{{short description|Cannabis sativa L. (marijuana; hemp) used medicinally}} {{other uses of|Cannabis}} {{redirect|Medical marijuana|the company|Medical Marijuana, Inc.}} {{pp-semi-indef}} {{cs1 config|name-list-style=vanc|display-authors=6}} {{Use dmy dates|date=October 2017}} {{Use American English|date=October 2017}} {{Cannabis sidebar}}
<!-- Definition and uses --> '''Medical cannabis''', '''medicinal cannabis''' or '''medical marijuana''' ('''MMJ''') includes cannabis products and cannabinoid molecules that are prescribed by physicians for their patients.<ref>{{cite journal | vauthors = Murnion B | title = Medicinal cannabis | journal = Australian Prescriber | volume = 38 | issue = 6 | pages = 212–15 | date = December 2015 | pmid = 26843715 | pmc = 4674028 | doi = 10.18773/austprescr.2015.072 }}</ref><ref>{{cite web |title= What is medical marijuana? |url= https://www.drugabuse.gov/publications/drugfacts/marijuana-medicine |website= National Institute of Drug Abuse |access-date= 19 April 2016 |date= July 2015 |quote= The term medical marijuana refers to using the whole unprocessed marijuana plant or its basic extracts to treat a disease or symptom. |archive-date= 17 April 2016 |archive-url= https://web.archive.org/web/20160417154854/https://www.drugabuse.gov/publications/drugfacts/marijuana-medicine |url-status= live }}</ref><ref>{{Cite journal |last1=Sarris |first1=Jerome |last2=Sinclair |first2=Justin |last3=Karamacoska |first3=Diana |last4=Davidson |first4=Maggie |last5=Firth |first5=Joseph |date=2020-01-16 |title=Medicinal cannabis for psychiatric disorders: a clinically-focused systematic review |journal=BMC Psychiatry |language=en |volume=20 |issue=1 |page=24 |doi=10.1186/s12888-019-2409-8 |doi-access=free |issn=1471-244X |pmc=6966847 |pmid=31948424}}</ref><ref>{{Cite journal |last=O'Brien |first=Kylie |date=2019-06-01 |title=Medicinal Cannabis: Issues of evidence |url=https://www.sciencedirect.com/science/article/pii/S1876382019300216 |journal=European Journal of Integrative Medicine |volume=28 |pages=114–120 |doi=10.1016/j.eujim.2019.05.009 |issn=1876-3820|url-access=subscription }}</ref> The use of cannabis as medicine has a long history, but has not been as rigorously tested as other medicinal plants due to legal and governmental restrictions, resulting in limited research to define the safety and efficacy of using cannabis to treat diseases.<ref>{{cite journal | title = Release the strains | journal = Nature Medicine | volume = 21 | issue = 9 | page = 963 | date = September 2015 | pmid = 26340110 | doi = 10.1038/nm.3946 | doi-access = free }}</ref>
There is mixed and inconclusive evidence on the benefits of cannabis-based medicines, frequent mild adverse effects, and generally low-to-moderate quality of evidence.<ref name="pratt" /> Cannabis-based medicines may offer modest relief for chronic, especially neuropathic, pain and slight improvements in function and sleep in chronic pain patients, but evidence is limited and inconsistent; mild harms may outweigh the benefit and placebo effects may influence trial outcomes.<ref name="pratt" /><ref name="JAMA2015" /><ref name="wang2021">{{cite journal |last1=Wang |first1=Li |last2=Hong |first2=Patrick J |last3=May |first3=Curtis |last4=Rehman |first4=Yasir |last5=Oparin |first5=Yvgeniy |last6=Hong |first6=Chris J |last7=Hong |first7=Brian Y |last8=AminiLari |first8=Mahmood |last9=Gallo |first9=Lucas |date=2021-09-09 |title=Medical cannabis or cannabinoids for chronic non-cancer and cancer related pain: a systematic review and meta-analysis of randomised clinical trials |url=https://www.bmj.com/content/374/bmj.n1034 |url-status=live |journal=BMJ |volume=374 |article-number=n1034 |doi=10.1136/bmj.n1034 |issn=1756-1833 |pmid=34497047 |archive-url=https://web.archive.org/web/20210909220904/https://www.bmj.com/content/374/bmj.n1034 |archive-date=9 September 2021 |access-date=9 September 2021 |doi-access=free}}</ref><ref name=":6" /> Recent clinical reviews have concluded that evidence remains insufficient to support the use of cannabis or cannabinoids for most medical indications, emphasizing that modest potential benefits must be weighed against established risks.<ref>{{Cite journal |last=Hsu |first=Michael |last2=Shah |first2=Arya |last3=Jordan |first3=Ayana |last4=Gold |first4=Mark S. |last5=Hill |first5=Kevin P. |date=2025-11-26 |title=Therapeutic Use of Cannabis and Cannabinoids: A Review |url=https://jamanetwork.com/journals/jama/fullarticle/2842072 |journal=JAMA |language=en |doi=10.1001/jama.2025.19433 |issn=0098-7484|url-access=subscription }}</ref>
<!-- Side effects --> Short-term use increases the risk of minor and major adverse effects.<ref name=JAMA2015 /> Common side effects include dizziness, feeling tired, vomiting, and hallucinations.<ref name=JAMA2015 /> Long-term effects of cannabis are not clear.<ref name=JAMA2015 /> Concerns include memory and cognition problems, risk of addiction, schizophrenia in young people, and the risk of children taking it by accident.<ref name=Borgelt2013 />
Many cultures have used cannabis for therapeutic purposes for thousands of years.<ref name=BenAmar2006>{{cite journal | vauthors = Ben Amar M | title = Cannabinoids in medicine: A review of their therapeutic potential | journal = Journal of Ethnopharmacology | volume = 105 | issue = 1–2 | pages = 1–25 | date = April 2006 | pmid = 16540272 | doi = 10.1016/j.jep.2006.02.001 | type = Review | citeseerx = 10.1.1.180.308 }}</ref> Some American medical organizations have requested removal of cannabis from the list of Schedule I controlled substances, emphasizing that rescheduling would enable more extensive research and regulatory oversight to ensure safe access.<ref name="ANA" /><ref name="AAFP" /> Others oppose its legalization, such as the American Academy of Pediatrics.<ref name="AAP" /> Countries that allow the medical use of whole-plant cannabis include Argentina, Australia, Canada, Chile, Colombia, Germany, Greece, Israel, Italy, the Netherlands, Peru, Poland, Portugal, Spain, and Uruguay. In the United States, 38 states and the District of Columbia have legalized cannabis for medical purposes, beginning with the passage of California's Proposition 215 in 1996.<ref name="NCSL" />{{TOC limit|3}}
== Classification ==
In the U.S., the National Institute on Drug Abuse defines medical cannabis as "using the whole, unprocessed marijuana plant or its basic extracts to treat symptoms of illness and other conditions".<ref name=nida>{{cite web |publisher= National Institute on Drug Abuse |date= July 2019 |title= Marijuana as Medicine |url= https://www.drugabuse.gov/publications/drugfacts/marijuana-medicine |access-date= 19 April 2016 |archive-date= 17 April 2016 |archive-url= https://web.archive.org/web/20160417154854/https://www.drugabuse.gov/publications/drugfacts/marijuana-medicine |url-status= live }}</ref>
A cannabis plant includes more than 400 different chemicals, of which about 70 are cannabinoids.<ref name="Consumer Reports April 2016">{{cite web |author1 = Consumer Reports |title = Up in Smoke: Does Medical Marijuana Work? |url = http://www.consumerreports.org/medical-marijuana/does-medical-marijuana-work/ |website = Consumer Reports |access-date = 24 May 2016 |date = 28 April 2016 |archive-date = 14 March 2021 |archive-url = https://web.archive.org/web/20210314045548/https://www.consumerreports.org/medical-marijuana/does-medical-marijuana-work/ |url-status = live }}</ref> In comparison, typical government-approved medications contain only one or two chemicals.<ref name="Consumer Reports April 2016" /> The number of active chemicals in cannabis is one reason why treatment with cannabis is difficult to classify and study.<ref name="Consumer Reports April 2016" />
