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Wikipedia

Cannabis (drug)

December 14, 2023

"Marijuana" redirects here. For other uses, see Marijuana (disambiguation).

Cannabis,[a] also known as marijuana[b] or weed among other names, is a psychoactive drug from the cannabis plant. Native to Central or South Asia, the cannabis plant has been used as a drug for both recreational and entheogenic purposes and in various traditional medicines for centuries. Tetrahydrocannabinol (THC) is the main psychoactive component of cannabis, which is one of the 483 known compounds in the plant, including at least 65 other cannabinoids, such as cannabidiol (CBD). Cannabis can be used by smoking, vaporizing, within food, or as an extract.

Cannabis
Close-up of flowering cannabis plant
Pronunciation
Source plant(s)Cannabis sativa, Cannabis indica, Cannabis ruderalis
Part(s) of plantFlower and fruit
Geographic originCentral or South Asia
Active ingredientsTetrahydrocannabinol, cannabidiol, cannabinol, tetrahydrocannabivarin
Main producersAfghanistan, Canada, China, Colombia, India, Jamaica, Lebanon, Mexico, Morocco, Netherlands, Pakistan, Paraguay, Spain, Thailand, Turkey, United Kingdom, United States
Legal status

Cannabis has various mental and physical effects, which include euphoria, altered states of mind and sense of time, difficulty concentrating, impaired short-term memory, impaired body movement (balance and fine psychomotor control), relaxation, and an increase in appetite. Onset of effects is felt within minutes when smoked, but may take up to 90 minutes when eaten (as orally consumed drugs must be metabolized). The effects last for two to six hours, depending on the amount used. At high doses, mental effects can include anxiety, delusions (including ideas of reference), hallucinations, panic, paranoia, and psychosis. There is a strong relation between cannabis use and the risk of psychosis, though the direction of causality is debated. Physical effects include increased heart rate, difficulty breathing, nausea, and behavioral problems in children whose mothers used cannabis during pregnancy; short-term side effects may also include dry mouth and red eyes. Long-term adverse effects may include addiction, decreased mental ability in those who started regular use as adolescents,[3] chronic coughing, susceptibility to respiratory infections, and cannabinoid hyperemesis syndrome.

Cannabis is mostly used recreationally or as a medicinal drug, although it may also be used for spiritual purposes. In 2013, between 128 and 232 million people used cannabis (2.7% to 4.9% of the global population between the ages of 15 and 65). It is the most commonly used largely-illegal drug in the world, with the highest use among adults in Zambia, the United States, Canada, and Nigeria. Since the 1970s, the potency of illicit cannabis has increased, with THC levels rising and CBD levels dropping.

While cannabis plants have been grown since at least the 3rd millennium BCE, evidence suggests that it was being smoked for psychoactive effects at least 2,500 years ago in the Pamir Mountains, Asia.[4] Since the 14th century, cannabis has been subject to legal restrictions. The possession, use, and cultivation of cannabis has been illegal in most countries since the 20th century. In 2013, Uruguay became the first country to legalize recreational use of cannabis. Other countries to do so are Canada, Georgia, Luxembourg, Malta, Mexico, South Africa, and Thailand. In the U.S., the recreational use of cannabis is legalized in 24 states, 3 territories, and the District of Columbia, though the drug remains federally illegal. In Australia, it is legalized only in the Australian Capital Territory.

Etymology

Borrowed from Latin cannabis (“hemp”), from Ancient Greek κάνναβις (kánnabis).[citation needed]

The first reference to marihuana was found in 1842 in Mexican newspapers, and then the term made its way to the U.S. in the 1890s.[5]

Uses

Medical

Main article: Medical cannabis
 
Example of a container and the recreational cannabis purchase in Canada

Medical cannabis, or medical marijuana, refers to the use of cannabis to treat disease or improve symptoms; however, there is no single agreed-upon definition (e.g., cannabinoids derived from cannabis and synthetic cannabinoids are also used).[6][7][8] The rigorous scientific study of cannabis as a medicine has been hampered by production restrictions and by the fact that it is classified as an illegal drug by many governments.[9] There is some evidence suggesting cannabis can be used to reduce nausea and vomiting during chemotherapy, to improve appetite in people with HIV/AIDS, or to treat chronic pain and muscle spasms. Evidence for its use for other medical applications is insufficient for drawing conclusions about safety or efficacy.[10][11][12] There is evidence supporting the use of cannabis or its derivatives in the treatment of chemotherapy-induced nausea and vomiting, neuropathic pain, and multiple sclerosis. Lower levels of evidence support its use for AIDS wasting syndrome, epilepsy, rheumatoid arthritis, and glaucoma.[13]

The medical use of cannabis is legal only in a limited number of territories, including Canada,[14] Belgium, Australia, the Netherlands, New Zealand,[15][16] Spain, and many U.S. states. This usage generally requires a prescription, and distribution is usually done within a framework defined by local laws.[13]

Recreational

According to DEA Chief Administrative Law Judge, Francis Young, "cannabis is one of the safest therapeutically active substances known to man".[17] Being under the effects of cannabis is usually referred to as being "high".[18] Cannabis consumption has both psychoactive and physiological effects.[19] The "high" experience can vary widely, based (among other things) on the user's prior experience with cannabis, and the type of cannabis consumed.[20]: p647  When smoking cannabis, a euphoriant effect can occur within minutes of smoking.[21]: p104  Aside from a subjective change in perception and mood, the most common short-term physical and neurological effects include increased heart rate, increased appetite, impairment of short-term and working memory, and psychomotor coordination.[22][23]

Additional desired effects from consuming cannabis include relaxation, a general alteration of conscious perception, increased awareness of sensation, increased libido[24] and distortions in the perception of time and space. At higher doses, effects can include altered body image, auditory and/or visual illusions, pseudohallucinations and ataxia from selective impairment of polysynaptic reflexes.[citation needed] In some cases, cannabis can lead to dissociative states such as depersonalization[25][26] and derealization.[27]

Spiritual

Main article: Entheogenic use of cannabis

Cannabis has held sacred status in several religions and has served as an entheogen – a chemical substance used in religious, shamanic, or spiritual contexts[28] – in the Indian subcontinent since the Vedic period. The earliest known reports regarding the sacred status of cannabis in the Indian subcontinent come from the Atharva Veda, estimated to have been composed sometime around 1400 BCE.[29] The Hindu god Shiva is described as a cannabis user, known as the "Lord of bhang."[30]: p19 

In modern culture, the spiritual use of cannabis has been spread by the disciples of the Rastafari movement who use cannabis as a sacrament and as an aid to meditation.[29]

Consumption

Main article: Cannabis consumption

Modes of consumption

 
A joint prior to rolling, with a paper handmade filter on the left

Many different ways to consume cannabis involve heat to decarboxylate THCA into THC;[31][32] common modes include:

Consumption by country

Main article: Annual cannabis use by country
Global estimates of drug users in 2016
(in millions of users)[38]
Substance Best
estimate		 Low
estimate		 High
estimate
Amphetamine-
type stimulants		 34.16 13.42 55.24
Cannabis 192.15 165.76 234.06
Cocaine 18.20 13.87 22.85
Ecstasy 20.57 8.99 32.34
Opiates 19.38 13.80 26.15
Opioids 34.26 27.01 44.54

In 2013, between 128 and 232 million people used cannabis (2.7% to 4.9% of the global population between the ages of 15 and 65).[39] Cannabis is by far the most widely used illicit substance,[40] with the highest use among adults (as of 2018) in Zambia, the United States, Canada, and Nigeria.[41]

United States

Between 1973 and 1978, eleven states decriminalized marijuana.[42] In 2001, Nevada reduced marijuana possession to a misdemeanor and since 2012, several other states have decriminalized and even legalized marijuana.[42]

In 2018, almost half of the people in the United States had tried marijuana, 16% had used it in the past year, and 11% had used it in the past month.[43] In 2014, daily marijuana use amongst US college students had reached its highest level since records began in 1980, rising from 3.5% in 2007 to 5.9% in 2014 and had surpassed daily cigarette use.[44]

In the US, men are over twice as likely to use marijuana as women, and 18–29-year-olds are six times more likely to use as over-65-year-olds.[45] In 2015, a record 44% of the US population has tried marijuana in their lifetime, an increase from 38% in 2013 and 33% in 1985.[45]

Marijuana use in the United States is three times above the global average, but in line with other Western democracies. Forty-four percent of American 12th graders have tried the drug at least once, and the typical age of first-use is 16, similar to the typical age of first-use for alcohol but lower than the first-use age for other illicit drugs.[40]

A 2022 Gallup poll concluded Americans are smoking more marijuana than cigarettes for the first time.[46]

Adverse effects

Further information: Effects of cannabis

Short-term

 
Main short-term physical effects of cannabis

Acute negative effects may include anxiety and panic, impaired attention and memory, an increased risk of psychotic symptoms,[c] the inability to think clearly, and an increased risk of accidents.[49][50][51] Cannabis impairs a person's driving ability, and THC was the illicit drug most frequently found in the blood of drivers who have been involved in vehicle crashes. Those with THC in their system are from three to seven times more likely to be the cause of the accident than those who had not used either cannabis or alcohol, although its role is not necessarily causal because THC stays in the bloodstream for days to weeks after intoxication.[52][53][d]

Some immediate undesired side effects include a decrease in short-term memory, dry mouth, impaired motor skills, reddening of the eyes,[56] dizziness, feeling tired and vomiting.[11] Some users may experience an episode of acute psychosis, which usually abates after six hours, but in rare instances, heavy users may find the symptoms continuing for many days.[57]

Legalization has increased the rates at which children are exposed to cannabis, particularly from edibles. While the toxicity and lethality of THC in children is not known, they are at risk for encephalopathy, hypotension, respiratory depression severe enough to require ventilation, somnolence and coma.[58][59]

Fatality

There is no clear evidence for a link between cannabis use and deaths from cardiovascular disease, but a 2019 review noted that it may be an under-reported, contributory factor or direct cause in cases of sudden death, due to the strain it can place on the cardiovascular system. Some deaths have also been attributed to cannabinoid hyperemesis syndrome.[60] There is an association between cannabis use and suicide, particularly in younger users.[61]

A 16-month survey of Oregon and Alaska emergency departments found a report of the death of an adult who had been admitted for acute cannabis toxicity.[62]

Long-term

Main article: Long-term effects of cannabis
 
Addiction experts in psychiatry, chemistry, pharmacology, forensic science, epidemiology, and the police and legal services engaged in delphic analysis regarding 20 popular recreational drugs. Cannabis was ranked 11th in dependence, 17th in physical harm, and 10th in social harm.[63]

Psychological effects

A 2015 meta-analysis found that, although a longer period of abstinence was associated with smaller magnitudes of impairment, both retrospective and prospective memory were impaired in cannabis users. The authors concluded that some, but not all, of the deficits associated with cannabis use were reversible.[64] A 2012 meta-analysis found that deficits in most domains of cognition persisted beyond the acute period of intoxication, but was not evident in studies where subjects were abstinent for more than 25 days.[65] Few high quality studies have been performed on the long-term effects of cannabis on cognition, and the results were generally inconsistent.[66] Furthermore, effect sizes of significant findings were generally small.[65] One review concluded that, although most cognitive faculties were unimpaired by cannabis use, residual deficits occurred in executive functions.[67] Impairments in executive functioning are most consistently found in older populations, which may reflect heavier cannabis exposure, or developmental effects associated with adolescent cannabis use.[68] One review found three prospective cohort studies that examined the relationship between self-reported cannabis use and intelligence quotient (IQ). The study following the largest number of heavy cannabis users reported that IQ declined between ages 7–13 and age 38. Poorer school performance and increased incidence of leaving school early were both associated with cannabis use, although a causal relationship was not established.[69] Cannabis users demonstrated increased activity in task-related brain regions, consistent with reduced processing efficiency.[70]

A reduced quality of life is associated with heavy cannabis use, although the relationship is inconsistent and weaker than for tobacco and other substances.[71] The direction of cause and effect, however, is unclear.[71]

The long-term effects of cannabis are not clear.[11] There are concerns surrounding memory and cognition problems, risk of addiction, and the risk of schizophrenia in young people.[10]

Neuroimaging

Although global abnormalities in white matter and grey matter are not consistently associated with heavy cannabis use,[72] reduced hippocampal volume is consistently found.[73] Amygdala abnormalities are sometimes reported, although findings are inconsistent.[74][75][76]

