2008.01671.x | s2cid = 20161611 | doi-access = free }}</ref> CB2 receptors are found peripherally throughout the body and are thought to modulate pain and inflammation.<ref>{{cite journal | vauthors = Whiteside GT, Lee GP, Valenzano KJ | title = The role of the cannabinoid CB2 receptor in pain transmission and therapeutic potential of small molecule CB2 receptor agonists | journal = Current Medicinal Chemistry | volume = 14 | issue = 8 | pages = 917–36 | date = 2007 | pmid = 17430144 | doi = 10.2174/092986707780363023 }}</ref>
=== Pharmacologic THC and THC derivatives ===
In the U.S., the FDA has approved several cannabinoids for use as medical therapies: ] (]) and ]. These medicines are taken orally.


=== Absorption ===
These medications are usually used when first line treatments for nausea and vomiting associated with cancer chemotherapy fail to work. In extremely high doses and in rare cases "]" side effects are possible. The other commonly used antiemetic drugs are not associated with these side effects.
Cannabinoid absorption is dependent on its route of administration.


Inhaled and vaporized THC have similar absorption profiles to smoked THC, with a ] ranging from 10 to 35%. Oral administration has the lowest bioavailability of approximately 6%, variable absorption depending on the vehicle used, and the longest time to peak plasma levels (2 to 6 hours) compared to smoked or vaporized THC.<ref name=":0">{{cite journal | vauthors = Gaston TE, Friedman D | title = Pharmacology of cannabinoids in the treatment of epilepsy | journal = Epilepsy & Behavior | volume = 70 | issue = Pt B | pages = 313–18 | date = May 2017 | pmid = 28087250 | doi = 10.1016/j.yebeh.2016.11.016 | series = Cannabinoids and Epilepsy | s2cid = 3929024 }}</ref>
Marinol's manufacturer stated on their website: "The most frequently reported side effects in patients with AIDS during clinical studies involved the ] (CNS). These CNS effects (euphoria, dizziness, or thinking abnormalities, for example) were reported by 33% of patients taking MARINOL".<ref>{{Cite web |url=http://medicalmarijuana.procon.org/view.additional-resource.php?resourceID=000224 |title=Marijuana vs. Marinol – A side by side comparison |publisher=ProCon.org |accessdate=2013-01-07 |postscript=<!-- Bot inserted parameter. Either remove it; or change its value to "." for the cite to end in a ".", as necessary. -->{{inconsistent citations}}}}</ref><ref>. fda.gov (September 2004).</ref> Four documented fatalities resulting from Marinol have been reported.<ref>{{cite web|url=http://medicalmarijuana.procon.org/view.resource.php?resourceID=000145 |title=Deaths from Marijuana v. 17 FDA-Approved Drugs |publisher=ProCon.org |accessdate=2013-01-07}}</ref><ref>Stepper, H. P., Department of Health and Human Services (24 August 2005) . medicalmarijuana.procon.org</ref>


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.<ref name=":0" />
Canasol is a cannabis-based medication for glaucoma that relieves ] symptoms associated with late-stage glaucoma.


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.<ref>{{cite journal | vauthors = Mannila J, Järvinen T, Järvinen K, Tervonen J, Jarho P | title = Sublingual administration of Delta9-tetrahydrocannabinol/beta-cyclodextrin complex increases the bioavailability of Delta9-tetrahydrocannabinol in rabbits | journal = Life Sciences | volume = 78 | issue = 17 | pages = 1911–14 | date = March 2006 | pmid = 16266727 | doi = 10.1016/j.lfs.2005.08.025 }}</ref> Rectal administration in monkeys doubled bioavailability to 13.5% and achieved peak blood concentrations within 1 to 8 hours after administration.<ref name=":1">{{cite journal | vauthors = Huestis MA | title = Human cannabinoid pharmacokinetics | journal = Chemistry & Biodiversity | volume = 4 | issue = 8 | pages = 1770–804 | date = August 2007 | pmid = 17712819 | pmc = 2689518 | doi = 10.1002/cbdv.200790152 }}</ref>
It was created by an ophthalmologist, Dr. Albert Lockhart and Dr. Manley E. West, and began distribution in 1987.<ref>{{cite journal|title=Cannabis as a medicine|journal=Br. J. Anaesth|year=1996|volume= 76|issue=1|page=167| doi=10.1093/bja/76.1.167-a|last1=West|first1=M. E.|last2=Homi|first2=J.}}</ref><ref name="FFY">Dr Farid F. Youssef. "Cannibis Unmasked: What it is and why it does what it does". UWIToday: June 2010. http://sta.uwi.edu/uwitoday/archive/june_2010/article9.asp</ref> As of 2003, it was still being distributed in the United Kingdom, several U.S. states, and several Caribbean nations.<ref>Evans, T. ''The Gleaner'' (Jamaica). 24 August 2003.</ref>


=== Distribution ===
It is notable for being one of the first cannabis-containing pharmaceuticals to be developed for the ] and being one of the few such pharmaceuticals to have ever been legally marketed in the United States.<ref name="FFY"/><ref>Eulalee Thompson. . ''The Gleaner'' (Jamaica). 29 January 2001</ref>
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.<ref name=":1" /><ref name=":3">{{cite journal | vauthors = Badowski ME | title = A review of oral cannabinoids and medical marijuana for the treatment of chemotherapy-induced nausea and vomiting: a focus on pharmacokinetic variability and pharmacodynamics | journal = Cancer Chemotherapy and Pharmacology | volume = 80 | issue = 3 | pages = 441–49 | date = September 2017 | pmid = 28780725 | pmc = 5573753 | doi = 10.1007/s00280-017-3387-5 }}</ref> THC is highly protein bound once absorbed, with only 3% found unbound in the plasma. It distributes rapidly to highly vascularized organs such as the heart, lungs, liver, spleen, and kidneys, as well as to various glands. Low levels can be detected in the brain, testes, and unborn fetuses, all of which are protected from systemic circulation via barriers.<ref>{{cite journal | vauthors = Nahas GG | title = The pharmacokinetics of THC in fat and brain: resulting functional responses to marihuana smoking | journal = Human Psychopharmacology | volume = 16 | issue = 3 | pages = 247–55 | date = April 2001 | pmid = 12404577 | doi = 10.1002/hup.258 | s2cid = 30513770 }}</ref> 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.<ref name=":3" /><ref>{{cite journal | vauthors = Bridgeman MB, Abazia DT | title = Medicinal Cannabis: History, Pharmacology, And Implications for the Acute Care Setting | journal = P & T | volume = 42 | issue = 3 | pages = 180–88 | date = March 2017 | pmid = 28250701 | pmc = 5312634 }}</ref><ref>{{Cite book|url=https://books.google.com/books?id=AYH5BwAAQBAJ&pg=PA91|title=Marihuana and Medicine|last1=Nahas|first1=Gabriel G.|last2=Sutin|first2=Kenneth M.|last3=Harvey|first3=David J.|last4=Agurell|first4=Stig|year=1999|publisher=Springer Science & Business Media|isbn=978-1-59259-710-9|access-date=20 September 2020|archive-date=13 January 2023|archive-url=https://web.archive.org/web/20230113004528/https://books.google.com/books?id=AYH5BwAAQBAJ&pg=PA91|url-status=live}}</ref>


=== Metabolism ===
The prescription drug ], an extract of cannabis administered as a sublingual spray, has been approved in Canada for the adjunctive treatment (use alongside other medicines) of both ] and cancer related pain.<ref name="SativexC">{{Cite news|first=Wendy |last=Koch |date=23 June 2005 |url=http://www.usatoday.com/news/health/2005-06-23-pot-spray_x.htm |title=Spray alternative to pot on the market in Canada |work=] |accessdate=16 August 2009}}</ref><ref>
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.<ref name=":2">{{Cite news|url=https://sapiensoup.com/human-metabolism-thc|title=Human Metabolism of THC|date=2016-12-21|work=Sapiensoup Blog|access-date=2017-11-01|language=en-US|archive-date=26 June 2021|archive-url=https://web.archive.org/web/20210626101148/https://sapiensoup.com/human-metabolism-thc|url-status=live}}</ref>&nbsp;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.<ref>{{Cite web|url=http://profofpot.com/11-hydroxy-tetrahydrocannabinol-potency-edibles/|title=11-Hydroxy-THC - Increased Potency That Explains the Effect of Edibles? – Prof of Pot|website=profofpot.com|date=2 July 2016|language=en-US|access-date=2017-11-01|archive-date=28 June 2021|archive-url=https://web.archive.org/web/20210628171055/https://profofpot.com/11-hydroxy-tetrahydrocannabinol-potency-edibles/}}</ref>
{{cite web
|url=http://www.drugdevelopment-technology.com/projects/sativex/
|title=Sativex – Investigational Cannabis-Based Treatment for Pain and Multiple Sclerosis Drug Development Technology
|publisher=SPG Media
|accessdate=2008-08-08
}}
</ref> Sativex has also been approved in the United Kingdom, New Zealand, and the Czech Republic, and is expected to gain approval in other European countries.<ref>Cooper, Rachel."" ''The Telegraph.'' 21 June 2010. Retrieved 15 May 2011.</ref><ref>"" GW Pharmaceuticals. 3 Nov.2010. Retrieved 15 May 2011.</ref><ref>"" GW Pharmaceuticals. 15 April 2011. Retrieved 15 May 2011.</ref> William Notcutt is one of the chief researchers that has developed Sativex, and he has been working with GW and founder Geoffrey Guy since the company's inception in 1998. Notcutt states that the use of MS as the disease to study "had everything to do with politics."<ref name="Respectable Reefer">{{Cite news|last=Greenberg |first=Gary |title=Respectable Reefer |work=] |year=2005 |url=http://www.motherjones.com/politics/2005/11/respectable-reefer |accessdate=15 August 2009}}</ref>


Next, 11-OH-THC is metabolized in the liver into 11-COOH-THC, which is the second metabolic product of THC.<ref>{{Cite web|url=http://www.consultox.com/toxicology-marijuana.shtml|title=Toxicology Litigation Support: Marijuana|website=consultox.com|access-date=2017-11-01|archive-date=26 June 2021|archive-url=https://web.archive.org/web/20210626101148/http://www.consultox.com/toxicology-marijuana.shtml|url-status=live}}</ref>&nbsp;11-COOH-THC is not psychoactive.<ref name=":2" />
{| class="wikitable"
|-
! Medication
! Approval
! Country
! Licensed indications
! Cost
|-
| Nabilone
| 1985
| U.S., Canada
| Nausea of cancer chemotherapy that has failed to respond adequately to other antiemetics
|US$4000.00 for a year's supply (in Canada)<ref>{{Cite journal|author=Skrabek RQ, Galimova L, Ethans K, Perry D |title=Nabilone for the treatment of pain in fibromyalgia |journal=The Journal of Pain |volume=9 |issue=2 |pages=164–73 |year=2008|pmid=17974490 |doi=10.1016/j.jpain.2007.09.002 |laysummary=http://www.news-medical.net/news/2008/02/17/35301.aspx |laysource=News-Medical.Net |laydate=17 February 2008}}</ref>
|-
| Canasol
| 1987
| U.S., Canada, several Caribbean nations
| Introcular pressure associated with late-stage Glaucoma
|
|-
| rowspan="2"|Marinol
| 1985
| U.S.,<br />Canada (1992)
| Nausea and vomiting associated with cancer chemotherapy in patients who have failed to respond adequately to conventional treatments
| rowspan="2" |
US$652 for 30 doses @ 10&nbsp;mg online<ref>
{{cite web
|url=http://www.pharmacychecker.com/Pricing.asp?DrugName=Marinol&DrugId=25680&DrugStrengthId=43149
|title=ALL PRICES FOR: Marinol – Brand Version: 10 mg
|publisher=PharmacyChecker.com
|accessdate=2009-08-15
}}
</ref>
|-
| 1992
| U.S.
| Anorexia associated with AIDS–related weight loss<ref>{{cite press release |title=FDA approves new indication for Dronabinol |publisher=] |date=23 December 1992 |url=http://www.fda.gov/bbs/topics/ANSWERS/ANS00457.html|accessdate=15 August 2009 |archiveurl=http://web.archive.org/web/19970506023515/http://www.fda.gov/bbs/topics/ANSWERS/ANS00457.html |archivedate=6 May 1997}}</ref>
|-
| rowspan="2"|Sativex
| 1995
| Canada
| Adjunctive treatment for the symptomatic relief of neuropathic pain in multiple sclerosis in adults
| rowspan="2" |
] 9,351 per year<ref>{{cite web|url=http://www.cadth.ca/media/cdr/cdr_complete_Sativex_September-26-2007.pdf |title=Sativex: CEDAC Final Recommendation on Reconsideration and Reasons for Recommendation |publisher=] |date=27 September 2007 |accessdate=16 August 2009}}</ref>
|-
| 1997
| Canada
| Pain due to cancer
|}


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.<ref name=":2" /> Eventually, both routes of metabolism result in the metabolism of psychoactive THC to inactive 11-COOH-THC.
== Criticism ==
One of the major criticisms of cannabis as medicine is opposition to smoking as a method of consumption.<ref>{{cite web|last=Baltazar|first=Amanda|title=What is Medical Marijuana|url=http://pharmacy.about.com/od/Products/a/What-Is-Medical-Marijuana.htm|publisher=About.com|accessdate=09/30/01}}</ref> However, smoking is not necessary due to alternative methods of ingestion. Medicinal cannabis patients can use ]s, where the essential cannabis compounds are extracted and inhaled. In addition, edible cannabis, which is produced in various baked goods, is also available, and has demonstrated longer lasting effects.<ref>{{cite web|last=Group|first=United Patients|title=Ways to Consume Medical Marijuana|url=http://www.unitedpatientsgroup.com/resources/methods-of-consumption|accessdate=10/01/2013}}</ref>


=== Excretion ===
The United States ] (FDA) issued an advisory<ref>{{Cite web |url=http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2006/ucm108643.htm |title=Inter-agency advisory regarding claims that smoked marijuana is a medicine |publisher=fda.gov |year=2006 |accessdate=2012-12-24 |postscript=<!-- Bot inserted parameter. Either remove it; or change its value to "." for the cite to end in a ".", as necessary. -->{{inconsistent citations}}}}</ref> against ''smoked'' medical cannabis stating that, "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." The National Institute on Drug Abuse ] state that "Marijuana itself is an unlikely medication candidate for several reasons: (1) it is an unpurified plant containing numerous chemicals with unknown health effects; (2) it is typically consumed by smoking further contributing to potential adverse effects; and (3) its cognitive impairing effects may limit its utility".<ref>{{cite web |url=http://www.nida.nih.gov/tib/marijuana.html |title=Nida: Marijuana, An update from the National Institute on Drug Abuse |publisher=Nida.nih.gov |year=2011 |month=February |accessdate=2011-08-23}}</ref>
Due to substantial metabolism of THC and CBD, their metabolites are excreted mostly via ], rather than by urine.<ref name=":0" /><ref name="devinsky">{{cite journal | vauthors = Devinsky O, Cilio MR, Cross H, Fernandez-Ruiz J, French J, Hill C, Katz R, Di Marzo V, Jutras-Aswad D, Notcutt WG, Martinez-Orgado J, Robson PJ, Rohrback BG, Thiele E, Whalley B, Friedman D | title = Cannabidiol: pharmacology and potential therapeutic role in epilepsy and other neuropsychiatric disorders | journal = Epilepsia | volume = 55 | issue = 6 | pages = 791–802 | date = June 2014 | pmid = 24854329 | pmc = 4707667 | doi = 10.1111/epi.12631 }}</ref> 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 which are products of ]. Approximately 65% of THC is excreted in feces and 25% in the urine, while the remaining 10% is excreted by other means.<ref name=":0" /> The terminal half-life of THC is 25 to 36 hours,<ref>{{cite journal | vauthors = Grotenhermen F | title = Pharmacokinetics and pharmacodynamics of cannabinoids | journal = Clinical Pharmacokinetics | volume = 42 | issue = 4 | pages = 327–60 | date = 2003-04-01 | pmid = 12648025 | doi = 10.2165/00003088-200342040-00003 | s2cid = 25623600 }}</ref> whereas for CBD it is 18 to 32 hours.<ref name=devinsky/>


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.<ref>{{Cite journal |vauthors=Zendulka O, Dovrtělová G, Nosková K, Turjap M, Šulcová A, Hanuš L, Juřica J |date=2016-02-29|title=Cannabinoids and Cytochrome P450 Interactions|url=http://www.eurekaselect.com/137749/article|journal=Current Drug Metabolism|language=en|volume=17|issue=3|pages=206–226|doi=10.2174/1389200217666151210142051|pmid=26651971|access-date=1 November 2017|archive-date=3 July 2021|archive-url=https://web.archive.org/web/20210703094804/https://www.eurekaselect.com/137749/article|url-status=live}}</ref> Similar to delta-9-THC, a majority of CBD is excreted in feces and some in the urine.<ref name=":0" /> The terminal half-life is approximately 18–32 hours.<ref>{{cite journal | vauthors = Ohlsson A, Lindgren JE, Andersson S, Agurell S, Gillespie H, Hollister LE | title = Single-dose kinetics of deuterium-labelled cannabidiol in man after smoking and intravenous administration | journal = Biomedical & Environmental Mass Spectrometry | volume = 13 | issue = 2 | pages = 77–83 | date = February 1986 | pmid = 2937482 | doi = 10.1002/bms.1200130206 }}</ref>
The ], run by the ], conducted a comprehensive study in 1999 to assess the potential health benefits of cannabis and its constituent cannabinoids. The study concluded that smoking cannabis is not recommended for the treatment of any disease condition, but did conclude that nausea, appetite loss, pain and anxiety can all be mitigated by marijuana. While the study expressed reservations about smoked cannabis due to the health risks associated with smoking, the study team concluded that until another mode of ingestion was perfected that could provide the same relief as smoked cannabis, there was no alternative. In addition, the study pointed out the inherent difficulty in marketing a non-patentable herb. Pharmaceutical companies will probably make less investments in product development if the result is not possible to patent. The Institute of Medicine stated that there is little future in smoked cannabis as a medically approved medication. The report also concluded that for certain patients, such as the terminally ill or those with debilitating symptoms, the long-term risks are not of great concern.<ref>{{cite press release |title=Medical Marijuana Passes House Civil Justice Committee Without Dissent |publisher=Minnesotans for Compassionate Care |date=11 March 2009 |url=http://stopthedrugwar.org/in_the_trenches/2009/mar/11/press_release_medical_marijuana_ |accessdate=10 August 2009}}</ref><ref>{{Cite book |editor1-first=Janet E. |editor1-last=Joy |editor2-first=Stanley J. |editor2-last=Watson |editor3-first=John A. |editor3-last=Benson |year=1999 |title=Marijuana and Medicine: Assessing the Science Base |url=http://www.nap.edu/openbook.php?isbn=0309071550 |publisher=] |location=Washington, D.C. |isbn=978-0-309-07155-0 |oclc=246585475}}</ref>


== Administration ==
], a synthetic cannabinoid, was less effective than the ] ] in helping cancer patients regain lost appetites.<ref>{{cite web|title=Marinol|url=http://www.fda.gov/ohrms/dockets/dockets/05n0479/05N-0479-emc0004-04.pdf|publisher=FDA|accessdate=10/1/13}}</ref><ref>{{Cite journal|author=Jatoi A |title=Dronabinol versus megestrol acetate versus combination therapy for cancer-associated anorexia: a North Central Cancer Treatment Group study |journal=Journal of Clinical Oncology|publisher=]|location=Alexandria, VA|volume=20 |issue=2 |pages=567–73 |year=2002|pmid=11786587 |doi=10.1200/JCO.20.2.567|format=PDF |laysummary=http://www.medscape.com/viewarticle/423300 |laysource=] |laydate=30 January 2002 |last12=Christensen |first12=B |author2=Windschitl HE |author3=Loprinzi CL |last4=Sloan |first4=JA |last5=Dakhil |first5=SR |last6=Mailliard |first6=JA |last7=Pundaleeka |first7=S |last8=Kardinal |first8=CG |last9=Fitch |first9=TR|first10=JE|first11=PJ}}</ref> A phase III study found no difference in effects of an oral cannabis extract or THC on appetite and quality of life (QOL) in patients with cancer-related ]-] ] (CACS) to ].<ref>{{cite journal |pmid=16849753 |year=2006 |last2=Strasser |first2=F |last3=Luftner |first3=D |last4=Possinger |first4=K |last5=Ernst |first5=G |last6=Ruhstaller |first6=T |last7=Meissner |first7=W |last8=Ko |first8=YD |last9=Schnelle |first9=M |last10=Reif |first10=M |last11=Cerny |first11=T |title=Comparison of orally administered cannabis extract and delta-9-tetrahydrocannabinol in treating patients with cancer-related anorexia-cachexia syndrome: A multicenter, phase III, randomized, double-blind, placebo-controlled clinical trial from the Cannabis-In-Cachexia-Study-Group |volume=24 |issue=21 |pages=3394–400 |doi=10.1200/JCO.2005.05.1847 |journal=Journal of clinical oncology : official journal of the American Society of Clinical Oncology |last1=Strasser |first1=F.}}</ref> "Citing the dangers of cannabis and the lack of clinical research supporting its medicinal value" the ] in March 2011 issued a white paper recommending a halt to using marijuana as a medicine in U.S. states where it has been declared legal.<ref name="Prnewswire.com">{{cite news|url=http://www.prnewswire.com/news-releases/american-society-of-addiction-medicine-rejects-use-of-medical-marijuana-citing-dangers-and-failure-to-meet-standards-of-patient-care-118534464.html |title=American Society of Addiction Medicine Rejects Use of 'Medical Marijuana,' Citing Dangers and Failure To Meet Standards of Patient Care, March 23, 2011 |location=Maryland |agency=PR Newswire |accessdate=2011-04-20}}</ref><ref name="Asam.org">{{cite web |url=http://www.asam.org/MedicalMarijuana.html |title=Medical Marijuana, American Society of Addiction Medicine, 2010 |publisher=Asam.org |date=1 April 2010 |accessdate=2011-04-20}}{{dead link|date=April 2013}}</ref>
]


] has been the means of administration of cannabis for many users, but it is not suitable for the use of cannabis as a medicine.<ref name=CurtisClarke2009>{{cite journal | vauthors = Curtis A, Clarke CE, Rickards HE | title = Cannabinoids for Tourette's Syndrome | journal = The Cochrane Database of Systematic Reviews | issue = 4 | pages = CD006565 | date = October 2009 | volume = 2009 | pmid = 19821373 | doi = 10.1002/14651858.CD006565.pub2 | type = Review | pmc = 7387115 }}</ref> It was the most common method of medical cannabis consumption in the US {{as of|lc=yes|2013}}.<ref name=Borgelt2013 /> It is difficult to predict the pharmacological response to cannabis because concentration of cannabinoids varies widely, as there are different ways of preparing it for consumption (smoked, applied as oils, eaten, infused into other foods, or drunk) and a lack of production controls.<ref name=Borgelt2013 /> The potential for adverse effects from smoke inhalation makes smoking a less viable option than oral preparations.<ref name=CurtisClarke2009 /> ] have gained popularity because of a perception among users that fewer harmful chemicals are ingested when components are inhaled via aerosol rather than smoke.<ref name=Borgelt2013 /> Cannabinoid medicines are available in pill form (] and ]) and liquid extracts formulated into an oromucosal spray (]).<ref name=Borgelt2013 /> Oral preparations are "problematic due to the uptake of cannabinoids into fatty tissue, from which they are released slowly, and the significant first-pass liver metabolism, which breaks down Δ9THC and contributes further to the variability of plasma concentrations".<ref name=CurtisClarke2009 />
=== Mental disorders ===
A study of 50,000 Swedish soldiers who had smoked at least once were twice as likely to develop ] as those who had not smoked. The study concluded that either smoking caused a higher rate of schizophrenia, or that those with schizophrenia were more likely to be drawn to cannabis.<ref>{{cite journal |pmid=20499454 |year=2010 |title=Medical marijuana and the mind. More is known about the psychiatric risks than the benefits |volume=26 |issue=10 |pages=1–3 |journal=The Harvard mental health letter / from Harvard Medical School}}</ref>


The US Food and Drug Administration (FDA) has not approved smoked cannabis for any condition or disease, as it deems that evidence is lacking concerning safety and efficacy.<ref name=FDA2006 /> 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."<ref name=FDA2006>{{Cite press release |url = https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2006/ucm108643.htm |title = Inter-agency advisory regarding claims that smoked marijuana is a medicine |publisher = fda.gov |date = 20 April 2006 |access-date = 24 December 2012 |archive-date = 13 October 2012 |archive-url = https://web.archive.org/web/20121013080059/http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2006/ucm108643.htm |url-status = live }}</ref>
A study by ] commissioned by the British government found that between 1996 and 2005 there had been significant reductions in the incidence and prevalence of schizophrenia. From 2000 onwards there were also significant reductions in the prevalence of psychoses. The authors say this data is "not consistent with the hypothesis that increasing cannabis use in earlier decades is associated with increasing schizophrenia or psychoses from the mid-1990s onwards".<ref>{{cite journal |doi=10.1016/j.schres.2009.05.031 |title=Assessing the impact of cannabis use on trends in diagnosed schizophrenia in the United Kingdom from 1996 to 2005 |year=2009 |last1=Frisher |first1=Martin |last2=Crome |first2=Ilana |last3=Martino |first3=Orsolina |last4=Croft |first4=Peter |journal=Schizophrenia Research |volume=113 |issue=2–3 |pages=123–8 |pmid=19560900}}</ref>

A 10-year study on 1,923 individuals from the general population in Germany, aged 14–24, concluded that cannabis use is a risk factor for the development of incident ] symptoms, and the continued use might increase the risk.<ref>{{cite journal |title=Continued cannabis use and risk of incidence and persistence of psychotic symptoms: 10 year follow-up cohort study |year=2011 |last1=Kuepper |first1=R. |last2=Van Os |first2=J. |last3=Lieb |first3=R. |last4=Wittchen |first4=H.-U. |last5=Hofler |first5=M. |last6=Henquet |first6=C. |journal=] |volume=342 |pages=d738 |pmid=21363868 |pmc=3047001 |doi=10.1136/bmj.d738}}</ref> A study conducted by Thomas F. Denson and Mitchell Earleywine found fewer weekly users with symptoms of depression than those that did not use marijuana. They also reported that used marijuana for medical reasons were found to have been more depressed than recreational users, but reported fewer negative symptomatic issues.<ref name="DoiaddbehMissing" />