A 2014 review stated that the variations in ratio of CBD-to-THC in botanical and pharmaceutical preparations determines the therapeutic vs psychoactive effects (CBD attenuates THC's psychoactive effects<ref name="Schubart et al.2014">{{cite journal | vauthors = Schubart CD, Sommer IE, Fusar-Poli P, de Witte L, Kahn RS, Boks MP | title = Cannabidiol as a potential treatment for psychosis | journal = European Neuropsychopharmacology | volume = 24 | issue = 1 | pages = 51–64 | date = January 2014 | pmid = 24309088 | doi = 10.1016/j.euroneuro.2013.11.002 | s2cid = 13197304 | url = http://cannabisclinicians.org/wp-content/uploads/2013/12/CBD-psychosis-2013.pdf | access-date = 9 July 2016 | archive-date = 20 October 2018 | archive-url = https://web.archive.org/web/20181020210452/http://cannabisclinicians.org/wp-content/uploads/2013/12/CBD-psychosis-2013.pdf }}</ref>) of cannabis products.<ref name="ReferenceA">{{cite journal | vauthors = Koppel BS, Brust JC, Fife T, Bronstein J, Youssof S, Gronseth G, Gloss D | title = Systematic review: efficacy and safety of medical marijuana in selected neurologic disorders: report of the Guideline Development Subcommittee of the American Academy of Neurology | journal = Neurology | volume = 82 | issue = 17 | pages = 1556–1563 | date = April 2014 | pmid = 24778283 | pmc = 4011465 | doi = 10.1212/WNL.0000000000000363 }}</ref>
== Medical uses and research == {{main|Medical cannabis research}} thumb|right|''Cannabis'' as illustrated in Köhler's ''Book of Medicinal Plants'', 1897
A scoping review of 72 systematic reviews found mixed and inconclusive evidence on the benefits of cannabis-based medicines, frequent mild adverse effects, and generally low-to-moderate quality of evidence.<ref name="pratt">{{cite journal |vauthors=Pratt M, Stevens A, Thuku M, Butler C, Skidmore B, Wieland LS, Clemons M, Kanji S, Hutton B |date=December 2019 |title=Benefits and harms of medical cannabis: a scoping review of systematic reviews |journal=Syst Rev |type=Systematic review |volume=8 |issue=1 |doi=10.1186/s13643-019-1243-x |pmc=6905063 |pmid=31823819 |doi-access=free |article-number=320}}</ref>
Low quality evidence suggests its use for reducing nausea during chemotherapy, improving appetite in HIV/AIDS, improving sleep, and improving tics in Tourette syndrome.<ref name=JAMA2015>{{cite journal | vauthors = Whiting PF, Wolff RF, Deshpande S, Di Nisio M, Duffy S, Hernandez AV, Keurentjes JC, Lang S, Misso K, Ryder S, Schmidlkofer S, Westwood M, Kleijnen J | title = Cannabinoids for Medical Use: A Systematic Review and Meta-analysis | journal = JAMA | volume = 313 | issue = 24 | pages = 2456–73 | date = 23 June 2015 | pmid = 26103030 | doi = 10.1001/jama.2015.6358 | doi-access = free | hdl = 10757/558499 | hdl-access = free }}</ref> When usual treatments are ineffective, cannabinoids have also been recommended for anorexia, arthritis, glaucoma,<ref name="Sachs et al. 2015" /> and migraine.<ref name="Distillations">{{cite web |title=Sex(ism), Drugs, and Migraines: Distillations Podcast and Transcript, Episode 237 |date=15 January 2019 |url=https://www.sciencehistory.org/distillations/podcast/sexism-drugs-and-migraines |website=Distillations |publisher=Science History Institute |access-date=28 August 2019 |archive-date=14 March 2021 |archive-url=https://web.archive.org/web/20210314045616/https://www.sciencehistory.org/distillations/podcast/sexism-drugs-and-migraines |url-status=live }}</ref>
It is unclear whether American states might be able to mitigate the adverse effects of the opioid epidemic by prescribing medical cannabis as an alternative pain management drug.<ref>{{cite journal |last1=Gilson |first1=Aaron M. |last2=LeBaron |first2=Virginia T. |last3=Vyas |first3=Marianne Beare |title=The use of cannabis in response to the opioid crisis: A review of the literature |journal=Nursing Outlook |date=1 January 2018 |volume=66 |issue=1 |pages=56–65 |pmid=28993073 |doi=10.1016/j.outlook.2017.08.012 |issn=0029-6554}}</ref>
Cannabis should not be used in pregnancy.<ref>{{cite journal | author = American College of Obstetricians Gynecologists Committee on Obstetric Practice | title = Committee Opinion No. 637: Marijuana Use During Pregnancy and Lactation | journal = Obstetrics and Gynecology | volume = 126 | issue = 1 | pages = 234–38 | date = July 2015 | pmid = 26241291 | doi = 10.1097/01.AOG.0000467192.89321.a6 }}</ref>
=== Pain === Cannabis-based medicines may provide modest relief for chronic pain, particularly neuropathic pain, as well as small improvements in physical function and sleep in chronic pain patients.<ref name="wang2021" /><ref name="aviram">{{cite journal |vauthors=Aviram J, Samuelly-Leichtag G |date=September 2017 |title=Efficacy of Cannabis-Based Medicines for Pain Management: A Systematic Review and Meta-Analysis of Randomized Controlled Trials |url=http://www.painphysicianjournal.com/current/pdf?article=NDYwNA%3D%3D&journal=107 |url-status=live |journal=Pain Physician |volume=20 |issue=6 |pages=E755–96 |doi=10.36076/ppj.20.5.E755 |pmid=28934780 |archive-url=https://web.archive.org/web/20210630092212/https://www.painphysicianjournal.com/current/pdf?article=NDYwNA%3D%3D&journal=107 |archive-date=30 June 2021 |access-date=12 January 2018 |doi-access=free}}</ref><ref name="pmid356670662">{{cite journal |vauthors=McDonagh MS, Morasco BJ, Wagner J, Ahmed AY, Fu R, Kansagara D |year=2022 |title=Cannabis-Based Products for Chronic Pain: A Systematic Review |url=https://www.acpjournals.org/doi/full/10.7326/M21-4520 |url-status=live |journal=Ann Intern Med |volume=175 |issue=8 |pages=1143–1153 |doi=10.7326/M21-4520 |pmid=35667066 |s2cid=249433147 |url-access=subscription |archive-url=https://web.archive.org/web/20230219233343/https://www.acpjournals.org/doi/full/10.7326/M21-4520 |archive-date=19 February 2023 |access-date=19 February 2023}}</ref> Cannabis-based medicines show limited and inconsistent evidence for pain relief, with mild harms commonly reported that may outweigh potential benefits.<ref name="pratt" />
Short-term use of oral or sublingual cannabis, particularly high-THC synthetic or comparable-THC extracted products, may modestly reduce chronic pain but increases risks of dizziness, sedation, and other adverse effects, with limited evidence on long-term outcomes.<ref name="pmid356670662"/>
Placebo effects contribute to pain reduction in cannabinoid clinical trials, and while media attention is high, it does not directly correlate with clinical outcomes but may influence future expectations and trial results.<ref name=":6">{{cite journal |author1=Filip Gedin |author2=Sebastian Blomé |author3=Moa Pontén |author4=Maria Lalouni |author5=Jens Fust |author6=Andreé Raquette |author7=Viktor Vadenmark Lundquist |author8=William H. Thompson |author9=Karin Jensen |date=November 28, 2022 |title=Placebo Response and Media Attention in Randomized Clinical Trials Assessing Cannabis-Based Therapies for PainA Systematic Review and Meta-analysis |journal=JAMA Network Open |volume=5 |issue=11 |pages=e2243848 |doi=10.1001/jamanetworkopen.2022.43848 |pmc=9706362 |pmid=36441553 |doi-access=free}}</ref>