Cannabis use is associated with increased recruitment of task-related areas, such as the dorsolateral prefrontal cortex, which is thought to reflect compensatory activity due to reduced processing efficiency.[76][75][77] Cannabis use is also associated with downregulation of CB1 receptors. The magnitude of down regulation is associated with cumulative cannabis exposure, and is reversed after one month of abstinence.[69][78][79] There is limited evidence that chronic cannabis use can reduce levels of glutamate metabolites in the human brain.[80]

Cannabis dependence

Main article: Cannabis dependence

About 9% of those who experiment with marijuana eventually become dependent according to DSM-IV (1994) criteria.[13] A 2013 review estimates daily use is associated with a 10–20% rate of dependence.[10] The highest risk of cannabis dependence is found in those with a history of poor academic achievement, deviant behavior in childhood and adolescence, rebelliousness, poor parental relationships, or a parental history of drug and alcohol problems.[81] Of daily users, about 50% experience withdrawal upon cessation of use (i.e. are dependent), characterized by sleep problems, irritability, dysphoria, and craving.[69] Cannabis withdrawal is less severe than withdrawal from alcohol.[82]

According to DSM-V criteria, 9% of those who are exposed to cannabis develop cannabis use disorder, compared to 20% for cocaine, 23% for alcohol and 68% for nicotine. Cannabis use disorder in the DSM-V involves a combination of DSM-IV criteria for cannabis abuse and dependence, plus the addition of craving, without the criterion related to legal troubles.[69]

Psychiatric

See also: Long-term effects of cannabis § Mental health

At an epidemiological level, a dose–response relationship exists between cannabis use and increased risk of psychosis[83][84][85][86] and earlier onset of psychosis.[87] Although the epidemiological association is robust, evidence to prove a causal relationship is lacking.[88]

Cannabis may also increase the risk of depression, but insufficient research has been performed to draw a conclusion.[89][85] Cannabis use is associated with increased risk of anxiety disorders, although causality has not been established.[90]

A review in 2019 found that research was insufficient to determine the safety and efficacy of using cannabis to treat schizophrenia, psychosis, or other mental disorders.[91][92] Another found that cannabis during adolescence was associated with an increased risk of developing depression and suicidal behavior later in life, while finding no effect on anxiety.[93]

Physical

Heavy, long-term exposure to marijuana may have physical, mental, behavioral and social health consequences. It may be "associated with diseases of the liver (particularly with co-existing hepatitis C), lungs, heart, and vasculature".[94] A 2014 review found that while cannabis use may be less harmful than alcohol use, the recommendation to substitute it for problematic drinking was premature without further study.[95] Various surveys conducted between 2015 and 2019 found that many users of cannabis substitute it for prescription drugs (including opioids), alcohol, and tobacco; most of those who used it in place of alcohol or tobacco either reduced or stopped their intake of the latter substances.[96]

Cannabinoid hyperemesis syndrome (CHS) is a severe condition seen in some chronic cannabis users where they have repeated bouts of uncontrollable vomiting for 24–48 hours. Four cases of death have been reported as a result of CHS.[97][98]

A limited number of studies have examined the effects of cannabis smoking on the respiratory system.[99] Chronic heavy marijuana smoking is associated with respiratory infections,[100] coughing, production of sputum, wheezing, and other symptoms of chronic bronchitis.[49] The available evidence does not support a causal relationship between cannabis use and chronic obstructive pulmonary disease.[101] Short-term use of cannabis is associated with bronchodilation.[102] Other side effects of cannabis use include cannabinoid hyperemesis syndrome (CHS), a condition which involves recurrent nausea, cramping abdominal pain, and vomiting.[103]

Cannabis smoke contains thousands of organic and inorganic chemical compounds. This tar is chemically similar to that found in tobacco smoke,[104] and over fifty known carcinogens have been identified in cannabis smoke,[105] including; nitrosamines, reactive aldehydes, and polycylic hydrocarbons, including benz[a]pyrene.[106] Cannabis smoke is also inhaled more deeply than tobacco smoke.[107] As of 2015, there is no consensus regarding whether cannabis smoking is associated with an increased risk of cancer.[108] Light and moderate use of cannabis is not believed to increase risk of lung or upper airway cancer. Evidence for causing these cancers is mixed concerning heavy, long-term use. In general there are far lower risks of pulmonary complications for regular cannabis smokers when compared with those of tobacco.[109] A 2015 review found an association between cannabis use and the development of testicular germ cell tumors (TGCTs), particularly non-seminoma TGCTs.[110] Another 2015 meta-analysis found no association between lifetime cannabis use and risk of head or neck cancer.[111] Combustion products are not present when using a vaporizer, consuming THC in pill form, or consuming cannabis foods.[112]

There is concern that cannabis may contribute to cardiovascular disease,[113] but as of 2018, evidence of this relationship was unclear.[114] Research in these events is complicated because cannabis is often used in conjunction with tobacco, and drugs such as alcohol and cocaine that are known to have cardiovascular risk factors.[115] Smoking cannabis has also been shown to increase the risk of myocardial infarction by 4.8 times for the 60 minutes after consumption.[116]

There is preliminary evidence that cannabis interferes with the anticoagulant properties of prescription drugs used for treating blood clots.[117] As of 2019, the mechanisms for the anti-inflammatory and possible pain relieving effects of cannabis were not defined, and there were no governmental regulatory approvals or clinical practices for use of cannabis as a drug.[92]

Emergency department visits

Emergency room (ER) admissions associated with cannabis use rose significantly from 2012 to 2016; adolescents from age 12–17 had the highest risk.[118] At one Colorado medical center following legalization, approximately two percent of ER admissions were classified as cannabis users. The symptoms of one quarter of these users were partially attributed to cannabis (a total of 2567 out of 449,031 patients); other drugs were sometimes involved. Of these cannabis admissions, one quarter were for acute psychiatric effects, primarily suicidal ideation, depression, and anxiety. An additional third of the cases were for gastrointestinal issues including Cannabinoid hyperemesis syndrome.[119]

According to the United States Department of Health and Human Services, there were 455,000 emergency room visits associated with cannabis use in 2011. These statistics include visits in which the patient was treated for a condition induced by or related to recent cannabis use. The drug use must be "implicated" in the emergency department visit, but does not need to be the direct cause of the visit. Most of the illicit drug emergency room visits involved multiple drugs.[120] In 129,000 cases, cannabis was the only implicated drug.[120][13]

Reproductive health

Further information: Cannabis in pregnancy

There is sufficient evidence of reproductive health harms from cannabis that its use when trying to conceive, during pregnancy, and while breastfeeding, is not advisable.[121]

It has been recommended that cannabis use be stopped before and during pregnancy as it can result in negative outcomes for both the mother and baby,[122][123] such as behavioral problems.[124] However, maternal use of marijuana during pregnancy does not appear to be associated with low birth weight or early delivery after controlling for tobacco use and other confounding factors.[125]

Pharmacology

Mechanism of action

See also: Effects of cannabis § Biochemical mechanisms in the brain

THC is a weak partial agonist at CB1 receptors, while CBD is a CB1 receptor antagonist.[126][127] The CB1 receptor is found primarily in the brain as well as in some peripheral tissues, and the CB2 receptor is found primarily in peripheral tissues, but is also expressed in neuroglial cells.[128] THC appears to alter mood and cognition through its agonist actions on the CB1 receptors, which inhibit a secondary messenger system (adenylate cyclase) in a dose-dependent manner.

Via CB1 receptor activation, THC indirectly increases dopamine release and produces psychotropic effects.[129] CBD also acts as an allosteric modulator of the μ- and δ-opioid receptors.[130] THC also potentiates the effects of the glycine receptors.[131] It is unknown if or how these actions contribute to the effects of cannabis.[132]

Pharmacokinetics

The high lipid-solubility of cannabinoids results in their persisting in the body for long periods of time.[133] Even after a single administration of THC, detectable levels of THC can be found in the body for weeks or longer (depending on the amount administered and the sensitivity of the assessment method).[133] Investigators have suggested that this is an important factor in marijuana's effects, perhaps because cannabinoids may accumulate in the body, particularly in the lipid membranes of neurons.[134]

Chemistry

Chemical composition

See also: Difference between C. indica and C. sativa

The main psychoactive component of cannabis is tetrahydrocannabinol (THC), which is formed via decarboxylation of tetrahydrocannabinolic acid (THCA) from the application of heat. Raw leaf is not psychoactive because the cannabinoids are in the form of carboxylic acids.[citation needed] THC is one of the 483 known compounds in the plant,[135] including at least 65 other cannabinoids,[136] such as cannabidiol (CBD).[51]

Detection in body fluids

Main article: Cannabis drug testing

THC and its major (inactive) metabolite, THC-COOH, can be measured in blood, urine, hair, oral fluid or sweat using chromatographic techniques as part of a drug use testing program or a forensic investigation of a traffic or other criminal offense.[57] The concentrations obtained from such analyses can often be helpful in distinguishing active use from passive exposure, elapsed time since use, and extent or duration of use. These tests cannot, however, distinguish authorized cannabis smoking for medical purposes from unauthorized recreational smoking.[137] Commercial cannabinoid immunoassays, often employed as the initial screening method when testing physiological specimens for marijuana presence, have different degrees of cross-reactivity with THC and its metabolites.[138] Urine contains predominantly THC-COOH, while hair, oral fluid and sweat contain primarily THC.[57] Blood may contain both substances, with the relative amounts dependent on the recency and extent of usage.[57]

The Duquenois–Levine test is commonly used as a screening test in the field, but it cannot definitively confirm the presence of cannabis, as a large range of substances have been shown to give false positives.[139] Researchers at John Jay College of Criminal Justice reported that dietary zinc supplements can mask the presence of THC and other drugs in urine.[140] However, a 2013 study conducted by researchers at the University of Utah School of Medicine refute the possibility of self-administered zinc producing false-negative urine drug tests.[141]

Varieties and strains

 
Types of cannabis
 
A macro cannabis bud

CBD is a 5-HT1A receptor agonist, which is under laboratory research to determine if it has an anxiolytic effect.[142] It is often claimed that sativa strains provide a more stimulating psychoactive high while indica strains are more sedating with a body high.[143] However, this is disputed by researchers.[144]

A 2015 review found that the use of high CBD-to-THC strains of cannabis showed significantly fewer positive symptoms, such as delusions and hallucinations, better cognitive function and both lower risk for developing psychosis, as well as a later age of onset of the illness, compared to cannabis with low CBD-to-THC ratios.[145]

Psychoactive ingredients

According to the United Nations Office on Drugs and Crime (UNODC), "the amount of THC present in a cannabis sample is generally used as a measure of cannabis potency."[146] The three main forms of cannabis products are the flower/fruit, resin (hashish), and oil (hash oil). The UNODC states that cannabis often contains 5% THC content, resin "can contain up to 20% THC content", and that "Cannabis oil may contain more than 60% THC content."[146]

Studies have found that the potency of illicit cannabis has greatly increased since the 1970s, with THC levels rising and CBD levels dropping.[147][148][149] It is unclear, however, whether the increase in THC content has caused people to consume more THC or if users adjust based on the potency of the cannabis. It is likely that the higher THC content allows people to ingest less tar. At the same time, CBD levels in seized samples have lowered, in part because of the desire to produce higher THC levels and because more illegal growers cultivate indoors using artificial lights. This helps avoid detection but reduces the CBD production of the plant.[150]

Australia's National Cannabis Prevention and Information Centre (NCPIC) states that the buds (infructescences) of the female cannabis plant contain the highest concentration of THC, followed by the leaves. The stalks and seeds have "much lower THC levels".[151] The UN states that the leaves can contain ten times less THC than the buds, and the stalks one hundred times less THC.[146]

After revisions to cannabis scheduling in the UK, the government moved cannabis back from a class C to a class B drug. A purported reason was the appearance of high potency cannabis. They believe skunk accounts for between 70 and 80% of samples seized by police[152] (despite the fact that skunk can sometimes be incorrectly mistaken for all types of herbal cannabis).[153][154] Extracts such as hashish and hash oil typically contain more THC than high potency cannabis infructescences.[155]

Laced cannabis and synthetic cannabinoids

See also: Synthetic cannabinoids § Hemp (or low potent cannabis) buds

Hemp buds (or low-potency cannabis buds) laced with synthetic cannabinoids started to be sold as cannabis street drug in 2020.[156][157][158][159]