However a medical study published in 2009 taken by the ] in London, showed there was no significant effect of THC on -raclopride binding. Thus concluding, recreational cannabis users do not release significant amounts of dopamine from an oral THC dose equivalent to a standard cannabis cigarette. This result challenges current models of striatal dopamine release as the mechanism mediating cannabis as risk factor for schizophrenia.<ref>{{cite journal |pmid=19539765 |year=2009 |last1=Stokes |first1=PR |last2=Mehta |first2=MA |last3=Curran |first3=HV |last4=Breen |first4=G |last5=Grasby |first5=PM |title=Can recreational doses of THC produce significant dopamine release in the human striatum? |volume=48 |issue=1 |pages=186–90 |doi=10.1016/j.neuroimage.2009.06.029 |journal=NeuroImage}}</ref>

=== Lung cancer and chronic obstructive pulmonary disease ===
The evidence to date is conflicting as to whether smoking cannabis increases the risk of developing lung cancer or ] (COPD) among people who do not smoke tobacco. Some of these research results follow below:
* In 2006, Hashibe, Morgenstern, Cui, Tashkin, ''et al.'' presented the results from a study involving 2,240 subjects that showed non-tobacco users who smoked marijuana did not exhibit an increased incidence of lung cancer or head-and-neck malignancies. These results were supported even among very long-term, very heavy users of marijuana.<ref name="tashink">
{{Cite journal
|author=Hashibe M
|title=Marijuana use and the risk of lung and upper aerodigestive tract cancers: results of a population-based case-control study
|journal=Cancer Epidemiol. Biomarkers Prev.
|volume=15
|issue=10
|pages=1829–34
|year=2006
|pmid=17035389
|doi=10.1158/1055-9965.EPI-06-0330
|laysummary=http://scienceblog.com/cms/study-finds-no-link-between-marijuana-use-and-lung-cancer-10660.html
|author2=Morgenstern H
|author3=Cui Y
|author4=Tashkin D
|last5=Zhang
|first5=Z.-F.
|last6=Cozen
|first6=W.
|last7=Mack
|first7=T. M.
|last8=Greenland
|first8=S.
}}
</ref> Tashkin, a pulmonologist who has studied cannabis for 30 years, commenting in news reports in the lay media on the results of the study he co-authored, suggested, "It's possible that tetrahydrocannabinol ] in cannabis smoke may encourage ], or programmed cell death, causing cells to die off before they have a chance to undergo malignant transformation". He summarized the results found by his study, saying "We hypothesized that there would be a positive association between cannabis use and lung cancer, and that the association would be more positive with heavier use. What we found instead was no association at all, and even a suggestion of some protective effect."<ref>{{cite web |first=Neil |last=Osterweil |url=http://www.medpagetoday.com/HematologyOncology/LungCancer/3393 |title=ATS: Marijuana Smoking Found Non-Carcinogenic |publisher=] |date=24 May 2006 |accessdate=12 August 2009}}</ref><ref>{{Cite news |first=Marc |last=Kaufman |url=http://www.washingtonpost.com/wp-dyn/content/article/2006/05/25/AR2006052501729.html |title=Study Finds No Cancer-Marijuana Connection |work=] |date=26 May 2006 |accessdate=12 August 2009}}</ref>
* A case-control study involving 79 cases and 324 controls looked at lung cancer in adults 55 years of age and younger, and found the risk of lung cancer increased 8% (95% confidence interval (CI) 2–15) for each joint-year of cannabis smoking, after adjustment for confounding variables including cigarette smoking, and 7% (95% CI 5–9) for each pack-year of cigarette smoking, after adjustment for confounding variables including cannabis smoking.<ref>
{{Cite journal
|author=Aldington S
|title=Cannabis use and risk of lung cancer: a case-control study
|journal=European Respiratory Journal
|volume=31
|issue=1
|pages=280–6
|year=2008
|pmid=18238947
|doi=10.1183/09031936.00065707
|pmc=2516340
|author2=Harwood M
|author3=Cox B
|last4=Weatherall
|first4=M.
|last5=Beckert
|first5=L.
|last6=Hansell
|first6=A.
|last7=Pritchard
|first7=A.
|last8=Robinson
|first8=G.
|last9=Beasley
|first9=R.
}}
</ref>
* A 2008 study by Hii, Tam, Thompson, and Naughton found that cannabis smoking leads to asymmetrical bullous disease, often in the setting of normal CXR and lung function. In subjects who smoke cannabis, these pathological changes occur at a younger age (approximately 20 years earlier) than in tobacco smokers. However this study involved only 10 patients who also smoked tobacco and had symptoms of the disease prior to the study. There was no control group in the study.<ref>
{{Cite journal
|author=Hii SW, Tam JD, Thompson BR, Naughton MT
|title=Bullous lung disease due to marijuana
|journal=Respirology
|volume=13
|issue=1
|pages=122–7
|year=2008
|pmid=18197922
|laysummary=http://www.sciencedaily.com/releases/2008/01/080123104017.htm
|doi=10.1111/j.1440-1843.2007.01186.x
}}
</ref> The '']'' in 2004 found insufficient evidence for a causative link between cannabis smoke and bullous disease.<ref>{{cite journal |first1=Carol |last1=Tan |first2=N |last2=Hatam |first3=Tom |last3=Treasure |pmid=16449781 |year=2006 |title=Bullous disease of the lung and cannabis smoking: Insufficient evidence for a causative link |volume=99 |issue=2 |pages=77–80 |doi=10.1258/jrsm.99.2.77 |pmc=1360494 |journal=Journal of the Royal Society of Medicine}}</ref>
* Researchers from the University of British Columbia presented a study at the American Thoracic Society 2007 International Conference showing that smoking cannabis and tobacco together more than tripled the risk of developing COPD over just smoking tobacco alone.{{Unreliable medical source|date=August 2010}}<ref>{{Unreliable medical source|date=August 2010}}{{cite press release |title=http://www-archive.thoracic.org/sections/publications/press-releases/conference/articles/2007/press-releases/marijuana-worsens-copd-symptoms-in-current-cigarette-smokers.html|publisher=] |date=21 May 2007 |url=http://www.thoracic.org/sections/publications/press-releases/conference/articles/2007/press-releases/marijuana-worsens-copd-symptoms-in-current-cigarette-smokers.html |accessdate=11 August 2009}}</ref>{{Dead link|date=May 2013}} Similar findings were released in April 2009 by the Vancouver Burden of Obstructive Lung Disease Research Group. The study reported that smoking both tobacco and cannabis synergistically increased the risk of respiratory symptoms and COPD. Smoking only cannabis, however, was not associated with an increased risk of respiratory symptoms of COPD.<ref>{{cite journal |doi=10.1503/cmaj.081040 |laysummary=http://www.physorg.com/news158861123.html |laydate=13 April 2009 |laysource=] |title=Marijuana and chronic obstructive lung disease: A population-based study |year=2009 |last1=Tan |first1=W. C. |last2=Lo |first2=C. |last3=Jong |first3=A. |last4=Xing |first4=L. |last5=Fitzgerald |first5=M. J. |last6=Vollmer |first6=W. M. |last7=Buist |first7=S. A. |last8=Sin |first8=D. D. |journal=Canadian Medical Association Journal |volume=180 |issue=8 |pages=814–20 |pmid=19364790 |author9=Vancouver Burden of Obstructive Lung Disease (BOLD) Research Group |pmc=2665947}}</ref> In a related commentary, pulmonary researcher Donald Tashkin wrote, "... we can be close to concluding that cannabis smoking by itself does not lead to COPD".<ref>{{cite journal |doi=10.1503/cmaj.090142 |title=Does smoking marijuana increase the risk of chronic obstructive pulmonary disease? |year=2009 |last1=Tashkin |first1=D. P. |journal=Canadian Medical Association Journal |volume=180 |issue=8 |pages=797–8 |pmid=19364782 |pmc=2665954}}</ref>

== Methods of consumption ==
]'']]
Any possible harm caused by ] can be minimized by the use of a ]<ref name="vap">{{cite web |url=http://web.archive.org/web/20080207013804/http://www.maps.org/mmj/vaporizer.html |title=MAPS/CaNORML vaporizer and waterpipe studies |publisher=Maps.org |accessdate=2009-11-14}}</ref> or ] the drug in an ]. Vaporizers are devices that heat the ] to a temperature below the ignition point of the cannabis, so that the resultant vapors can be inhaled. Combustion of plant material is avoided, thus preventing the formation of ] and carcinogens, such as ] and ]. There are pocket-sized forms of vaporizer which use rechargeable batteries, are constructed from wood, and feature removable covers.<ref>{{cite web|title=Stealth stoner|url=http://www.aeonmagazine.com/altered-states/what-is-it-like-to-get-high-on-marijuana-in-public/?utm_source=Aeon%20newsletter&utm_campaign=990bd537e1-Weekly_13_July_20137_26_2013&utm_medium=email&utm_term=0_411a82e59d-990bd537e1-68601341|work=Aeon Magazine|publisher=Aeon Magazine Ltd|accessdate=14 September 2013|author=Jeff Winkler|date=13 September 2013}}</ref>

A pilot study led by Donald Abrams of ] showed that vaporizers eliminate the release of irritants and toxic compounds, while delivering equivalent amounts of THC into the bloodstream.<ref>{{cite journal |doi=10.1038/sj.clpt.6100200 |title=Vaporization as a Smokeless Cannabis Delivery System: A Pilot Study |year=2007 |last1=Abrams |first1=D I |last2=Vizoso |first2=H P |last3=Shade |first3=S B |last4=Jay |first4=C |last5=Kelly |first5=M E |last6=Benowitz |first6=N L |journal=Clinical Pharmacology &#38; Therapeutics |volume=82 |issue=5 |pages=572}}</ref>

In order to kill ]s, especially the molds '']'', '']'' and '']'', Levitz and Diamond suggested baking marijuana at {{Convert|150|C|F}} for five minutes. They also found that tetrahydrocannabinol (THC) was not degraded by this process.<ref>{{cite journal |pmid=1652910 |year=1991 |last1=Levitz |first1=SM |last2=Diamond |first2=RD |title=Aspergillosis and marijuana |volume=115 |issue=7 |pages=578–9 |journal=Annals of internal medicine |doi=10.7326/0003-4819-115-7-578_2}}</ref>
<gallery>
<Float: Left>
File:Three space brownies.jpg
</gallery>

== Methods of acquisition ==
The method of obtaining medical cannabis varies by region and by legislation. Currently some of the permitted methods are through regulated marijuana dispensaries (or marijuana clubs) or by self-propagation. Meaning that in some areas it is legal for a person to grow their own marijuana for personal use.

=== Dispensing machines ===

A marijuana vending machine is a ] for selling or dispensing ]. They are currently in use in the ]. In the United States, they are normally located in secure rooms in medical marijuana dispensaries. They are operated by employees after a ] is obtained from the patient. In Canada, marijuana vending machines are planned to be used in centres that cultivate the drug.<ref>{{cite web|last=Laskow |first=Sarah |url=http://grist.org/list/marijuana-vending-machines-are-the-future-of-recreational-drug-use/ |title=Marijuana vending machines are the future of recreational drug use |publisher=Grist |date=2013-06-10 |accessdate=2013-10-19}}</ref><ref>{{cite web|url=http://news.msn.com/us/marijuana-vending-machines |title=Marijuana vending machines |publisher=News.msn.com |date= |accessdate=2013-10-19}}</ref><ref name="nationalpost1">{{cite web|url=http://news.nationalpost.com/2013/10/16/pot-vending-machines-to-start-rolling-into-canada-after-firm-partners-with-u-s-company/ |title=The pot vending machine's first foreign market? Canada, of course, 'a seed for the rest of the world' &#124; National Post |publisher=News.nationalpost.com |date= |accessdate=2013-10-19}}</ref><ref>{{cite web|url=http://sanfrancisco.cbslocal.com/2013/03/20/marijuana-vending-machines-popping-up-at-california-pot-clubs/ |title=Marijuana Vending Machines Popping Up At California Pot Clubs " CBS San Francisco |publisher=Sanfrancisco.cbslocal.com |date=2013-03-20 |accessdate=2013-10-19}}</ref><ref>{{cite web|last=Vrankulj |first=Adam |url=http://www.biometricupdate.com/201310/medbox-partners-with-canadian-medical-marijuana-rd-lab |title=Medbox partners with Canadian medical marijuana R&D lab |publisher=BiometricUpdate.com |date=2012-11-13 |accessdate=2013-10-19}}</ref><ref>{{cite web|url=http://www.dailymail.co.uk/news/article-2338726/Marijuana-vending-machines-coming-store-near-you.html |title=Marijuana vending machines coming to a store near you? &#124; Mail Online |publisher=Dailymail.co.uk |date=2013-06-10 |accessdate=2013-10-19}}</ref><ref>{{cite web|last=Epstein |first=Mike |url=http://www.geekosystem.com/medical-marijuana-vending-machine/ |title=Marijuana Vending Machine Maker's Stock Skyrockets and Everybody Freaks Out |publisher=Geekosystem |date=2012-11-16 |accessdate=2013-10-19}}</ref><ref name="huffingtonpost1">{{cite web|url=http://www.huffingtonpost.com/2013/06/09/marijuana-vending-machines_n_3405314.html |title=Marijuana Vending Machines, Stoner Fantasy, May Become Industry Norm |publisher=Huffingtonpost.com |date= |accessdate=2013-10-19}}</ref><ref>{{cite web|url=http://www.tokeofthetown.com/2013/03/marijuana_vending_machines_helfpul_or_just_hype_medbox.php |title=Marijuana vending machines: helfpul or just hype? &#124; Marijuana and Cannabis News |publisher=Toke of the Town |date=2013-03-29 |accessdate=2013-10-19}}</ref><ref>{{cite web|url=http://www.wealthdaily.com/articles/marijuana-vending-machine-investing/4281 |title=Marijuana Vending Machine Investing |publisher=Wealthdaily.com |date=2013-05-13 |accessdate=2013-10-19}}</ref>

At least three companies are developing the vending machines.<ref name="huffingtonpost1"/> Endexx Corp. (ticker symbol: EDXC) has recently acquired two smaller companies to merge their respective technologies into a marijuana vending machine. The first acquisition, called Cann-Can LLC, was announced by Endexx on April 9, 2013.<ref>{{cite web|title=Endexx Acquires Cann-Can LLC|url=http://ih.advfn.com/p.php?pid=nmona&article=57093309|publisher=PR Newswire (US)}}</ref> Cann-Can's founder and developer, David Levine, was brought onto the Endexx board as a specialty consultant. David Levine has extensive vending machine expertise and holds a patent for a vending machine messaging system.<ref>{{cite web|title=MB Media Brokers To License Vending Messaging System|url=http://www.vendingmarketwatch.com/news/11129783/mb-media-brokers-to-license-vending-messaging-system|publisher=Vending Market Watch}}</ref> The second acquisition, known as Dispense Labs LLC, was finalized and announced by Endexx on October 7, 2013.<ref>{{cite web|title=Endexx closes Acquisition of Dispense Labs LLC|url=http://ih.advfn.com/p.php?pid=nmona&article=58718702|publisher=PR Newswire (US)}}</ref> Dispense Labs has developed an advanced vending machine, known as Autospense, through its partnership with the leader in industrial vending inventory solutions, Autocrib, Inc. The Autospense machines have many built-in benefits and features to improve security, inventory management, profitability, efficiency, accountability and to mitigate risk.<ref>{{cite web|title=www.Autospense.com|url=http://www.autospense.com/}}</ref> Endexx, through its wholly owned subsidiary, Dispense Labs, has secured exclusive worldwide rights for medical marijuana dispensing technology with Autocrib.<ref>{{cite web|title=Endexx Secures Exclusive World Wide Rights for Medical Marijuana Dispensing Technology|url=http://ih.advfn.com/p.php?pid=nmona&article=58777180|publisher=PR Newswire (US)}}</ref> Together, with M3Hub<ref>{{cite web|title=www.m3hub.com|url=http://www.m3hub.com/}}</ref> and the recent acquisition of THCFinder.com,<ref>{{cite web|title=www.thcfinder.com/|url=http://www.thcfinder.com/}}</ref> these vending machine acquisitions will enable Endexx to provide a complete seed-to-sale solution to assist dispensaries, and other cannabis-related businesses, to work within the confines of the law.<ref>{{cite web|title=Endexx's M3Hub(TM) Platform Supports State Legalized Marijuana Laws|url=http://ih.advfn.com/p.php?pid=nmona&article=59014857|publisher=PR Newswire (US)}}</ref><ref>{{cite web|title=Endexx's M3Hub Platform Is the Robust "Seed to Sale" Tracking Solution|url=http://ih.advfn.com/p.php?pid=nmona&article=59166832|publisher=PR Newswire (US)}}</ref> Additionally, it is expected that the THC Finder website will enable marijuana patients to locate the nearest dispensary with an Autospense marijuana vending machine.<ref>{{cite web|title=THCFinder.com Joins the M3Hub(TM)|url=http://ih.advfn.com/p.php?pid=nmona&article=59437491|publisher=PR Newswire (US)}}</ref>

Medbox Inc. is the industry leader in medical marijuana dispensing machines. They sell two machines for $50,000, one for ] like brownies, and the other for portions of marijuana itself.<ref name="huffingtonpost1"/> As of October 2013, Medbox has sold approximately 160 marijuana vending machines to US medical marijuana dispensaries.<ref name="nationalpost1"/>

Tranzbyte Corp. plans to commence distribution of vending machines that use ] tags.<ref name="huffingtonpost1"/>

== Pharmaceutical products ==
* ] (],<ref>United States Adopted Names Coincil: </ref> trade name '''Sativex''') is an aerosolized mist for oral administration intended for the treatment of pain.

== Reclassification in the USA ==
A number of medical organizations have endorsed reclassification of marijuana to allow for further study. These include, but are not limited to:

*The ]<ref name="AMAnews"> By Kevin B. O'Reilly, American Medical News. 30 November 2009</ref><ref name="ama">{{cite web|url=http://www.safeaccessnow.org/article.php?id=5870#5|title=AMA Urges Reclassifying Marijuana|publisher=Americans for Safe Access|accessdate=10 January 2010}}</ref><ref name="amapdf">{{cite web|url=http://www.ama-assn.org/ama1/pub/upload/mm/443/csaph-report3-i09.pdf|title=Use of Cannabis for Medicinal Purposes|work=Report 3 of the Council on Science and Public Health (I-09)|publisher=American Medical Assn|accessdate=10 January 2010}}</ref>
* The ] – America's second largest physicians group<ref>{{cite web|url=http://www.acponline.org/advocacy/where_we_stand/other_issues/medmarijuana.pdf |format=PDF| title=Supporting Research into the Therapeutic Role of Marijuana |publisher=The ] |accessdate=15 August 2009 |year=2008}}</ref>
* ] – America's second largest cancer charity<ref>{{cite web|url =http://www.mpp.org/library/medical-marijuana-endorsements-and-statements-of-support.html |title=Medical Marijuana Endorsements and Statements of Support |publisher=] |accessdate=29 January 2008 |year=2007 |archiveurl = http://web.archive.org/web/20080314130122/http://www.mpp.org/library/medical-marijuana-endorsements-and-statements-of-support.html |archivedate = 14 March 2008}}</ref>
* ] opposes the use of marijuana except under medical supervision<ref>{{cite web|url =http://www.aafp.org/online/en/home/policy/policies/m/marijuana.html |title=Marijuana: Policy & Advocacy |publisher=] |accessdate=6 October 2009 |year=2009}}</ref>

Other medical organizations recommend a halt to using marijuana as a medicine in U.S.
* The ]<ref name="Prnewswire.com"/><ref name="Asam.org"/>
<gallery>
File:Map-of-US-state-cannabis-laws.png|United States cannabis laws.{{legend|#adff2f|States with medical cannabis laws}} {{legend|#6b8e23|States with decriminalization laws}} {{legend|#006400|States with both}} {{legend|#9B30FF|State with legalized cannabis}}</gallery>


== History == == History ==
{{Main|History of medical cannabis}}


=== Ancient China and Taiwan === === Ancient ===
Cannabis, called ''má'' ] (meaning "hemp; cannabis; numbness") or ''dàmá'' ] (with "big; great") in Chinese, was used in ] for fiber starting about 10,000 years ago.<ref>{{Cite book |first = Ernest L. |last = Abel |year = 1980 |chapter = Cannabis in the Ancient World |chapter-url = http://www.druglibrary.org/schaffer/hemp/history/first12000/1.htm |title = Marihuana: the first twelve thousand years |publisher = Plenum Publishers |location = New York City |isbn = 978-0-306-40496-2 |access-date = 29 October 2008 |archive-date = 28 June 2021 |archive-url = https://web.archive.org/web/20210628135448/https://www.druglibrary.org/schaffer/hemp/history/first12000/1.htm |url-status = live }}{{Page needed|date=August 2010}}</ref> The botanist ] 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."<ref>Li, Hui-Lin (1974). "An Archaeological and Historical Account of Cannabis in China", ''Economic Botany'' 28.4:437–48, p. 444.</ref> Emperor ], who was also a pharmacologist, wrote a book on treatment methods in 2737 BCE that included the medical benefits of cannabis. He recommended the substance for many ailments, including constipation, gout, rheumatism, and absent-mindedness.<ref name=autogenerated2>{{cite book |last = Bloomquist |first = Edward |title = Marijuana: The Second Trip |year = 1971 |publisher = Glencoe Press |location = California }}</ref> Cannabis is one of the ] in ].<ref name="Wong">{{Cite book |last = Wong |first = Ming |year = 1976 |title = La Médecine chinoise par les plantes |publisher = Tchou |location = Paris |oclc = 2646789 }}{{Page needed|date=August 2010}}</ref>
]. "Dà má" (] pronunciation) is the Chinese expression for cannabis, the first character meaning "big" and the second character meaning "hemp."]]


The ] ({{circa|1550 BCE}}) from ] describes medical cannabis.<ref name="ebers">{{unreliable source?|date=December 2013}} {{cite web |url = http://www.onlinepot.org/medical/eberspapyrus.htm |title = The Ebers Papyrus The Oldest (confirmed) Written Prescriptions For Medical Marihuana era 1,550 BC |publisher = onlinepot.org |access-date = 10 June 2008 |archive-date = 4 March 2016 |archive-url = https://web.archive.org/web/20160304080726/http://www.onlinepot.org/medical/eberspapyrus.htm }}</ref> The ancient Egyptians used hemp (cannabis) in ] for relieving the pain of ]s.<ref>{{Cite news |url = https://www.newscientist.com/channel/health/mg19626341.600-the-pharaohs-pharmacists.html |title = The Pharaoh's pharmacists |last = Pain |first = Stephanie |date = 15 December 2007 |work = New Scientist |publisher = Reed Business Information Ltd. |access-date = 4 September 2017 |archive-date = 21 May 2008 |archive-url = https://web.archive.org/web/20080521162813/http://www.newscientist.com/channel/health/mg19626341.600-the-pharaohs-pharmacists.html |url-status = live }}</ref>
Cannabis, called ''má'' ] (meaning "hemp; cannabis; numbness") or ''dàmá'' ] (with "big; great") in Chinese, was used in ] for fiber starting about 10,000 years ago.<ref>{{Cite book|first=Ernest L. |last=Abel |year=1980 |chapter=Cannabis in the Ancient World |chapterurl=http://www.druglibrary.org/schaffer/hemp/history/first12000/1.htm |title=Marihuana: the first twelve thousand years |publisher=Plenum Publishers |location=New York City |isbn=978-0-306-40496-2}}{{Page needed|date=August 2010}}</ref>
The botanist Li Hui-Lin 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."<ref>Li, Hui-Lin (1974). "An Archaeological and Historical Account of Cannabis in China", ''Economic Botany'' 28.4:437–448, p. 444.</ref> The oldest Chinese pharmacopeia, the (ca. 100 CE) '']'' 神農本草經 ("]'s ] Classic"), describes ''dama'' "cannabis".
<blockquote>The flowers when they burst (when the pollen is scattered) are called 麻蕡 or 麻勃 . The best time for gathering is the seventh day of the seventh month. The seeds are gathered in the ninth month. The seeds which have entered the soil are injurious to man. It grows in </nowiki>]] (in </nowiki>]] ...). The flowers, the fruit (seed) and the leaves are ]. The leaves and the fruit are said to be poisonous, but not the flowers and the kernels of the seeds.<ref>] (1895). ''Botanicon Sinicum: Notes on Chinese Botany from Native and Western Sources. Part III, Botanical Investigations in the Materia Medica of the Ancient Chinese''. Kelly & Walsh. .</ref></blockquote>


Surviving texts from ] 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.<ref>{{cite journal | vauthors = Touw M | title = The religious and medicinal uses of Cannabis in China, India and Tibet | journal = Journal of Psychoactive Drugs | volume = 13 | issue = 1 | pages = 23–34 | year = 1981 | pmid = 7024492 | doi = 10.1080/02791072.1981.10471447 }}</ref>
Emperor Shen-Nung, who was also a pharmacologist, wrote a book on treatment methods in 2737 that included the medical benefits of cannabis. He recommended the substance for many ailments, including constipation, gout, rheumatism, and absent-mindedness.<ref name=autogenerated2>{{cite book|last=Bloomquist|first=Edward|title=Marijuana: The Second Trip|year=1971|publisher=Glencoe Press|location=California}}</ref> ] lived many years later, yet he is credited with being the first person known to use cannabis as an ]. He reduced the plant to powder and mixed it with wine for administration.<ref>{{Cite book|last=de Crespigny |first=Rafe |year=2007 |title=A Biographical Dictionary of Later Han to the Three Kingdoms (23–220 CE) |location=] |publisher=] |isbn=978-90-04-15605-0 |page=332 |oclc=71779118}}</ref> In China, the era of Han Western, the 3rd century the great surgeon Hua Tuo conducts operations under anesthesia using Indian hemp. The Chinese term for anesthesia (麻醉: má zui ) is also composed of the ideogram which means hemp, followed by means of intoxication. ] says the Chinese evidence "proves a knowledge of the narcotic properties of ''Cannabis'' at least from the 1st millennium B.C." when ''ma'' was already used in a secondary meaning of "numbness; senseless." "Such a strong drug, however, suggests that the Chinese pharmacists had now obtained from far to the southwest not THC-bearing ''Cannabis sativa'' but ''Cannabis indica'', so strong it knocks you out cold.<ref>Barber, Elizabeth Wayland. (1992). ''Prehistoric Textiles: The Development of Cloth in the Neolithic and Bronze Ages with Special Reference to the Aegean''. Princeton University Press. p. 38.</ref>


The ] used cannabis to dress wounds and sores on their horses,<ref name="hawthorne">{{cite journal |doi = 10.1300/J175v02n02_04 |title = The Medical Use of Cannabis Among the Greeks and Romans |year = 2002 |last1 = Butrica |first1 = James L. |journal = Journal of Cannabis Therapeutics |volume = 2 |issue = 2 |pages = 51–70 |url = http://www.cannabis-med.org/data/pdf/2002-02-3.pdf |access-date = 8 November 2014 |archive-date = 11 November 2014 |archive-url = https://web.archive.org/web/20141111224607/http://www.cannabis-med.org/data/pdf/2002-02-3.pdf }}</ref> and in humans, dried leaves of cannabis were used to treat nose bleeds, and cannabis seeds were used to expel tapeworms.<ref name="hawthorne" />
Cannabis is one of the ] in ],<ref name="Wong"/> and is prescribed to treat diverse indications.
<blockquote>Every part of the hemp plant is used in medicine; the dried flowers (勃), the ] (蕡), the seeds (麻仁), the oil (麻油), the leaves, the stalk, the root, and the juice. The flowers are recommended in the 120 different forms of (風 ''feng'') disease, in menstrual disorders, and in wounds. The achenia, which are considered to be poisonous, stimulate the nervous system, and if used in excess, will produce hallucinations and staggering gait. They are prescribed in nervous disorders, especially those marked by local anaesthesia. The seeds, by which is meant the white kernels of the achenia, are used for a great variety of affections, and are considered to be tonic, ], alterative, ], ], ], ], and corrective. They are made into a ] by boiling with water, mixed with wine by a particular process, made into pills, and beaten into a paste. A very common mode of exhibition, however, is by simply eating the kernels. It is said that their continued use renders the flesh firm and prevents old age. They are prescribed internally in fluxes, post-partum difficulties, ] poisoning, ] poisoning, constipation, and obstinate vomiting. Externally they are used for eruptions, ]s, ], wounds, and falling of the hair. The oil is used for falling hair, sulfur poisoning, and dryness of the throat. The leaves are considered to be poisonous, and the freshly expressed juice is used as an ], in scorpion stings, to stop the hair from falling out and to prevent it from turning gray. They are especially thought to have antiperiodic properties (prevention of regular recurrence of the symptoms of a disease). The stalk, or its bark, is considered to be diuretic, and is used with other drugs in gravel. The juice of the root is used for similar purposes, and is also thought to have a beneficial action in retained placenta and post-partum hemorrhage. An infusion of hemp (for the preparation of which no directions are given) is used as a demulcent drink for quenching thirst and relieving fluxes.<ref>Smith, Frederick Porter (1911). ''Chinese Materia Medica: Vegetable Kingdom''. Shanghai: American Presbyterian Mission Press. pp. 90–91.</ref></blockquote>


In the ], ] made use of the ], ], ], ], ] and ] properties of '']'', and used it extensively as medication from the 8th to 18th centuries.<ref>{{cite journal |doi = 10.1300/J175v01n01_05 |title = The Therapeutic Use of Cannabis sativa (L.) in Arabic Medicine |year = 2001 |last1 = Lozano |first1 = Indalecio |journal = Journal of Cannabis Therapeutics |volume = 1 |pages = 63–70 |citeseerx = 10.1.1.550.1717 }}</ref>
=== Ancient Egypt ===
] (ca. 1550 BCE) from ] has a prescription for medical marijuana applied directly for inflammation.]]