=== Insomnia === Cannabis administration does not have a noted effect on sleep. Cannabis withdrawal is associated with a reduction in hours spent asleep, an increase in the duration of sleep onset, and rapid eye movement rebounds.<ref>{{cite journal | last1=Velzeboer | first1=Rob | last2=Malas | first2=Adeeb | last3=Wei | first3=Sabrina | last4=Berger | first4=Renee | last5=Parmar | first5=Varinder | last6=Lai | first6=Wayne W.K. | title=Cannabis and sleep architecture: A systematic review and meta-analysis | journal=Sleep Medicine Reviews | publisher=Elsevier BV | volume=84 | year=2025 | issn=1087-0792 | doi=10.1016/j.smrv.2025.102164 | article-number=102164| doi-access=free }}</ref>
=== Nausea and vomiting === Medical cannabis is somewhat effective in chemotherapy-induced nausea and vomiting (CINV)<ref name=Borgelt2013 /><ref name="Sachs et al. 2015">{{cite journal | vauthors = Sachs J, McGlade E, Yurgelun-Todd D | title = Safety and Toxicology of Cannabinoids | journal = Neurotherapeutics | volume = 12 | issue = 4 | pages = 735–46 | date = October 2015 | pmid = 26269228 | pmc = 4604177 | doi = 10.1007/s13311-015-0380-8 }}</ref> and may be a reasonable option in those who do not improve following preferential treatment.<ref name=Grotenhermen2012 /> Comparative studies have found cannabinoids to be more effective than some conventional antiemetics such as prochlorperazine, promethazine, and metoclopramide in controlling CINV,<ref name=Bowels2012>{{cite journal | vauthors = Bowles DW, O'Bryant CL, Camidge DR, Jimeno A | title = The intersection between cannabis and cancer in the United States | journal = Critical Reviews in Oncology/Hematology | volume = 83 | issue = 1 | pages = 1–10 | date = July 2012 | pmid = 22019199 | doi = 10.1016/j.critrevonc.2011.09.008 | type = Review }}</ref> but these are used less frequently because of side effects including dizziness, dysphoria, and hallucinations.<ref name=Wang2008>{{cite journal | vauthors = Wang T, Collet JP, Shapiro S, Ware MA | title = Adverse effects of medical cannabinoids: a systematic review | journal = CMAJ | volume = 178 | issue = 13 | pages = 1669–78 | date = June 2008 | pmid = 18559804 | pmc = 2413308 | doi = 10.1503/cmaj.071178 | type = Review }}</ref><ref name=Jordan2007>{{cite journal | vauthors = Jordan K, Sippel C, Schmoll HJ | title = Guidelines for antiemetic treatment of chemotherapy-induced nausea and vomiting: past, present, and future recommendations | journal = The Oncologist | volume = 12 | issue = 9 | pages = 1143–50 | date = September 2007 | pmid = 17914084 | doi = 10.1634/theoncologist.12-9-1143 | s2cid = 17612434 | type = Review | url = http://pdfs.semanticscholar.org/d98c/026bda42b4b6ea1b0286d1893b362b46cca4.pdf | archive-url = https://web.archive.org/web/20190307023741/http://pdfs.semanticscholar.org/d98c/026bda42b4b6ea1b0286d1893b362b46cca4.pdf | archive-date = 2019-03-07 }}</ref> Long-term cannabis use may cause nausea and vomiting, a condition known as cannabinoid hyperemesis syndrome (CHS).<ref name=Nicolson2012>{{cite journal | vauthors = Nicolson SE, Denysenko L, Mulcare JL, Vito JP, Chabon B | title = Cannabinoid hyperemesis syndrome: a case series and review of previous reports | journal = Psychosomatics | volume = 53 | issue = 3 | pages = 212–19 | date = May–Jun 2012 | pmid = 22480624 | doi = 10.1016/j.psym.2012.01.003 | type = Review, case series }}</ref>
A 2016 Cochrane review said that cannabinoids were "probably effective" in treating chemotherapy-induced nausea in children, but with a high side-effect profile (mainly drowsiness, dizziness, altered moods, and increased appetite). Less common side effects were "ocular problems, orthostatic hypotension, muscle twitching, pruritus, vagueness, hallucinations, lightheadedness and dry mouth".<ref>{{cite journal | vauthors = Phillips RS, Friend AJ, Gibson F, Houghton E, Gopaul S, Craig JV, Pizer B | title = Antiemetic medication for prevention and treatment of chemotherapy-induced nausea and vomiting in childhood | journal = The Cochrane Database of Systematic Reviews | volume = 2016 | article-number = CD007786 | date = February 2016 | issue = 2 | pmid = 26836199 | doi = 10.1002/14651858.CD007786.pub3 | pmc = 7073407 | url = http://eprints.whiterose.ac.uk/95658/1/Phillips_et_al_2016_The_Cochrane_library.sup_2.pdf | access-date = 23 September 2019 | archive-date = 30 June 2021 | archive-url = https://web.archive.org/web/20210630071713/https://eprints.whiterose.ac.uk/95658/1/Phillips_et_al_2016_The_Cochrane_library.sup_2.pdf | url-status = live }}</ref>
=== HIV/AIDS === Evidence is lacking for both efficacy and safety of cannabis and cannabinoids in treating patients with HIV/AIDS or for anorexia associated with AIDS. As of 2013, current studies suffer from the effects of bias, small sample size, and lack of long-term data.<ref name=Lutge2013>{{cite journal | vauthors = Lutge EE, Gray A, Siegfried N | title = The medical use of cannabis for reducing morbidity and mortality in patients with HIV/AIDS | journal = The Cochrane Database of Systematic Reviews | volume = 2013 | issue = 4 | article-number = CD005175 | date = April 2013 | pmid = 23633327 | doi = 10.1002/14651858.CD005175.pub3 | pmc = 12127901 | type = Review }}</ref>
=== Neurological conditions === Cannabis' efficacy is not clear in treating neurological problems, including multiple sclerosis (MS) and movement problems.<ref name="ReferenceA"/> Evidence also suggests that oral cannabis extract is effective for reducing patient-centered measures of spasticity.<ref name="ReferenceA"/> A trial of cannabis is deemed to be a reasonable option if other treatments have not been effective.<ref name=Borgelt2013 />{{By whom|date=April 2017}} Its use for MS is approved in ten countries.<ref name=Borgelt2013 /><ref name=Clark2011>{{cite journal | vauthors = Clark PA, Capuzzi K, Fick C | title = Medical marijuana: medical necessity versus political agenda | journal = Medical Science Monitor | volume = 17 | issue = 12 | pages = RA249–61 | date = December 2011 | pmid = 22129912 | pmc = 3628147 | doi = 10.12659/MSM.882116 | type = Review }}</ref>{{COI source|date=December 2013}} A 2012 review found no problems with tolerance, abuse, or addiction.<ref>{{cite journal | vauthors = Oreja-Guevara C | title = [Treatment of spasticity in multiple sclerosis: new perspectives regarding the use of cannabinoids] | language = es | journal = Revista de Neurología | volume = 55 | issue = 7 | pages = 421–30 | date = October 2012 | pmid = 23011861 | type = Review }}</ref> In the United States, cannabidiol, one of the cannabinoids found in the marijuana plant, has been approved for treating two severe forms of epilepsy, Lennox–Gastaut syndrome and Dravet syndrome.<ref name=":4">{{Cite journal|last=Commissioner|first=Office of the|date=2019-06-10|title=FDA and Marijuana|url=https://www.fda.gov/news-events/public-health-focus/fda-and-marijuana|journal=FDA|language=en|access-date=16 December 2019|archive-date=16 November 2019|archive-url=https://web.archive.org/web/20191116160049/https://www.fda.gov/news-events/public-health-focus/fda-and-marijuana}}</ref>
=== Mental health === {{Further|Cannabis use and trauma|Posttraumatic stress disorder#Cannabinoids}}