The short-term effects of cannabis can be altered if it has been laced with opioid drugs such as heroin or fentanyl.[160] The added drugs are meant to enhance the psychoactive properties, add to its weight, and increase profitability, despite the increased danger of overdose.[161][e]

Preparations

  •  

    Dried flower buds (marijuana)

  •  

    A gram of kief

  •  

    Hashish

  •  

    Hash oil

  •  

    Infusion (dairy butter)

Marijuana

Further information: Marijuana (word)

Marijuana or marihuana (herbal cannabis)[163] consists of the dried flowers and fruits and subtending leaves and stems of the female cannabis plant.[164][165][166][167] This is the most widely consumed form,[167] containing 3% to 20% THC,[168] with reports of up to 33% THC.[169] This is the stock material from which all other preparations are derived. Although herbal cannabis and industrial hemp derive from the same species and contain the psychoactive component (THC), they are distinct strains with unique biochemical compositions and uses. Hemp has lower concentrations of THC and higher concentrations of CBD, which gives lesser psychoactive effects.[170][171]

Kief

Main article: Kief

Kief is a powder, rich in trichomes,[172] which can be sifted from the leaves, flowers and fruits of cannabis plants and either consumed in powder form or compressed to produce cakes of hashish.[173] The word "kif" derives from colloquial Arabic كيف kēf/kīf, meaning pleasure.[174]

Hashish

Main article: Hashish
 
Legal hashish shop in Kathmandu, Nepal in 1973

Hashish (also spelled hasheesh, hashisha, or simply hash) is a concentrated resin cake or ball produced from pressed kief, the detached trichomes and fine material that falls off cannabis fruits, flowers and leaves.[175] or from scraping the resin from the surface of the plants and rolling it into balls. It varies in color from black to golden brown depending upon purity and variety of cultivar it was obtained from.[176] It can be consumed orally or smoked, and is also vaporized, or 'vaped'.[177] The term "rosin hash" refers to a high quality solventless product obtained through heat and pressure.[178]

Tincture

Main article: Tincture of cannabis

Cannabinoids can be extracted from cannabis plant matter using high-proof spirits (often grain alcohol) to create a tincture, often referred to as "green dragon".[30]: p17  Nabiximols is a branded product name from a tincture manufacturing pharmaceutical company.[179]

Hash oil

Main article: Hash oil

Hash oil is a resinous matrix of cannabinoids obtained from the cannabis plant by solvent extraction,[180] formed into a hardened or viscous mass.[181] Hash oil can be the most potent of the main cannabis products because of its high level of psychoactive compound per its volume, which can vary depending on the plant's mix of essential oils and psychoactive compounds.[182] Butane and supercritical carbon dioxide hash oil have become popular in recent years.[183]

Infusions

There are many varieties of cannabis infusions owing to the variety of non-volatile solvents used.[184] The plant material is mixed with the solvent and then pressed and filtered to express the oils of the plant into the solvent. Examples of solvents used in this process are cocoa butter, dairy butter, cooking oil, glycerine, and skin moisturizers. Depending on the solvent, these may be used in cannabis foods or applied topically.[185]

Marihuana prensada

Main article: Marihuana prensada

Marihuana prensada ('pressed marijuana') is a cannabis-derived product widespread among the lower classes of South America,[186] especially from the 90s. Locally it is known as "paraguayo" or "paragua", since its main producer is Paraguay.[187] Marijuana is dried and mixed with binding agents that make it toxic and highly harmful to health.[188] It is cut into the shape of bricks (ladrillos) and sold for a low price in Argentina, Brazil, Chile, Peru, Venezuela, and even the United States.[189]

History

Main articles: History of cannabis, Timeline of cannabis law, and Religion and drugs

Ancient history

 
Present-day map of the Jirzankal Cemetery, site of the earliest evidence of cannabis smoking

Cannabis is indigenous to Central or South Asia[190] and its uses for fabric and rope dates back to the Neolithic age in China and Japan.[191][192] It is unclear when cannabis first became known for its psychoactive properties. The oldest archeological evidence for the burning of cannabis was found in Romanian kurgans dated 3,500 BC, and scholars suggest that the drug was first used in ritual ceremonies by Proto-Indo-European tribes living in the Pontic-Caspian steppe during the Chalcolithic period, a custom they eventually spread throughout Western Eurasia during the Indo-European migrations.[193][194] Some research suggests that the ancient Indo-Iranian drug soma, mentioned in the Vedas, sometimes contained cannabis. This is based on the discovery of a basin containing cannabis in a shrine of the second millennium BC in Turkmenistan.[195]

Cannabis was known to the ancient Assyrians, who discovered its psychoactive properties through the Iranians.[196] Using it in some religious ceremonies, they called it qunubu (meaning "way to produce smoke"), a probable origin of the modern word "cannabis".[197] The Iranians also introduced cannabis to the Scythians, Thracians and Dacians, whose shamans (the kapnobatai – "those who walk on smoke/clouds") burned cannabis infructescences to induce trance.[198] The plant was used in China before 2800 BC, and found therapeutic use in India by 1000 BC, where it was used in food and drink, including bhang.[199][200]

 
Cannabis sativa from Vienna Dioscurides, c. 512 CE

Cannabis has an ancient history of ritual use and has been used by religions around the world. It has been used as a drug for both recreational and entheogenic purposes and in various traditional medicines for centuries.[201][202][163] The earliest evidence of cannabis smoking has been found in the 2,500-year-old tombs of Jirzankal Cemetery in the Pamir Mountains in Western China, where cannabis residue were found in burners with charred pebbles possibly used during funeral rituals.[203][204] Hemp seeds discovered by archaeologists at Pazyryk suggest early ceremonial practices like eating by the Scythians occurred during the 5th to 2nd century BC, confirming previous historical reports by Herodotus.[205] It was used by Muslims in various Sufi orders as early as the Mamluk period, for example by the Qalandars.[206] Smoking pipes uncovered in Ethiopia and carbon-dated to around c. AD 1320 were found to have traces of cannabis.[207]

Modern history

Cannabis was introduced to the New World by the Spaniards in 1530–1545.[208][209][210] Following an 1836–1840 travel in North Africa and the Middle East, French physician Jacques-Joseph Moreau wrote on the psychological effects of cannabis use; he founded the Paris' Club des Hashischins in 1844.[211] In 1842, Irish physician William Brooke O'Shaughnessy, who had studied the drug while working as a medical officer in Bengal with the East India Company, brought a quantity of cannabis with him on his return to Britain, provoking renewed interest in the West.[212] Examples of classic literature of the period featuring cannabis include Les paradis artificiels (1860) by Charles Baudelaire and The Hasheesh Eater (1857) by Fitz Hugh Ludlow.

 
Anti-cannabis propaganda from 1935

Cannabis was criminalized in some countries beginning in the 14th century and was illegal in most countries by the middle of the 20th century. The colonial government of Mauritius banned cannabis in 1840 over concerns on its effect on Indian indentured workers;[213] the same occurred in Singapore in 1870.[214] In the United States, the first restrictions on sale of cannabis came in 1906 (in the District of Columbia).[215] Canada criminalized cannabis in The Opium and Narcotic Drug Act, 1923,[216] before any reports of the use of the drug in Canada, but eventually legalized its consumption for recreational and medicinal purposes in 2018.[14]

In 1925, a compromise was made at an international conference in The Hague about the International Opium Convention that banned exportation of "Indian hemp" to countries that had prohibited its use, and requiring importing countries to issue certificates approving the importation and stating that the shipment was required "exclusively for medical or scientific purposes". It also required parties to "exercise an effective control of such a nature as to prevent the illicit international traffic in Indian hemp and especially in the resin".[217][218] In the United States in 1937, the Marihuana Tax Act was passed,[219] and prohibited the production of hemp in addition to cannabis.

 
Cannabis indica fluid extract, American Druggists Syndicate (pre-1937)

In 1972, the Dutch government divided drugs into more- and less-dangerous categories, with cannabis being in the lesser category. Accordingly, possession of 30 grams (1.1 oz) or less was made a misdemeanor.[220] Cannabis has been available for recreational use in coffee shops since 1976.[221] Cannabis products are only sold openly in certain local "coffeeshops" and possession of up to 5 grams (0.18 oz) for personal use is decriminalized, however: the police may still confiscate it, which often happens in car checks near the border. Other types of sales and transportation are not permitted, although the general approach toward cannabis was lenient even before official decriminalization.[222][223][224]

In Uruguay, President Jose Mujica signed legislation to legalize recreational cannabis in December 2013, making Uruguay the first country in the modern era to legalize cannabis. In August 2014, Uruguay legalized growing up to six plants at home, as well as the formation of growing clubs (Cannabis social club), and a state-controlled marijuana dispensary regime.

As of 17 October 2018, when recreational use of cannabis was legalized in Canada, dietary supplements for human use and veterinary health products containing not more than 10 parts per million of THC extract were approved for marketing; Nabiximols (as Sativex) is used as a prescription drug in Canada.[14]

The United Nations' World Drug Report stated that cannabis "was the world's most widely produced, trafficked, and consumed drug in the world in 2010", and estimated between 128 million and 238 million users globally in 2015.[225][226]

Culture, legality and economics

Culture

Main article: Cannabis culture
See also: Drug culture and 420 (cannabis culture)
 
Process of making bhang in a Sikh village in Punjab, India. On the Hindu and Sikh festival of colors called Holi, it is a customary addition to some intoxicating drinks.[227]

Cannabis has been one of the most used psychoactive drugs in the world since the late 20th century, following only tobacco and alcohol in popularity.[228] According to Vera Rubin, the use of cannabis has been encompassed by two major cultural complexes over time: a continuous, traditional folk stream, and a more circumscribed, contemporary configuration.[229] The former involves both sacred and secular use, and is usually based on small-scale cultivation: the use of the plant for cordage, clothing, medicine, food, and a "general use as an euphoriant and symbol of fellowship."[229][230] The second stream of expansion of cannabis use encompasses "the use of hemp for commercial manufacturers utilizing large-scale cultivation primarily as a fiber for mercantile purposes"; but it is also linked to the search for psychedelic experiences (which can be traced back to the formation of the Parisian Club des Hashischins).[230]

Legality

Main article: Legality of cannabis
See also: Prohibition of drugs and Drug liberalization
 
Legal status of cannabis possession for non-medical use
  Legal
  Illegal but decriminalized
  Illegal but often unenforced
  Illegal
See also countries that have legalized medical use of cannabis.

Since the beginning of the 20th century, most countries have enacted laws against the cultivation, possession or transfer of cannabis.[231] These laws have had an adverse effect on cannabis cultivation for non-recreational purposes, but there are many regions where handling of cannabis is legal or licensed. Many jurisdictions have lessened the penalties for possession of small quantities of cannabis so that it is punished by confiscation and sometimes a fine, rather than imprisonment, focusing more on those who traffic the drug on the black market.