=== Landrace strains ===
The ] (ca. 1550 BCE) from ] describes medical cannabis.<ref name="ebers">
], ''Cannabis ruderalis'', still grows wild today.]]
{{cite web
|url=http://www.onlinepot.org/medical/eberspapyrus.htm
|title=The Ebers Papyrus The Oldest (confirmed) Written Prescriptions For Medical Marihuana era 1,550 BC
|publisher=onlinepot.org
|accessdate=2008-06-10
}}
</ref> Other ancient Egyptian papyri that mention medical cannabis are the ] (1700 BC), the ] (1300 BCE) and the ] VI (1300 BCE).<ref>
{{cite web
|url=http://www.reefermadnessmuseum.org/history/AEgyptian.htm
|title=History of Cannabis
|publisher=reefermadnessmuseum.org
|accessdate=2008-07-09
|archiveurl = http://web.archive.org/web/20080525095053/http://www.reefermadnessmuseum.org/history/AEgyptian.htm |archivedate = 25 May 2008}}
</ref> The ]ians even used hemp (cannabis) in ] for relieving the pain of ]s.<ref>{{Cite news|url=http://www.newscientist.com/channel/health/mg19626341.600-the-pharaohs-pharmacists.html |title=The Pharaoh's pharmacists |last=Pain |first=Stephanie |date=15 December 2007 |work=New Scientist |publisher=Reed Business Information Ltd.}}</ref> Around 2,000 BCE, the ancient Egyptians used cannabis to treat sore eyes.<ref>(Webley, Kayla. "Brief History: Medical Marijuana." Time 21 June 2010.)</ref> The ] Lise Manniche notes the reference to "plant medical cannabis" in several Egyptian texts, one of which dates back to the eighteenth century BCE.<ref>Lise Manniche, ''An Ancient Egyptian Herbal'', University of Texas Press, 1989, ISBN 978-0-292-70415-2{{Page needed|date=August 2010}}</ref>


Cannabis seeds may have been used for food, rituals or religious practices in ancient Europe and China.<ref name = "Holland_2018">{{cite book|editor=Holland, Julie|title=The Pot Book: A Complete Guide to Cannabis|date=2010|publisher=Simon and Schuster|location=New York|isbn=978-1-59477-898-8|access-date=22 April 2018|url=https://books.google.com/books?id=tV0oDwAAQBAJ|archive-date=13 January 2023|archive-url=https://web.archive.org/web/20230113004529/https://books.google.com/books?id=tV0oDwAAQBAJ|url-status=live}}</ref>{{rp|19–22}} Harvesting the plant led to the spread of cannabis throughout ] about 10,000 to 5,000 years ago, with further distribution to the ] and Africa about 2,000 to 500 years ago.<ref name = "Holland_2018" />{{rp|18–19}} A ] ] of cannabis developed over centuries.<ref>{{cite book|last1=Evert|first1=Ray F.|last2=Eichhorn|first2=Susan E. |title=Raven Biology of Plants|date=2013|publisher=W. H. Freeman and Company|location=New York|isbn=978-1-4292-1961-7|pages=213–17|edition=8th}}</ref> They are cultivars of the plant that originated in one specific region.
==== Ramesseum III Papyrus (1700 BCE) ====
{{main|Ramesseum medical papyri}}


Widely cultivated strains of cannabis, such as "Afghani" or "Hindu Kush", are indigenous to the ] and ] regions, while "Durban Poison" is native to Africa.<ref name = "Holland_2018" />{{rp|45–48}} There are approximately 16 landrace strains of cannabis identified from Pakistan, Jamaica, Africa, Mexico, Central America and Asia.<ref>{{cite book|last1=Evert|first1=Ray F.|last2=Eichhorn|first2=Susan E. |title=Raven Biology of Plants|date=2013|publisher=W.H. Freeman and Company|location=New York|isbn=978-1-4292-1961-7|pages=501–04|edition=8th}}</ref>
Papyrus Ramassei III, col. 26:<br/>
<hiero>V31\:X1-F48:X1:Z1*Z1*Z1*N33-U1:X1*X1-M2-N37:G17-N37:G17*X1-M2:Z2-N29:N35-N29:N35-Z9-A55-N35-D26-N4-M17-D36:N35:N35:N35-D4:D4-N35:O34-A1-M17-G17-N14-G1-F35-N5:Z7*Z4</hiero>
<span>K.t p<span style="text-decoration:underline;">h</span>r.t</span>: mɜt.t šmšm.t qnqn, s<span style="text-decoration:underline;">d</span>r n ỉɜd.t, ỉ<sup>c</sup> ỉr.ty n=s ỉm dwɜy<br/>
<span>''Alia praecepta''</span>: parsley, hemp and obey, in the dew of rest, wash eyes in that early in the morning


=== Ancient India === === Modern ===
An Irish physician, ], is credited with introducing cannabis to Western medicine.<ref name=Mack>{{cite book |author1 = Alison Mack |author2 = Janet Joy |title = Marijuana As Medicine?: The Science Beyond the Controversy |url = https://books.google.com/books?id=ZriSkC7aQOEC&pg=PA15 |year = 2000 |publisher = National Academies Press |isbn = 978-0-309-06531-3 |pages = 15– |access-date = 20 December 2015 |archive-date = 13 January 2023 |archive-url = https://web.archive.org/web/20230113004529/https://www.google.com/books/edition/Marijuana_As_Medicine/ZriSkC7aQOEC?hl=en&gbpv=1&pg=PA15&printsec=frontcover |url-status = live }}</ref> O'Shaughnessy discovered cannabis in the 1830s while living abroad in ], where he conducted numerous experiments investigating the drug's medical utility (noting in particular its ] and ] effects).<ref name="Booth">{{cite book |last1 = Booth |first1 = Martin |title = Cannabis: A History |year=2005 |publisher = St. Martin's Press |location = New York |isbn = 978-0-312-42494-7 }}</ref> He returned to ] with a supply of cannabis in 1842, after which its use spread through Europe and the United States.<ref name="Grinspoon">{{cite book |last1 = Grinspoon |first1 = Lester |last2 = Bakalar |first2 = James |title = Marihuana, the Forbidden Medicine |date = 1997 |publisher = Yale University Press |isbn = 978-0-300-07086-6 |edition = Revised and expanded }}</ref> In 1845 French physician ] published a book about the use of cannabis in psychiatry.<ref>Hans Bangen:''Geschichte der medikamentösen Therapie der Schizophrenie.'' Berlin 1992, p. 22.</ref> In 1850 cannabis was entered into the ].<ref name="Booth" /> An anecdotal report of '']'' as a treatment for ] appeared in ] in 1880.<ref>{{Cite book|url=https://books.google.com/books?id=6ok9AQAAIAAJ|title=Scientific American, "Successful Treatment of Tetanus"|date=1880-07-10|publisher=Munn & Company|page=25|language=en|access-date=5 June 2021|archive-date=12 January 2023|archive-url=https://web.archive.org/web/20230112202810/https://books.google.com/books?id=6ok9AQAAIAAJ|url-status=live}}</ref>
Cannabis was a major component in religious practices in ancient India as well as in medicinal practices. For many centuries, most parts of life in ancient India incorporated cannabis of some form.<ref name=autogenerated2 /> Surviving texts from ] confirm that cannabis' psychoactive properties were recognized, and doctors used it for treating a variety of illnesses and ailments. These included insomnia, headaches, a whole host of gastrointestinal disorders, and pain: cannabis was frequently used to relieve the pain of childbirth.<ref>{{cite journal |doi=10.1080/02791072.1981.10471447 |title=The Religious and Medicinal Uses ofCannabisin China, India and Tibet |year=1981 |last1=Touw |first1=Mia |journal=Journal of Psychoactive Drugs |volume=13 |pages=23–34 |pmid=7024492 |issue=1}}</ref> One Indian philosopher expressed his views on the nature and uses of bhang (a form of cannabis), which combined religious thought with medical practices. "A guardian lives in the bhang leaf. …To see in a dream the leaves, plant, or water of bhang is lucky. …A longing for bhang foretells happiness. It cures dysentry and sunstroke, clears phlegm, quickens digestion, sharpens appetite, makes the tongue of the lisper plain, freshens the intellect and gives alertness to the body and gaiety to the mind. Such are the useful and needful ends for which in His goodness the Almighty made bhang."<ref name=autogenerated2 />


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 ]-derived drugs.<ref name="Grinspoon" /> Also, the advent of the hypodermic ] allowed these drugs to be injected for immediate effect, in contrast to cannabis which is not water-soluble and therefore cannot be injected.<ref name="Grinspoon" />
=== Ancient Greece ===
] used cannabis not only for human medicine, but also in ] to dress wounds and sores on their horses.<ref name="hawthorne">{{cite journal |doi=10.1300/J175v02n02_04 |title=The Medical Use of Cannabis Among the Greeks and Romans |year=2002 |last1=Butrica |first1=James L. |journal=Journal of Cannabis Therapeutics |volume=2 |issue=2 |pages=51}}</ref> ]]


In the United States, the medical use of cannabis further declined with the passage of the ], which imposed new regulations and fees on physicians prescribing cannabis.<ref>{{cite journal |last1 = Pacula |first1 = Rosalie Piccardo |title = State Medical Marijuana Laws: Understanding the Laws and Their Limitations |journal = Journal of Public Health Policy |date = February 2002 |doi = 10.2307/3343240 |url = http://impacteen.uic.edu/generalarea_PDFs/medicalmarijuanapaper100301.pdf |volume = 23 |issue = 4 |pages = 413–39 |jstor = 3343240 |pmid = 12532682 |citeseerx = 10.1.1.202.2274 |s2cid = 13389317 |access-date = 20 March 2018 |archive-date = 2 March 2021 |archive-url = https://web.archive.org/web/20210302173927/https://impacteen.uic.edu/generalarea_PDFs/medicalmarijuanapaper100301.pdf |url-status = live }}</ref> Cannabis was removed from the U.S. Pharmacopeia in 1941, and officially banned for any use with the passage of the ] of 1970.<ref name="Grinspoon" />
The ] used cannabis to dress wounds and sores on their horses.<ref name="hawthorne"/> In humans, dried leaves of cannabis were used to treat nose bleeds, and cannabis seeds were used to expel tapeworms.<ref name="hawthorne"/> The most frequently described use of cannabis in humans was to steep green seeds of cannabis in either water or wine, later taking the seeds out and using the warm extract to treat inflammation and pain resulting from obstruction of the ear.<ref name="hawthorne"/>


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 ] and ].<ref>{{cite news |last1 = Joy |first1 = Janet E. |last2 = Watson |first2 = Stanley J. |last3 = Benson |first3 = John A. |title = Marijuana and Medicine – Assessing the Science Base |url = http://medicalmarijuana.procon.org/sourcefiles/IOM_Report.pdf |publisher = National Academy Press |location = Washington, D.C. |date = 1999 |access-date = 28 July 2017 |archive-url = https://web.archive.org/web/20180123184348/https://medicalmarijuana.procon.org/sourcefiles/IOM_Report.pdf |archive-date = 23 January 2018 }}</ref> In 1996, ] became the first U.S. state to legalize medical cannabis in defiance of federal law.<ref>{{cite web |title = History of Marijuana as Medicine – 2900 BC to Present |url = http://medicalmarijuana.procon.org/view.timeline.php?timelineID=000026 |website = ProCon.org |access-date = 27 July 2017 |archive-date = 15 July 2017 |archive-url = https://web.archive.org/web/20170715175551/http://medicalmarijuana.procon.org/view.timeline.php?timelineID=000026 |url-status = live }}</ref> In 2001, ] became the first country to adopt a system regulating the medical use of cannabis.<ref>{{cite news |title = Marijuana's journey to legal health treatment: the Canadian experience |url = http://www.cbc.ca/news/health/marijuana-s-journey-to-legal-health-treatment-the-canadian-experience-1.799488 |access-date = 27 July 2017 |work = CBC News |date = 17 August 2009 |archive-date = 14 June 2017 |archive-url = https://web.archive.org/web/20170614170017/http://www.cbc.ca/news/health/marijuana-s-journey-to-legal-health-treatment-the-canadian-experience-1.799488 |url-status = live }}</ref>
In the 5th century BCE ], a Greek historian, described how the ] of the Middle East used cannabis in steam baths. These baths drove the people to a frenzied state.<ref name="hawthorne"/>


<gallery class="center" caption="" widths="200px" heights="150px">
=== South East Asia ===
File:Da-ma.png|The use of cannabis, at least as fiber, has been shown to go back at least 10,000 years in ]. "Dà má" (] pronunciation) is the Chinese expression for cannabis, the first character meaning "big" and the second character meaning "hemp".
Patani from Asia are primary natural producers of the ], ], ], ], ] and ] properties of '']'', and used it extensively for 'Kopi Kapuganja' and 'Pecel Ganja', as recreation food, drinks and relaxing medication for centuries.{{citation needed|date=September 2012}}
File:Drug bottle containing cannabis.jpg|''Cannabis indica'' fluid extract, American Druggists Syndicate, pre-1937
File:CannabisAmericana JLHopkins B.jpg|An advertisement for ''cannabis americana'' distributed by a pharmacist in New York in 1917
File:PEbers c41-bc.jpg|The ] ({{circa|1550 BCE}}) from Ancient Egypt has a prescription for medical marijuana applied directly for inflammation.
</gallery>


=== Medieval Islamic world === == Society and culture ==
In the ], ] made use of the ], ], ], ], ] and ] properties of '']'', and used it extensively as medication from the 8th to 18th centuries.<ref>{{cite journal |doi=10.1300/J175v01n01_05 |title=The Therapeutic Use of Cannabis sativa (L.) in Arabic Medicine |year=2001 |last1=Lozano |first1=Indalecio |journal=Journal of Cannabis Therapeutics |volume=1 |pages=63}}</ref>


=== Legal status ===
]'' from '']'', 512 AD]]
{{See also|Legality of cannabis by country}}


[[File:Map-of-world-medical-cannabis-laws.svg|thumb|right|380px|alt=Map of world medical cannabis laws|
== Modern history ==
'''Legal status of (whole-plant) medical cannabis worldwide''' (only '']''; may not reflect actual access in these countries)
] (1800)]]
----
{{legend|#0ea817|Legal as authorized by a physician}}
{{legend|#0d00f2|Legal for any use (no prescription required)}}
----
<small>See also ].</small>
]]