Evidence for cannabis and cannabinoids in mental health treatment is limited and low-quality; they show no benefit for most mental disorders, increase general adverse events, and are not justified for routine use.<ref>{{Cite journal |last=Wilson |first=Jack |last2=Dobson |first2=Olivia |last3=Langcake |first3=Andrew |last4=Mishra |first4=Palkesh |last5=Bryant |first5=Zachary |last6=Leung |first6=Janni |last7=Dawson |first7=Danielle |last8=Graham |first8=Myfanwy |last9=Teesson |first9=Maree |last10=Freeman |first10=Tom P. |last11=Hall |first11=Wayne |last12=Chan |first12=Gary C. K. |last13=Stockings |first13=Emily |date=2026-04-01 |title=The efficacy and safety of cannabinoids for the treatment of mental disorders and substance use disorders: a systematic review and meta-analysis |url=https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(26)00015-5/fulltext?utm_campaign=tlpr&utm_medium=email&_hsmi=408644336&utm_content=408644336&utm_source=hs_email) |journal=The Lancet Psychiatry |language=English |volume=13 |issue=4 |pages=304–315 |doi=10.1016/S2215-0366(26)00015-5 |issn=2215-0366 |pmid=41856154|doi-access=free }}</ref><ref name=":7">{{Cite journal |last=Kansagara |first=Devan |last2=Terry |first2=Garth E. |last3=Ayers |first3=Chelsea K. |last4=D'Souza |first4=Deepak C. |date=2026-03-09 |title=Cannabis and Mental Health: A Review |journal=JAMA Internal Medicine |language=en |doi=10.1001/jamainternmed.2025.8215 |issn=2168-6106}}</ref> Risks (including psychosis, worsening bipolar symptoms, and cannabis use disorder) are substantial, especially in vulnerable populations.<ref name=":7" />
The relationship between cannabis use and anxiety symptoms is complex, and while some users report relief, the overall evidence from observational studies and clinical trials remains inconclusive.<ref>{{Cite journal |last1=Sarris |first1=Jerome |last2=Sinclair |first2=Justin |last3=Karamacoska |first3=Diana |last4=Davidson |first4=Maggie |last5=Firth |first5=Joseph |date=2020-01-16 |title=Medicinal cannabis for psychiatric disorders: a clinically-focused systematic review |journal=BMC Psychiatry |volume=20 |issue=1 |page=24 |doi=10.1186/s12888-019-2409-8 |doi-access=free |issn=1471-244X |pmc=6966847 |pmid=31948424}}</ref>
Cannabis use, especially at high doses, is associated with a higher risk of psychosis, particularly in individuals with a genetic predisposition to psychotic disorders like schizophrenia. Some studies have shown that cannabis can trigger a temporary psychotic episode, which may increase the risk of developing a psychotic disorder later.<ref name=":5">{{Cite web |last=Abuse |first=National Institute on Drug |date=2023-05-08 |title=Is there a link between marijuana use and psychiatric disorders? {{!}} National Institute on Drug Abuse (NIDA) |url=https://nida.nih.gov/publications/research-reports/marijuana/there-link-between-marijuana-use-psychiatric-disorders |archive-url=https://web.archive.org/web/20220128175021/https://nida.nih.gov/publications/research-reports/marijuana/there-link-between-marijuana-use-psychiatric-disorders |archive-date=28 January 2022 |access-date=2024-04-09 |website=nida.nih.gov |language=en}}</ref>
The impact of cannabis on depression is less clear. Some studies suggest a potential increase in depression risk among adolescents who use cannabis, though findings are inconsistent across studies.<ref name=":5" />
== Adverse effects == thumb|right|American medical hashish
=== Medical use === There is insufficient data to draw strong conclusions about the safety of medical cannabis.<ref name=oxpain>{{cite book |first1 = Tabitha A. |last1 = Washington |first2 = Khalilah M. |last2 = Brown |first3 = Gilbert J. |last3 = Fanciullo |title = Pain |chapter = Chapter 31: Medical Cannabis |page = 165 |year = 2012 |publisher = Oxford University Press |isbn = 978-0-19-994274-9 |quote = Proponents of medical cannabis site its safety, but there studies in later years that support that smoking of marijuana is associated with risk for dependence and that THC alters the structures of cells in the brain }}</ref> Typically, adverse effects of medical cannabis use are not serious;<ref name=Borgelt2013>{{cite journal | vauthors = Borgelt LM, Franson KL, Nussbaum AM, Wang GS | title = The pharmacologic and clinical effects of medical cannabis | journal = Pharmacotherapy | volume = 33 | issue = 2 | pages = 195–209 | date = February 2013 | pmid = 23386598 | doi = 10.1002/phar.1187 | s2cid = 8503107 | url = https://wsma.org/doc_library/LegalResourceCenter/MedicalCannabis/Med%20Mar%20-%20Pharmacologic%20and%20Clinical%20Effects.pdf | access-date = 11 November 2017 | archive-date = 28 August 2021 | archive-url = https://web.archive.org/web/20210828161528/https://wsma.org/doc_library/LegalResourceCenter/MedicalCannabis/Med%20Mar%20-%20Pharmacologic%20and%20Clinical%20Effects.pdf | url-status = live }}</ref> they include tiredness, dizziness, increased appetite, and cardiovascular and psychoactive effects. Other effects can include impaired short-term memory; impaired motor coordination; altered judgment; and paranoia or psychosis at high doses.<ref>{{cite journal | vauthors = Gage SH, Hickman M, Zammit S | title = Association Between Cannabis and Psychosis: Epidemiologic Evidence | journal = Biological Psychiatry | volume = 79 | issue = 7 | pages = 549–56 | date = April 2016 | pmid = 26386480 | doi = 10.1016/j.biopsych.2015.08.001 | hdl = 1983/b8fb2d3b-5a55-4d07-97c0-1650b0ffc05d | s2cid = 1055335 | url = https://research-information.bris.ac.uk/en/publications/association-between-cannabis-and-psychosis(b8fb2d3b-5a55-4d07-97c0-1650b0ffc05d).html | hdl-access = free | access-date = 11 March 2020 | archive-date = 26 February 2020 | archive-url = https://web.archive.org/web/20200226185900/https://research-information.bris.ac.uk/en/publications/association-between-cannabis-and-psychosis(b8fb2d3b-5a55-4d07-97c0-1650b0ffc05d).html | url-status = live }}</ref> Tolerance to these effects develops over a period of days or weeks. The amount of cannabis normally used for medicinal purposes is not believed to cause any permanent cognitive impairment in adults, though long-term treatment in adolescents should be weighed carefully as they are more susceptible to these impairments. Withdrawal symptoms are rarely a problem with controlled medical administration of cannabinoids. The ability to drive vehicles or to operate machinery may be impaired until a tolerance is developed.<ref name=Grotenhermen2012>{{cite journal | vauthors = Grotenhermen F, Müller-Vahl K | title = The therapeutic potential of cannabis and cannabinoids | journal = Deutsches Ärzteblatt International | volume = 109 | issue = 29–30 | pages = 495–501 | date = July 2012 | pmid = 23008748 | pmc = 3442177 | doi = 10.3238/arztebl.2012.0495 }}</ref> Although supporters of medical cannabis say that it is safe,<ref name=oxpain /> further research is required to assess the long-term safety of its use.<ref name=Wang2008 /><ref name=barceloux866931>{{cite book |first = Donald G |last = Barceloux |title = Medical Toxicology of Drug Abuse: Synthesized Chemicals and Psychoactive Plants |chapter = Chapter 60: Marijuana (''Cannabis sativa'' L.) and synthetic cannabinoids |isbn = 978-0-471-72760-6 |year = 2012 |pages = 886–931 |publisher = John Wiley & Sons |chapter-url = https://books.google.com/books?id=OWFiVaDZnkQC&pg=PA886 |access-date = 20 December 2015 |archive-date = 13 January 2023 |archive-url = https://web.archive.org/web/20230113004526/https://books.google.com/books?id=OWFiVaDZnkQC&pg=PA886 |url-status = live }}</ref>