In some areas where cannabis use had been historically tolerated, new restrictions were instituted, such as the closing of cannabis coffee shops near the borders of the Netherlands,[232] and closing of coffee shops near secondary schools in the Netherlands.[233] In Copenhagen, Denmark in 2014, mayor Frank Jensen discussed possibilities for the city to legalize cannabis production and commerce.[234]

Some jurisdictions use free voluntary treatment programs and/or mandatory treatment programs for frequent known users. Simple possession can carry long prison terms in some countries, particularly in East Asia, where the sale of cannabis may lead to a sentence of life in prison or even execution. Political parties, non-profit organizations, and causes based on the legalization of medical cannabis and/or legalizing the plant entirely (with some restrictions) have emerged in such countries as China and Thailand.[235][236]

In December 2012, the U.S. state of Washington became the first state to officially legalize cannabis in a state law (Washington Initiative 502) (but still illegal by federal law),[237] with the state of Colorado following close behind (Colorado Amendment 64).[238] On 1 January 2013, the first cannabis "club" for private marijuana smoking (no buying or selling, however) was allowed for the first time in Colorado.[239] The California Supreme Court decided in May 2013 that local governments can ban medical cannabis dispensaries despite a state law in California that permits the use of cannabis for medical purposes. At least 180 cities across California have enacted bans in recent years.[240]

In December 2013, Uruguay became the first country to legalize growing, sale and use of cannabis.[241] After a long delay in implementing the retail component of the law, in 2017 sixteen pharmacies were authorized to sell cannabis commercially.[242] On 19 June 2018, the Canadian Senate passed a bill and the Prime Minister announced the effective legalization date as 17 October 2018.[14][243] Canada is the second country to legalize the drug.[244]

In November 2015, Uttarakhand became the first state of India to legalize the cultivation of hemp for industrial purposes.[245] Usage within the Hindu and Buddhist cultures of the Indian subcontinent is common, with many street vendors in India openly selling products infused with cannabis, and traditional medical practitioners in Sri Lanka selling products infused with cannabis for recreational purposes and well as for religious celebrations.[246] Indian laws criminalizing cannabis date back to the colonial period. India and Sri Lanka have allowed cannabis to be taken in the context of traditional culture for recreational/celebratory purposes and also for medicinal purposes.[246]

On 17 October 2015, Australian health minister Sussan Ley presented a new law that will allow the cultivation of cannabis for scientific research and medical trials on patients.[247]

On 17 October 2018, Canada legalized cannabis for recreational adult use[248] making it the second country in the world to do so after Uruguay and the first G7 nation.[249] The Canadian Licensed Producer system aims to become the Gold Standard in the world for safe and secure cannabis production,[250] including provisions for a robust craft cannabis industry where many expect opportunities for experimenting with different strains.[251] Laws around use vary from province to province including age limits, retail structure, and growing at home.[248]

As the drug has increasingly been seen as a health issue instead of criminal behavior, cannabis has also been legalized or decriminalized in: Czech Republic,[252] Colombia,[253][254] Ecuador,[255][256][257] Portugal,[258] South Africa[259] and Canada.[14] Medical marijuana was legalized in Mexico in mid-2017; legislators plan to legalize its recreational use by late 2019.[260][261][262]

On 28 June 2021, Clarence Thomas, one of the U.S. Supreme Court's most conservative justices, possibly opened the door to federal legalization of cannabis in the United States when he wrote "A prohibition on interstate use or cultivation of [cannabis] may no longer be necessary or proper to support the federal government's piecemeal approach."[263]

Legal status by country

As of 2022, Uruguay and Canada are the only countries that have fully legalized the cultivation, consumption and bartering of recreational cannabis nationwide.[264][265] In the United States, 24 states, 3 territories, and the District of Columbia have legalized the recreational use of cannabis – though the drug remains illegal at the federal level.[266] Laws vary from state to state when it comes to the commercial sale. Court rulings in Georgia and South Africa have led to the legalization of cannabis consumption, but not legal sales. A policy of limited enforcement has also been adopted in many countries, in particular Spain and the Netherlands where the sale of cannabis is tolerated at licensed establishments.[267][268] Contrary to popular belief, cannabis is not legal in the Netherlands,[269] but it has been decriminalized since the 1970s. In 2021, Malta was the first European Union member to legalize the use of cannabis for recreational purposes.[270] In Estonia, it is only legal to sell cannabis products with a THC content of less than 0.2%, although products may contain more cannabidiol.[271] Lebanon has recently become the first Arab country to legalize the plantation of cannabis for medical use.[272]

Penalties for illegal recreational use ranges from confiscation or small fines to jail time and even death.[273] In some countries citizens can be punished if they have used the drug in another country, including Singapore and South Korea.[274][275]

Economics

Production

Main articles: Cannabis cultivation, Cannabis industry, and Cannabis product testing
 
Woman selling cannabis and bhang in Guwahati, Assam, India

Sinsemilla (Spanish for "without seed") is the dried, seedless (i.e. parthenocarpic) infructescences of female cannabis plants. Because THC production drops off once pollination occurs, the male plants (which produce little THC themselves) are eliminated before they shed pollen to prevent pollination, thus inducing the development of parthenocarpic fruits gathered in dense infructescences. Advanced cultivation techniques such as hydroponics, cloning, high-intensity artificial lighting, and the sea of green method are frequently employed as a response (in part) to prohibition enforcement efforts that make outdoor cultivation more risky.

"Skunk" refers to several named strains of potent cannabis, grown through selective breeding and sometimes hydroponics. It is a cross-breed of Cannabis sativa and C. indica (although other strains of this mix exist in abundance). Skunk cannabis potency ranges usually from 6% to 15% and rarely as high as 20%. The average THC level in coffee shops in the Netherlands is about 18–19%.[276]

The average levels of THC in cannabis sold in the United States rose dramatically between the 1970s and 2000.[277] This is disputed for various reasons, and there is little consensus as to whether this is a fact or an artifact of poor testing methodologies.[277] According to Daniel Forbes writing for slate.com, the relative strength of modern strains are likely skewed because undue weight is given to much more expensive and potent, but less prevalent, samples.[278] Some suggest that results are skewed by older testing methods that included low-THC-content plant material such as leaves in the samples, which are excluded in contemporary tests. Others believe that modern strains actually are significantly more potent than older ones.[277]

The main producing countries of cannabis are Afghanistan,[279] Canada,[280] China, Colombia,[281] India,[279] Jamaica,[279] Lebanon,[282] Mexico,[283] Morocco,[279] the Netherlands, Pakistan, Paraguay,[283] Spain,[279] Thailand, Turkey, the United Kingdom,[284] and the United States.[279]

Price

The price or street value of cannabis varies widely depending on geographic area and potency.[285] Prices and overall markets have also varied considerably over time.

  • In 1997, cannabis was estimated to be overall the number four value crop in the US, and number one or two in many states, including California, New York, and Florida. This estimate is based on a value to growers of ~60% of retail value, or $3,000 per pound ($6,600/kg).[286]
  • In 2006, cannabis was estimated to have been a $36 billion market.[287] This estimate has been challenged as exaggerated.[40] The UN World Drug Report (2008) estimated that 2006 street prices in the US and Canada ranged from about US$8.8 to $25 per gram (approximately $250 to $700 per ounce), depending on quality.[288] Typical U.S. retail prices were $10–15 per gram (approximately $280–420 per ounce).
  • In 2017, the U.S. was estimated to constitute 90% of the worldwide $9.5 billion legal trade in cannabis.[289]

After some U.S. states legalized cannabis, street prices began to drop. In Colorado, the price of smokable buds (infructescences) dropped 40 percent between 2014 and 2019, from $200 per ounce to $120 per ounce ($7 per gram to $4.19 per gram).[290]

The European Monitoring Centre for Drugs and Drug Addiction reports that typical retail prices in Europe for cannabis varied from €2 to €20 per gram in 2008, with a majority of European countries reporting prices in the range €4–10.[291]

Cannabis as a gateway drug

See also: Gateway drug effect

The gateway hypothesis states that cannabis use increases the probability of trying "harder" drugs. The hypothesis has been hotly debated as it is regarded by some as the primary rationale for the United States prohibition on cannabis use.[292][293] A Pew Research Center poll found that political opposition to marijuana use was significantly associated with concerns about the health effects and whether legalization would increase cannabis use by children.[294]

Some studies state that while there is no proof for the gateway hypothesis,[295] young cannabis users should still be considered as a risk group for intervention programs.[296] Other findings indicate that hard drug users are likely to be poly-drug users, and that interventions must address the use of multiple drugs instead of a single hard drug.[297] Almost two-thirds of the poly drug users in the 2009–2010 Scottish Crime and Justice Survey used cannabis.[298]

The gateway effect may appear due to social factors involved in using any illegal drug. Because of the illegal status of cannabis, its consumers are likely to find themselves in situations allowing them to acquaint with individuals using or selling other illegal drugs.[299][300] Studies have shown that alcohol and tobacco may additionally be regarded as gateway drugs;[301] however, a more parsimonious explanation could be that cannabis is simply more readily available (and at an earlier age) than illegal hard drugs. In turn, alcohol and tobacco are typically easier to obtain at an earlier age than is cannabis (though the reverse may be true in some areas), thus leading to the "gateway sequence" in those individuals, since they are most likely to experiment with any drug offered.[292]

A related alternative to the gateway hypothesis is the common liability to addiction (CLA) theory. It states that some individuals are, for various reasons, willing to try multiple recreational substances. The "gateway" drugs are merely those that are (usually) available at an earlier age than the harder drugs. Researchers have noted in an extensive review that it is dangerous to present the sequence of events described in gateway "theory" in causative terms as this hinders both research and intervention.[302]

In 2020, the National Institute on Drug Abuse released a study backing allegations that marijuana is a gateway to harder drugs, though not for the majority of marijuana users.[303] The National Institute on Drug Abuse determined that marijuana use is "likely to precede use of other licit and illicit substances" and that "adults who reported marijuana use during the first wave of the survey were more likely than adults who did not use marijuana to develop an alcohol use disorder within 3 years; people who used marijuana and already had an alcohol use disorder at the outset were at greater risk of their alcohol use disorder worsening. Marijuana use is also linked to other substance use disorders including nicotine addiction."[303] It also reported that "These findings are consistent with the idea of marijuana as a "gateway drug." However, the majority of people who use marijuana do not go on to use other, "harder" substances. Also, cross-sensitization is not unique to marijuana. Alcohol and nicotine also prime the brain for a heightened response to other drugs and are, like marijuana, also typically used before a person progresses to other, more harmful substances."[303]

Research

See also: Medical cannabis research

Research on cannabis is challenging since the plant is illegal in most countries.[304][305][306][307][308] Research-grade samples of the drug are difficult to obtain for research purposes, unless granted under authority of national regulatory agencies, such as the US Food and Drug Administration.[309]

There are also other difficulties in researching the effects of cannabis. Many people who smoke cannabis also smoke tobacco.[310] This causes confounding factors, where questions arise as to whether the tobacco, the cannabis, or both that have caused a cancer. Another difficulty researchers have is in recruiting people who smoke cannabis into studies. Because cannabis is an illegal drug in many countries, people may be reluctant to take part in research, and if they do agree to take part, they may not say how much cannabis they actually smoke.[311]

See also

References

Footnotes

  1. ^ /ˈkænəbɪs/[1]
  2. ^ /ˌmærəˈwɑːnə/[2]
  3. ^ Psychotic episodes are well-documented and typically resolve within minutes or hours, while symptoms may last longer.[47] The use of a single joint can temporarily induce some psychiatric symptoms.[48]
  4. ^ A 2016 review also found a statistically significant increase in crash risk associated with marijuana use, but noted that this risk was "of low to medium magnitude."[54] The increase in risk of motor vehicle crash for cannabis use is between 2 and 3 times relative to baseline, whereas that for comparable doses of alcohol is between 6 and 15 times.[55]
  5. ^ Advocates of legalizing marijuana for recreational use, such as former Illinois state Senator Heather Steans, say that legalizing it would help reduce such hazardous added drugs: "Over 95 percent are buying it on the black market. You don't know what you're buying. It's not a safe product. We've seen it laced with rat poison, fentanyl, all sorts of things. It's funding the cartels and other criminal activity."[162]