Countries that have legalized the medical use of cannabis include ],<ref>{{cite news |last1=Politi |first1=Daniel |title=Argentina to Allow Medicinal Marijuana to Be Grown at Home |url=https://www.nytimes.com/2020/11/12/world/americas/argentina-cannabis-marijuana.html |access-date=22 January 2023 |work=The New York Times |date=12 November 2020 |archive-date=23 January 2023 |archive-url=https://web.archive.org/web/20230123041514/https://www.nytimes.com/2020/11/12/world/americas/argentina-cannabis-marijuana.html |url-status=live }}</ref> ],<ref>{{cite news |last1=Jolly |first1=William |title=Medicinal Marijuana Legal In Australia |url=https://www.canstar.com.au/health-insurance/victoria-legalises-medicinal-marijuana/ |access-date=16 July 2018 |work=Canstar |date=28 February 2018 |archive-date=17 July 2018 |archive-url=https://web.archive.org/web/20180717013204/https://www.canstar.com.au/health-insurance/victoria-legalises-medicinal-marijuana/ |url-status=live }}</ref> ],<ref>{{cite news |last1=Ponieman |first1=Natan |title=Brazil Regulates Sale Of Medical Marijuana Products |url=https://www.benzinga.com/markets/cannabis/19/12/14924387/brazil-regulates-sale-of-medical-marijuana-products |access-date=10 December 2019 |work=Benzinga |date=3 December 2019 |archive-date=14 March 2021 |archive-url=https://web.archive.org/web/20210314045550/https://www.benzinga.com/markets/cannabis/19/12/14924387/brazil-regulates-sale-of-medical-marijuana-products |url-status=live }}</ref> ],<ref name="Motley">{{cite news|last1=Williams|first1=Sean|title=10 Countries (Aside From the U.S.) Where Some Form of Medical Marijuana Is Legal|url=https://www.fool.com/investing/general/2016/05/15/10-countries-aside-from-the-us-where-some-form-of.aspx|access-date=5 November 2017|work=The Motley Fool|date=15 May 2016|archive-date=11 November 2017|archive-url=https://web.archive.org/web/20171111152109/https://www.fool.com/investing/general/2016/05/15/10-countries-aside-from-the-us-where-some-form-of.aspx|url-status=live}}</ref> ],<ref name="Motley" /> ],<ref name="Motley" /> ],<ref>{{cite news |title=Costa Rica legalizes medicinal marijuana use, hemp growing |url=https://apnews.com/article/health-caribbean-marijuana-recreational-marijuana-costa-rica-7fc0e4e7b8881613210164f6acf6d9e8 |access-date=22 January 2023 |work=Associated Press |date=2 March 2022 |archive-date=7 March 2022 |archive-url=https://web.archive.org/web/20220307050530/https://apnews.com/article/health-caribbean-marijuana-recreational-marijuana-costa-rica-7fc0e4e7b8881613210164f6acf6d9e8 |url-status=live }}</ref> ],<ref>{{cite news|last1=Veselica|first1=Lajla|title=Croatia legalises marijuana for medical use|url=https://www.yahoo.com/news/croatia-allows-marijuana-medical-114920214.html|access-date=4 November 2017|work=Yahoo News|agency=AFP|date=15 October 2015|archive-date=14 March 2021|archive-url=https://web.archive.org/web/20210314045549/https://www.yahoo.com/news/croatia-allows-marijuana-medical-114920214.html}}</ref> ],<ref>{{cite news |title=Cyprus begins to distribute medical cannabis |url=http://in-cyprus.com/cyprus-begins-to-distribute-medical-cannabis |access-date=11 November 2017 |work=InCyprus |date=22 May 2017 |archive-url=https://web.archive.org/web/20170609034857/http://in-cyprus.com/cyprus-begins-to-distribute-medical-cannabis |archive-date=9 June 2017}}</ref> ],<ref name="Motley" /> ],<ref>{{cite web |title= Legal status of cannabis in Finland – An overview |url= https://sensiseeds.com/en/blog/legal-status-cannabis-finland-overview |website= Sensi Seeds |access-date= 4 November 2017 |archive-date= 14 March 2021 |archive-url= https://web.archive.org/web/20210314045550/https://sensiseeds.com/en/blog/countries/cannabis-in-finland-laws-use-history/ |url-status= live }}</ref> ],<ref>{{cite news |last1= Senthilingam |first1= Meera |title= Germany joins the global experiment on marijuana legalization |work= CNN.com |url= http://www.cnn.com/2016/12/29/health/global-marijuana-cannabis-laws/index.html |access-date= 4 November 2017 |date= 6 March 2017 |archive-date= 14 March 2021 |archive-url= https://web.archive.org/web/20210314045553/https://www.cnn.com/2016/12/29/health/global-marijuana-cannabis-laws/index.html |url-status= live }}</ref> ],<ref>{{cite news |last1= Revesz |first1=Rachael |title=Greece legalises marijuana for medical purposes |url= https://www.independent.co.uk/news/world/europe/greece-marijuana-legal-medical-cannabis-weed-law-passes-a7821771.html |archive-url=https://ghostarchive.org/archive/20220512/https://www.independent.co.uk/news/world/europe/greece-marijuana-legal-medical-cannabis-weed-law-passes-a7821771.html |archive-date=12 May 2022 |url-access=subscription |url-status=live |access-date=4 November 2017 |work= The Independent |date=3 July 2017}}</ref> ],<ref>{{cite news |last1=Schwartz |first1=Yardena |title=How the Booming Israeli Weed Industry Is Changing American Pot |work=Rollingstone.com |url=https://www.rollingstone.com/culture/features/how-booming-israeli-weed-industry-is-changing-american-pot-w499117 |access-date=4 November 2017 |date=24 August 2017 |archive-date=4 November 2017 |archive-url=https://web.archive.org/web/20171104043420/http://www.rollingstone.com/culture/features/how-booming-israeli-weed-industry-is-changing-american-pot-w499117 |url-status=live }}</ref> ],<ref>{{cite news |last=Samuels |first=Gabriel |title= Italian army aims to produce "the best-quality" medical marijuana after finding current batches deficient |url= https://www.independent.co.uk/news/world/europe/cannabis-italy-army-medical-marijuana-italian-military-produces-best-quality-weed-a7156176.html |archive-url=https://ghostarchive.org/archive/20220512/https://www.independent.co.uk/news/world/europe/cannabis-italy-army-medical-marijuana-italian-military-produces-best-quality-weed-a7156176.html |archive-date=12 May 2022 |url-access=subscription |url-status=live |access-date=4 November 2017 |work=The Independent |date=26 July 2016}}</ref> ],<ref>{{cite news |last1=Bud |first1=Monterey |title=Jamaica's Kaya Farms Becomes First Medical Marijuana Dispensary To Open |url=https://www.marijuana.com/news/2018/03/jamaicas-kaya-farms-becomes-first-medical-marijuana-dispensary-to-open |access-date=16 July 2018 |work=marijuana.com |date=19 March 2018 |archive-date=14 March 2021 |archive-url=https://web.archive.org/web/20210314045550/https://weedmaps.com/news/ |url-status=live }}</ref> ],<ref>{{cite news |url=https://www.nytimes.com/reuters/2020/04/21/world/middleeast/21reuters-lebanon-crisis-cannabis.html |title=Lebanon Legalizes Cannabis Farming for Medicinal Use |work=The New York Times |agency=Reuters |date=21 April 2020 |access-date=25 April 2020 |archive-date=23 April 2020 |archive-url=https://web.archive.org/web/20200423112646/https://www.nytimes.com/reuters/2020/04/21/world/middleeast/21reuters-lebanon-crisis-cannabis.html |url-status=live }}</ref> ],<ref>{{cite news |last1= Pritchard |first1= Heledd |title= Cannabis for medical use legalised in Luxembourg |url= https://luxtimes.lu/luxembourg/34274-cannabis-for-medical-use-legalised-in-luxembourg |access-date= 8 July 2018 |work= Luxembourg Times |date= 29 June 2018 |archive-date= 29 June 2018 |archive-url= https://web.archive.org/web/20180629104554/https://luxtimes.lu/luxembourg/34274-cannabis-for-medical-use-legalised-in-luxembourg |url-status= live }}</ref> ],<ref>{{cite news |last1=Pace |first1=Maria |title=Malta has officially legalised medical cannabis |url=https://www.maltatoday.com.mt/news/national/85616/malta_has_officially_legalised_medical_cannabis |access-date=24 August 2018 |work=Malta Today |date=27 March 2018 |archive-date=1 July 2021 |archive-url=https://web.archive.org/web/20210701160703/https://www.maltatoday.com.mt/news/national/85616/malta_has_officially_legalised_medical_cannabis |url-status=live }}</ref> ],<ref>{{cite news |title=Morocco: Bill to legalise cannabis enters into force |url=https://www.middleeastmonitor.com/20210731-morocco-bill-to-legalise-cannabis-enters-into-force/ |access-date=22 January 2023 |work=Middle East Monitor |date=31 July 2021 |archive-date=11 August 2021 |archive-url=https://web.archive.org/web/20210811195407/https://www.middleeastmonitor.com/20210731-morocco-bill-to-legalise-cannabis-enters-into-force/ |url-status=live }}</ref> the ],<ref name="Motley" /> ],<ref>{{cite news |last1=Ainge Roy |first1=Eleanor |title=New Zealand passes laws to make medical marijuana widely available |url=https://www.theguardian.com/world/2018/dec/11/new-zealand-passes-laws-to-make-medical-marijuana-widely-available |access-date=20 January 2019 |work=The Guardian |date=11 December 2018 |archive-date=13 January 2019 |archive-url=https://web.archive.org/web/20190113005629/https://www.theguardian.com/world/2018/dec/11/new-zealand-passes-laws-to-make-medical-marijuana-widely-available |url-status=live }}</ref> ],<ref>{{cite news |last1=Marusic |first1=Sinisa Jakov |title=Macedonia Allows Medical Marijuana in Pharmacies |url=http://www.balkaninsight.com/en/article/macedonia-allows-medical-marijuana-in-pharmacies-05-31-2016 |access-date=4 November 2017 |work=Balkan Insight |date=1 June 2016 |archive-date=31 October 2017 |archive-url=https://web.archive.org/web/20171031051345/http://www.balkaninsight.com/en/article/macedonia-allows-medical-marijuana-in-pharmacies-05-31-2016 |url-status=live }}</ref> ],<ref>{{cite news |title=El gobierno de Panamá legalizó el uso medicinal y terapéutico del cannabis |url=https://www.infobae.com/america/america-latina/2021/10/14/el-gobierno-de-panama-legalizo-el-uso-medicinal-y-terapeutico-del-cannabis/ |access-date=22 January 2023 |work=Infobae |date=14 October 2021 |archive-date=17 October 2021 |archive-url=https://web.archive.org/web/20211017212957/https://www.infobae.com/america/america-latina/2021/10/14/el-gobierno-de-panama-legalizo-el-uso-medicinal-y-terapeutico-del-cannabis/ |url-status=live }}</ref> ],<ref>{{cite news |last1=Collyns |first1=Dan |title=Peru legalises medical marijuana in move spurred by mother's home lab |url=https://www.theguardian.com/world/2017/oct/20/peru-marijuana-cannabis-legal-terminally-ill-children |access-date=4 Nov 2017 |work=The Guardian |date=20 October 2017 |archive-date=3 July 2018 |archive-url=https://web.archive.org/web/20180703075436/https://www.theguardian.com/world/2017/oct/20/peru-marijuana-cannabis-legal-terminally-ill-children |url-status=live }}</ref> ],<ref>{{cite news |title=Medical use of cannabis officially legal in Poland |url=http://www.thenews.pl/1/9/Artykul/333153,Medical-use-of-cannabis-officially-legal-in-Poland |access-date=4 November 2017 |work=Radio Poland |agency=PAP |date=11 February 2017 |archive-date=14 March 2021 |archive-url=https://web.archive.org/web/20210314045554/https://connect.facebook.net/en_US/fbds.js }}</ref> ],<ref>{{cite news |last1=Lamers |first1=Matt |title=Portugal passes medical cannabis law, opens domestic market |url=https://mjbizdaily.com/portugal-passes-medical-cannabis-law-opens-domestic-market/ |access-date=24 August 2018 |work=Marijuana Business Daily |date=21 June 2018 |archive-date=5 September 2019 |archive-url=https://web.archive.org/web/20190905191222/https://mjbizdaily.com/portugal-passes-medical-cannabis-law-opens-domestic-market/ |url-status=live }}</ref> ],<ref>{{cite news |last1=Mwai |first1=Collins |title=10 things to know after Rwanda gives the green light for medical marijuana |url=https://www.newtimes.co.rw/article/187172/News/10-things-to-know-after-rwanda-gives-the-green-light-for-medical-marijuana |access-date=22 January 2023 |work=The New Times |date=29 June 2021 |archive-date=23 January 2023 |archive-url=https://web.archive.org/web/20230123022218/https://www.newtimes.co.rw/article/187172/News/10-things-to-know-after-rwanda-gives-the-green-light-for-medical-marijuana |url-status=live }}</ref> ],<ref>{{citation |title=South Asia Regional Profile |url=https://www.unodc.org/pdf/india/publications/south_Asia_Regional_Profile_Sept_2005/13_srilanka.pdf |access-date=2 February 2019 |publisher=United Nations Office on Drugs and Crime |date=15 September 2005 |archive-date=23 September 2020 |archive-url=https://web.archive.org/web/20200923171657/https://www.unodc.org/pdf/india/publications/south_Asia_Regional_Profile_Sept_2005/13_srilanka.pdf |url-status=live }}</ref> ],<ref>{{cite news |title=Switzerland to legalise medicinal cannabis from Monday |url=https://www.thelocal.ch/20220728/switzerland-to-legalise-medicinal-cannabis-from-monday |access-date=22 January 2023 |work=The Local |date=28 July 2022 |archive-url=https://web.archive.org/web/20220809105423/https://www.thelocal.ch/20220728/switzerland-to-legalise-medicinal-cannabis-from-monday/ |archive-date=9 August 2022}}</ref> ],<ref>{{cite news |last1=Mosbergen |first1=Dominique |title=Thailand Approves Medical Marijuana In Regional First |url=https://www.huffingtonpost.com/entry/thailand-medical-marijuana_us_5c22e6aae4b0407e907e7c18 |access-date=20 January 2019 |work=HuffPost |date=25 December 2018 |archive-date=19 January 2019 |archive-url=https://web.archive.org/web/20190119155356/https://www.huffingtonpost.com/entry/thailand-medical-marijuana_us_5c22e6aae4b0407e907e7c18 |url-status=live }}</ref> the ],<ref>{{cite news |title=Medicinal cannabis products to be legalised |url=https://www.bbc.co.uk/news/health-44968386 |access-date=28 July 2018 |work=BBC |date=26 July 2018 |archive-date=28 July 2018 |archive-url=https://web.archive.org/web/20180728045627/https://www.bbc.co.uk/news/health-44968386 |url-status=live }}</ref> and ].<ref name="Motley" /> Other countries have more restrictive laws that allow only the use of isolated cannabinoid drugs such as ] or ].<ref>{{cite web |title=Sativex (delta-9-tetrahydrocannabinol and cannabidiol) |url= https://www.gwpharm.com/products-pipeline/sativex-delta-9-tetrahydrocannabinol-and-cannabidiol |website=GW Pharmaceuticals |access-date=5 November 2017 |archive-url=https://web.archive.org/web/20171210062733/https://www.gwpharm.com/products-pipeline/sativex-delta-9-tetrahydrocannabinol-and-cannabidiol |archive-date=10 December 2017}}</ref><ref>{{citation |title=Medical use of cannabis and cannabinoids |url=http://www.emcdda.europa.eu/system/files/publications/10171/20185584_TD0618186ENN_PDF.pdf |publisher=European Monitoring Centre for Drugs and Drug Addiction |date=December 2018 |access-date=11 December 2019 |archive-date=28 June 2021 |archive-url=https://web.archive.org/web/20210628171058/https://www.emcdda.europa.eu/system/files/publications/10171/20185584_TD0618186ENN_PDF.pdf |url-status=live }}</ref> Countries with the most relaxed policies include Canada,<ref>{{cite news |last=Sapra |first=Bani |title=Canada becomes second nation in the world to legalize marijuana |url=https://www.cnn.com/2018/06/20/health/canada-legalizes-marijuana/index.html |access-date=3 July 2018 |work=CNN |date=20 June 2018 |archive-date=12 February 2019 |archive-url=https://web.archive.org/web/20190212125138/https://www.cnn.com/2018/06/20/health/canada-legalizes-marijuana/index.html |url-status=live }}</ref> the Netherlands,<ref name="Motley" /> Thailand,<ref>{{cite news |last1=Ives |first1=Mike |title=Weed Is Now Legal in Thailand. How Long Will the High Times Last? |url=https://www.nytimes.com/2022/11/10/world/asia/thailand-weed-cannabis-law.html |access-date=22 January 2023 |work=The New York Times |date=10 November 2022 |archive-url=https://web.archive.org/web/20221127104321/https://www.nytimes.com/2022/11/10/world/asia/thailand-weed-cannabis-law.html |archive-date=27 November 2022}}</ref> and Uruguay,<ref name="Motley" /> where cannabis can be purchased without need for a prescription. In ], THC content of medical cannabis is limited to one percent.<ref>{{cite news |last1= Janikian |first1= Michelle |title= Legal Pot In Mexico: Everything You Need to Know |url= https://www.rollingstone.com/culture/features/legal-pot-in-mexico-everything-you-need-to-know-w503038 |access-date= 5 November 2017 |magazine= Rolling Stone |date= 14 September 2017 |archive-date= 11 November 2017 |archive-url= https://web.archive.org/web/20171111151947/http://www.rollingstone.com/culture/features/legal-pot-in-mexico-everything-you-need-to-know-w503038 |url-status= live }}</ref> In the ], the legality of medical cannabis varies by state.<ref name="NCSL" />
An Irish physician, ], is credited with introducing the therapeutic use of cannabis to Western medicine. He was Assistant-Surgeon and Professor of Chemistry at the Medical College of ], and conducted a cannabis experiment in the 1830s, first testing his preparations on animals, then administering them to patients to help treat muscle spasms, stomach cramps or general pain.<ref name=Mack>{{Cite book
|last = Mack
|first = Allyson
|coauthors = Janet Elizabeth Joy
|title = Marijuana as Medicine?: The Science Beyond the Controversy
|publisher = National Academy Press
|year = 2001
|isbn =0309065313
}}{{page needed|date=November 2013}}</ref>


However, in many of these countries, access may not always be possible under the same conditions.
Cannabis as a medicine became common throughout much of the Western world by the 19th century. In the 19th century was cannabis one of the secret ingredients in several so called ]. There were at least 2000 cannabis medicines prior to 1937, produced by over 280 manufacturers.<ref>. antiquecannabisbook.com (16 March 2012). Retrieved 2012-05-19.</ref> Cannabis was used as the primary pain reliever until the invention of ].<ref name="bbchistory">{{Cite news |url=http://news.bbc.co.uk/1/hi/programmes/panorama/1632726.stm |title=History of Cannabis |publisher=BBC News |date=2 November 2001 |accessdate=17 August 2011}}</ref> A Swedish lexicon printed in 1912 describes the cannabis drug and extract as a "deserted" method for medical treatment.<ref>{{cite web |url=http://runeberg.org/nf/hasjisj.html |title=Hasjisj in Nordisk Famijebok 1912 |publisher=Runeberg.org |language=sv |accessdate=2012-01-15}}</ref>


==== International law ====
Modern medical and scientific inquiry began with doctors like ] and ], who used it to treat ] and ]s, and as a sleeping aid, analgesic and ]. At the local level authorities introduced various laws that required the mixtures that contained cannabis, that was not sold on prescription, must be marked with warning labels under the so-called poison laws.<ref>{{cite journal |title=The Newsweekly for Pharmacy |journal=] |volume=28 |publisher=Benn Brothers |year=1886 |location=London, New York City, Melbourne |pages=68, 330 |url=http://books.google.com/books?id=qiPOAAAAMAAJ }}</ref> In 1905 ] published an exposé entitled "The Great American Fraud" in '']'' about the ] that led to the passage of the first ] in 1906.<ref>{{cite book |title=The Great American Fraud (4th ed., 1907) |last=Adams |first=Samuel Hopkins |authorlink=Samuel Hopkins Adams |coauthors= |year=1905 |publisher=American Medical Association |location=Chicago |isbn= |page= |pages= |url=http://books.google.com/?id=oH0xqp0M-U0C |accessdate=2009-07-30}}</ref> This ] did not ban the alcohol, narcotics, and stimulants in the medicines; rather, it required medicinal products to be labeled as such and curbed some of the more misleading, overstated, or ]ulent claims that previously appeared on labels.
{{See also|Removal of cannabis and cannabis resin from Schedule IV of the Single Convention on narcotic drugs, 1961}}


Cannabis and its derivatives are subject to regulation under three ] ]: the 1961 ], the 1971 ], and the 1988 ].<ref>{{cite journal |last1=Habibi |first1=Roojin |last2=Hoffman |first2=Steven J. |title=Legalizing Cannabis Violates the UN Drug Control Treaties, But Progressive Countries Like Canada Have Options |journal=Ottawa Law Review |date=March 2018 |volume=49 |issue=2 |url=https://www.researchgate.net/publication/323697447 |access-date=8 January 2021 |archive-date=28 August 2021 |archive-url=https://web.archive.org/web/20210828161532/https://www.researchgate.net/publication/323697447_Legalizing_Cannabis_Violates_the_UN_Drug_Control_Treaties_But_Progressive_Countries_Like_Canada_Have_Options |url-status=live }}</ref>
The product "Maltos-cannabis" was sold based upon a claim from its manufacturer that it contained ] sugar from hemp seeds (maltose sugar can also be obtained from the process of softening and germinating grain in water). It is likely that Maltose-cannabis contained a very low percentage of THC.<ref></ref>
]


Cannabis and cannabis resin are classified as a Schedule I drug under the Single Convention treaty, meaning that medical use is considered "indispensible for the relief of pain and suffering" but that it is considered to be an addictive medication with risks of abuse.<ref>{{cite web |title=Classification of controlled drugs |url=https://www.emcdda.europa.eu/publications/topic-overviews/classification-of-controlled-drugs/html_en |website=European Monitoring Centre for Drugs and Drug Addiction |access-date=7 January 2021 |archive-date=8 January 2021 |archive-url=https://web.archive.org/web/20210108164743/https://www.emcdda.europa.eu/publications/topic-overviews/classification-of-controlled-drugs/html_en |url-status=live }}</ref> Countries have an obligation to provide access and sufficient availability of drugs listed in Schedule I for the purposes of medical uses.<ref>{{Cite book |last=] |url=https://syntheticdrugs.unodc.org/uploads/syntheticdrugs/res/library/access_html/2010.pdf |title=Report of the International Narcotics Control Board on the Availability of Internationally Controlled Drugs: Ensuring Adequate Access for Medical and Scientific Purposes |publisher=] |year=2010 |location=Vienna}}</ref><ref>{{Cite web |last=International Centre on Human Rights and Drug Policy (]), ], ], ], ] |date=2012 |title=Obligations arising from human rights standards: Access to controlled substances as medicines |url=https://www.humanrights-drugpolicy.org/guidelines/obligations-arising-from-human-rights-standards/access-to-controlled-substances-as-medicines/ |access-date=2024-08-30 |website=International Guidelines on Human Rights and Drug Policy}}</ref>
Later in the century, researchers investigating methods of detecting cannabis intoxication discovered that smoking the drug reduced ].<ref>{{cite web|url=http://www.zauberpilz.com/golden/g31-40.htm |title=Golden Guide |publisher=zauberpilz.com}}</ref> In 1955 the antibacterial effects were described at the ]. Since 1971 ] was growing cannabis for his scientific research on two large fields in authority of the University. The marijuana extracts were then used at the University hospital as a cure for aphthae and haze.<ref name="blisty1">{{cz icon}} {{cite web |url=http://blisty.cz/art/42801.html |title=Nad léčivými jointy s Lumírem Hanušem |accessdate=2011-05-03 |publisher=blisty.cz}}</ref> In 1973 physician ] reignited the debate concerning cannabis as medicine when he published "Marijuana Medical Papers". High intraocular pressure causes blindness in ] patients, so he hypothesized that using the drug could prevent blindness in patients. Many ] veterans also found that the drug prevented muscle spasms caused by spinal injuries suffered in battle.<ref>{{Cite book
|last = Zimmerman
|first = Bill
|coauthors = Nancy Crumpacker and Rick Bayer
|title = Is Marijuana the Right Medicine for You?: A Factual Guide to Medical Uses of Marijuana
|publisher = Keats Publishing
|year = 1998
|isbn = 0-87983-906-6
}}{{Page needed|date=August 2010}}</ref> Later medical use focused primarily on its role in preventing the ] syndromes and chronic loss of appetite associated with ] and AIDS, along with a variety of rare muscular and skeletal disorders.


Prior to December 2020 cannabis and cannabis resin were also included in Schedule IV, a more restrictive level of control, which is for only the most dangerous drugs such as heroin and fentanyl.<ref>{{cite news |last1=Kaur |first1=Harmeet |title=The UN removes cannabis from a list of the most dangerous substances |url=https://www.cnn.com/2020/12/02/health/un-reclassifies-cannabis-scn-trnd/index.html |access-date=7 January 2021 |work=CNN |date=2 December 2020 |archive-date=12 December 2020 |archive-url=https://web.archive.org/web/20201212164024/https://www.cnn.com/2020/12/02/health/un-reclassifies-cannabis-scn-trnd/index.html |url-status=live }}</ref> They were removed after an independent scientific assessment by the ] in 2018-1029.
In 1964, Dr. Albert Lockhart and Manley West began studying the health effects of traditional cannabis use in ] communities. They discovered that ]s had unusually low glaucoma rates and local fishermen were washing their eyes with cannabis extract in the belief that it would improve their sight. Lockhart and West developed, and in 1987 gained permission to market, the pharmaceutical ]: one of the first cannabis extracts. They continued to work with cannabis, developing more pharmaceuticals and eventually receiving the ] for their work.<ref name="FFY"/>


Member nations of the ] voted 27–25 to remove it from Schedule IV on 2 December 2020,<ref>{{cite news |last1=Kwai |first1=Isabella |title=U.N. Reclassifies Cannabis as a Less Dangerous Drug |url=https://www.nytimes.com/2020/12/02/world/europe/cannabis-united-nations-drug-policy.html |access-date=7 January 2021 |work=The New York Times |date=2 December 2020 |archive-date=10 January 2021 |archive-url=https://web.archive.org/web/20210110040927/https://www.nytimes.com/2020/12/02/world/europe/cannabis-united-nations-drug-policy.html |url-status=live }}</ref> following a ] recommendation for removal in January 2019.<ref>{{cite news |title=WHO recommends rescheduling of cannabis |url=https://www.emcdda.europa.eu/news/2019/who-recommends-rescheduling-of-cannabis_en |access-date=7 January 2021 |work=European Monitoring Centre for Drugs and Drug Addiction |date=25 March 2019 |archive-date=28 December 2020 |archive-url=https://web.archive.org/web/20201228094221/https://www.emcdda.europa.eu/news/2019/who-recommends-rescheduling-of-cannabis_en |url-status=live }}</ref><ref>{{cite news |last1=Georgiou |first1=Aristos |title=WHO Recommends Rescheduling Cannabis in International Law for First Time in History |url=https://www.newsweek.com/who-recommends-rescheduling-cannabis-international-law-first-time-history-1324613 |access-date=7 January 2021 |work=Newsweek |date=8 February 2019 |archive-date=20 December 2020 |archive-url=https://web.archive.org/web/20201220172821/https://www.newsweek.com/who-recommends-rescheduling-cannabis-international-law-first-time-history-1324613 |url-status=live }}</ref>
Later, in the 1970s, a ] version of ] was produced and approved for use in the United States as the drug ]. It was delivered as a capsule, to be swallowed. Patients complained that the violent nausea associated with chemotherapy made swallowing capsules difficult. Further, along with ingested cannabis, capsules are harder to ] accurately than smoked cannabis because their onset of action is so much slower. Smoking has remained the route of choice for many patients because its onset of action provides almost immediate relief from symptoms and because that fast onset greatly simplifies titration. For these reasons, and because of the difficulties arising from the way cannabinoids are metabolized after being ingested, oral dosing is probably the least satisfactory route for cannabis administration.<ref name="Lancet2003">{{cite journal |doi=10.1016/S1474-4422(03)00381-8 |title=The therapeutic potential of cannabis |year=2003 |last1=Baker |first1=David |last2=Pryce |first2=Gareth |last3=Giovannoni |first3=Gavin |last4=Thompson |first4=Alan J |journal=The Lancet Neurology |volume=2 |issue=5 |pages=291}}</ref> Relatedly, some studies have indicated that at least some of the beneficial effects that cannabis can provide may derive from ] among the multiplicity of cannabinoids and other chemicals present in the dried plant material.<ref>{{cite journal |doi=10.1300/J175v01n03_08 |title=Cannabis and Cannabis Extracts |year=2001 |last1=McPartland |first1=John M. |last2=Russo |first2=Ethan B. |journal=Journal of Cannabis Therapeutics |volume=1 |issue=3–4 |pages=103}}</ref> Such synergy is, by definition, impossible with respect to the use of single-cannabinoid drugs like Marinol.


==== United States ====
During the 1970s and 1980s, six U.S. states' health departments performed studies on the use of medical cannabis. These are widely considered some of the most useful and pioneering studies on the subject.{{Citation needed|date=February 2007}} Voters in eight states showed their support for cannabis prescriptions or recommendations given by physicians between 1996 and 1999, including Alaska, Arizona, California, Colorado, Maine, Michigan, Nevada, Oregon, and Washington, going against policies of the federal government.<ref>{{Cite book|title=Marijuana As Medicine |author=Mack,Alison ; Joy, Janet |publisher=National Academy Press |year=2001 |isbn=0-309-06531-3}}{{Page needed|date=August 2010}}</ref> In May 2001, "The Chronic Cannabis Use in the ]: An Examination of Benefits and Adverse Effects of Legal Clinical Cannabis" (Russo, Mathre, Byrne et al.) was completed. This three-day examination of major body functions of four of the five living US federal cannabis patients found "mild ] changes" in two patients.<ref>{{cite journal |doi=10.1300/J175v02n01_02 |title=Chronic Cannabis Use in the Compassionate Investigational New Drug Program |year=2002 |last1=Russo |first1=Ethan |last2=Mathre |first2=Mary Lynn |last3=Byrne |first3=Al |last4=Velin |first4=Robert |last5=Bach |first5=Paul J. |last6=Sanchez-Ramos |first6=Juan |last7=Kirlin |first7=Kristin A. |journal=Journal of Cannabis Therapeutics |volume=2 |pages=3}}</ref>
{{See also|Medical cannabis in the United States}}


In the United States, the use of cannabis for medical purposes is legal in 38 states, four out of five permanently inhabited ], and the ].<ref name="NCSL">{{cite web |title = State Medical Marijuana Laws |url = http://www.ncsl.org/research/health/state-medical-marijuana-laws.aspx |website = National Conference of State Legislatures |date = 12 September 2022 |access-date = 6 October 2022 |archive-date = 11 December 2018 |archive-url = https://web.archive.org/web/20181211125951/http://www.ncsl.org/research/health/state-medical-marijuana-laws.aspx |url-status = live }}</ref> An additional 10 states have more restrictive laws allowing the use of low-THC products.<ref name="NCSL" /> Cannabis remains illegal at the federal level under the ], which classifies it as a Schedule I drug with a high potential for abuse and no accepted medical use. In December 2014, however, the ] was signed into law, prohibiting the ] from prosecuting individuals acting in accordance with state medical cannabis laws.<ref>{{cite news |last1 = Ingraham |first1 = Christopher |title = Jeff Sessions personally asked Congress to let him prosecute medical-marijuana providers |url = https://www.washingtonpost.com/news/wonk/wp/2017/06/13/jeff-sessions-personally-asked-congress-to-let-him-prosecute-medical-marijuana-providers/ |access-date = 9 July 2017 |newspaper = The Washington Post |date = 13 June 2017 |archive-date = 4 July 2017 |archive-url = https://web.archive.org/web/20170704095547/https://www.washingtonpost.com/news/wonk/wp/2017/06/13/jeff-sessions-personally-asked-congress-to-let-him-prosecute-medical-marijuana-providers/ |url-status = live }}</ref>
Among the more than 108,000 persons in Colorado who in 2012 had received a certificate in Colorado of a doctor recommending them to use marijuana for medical purposes stated 94% severe pain be the reason for the requested certificate, 3% cancer and 1% HIV/Aids. The typical card holder was 41 year old man and that is not the normal pattern for patients with pain problems. 12 doctors had issued 50% of the certificates.<ref></ref>


In the US, the FDA has approved two oral cannabinoids for use as medicine in 1985:<ref>{{cite news |last1=Clark |first1=Amy |date=16 May 2006 |title="New" Pot Pill For Chemo Patients |url=http://www.cbsnews.com/news/new-pot-pill-for-chemo-patients/ |url-status=live |archive-url=https://web.archive.org/web/20170728172927/http://www.cbsnews.com/news/new-pot-pill-for-chemo-patients/ |archive-date=28 July 2017 |access-date=26 July 2017 |work=CBS News |agency=Associated Press}}</ref> ] (pure delta-9-THC; brand name Marinol) and ] (a ]; brand name Cesamet).<ref name="Borgelt2013" /> In the US, they are both listed as Schedule II, indicating high potential for side effects and addiction.<ref name="Svrakic2012" /><ref>{{cite web |title=Final Rule: Placement of FDA-Approved Products of Oral Solutions Containing Dronabinol in Schedule II |url=https://www.deadiversion.usdoj.gov/fed_regs/rules/2017/fr1122_6.htm |archive-url=https://web.archive.org/web/20180328121003/https://www.deadiversion.usdoj.gov/fed_regs/rules/2017/fr1122_6.htm |archive-date=28 March 2018 |access-date=2 February 2018 |website=U.S. Department of Justice}}</ref>
== National and international regulations ==
{{Main|Legal and medical status of cannabis}}
] possession for medical purposes]]


=== Economics ===
Medical use of cannabis or preparation containing THC as the active substance is legalized in Canada, Belgium, Austria, Netherlands, UK, Spain, Israel, Finland and some states in the U.S., although it is still illegal under U.S. federal law.