=== Cognitive effects === {{Further|long-term effects of cannabis}} Recreational use of cannabis is associated with cognitive deficits, especially for those who begin to use cannabis in adolescence. {{as of|2021}} there is a lack of research into long-term cognitive effects of medical use of cannabis, but one 12-month observational study reported that "MC patients demonstrated significant improvements on measures of executive function and clinical state over the course of 12 months".<ref>{{cite journal |last1=Sagar |first1=Kelly A. |last2=Dahlgren |first2=M. Kathryn |last3=Lambros |first3=Ashley M. |last4=Smith |first4=Rosemary T. |last5=El-Abboud |first5=Celine |last6=Gruber |first6=Staci A. |title=An Observational, Longitudinal Study of Cognition in Medical Cannabis Patients over the Course of 12 Months of Treatment: Preliminary Results |journal=Journal of the International Neuropsychological Society |date=2021 |volume=27 |issue=6 |pages=648–60 |doi=10.1017/S1355617721000114 |pmid=34261553 |s2cid=235824932 |language=en |issn=1355-6177|doi-access=free }}</ref>
=== Impact on psychosis === Exposure to THC can cause acute transient psychotic symptoms in healthy individuals and people with schizophrenia.<ref name="Schubart et al.2014" />
A 2007 meta analysis concluded that cannabis use reduced the average age of onset of psychosis by 2.7 years relative to non-cannabis use.<ref>{{cite journal | vauthors = Large M, Sharma S, Compton MT, Slade T, Nielssen O | title = Cannabis use and earlier onset of psychosis: a systematic meta-analysis | journal = Archives of General Psychiatry | volume = 68 | issue = 6 | pages = 555–61 | date = June 2011 | pmid = 21300939 | doi = 10.1001/archgenpsychiatry.2011.5 | doi-access = free }}</ref> A 2005 meta analysis concluded that adolescent use of cannabis increases the risk of psychosis, and that the risk is dose-related.<ref>{{cite journal | vauthors = Semple DM, McIntosh AM, Lawrie SM | title = Cannabis as a risk factor for psychosis: systematic review | journal = Journal of Psychopharmacology | volume = 19 | issue = 2 | pages = 187–94 | date = March 2005 | pmid = 15871146 | doi = 10.1177/0269881105049040 | s2cid = 44651274 }}</ref> A 2004 literature review on the subject concluded that cannabis use is associated with a two-fold increase in the risk of psychosis, but that cannabis use is "neither necessary nor sufficient" to cause psychosis.<ref name=Arseneault2004>{{cite journal | vauthors = Arseneault L, Cannon M, Witton J, Murray RM | title = Causal association between cannabis and psychosis: examination of the evidence | journal = The British Journal of Psychiatry | volume = 184 | issue = 2 | pages = 110–17 | date = February 2004 | pmid = 14754822 | doi = 10.1192/bjp.184.2.110 | doi-access = free }}</ref> A French review from 2009 came to a conclusion that cannabis use, particularly that before age 15, was a factor in the development of schizophrenic disorders.<ref name="Laqueille">{{cite journal | vauthors = Laqueille X | title = [Is cannabis a vulnerability factor in schizophrenic disorders] | journal = Archives de Pédiatrie | volume = 16 | issue = 9 | pages = 1302–05 | date = September 2009 | pmid = 19640690 | doi = 10.1016/j.arcped.2009.03.016 | trans-title = Is cannabis is a vulnerability factor of schizophrenic disorders? }}</ref>
== Pharmacology == The genus ''Cannabis'' contains two species which produce useful amounts of psychoactive cannabinoids: ''Cannabis indica'' and ''Cannabis sativa'', which are listed as Schedule I medicinal plants in the US;<ref name=Borgelt2013 /> a third species, ''Cannabis ruderalis'', has few psychogenic properties.<ref name=Borgelt2013 /> Cannabis contains more than 460 compounds;<ref name=BenAmar2006 /> at least 80 of these are cannabinoids<ref>{{cite journal | vauthors = Downer EJ, Campbell VA | title = Phytocannabinoids, CNS cells and development: a dead issue? | journal = Drug and Alcohol Review | volume = 29 | issue = 1 | pages = 91–98 | date = January 2010 | pmid = 20078688 | doi = 10.1111/j.1465-3362.2009.00102.x | type = Review }}</ref><ref>{{cite journal | vauthors = Burns TL, Ineck JR | title = Cannabinoid analgesia as a potential new therapeutic option in the treatment of chronic pain | journal = The Annals of Pharmacotherapy | volume = 40 | issue = 2 | pages = 251–60 | date = February 2006 | pmid = 16449552 | doi = 10.1345/aph.1G217 | s2cid = 6858360 | type = Review }}</ref> – chemical compounds that interact with cannabinoid receptors in the brain.<ref name=Borgelt2013 /> As of 2012, more than 20 cannabinoids were being studied by the U.S. FDA.<ref name=Svrakic2012>{{cite journal | vauthors = Svrakic DM, Lustman PJ, Mallya A, Lynn TA, Finney R, Svrakic NM | title = Legalization, decriminalization & medicinal use of cannabis: a scientific and public health perspective | journal = Missouri Medicine | volume = 109 | issue = 2 | pages = 90–98 | year = 2012 | pmid = 22675784 | pmc = 6181739 | type = Review }}</ref>
The most psychoactive cannabinoid found in the cannabis plant is tetrahydrocannabinol (or delta-9-tetrahydrocannabinol, commonly known as THC).<ref name=BenAmar2006 /> Other cannabinoids include delta-8-tetrahydrocannabinol, cannabidiol (CBD), cannabinol (CBN), cannabicyclol (CBL), cannabichromene (CBC) and cannabigerol (CBG); they have less psychotropic effects than THC, but may play a role in the overall effect of cannabis.<ref name=BenAmar2006 /> The most studied are THC, CBD and CBN.<ref name=Gordon2013>{{cite journal | vauthors = Gordon AJ, Conley JW, Gordon JM | title = Medical consequences of marijuana use: a review of current literature | journal = Current Psychiatry Reports | volume = 15 | issue = 12 | article-number = 419 | date = December 2013 | pmid = 24234874 | doi = 10.1007/s11920-013-0419-7 | s2cid = 29063282 | type = Review | url = https://zenodo.org/record/1232874 | access-date = 12 July 2019 | archive-date = 7 August 2019 | archive-url = https://web.archive.org/web/20190807172632/https://zenodo.org/record/1232874 | url-status = live }}</ref>
CB1 and CB2 are the primary cannabinoid receptors responsible for several of the effects of cannabinoids, although other receptors may play a role as well. Both belong to a group of receptors called G protein-coupled receptors (GPCRs). CB1 receptors are found in very high levels in the brain and are thought to be responsible for psychoactive effects.<ref>{{cite journal | vauthors = Mackie K | title = Cannabinoid receptors: where they are and what they do | journal = Journal of Neuroendocrinology | volume = 20 | pages = 10–14 | date = May 2008 | issue = Suppl 1 | pmid = 18426493 | doi = 10.1111/j.1365-2826.2008.01671.x | s2cid = 20161611 | doi-access = free }}</ref> CB2 receptors are found peripherally throughout the body and are thought to modulate pain and inflammation.<ref>{{cite journal | vauthors = Whiteside GT, Lee GP, Valenzano KJ | title = The role of the cannabinoid CB2 receptor in pain transmission and therapeutic potential of small molecule CB2 receptor agonists | journal = Current Medicinal Chemistry | volume = 14 | issue = 8 | pages = 917–36 | date = 2007 | pmid = 17430144 | doi = 10.2174/092986707780363023 }}</ref>
=== Absorption === Cannabinoid absorption is dependent on its route of administration.