Citations

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December 14, 2023
cannabis, drug, marijuana, redirects, here, other, uses, marijuana, disambiguation, cannabis, also, known, marijuana, weed, among, other, names, psychoactive, drug, from, cannabis, plant, native, central, south, asia, cannabis, plant, been, used, drug, both, r. Marijuana redirects here For other uses see Marijuana disambiguation Cannabis a also known as marijuana b or weed among other names is a psychoactive drug from the cannabis plant Native to Central or South Asia the cannabis plant has been used as a drug for both recreational and entheogenic purposes and in various traditional medicines for centuries Tetrahydrocannabinol THC is the main psychoactive component of cannabis which is one of the 483 known compounds in the plant including at least 65 other cannabinoids such as cannabidiol CBD Cannabis can be used by smoking vaporizing within food or as an extract CannabisClose up of flowering cannabis plantPronunciationCannabis ˈ k ae n e b ɪ s Marijuana ˌ m ae r e ˈ w ɑː n e Source plant s Cannabis sativa Cannabis indica Cannabis ruderalisPart s of plantFlower and fruitGeographic originCentral or South AsiaActive ingredientsTetrahydrocannabinol cannabidiol cannabinol tetrahydrocannabivarinMain producersAfghanistan Canada China Colombia India Jamaica Lebanon Mexico Morocco Netherlands Pakistan Paraguay Spain Thailand Turkey United Kingdom United StatesLegal statusAU S8 Controlled drug BR Class E Controlled plants CA Unscheduled DE Medical cannabis from state controlled production Anlage IIIOther cannabis I NZ Class B concentrate Class C plant UK Class B US Schedule I UN Narcotic Schedule ICannabis has various mental and physical effects which include euphoria altered states of mind and sense of time difficulty concentrating impaired short term memory impaired body movement balance and fine psychomotor control relaxation and an increase in appetite Onset of effects is felt within minutes when smoked but may take up to 90 minutes when eaten as orally consumed drugs must be metabolized The effects last for two to six hours depending on the amount used At high doses mental effects can include anxiety delusions including ideas of reference hallucinations panic paranoia and psychosis There is a strong relation between cannabis use and the risk of psychosis though the direction of causality is debated Physical effects include increased heart rate difficulty breathing nausea and behavioral problems in children whose mothers used cannabis during pregnancy short term side effects may also include dry mouth and red eyes Long term adverse effects may include addiction decreased mental ability in those who started regular use as adolescents 3 chronic coughing susceptibility to respiratory infections and cannabinoid hyperemesis syndrome Cannabis is mostly used recreationally or as a medicinal drug although it may also be used for spiritual purposes In 2013 between 128 and 232 million people used cannabis 2 7 to 4 9 of the global population between the ages of 15 and 65 It is the most commonly used largely illegal drug in the world with the highest use among adults in Zambia the United States Canada and Nigeria Since the 1970s the potency of illicit cannabis has increased with THC levels rising and CBD levels dropping While cannabis plants have been grown since at least the 3rd millennium BCE evidence suggests that it was being smoked for psychoactive effects at least 2 500 years ago in the Pamir Mountains Asia 4 Since the 14th century cannabis has been subject to legal restrictions The possession use and cultivation of cannabis has been illegal in most countries since the 20th century In 2013 Uruguay became the first country to legalize recreational use of cannabis Other countries to do so are Canada Georgia Luxembourg Malta Mexico South Africa and Thailand In the U S the recreational use of cannabis is legalized in 24 states 3 territories and the District of Columbia though the drug remains federally illegal In Australia it is legalized only in the Australian Capital Territory Contents 1 Etymology 2 Uses 2 1 Medical 2 2 Recreational 2 3 Spiritual 3 Consumption 3 1 Modes of consumption 3 2 Consumption by country 3 2 1 United States 4 Adverse effects 4 1 Short term 4 2 Fatality 4 3 Long term 4 3 1 Psychological effects 4 3 2 Neuroimaging 4 4 Cannabis dependence 4 4 1 Psychiatric 4 4 2 Physical 4 4 2 1 Emergency department visits 4 4 3 Reproductive health 5 Pharmacology 5 1 Mechanism of action 5 2 Pharmacokinetics 6 Chemistry 6 1 Chemical composition 6 2 Detection in body fluids 7 Varieties and strains 7 1 Psychoactive ingredients 7 1 1 Laced cannabis and synthetic cannabinoids 8 Preparations 8 1 Marijuana 8 2 Kief 8 3 Hashish 8 4 Tincture 8 5 Hash oil 8 6 Infusions 8 7 Marihuana prensada 9 History 9 1 Ancient history 9 2 Modern history 10 Culture legality and economics 10 1 Culture 10 2 Legality 10 2 1 Legal status by country 10 3 Economics 10 3 1 Production 10 3 2 Price 11 Cannabis as a gateway drug 12 Research 13 See also 14 References 15 External linksEtymologyBorrowed from Latin cannabis hemp from Ancient Greek kannabis kannabis citation needed The first reference to marihuana was found in 1842 in Mexican newspapers and then the term made its way to the U S in the 1890s 5 UsesMedical Main article Medical cannabis nbsp Example of a container and the recreational cannabis purchase in CanadaMedical cannabis or medical marijuana refers to the use of cannabis to treat disease or improve symptoms however there is no single agreed upon definition e g cannabinoids derived from cannabis and synthetic cannabinoids are also used 6 7 8 The rigorous scientific study of cannabis as a medicine has been hampered by production restrictions and by the fact that it is classified as an illegal drug by many governments 9 There is some evidence suggesting cannabis can be used to reduce nausea and vomiting during chemotherapy to improve appetite in people with HIV AIDS or to treat chronic pain and muscle spasms Evidence for its use for other medical applications is insufficient for drawing conclusions about safety or efficacy 10 11 12 There is evidence supporting the use of cannabis or its derivatives in the treatment of chemotherapy induced nausea and vomiting neuropathic pain and multiple sclerosis Lower levels of evidence support its use for AIDS wasting syndrome epilepsy rheumatoid arthritis and glaucoma 13 The medical use of cannabis is legal only in a limited number of territories including Canada 14 Belgium Australia the Netherlands New Zealand 15 16 Spain and many U S states This usage generally requires a prescription and distribution is usually done within a framework defined by local laws 13 Recreational According to DEA Chief Administrative Law Judge Francis Young cannabis is one of the safest therapeutically active substances known to man 17 Being under the effects of cannabis is usually referred to as being high 18 Cannabis consumption has both psychoactive and physiological effects 19 The high experience can vary widely based among other things on the user s prior experience with cannabis and the type of cannabis consumed 20 p647 When smoking cannabis a euphoriant effect can occur within minutes of smoking 21 p104 Aside from a subjective change in perception and mood the most common short term physical and neurological effects include increased heart rate increased appetite impairment of short term and working memory and psychomotor coordination 22 23 Additional desired effects from consuming cannabis include relaxation a general alteration of conscious perception increased awareness of sensation increased libido 24 and distortions in the perception of time and space At higher doses effects can include altered body image auditory and or visual illusions pseudohallucinations and ataxia from selective impairment of polysynaptic reflexes citation needed In some cases cannabis can lead to dissociative states such as depersonalization 25 26 and derealization 27 Spiritual Main article Entheogenic use of cannabis Cannabis has held sacred status in several religions and has served as an entheogen a chemical substance used in religious shamanic or spiritual contexts 28 in the Indian subcontinent since the Vedic period The earliest known reports regarding the sacred status of cannabis in the Indian subcontinent come from the Atharva Veda estimated to have been composed sometime around 1400 BCE 29 The Hindu god Shiva is described as a cannabis user known as the Lord of bhang 30 p19 In modern culture the spiritual use of cannabis has been spread by the disciples of the Rastafari movement who use cannabis as a sacrament and as an aid to meditation 29 ConsumptionMain article Cannabis consumption Modes of consumption nbsp A joint prior to rolling with a paper handmade filter on the leftMany different ways to consume cannabis involve heat to decarboxylate THCA into THC 31 32 common modes include Smoking involves burning and inhaling cannabinoids smoke from small pipes bongs portable versions of hookahs with a water chamber paper wrapped joints tobacco leaf wrapped blunts or the like 33 Vaporizing heating various forms of cannabis to 165 190 C 329 374 F 34 causing the active ingredients to form vapor without combustion of the plant material the boiling point of THC is 157 C 315 F at atmospheric pressure 35 Edibles adding cannabis as an ingredient to a wide variety of foods including butter and baked goods In India it is commonly consumed as the beverage bhang Cannabis tea prepared with attention to lipophilic quality of THC which is only slightly water soluble 2 8 mg per liter 36 often involving cannabis in a saturated fat 37 Tincture of cannabis sometimes known as green dragon is an alcoholic cannabis concentrate Capsules typically containing cannabis oil and other dietary supplement products for which some 220 were approved in Canada in 2018 14 Consumption by country Main article Annual cannabis use by country Global estimates of drug users in 2016 in millions of users 38 Substance Bestestimate Lowestimate HighestimateAmphetamine type stimulants 34 16 13 42 55 24Cannabis 192 15 165 76 234 06Cocaine 18 20 13 87 22 85Ecstasy 20 57 8 99 32 34Opiates 19 38 13 80 26 15Opioids 34 26 27 01 44 54In 2013 between 128 and 232 million people used cannabis 2 7 to 4 9 of the global population between the ages of 15 and 65 39 Cannabis is by far the most widely used illicit substance 40 with the highest use among adults as of 2018 update in Zambia the United States Canada and Nigeria 41 United States Between 1973 and 1978 eleven states decriminalized marijuana 42 In 2001 Nevada reduced marijuana possession to a misdemeanor and since 2012 several other states have decriminalized and even legalized marijuana 42 In 2018 almost half of the people in the United States had tried marijuana 16 had used it in the past year and 11 had used it in the past month 43 In 2014 daily marijuana use amongst US college students had reached its highest level since records began in 1980 rising from 3 5 in 2007 to 5 9 in 2014 and had surpassed daily cigarette use 44 In the US men are over twice as likely to use marijuana as women and 18 29 year olds are six times more likely to use as over 65 year olds 45 In 2015 a record 44 of the US population has tried marijuana in their lifetime an increase from 38 in 2013 and 33 in 1985 45 Marijuana use in the United States is three times above the global average but in line with other Western democracies Forty four percent of American 12th graders have tried the drug at least once and the typical age of first use is 16 similar to the typical age of first use for alcohol but lower than the first use age for other illicit drugs 40 A 2022 Gallup poll concluded Americans are smoking more marijuana than cigarettes for the first time 46 Adverse effectsFurther information Effects of cannabis Short term nbsp Main short term physical effects of cannabisAcute negative effects may include anxiety and panic impaired attention and memory an increased risk of psychotic symptoms c the inability to think clearly and an increased risk of accidents 49 50 51 Cannabis impairs a person s driving ability and THC was the illicit drug most frequently found in the blood of drivers who have been involved in vehicle crashes Those with THC in their system are from three to seven times more likely to be the cause of the accident than those who had not used either cannabis or alcohol although its role is not necessarily causal because THC stays in the bloodstream for days to weeks after intoxication 52 53 d Some immediate undesired side effects include a decrease in short term memory dry mouth impaired motor skills reddening of the eyes 56 dizziness feeling tired and vomiting 11 Some users may experience an episode of acute psychosis which usually abates after six hours but in rare instances heavy users may find the symptoms continuing for many days 57 Legalization has increased the rates at which children are exposed to cannabis particularly from edibles While the toxicity and lethality of THC in children is not known they are at risk for encephalopathy hypotension respiratory depression severe enough to require ventilation somnolence and coma 58 59 Fatality There is no clear evidence for a link between cannabis use and deaths from cardiovascular disease but a 2019 review noted that it may be an under reported contributory factor or direct cause in cases of sudden death due to the strain it can place on the cardiovascular system Some deaths have also been attributed to cannabinoid hyperemesis syndrome 60 There is an association between cannabis use and suicide particularly in younger users 61 A 16 month survey of Oregon and Alaska emergency departments found a report of the death of an adult who had been admitted for acute cannabis toxicity 62 Long term Main article Long term effects of cannabis nbsp Addiction experts in psychiatry chemistry pharmacology forensic science epidemiology and the police and legal services engaged in delphic analysis regarding 20 popular recreational drugs Cannabis was ranked 11th in dependence 17th in physical harm and 10th in social harm 63 Psychological effects A 2015 meta analysis found that although a longer period of abstinence was associated with smaller magnitudes of impairment both retrospective and prospective memory were impaired in cannabis users The authors concluded that some but not all of the deficits associated with cannabis use were reversible 64 A 2012 meta analysis found that deficits in most domains of cognition persisted beyond the acute period of intoxication but was not evident in studies where subjects were abstinent for more than 25 days 65 Few high quality studies have been performed on the long term effects of cannabis on cognition and the results were generally inconsistent 66 Furthermore effect sizes of significant findings were generally small 65 One review concluded that although most cognitive faculties were unimpaired by cannabis use residual deficits occurred in executive functions 67 Impairments in executive functioning are most consistently found in older populations which may reflect heavier cannabis exposure or developmental effects associated with