Marijuana is the most commonly used illicit substance in the United States. Also known as "pot," "grass," "weed," hash, or tetrahydrocannabinol (THC), it is a hallucinogenic agent prepared from the dried leaves of Cannabis sativa. Its primary psychoactive constituent is THC. The medical use of cannabis in the treatment of pain and other symptomatology has long been practiced. The first recorded use of medical cannabis dates back to 2700 BC; in the United States, medical marijuana was routinely used until 1942. However, because of growing concerns over its addictive potential, the medical and psychosocial side effects of its chronic use, US physicians had been prohibited by the federal government to prescribe these drugs. Other countries such as the Netherlands and Canada still routinely use medical marijuana in the treatment of pain and other disorders such as anorexia (Cohen 2008).
Marijuana is most commonly inhaled, i.e., smoked via cigarette, a water pipe, or a blunt (a hollow cigar filled with marijuana), but can also be taken orally (Hernandez et al. 2005). Users experience an intense feeling of relaxation and euphoria within minutes and its effects rarely last more than 2-3 h. However, due to its high lipid solubility cannabinoids may rapidly accumulate in adipose tissue which may in part account for the long elimination half-life of up to a week. While side effects include tachycardia, conjunctival congestion and anxiety, adverse reactions mostly include anxiety, depression, fear, delusions, hallucinations, and violent behavior. Chronic use may lead to cognitive impairment, shortened memory span, confusion, altered time perception, and dulled reflexes. Abstinence after chronic use can lead to a withdrawal syndrome characterized by troubled sleep and negative mood. When taken in combination, marijuana can augment the sedative effects of drugs such as alcohol and ben-zodiazepines or amplify the stimulatory actions of cocaine and amphetamines (Greydanus and Patel 2003). In recent years, there has been a renewed interest in both legalizing and legitimizing the use of marijuana especially in the treatment of chronic pain.
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