==== Distribution ====
Cannabis is in Schedule IV of the United Nations' ], making it subject to special restrictions. Article 2 provides for the following, in reference to Schedule IV drugs:<ref name="Single Convention">{{cite web|url=http://www.unodc.org/unodc/en/treaties/single-convention.html|title=Single Convention on Narcotic Drugs, 1961 As amended by the 1972 Protocol|date=13 March 1961|work=]|publisher=United Nations|pages=2–3|accessdate=17 August 2009|format=PDF}}</ref>
] ]]


The method of obtaining medical cannabis varies by region and by legislation. In the US, most consumers grow their own or buy it from ] in states where it is legal.<ref name=Borgelt2013 /><ref name=BaltSun>{{cite news |url = http://www.baltimoresun.com/news/maryland/sun-investigates/bs-md-medical-marijuana-fees-20141011,0,3253557.story?page=1 |title = Medical marijuana fees stir debate in Maryland |newspaper = The Baltimore Sun |author = Timothy B. Wheeler |date = 11 October 2014 |access-date = 12 October 2014 |archive-date = 16 October 2014 |archive-url = https://web.archive.org/web/20141016223445/http://www.baltimoresun.com/news/maryland/sun-investigates/bs-md-medical-marijuana-fees-20141011,0,3253557.story?page=1 }}</ref> ]s for selling or dispensing cannabis are in use in the United States and are planned to be used in Canada.<ref name=FirstForeignMarket>{{cite news |url = http://news.nationalpost.com/2013/10/16/pot-vending-machines-to-start-rolling-into-canada-after-firm-partners-with-u-s-company/ |title = The pot vending machine's first foreign market? Canada, of course, "a seed for the rest of the world" |newspaper = National Post |author = Blackwell, Tom |date = 16 October 2013 |access-date = 4 December 2013 }}</ref> In 2014, the startup Meadow began offering on-demand delivery of medical marijuana in the San Francisco Bay Area, through their mobile app.<ref>{{cite web |url = https://techcrunch.com/2014/10/14/uber-for-weed-startup-meadow-lights-up-in-san-francisco/ |title = Uber-For-Weed Startup Meadow Lights Up In San Francisco |date = 14 October 2014 |publisher = AOL |work = TechCrunch |access-date = 22 January 2016 |archive-date = 23 January 2016 |archive-url = https://web.archive.org/web/20160123174609/http://techcrunch.com/2014/10/14/uber-for-weed-startup-meadow-lights-up-in-san-francisco/ |url-status = live }}</ref>
{{quote|''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.''}}


Almost 70% of medical cannabis is exported from the United Kingdom, according to a 2017 United Nations report, with much of the remaining amount coming from Canada and the Netherlands.<ref>{{Cite web|date=2018-03-07|title=The UK is the world's largest producer of legal Cannabis, UN body finds|url=https://www.independent.co.uk/news/uk/home-news/cannabis-legal-uk-worlds-largest-producer-marijuana-weed-un-body-findings-a8243921.html |archive-url=https://ghostarchive.org/archive/20220512/https://www.independent.co.uk/news/uk/home-news/cannabis-legal-uk-worlds-largest-producer-marijuana-weed-un-body-findings-a8243921.html |archive-date=12 May 2022 |url-access=subscription |url-status=live|access-date=2020-12-07|website=The Independent|language=en}}</ref>
The convention thus allows countries to outlaw cannabis for all non-research purposes but lets nations choose to allow medical and scientific purposes if they believe total prohibition is not the most appropriate means of protecting health and welfare. The convention requires that states that permit the production or use of medical cannabis must operate a licensing system for all cultivators, manufacturers and distributors and ensure that the total cannabis market of the state shall not exceed that required "for medical and scientific purposes."<ref name="Single Convention"/>


=== African countries === ==== Insurance ====
In the United States, health insurance companies may not pay for a medical marijuana prescription as the ] 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 in 1970. Therefore, all expenses incurred fulfilling a medical marijuana prescription will possibly be incurred as out-of-pocket.<ref>{{cite web |url = http://www.insurancecompliancecorner.com/the-medical-marijuana-debate/ |title = The Medical Marijuana Debate |last1 = Clark |first1 = Tonya Body |date = 10 February 2015 |website = Compliance Corner |publisher = Wolters Kluwer Financial Services |access-date = 26 February 2015 |archive-date = 26 February 2015 |archive-url = https://web.archive.org/web/20150226193755/http://www.insurancecompliancecorner.com/the-medical-marijuana-debate/ }}</ref> However, the ] has ruled that ] insurance must pay for prescribed marijuana as part of the state's Medical Cannabis Program.<ref>{{cite web |url = http://nmpoliticalreport.com/4483/court-employer-cant-block-workers-comp-for-medical-marijuana/ |title = Court: Employer can't block workers' comp for medical marijuana |last1 = Peters |first1 = Joey |date = 29 June 2015 |website = NM Political Report |access-date = 30 June 2015 |archive-date = 30 June 2015 |archive-url = https://web.archive.org/web/20150630061942/http://nmpoliticalreport.com/4483/court-employer-cant-block-workers-comp-for-medical-marijuana/ |url-status = live }}</ref>
Cannabis has been used in African countries since at least the 15th century. Its use was introduced by Arab traders, somehow connected to India. "In Africa, the plant was used for snake bite, to facilitate childbirth, ], fever, blood poisoning, ], asthma, and ]." (Zuardi, 2006, 4) Though African governments have tried to limit and stop its use, it still seems to be deeply ingrained, mostly through religious rituals.


=== Positions of medical organizations ===
=== Austria ===
Medical organizations that have issued statements in support of allowing access to medical cannabis include the ],<ref name="ANA">{{citation |title = Therapeutic Use of Marijuana and Related Cannabinoids |url = https://www.nursingworld.org/~4ad4a8/globalassets/docs/ana/therapeutic-use-of-marijuana-and-related-cannabinoids.pdf |publisher = American Nurses Association |date = 2016 |access-date = 13 May 2018 |archive-date = 21 September 2020 |archive-url = https://web.archive.org/web/20200921162957/https://www.nursingworld.org/~4ad4a8/globalassets/docs/ana/therapeutic-use-of-marijuana-and-related-cannabinoids.pdf |url-status = live }}</ref> ],<ref>{{cite web |title = Resolution on Medical Marijuana |url = http://druglibrary.org/schaffer/hemp/medical/apha.htm |website = druglibrary.org |access-date = 30 July 2017 |archive-date = 19 October 2017 |archive-url = https://web.archive.org/web/20171019170836/http://druglibrary.org/schaffer/hemp/medical/apha.htm |url-status = live }}</ref> ],<ref>{{cite web |title = House of Delegates 2017, Resolution: A8 |url = http://www.amsa.org/wp-content/uploads/2015/05/A8-Principles-Regarding-Illegal-drugs-alcohol-and-tobacco-1.pdf |website = amsa.org |publisher = American Medical Student Association |access-date = 30 July 2017 |archive-date = 1 August 2017 |archive-url = https://web.archive.org/web/20170801124633/http://www.amsa.org/wp-content/uploads/2015/05/A8-Principles-Regarding-Illegal-drugs-alcohol-and-tobacco-1.pdf |url-status = live }}</ref> ],<ref>{{cite web |title = Medical Marijuana (Cannabis) FAQs |url = http://www.nationalmssociety.org/Treating-MS/Complementary-Alternative-Medicines/Marijuana/Marijuana-FAQs |website = National Multiple Sclerosis Society |access-date = 30 July 2017 |archive-date = 31 July 2017 |archive-url = https://web.archive.org/web/20170731163441/http://www.nationalmssociety.org/Treating-MS/Complementary-Alternative-Medicines/Marijuana/Marijuana-FAQs |url-status = live }}</ref> ],<ref>{{cite press release |last1 = Gattone |first1 = Philip M. |last2 = Lammert |first2 = Warreb |title = Epilepsy Foundation Calls for Increased Medical Marijuana Access and Research |url = http://www.epilepsy.com/article/2014/2/epilepsy-foundation-calls-increased-medical-marijuana-access-and-research |access-date = 30 July 2017 |location = Washington, D.C. |publisher = Epilepsy Foundation |date = 20 February 2014 |archive-date = 31 July 2017 |archive-url = https://web.archive.org/web/20170731185604/http://www.epilepsy.com/article/2014/2/epilepsy-foundation-calls-increased-medical-marijuana-access-and-research |url-status = live }}</ref> and ].<ref>{{cite web |title = Medical Marijuana Use and Research |url = https://www.maps.org/research-archive/mmj/lnls-res.pdf |website = maps.org |publisher = Leukemia & Lymphoma Society |access-date = 30 July 2017 |archive-date = 19 October 2017 |archive-url = https://web.archive.org/web/20171019171337/https://www.maps.org/research-archive/mmj/lnls-res.pdf |url-status = live }}</ref>
In ], both Δ<sup>9</sup>-THC and pharmaceutical preparations containing Δ<sup>9</sup>-THC are listed in annex V of the Narcotics Decree (''Suchtgiftverordnung'').<ref>{{De icon}} {{cite web|url=http://www.ris.bka.gv.at/GeltendeFassung.wxe?Abfrage=Bundesnormen&amp;Gesetzesnummer=10011053|title=Verordnung der Bundesministerin für Arbeit, Gesundheit und Soziales über den Verkehr und die Gebarung mit Suchtgiften – SV|year=2011|publisher=Bundesministerium für Arbeit, Gesundheit und Soziales|accessdate=25 March 2011}}</ref> Compendial formulations are manufactured upon prescription according to the German ''Neues Rezeptur-Formularium''.<ref>{{De-icon}} {{Cite journal|last=Valenta|first=Claudia|year=2005|title=Magistrale Problem-Rezepturen| journal=Österreichische Apothekerzeitung| publisher=Österreichische Apotheker-Verlagsges.m.b.H.| location=Vienna| issue=5| url=http://web.archive.org/web/20051214174258/http://www.oeaz.at/zeitung/3aktuell/2005/05/haupt/haupt5_2005rezept.html| accessdate=30 July 2009}}</ref><ref name="NRF">{{De icon}} {{Cite journal|last=ABDA – Bundesvereinigung Deutscher Apothekerverbände| date=21 April 2008| title=Rezepturhinweise: Dronabinol- und Cannabis-Zubereitungen| journal=Pharmazeutische Zeitung|publisher=Govi-Verlag Pharmazeutischer Verlag GmbH|location=Eschborn| url=http://www.pharmazeutische-zeitung.de/fileadmin/nrf/PDF/1-Dronabinol.pdf| format=PDF| accessdate=30 July 2009}}</ref>


Organizations that oppose the legalization of medical cannabis include the ] (AAP)<ref name="AAP">{{citation |title = American Academy of Pediatrics Reaffirms Opposition to Legalizing Marijuana for Recreational or Medical Use |url = https://www.aap.org/en-us/about-the-aap/aap-press-room/Pages/American-Academy-of-Pediatrics-Reaffirms-Opposition-to-Legalizing-Marijuana-for-Recreational-or-Medical-Use.aspx |access-date = 30 July 2017 |publisher = American Academy of Pediatrics |date = 26 January 2015 |archive-date = 26 April 2018 |archive-url = https://web.archive.org/web/20180426075849/https://www.aap.org/en-us/about-the-aap/aap-press-room/pages/American-Academy-of-Pediatrics-Reaffirms-Opposition-to-Legalizing-Marijuana-for-Recreational-or-Medical-Use.aspx }}</ref> and ].<ref>{{cite web |title = Position Statement on Marijuana as Medicine |url = https://www.psychiatry.org/file%20library/about-apa/organization-documents-policies/policies/position-2013-marijuana-as-medicine.pdf |website = American Psychiatric Association |access-date = 30 July 2017 |archive-date = 31 July 2017 |archive-url = https://web.archive.org/web/20170731152505/https://www.psychiatry.org/file%20library/about-apa/organization-documents-policies/policies/position-2013-marijuana-as-medicine.pdf }}</ref> However, the AAP also supports rescheduling for the purpose of facilitating research.<ref name="AAP" />
On 9 July 2008, the Austrian Parliament approved cannabis cultivation for scientific and medical uses.<ref>{{cite news|url=http://afp.google.com/article/ALeqM5gMXaMnzKEu6FxfDVlCHd4xMcmEbg
|title=AFP: Austria allows cannabis for medical purposes |publisher=Google News |agency=Agence France-Presse |accessdate=21 July 2008}}</ref> Cannabis cultivation is controlled by the Austrian Agency for Health and Food Safety (''Österreichische Agentur für Gesundheit und Ernährungssicherheit, AGES'').<ref>{{De icon}} {{Cite journal|date=19 December 2008|title=Änderung des Suchtmittelgesetzes – SMG| journal=Bundesgesetzblatt für die Republik Österreich| publisher=Österreichischer Bundesverlag| location=Vienna| url=http://www.ris.bka.gv.at/Dokumente/BgblAuth/BGBLA_2008_I_143/BGBLA_2008_I_143.pdf| accessdate=30 July 2009| format=PDF|author=Anon}}</ref>


The ]<ref>{{citation |title = Use of Cannabis for Medicinal Purposes |url = https://www.ama-assn.org/sites/default/files/media-browser/public/about-ama/councils/Council%20Reports/council-on-science-public-health/i09-csaph-medical-marijuana.pdf |publisher = American Medical Association |date = 2009 |access-date = 1 July 2017 |archive-date = 19 October 2017 |archive-url = https://web.archive.org/web/20171019170230/https://www.ama-assn.org/sites/default/files/media-browser/public/about-ama/councils/Council%20Reports/council-on-science-public-health/i09-csaph-medical-marijuana.pdf }}</ref> and ]<ref>{{citation |title = Supporting Research into the Therapeutic Role of Marijuana |url = https://www.acponline.org/acp_policy/policies/supporting_research_therapeutic_role_of_marijuana_2016.pdf |publisher = American College of Physicians |date = February 2016 |access-date = 1 August 2017 |archive-date = 3 August 2020 |archive-url = https://web.archive.org/web/20200803220748/https://www.acponline.org/acp_policy/policies/supporting_research_therapeutic_role_of_marijuana_2016.pdf |url-status = live }}</ref> do not take a position on the legalization of medical cannabis, but have called for the Schedule I classification to be reviewed. The ]<ref name="AAFP">{{cite news |title=AAFP Releases Marijuana, Cannabinoids Position Paper |url=https://www.aafp.org/news/health-of-the-public/20190920cannabispaper.html |access-date=6 October 2019 |work=American Academy of Family Physicians |date=20 September 2019 |archive-date=28 September 2019 |archive-url=https://web.archive.org/web/20190928025405/https://www.aafp.org/news/health-of-the-public/20190920cannabispaper.html |url-status=live }}</ref> and ]<ref>{{cite press release |date=13 October 2020 |title=ASAM Issues New Public Policy Statement on Cannabis |url=https://www.asam.org/Quality-Science/publications/magazine/read/asam-advocacy-blog/2020/10/13/asam-issues-new-public-policy-statement-on-cannabis |location=Rockville, MD |publisher=American Society of Addiction Medicine |access-date=1 November 2020 |archive-date=8 November 2020 |archive-url=https://web.archive.org/web/20201108221433/https://www.asam.org/Quality-Science/publications/magazine/read/asam-advocacy-blog/2020/10/13/asam-issues-new-public-policy-statement-on-cannabis }}</ref> also do not take a position, but do support rescheduling to better facilitate research. The ] says that "many of the concerning health implications of cannabis include cardiovascular diseases" but that it supports rescheduling to allow "more nuanced ... marijuana legislation and regulation" and to "reflect the existing science behind cannabis".<ref>{{cite journal |author=American Heart Association |title=Medical Marijuana, Recreational Cannabis, and Cardiovascular Health |journal=Circulation |date=5 August 2020 |volume=142 |issue=10 |pages=e131–52 |doi=10.1161/CIR.0000000000000883 |pmid=32752884 |doi-access=free }}</ref> The ]<ref name="ACS">{{cite web |title = Marijuana and Cancer |url = https://www.cancer.org/treatment/treatments-and-side-effects/complementary-and-alternative-medicine/marijuana-and-cancer.html |website = American Cancer Society |access-date = 12 July 2017 |archive-date = 22 June 2017 |archive-url = https://web.archive.org/web/20170622082320/https://www.cancer.org/treatment/treatments-and-side-effects/complementary-and-alternative-medicine/marijuana-and-cancer.html |url-status = live }}</ref> and ]<ref name="APA">{{cite news |title = Marijuana research: Overcoming the barriers |url = http://advocacy.apascience.org/blog/2017/9/13/marijuana-research-overcoming-the-barriers |access-date = 9 October 2017 |work = American Psychological Association |date = 14 September 2017 |archive-date = 4 October 2017 |archive-url = https://web.archive.org/web/20171004035308/http://advocacy.apascience.org/blog/2017/9/13/marijuana-research-overcoming-the-barriers }}</ref> 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.
=== Canada ===
], au ]]]


] say that while cannabis is being studied for therapeutic potential, "claims that there is solid "proof" that cannabis or cannabinoids can cure cancer is highly misleading to patients and their families, and builds a false picture of the state of progress in this area".<ref>{{cite web|url=http://scienceblog.cancerresearchuk.org/2012/07/25/cannabis-cannabinoids-and-cancer-the-evidence-so-far/|title=Cannabis, cannabinoids and cancer – the evidence so far|last=Arney|first=Kat|date=25 July 2012|publisher=]|archive-url=https://web.archive.org/web/20140211145440/http://scienceblog.cancerresearchuk.org/2012/07/25/cannabis-cannabinoids-and-cancer-the-evidence-so-far/|archive-date=11 February 2014}}</ref>
In Canada, the regulation on access to cannabis for medical purposes, established by ] in February 2000, defines two categories of patients eligible for access to medical cannabis. BC College of Physicians and Surgeons’ recommendation, as well as the CMPA position, is that physicians may prescribe cannabis if they feel comfortable with it. The MMAR forms are a confidential document between Health Canada, the physician and the patient. The information is not shared with the College or with the RCMP. No doctor has ever gone to court or faced prosecution for filling out a form or for prescribing medical cannabis.<ref name="MMARI FAQ">{{cite web|url=http://web.archive.org/web/20110926061855/http://kingstoncompassion.org/index.php/mmar-information|title=MMAR FAQ|work=MMAR FAQ}}</ref> Category 1 covers any symptoms treated within the context of providing compassionate ] or the symptoms associated with different medical conditions. Category 2 is for applicants who have debilitating symptom(s) of medical condition(s), other than those described in Category 1. The application of eligible patients must be supported by a medical practitioner.<ref>{{cite web|url=http://www.hc-sc.gc.ca/dhp-mps/marihuana/about-apropos/faq-eng.php |title=Frequently Asked Questions – Medical Use of Marihuana |publisher=] |date=13 June 2005 |accessdate=23 September 2009}}</ref>


=== Nonproprietary names ===
The cannabis distributed by Health Canada is provided under the brand CannaMed by the company ] Inc. In 2006, 420&nbsp;kg of CannaMed cannabis was sold, representing an increase of 80% over the previous year.<ref>{{Cite news|url=http://www.cbc.ca/news/story/2006/10/23/prairie-plant.html |title=More pot, please: Demand booming for Prairie Plant's marijuana |publisher=] |date=23 October 2006 |accessdate=23 September 2009}}</ref> However, patients complain of the single strain selection as well as low potency, providing a pre-ground product put through a wood chipper (which deteriorates rapidly) as well as gamma irradation and foul taste and smell.<ref>{{cite web|first=Rielle |last=Capler |year=2007 |title=A Review of the Cannabis Cultivation Contract between Health Canada and Prairie Plant Systems |url=http://web.archive.org/web/20110511205020/http://www.thecompassionclub.org/resources/HC_PPS_Contract_Report.pdf |publisher=British Columbia Compassion Club Society |accessdate=23 September 2009}}</ref>
There are three ] (INN) granted for cannabinoids: two plant-derived ] and one ]:


* ] is the INN for delta-9-THC<ref>{{Cite journal |last=] |date=1984 |title=List of Proposed INNs No. 51 |url=https://cdn.who.int/media/docs/default-source/international-nonproprietary-names-(inn)/pl51.pdf?sfvrsn=3ded55af_9&download=true |journal=WHO Chronicle |volume=38 |issue=2 |page=6}}</ref><ref>{{Cite journal |last=] |date=1984 |title=List of Recommended INNs No. 24 |url=https://cdn.who.int/media/docs/default-source/international-nonproprietary-names-(inn)/rl24.pdf?sfvrsn=99779214_6&download=true |journal=WHO Chronicle |volume=38 |issue=6 |page=4}}</ref> (there is a common confusion according to which the word "dronabinol" would only refer to synthetic delta-9-THC, which is incorrect<ref>{{Cite journal |last=Riboulet-Zemouli |first=Kenzi |date=2020 |title='Cannabis' ontologies I: Conceptual issues with Cannabis and cannabinoids terminology |url=http://journals.sagepub.com/doi/10.1177/2050324520945797 |journal=Drug Science, Policy and Law |language=en |volume=6 |pages=205032452094579 |doi=10.1177/2050324520945797 |issn=2050-3245}}</ref>).
]
* ] is also the official INN for the molecule, granted in 2017.<ref>{{Cite journal |last=] |date=2017 |title=List of Recommended INNs No. 77 |url=https://cdn.who.int/media/docs/default-source/international-nonproprietary-names-(inn)/rl77.pdf?sfvrsn=c1e6fc91_6&download=true |journal=WHO Drug Information |volume=31 |issue=1 |page=75}}</ref>
It is also legal for patients approved by Health Canada to grow their own cannabis for personal consumption, and it's possible to obtain a production license as a person designated by a patient. Designated producers were permitted to grow a cannabis supply for only a single patient. However, that regulation and related restrictions on supply were found unconstitutional by the Federal Court of Canada in January 2008. The court found that these regulations did not allow a sufficient legal supply of medical cannabis, and thus forced many patients to purchase their medicine from unauthorized, black market sources. This was the eighth time in the previous ten years that the courts ruled against Health Canada's regulations restricting the supply of the medicine.<ref name=NationalPost_01>{{Cite news| title=Court challenge aims to legalize all cannabis use; Advocates say previous rule a 'mockery'| first=Shannon|last=Kari|newspaper=]|location=Toronto|id=ProQuest Newsstand, Document ID: 1739130721|date=1 June 2009|page=A.6}}</ref> On 14 Dec 2012 the Canadian government announced plans to overhaul its rules regarding medical cannabis.<ref>http://www.ipolitics.ca/2012/12/14/health-canada-getting-out-of-the-marijuana-trade/{{full|date=November 2013}}</ref>
* ] is the INN for a synthetic cannabinoid analog (not present in '']'' plants).


] is the generic name (but not recognized as an INN) of a mixture of Cannabidiol and Dronabinol. Its most common form is the oromucosal spray derived from two strains of ''Cannabis sativa'' and containing THC and CBD traded under the brand name Sativex®.<ref name="Svrakic2012" /> It is not approved in the United States, but is approved in several European countries, Canada, and New Zealand as of 2013.<ref name="Borgelt2013" />
In Canada, there are four forms of medical cannabis. The first one is a cannabis extract called Sativex that contains THC and cannabidiol in a spray form. The second is a synthetic or manmade THC called dronabinol marketed as Marinol. The third also a synthetic version of THC called nabilone that is called Cesamet on the markets. The fourth product is the herbal form of cannabis often referred to as marijuana.<ref name="Wang-2008" />


{| class="wikitable"
=== Czech Republic ===
|-
Medical use of cannabis has been legal and regulated in the ] since April 1, 2013.<ref>. www.lidovky.cz. Retrieved on 2013-04-17.</ref><ref>. Radio.cz. Retrieved on 2013-04-17.</ref>
! Generic<br />name

! Brand <br /> name(s)
===France===
! Country (non-exhaustive)
As of June 8, 2013, cannabis derivatives can be used in France for the manufacture of medicinal products. The products can only be obtained with a prescription and will only be prescribed when all other medications have failed to effectively relieve suffering. The amended legislation decriminalizes "the production, transport, export, possession, offering, acquisition or use of speciality pharmaceutials that contains one of these (cannabis-derivative) substances”, while all cannabis products must be approved by the National Medical Safety Agency (Agence nationale de sécurité du médicament – ANSM). A Pharmacists' Union spokesperson explained to the media that the change will make it more straightforward to conduct research into cannabinoids.<ref>{{cite news|title=French law on pot-based medicine takes effect|url=http://www.thelocal.fr/20130610/legalized-cannabis-tea-could-be-on-drug-menu-for-french-patients-in-pharmacies|accessdate=12 June 2013|newspaper=The Local|date=10 June 2013|author=Ann Törnkvist}}</ref>
! Licensed indications

|-
=== Germany ===
| ]
In February 2008, seven German patients could legally be treated with medicinal cannabis, distributed by prescription in pharmacies.<ref>{{cite web |url=http://www.cannabis-med.org/english/bulletin/ww_en_db_cannabis_artikel.php?id=289 |title=Germany: First Patients to Receive cannabis from the pharmacy |work=IACM-Bulletin |date=15 February 2009}}</ref> To regulate therapeutic use, Germany modeled on Dutch neighbor who distributes this way since in 2003 (120&nbsp;kg in 2008).
| ]

| rowspan="2" | U.S., Canada
In Germany, dronabinol was rescheduled in 1994 from annex I to annex II of the Narcotics Law (''Betäubungsmittelgesetz'') in order to ease research; in 1998 dronabinol was rescheduled from annex II to annex III and since then has been available by prescription,<ref>{{cite journal |doi=10.1177/002204260203200218 |title=The Medical use of Cannabis in Germany |year=2002 |last1=Grotenhermen |first1=F. |journal=Journal of Drug Issues |volume=32 |issue=2 |pages=607}}</ref> whereas Δ<sup>9</sup>-THC is still listed in annex I.<ref>{{De icon}} {{cite web|url=http://bundesrecht.juris.de/bundesrecht/btmg_1981/gesamt.pdf|title=Gesetz über den Verkehr mit Betäubungsmitteln (Betäubungsmittelgesetz – BtMG)|date=19 January 2009|publisher=Bundesministerium der Justiz|accessdate=30 July 2009|format=PDF}}</ref> Manufacturing instructions for dronabinol containing compendial formulations are described in the ''Neues Rezeptur-Formularium''.<ref name="NRF"/>
| rowspan="2" | ] (treatment of nausea or vomiting) associated with chemotherapy that has failed to respond adequately to conventional therapy<ref name=Borgelt2013 />

|-
=== Israel ===
| rowspan="2"| ]
] isolated ] from '']'' in 1964 (along with Yechiel Gaoni) and later discovered ].]]
|]

|-
Marijuana for medical use has been permitted in ] since the early 1990s for cancer patients and those with pain-related illnesses such as Parkinson's, multiple sclerosis, ], other chronic pain and post-traumatic stress disorder. Patients can smoke the drug, ingest it in liquid form, or apply it to the skin as a balm. The numbers of patients authorized to use marijuana in Israel in 2012 is about 10,000.<ref name=Bohn>{{cite web|last=Bohn|first=Lauren E.|title=Israel pushing ahead in medical marijuana industry|url=http://seattletimes.com/html/nationworld/2019588145_apmlisraelmedicalmarijuana.html|work=The Seattle Times|date=2 November 2012}}</ref><ref name=Kloosterman>{{cite web|last=Kloosterman|first=Karin|title=Israeli medicine goes to pot|url=http://israel21c.org/health/alternative-medicine/israeli-medicine-goes-to-pot/|publisher=Israel 21C|accessdate=4 November 2012|date=29 March 2012}}</ref>
|]

| U.S.
There are eight government-sanctioned cannabis growing operations in Israel, which distribute it for medical purposes to patients who have a prescription from a doctor, via either a company's store, or in a medical center.<ref name=Bohn/>
| Anorexia associated with AIDS–related weight loss<ref name=Borgelt2013 />

|-
THC, the psychoactive chemical component in marijuana that causes a high, was first isolated by Israeli scientists ] of the ]'s Center for Research on Pain and ] of the ] in 1964.<ref name=Bohn/><ref name=Kloosterman/>
|]

|]
The Tikkun Olam company has developed a variety of marijuana that is reported to provide the medical benefits of cannabis, but without THC. The cannabis instead contains high quantities of CBD, a substance that is believed to be an anti-inflammatory ingredient, which helps alleviate pain.<ref name=Bohn/><ref>. Israelvalley.com – Site officiel de la Cambre de Commerce France-Israël, CCFI (22 November 2010). Retrieved 2012-05-19.</ref>
| Canada, New Zealand,<br />majority of the EU<ref>{{cite journal | vauthors = Abuhasira R, Shbiro L, Landschaft Y | title = Medical use of cannabis and cannabinoids containing products – Regulations in Europe and North America | journal = European Journal of Internal Medicine | volume = 49 | pages = 2–6 | date = March 2018 | pmid = 29329891 | doi = 10.1016/j.ejim.2018.01.001 }}</ref>

| Limited treatment for spasticity and neuropathic pain associated with ] and intractable cancer pain.<ref name=Borgelt2013 />
=== Netherlands ===
|}
Since 2003, the country's pharmacies distribute medicinal cannabis (pharmaceutical form of the natural plant) by prescription, in addition to other drugs containing cannabinoids (dronabinol, Sativex).{{citation needed|date=June 2013}}