Inhaled and vaporized THC have similar absorption profiles to smoked THC, with a bioavailability ranging from 10 to 35%. Oral administration has the lowest bioavailability of approximately 6%, variable absorption depending on the vehicle used, and the longest time to peak plasma levels (2 to 6 hours) compared to smoked or vaporized THC.<ref name=":0">{{cite journal | vauthors = Gaston TE, Friedman D | title = Pharmacology of cannabinoids in the treatment of epilepsy | journal = Epilepsy & Behavior | volume = 70 | issue = Pt B | pages = 313–18 | date = May 2017 | pmid = 28087250 | doi = 10.1016/j.yebeh.2016.11.016 | series = Cannabinoids and Epilepsy | s2cid = 3929024 }}</ref>
Similar to THC, CBD has poor oral bioavailability, approximately 6%. The low bioavailability is largely attributed to significant first-pass metabolism in the liver and erratic absorption from the gastrointestinal tract. However, oral administration of CBD has a faster time to peak concentrations (2 hours) than THC.<ref name=":0" />
Due to the poor bioavailability of oral preparations, alternative routes of administration have been studied, including sublingual and rectal. These alternative formulations maximize bioavailability and reduce first-pass metabolism. Sublingual administration in rabbits yielded bioavailability of 16% and time to peak concentration of 4 hours.<ref>{{cite journal | vauthors = Mannila J, Järvinen T, Järvinen K, Tervonen J, Jarho P | title = Sublingual administration of Delta9-tetrahydrocannabinol/beta-cyclodextrin complex increases the bioavailability of Delta9-tetrahydrocannabinol in rabbits | journal = Life Sciences | volume = 78 | issue = 17 | pages = 1911–14 | date = March 2006 | pmid = 16266727 | doi = 10.1016/j.lfs.2005.08.025 }}</ref> Rectal administration in monkeys doubled bioavailability to 13.5% and achieved peak blood concentrations within 1 to 8 hours after administration.<ref name=":1">{{cite journal | vauthors = Huestis MA | title = Human cannabinoid pharmacokinetics | journal = Chemistry & Biodiversity | volume = 4 | issue = 8 | pages = 1770–804 | date = August 2007 | pmid = 17712819 | pmc = 2689518 | doi = 10.1002/cbdv.200790152 }}</ref>
=== Distribution === Like cannabinoid absorption, distribution is also dependent on route of administration. Smoking and inhalation of vaporized cannabis have better absorption than do other routes of administration, and therefore also have more predictable distribution.<ref name=":1" /><ref name=":3">{{cite journal | vauthors = Badowski ME | title = A review of oral cannabinoids and medical marijuana for the treatment of chemotherapy-induced nausea and vomiting: a focus on pharmacokinetic variability and pharmacodynamics | journal = Cancer Chemotherapy and Pharmacology | volume = 80 | issue = 3 | pages = 441–49 | date = September 2017 | pmid = 28780725 | pmc = 5573753 | doi = 10.1007/s00280-017-3387-5 }}</ref> THC is highly protein bound once absorbed, with only 3% found unbound in the plasma. It distributes rapidly to highly vascularized organs such as the heart, lungs, liver, spleen, and kidneys, as well as to various glands. Low levels can be detected in the brain, testes, and unborn fetuses, all of which are protected from systemic circulation via barriers.<ref>{{cite journal | vauthors = Nahas GG | title = The pharmacokinetics of THC in fat and brain: resulting functional responses to marihuana smoking | journal = Human Psychopharmacology | volume = 16 | issue = 3 | pages = 247–55 | date = April 2001 | pmid = 12404577 | doi = 10.1002/hup.258 | s2cid = 30513770 }}</ref> THC further distributes into fatty tissues a few days after administration due to its high lipophilicity, and is found deposited in the spleen and fat after redistribution.<ref name=":3" /><ref>{{cite journal | vauthors = Bridgeman MB, Abazia DT | title = Medicinal Cannabis: History, Pharmacology, And Implications for the Acute Care Setting | journal = P & T | volume = 42 | issue = 3 | pages = 180–88 | date = March 2017 | pmid = 28250701 | pmc = 5312634 }}</ref><ref>{{Cite book|url=https://books.google.com/books?id=AYH5BwAAQBAJ&pg=PA91|title=Marihuana and Medicine|last1=Nahas|first1=Gabriel G.|last2=Sutin|first2=Kenneth M.|last3=Harvey|first3=David J.|last4=Agurell|first4=Stig|year=1999|publisher=Springer Science & Business Media|isbn=978-1-59259-710-9|access-date=20 September 2020|archive-date=13 January 2023|archive-url=https://web.archive.org/web/20230113004528/https://books.google.com/books?id=AYH5BwAAQBAJ&pg=PA91|url-status=live}}</ref>
=== Metabolism === Delta-9-THC is the primary molecule responsible for the effects of cannabis. Delta-9-THC is metabolized in the liver and turns into 11-OH-THC.<ref name=":2">{{Cite news|url=https://sapiensoup.com/human-metabolism-thc|title=Human Metabolism of THC|date=2016-12-21|work=Sapiensoup Blog|access-date=2017-11-01|language=en-US|archive-date=26 June 2021|archive-url=https://web.archive.org/web/20210626101148/https://sapiensoup.com/human-metabolism-thc|url-status=live}}</ref> 11-OH-THC is the first metabolic product in this pathway. Both Delta-9-THC and 11-OH-THC are psychoactive. The metabolism of THC into 11-OH-THC plays a part in the heightened psychoactive effects of edible cannabis.<ref>{{Cite web|url=http://profofpot.com/11-hydroxy-tetrahydrocannabinol-potency-edibles/|title=11-Hydroxy-THC - Increased Potency That Explains the Effect of Edibles? – Prof of Pot|website=profofpot.com|date=2 July 2016|language=en-US|access-date=2017-11-01|archive-date=28 June 2021|archive-url=https://web.archive.org/web/20210628171055/https://profofpot.com/11-hydroxy-tetrahydrocannabinol-potency-edibles/}}</ref>
Next, 11-OH-THC is metabolized in the liver into 11-COOH-THC, which is the second metabolic product of THC.<ref>{{Cite web|url=http://www.consultox.com/toxicology-marijuana.shtml|title=Toxicology Litigation Support: Marijuana|website=consultox.com|access-date=2017-11-01|archive-date=26 June 2021|archive-url=https://web.archive.org/web/20210626101148/http://www.consultox.com/toxicology-marijuana.shtml|url-status=live}}</ref> 11-COOH-THC is not psychoactive.<ref name=":2" />
Ingestion of edible cannabis products lead to a slower onset of effect than the inhalation of it because the THC travels to the liver first through the blood before it travels to the rest of the body. Inhaled cannabis can result in THC going directly to the brain, where it then travels from the brain back to the liver in recirculation for metabolism.<ref name=":2" /> Eventually, both routes of metabolism result in the metabolism of psychoactive THC to inactive 11-COOH-THC.