adolescent cannabis use 68 One review found three prospective cohort studies that examined the relationship between self reported cannabis use and intelligence quotient IQ The study following the largest number of heavy cannabis users reported that IQ declined between ages 7 13 and age 38 Poorer school performance and increased incidence of leaving school early were both associated with cannabis use although a causal relationship was not established 69 Cannabis users demonstrated increased activity in task related brain regions consistent with reduced processing efficiency 70 A reduced quality of life is associated with heavy cannabis use although the relationship is inconsistent and weaker than for tobacco and other substances 71 The direction of cause and effect however is unclear 71 The long term effects of cannabis are not clear 11 There are concerns surrounding memory and cognition problems risk of addiction and the risk of schizophrenia in young people 10 Neuroimaging Although global abnormalities in white matter and grey matter are not consistently associated with heavy cannabis use 72 reduced hippocampal volume is consistently found 73 Amygdala abnormalities are sometimes reported although findings are inconsistent 74 75 76 Cannabis use is associated with increased recruitment of task related areas such as the dorsolateral prefrontal cortex which is thought to reflect compensatory activity due to reduced processing efficiency 76 75 77 Cannabis use is also associated with downregulation of CB1 receptors The magnitude of down regulation is associated with cumulative cannabis exposure and is reversed after one month of abstinence 69 78 79 There is limited evidence that chronic cannabis use can reduce levels of glutamate metabolites in the human brain 80 Cannabis dependence Main article Cannabis dependence About 9 of those who experiment with marijuana eventually become dependent according to DSM IV 1994 criteria 13 A 2013 review estimates daily use is associated with a 10 20 rate of dependence 10 The highest risk of cannabis dependence is found in those with a history of poor academic achievement deviant behavior in childhood and adolescence rebelliousness poor parental relationships or a parental history of drug and alcohol problems 81 Of daily users about 50 experience withdrawal upon cessation of use i e are dependent characterized by sleep problems irritability dysphoria and craving 69 Cannabis withdrawal is less severe than withdrawal from alcohol 82 According to DSM V criteria 9 of those who are exposed to cannabis develop cannabis use disorder compared to 20 for cocaine 23 for alcohol and 68 for nicotine Cannabis use disorder in the DSM V involves a combination of DSM IV criteria for cannabis abuse and dependence plus the addition of craving without the criterion related to legal troubles 69 Psychiatric See also Long term effects of cannabis Mental health At an epidemiological level a dose response relationship exists between cannabis use and increased risk of psychosis 83 84 85 86 and earlier onset of psychosis 87 Although the epidemiological association is robust evidence to prove a causal relationship is lacking 88 Cannabis may also increase the risk of depression but insufficient research has been performed to draw a conclusion 89 85 Cannabis use is associated with increased risk of anxiety disorders although causality has not been established 90 A review in 2019 found that research was insufficient to determine the safety and efficacy of using cannabis to treat schizophrenia psychosis or other mental disorders 91 92 Another found that cannabis during adolescence was associated with an increased risk of developing depression and suicidal behavior later in life while finding no effect on anxiety 93 Physical Heavy long term exposure to marijuana may have physical mental behavioral and social health consequences It may be associated with diseases of the liver particularly with co existing hepatitis C lungs heart and vasculature 94 A 2014 review found that while cannabis use may be less harmful than alcohol use the recommendation to substitute it for problematic drinking was premature without further study 95 Various surveys conducted between 2015 and 2019 found that many users of cannabis substitute it for prescription drugs including opioids alcohol and tobacco most of those who used it in place of alcohol or tobacco either reduced or stopped their intake of the latter substances 96 Cannabinoid hyperemesis syndrome CHS is a severe condition seen in some chronic cannabis users where they have repeated bouts of uncontrollable vomiting for 24 48 hours Four cases of death have been reported as a result of CHS 97 98 A limited number of studies have examined the effects of cannabis smoking on the respiratory system 99 Chronic heavy marijuana smoking is associated with respiratory infections 100 coughing production of sputum wheezing and other symptoms of chronic bronchitis 49 The available evidence does not support a causal relationship between cannabis use and chronic obstructive pulmonary disease 101 Short term use of cannabis is associated with bronchodilation 102 Other side effects of cannabis use include cannabinoid hyperemesis syndrome CHS a condition which involves recurrent nausea cramping abdominal pain and vomiting 103 Cannabis smoke contains thousands of organic and inorganic chemical compounds This tar is chemically similar to that found in tobacco smoke 104 and over fifty known carcinogens have been identified in cannabis smoke 105 including nitrosamines reactive aldehydes and polycylic hydrocarbons including benz a pyrene 106 Cannabis smoke is also inhaled more deeply than tobacco smoke 107 As of 2015 update there is no consensus regarding whether cannabis smoking is associated with an increased risk of cancer 108 Light and moderate use of cannabis is not believed to increase risk of lung or upper airway cancer Evidence for causing these cancers is mixed concerning heavy long term use In general there are far lower risks of pulmonary complications for regular cannabis smokers when compared with those of tobacco 109 A 2015 review found an association between cannabis use and the development of testicular germ cell tumors TGCTs particularly non seminoma TGCTs 110 Another 2015 meta analysis found no association between lifetime cannabis use and risk of head or neck cancer 111 Combustion products are not present when using a vaporizer consuming THC in pill form or consuming cannabis foods 112 There is concern that cannabis may contribute to cardiovascular disease 113 but as of 2018 update evidence of this relationship was unclear 114 Research in these events is complicated because cannabis is often used in conjunction with tobacco and drugs such as alcohol and cocaine that are known to have cardiovascular risk factors 115 Smoking cannabis has also been shown to increase the risk of myocardial infarction by 4 8 times for the 60 minutes after consumption 116 There is preliminary evidence that cannabis interferes with the anticoagulant properties of prescription drugs used for treating blood clots 117 As of 2019 update the mechanisms for the anti inflammatory and possible pain relieving effects of cannabis were not defined and there were no governmental regulatory approvals or clinical practices for use of cannabis as a drug 92 Emergency department visits Emergency room ER admissions associated with cannabis use rose significantly from 2012 to 2016 adolescents from age 12 17 had the highest risk 118 At one Colorado medical center following legalization approximately two percent of ER admissions were classified as cannabis users The symptoms of one quarter of these users were partially attributed to cannabis a total of 2567 out of 449 031 patients other drugs were sometimes involved Of these cannabis admissions one quarter were for acute psychiatric effects primarily suicidal ideation depression and anxiety An additional third of the cases were for gastrointestinal issues including Cannabinoid hyperemesis syndrome 119 According to the United States Department of Health and Human Services there were 455 000 emergency room visits associated with cannabis use in 2011 These statistics include visits in which the patient was treated for a condition induced by or related to recent cannabis use The drug use must be implicated in the emergency department visit but does not need to be the direct cause of the visit Most of the illicit drug emergency room visits involved multiple drugs 120 In 129 000 cases cannabis was the only implicated drug 120 13 Reproductive health Further information Cannabis in pregnancy There is sufficient evidence of reproductive health harms from cannabis that its use when trying to conceive during pregnancy and while breastfeeding is not advisable 121 It has been recommended that cannabis use be stopped before and during pregnancy as it can result in negative outcomes for both the mother and baby 122 123 such as behavioral problems 124 However maternal use of marijuana during pregnancy does not appear to be associated with low birth weight or early delivery after controlling for tobacco use and other confounding factors 125 PharmacologyMechanism of action See also Effects of cannabis Biochemical mechanisms in the brain THC is a weak partial agonist at CB1 receptors while CBD is a CB1 receptor antagonist 126 127 The CB1 receptor is found primarily in the brain as well as in some peripheral tissues and the CB2 receptor is found primarily in peripheral tissues but is also expressed in neuroglial cells 128 THC appears to alter mood and cognition through its agonist actions on the CB1 receptors which inhibit a secondary messenger system adenylate cyclase in a dose dependent manner Via CB1 receptor activation THC indirectly increases dopamine release and produces psychotropic effects 129 CBD also acts as an allosteric modulator of the m and d opioid receptors 130 THC also potentiates the effects of the glycine receptors 131 It is unknown if or how these actions contribute to the effects of cannabis 132 Pharmacokinetics The high lipid solubility of cannabinoids results in their persisting in the body for long periods of time 133 Even after a single administration of THC detectable levels of THC can be found in the body for weeks or longer depending on the amount administered and the sensitivity of the assessment method 133 Investigators have suggested that this is an important factor in marijuana s effects perhaps because cannabinoids may accumulate in the body particularly in the lipid membranes of neurons 134 ChemistryChemical composition See also Difference between C indica and C sativa The main psychoactive component of cannabis is tetrahydrocannabinol THC which is formed via decarboxylation of tetrahydrocannabinolic acid THCA from the application of heat Raw leaf is not psychoactive because the cannabinoids are in the form of carboxylic acids citation needed THC is one of the 483 known compounds in the plant 135 including at least 65 other cannabinoids 136 such as cannabidiol CBD 51 Detection in body fluids Main article Cannabis drug testing THC and its major inactive metabolite THC COOH can be measured in blood urine hair oral fluid or sweat using chromatographic techniques as part of a drug use testing program or a forensic investigation of a traffic or other criminal offense 57 The concentrations obtained from such analyses can often be helpful in distinguishing active use from passive exposure elapsed time since use and extent or duration of use These tests cannot however distinguish authorized cannabis smoking for medical purposes from unauthorized recreational smoking 137 Commercial cannabinoid immunoassays often employed as the initial screening method when testing physiological specimens for marijuana presence have different degrees of cross reactivity with THC and its metabolites 138 Urine contains predominantly THC COOH while hair oral fluid and sweat contain primarily THC 57 Blood may contain both substances with the relative amounts dependent on the recency and extent of usage 57 The Duquenois Levine test is commonly used as a screening test in the field but it cannot definitively confirm the presence of cannabis as a large range of substances have been shown to give false positives 139 Researchers at John Jay College of Criminal Justice reported that dietary zinc supplements can mask the presence of THC and other drugs in urine 140 However a 2013 study conducted by researchers at the University of Utah School of Medicine refute the possibility of self administered zinc producing false negative urine drug tests 141 Varieties and strains nbsp Types of cannabis nbsp A macro cannabis budCBD is a 5 HT1A receptor agonist which is under laboratory research to determine if it has an anxiolytic effect 142 It is often claimed that sativa strains provide a more stimulating psychoactive high while indica strains are more sedating with a body high 143 However this is disputed by researchers 144 A 2015 review found that the use of high CBD to THC strains of cannabis showed significantly fewer positive symptoms such as delusions and hallucinations better cognitive function and both lower risk for developing psychosis as well as a later age of onset of the illness compared to cannabis with low CBD to THC ratios 145 Psychoactive ingredients According to the United Nations Office on Drugs and Crime UNODC the amount of THC present in a cannabis sample is generally used as a measure of cannabis potency 146 The three main forms of cannabis products are the flower fruit resin hashish and oil hash oil The UNODC states that cannabis often contains 5 THC content resin can contain up to 20 THC content and that Cannabis oil may contain more than 60 THC content 146 Studies have found that the potency of illicit cannabis has greatly increased since the 1970s with THC levels rising and CBD levels dropping 147 148 149 It is unclear however whether the increase in THC content has caused people to consume more THC or if users adjust based on the potency of the cannabis It is likely that the higher THC content allows people to ingest less tar At the same time CBD levels in seized samples have lowered in part because of the desire to produce higher THC levels and because more illegal growers cultivate indoors using artificial lights This helps avoid detection but reduces the CBD production of the plant 150 Australia s National Cannabis Prevention and Information Centre NCPIC states that the buds infructescences of the female cannabis plant contain the highest concentration of THC followed by the leaves The stalks and seeds have much lower THC levels 151 The UN states that the leaves can contain ten times less THC than the buds and the stalks one hundred times less THC 146 After revisions to cannabis scheduling in the UK the government moved cannabis back from a class C to a class B drug A purported reason was the appearance of high potency cannabis They believe skunk accounts for between 70 and 80 of samples seized by police 152 despite the fact that skunk can sometimes be incorrectly mistaken for all types of herbal cannabis 153 154 Extracts such as hashish and hash oil typically contain more THC than high potency cannabis infructescences 