=== Spain ===
In Spain, since the late 1990s and early 2000s, medical cannabis underwent a process of progressive decriminalization and legalisation. The parliament of the region of ] was the first in Spain to have voted unanimously in 2001 legalizing medical marijuana; it was quickly followed by parliaments of ] and the ].{{Citation needed|date=November 2009}} The Spanish Penal Code prohibits the sale of cannabis but it does not prohibit consumption (although consumption on the street is fined). Until early 2000, the Penal Code did not distinguish between therapeutic use of cannabis and recreational use, however, several court decisions show that this distinction is increasingly taken into account by judges. From 2006, the sale of seed is legalized,{{Citation needed|date=November 2009}} the sale and public consumption remains illegal, and private cultivation and use are permitted to associations.<ref>Hidalgo, Susana (01-03-2009). ]</ref><ref name=Perez>Pérez-Lanzac C. (12 September 2008) El País.</ref>

Several studies have been conducted to study the effects of cannabis on patients suffering from diseases like cancer, AIDS, multiple sclerosis, seizures or asthma. This research was conducted by various Spanish agencies at the Universidad Complutense de Madrid headed by Manuel Guzman, the hospital of La Laguna in Tenerife led neurosurgeon Luis González Feria or the ].{{Citation needed|date=August 2009}}

Several cannabis consumption clubs and user associations have been established throughout Spain. These clubs, the first of which was created in 1991, are non-profit associations who grow cannabis and sell it at cost to its members. The legal status of these clubs is uncertain: in 1997, four members of the first club, the Barcelona Ramón Santos Association of Cannabis Studies, were sentenced to 4 months in prison and a 3000 euro fine, while at about the same time, the court of Bilbao ruled that another club was not in violation of the law. The Andalusian regional government also commissioned a study by criminal law professors on the "Therapeutic use of cannabis and the creation of establishments of acquisition and consumption. The study concluded that such clubs are legal as long as they distribute only to a restricted list of legal adults, provide only the amount of drugs necessary for immediate consumption, and not earn a profit. The Andalusian government never formally accepted these guidelines and the legal situation of the clubs remains insecure. In 2006 and 2007, members of these clubs were acquitted in trial for possession and sale of cannabis and the police were ordered to return seized crops.<ref name=Perez/>

=== United Kingdom ===
In England and ], the use of cannabis medicinally is accepted as a mitigating factor under Sentencing Council guidelines, if it is being cultivated or found in possession of someone.<ref>{{cite web|title=Drug Offences Definitive Guideline|url=http://sentencingcouncil.judiciary.gov.uk/docs/Drug_Offences_Definitive_Guideline_final_(web).pdf|publisher=Sentencing Council}}</ref> However, in the United Kingdom, possession of small quantities of cannabis does not usually warrant an arrest or court appearance (street cautions or fines are often given out instead). Under UK law, certain cannabinoids are permitted medically,<ref name="parliament.the-stationery-office.co.uk">{{cite web|author=The Committee Office, House of Lords |url=http://www.parliament.the-stationery-office.co.uk/pa/ld199798/ldselect/ldsctech/151/15106.htm |title=House of Lords – Science and Technology – Ninth Report |publisher=Parliament.the-stationery-office.co.uk |accessdate=2010-10-20}}</ref> but these are strictly controlled with many provisos under the ] (in the 1985 amendments).

The ]'s official stance is "users of cannabis for medical purposes should be aware of the risks, should enrol for clinical trials, and should talk to their doctors about new alternative treatments; but we do not advise them to stop."<ref name="parliament.the-stationery-office.co.uk"/>

=== United States ===
{{Main|Medical cannabis in the United States}}

]
] Division of the ] holds a patent for medical cannabis.<ref name="patent" />]]

In the United States, cannabis '']'' has been criminalized at the Federal level by implementation of the ], which classifies cannabis as a ] – the strictest classification, on par with heroin, ] and ]. In 2005, the ] ruled in '']'' that the ] of the ] allows the government to ban any use of cannabis, including medical use. The United States ] states "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".<ref name="InterAgency">{{cite press release |title=Inter-Agency Advisory Regarding Claims That Smoked Marijuana Is a Medicine |publisher=] |date=20 April 2006 |url=http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2006/ucm108643.htm |accessdate=9 August 2009}}</ref><ref>{{cite web|url=http://www.justice.gov/dea/marijuana_position.html |title=The DEA Position on Marijuana |publisher=] |year=2006 |accessdate=11 August 2009 |archiveurl=http://web.archive.org/web/20100828044917/http://www.justice.gov/dea/marijuana_position.html |archivedate=28 August 2010}}</ref>

Two American (for-profit) companies, ], and ], are working towards getting FDA approval for cannabis based medicines (including smoked cannabis). Cannabis Science Inc. wants to have medical cannabis approved by the FDA so anyone, regardless of state, will have access to the medicine.<ref>{{cite web|url=http://www.cannabisscience.com/index.php/news-media/news-releases/251-cannabis-science-continues-forward-with-fda-ind-process-as-patients-report-successful-cancer-treatments |title=Cannabis science continues forward with FDA IND process as patients report successful cancer treatments |publisher=Cannabis Science |date=2 April 2012 |accessdate=2012-12-24}}</ref> Also, there is one non-profit organization, the ] (MAPS) working towards getting Cannabis approved by the FDA for PTSD.

Since the ] began, nineteen states and ], starting with California in 1996, have legalized medical cannabis or effectively decriminalized it: ],<ref name="Alaska1">{{cite web |url=http://web.archive.org/web/20090218131223/http://www.hss.state.ak.us/dph/bvs/marijuana.htm |title=Marijuana Registry |publisher=Alaska Health and Social Services |accessdate=2009-10-08}}</ref> ],<ref name="Arizona">{{cite news |agency=Associated Press |title=Arizona Becomes 15th State to Approve Medical Marijuana |newspaper=The New York Times |date=14 November 2010 |url=http://www.nytimes.com/2010/11/15/us/politics/15arizona.html |accessdate=2010-11-15}}</ref> California,<ref name="California1">{{cite web |url=http://web.archive.org/web/20100101143455/http://www.cdph.ca.gov/programs/MMP/Pages/Medical%20Marijuana%20Program.aspx |title=Medical Marijuana Program |publisher=California Department of Public Health |accessdate=2009-10-08}}</ref> ],<ref name="Colorado1">{{cite web |url=http://web.archive.org/web/20080214145224/http://www.cdphe.state.co.us/hs/medicalmarijuana/marijuanafactsheet.html |title=Colorado Medical Marijuana Registry |publisher=Colorado Department of Public Health and Environment |accessdate=2009-10-08}}</ref> ],<ref>{{cite web|last=Zalaznick|first=Matt|title=Connecticut Docs Can Prescribe Medical Marijuana|url=http://norwalk.dailyvoice.com/wellness/connecticut-docs-can-prescribe-medical-marijuana|publisher=The Norwalk Daily Voice|accessdate=26 July 2012}}</ref><ref name="Connecticut">{{cite web |url=http://abclocal.go.com/kabc/story?section=news/national_world&id=8649691|title=Connecticut Senate Passes Medical Marijuana Bill |publisher=ABC News|accessdate=2012-05-05}}</ref> ],<ref name="Delaware">{{cite web |url=http://delawarechronic.com/laws/ |title=Delaware Medical Marijuana Patient Laws |publisher=Chronic Resource for Delaware Marijuana |accessdate=2012-01-20}}</ref><ref>{{cite news |url=http://www.reuters.com/article/2011/05/13/us-delaware-legalizes-medical-marijuana-idUSTRE74C6X120110513 |title=Delaware legalizes medical marijuana |agency=Reuters |date=13 May 2011 |accessdate=2012-01-20}}</ref> Hawaii,<ref name="Hawaii1">{{cite web |url=http://hawaii.gov/psd/law-enforcement/narcotics-enforcement |title=Narcotics Enforcement Division|publisher=Hawaii Department of Public Safety |accessdate=2009-10-08}}</ref> ],<ref name="Maine1">{{cite web |url=http://pressherald.mainetoday.com/story.php?id=241787&ac=PHnws |title=Maine's cannabis contradiction |last=Nemitz |first=Bill |date=26 February 2009 |publisher=Portland Press Herald |accessdate=2009-10-08 |archiveurl=http://web.archive.org/web/20090502054211/http://pressherald.mainetoday.com/story.php?id=241787&ac=PHnws |archivedate=2 May 2009}}</ref> ], ],<ref name="Michigan1">{{cite web |url=http://www.michigan.gov/mdch/0,1607,7-132-27417_51869---,00.html |title=Michigan Medical Marijuana Program |publisher=Michigan Department of Community Health |accessdate=2009-10-08}}</ref> ],<ref name="Montana1">{{cite web |url=http://web.archive.org/web/20100321014735/http://www.dphhs.mt.gov/medicalmarijuana/ |title=Montana Medical Marijuana Program |publisher=Montana Department of Public Health and Human Services |accessdate=2009-10-08}}</ref> ],<ref name="Nevada1">{{cite web |url=http://health.nv.gov/MedicalMarijuana.htm |title=Medical Marijuana |publisher=Nevada Department of Health and Human Services |accessdate=2009-10-08}}</ref> ], ],<ref>{{cite news |url=http://www.nytimes.com/2010/01/12/nyregion/12marijuana.html?hp |title=New Jersey Lawmakers Pass Medical Marijuana Bill |work=The New York Times |date=11 January 2010 |accessdate=15 May 2010 |first=David |last=Kocieniewski}}</ref> ],<ref name="NMHealth1">{{cite web |url=http://www.health.state.nm.us/idb/medical_cannabis.shtml |title=Medical Cannabis Program |publisher=New Mexico Department of Health |accessdate=2009-10-08}}</ref> ],<ref name="OMMP1">{{cite web |url=http://www.oregon.gov/DHS/ph/ommp |title=Oregon Medical Marijuana Program (OMMP) |publisher=State of Oregon – Department of Human Services |accessdate=2009-10-07}}</ref> ],<ref name="RhodeIsland1">{{cite web |url=http://www.health.ri.gov/hsr/mmp/index.php |title=Medical Marijuana Program (MMP) |publisher=Rhode Island Department of Health |accessdate=2009-10-08}}</ref> ],<ref name="Vermont1">{{cite web |url=http://web.archive.org/web/20060204002126/http://www.dps.state.vt.us/cjs/marijuana.htm |title=Vermont Marijuana Registry: A Guide for Patients and Physicians |publisher=Vermont Criminal Information Center |accessdate=2009-10-08}}</ref> ];<ref name="Washington1">{{cite web |url=http://www.doh.wa.gov/hsqa/medical-marijuana/default.htm|title=Medical Marijuana Frequently Asked Questions |publisher=Washington State Department of Health |accessdate=2009-10-08}}</ref><ref> Accessed: 8/13/2013</ref> Maryland allows for reduced or no penalties if cannabis use has a medical basis.<ref>{{Cite news |title=US medical cannabis policy eased |url=http://news.bbc.co.uk/2/hi/8315603.stm |date=20 October 2009 |publisher=BBC News |accessdate=30 October 2009}}</ref><ref name=norml-maryland>NORML – {{cite web |url=http://norml.org/legal/item/maryland-medical-marijuana?category_id=835 | title=Maryland Medical Marijuana}}</ref><ref name=md-ga-2011-sb-308>{{cite web |url=http://mlis.state.md.us/2011rs/billfile/SB0308.htm | title=BILL INFO-2011 Regular Session-SB 308|work=mlis.state.md.us}}</ref> Despite legalization of marijuana in Washington and Colorado, an employee may still be fired if they test positive on a drug test, despite having a doctor's recommendation.<ref>{{cite web |url=http://medicalmarijuanabill.com/2011/06/employers-fire-legally-washington/ |title=Employers now able to fire medical marijuana users legally in Washington |publisher=MedicalMarijuanaBill.com |date=13 June 2011 |accessdate=2011-07-31}}</ref> California, Colorado, New Mexico, Maine, Rhode Island, Montana, and Michigan are currently the only states to utilize ] to sell medical cannabis; Connecticut and Massachusetts are also planning to do so. During 2008, California's medical cannabis industry took in about $2 billion and generated $100 million in state sales taxes<ref>{{Cite news |url=http://www.nytimes.com/2008/05/31/technology/31online.html |title=Legitimizing Marijuana |first=Dan |last=Mitchell |date=31 May 2008 |work=] |accessdate=11 August 2009}}</ref> with an estimated 2,100 dispensaries, co-operatives, wellness clinics and taxi delivery services in the sector colloquially known as "cannabusiness".<ref>, The Times, 28 September 2009</ref>


As an ], these medications are usually used when conventional treatment for nausea and vomiting associated with cancer chemotherapy fail to work.<ref name=Borgelt2013 />
Though it does not have an established medical registry program, the state of ],<ref name="Virginia1">{{cite web |url=http://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+18.2-251.1 |title=§ 18.2–251.1. Possession or distribution of marijuana for medical purposes permitted |publisher=Virginia Department of Health |accessdate=2010-08-30}}</ref> does allow for possession under the directive as medicine.


] is used for treatment of spasticity associated with MS when other therapies have not worked, and when an initial trial demonstrates "meaningful improvement".<ref name=Borgelt2013 /> Trials for FDA approval in the US are underway.<ref name=Borgelt2013 /> It is also approved in several European countries for overactive bladder and ].<ref name=Svrakic2012 /> When sold under the trade name Sativex as a mouth spray, the prescribed daily dose in Sweden delivers a maximum of 32.4&nbsp;mg of ] and 30&nbsp;mg of ]; mild to moderate dizziness is common during the first few weeks.<ref>{{cite web |url = http://www.fass.se/LIF/product?1&docType=6&specId&userType&nplId=20101019000051 |title = Produkt – FASS Allmänhet |work = fass.se |access-date = 26 December 2013 |archive-date = 19 October 2017 |archive-url = https://web.archive.org/web/20171019170842/http://www.fass.se/LIF/product?1&docType=6&specId&userType&nplId=20101019000051 |url-status = live }}</ref>
Some individual states such as Oregon choose to issue ]s<ref>{{Cite web |url=http://public.health.oregon.gov/diseasesconditions/chronicdisease/medicalmarijuanaprogram/pages/noticeofommpfeechanges.aspx |title=Oregon Medical Marijuana Program |publisher=public.health.oregon.gov |date=1 October 2011 |accessdate=2012-12-24 |postscript=<!-- Bot inserted parameter. Either remove it; or change its value to "." for the cite to end in a ".", as necessary. -->{{inconsistent citations}}}}</ref> to residents with a doctors recommendation after paying a fee.


Relative to inhaled consumption, peak concentration of oral THC is delayed, and it may be difficult to determine optimal dosage because of variability in patient absorption.<ref name=Borgelt2013 />
In October 2009, the U.S. Deputy Attorney General issued a U.S. Department of Justice memorandum to "All United States Attorneys" providing clarification and guidance to federal prosecutors in states that have enacted medical marijuana laws. The document is intended solely as "a guide to the exercise of investigative and prosecutorial discretion and as guidance on resource allocation and federal priorities." It includes seven criteria to help determine whether a patient's use, or their caregiver's provision, of medical cannabis "represents part of a recommended treatment regiment consistent with applicable state law". The Department advised that it "likely was not an efficient use of federal resources to focus enforcement efforts on seriously ill individuals, or on their individual caregivers. ... Large-scale, for-profit commercial enterprises, on the other , ... continued to be appropriate targets for federal enforcement and prosecution."


In 1964, Albert Lockhart and ] began studying the health effects of traditional cannabis use in ] communities. They developed, and in 1987 gained permission to market, the pharmaceutical "Canasol", one of the first cannabis extracts.<ref name="FFY">{{cite web | first=Farid F. | last=Youssef | title=Cannabis Unmasked: What it is and why it does what it does | work=UWIToday | date=June 2010 | url=https://sta.uwi.edu/uwitoday/archive/june_2010/article9.asp | access-date=11 May 2021 | archive-date=17 March 2021 | archive-url=https://web.archive.org/web/20210317175037/https://sta.uwi.edu/uwitoday/archive/june_2010/article9.asp | url-status=live }}</ref>
The sale and distribution of cannabis remains illegal under federal law,<ref>{{cite web |url=http://www.justice.gov/opa/documents/medical-marijuana.pdf |title=19 October 2009; Office of the Deputy Attorney General, US Dept. of Justice, Washington D.C. 20530. Memorandum for Selected United States Attorneys. Subject: Investigations and Prosecutions in States Authorizing the Medical Use of Marijuana |format=PDF |accessdate=2010-10-20}}</ref> however, as the ]'s position – that marijuana has no accepted value in the treatment of any disease in the United States – remains unchanged.<ref name="InterAgency" />


== Research ==
The ] holds a patent for medical cannabis.<ref name="patent">{{cite patent | country = US | number = 6630507 | status = patent | title = Cannabinoids as antioxidants and neuroprotectants | gdate = 2003-10-07 | fdate = 1999-04-21 | invent1 = Aidan J. Hampson | invent2 = Iulius Axelrod | invent3 = Maurizio Grimaldi | assign1 = The United States of America as represented by the Department of Health and Human Services}}</ref> The patent, "Cannabinoids as ]s and ]s", issued October 2003<ref name=patent6630507>{{US patent reference |number=6630507 |y=2003 |m=10 |d=07 |inventor=Hampson, Aidan J.; Axelrod, Julius; Grimaldi, Maurizio |title=Cannabinoids as antioxidants and neuroprotectants}}</ref> reads: {{cquote|] have been found to have ] properties, unrelated to ] receptor antagonism. This new found property makes cannabinoids useful in the treatment and ] of wide variety of ] associated diseases, such as ], age-related, ] and ] diseases. The cannabinoids are found to have particular application as neuroprotectants, for example in limiting neurological damage following ischemic insults, such as stroke and ], or in the treatment of ], such as Alzheimer's disease, Parkinson's disease and HIV dementia... .<ref>{{Cite news|url=http://www.digitaljournal.com/article/257008 |title=Opinion: US Government Holds Patent For Medical Marijuana, Shows Hipocrisy |publisher=] |date=7 July 2008 |first=Michael |last=Billy |accessdate=11 August 2009}}</ref>}}
{{main|Medical cannabis research}}


A 2022 review concluded that "oral, synthetic cannabis products with high THC-to-CBD ratios and sublingual, extracted cannabis products with comparable THC-to-CBD ratios may be associated with short-term improvements in chronic pain and increased risk for dizziness and sedation."<ref name="pmid35667066">{{cite journal | vauthors=McDonagh MS, Morasco BJ, Wagner J, Ahmed AY, Fu R, Kansagara D | title=Cannabis-Based Products for Chronic Pain: A Systematic Review | journal=Ann Intern Med | year=2022 | volume=175 | issue=8 | pages=1143–1153 | pmid=35667066 | doi=10.7326/M21-4520 | s2cid=249433147 | url=https://www.acpjournals.org/doi/full/10.7326/M21-4520 | access-date=19 February 2023 | archive-date=19 February 2023 | archive-url=https://web.archive.org/web/20230219233343/https://www.acpjournals.org/doi/full/10.7326/M21-4520 | url-status=live }}</ref>
In November 2011, in accordance with 35 U.S.C. 209(c)(1) and 37 CFR part 404.7(a)(1)(i), the NIH announced that it is contemplating the grant of an exclusive patent license to practice the invention embodied therein to ]. The prospective exclusive license territory may be worldwide, and the field of use may be limited to: The development and sale of cannabinoid(s) and cannabidiol(s) based therapeutics as antioxidants and neuroprotectants for use and delivery in humans, for the treatment of hepatic encephalopathy, as claimed in the Licensed Patent Rights.<ref>{{cite web|url=http://www.federalregister.gov/articles/2011/11/17/2011-29726/prospective-grant-of-exclusive-license-development-of-cannabinoids-and-cannabidiols-based |title=Federal Register &#124; Prospective Grant of Exclusive License: Development of Cannabinoid(s) and Cannabidiol(s) Based Therapeutics To Treat Hepatic Encephalopathy in Humans |publisher=Federalregister.gov |date=17 November 2011 |accessdate=2012-08-13}}</ref>


== See also == == See also ==
{{portal|Cannabis}} {{portal|Cannabis|Medicine}}
* ]
* ] * ]
* ]
* ]
* ] * ]


== References == == References ==
{{Reflist|colwidth=30em}} {{Reflist}}


== Further reading == == Further reading ==

{{Refbegin}} {{Refbegin}}
* {{cite book | title = The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research | date = 2017 | pmid = 28182367 | doi = 10.17226/24625 | url = http://nationalacademies.org/hmd/reports/2017/health-effects-of-cannabis-and-cannabinoids.aspx | via = nationalacademies.org | publisher = National Academies of Sciences, Engineering, and Medicine: The National Academies Press | author-link1 = National Academies of Sciences, Engineering, and Medicine | isbn = 978-0-309-45304-2 | last1 = National Academies Of Sciences | first1 = Engineering | last2 = Health Medicine | first2 = Division | author3 = Board on Population Health Public Health Practice | author4 = Committee on the Health Effects of Marijuana: An Evidence Review Research Agenda | access-date = 7 February 2017 | archive-date = 14 July 2020 | archive-url = https://web.archive.org/web/20200714035337/https://www.nationalacademies.org/hmd/Reports/2017/health-effects-of-cannabis-and-cannabinoids.aspx | url-status = live }} {{open access}}
*{{cite book|title=The Science of Marijuana|last=Iversen|first=Leslie L.|publisher=Oxford University Press|year=2000|isbn=0-19-513123-1}}
*
* {{Cite journal|doi=10.1300/J175v01n03_06 |title=Marijuana and Cannabinoids: Effects on Infections, Immunity, and AIDS|year=2001 |first=Guy A. |last=Cabral |journal=Journal of Cannabis Therapeutics |volume=1 |issue=3–4 |pages=61–85}} See also its alternate publication: {{Cite book|first=Guy A. |last=Cabral |chapter=Marijuana and cannabinoids: effects on infections, immunity, and AIDS |chapterurl=http://books.google.com/books?hl=en&lr=&id=qUMQqa1PT4QC&oi=fnd&pg=PA61 |year=2001 |editor=Ethan Russo |title=Cannabis therapeutics in HIV/AIDS |publisher=Routledge |pages=61–85 |isbn=978-0-7890-1699-7}}
* {{cite journal |doi=10.1001/archpsyc.57.6.547 |title=Marijuana and Medicine: Assessing the Science Base: A Summary of the 1999 Institute of Medicine Report |year=2000 |last1=Watson |first1=S. J. |journal=Archives of General Psychiatry |volume=57 |issue=6 |pages=547–52 |pmid=10839332 |last2=Benson Jr |first2=JA |last3=Joy |first3=JE}}
* {{cite web|work=Schaffer Library of Drug Policy |url=http://www.druglibrary.org/schaffer/hemp/medical/ms_mj_ref.htm |title=References on Multiple Sclerosis and Marijuana}}
* {{Cite book|first=Donald P. |last=Tashkin |chapter=Effects of Smoked Marijuana on the Lung and Its Immune Defenses: Implications for Medicinal Use in HIV-Infected Patients |chapterurl=http://books.google.com/books?id=qUMQqa1PT4QC&lpg=PA87 |editor=Ethan Russo |title=Cannabis therapeutics in HIV/AIDS |year=2001 |location=New York City |publisher=] |isbn=978-0-7890-1699-7 |pages=87–102}}
* {{cite web|first=Dominik |last=Wujastyk |date=12 September 2001 |title=Cannabis in Traditional Indian Herbal Medicine |url=http://www.ucl.ac.uk/~ucgadkw/papers/cannabis.pdf |accessdate=23 September 2009}}
* {{Cite book|editor1-first=Janet E. |editor1-last=Joy |editor2-first=Stanley J. |editor2-last=Watson |editor3-first=John A. |editor3-last=Benson |year=1999 |title=Marijuana and Medicine: Assessing the Science Base |url=http://www.nap.edu/openbook.php?isbn=0309071550 |publisher=] |location=Washington, D.C. |isbn=978-0-309-07155-0 |oclc=246585475}}
* {{cite journal |doi=10.1590/S1516-44462006000200015 |title=History of cannabis as a medicine: A review |year=2006 |last1=Zuardi |first1=Antonio Waldo |journal=Revista Brasileira de Psiquiatria |volume=28 |issue=2 |pages=153–7 |pmid=16810401}}
* {{cite web|first=Martin |last=Martinez |date=4 August 2008 |title=History of Medical Cannabis |url=http://www.cannabismd.net/history-of-medical-cannabis/ |accessdate=23 September 2009}}
*{{cite journal |pmid=19662925 |laysummary=http://blogs.sfweekly.com/thesnitch/2009/09/chronic_city_summing_up_the_ev.php |laysource=] |laydate=15 September 2009 |year=2009 |last1=Aggarwal |first1=SK |last2=Carter |first2=GT |last3=Sullivan |first3=MD |last4=Zumbrunnen |first4=C |last5=Morrill |first5=R |last6=Mayer |first6=JD |title=Medicinal use of cannabis in the United States: Historical perspectives, current trends, and future directions |volume=5 |issue=3 |pages=153–68 |journal=Journal of opioid management}}
{{Refend}} {{Refend}}


== External links == == External links ==

{{Commons category|Medical cannabis}} {{Commons category|Medical cannabis}}
, links to websites about medical cannabis
* Book discussion on C-SPAN by Clint Werner
* from the U.S. ]
* {{dmoz|Society/Issues/Health/Drugs/Illegal/Pro-Legalization/Marijuana/Medical_Purposes/}}, links to websites about medical cannabis.
* from ]
* Congressional Research Service.
* . *
* – a 2014–2015 three-part ] documentary produced by ]
* ''Advances in the History of Psychology'', ].
* {{NYTtopic|subjects/m/marijuana|Marijuana and Medical Marijuana}}
* , an independent site operated by ] faculty members James Bakalar and ].
* Online Medicinal Marijuana magazine based in British Columbia.
* Medical Marijuana in the U.S.