=== Excretion === Due to substantial metabolism of THC and CBD, their metabolites are excreted mostly via feces, rather than by urine.<ref name=":0" /><ref name="devinsky">{{cite journal | vauthors = Devinsky O, Cilio MR, Cross H, Fernandez-Ruiz J, French J, Hill C, Katz R, Di Marzo V, Jutras-Aswad D, Notcutt WG, Martinez-Orgado J, Robson PJ, Rohrback BG, Thiele E, Whalley B, Friedman D | title = Cannabidiol: pharmacology and potential therapeutic role in epilepsy and other neuropsychiatric disorders | journal = Epilepsia | volume = 55 | issue = 6 | pages = 791–802 | date = June 2014 | pmid = 24854329 | pmc = 4707667 | doi = 10.1111/epi.12631 }}</ref> After delta-9-THC is hydroxylated into 11-OH-THC via CYP2C9, CYP2C19, and CYP3A4, it undergoes phase II metabolism into more than 30 metabolites, a majority of which are products of glucuronidation. Approximately 65% of THC is excreted in feces and 25% in the urine, while the remaining 10% is excreted by other means.<ref name=":0" /> The terminal half-life of THC is 25 to 36 hours,<ref>{{cite journal | vauthors = Grotenhermen F | title = Pharmacokinetics and pharmacodynamics of cannabinoids | journal = Clinical Pharmacokinetics | volume = 42 | issue = 4 | pages = 327–60 | date = 2003-04-01 | pmid = 12648025 | doi = 10.2165/00003088-200342040-00003 | s2cid = 25623600 }}</ref> whereas for CBD it is 18 to 32 hours.<ref name=devinsky/>
CBD is hydroxylated by P450 liver enzymes into 7-OH-CBD. Its metabolites are products of primarily CYP2C19 and CYP3A4 activity, with potential activity of CYP1A1, CYP1A2, CYP2C9, and CYP2D6.<ref>{{Cite journal |vauthors=Zendulka O, Dovrtělová G, Nosková K, Turjap M, Šulcová A, Hanuš L, Juřica J |date=2016-02-29|title=Cannabinoids and Cytochrome P450 Interactions|url=http://www.eurekaselect.com/137749/article|journal=Current Drug Metabolism|language=en|volume=17|issue=3|pages=206–226|doi=10.2174/1389200217666151210142051|pmid=26651971|access-date=1 November 2017|archive-date=3 July 2021|archive-url=https://web.archive.org/web/20210703094804/https://www.eurekaselect.com/137749/article|url-status=live|url-access=subscription}}</ref> Similar to delta-9-THC, a majority of CBD is excreted in feces and some in the urine.<ref name=":0" /> The terminal half-life is approximately 18–32 hours.<ref>{{cite journal | vauthors = Ohlsson A, Lindgren JE, Andersson S, Agurell S, Gillespie H, Hollister LE | title = Single-dose kinetics of deuterium-labelled cannabidiol in man after smoking and intravenous administration | journal = Biomedical & Environmental Mass Spectrometry | volume = 13 | issue = 2 | pages = 77–83 | date = February 1986 | pmid = 2937482 | doi = 10.1002/bms.1200130206 }}</ref>
== Administration == thumb|left|Illustrating various forms of medicinal cannabis
Smoking has been the means of administration of cannabis for many users, but it is not suitable for the use of cannabis as a medicine.<ref name=CurtisClarke2009>{{cite journal | vauthors = Curtis A, Clarke CE, Rickards HE | title = Cannabinoids for Tourette's Syndrome | journal = The Cochrane Database of Systematic Reviews | issue = 4 | article-number = CD006565 | date = October 2009 | volume = 2009 | pmid = 19821373 | doi = 10.1002/14651858.CD006565.pub2 | type = Review | pmc = 7387115 }}</ref> It was the most common method of medical cannabis consumption in the US {{as of|lc=yes|2013}}.<ref name=Borgelt2013 /> It is difficult to predict the pharmacological response to cannabis because concentration of cannabinoids varies widely, as there are different ways of preparing it for consumption (smoked, applied as oils, eaten, infused into other foods, or drunk) and a lack of production controls.<ref name=Borgelt2013 /> The potential for adverse effects from smoke inhalation makes smoking a less viable option than oral preparations.<ref name=CurtisClarke2009 /> Cannabis vaporizers have gained popularity because of a perception among users that fewer harmful chemicals are ingested when components are inhaled via aerosol rather than smoke.<ref name=Borgelt2013 /> Cannabinoid medicines are available in pill form (dronabinol and nabilone) and liquid extracts formulated into an oromucosal spray (nabiximols).<ref name=Borgelt2013 /> Oral preparations are "problematic due to the uptake of cannabinoids into fatty tissue, from which they are released slowly, and the significant first-pass liver metabolism, which breaks down Δ9THC and contributes further to the variability of plasma concentrations".<ref name=CurtisClarke2009 />
The US Food and Drug Administration (FDA) has not approved smoked cannabis for any condition or disease, as it deems that evidence is lacking concerning safety and efficacy.<ref name=FDA2006 /> The FDA issued a 2006 advisory against ''smoked'' medical cannabis stating: "marijuana has a high potential for abuse, has no currently accepted medical use in treatment in the United States, and has a lack of accepted safety for use under medical supervision."<ref name=FDA2006>{{Cite press release |url = https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2006/ucm108643.htm |title = Inter-agency advisory regarding claims that smoked marijuana is a medicine |publisher = fda.gov |date = 20 April 2006 |access-date = 24 December 2012 |archive-date = 13 October 2012 |archive-url = https://web.archive.org/web/20121013080059/http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2006/ucm108643.htm }}</ref>
== History == {{Main|History of medical cannabis}}
=== Ancient === Cannabis, called ''má'' 麻 (meaning "hemp; cannabis; numbness") or ''dàmá'' 大麻 (with "big; great") in Chinese, was used in Taiwan for fiber starting about 10,000 years ago.<ref>{{Cite book |first = Ernest L. |last = Abel |year = 1980 |chapter = Cannabis in the Ancient World |chapter-url = http://www.druglibrary.org/schaffer/hemp/history/first12000/1.htm |title = Marihuana: the first twelve thousand years |publisher = Plenum Publishers |location = New York City |isbn = 978-0-306-40496-2 |access-date = 29 October 2008 |archive-date = 28 June 2021 |archive-url = https://web.archive.org/web/20210628135448/https://www.druglibrary.org/schaffer/hemp/history/first12000/1.htm |url-status = live }}{{Page needed|date=August 2010}}</ref> The botanist Hui-lin Li wrote that in China, "The use of Cannabis in medicine was probably a very early development. Since ancient humans used hemp seed as food, it was quite natural for them to also discover the medicinal properties of the plant."<ref>Li, Hui-Lin (1974). "An Archaeological and Historical Account of Cannabis in China", ''Economic Botany'' 28.4:437–48, p. 444.</ref> Emperor Shen-Nung, who was also a pharmacologist, wrote a book on treatment methods in 2737 BCE that included the medical benefits of cannabis. He recommended the substance for many ailments, including constipation, gout, rheumatism, and absent-mindedness.<ref name=autogenerated2>{{cite book |last = Bloomquist |first = Edward |title = Marijuana: The Second Trip |year = 1971 |publisher = Glencoe Press |location = California }}</ref> Cannabis is one of the 50 "fundamental" herbs in traditional Chinese medicine.<ref name="Wong">{{Cite book |last = Wong |first = Ming |year = 1976 |title = La Médecine chinoise par les plantes |publisher = Tchou |location = Paris |oclc = 2646789 }}{{Page needed|date=August 2010}}</ref>
The Ebers Papyrus ({{circa|1550 BCE}}) from Ancient Egypt describes medical cannabis.<ref name="ebers">{{unreliable source?|date=December 2013}} {{cite web |url = http://www.onlinepot.org/medical/eberspapyrus.htm |title = The Ebers Papyrus The Oldest (confirmed) Written Prescriptions For Medical Marihuana era 1,550 BC |publisher = onlinepot.org |access-date = 10 June 2008 |archive-date = 4 March 2016 |archive-url = https://web.archive.org/web/20160304080726/http://www.onlinepot.org/medical/eberspapyrus.htm }}</ref> The ancient Egyptians used hemp (cannabis) in suppositories for relieving the pain of hemorrhoids.<ref>{{Cite news |url = https://www.newscientist.com/channel/health/mg19626341.600-the-pharaohs-pharmacists.html |title = The Pharaoh's pharmacists |last = Pain |first = Stephanie |date = 15 December 2007 |work = New Scientist |publisher = Reed Business Information Ltd. |access-date = 4 September 2017 |archive-date = 21 May 2008 |archive-url = https://web.archive.org/web/20080521162813/http://www.newscientist.com/channel/health/mg19626341.600-the-pharaohs-pharmacists.html |url-status = live }}</ref>
Surviving texts from ancient India confirm that cannabis' psychoactive properties were recognized, and doctors used it for treating a variety of illnesses and ailments, including insomnia, headaches, gastrointestinal disorders, and pain, including during childbirth.<ref>{{cite journal | vauthors = Touw M | title = The religious and medicinal uses of Cannabis in China, India and Tibet | journal = Journal of Psychoactive Drugs | volume = 13 | issue = 1 | pages = 23–34 | year = 1981 | pmid = 7024492 | doi = 10.1080/02791072.1981.10471447 }}</ref>
The Ancient Greeks used cannabis to dress wounds and sores on their horses,<ref name="hawthorne">{{cite journal |doi = 10.1300/J175v02n02_04 |title = The Medical Use of Cannabis Among the Greeks and Romans |year = 2002 |last1 = Butrica |first1 = James L. |journal = Journal of Cannabis Therapeutics |volume = 2 |issue = 2 |pages = 51–70 |url = http://www.cannabis-med.org/data/pdf/2002-02-3.pdf |access-date = 8 November 2014 |archive-date = 11 November 2014 |archive-url = https://web.archive.org/web/20141111224607/http://www.cannabis-med.org/data/pdf/2002-02-3.pdf }}</ref> and in humans, dried leaves of cannabis were used to treat nose bleeds, and cannabis seeds were used to expel tapeworms.<ref name="hawthorne" />
In the medieval Islamic world, Arabic physicians made use of the diuretic, antiemetic, antiepileptic, anti-inflammatory, analgesic and antipyretic properties of ''Cannabis sativa'', and used it extensively as medication from the 8th to 18th centuries.<ref>{{cite journal |doi = 10.1300/J175v01n01_05 |title = The Therapeutic Use of Cannabis sativa (L.) in Arabic Medicine |year = 2001 |last1 = Lozano |first1 = Indalecio |journal = Journal of Cannabis Therapeutics |volume = 1 |pages = 63–70 |citeseerx = 10.1.1.550.1717 }}</ref>
=== Landrace strains === [[File:The Three Cultivars of the Cannabis Plant.png|thumb|Evolution of cultivated cannabis strains. The cultivar, ''Cannabis ruderalis'', still grows wild today.]]