155 Laced cannabis and synthetic cannabinoids See also Synthetic cannabinoids Hemp or low potent cannabis buds Hemp buds or low potency cannabis buds laced with synthetic cannabinoids started to be sold as cannabis street drug in 2020 156 157 158 159 The short term effects of cannabis can be altered if it has been laced with opioid drugs such as heroin or fentanyl 160 The added drugs are meant to enhance the psychoactive properties add to its weight and increase profitability despite the increased danger of overdose 161 e Preparations nbsp Dried flower buds marijuana nbsp A gram of kief nbsp Hashish nbsp Hash oil nbsp Infusion dairy butter Marijuana Further information Marijuana word Marijuana or marihuana herbal cannabis 163 consists of the dried flowers and fruits and subtending leaves and stems of the female cannabis plant 164 165 166 167 This is the most widely consumed form 167 containing 3 to 20 THC 168 with reports of up to 33 THC 169 This is the stock material from which all other preparations are derived Although herbal cannabis and industrial hemp derive from the same species and contain the psychoactive component THC they are distinct strains with unique biochemical compositions and uses Hemp has lower concentrations of THC and higher concentrations of CBD which gives lesser psychoactive effects 170 171 Kief Main article Kief Kief is a powder rich in trichomes 172 which can be sifted from the leaves flowers and fruits of cannabis plants and either consumed in powder form or compressed to produce cakes of hashish 173 The word kif derives from colloquial Arabic كيف kef kif meaning pleasure 174 Hashish Main article Hashish nbsp Legal hashish shop in Kathmandu Nepal in 1973Hashish also spelled hasheesh hashisha or simply hash is a concentrated resin cake or ball produced from pressed kief the detached trichomes and fine material that falls off cannabis fruits flowers and leaves 175 or from scraping the resin from the surface of the plants and rolling it into balls It varies in color from black to golden brown depending upon purity and variety of cultivar it was obtained from 176 It can be consumed orally or smoked and is also vaporized or vaped 177 The term rosin hash refers to a high quality solventless product obtained through heat and pressure 178 Tincture Main article Tincture of cannabis Cannabinoids can be extracted from cannabis plant matter using high proof spirits often grain alcohol to create a tincture often referred to as green dragon 30 p17 Nabiximols is a branded product name from a tincture manufacturing pharmaceutical company 179 Hash oil Main article Hash oil Hash oil is a resinous matrix of cannabinoids obtained from the cannabis plant by solvent extraction 180 formed into a hardened or viscous mass 181 Hash oil can be the most potent of the main cannabis products because of its high level of psychoactive compound per its volume which can vary depending on the plant s mix of essential oils and psychoactive compounds 182 Butane and supercritical carbon dioxide hash oil have become popular in recent years 183 Infusions There are many varieties of cannabis infusions owing to the variety of non volatile solvents used 184 The plant material is mixed with the solvent and then pressed and filtered to express the oils of the plant into the solvent Examples of solvents used in this process are cocoa butter dairy butter cooking oil glycerine and skin moisturizers Depending on the solvent these may be used in cannabis foods or applied topically 185 Marihuana prensada Main article Marihuana prensada Marihuana prensada pressed marijuana is a cannabis derived product widespread among the lower classes of South America 186 especially from the 90s Locally it is known as paraguayo or paragua since its main producer is Paraguay 187 Marijuana is dried and mixed with binding agents that make it toxic and highly harmful to health 188 It is cut into the shape of bricks ladrillos and sold for a low price in Argentina Brazil Chile Peru Venezuela and even the United States 189 HistoryMain articles History of cannabis Timeline of cannabis law and Religion and drugs Ancient history nbsp Present day map of the Jirzankal Cemetery site of the earliest evidence of cannabis smokingCannabis is indigenous to Central or South Asia 190 and its uses for fabric and rope dates back to the Neolithic age in China and Japan 191 192 It is unclear when cannabis first became known for its psychoactive properties The oldest archeological evidence for the burning of cannabis was found in Romanian kurgans dated 3 500 BC and scholars suggest that the drug was first used in ritual ceremonies by Proto Indo European tribes living in the Pontic Caspian steppe during the Chalcolithic period a custom they eventually spread throughout Western Eurasia during the Indo European migrations 193 194 Some research suggests that the ancient Indo Iranian drug soma mentioned in the Vedas sometimes contained cannabis This is based on the discovery of a basin containing cannabis in a shrine of the second millennium BC in Turkmenistan 195 Cannabis was known to the ancient Assyrians who discovered its psychoactive properties through the Iranians 196 Using it in some religious ceremonies they called it qunubu meaning way to produce smoke a probable origin of the modern word cannabis 197 The Iranians also introduced cannabis to the Scythians Thracians and Dacians whose shamans the kapnobatai those who walk on smoke clouds burned cannabis infructescences to induce trance 198 The plant was used in China before 2800 BC and found therapeutic use in India by 1000 BC where it was used in food and drink including bhang 199 200 nbsp Cannabis sativa from Vienna Dioscurides c 512 CECannabis has an ancient history of ritual use and has been used by religions around the world It has been used as a drug for both recreational and entheogenic purposes and in various traditional medicines for centuries 201 202 163 The earliest evidence of cannabis smoking has been found in the 2 500 year old tombs of Jirzankal Cemetery in the Pamir Mountains in Western China where cannabis residue were found in burners with charred pebbles possibly used during funeral rituals 203 204 Hemp seeds discovered by archaeologists at Pazyryk suggest early ceremonial practices like eating by the Scythians occurred during the 5th to 2nd century BC confirming previous historical reports by Herodotus 205 It was used by Muslims in various Sufi orders as early as the Mamluk period for example by the Qalandars 206 Smoking pipes uncovered in Ethiopia and carbon dated to around c AD 1320 were found to have traces of cannabis 207 Modern history Cannabis was introduced to the New World by the Spaniards in 1530 1545 208 209 210 Following an 1836 1840 travel in North Africa and the Middle East French physician Jacques Joseph Moreau wrote on the psychological effects of cannabis use he founded the Paris Club des Hashischins in 1844 211 In 1842 Irish physician William Brooke O Shaughnessy who had studied the drug while working as a medical officer in Bengal with the East India Company brought a quantity of cannabis with him on his return to Britain provoking renewed interest in the West 212 Examples of classic literature of the period featuring cannabis include Les paradis artificiels 1860 by Charles Baudelaire and The Hasheesh Eater 1857 by Fitz Hugh Ludlow nbsp Anti cannabis propaganda from 1935Cannabis was criminalized in some countries beginning in the 14th century and was illegal in most countries by the middle of the 20th century The colonial government of Mauritius banned cannabis in 1840 over concerns on its effect on Indian indentured workers 213 the same occurred in Singapore in 1870 214 In the United States the first restrictions on sale of cannabis came in 1906 in the District of Columbia 215 Canada criminalized cannabis in The Opium and Narcotic Drug Act 1923 216 before any reports of the use of the drug in Canada but eventually legalized its consumption for recreational and medicinal purposes in 2018 14 In 1925 a compromise was made at an international conference in The Hague about the International Opium Convention that banned exportation of Indian hemp to countries that had prohibited its use and requiring importing countries to issue certificates approving the importation and stating that the shipment was required exclusively for medical or scientific purposes It also required parties to exercise an effective control of such a nature as to prevent the illicit international traffic in Indian hemp and especially in the resin 217 218 In the United States in 1937 the Marihuana Tax Act was passed 219 and prohibited the production of hemp in addition to cannabis nbsp Cannabis indica fluid extract American Druggists Syndicate pre 1937 In 1972 the Dutch government divided drugs into more and less dangerous categories with cannabis being in the lesser category Accordingly possession of 30 grams 1 1 oz or less was made a misdemeanor 220 Cannabis has been available for recreational use in coffee shops since 1976 221 Cannabis products are only sold openly in certain local coffeeshops and possession of up to 5 grams 0 18 oz for personal use is decriminalized however the police may still confiscate it which often happens in car checks near the border Other types of sales and transportation are not permitted although the general approach toward cannabis was lenient even before official decriminalization 222 223 224 In Uruguay President Jose Mujica signed legislation to legalize recreational cannabis in December 2013 making Uruguay the first country in the modern era to legalize cannabis In August 2014 Uruguay legalized growing up to six plants at home as well as the formation of growing clubs Cannabis social club and a state controlled marijuana dispensary regime As of 17 October 2018 update when recreational use of cannabis was legalized in Canada dietary supplements for human use and veterinary health products containing not more than 10 parts per million of THC extract were approved for marketing Nabiximols as Sativex is used as a prescription drug in Canada 14 The United Nations World Drug Report stated that cannabis was the world s most widely produced trafficked and consumed drug in the world in 2010 and estimated between 128 million and 238 million users globally in 2015 225 226 Culture legality and economicsCulture Main article Cannabis culture See also Drug culture and 420 cannabis culture nbsp Process of making bhang in a Sikh village in Punjab India On the Hindu and Sikh festival of colors called Holi it is a customary addition to some intoxicating drinks 227 Cannabis has been one of the most used psychoactive drugs in the world since the late 20th century following only tobacco and alcohol in popularity 228 According to Vera Rubin the use of cannabis has been encompassed by two major cultural complexes over time a continuous traditional folk stream and a more circumscribed contemporary configuration 229 The former involves both sacred and secular use and is usually based on small scale cultivation the use of the plant for cordage clothing medicine food and a general use as an euphoriant and symbol of fellowship 229 230 The second stream of expansion of cannabis use encompasses the use of hemp for commercial manufacturers utilizing large scale cultivation primarily as a fiber for mercantile purposes but it is also linked to the search for psychedelic experiences which can be traced back to the formation of the Parisian Club des Hashischins 230 Legality Main article Legality of cannabis See also Prohibition of drugs and Drug liberalization nbsp Legal status of cannabis possession for non medical use Legal Illegal but decriminalized Illegal but often unenforced Illegal See also countries that have legalized medical use of cannabis Since the beginning of the 20th century most countries have enacted laws against the cultivation possession or transfer of cannabis 231 These laws have had an adverse effect on cannabis cultivation for non recreational purposes but there are many regions where handling of cannabis is legal or licensed Many jurisdictions have lessened the penalties for possession of small quantities of cannabis so that it is punished by confiscation and sometimes a fine rather than imprisonment focusing more on those who traffic the drug on the black market In some areas where cannabis use had been historically tolerated new restrictions were instituted such as the closing of cannabis coffee shops near the borders of the Netherlands 232 and closing of coffee shops near secondary schools in the Netherlands 233 In Copenhagen Denmark in 2014 mayor Frank Jensen discussed possibilities for the city to legalize cannabis production and commerce 234 Some jurisdictions use free voluntary treatment programs and or mandatory treatment programs for frequent known users Simple possession can carry long prison terms in some countries particularly in East Asia where the sale of cannabis may lead to a sentence of life in prison or even execution Political parties non profit organizations and causes based on the legalization of medical cannabis and or legalizing the plant entirely with some restrictions have emerged in such countries as China and Thailand 235 236 In December 2012 the U S state of Washington became the first state to officially legalize cannabis in a state law Washington Initiative 502 but still illegal by federal law 237 with the state of Colorado following close behind Colorado Amendment 64 238 On 1 January 2013 the first cannabis club for private marijuana smoking no buying or selling however was allowed for the first time in Colorado 239 The California Supreme Court decided in May 2013 that local governments can ban medical cannabis dispensaries despite a state law in California that permits the use of cannabis for medical purposes At least 180 cities across California have enacted bans in recent years 240 In December 2013 Uruguay became the first country to legalize growing sale and use of cannabis 241 After a long delay in implementing the retail component of the law in 2017 sixteen pharmacies were authorized to sell cannabis commercially 242 On 19 June 2018 the Canadian Senate passed a bill and the Prime Minister announced the effective legalization date as 17 October 2018 14 243 Canada is the second country to legalize the drug 244 In November 2015 Uttarakhand became the first state of India to legalize the cultivation of hemp for industrial purposes 245 Usage within the Hindu and Buddhist cultures of the Indian subcontinent is common with many street vendors in India openly selling products infused with cannabis and traditional medical practitioners in Sri Lanka selling products infused with cannabis for recreational purposes and well as for religious celebrations 246 Indian laws criminalizing cannabis date back to the colonial period India and Sri Lanka have allowed cannabis to be taken in the context of traditional culture for recreational celebratory purposes and also for medicinal purposes 246 On 17 October 2015 Australian health minister Sussan Ley presented a new law that will allow the cultivation of cannabis for scientific research and medical trials on patients 247 On 17 October 2018 Canada legalized