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Latest revision as of 23:06, 30 November 2024

Cannabis sativa L. (marijuana; hemp) used medicinally For other uses of "Cannabis", see Cannabis (disambiguation). "Medical marijuana" redirects here. For the company, see Medical Marijuana, Inc.

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Medical cannabis, medicinal cannabis or medical marijuana (MMJ) refers to cannabis products and cannabinoid molecules that are prescribed by physicians for their patients. The use of cannabis as medicine has a long history, but has not been as rigorously tested as other medicinal plants due to legal and governmental restrictions, resulting in limited clinical research to define the safety and efficacy of using cannabis to treat diseases.

Preliminary evidence has indicated that cannabis might reduce nausea and vomiting during chemotherapy and reduce chronic pain and muscle spasms. Regarding non-inhaled cannabis or cannabinoids, a 2021 review found that it provided little relief against chronic pain and sleep disturbance, and caused several transient adverse effects, such as cognitive impairment, nausea, and drowsiness.

Short-term use increases the risk of minor and major adverse effects. Common side effects include dizziness, feeling tired, vomiting, and hallucinations. 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.

Many cultures have used cannabis for therapeutic purposes for thousands of years. Some American medical organizations have requested removal of cannabis from the list of Schedule I controlled substances maintained by the United States federal government, followed by regulatory and scientific review. Others oppose its legalization, such as the American Academy of Pediatrics.

Medical cannabis can be administered through various methods, including capsules, lozenges, tinctures, dermal patches, oral or dermal sprays, cannabis edibles, and vaporizing or smoking dried buds. Synthetic cannabinoids are available for prescription use in some countries, such as synthetic delta-9-THC and nabilone. Countries that allow the medical use of whole-plant cannabis include Argentina, Australia, Canada, Chile, Colombia, Germany, Greece, Israel, Italy, the Netherlands, Peru, Poland, Portugal, Spain, and Uruguay. In the United States, 38 states and the District of Columbia have legalized cannabis for medical purposes, beginning with the passage of California's Proposition 215 in 1996. Although cannabis remains prohibited for any use at the federal level, the Rohrabacher–Farr amendment was enacted in December 2014, limiting the ability of federal law to be enforced in states where medical cannabis has been legalized.

Classification

In the U.S., the National Institute on Drug Abuse defines medical cannabis as "using the whole, unprocessed marijuana plant or its basic extracts to treat symptoms of illness and other conditions".

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 study.

A 2014 review stated that the variations in ratio of CBD-to-THC in botanical and pharmaceutical preparations determines the therapeutic vs psychoactive effects (CBD attenuates THC's psychoactive effects) of cannabis products.

Medical uses

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

Overall, research into the health effects of medical cannabis has been of low quality and it is not clear whether it is a useful treatment for any condition, or whether harms outweigh any benefit. There is no consistent evidence that it helps with 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, glaucoma, and migraine.

It is unclear whether American states might be able to mitigate the adverse effects of the opioid epidemic by prescribing medical cannabis as an alternative pain management drug.

Cannabis should not be used in pregnancy.

Insomnia

Research analyzing data from the National Health and Nutrition Examination Survey (NHANES) did not find significant differences in sleep duration between cannabis users and non-users. This suggests that while some individuals may perceive benefits from cannabis use in terms of sleep, it may not significantly change overall sleep patterns across the general population.

A review of literature up to 2018 indicates that cannabidiol (CBD) may have therapeutic potential for the treatment of insomnia. CBD, a non-psychoactive component of cannabis, is of particular interest due to its potential to influence sleep without the psychoactive effects associated with tetrahydrocannabinol (THC).

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 (CHS).

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 "ocular problems, orthostatic hypotension, muscle twitching, pruritus, vagueness, hallucinations, lightheadedness and dry mouth".

HIV/AIDS

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 the effects of bias, small sample size, and lack of long-term data.

Pain

A 2021 review found little effect of using non-inhaled cannabis to relieve chronic pain. According to a 2019 systematic review, there have been inconsistent results of using cannabis for neuropathic pain, spasms associated with multiple sclerosis and pain from rheumatic disorders, but was not effective treating chronic cancer pain. The authors state that additional randomized controlled trials of different cannabis products are necessary to make conclusive recommendations.

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 2011 review considered cannabis to be generally safe, and it appears safer than opioids in palliative care.

A 2022 review concluded the pain relief experienced after using medical cannabis is due to the placebo effect, especially given widespread media attention that sets the expectation for pain relief.

Neurological conditions

Cannabis' efficacy is not clear in treating neurological problems, including multiple sclerosis (MS) and movement problems. 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. Its use for MS is approved in ten countries. A 2012 review found no problems with tolerance, abuse, or addiction. In the United States, cannabidiol, one of the cannabinoids found in the marijuana plant, has been approved for treating two severe forms of epilepsy, Lennox-Gastaut syndrome and Dravet syndrome.

Mental health

Further information: Cannabis use and trauma and Posttraumatic stress disorder § Cannabinoids

A 2019 systematic review found that there is a lack of evidence that cannabinoids are effective in treating depressive or anxiety disorders, attention-deficit hyperactivity disorder (ADHD), Tourette syndrome, post-traumatic stress disorder, or psychosis.

Research indicates that cannabis, particularly CBD, may have anxiolytic (anxiety-reducing) effects. A study found that CBD significantly reduced anxiety during a simulated public speaking test for individuals with social anxiety disorder. However, the relationship between cannabis use and anxiety symptoms is complex, and while some users report relief, the overall evidence from observational studies and clinical trials remains inconclusive. Cannabis is often used by people to cope with anxiety, yet the efficacy and safety of cannabis for treating anxiety disorders is yet to be researched.

Cannabis use, especially at high doses, is associated with a higher risk of psychosis, particularly in individuals with a genetic predisposition to psychotic disorders like schizophrenia. Some studies have shown that cannabis can trigger a temporary psychotic episode, which may increase the risk of developing a psychotic disorder later.

The impact of cannabis on depression is less clear. Some studies suggest a potential increase in depression risk among adolescents who use cannabis, though findings are inconsistent across studies.

Adverse effects

American medical hashish

Medical use

There is insufficient data to draw strong conclusions about the safety of medical cannabis. Typically, adverse effects of medical cannabis use are not serious; they include tiredness, dizziness, increased appetite, and cardiovascular and psychoactive effects. Other effects can include impaired short-term memory; impaired motor coordination; altered judgment; and paranoia or psychosis at high doses. 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 use.

Cognitive effects

Further information: long-term effects of cannabis

Recreational use of cannabis is associated with cognitive deficits, especially for those who begin to use cannabis in adolescence. As of 2021 there is a lack of research into long-term cognitive effects of medical use of cannabis, but one 12-month observational study reported that "MC patients demonstrated significant improvements on measures of executive function and clinical state over the course of 12 months".

Impact on psychosis

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. 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.

Pharmacology

The genus Cannabis contains two species which produce useful amounts of psychoactive cannabinoids: Cannabis indica and Cannabis sativa, which are listed as Schedule I medicinal plants in the US; a third species, 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 inflammation.

Absorption

Cannabinoid absorption is dependent on its route of administration.

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 vaporized THC.

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 administration.

Distribution

Like cannabinoid absorption, distribution is also dependent on route of administration. Smoking and inhalation of vaporized cannabis have better absorption than do other routes of administration, and therefore also have more predictable distribution. THC is highly protein bound once absorbed, with only 3% found unbound in the plasma. It distributes rapidly to highly vascularized organs such as the heart, lungs, liver, spleen, and kidneys, as well as to various glands. Low levels can be detected in the brain, testes, and unborn fetuses, all of which are protected from systemic circulation via barriers. 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.

Metabolism

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. 11-COOH-THC is not psychoactive.

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.

Excretion

Due to substantial metabolism of THC and CBD, their metabolites are excreted mostly via feces, rather than by 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 which are products of glucuronidation. Approximately 65% of THC is excreted in feces and 25% in the urine, while the remaining 10% is excreted by other means. The terminal half-life of THC is 25 to 36 hours, whereas for CBD it is 18 to 32 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 hours.

Administration

Illustrating various forms of medicinal cannabis

Smoking has been the means of administration of cannabis for many users, but it is not suitable for the use of cannabis as a medicine. It was 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 it 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 a perception among users that fewer 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 down Δ9THC and contributes further to the variability of plasma concentrations".

The US Food and Drug Administration (FDA) has not approved smoked cannabis for any condition or disease, as it deems that evidence is lacking concerning safety and efficacy. 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."

History

Main article: History of medical cannabis

Ancient

Cannabis, called má 麻 (meaning "hemp; cannabis; numbness") or dàmá 大麻 (with "big; great") in Chinese, was used in Taiwan for 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, and absent-mindedness. Cannabis is one of the 50 "fundamental" herbs in traditional Chinese medicine.

The 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.

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.

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.

Landrace strains

Evolution of cultivated cannabis strains. 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. They are cultivars of the plant that originated in one specific region.

Widely cultivated strains of cannabis, such as "Afghani" or "Hindu Kush", are indigenous to the Pakistan and Afghanistan regions, while "Durban Poison" is native to Africa. There are approximately 16 landrace strains of cannabis identified from Pakistan, Jamaica, Africa, Mexico, Central America and Asia.

Modern

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 the drug's medical utility (noting in particular its analgesic and anticonvulsant effects). He returned to England with a supply of cannabis in 1842, after which its use spread through Europe and the United States. In 1845 French physician Jacques-Joseph Moreau published a book about the use of cannabis in psychiatry. In 1850 cannabis was entered into the United States Pharmacopeia. An anecdotal report of Cannabis indica as a treatment for tetanus appeared in Scientific American in 1880.

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 of 1970.

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". 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 Cannabis indica fluid extract, American Druggists Syndicate, pre-1937
  • An advertisement for cannabis americana distributed by a pharmacist in New York in 1917 An advertisement for cannabis americana distributed by a pharmacist in New York in 1917
  • The Ebers Papyrus (c. 1550 BCE) from Ancient Egypt has a prescription for medical marijuana applied directly for inflammation. The Ebers Papyrus (c. 1550 BCE) from Ancient Egypt has a prescription for medical marijuana applied directly for inflammation.

Society and culture

Legal status

See also: Legality of cannabis by country
Map of world medical cannabis laws
Legal status of (whole-plant) medical cannabis worldwide (only de jure; may not reflect actual access in these countries)
  Legal as authorized by a physician   Legal for any use (no prescription required)
See also countries that have decriminalized or where enforcement is limited.

Countries that have legalized the medical use of cannabis include Argentina, Australia, Brazil, Canada, Chile, Colombia, Costa Rica, Croatia, Cyprus, Czech Republic, Finland, Germany, Greece, Israel, Italy, Jamaica, Lebanon, Luxembourg, Malta, Morocco, the Netherlands, New Zealand, North Macedonia, Panama, Peru, Poland, Portugal, Rwanda, Sri Lanka, Switzerland, Thailand, the United Kingdom, and Uruguay. Other countries have more restrictive laws that allow only the use of isolated cannabinoid drugs such as Sativex or Epidiolex. Countries with the most relaxed policies include Canada, the Netherlands, Thailand, and Uruguay, where cannabis can be purchased without need for a prescription. In Mexico, THC content of medical cannabis is limited to one percent. In the United States, the legality of medical cannabis varies by state.

However, in many of these countries, access may not always be possible under the same conditions.

International law

See also: Removal of cannabis and cannabis resin from Schedule IV of the Single Convention on narcotic drugs, 1961

Cannabis and its derivatives are subject to regulation under three United Nations drug control treaties: the 1961 Single Convention on Narcotic Drugs, the 1971 Convention on Psychotropic Substances, and the 1988 Convention Against Illicit Traffic in Narcotic Drugs and Psychotropic Substances.

Cannabis and cannabis resin are classified as a Schedule I drug under the Single Convention treaty, meaning that medical use is considered "indispensible for the relief of pain and suffering" but that it is considered to be an addictive medication with risks of abuse. Countries have an obligation to provide access and sufficient availability of drugs listed in Schedule I for the purposes of medical uses.

Prior to December 2020 cannabis and cannabis resin were also included in Schedule IV, a more restrictive level of control, which is for only the most dangerous drugs such as heroin and fentanyl. They were removed after an independent scientific assessment by the World Health Organization in 2018-1029.

Member nations of the UN Commission on Narcotic Drugs voted 27–25 to remove it from Schedule IV on 2 December 2020, following a World Health Organization recommendation for removal in January 2019.

United States

See also: Medical cannabis in the United States

In the United States, the use of cannabis for medical purposes is legal in 38 states, four out of five permanently inhabited U.S. territories, and the District of Columbia. An additional 10 states have more restrictive laws allowing the use of low-THC products. Cannabis remains illegal at the federal level under the Controlled Substances Act, which classifies it 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.

In the US, the FDA has approved two oral cannabinoids for use as medicine in 1985: dronabinol (pure delta-9-THC; brand name Marinol) and nabilone (a synthetic neocannabinoid; brand name Cesamet). In the US, they are both listed as Schedule II, indicating high potential for side effects and addiction.

Economics

Distribution

Medical marijuana dispensary in Denver, Colorado

The method of obtaining medical cannabis varies by region and by legislation. In the US, most consumers grow their own or buy it from cannabis dispensaries in states where it is legal. Marijuana vending 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.

Almost 70% of medical cannabis is exported from the United Kingdom, according to a 2017 United Nations report, with much of the remaining amount coming from Canada and the Netherlands.

Insurance

In the United States, health insurance companies may not pay for a medical marijuana prescription as the Food and Drug Administration must approve any substance for medicinal purposes. Before this can happen, the FDA must first permit the study of the medical benefits and drawbacks of the substance, which it has not done since it was placed on Schedule I of the Controlled Substances Act in 1970. Therefore, all expenses incurred fulfilling a medical marijuana prescription will possibly be incurred as out-of-pocket. However, the New Mexico Court of Appeals has ruled that workers' compensation insurance must pay for prescribed marijuana as part of the state's Medical Cannabis Program.

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 Society.

Organizations that oppose the legalization of medical cannabis include the American Academy of Pediatrics (AAP) and American Psychiatric Association. 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 to be reviewed. The American Academy of Family Physicians and American Society of Addiction Medicine also do not take a position, but do support rescheduling to better facilitate research. The American Heart Association says that "many of the concerning health implications of cannabis include cardiovascular diseases" but that it supports rescheduling to allow "more nuanced ... marijuana legislation and regulation" and to "reflect the existing science behind cannabis". 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.

Cancer Research UK say that while cannabis is being studied for therapeutic potential, "claims that there is solid "proof" that cannabis or cannabinoids can cure cancer is highly misleading to patients and their families, and builds a false picture of the state of progress in this area".

Nonproprietary names

There are three International Nonproprietary Name (INN) granted for cannabinoids: two plant-derived phytocannabinoids and one neocannabinoid:

  • Dronabinol is the INN for delta-9-THC (there is a common confusion according to which the word "dronabinol" would only refer to synthetic delta-9-THC, which is incorrect).
  • Cannabidiol is also the official INN for the molecule, granted in 2017.
  • Nabilone is the INN for a synthetic cannabinoid analog (not present in Cannabis plants).

Nabiximols is the generic name (but not recognized as an INN) of a mixture of Cannabidiol and Dronabinol. Its most common form is the oromucosal spray derived from two strains of Cannabis sativa and containing THC and CBD traded under the brand name Sativex®. It is not approved in the United States, but is approved in several European countries, Canada, and New Zealand as of 2013.

Generic
name 		Brand
name(s) 		Country (non-exhaustive) Licensed indications
Nabilone Cesamet U.S., Canada Antiemetic (treatment of nausea or vomiting) associated with chemotherapy that has failed to respond adequately to conventional therapy
Dronabinol Marinol
Syndros U.S. Anorexia associated with AIDS–related weight loss
Nabiximols Sativex Canada, New Zealand,
majority of the EU 		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 trade name 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 weeks.

Relative to inhaled consumption, peak concentration of oral THC is 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.

Research

Main article: Medical cannabis research

A 2022 review concluded that "oral, synthetic cannabis products with high THC-to-CBD ratios and sublingual, extracted cannabis products with comparable THC-to-CBD ratios may be associated with short-term improvements in chronic pain and increased risk for dizziness and sedation."