cannabis for recreational adult use 248 making it the second country in the world to do so after Uruguay and the first G7 nation 249 The Canadian Licensed Producer system aims to become the Gold Standard in the world for safe and secure cannabis production 250 including provisions for a robust craft cannabis industry where many expect opportunities for experimenting with different strains 251 Laws around use vary from province to province including age limits retail structure and growing at home 248 As the drug has increasingly been seen as a health issue instead of criminal behavior cannabis has also been legalized or decriminalized in Czech Republic 252 Colombia 253 254 Ecuador 255 256 257 Portugal 258 South Africa 259 and Canada 14 Medical marijuana was legalized in Mexico in mid 2017 legislators plan to legalize its recreational use by late 2019 260 261 262 On 28 June 2021 Clarence Thomas one of the U S Supreme Court s most conservative justices possibly opened the door to federal legalization of cannabis in the United States when he wrote A prohibition on interstate use or cultivation of cannabis may no longer be necessary or proper to support the federal government s piecemeal approach 263 Legal status by country As of 2022 Uruguay and Canada are the only countries that have fully legalized the cultivation consumption and bartering of recreational cannabis nationwide 264 265 In the United States 24 states 3 territories and the District of Columbia have legalized the recreational use of cannabis though the drug remains illegal at the federal level 266 Laws vary from state to state when it comes to the commercial sale Court rulings in Georgia and South Africa have led to the legalization of cannabis consumption but not legal sales A policy of limited enforcement has also been adopted in many countries in particular Spain and the Netherlands where the sale of cannabis is tolerated at licensed establishments 267 268 Contrary to popular belief cannabis is not legal in the Netherlands 269 but it has been decriminalized since the 1970s In 2021 Malta was the first European Union member to legalize the use of cannabis for recreational purposes 270 In Estonia it is only legal to sell cannabis products with a THC content of less than 0 2 although products may contain more cannabidiol 271 Lebanon has recently become the first Arab country to legalize the plantation of cannabis for medical use 272 Penalties for illegal recreational use ranges from confiscation or small fines to jail time and even death 273 In some countries citizens can be punished if they have used the drug in another country including Singapore and South Korea 274 275 Economics Production Main articles Cannabis cultivation Cannabis industry and Cannabis product testing nbsp Woman selling cannabis and bhang in Guwahati Assam IndiaSinsemilla Spanish for without seed is the dried seedless i e parthenocarpic infructescences of female cannabis plants Because THC production drops off once pollination occurs the male plants which produce little THC themselves are eliminated before they shed pollen to prevent pollination thus inducing the development of parthenocarpic fruits gathered in dense infructescences Advanced cultivation techniques such as hydroponics cloning high intensity artificial lighting and the sea of green method are frequently employed as a response in part to prohibition enforcement efforts that make outdoor cultivation more risky Skunk refers to several named strains of potent cannabis grown through selective breeding and sometimes hydroponics It is a cross breed of Cannabis sativa and C indica although other strains of this mix exist in abundance Skunk cannabis potency ranges usually from 6 to 15 and rarely as high as 20 The average THC level in coffee shops in the Netherlands is about 18 19 276 The average levels of THC in cannabis sold in the United States rose dramatically between the 1970s and 2000 277 This is disputed for various reasons and there is little consensus as to whether this is a fact or an artifact of poor testing methodologies 277 According to Daniel Forbes writing for slate com the relative strength of modern strains are likely skewed because undue weight is given to much more expensive and potent but less prevalent samples 278 Some suggest that results are skewed by older testing methods that included low THC content plant material such as leaves in the samples which are excluded in contemporary tests Others believe that modern strains actually are significantly more potent than older ones 277 The main producing countries of cannabis are Afghanistan 279 Canada 280 China Colombia 281 India 279 Jamaica 279 Lebanon 282 Mexico 283 Morocco 279 the Netherlands Pakistan Paraguay 283 Spain 279 Thailand Turkey the United Kingdom 284 and the United States 279 Price The price or street value of cannabis varies widely depending on geographic area and potency 285 Prices and overall markets have also varied considerably over time In 1997 cannabis was estimated to be overall the number four value crop in the US and number one or two in many states including California New York and Florida This estimate is based on a value to growers of 60 of retail value or 3 000 per pound 6 600 kg 286 In 2006 cannabis was estimated to have been a 36 billion market 287 This estimate has been challenged as exaggerated 40 The UN World Drug Report 2008 estimated that 2006 street prices in the US and Canada ranged from about US 8 8 to 25 per gram approximately 250 to 700 per ounce depending on quality 288 Typical U S retail prices were 10 15 per gram approximately 280 420 per ounce In 2017 the U S was estimated to constitute 90 of the worldwide 9 5 billion legal trade in cannabis 289 After some U S states legalized cannabis street prices began to drop In Colorado the price of smokable buds infructescences dropped 40 percent between 2014 and 2019 from 200 per ounce to 120 per ounce 7 per gram to 4 19 per gram 290 The European Monitoring Centre for Drugs and Drug Addiction reports that typical retail prices in Europe for cannabis varied from 2 to 20 per gram in 2008 with a majority of European countries reporting prices in the range 4 10 291 Cannabis as a gateway drugSee also Gateway drug effect The gateway hypothesis states that cannabis use increases the probability of trying harder drugs The hypothesis has been hotly debated as it is regarded by some as the primary rationale for the United States prohibition on cannabis use 292 293 A Pew Research Center poll found that political opposition to marijuana use was significantly associated with concerns about the health effects and whether legalization would increase cannabis use by children 294 Some studies state that while there is no proof for the gateway hypothesis 295 young cannabis users should still be considered as a risk group for intervention programs 296 Other findings indicate that hard drug users are likely to be poly drug users and that interventions must address the use of multiple drugs instead of a single hard drug 297 Almost two thirds of the poly drug users in the 2009 2010 Scottish Crime and Justice Survey used cannabis 298 The gateway effect may appear due to social factors involved in using any illegal drug Because of the illegal status of cannabis its consumers are likely to find themselves in situations allowing them to acquaint with individuals using or selling other illegal drugs 299 300 Studies have shown that alcohol and tobacco may additionally be regarded as gateway drugs 301 however a more parsimonious explanation could be that cannabis is simply more readily available and at an earlier age than illegal hard drugs In turn alcohol and tobacco are typically easier to obtain at an earlier age than is cannabis though the reverse may be true in some areas thus leading to the gateway sequence in those individuals since they are most likely to experiment with any drug offered 292 A related alternative to the gateway hypothesis is the common liability to addiction CLA theory It states that some individuals are for various reasons willing to try multiple recreational substances The gateway drugs are merely those that are usually available at an earlier age than the harder drugs Researchers have noted in an extensive review that it is dangerous to present the sequence of events described in gateway theory in causative terms as this hinders both research and intervention 302 In 2020 the National Institute on Drug Abuse released a study backing allegations that marijuana is a gateway to harder drugs though not for the majority of marijuana users 303 The National Institute on Drug Abuse determined that marijuana use is likely to precede use of other licit and illicit substances and that adults who reported marijuana use during the first wave of the survey were more likely than adults who did not use marijuana to develop an alcohol use disorder within 3 years people who used marijuana and already had an alcohol use disorder at the outset were at greater risk of their alcohol use disorder worsening Marijuana use is also linked to other substance use disorders including nicotine addiction 303 It also reported that These findings are consistent with the idea of marijuana as a gateway drug However the majority of people who use marijuana do not go on to use other harder substances Also cross sensitization is not unique to marijuana Alcohol and nicotine also prime the brain for a heightened response to other drugs and are like marijuana also typically used before a person progresses to other more harmful substances 303 ResearchSee also Medical cannabis research Research on cannabis is challenging since the plant is illegal in most countries 304 305 306 307 308 Research grade samples of the drug are difficult to obtain for research purposes unless granted under authority of national regulatory agencies such as the US Food and Drug Administration 309 There are also other difficulties in researching the effects of cannabis Many people who smoke cannabis also smoke tobacco 310 This causes confounding factors where questions arise as to whether the tobacco the cannabis or both that have caused a cancer Another difficulty researchers have is in recruiting people who smoke cannabis into studies Because cannabis is an illegal drug in many countries people may be reluctant to take part in research and if they do agree to take part they may not say how much cannabis they actually smoke 311 See alsoCannabis rights Glossary of cannabis termsReferencesFootnotes ˈ k ae n e b ɪ s 1 ˌ m ae r e ˈ w ɑː n e 2 Psychotic episodes are well documented and typically resolve within minutes or hours while symptoms may last longer 47 The use of a single joint can temporarily induce some psychiatric symptoms 48 A 2016 review also found a statistically significant increase in crash risk associated with marijuana use but noted that this risk was of low to medium magnitude 54 The increase in risk of motor vehicle crash for cannabis use is between 2 and 3 times relative to baseline whereas that for comparable doses of alcohol is between 6 and 15 times 55 Advocates of legalizing marijuana for recreational use such as former Illinois state Senator Heather Steans say that legalizing it would help reduce such hazardous added drugs Over 95 percent are buying it on the black market You don t know what you re buying It s not a safe product We ve seen it laced with rat poison fentanyl all sorts of things It s funding the cartels and other criminal activity 162 Citations cannabis noun Definition pictures pronunciation and usage notes Oxford Advanced Learner s Dictionary at OxfordLearnersDictionaries com www oxfordlearnersdictionaries com Retrieved 10 November 2022 marijuana noun Definition pictures pronunciation and usage notes Oxford Advanced Learner s Dictionary at OxfordLearnersDictionaries com www oxfordlearnersdictionaries com Retrieved 18 April 2019 Shrivastava Amresh Johnston Megan Tsuang Ming 2011 Cannabis use and cognitive dysfunction Indian Journal of Psychiatry 53 3 187 191 doi 10 4103 0019 5545 86796 ISSN 0019 5545 PMC 3221171 PMID 22135433 Ren Meng Tang Zihua Wu Xinhua 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analysis and systematic review Journal of Clinical Pharmacology 42 S1 48S 57S doi 10 1002 j 1552 4604 2002 tb06003 x PMID 12412836 S2CID 37826919 Crean RD Crane NA Mason BJ March 2011 An evidence based review of acute and long term effects of cannabis use on executive cognitive functions Journal of Addiction Medicine 5 1 1 8 doi 10 1097 ADM 0b013e31820c23fa PMC 3037578 PMID 21321675 Cannabis appears to continue to exert impairing effects in executive functions even after 3 weeks of abstinence and beyond While basic attentional and working memory abilities are largely restored the most enduring and detectable deficits are seen in decision making concept formation and planning Broyd SJ van Hell HH Beale C Yucel M Solowij N April 2016 Acute and Chronic Effects of Cannabinoids on Human Cognition A Systematic Review Biological Psychiatry 79 7 557 67 doi 10 1016 j biopsych 2015 12 002 PMID 26858214 S2CID 9858298 a b c d Curran HV Freeman TP Mokrysz C Lewis DA Morgan CJ Parsons LH May 2016 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is an intricately balanced complex network of billions of neurons and supporting cells some might imagine that extrinsic substances could cause irreversible brain damage Our review paints a less gloomy picture of the substances reviewed however Following prolonged abstinence abusers of alcohol Pfefferbaum et al 2014 or opiates Wang et al 2011 have white matter microstructure that is not significantly different from non users There was also no evidence that the white matter microstructural changes observed in longitudinal studies of cannabis nicotine or cocaine were completely irreparable It is therefore possible that at least to some degree abstinence can reverse effects of substance abuse on white matter The ability of white matter to bounce back very likely depends on the level and duration of abuse as well as the substance being abused Yucel M Lorenzetti V Suo C Zalesky A Fornito A Takagi M J Lubman D I Solowij N January 2016 Hippocampal harms protection and recovery following regular cannabis use Translational Psychiatry 6 1 e710 doi 10 1038 tp 2015 201 PMC 5068875 PMID 26756903 Rocchetti M Crescini A Borgwardt S Caverzasi E Politi P Atakan Z Fusar Poli P November 2013 Is cannabis neurotoxic for the healthy brain A meta analytical review of structural brain alterations in non psychotic users Psychiatry and Clinical Neurosciences 67 7 483 92 doi 10 1111 pcn 12085 PMID 24118193 S2CID 8245635 a b Batalla A Bhattacharyya S Yucel M Fusar Poli P Crippa JA Nogue S Torrens M Pujol J Farre M Martin Santos R 2013 Structural and functional imaging studies in chronic cannabis users a systematic review of adolescent and adult findings PLOS ONE 8 2 e55821 Bibcode 2013PLoSO 855821B doi 10 1371 journal pone 0055821 PMC 3563634 PMID 23390554 The most consistently reported brain alteration was reduced hippocampal volume which was shown to persist even after several months of abstinence in one study and also to be related to the amount of cannabis use Other frequently 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