See also

References

  1. Murnion B (December 2015). "Medicinal cannabis". Australian Prescriber. 38 (6): 212–15. doi:10.18773/austprescr.2015.072. PMC 4674028. PMID 26843715.
  2. "What is medical marijuana?". National Institute of Drug Abuse. July 2015. Archived from the original on 17 April 2016. 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.
  3. Sarris J, Sinclair J, Karamacoska D, Davidson M, Firth J (16 January 2020). "Medicinal cannabis for psychiatric disorders: a clinically-focused systematic review". BMC Psychiatry. 20 (1): 24. doi:10.1186/s12888-019-2409-8. ISSN 1471-244X. PMC 6966847. PMID 31948424.
  4. O'Brien K (1 June 2019). "Medicinal Cannabis: Issues of evidence". European Journal of Integrative Medicine. 28: 114–120. doi:10.1016/j.eujim.2019.05.009. ISSN 1876-3820.
  5. "Release the strains". Nature Medicine. 21 (9): 963. September 2015. doi:10.1038/nm.3946. PMID 26340110.
  6. ^ 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. PMID 23386598. S2CID 8503107. Archived (PDF) from the original on 28 August 2021. Retrieved 11 November 2017.
  7. ^ Whiting PF, Wolff RF, Deshpande S, Di Nisio M, Duffy S, Hernandez AV, et al. (23 June 2015). "Cannabinoids for Medical Use: A Systematic Review and Meta-analysis". JAMA. 313 (24): 2456–73. doi:10.1001/jama.2015.6358. hdl:10757/558499. PMID 26103030.
  8. ^ Wang L, Hong PJ, May C, Rehman Y, Oparin Y, Hong CJ, et al. (9 September 2021). "Medical cannabis or cannabinoids for chronic non-cancer and cancer related pain: a systematic review and meta-analysis of randomised clinical trials". BMJ. 374: n1034. doi:10.1136/bmj.n1034. ISSN 1756-1833. PMID 34497047. Archived from the original on 9 September 2021. Retrieved 9 September 2021.
  9. ^ Ben Amar M (April 2006). "Cannabinoids in medicine: A review of their therapeutic potential". Journal of Ethnopharmacology (Review). 105 (1–2): 1–25. CiteSeerX 10.1.1.180.308. doi:10.1016/j.jep.2006.02.001. PMID 16540272.
  10. ^ Therapeutic Use of Marijuana and Related Cannabinoids (PDF), American Nurses Association, 2016, archived (PDF) from the original on 21 September 2020, retrieved 13 May 2018
  11. ^ "AAFP Releases Marijuana, Cannabinoids Position Paper". American Academy of Family Physicians. 20 September 2019. Archived from the original on 28 September 2019. Retrieved 6 October 2019.
  12. ^ American Academy of Pediatrics Reaffirms Opposition to Legalizing Marijuana for Recreational or Medical Use, American Academy of Pediatrics, 26 January 2015, archived from the original on 26 April 2018, retrieved 30 July 2017
  13. ^ "State Medical Marijuana Laws". National Conference of State Legislatures. 12 September 2022. Archived from the original on 11 December 2018. Retrieved 6 October 2022.
  14. "Marijuana as Medicine". National Institute on Drug Abuse. July 2019. Archived from the original on 17 April 2016. Retrieved 19 April 2016.
  15. ^ Consumer Reports (28 April 2016). "Up in Smoke: Does Medical Marijuana Work?". Consumer Reports. Archived from the original on 14 March 2021. Retrieved 24 May 2016.
  16. ^ Schubart CD, Sommer IE, Fusar-Poli P, de Witte L, Kahn RS, Boks MP (January 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. S2CID 13197304. Archived from the original (PDF) on 20 October 2018. Retrieved 9 July 2016.
  17. ^ Koppel BS, Brust JC, Fife T, Bronstein J, Youssof S, Gronseth G, et al. (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): 1556–1563. doi:10.1212/WNL.0000000000000363. PMC 4011465. PMID 24778283.
  18. ^ Pratt M, Stevens A, Thuku M, Butler C, Skidmore B, Wieland LS, et al. (December 2019). "Benefits and harms of medical cannabis: a scoping review of systematic reviews". Syst Rev (Systematic review). 8 (1): 320. doi:10.1186/s13643-019-1243-x. PMC 6905063. PMID 31823819.
  19. ^ Sachs J, McGlade E, Yurgelun-Todd D (October 2015). "Safety and Toxicology of Cannabinoids". Neurotherapeutics. 12 (4): 735–46. doi:10.1007/s13311-015-0380-8. PMC 4604177. PMID 26269228.
  20. "Sex(ism), Drugs, and Migraines: Distillations Podcast and Transcript, Episode 237". Distillations. Science History Institute. 15 January 2019. Archived from the original on 14 March 2021. Retrieved 28 August 2019.
  21. Gilson AM, LeBaron VT, Vyas MB (1 January 2018). "The use of cannabis in response to the opioid crisis: A review of the literature". Nursing Outlook. 66 (1): 56–65. doi:10.1016/j.outlook.2017.08.012. ISSN 0029-6554. PMID 28993073.
  22. American College of Obstetricians Gynecologists Committee on Obstetric Practice (July 2015). "Committee Opinion No. 637: Marijuana Use During Pregnancy and Lactation". Obstetrics and Gynecology. 126 (1): 234–38. doi:10.1097/01.AOG.0000467192.89321.a6. PMID 26241291.
  23. Diep C, Tian C, Vachhani K, Won C, Wijeysundera DN, Clarke H, et al. (24 November 2021). "Recent cannabis use and nightly sleep duration in adults: a population analysis of the NHANES from 2005 to 2018". Regional Anesthesia & Pain Medicine. 47 (2): 100–104. doi:10.1136/rapm-2021-103161. ISSN 1098-7339. PMID 34873024.
  24. Walsh JH, Maddison KJ, Rankin T, Murray K, McArdle N, Ree MJ, et al. (12 November 2021). "Treating insomnia symptoms with medicinal cannabis: a randomized, crossover trial of the efficacy of a cannabinoid medicine compared with placebo". SLEEP. 44 (11). doi:10.1093/sleep/zsab149. ISSN 0161-8105. PMC 8598183. PMID 34115851.
  25. ^ Grotenhermen F, Müller-Vahl K (July 2012). "The therapeutic potential of cannabis and cannabinoids". Deutsches Ärzteblatt International. 109 (29–30): 495–501. doi:10.3238/arztebl.2012.0495. PMC 3442177. PMID 23008748.
  26. Bowles DW, O'Bryant CL, Camidge DR, Jimeno A (July 2012). "The intersection between cannabis and cancer in the United States". Critical Reviews in Oncology/Hematology (Review). 83 (1): 1–10. doi:10.1016/j.critrevonc.2011.09.008. PMID 22019199.
  27. ^ 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. PMID 18559804.
  28. Jordan K, Sippel C, Schmoll HJ (September 2007). "Guidelines for antiemetic treatment of chemotherapy-induced nausea and vomiting: past, present, and future recommendations" (PDF). The Oncologist (Review). 12 (9): 1143–50. doi:10.1634/theoncologist.12-9-1143. PMID 17914084. S2CID 17612434. Archived from the original (PDF) on 7 March 2019.
  29. Nicolson SE, Denysenko L, Mulcare JL, Vito JP, Chabon B (May–June 2012). "Cannabinoid hyperemesis syndrome: a case series and review of previous reports". Psychosomatics (Review, case series). 53 (3): 212–19. doi:10.1016/j.psym.2012.01.003. PMID 22480624.
  30. Phillips RS, Friend AJ, Gibson F, Houghton E, Gopaul S, Craig JV, et al. (February 2016). "Antiemetic medication for prevention and treatment of chemotherapy-induced nausea and vomiting in childhood" (PDF). The Cochrane Database of Systematic Reviews. 2016 (2): CD007786. doi:10.1002/14651858.CD007786.pub3. PMC 7073407. PMID 26836199. Archived (PDF) from the original on 30 June 2021. Retrieved 23 September 2019.
  31. Lutge EE, Gray A, Siegfried N (April 2013). "The medical use of cannabis for reducing morbidity and mortality in patients with HIV/AIDS". The Cochrane Database of Systematic Reviews (Review). 4 (4): CD005175. doi:10.1002/14651858.CD005175.pub3. PMID 23633327.
  32. Aviram J, Samuelly-Leichtag G (September 2017). "Efficacy of Cannabis-Based Medicines for Pain Management: A Systematic Review and Meta-Analysis of Randomized Controlled Trials". Pain Physician. 20 (6): E755–96. doi:10.36076/ppj.20.5.E755. PMID 28934780. Archived from the original on 30 June 2021. Retrieved 12 January 2018.
  33. 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. PMID 21426373.
  34. Carter GT, Flanagan AM, Earleywine M, Abrams DI, Aggarwal SK, Grinspoon L (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. S2CID 19980960.
  35. Filip Gedin, Sebastian Blomé, Moa Pontén, Maria Lalouni, Jens Fust, Andreé Raquette, et al. (28 November 2022). "Placebo Response and Media Attention in Randomized Clinical Trials Assessing Cannabis-Based Therapies for PainA Systematic Review and Meta-analysis". JAMA Network Open. 5 (11): e2243848. doi:10.1001/jamanetworkopen.2022.43848. PMC 9706362. PMID 36441553.
  36. Clark PA, Capuzzi K, Fick C (December 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.
  37. Oreja-Guevara C (October 2012). "". Revista de Neurología (Review) (in Spanish). 55 (7): 421–30. PMID 23011861.
  38. Commissioner Oo (10 June 2019). "FDA and Marijuana". FDA. Archived from the original on 16 November 2019. Retrieved 16 December 2019.
  39. Black N, Stockings E, Campbell G, Tran LT, Zagic D, Hall WD, et al. (2019). "Cannabinoids for the treatment of mental disorders and symptoms of mental disorders: a systematic review and meta-analysis". Lancet Psychiatry (Systematic review & meta-analysis). 6 (12): 995–1010. doi:10.1016/S2215-0366(19)30401-8. PMC 6949116. PMID 31672337.
  40. "Anxiety and Cannabis: A Review of Recent Research". Medical Cannabis Research Center. 10 April 2023. Retrieved 9 April 2024.
  41. Sarris J, Sinclair J, Karamacoska D, Davidson M, Firth J (16 January 2020). "Medicinal cannabis for psychiatric disorders: a clinically-focused systematic review". BMC Psychiatry. 20 (1): 24. doi:10.1186/s12888-019-2409-8. ISSN 1471-244X. PMC 6966847. PMID 31948424.
  42. ^ Abuse NI (8 May 2023). "Is there a link between marijuana use and psychiatric disorders? | National Institute on Drug Abuse (NIDA)". nida.nih.gov. Retrieved 9 April 2024.
  43. ^ Washington TA, Brown KM, Fanciullo GJ (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 brain
  44. Gage SH, Hickman M, Zammit S (April 2016). "Association Between Cannabis and Psychosis: Epidemiologic Evidence". Biological Psychiatry. 79 (7): 549–56. doi:10.1016/j.biopsych.2015.08.001. hdl:1983/b8fb2d3b-5a55-4d07-97c0-1650b0ffc05d. PMID 26386480. S2CID 1055335. Archived from the original on 26 February 2020. Retrieved 11 March 2020.
  45. Barceloux DG (2012). "Chapter 60: Marijuana (Cannabis sativa L.) and synthetic cannabinoids". Medical Toxicology of Drug Abuse: Synthesized Chemicals and Psychoactive Plants. John Wiley & Sons. pp. 886–931. ISBN 978-0-471-72760-6. Archived from the original on 13 January 2023. Retrieved 20 December 2015.
  46. Sagar KA, Dahlgren MK, Lambros AM, Smith RT, El-Abboud C, Gruber SA (2021). "An Observational, Longitudinal Study of Cognition in Medical Cannabis Patients over the Course of 12 Months of Treatment: Preliminary Results". Journal of the International Neuropsychological Society. 27 (6): 648–60. doi:10.1017/S1355617721000114. ISSN 1355-6177. PMID 34261553. S2CID 235824932.
  47. Large M, Sharma S, Compton MT, Slade T, Nielssen O (June 2011). "Cannabis use and earlier onset of psychosis: a systematic meta-analysis". Archives of General Psychiatry. 68 (6): 555–61. doi:10.1001/archgenpsychiatry.2011.5. PMID 21300939.
  48. Semple DM, McIntosh AM, Lawrie SM (March 2005). "Cannabis as a risk factor for psychosis: systematic review". Journal of Psychopharmacology. 19 (2): 187–94. doi:10.1177/0269881105049040. PMID 15871146. S2CID 44651274.
  49. Arseneault L, Cannon M, Witton J, Murray RM (February 2004). "Causal association between cannabis and psychosis: examination of the evidence". The British Journal of Psychiatry. 184 (2): 110–17. doi:10.1192/bjp.184.2.110. PMID 14754822.
  50. Laqueille X (September 2009). "" [Is cannabis is a vulnerability factor of schizophrenic disorders?]. Archives de Pédiatrie. 16 (9): 1302–05. doi:10.1016/j.arcped.2009.03.016. PMID 19640690.
  51. Downer EJ, Campbell VA (January 2010). "Phytocannabinoids, CNS cells and development: a dead issue?". Drug and Alcohol Review (Review). 29 (1): 91–98. doi:10.1111/j.1465-3362.2009.00102.x. PMID 20078688.
  52. Burns TL, Ineck JR (February 2006). "Cannabinoid analgesia as a potential new therapeutic option in the treatment of chronic pain". The Annals of Pharmacotherapy (Review). 40 (2): 251–60. doi:10.1345/aph.1G217. PMID 16449552. S2CID 6858360.
  53. ^ 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". Missouri Medicine (Review). 109 (2): 90–98. PMC 6181739. PMID 22675784.
  54. Gordon AJ, Conley JW, Gordon JM (December 2013). "Medical consequences of marijuana use: a review of current literature". Current Psychiatry Reports (Review). 15 (12): 419. doi:10.1007/s11920-013-0419-7. PMID 24234874. S2CID 29063282. Archived from the original on 7 August 2019. Retrieved 12 July 2019.
  55. 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. PMID 18426493. S2CID 20161611.
  56. Whiteside GT, Lee GP, Valenzano KJ (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): 917–36. doi:10.2174/092986707780363023. PMID 17430144.
  57. ^ Gaston TE, Friedman D (May 2017). "Pharmacology of cannabinoids in the treatment of epilepsy". Epilepsy & Behavior. Cannabinoids and Epilepsy. 70 (Pt B): 313–18. doi:10.1016/j.yebeh.2016.11.016. PMID 28087250. S2CID 3929024.
  58. Mannila J, Järvinen T, Järvinen K, Tervonen J, Jarho P (March 2006). "Sublingual administration of Delta9-tetrahydrocannabinol/beta-cyclodextrin complex increases the bioavailability of Delta9-tetrahydrocannabinol in rabbits". Life Sciences. 78 (17): 1911–14. doi:10.1016/j.lfs.2005.08.025. PMID 16266727.
  59. ^ Huestis MA (August 2007). "Human cannabinoid pharmacokinetics". Chemistry & Biodiversity. 4 (8): 1770–804. doi:10.1002/cbdv.200790152. PMC 2689518. PMID 17712819.
  60. ^ Badowski ME (September 2017). "A review of oral cannabinoids and medical marijuana for the treatment of chemotherapy-induced nausea and vomiting: a focus on pharmacokinetic variability and pharmacodynamics". Cancer Chemotherapy and Pharmacology. 80 (3): 441–49. doi:10.1007/s00280-017-3387-5. PMC 5573753. PMID 28780725.
  61. Nahas GG (April 2001). "The pharmacokinetics of THC in fat and brain: resulting functional responses to marihuana smoking". Human Psychopharmacology. 16 (3): 247–55. doi:10.1002/hup.258. PMID 12404577. S2CID 30513770.
  62. Bridgeman MB, Abazia DT (March 2017). "Medicinal Cannabis: History, Pharmacology, And Implications for the Acute Care Setting". P & T. 42 (3): 180–88. PMC 5312634. PMID 28250701.
  63. Nahas GG, Sutin KM, Harvey DJ, Agurell S (1999). Marihuana and Medicine. Springer Science & Business Media. ISBN 978-1-59259-710-9. Archived from the original on 13 January 2023. Retrieved 20 September 2020.
  64. ^ "Human Metabolism of THC". Sapiensoup Blog. 21 December 2016. Archived from the original on 26 June 2021. Retrieved 1 November 2017.
  65. "11-Hydroxy-THC - Increased Potency That Explains the Effect of Edibles? – Prof of Pot". profofpot.com. 2 July 2016. Archived from the original on 28 June 2021. Retrieved 1 November 2017.
  66. "Toxicology Litigation Support: Marijuana". consultox.com. Archived from the original on 26 June 2021. Retrieved 1 November 2017.
  67. ^ Devinsky O, Cilio MR, Cross H, Fernandez-Ruiz J, French J, Hill C, et al. (June 2014). "Cannabidiol: pharmacology and potential therapeutic role in epilepsy and other neuropsychiatric disorders". Epilepsia. 55 (6): 791–802. doi:10.1111/epi.12631. PMC 4707667. PMID 24854329.
  68. Grotenhermen F (1 April 2003). "Pharmacokinetics and pharmacodynamics of cannabinoids". Clinical Pharmacokinetics. 42 (4): 327–60. doi:10.2165/00003088-200342040-00003. PMID 12648025. S2CID 25623600.
  69. Zendulka O, Dovrtělová G, Nosková K, Turjap M, Šulcová A, Hanuš L, et al. (29 February 2016). "Cannabinoids and Cytochrome P450 Interactions". Current Drug Metabolism. 17 (3): 206–226. doi:10.2174/1389200217666151210142051. PMID 26651971. Archived from the original on 3 July 2021. Retrieved 1 November 2017.
  70. Ohlsson A, Lindgren JE, Andersson S, Agurell S, Gillespie H, Hollister LE (February 1986). "Single-dose kinetics of deuterium-labelled cannabidiol in man after smoking and intravenous administration". Biomedical & Environmental Mass Spectrometry. 13 (2): 77–83. doi:10.1002/bms.1200130206. PMID 2937482.
  71. ^ Curtis A, Clarke CE, Rickards HE (October 2009). "Cannabinoids for Tourette's Syndrome". The Cochrane Database of Systematic Reviews (Review). 2009 (4): CD006565. doi:10.1002/14651858.CD006565.pub2. PMC 7387115. PMID 19821373.
  72. ^ "Inter-agency advisory regarding claims that smoked marijuana is a medicine" (Press release). fda.gov. 20 April 2006. Archived from the original on 13 October 2012. Retrieved 24 December 2012.
  73. Abel EL (1980). "Cannabis in the Ancient World". Marihuana: the first twelve thousand years. New York City: Plenum Publishers. ISBN 978-0-306-40496-2. Archived from the original on 28 June 2021. Retrieved 29 October 2008.
  74. Li, Hui-Lin (1974). "An Archaeological and Historical Account of Cannabis in China", Economic Botany 28.4:437–48, p. 444.
  75. Bloomquist E (1971). Marijuana: The Second Trip. California: Glencoe Press.
  76. Wong M (1976). La Médecine chinoise par les plantes. Paris: Tchou. OCLC 2646789.
  77. "The Ebers Papyrus The Oldest (confirmed) Written Prescriptions For Medical Marihuana era 1,550 BC". onlinepot.org. Archived from the original on 4 March 2016. Retrieved 10 June 2008.
  78. Pain S (15 December 2007). "The Pharaoh's pharmacists". New Scientist. Reed Business Information Ltd. Archived from the original on 21 May 2008. Retrieved 4 September 2017.
  79. Touw M (1981). "The religious and medicinal uses of Cannabis in China, India and Tibet". Journal of Psychoactive Drugs. 13 (1): 23–34. doi:10.1080/02791072.1981.10471447. PMID 7024492.
  80. ^ Butrica JL (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. Archived from the original (PDF) on 11 November 2014. Retrieved 8 November 2014.
  81. Lozano I (2001). "The Therapeutic Use of Cannabis sativa (L.) in Arabic Medicine". Journal of Cannabis Therapeutics. 1: 63–70. CiteSeerX 10.1.1.550.1717. doi:10.1300/J175v01n01_05.
  82. ^ Holland, Julie, ed. (2010). The Pot Book: A Complete Guide to Cannabis. New York: Simon and Schuster. ISBN 978-1-59477-898-8. Archived from the original on 13 January 2023. Retrieved 22 April 2018.
  83. Evert RF, Eichhorn SE (2013). Raven Biology of Plants (8th ed.). New York: W. H. Freeman and Company. pp. 213–17. ISBN 978-1-4292-1961-7.
  84. Evert RF, Eichhorn SE (2013). Raven Biology of Plants (8th ed.). New York: W.H. Freeman and Company. pp. 501–04. ISBN 978-1-4292-1961-7.
  85. Alison Mack, Janet Joy (2000). Marijuana As Medicine?: The Science Beyond the Controversy. National Academies Press. pp. 15–. ISBN 978-0-309-06531-3. Archived from the original on 13 January 2023. Retrieved 20 December 2015.
  86. ^ Booth M (2005). Cannabis: A History. New York: St. Martin's Press. ISBN 978-0-312-42494-7.
  87. ^ Grinspoon L, Bakalar J (1997). Marihuana, the Forbidden Medicine (Revised and expanded ed.). Yale University Press. ISBN 978-0-300-07086-6.
  88. Hans Bangen:Geschichte der medikamentösen Therapie der Schizophrenie. Berlin 1992, p. 22.
  89. Scientific American, "Successful Treatment of Tetanus". Munn & Company. 10 July 1880. p. 25. Archived from the original on 12 January 2023. Retrieved 5 June 2021.
  90. Pacula RP (February 2002). "State Medical Marijuana Laws: Understanding the Laws and Their Limitations" (PDF). Journal of Public Health Policy. 23 (4): 413–39. CiteSeerX 10.1.1.202.2274. doi:10.2307/3343240. JSTOR 3343240. PMID 12532682. S2CID 13389317. Archived (PDF) from the original on 2 March 2021. Retrieved 20 March 2018.
  91. Joy JE, Watson SJ, Benson JA (1999). "Marijuana and Medicine – Assessing the Science Base" (PDF). Washington, D.C.: National Academy Press. Archived from the original (PDF) on 23 January 2018. Retrieved 28 July 2017.
  92. "History of Marijuana as Medicine – 2900 BC to Present". ProCon.org. Archived from the original on 15 July 2017. Retrieved 27 July 2017.
  93. "Marijuana's journey to legal health treatment: the Canadian experience". CBC News. 17 August 2009. Archived from the original on 14 June 2017. Retrieved 27 July 2017.
  94. Politi D (12 November 2020). "Argentina to Allow Medicinal Marijuana to Be Grown at Home". The New York Times. Archived from the original on 23 January 2023. Retrieved 22 January 2023.
  95. Jolly W (28 February 2018). "Medicinal Marijuana Legal In Australia". Canstar. Archived from the original on 17 July 2018. Retrieved 16 July 2018.
  96. Ponieman N (3 December 2019). "Brazil Regulates Sale Of Medical Marijuana Products". Benzinga. Archived from the original on 14 March 2021. Retrieved 10 December 2019.
  97. ^ Williams S (15 May 2016). "10 Countries (Aside From the U.S.) Where Some Form of Medical Marijuana Is Legal". The Motley Fool. Archived from the original on 11 November 2017. Retrieved 5 November 2017.
  98. "Costa Rica legalizes medicinal marijuana use, hemp growing". Associated Press. 2 March 2022. Archived from the original on 7 March 2022. Retrieved 22 January 2023.
  99. Veselica L (15 October 2015). "Croatia legalises marijuana for medical use". Yahoo News. AFP. Archived from the original on 14 March 2021. Retrieved 4 November 2017.
  100. "Cyprus begins to distribute medical cannabis". InCyprus. 22 May 2017. Archived from the original on 9 June 2017. Retrieved 11 November 2017.
  101. "Legal status of cannabis in Finland – An overview". Sensi Seeds. Archived from the original on 14 March 2021. Retrieved 4 November 2017.
  102. Senthilingam M (6 March 2017). "Germany joins the global experiment on marijuana legalization". CNN.com. Archived from the original on 14 March 2021. Retrieved 4 November 2017.
  103. Revesz R (3 July 2017). "Greece legalises marijuana for medical purposes". The Independent. Archived from the original on 12 May 2022. Retrieved 4 November 2017.
  104. Schwartz Y (24 August 2017). "How the Booming Israeli Weed Industry Is Changing American Pot". Rollingstone.com. Archived from the original on 4 November 2017. Retrieved 4 November 2017.
  105. Samuels G (26 July 2016). "Italian army aims to produce "the best-quality" medical marijuana after finding current batches deficient". The Independent. Archived from the original on 12 May 2022. Retrieved 4 November 2017.
  106. Bud M (19 March 2018). "Jamaica's Kaya Farms Becomes First Medical Marijuana Dispensary To Open". marijuana.com. Archived from the original on 14 March 2021. Retrieved 16 July 2018.
  107. "Lebanon Legalizes Cannabis Farming for Medicinal Use". The New York Times. Reuters. 21 April 2020. Archived from the original on 23 April 2020. Retrieved 25 April 2020.
  108. Pritchard H (29 June 2018). "Cannabis for medical use legalised in Luxembourg". Luxembourg Times. Archived from the original on 29 June 2018. Retrieved 8 July 2018.
  109. Pace M (27 March 2018). "Malta has officially legalised medical cannabis". Malta Today. Archived from the original on 1 July 2021. Retrieved 24 August 2018.
  110. "Morocco: Bill to legalise cannabis enters into force". Middle East Monitor. 31 July 2021. Archived from the original on 11 August 2021. Retrieved 22 January 2023.
  111. Ainge Roy E (11 December 2018). "New Zealand passes laws to make medical marijuana widely available". The Guardian. Archived from the original on 13 January 2019. Retrieved 20 January 2019.
  112. Marusic SJ (1 June 2016). "Macedonia Allows Medical Marijuana in Pharmacies". Balkan Insight. Archived from the original on 31 October 2017. Retrieved 4 November 2017.
  113. "El gobierno de Panamá legalizó el uso medicinal y terapéutico del cannabis". Infobae. 14 October 2021. Archived from the original on 17 October 2021. Retrieved 22 January 2023.
  114. Collyns D (20 October 2017). "Peru legalises medical marijuana in move spurred by mother's home lab". The Guardian. Archived from the original on 3 July 2018. Retrieved 4 November 2017.
  115. "Medical use of cannabis officially legal in Poland". Radio Poland. PAP. 11 February 2017. Archived from the original on 14 March 2021. Retrieved 4 November 2017.
  116. Lamers M (21 June 2018). "Portugal passes medical cannabis law, opens domestic market". Marijuana Business Daily. Archived from the original on 5 September 2019. Retrieved 24 August 2018.
  117. Mwai C (29 June 2021). "10 things to know after Rwanda gives the green light for medical marijuana". The New Times. Archived from the original on 23 January 2023. Retrieved 22 January 2023.
  118. South Asia Regional Profile (PDF), United Nations Office on Drugs and Crime, 15 September 2005, archived (PDF) from the original on 23 September 2020, retrieved 2 February 2019
  119. "Switzerland to legalise medicinal cannabis from Monday". The Local. 28 July 2022. Archived from the original on 9 August 2022. Retrieved 22 January 2023.
  120. Mosbergen D (25 December 2018). "Thailand Approves Medical Marijuana In Regional First". HuffPost. Archived from the original on 19 January 2019. Retrieved 20 January 2019.
  121. "Medicinal cannabis products to be legalised". BBC. 26 July 2018. Archived from the original on 28 July 2018. Retrieved 28 July 2018.
  122. "Sativex (delta-9-tetrahydrocannabinol and cannabidiol)". GW Pharmaceuticals. Archived from the original on 10 December 2017. Retrieved 5 November 2017.
  123. Medical use of cannabis and cannabinoids (PDF), European Monitoring Centre for Drugs and Drug Addiction, December 2018, archived (PDF) from the original on 28 June 2021, retrieved 11 December 2019
  124. Sapra B (20 June 2018). "Canada becomes second nation in the world to legalize marijuana". CNN. Archived from the original on 12 February 2019. Retrieved 3 July 2018.
  125. Ives M (10 November 2022). "Weed Is Now Legal in Thailand. How Long Will the High Times Last?". The New York Times. Archived from the original on 27 November 2022. Retrieved 22 January 2023.
  126. Janikian M (14 September 2017). "Legal Pot In Mexico: Everything You Need to Know". Rolling Stone. Archived from the original on 11 November 2017. Retrieved 5 November 2017.
  127. Habibi R, Hoffman SJ (March 2018). "Legalizing Cannabis Violates the UN Drug Control Treaties, But Progressive Countries Like Canada Have Options". Ottawa Law Review. 49 (2). Archived from the original on 28 August 2021. Retrieved 8 January 2021.
  128. "Classification of controlled drugs". European Monitoring Centre for Drugs and Drug Addiction. Archived from the original on 8 January 2021. Retrieved 7 January 2021.
  129. International Narcotics Control Board (2010). Report of the International Narcotics Control Board on the Availability of Internationally Controlled Drugs: Ensuring Adequate Access for Medical and Scientific Purposes (PDF). Vienna: United Nations.
  130. International Centre on Human Rights and Drug Policy (University of Essex), United Nations Development Programme, Joint United Nations Programme on HIV/AIDS, Office of the United Nations High Commissioner for Human Rights, World Health Organization (2012). "Obligations arising from human rights standards: Access to controlled substances as medicines". International Guidelines on Human Rights and Drug Policy. Retrieved 30 August 2024. {{cite web}}: |last= has generic name (help)CS1 maint: multiple names: authors list (link)
  131. Kaur H (2 December 2020). "The UN removes cannabis from a list of the most dangerous substances". CNN. Archived from the original on 12 December 2020. Retrieved 7 January 2021.
  132. Kwai I (2 December 2020). "U.N. Reclassifies Cannabis as a Less Dangerous Drug". The New York Times. Archived from the original on 10 January 2021. Retrieved 7 January 2021.
  133. "WHO recommends rescheduling of cannabis". European Monitoring Centre for Drugs and Drug Addiction. 25 March 2019. Archived from the original on 28 December 2020. Retrieved 7 January 2021.
  134. Georgiou A (8 February 2019). "WHO Recommends Rescheduling Cannabis in International Law for First Time in History". Newsweek. Archived from the original on 20 December 2020. Retrieved 7 January 2021.
  135. Ingraham C (13 June 2017). "Jeff Sessions personally asked Congress to let him prosecute medical-marijuana providers". The Washington Post. Archived from the original on 4 July 2017. Retrieved 9 July 2017.
  136. Clark A (16 May 2006). ""New" Pot Pill For Chemo Patients". CBS News. Associated Press. Archived from the original on 28 July 2017. Retrieved 26 July 2017.
  137. "Final Rule: Placement of FDA-Approved Products of Oral Solutions Containing Dronabinol [(-)-delta-9-trans-tetrahydrocannabinol (delta-9-THC)] in Schedule II". U.S. Department of Justice. Archived from the original on 28 March 2018. Retrieved 2 February 2018.
  138. Timothy B. Wheeler (11 October 2014). "Medical marijuana fees stir debate in Maryland". The Baltimore Sun. Archived from the original on 16 October 2014. Retrieved 12 October 2014.
  139. 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.
  140. "Uber-For-Weed Startup Meadow Lights Up In San Francisco". TechCrunch. AOL. 14 October 2014. Archived from the original on 23 January 2016. Retrieved 22 January 2016.
  141. "The UK is the world's largest producer of legal Cannabis, UN body finds". The Independent. 7 March 2018. Archived from the original on 12 May 2022. Retrieved 7 December 2020.
  142. Clark TB (10 February 2015). "The Medical Marijuana Debate". Compliance Corner. Wolters Kluwer Financial Services. Archived from the original on 26 February 2015. Retrieved 26 February 2015.
  143. Peters J (29 June 2015). "Court: Employer can't block workers' comp for medical marijuana". NM Political Report. Archived from the original on 30 June 2015. Retrieved 30 June 2015.
  144. "Resolution on Medical Marijuana". druglibrary.org. Archived from the original on 19 October 2017. Retrieved 30 July 2017.
  145. "House of Delegates 2017, Resolution: A8" (PDF). amsa.org. American Medical Student Association. Archived (PDF) from the original on 1 August 2017. Retrieved 30 July 2017.
  146. "Medical Marijuana (Cannabis) FAQs". National Multiple Sclerosis Society. Archived from the original on 31 July 2017. Retrieved 30 July 2017.
  147. Gattone PM, Lammert W (20 February 2014). "Epilepsy Foundation Calls for Increased Medical Marijuana Access and Research" (Press release). Washington, D.C.: Epilepsy Foundation. Archived from the original on 31 July 2017. Retrieved 30 July 2017.
  148. "Medical Marijuana Use and Research" (PDF). maps.org. Leukemia & Lymphoma Society. Archived (PDF) from the original on 19 October 2017. Retrieved 30 July 2017.
  149. "Position Statement on Marijuana as Medicine" (PDF). American Psychiatric Association. Archived from the original (PDF) on 31 July 2017. Retrieved 30 July 2017.
  150. Use of Cannabis for Medicinal Purposes (PDF), American Medical Association, 2009, archived from the original (PDF) on 19 October 2017, retrieved 1 July 2017
  151. Supporting Research into the Therapeutic Role of Marijuana (PDF), American College of Physicians, February 2016, archived (PDF) from the original on 3 August 2020, retrieved 1 August 2017
  152. "ASAM Issues New Public Policy Statement on Cannabis" (Press release). Rockville, MD: American Society of Addiction Medicine. 13 October 2020. Archived from the original on 8 November 2020. Retrieved 1 November 2020.
  153. American Heart Association (5 August 2020). "Medical Marijuana, Recreational Cannabis, and Cardiovascular Health". Circulation. 142 (10): e131–52. doi:10.1161/CIR.0000000000000883. PMID 32752884.
  154. "Marijuana and Cancer". American Cancer Society. Archived from the original on 22 June 2017. Retrieved 12 July 2017.
  155. "Marijuana research: Overcoming the barriers". American Psychological Association. 14 September 2017. Archived from the original on 4 October 2017. Retrieved 9 October 2017.
  156. Arney K (25 July 2012). "Cannabis, cannabinoids and cancer – the evidence so far". Cancer Research UK. Archived from the original on 11 February 2014.
  157. World Health Organization (1984). "List of Proposed INNs No. 51" (PDF). WHO Chronicle. 38 (2): 6.
  158. World Health Organization (1984). "List of Recommended INNs No. 24" (PDF). WHO Chronicle. 38 (6): 4.
  159. Riboulet-Zemouli K (2020). "'Cannabis' ontologies I: Conceptual issues with Cannabis and cannabinoids terminology". Drug Science, Policy and Law. 6: 205032452094579. doi:10.1177/2050324520945797. ISSN 2050-3245.
  160. World Health Organization (2017). "List of Recommended INNs No. 77" (PDF). WHO Drug Information. 31 (1): 75.
  161. Abuhasira R, Shbiro L, Landschaft Y (March 2018). "Medical use of cannabis and cannabinoids containing products – Regulations in Europe and North America". European Journal of Internal Medicine. 49: 2–6. doi:10.1016/j.ejim.2018.01.001. PMID 29329891.
  162. "Produkt – FASS Allmänhet". fass.se. Archived from the original on 19 October 2017. Retrieved 26 December 2013.
  163. Youssef FF (June 2010). "Cannabis Unmasked: What it is and why it does what it does". UWIToday. Archived from the original on 17 March 2021. Retrieved 11 May 2021.
  164. McDonagh MS, Morasco BJ, Wagner J, Ahmed AY, Fu R, Kansagara D (2022). "Cannabis-Based Products for Chronic Pain: A Systematic Review". Ann Intern Med. 175 (8): 1143–1153. doi:10.7326/M21-4520. PMID 35667066. S2CID 249433147. Archived from the original on 19 February 2023. Retrieved 19 February 2023.

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