Cannabis seeds may have been used for food, rituals or religious practices in ancient Europe and China.<ref name = "Holland_2018">{{cite book|editor=Holland, Julie|title=The Pot Book: A Complete Guide to Cannabis|date=2010|publisher=Simon and Schuster|location=New York|isbn=978-1-59477-898-8|access-date=22 April 2018|url=https://books.google.com/books?id=tV0oDwAAQBAJ|archive-date=13 January 2023|archive-url=https://web.archive.org/web/20230113004529/https://books.google.com/books?id=tV0oDwAAQBAJ|url-status=live}}</ref>{{rp|19–22}} Harvesting the plant led to the spread of cannabis throughout Eurasia about 10,000 to 5,000 years ago, with further distribution to the Middle East and Africa about 2,000 to 500 years ago.<ref name = "Holland_2018" />{{rp|18–19}} A landrace strain of cannabis developed over centuries.<ref>{{cite book|last1=Evert|first1=Ray F.|last2=Eichhorn|first2=Susan E. |title=Raven Biology of Plants|date=2013|publisher=W. H. Freeman and Company|location=New York|isbn=978-1-4292-1961-7|pages=213–17|edition=8th}}</ref> They are cultivars of the plant that originated in one specific region.
Widely cultivated strains of cannabis, such as "Afghani" or "Hindu Kush", are indigenous to the Pakistan and Afghanistan regions, while "Durban Poison" is native to Africa.<ref name = "Holland_2018" />{{rp|45–48}} There are approximately 16 landrace strains of cannabis identified from Pakistan, Jamaica, Africa, Mexico, Central America and Asia.<ref>{{cite book|last1=Evert|first1=Ray F.|last2=Eichhorn|first2=Susan E. |title=Raven Biology of Plants|date=2013|publisher=W.H. Freeman and Company|location=New York|isbn=978-1-4292-1961-7|pages=501–04|edition=8th}}</ref>
=== Modern === An Irish physician, William Brooke O'Shaughnessy, is credited with introducing cannabis to Western medicine.<ref name=Mack>{{cite book |author1 = Alison Mack |author2 = Janet Joy |title = Marijuana As Medicine?: The Science Beyond the Controversy |url = https://books.google.com/books?id=ZriSkC7aQOEC&pg=PA15 |year = 2000 |publisher = National Academies Press |isbn = 978-0-309-06531-3 |pages = 15– |access-date = 20 December 2015 |archive-date = 13 January 2023 |archive-url = https://web.archive.org/web/20230113004529/https://www.google.com/books/edition/Marijuana_As_Medicine/ZriSkC7aQOEC?hl=en&gbpv=1&pg=PA15&printsec=frontcover |url-status = live }}</ref> O'Shaughnessy discovered cannabis in the 1830s while living abroad in India, where he conducted numerous experiments investigating the drug's medical utility (noting in particular its analgesic and anticonvulsant effects).<ref name="Booth">{{cite book |last1 = Booth |first1 = Martin |title = Cannabis: A History |year=2005 |publisher = St. Martin's Press |location = New York |isbn = 978-0-312-42494-7 }}</ref> He returned to England with a supply of cannabis in 1842, after which its use spread through Europe and the United States.<ref name="Grinspoon">{{cite book |last1 = Grinspoon |first1 = Lester |last2 = Bakalar |first2 = James |title = Marihuana, the Forbidden Medicine |date = 1997 |publisher = Yale University Press |isbn = 978-0-300-07086-6 |edition = Revised and expanded }}</ref> In 1845 French physician Jacques-Joseph Moreau published a book about the use of cannabis in psychiatry.<ref>Hans Bangen:''Geschichte der medikamentösen Therapie der Schizophrenie.'' Berlin 1992, p. 22.</ref> In 1850 cannabis was entered into the United States Pharmacopeia.<ref name="Booth" /> An anecdotal report of ''Cannabis indica'' as a treatment for tetanus appeared in Scientific American in 1880.<ref>{{Cite book|url=https://books.google.com/books?id=6ok9AQAAIAAJ|title=Scientific American, "Successful Treatment of Tetanus"|date=1880-07-10|publisher=Munn & Company|page=25|language=en|access-date=5 June 2021|archive-date=12 January 2023|archive-url=https://web.archive.org/web/20230112202810/https://books.google.com/books?id=6ok9AQAAIAAJ|url-status=live}}</ref>
The use of cannabis in medicine began to decline by the end of the 19th century, due to difficulty in controlling dosages and the rise in popularity of synthetic and opium-derived drugs.<ref name="Grinspoon" /> Also, the advent of the hypodermic syringe allowed these drugs to be injected for immediate effect, in contrast to cannabis which is not water-soluble and therefore cannot be injected.<ref name="Grinspoon" />
In the United States, the medical use of cannabis further declined with the passage of the Marihuana Tax Act of 1937, which imposed new regulations and fees on physicians prescribing cannabis.<ref>{{cite journal |last1 = Pacula |first1 = Rosalie Piccardo |title = State Medical Marijuana Laws: Understanding the Laws and Their Limitations |journal = Journal of Public Health Policy |date = February 2002 |doi = 10.2307/3343240 |url = http://impacteen.uic.edu/generalarea_PDFs/medicalmarijuanapaper100301.pdf |volume = 23 |issue = 4 |pages = 413–39 |jstor = 3343240 |pmid = 12532682 |citeseerx = 10.1.1.202.2274 |s2cid = 13389317 |access-date = 20 March 2018 |archive-date = 2 March 2021 |archive-url = https://web.archive.org/web/20210302173927/https://impacteen.uic.edu/generalarea_PDFs/medicalmarijuanapaper100301.pdf |url-status = live }}</ref> Cannabis was removed from the U.S. Pharmacopeia in 1941, and officially banned for any use with the passage of the Controlled Substances Act of 1970.<ref name="Grinspoon" />
Cannabis began to attract renewed interest as medicine in the 1970s and 1980s, in particular due to its use by cancer and AIDS patients who reported relief from the effects of chemotherapy and wasting syndrome.<ref>{{cite news |last1 = Joy |first1 = Janet E. |last2 = Watson |first2 = Stanley J. |last3 = Benson |first3 = John A. |title = Marijuana and Medicine – Assessing the Science Base |url = http://medicalmarijuana.procon.org/sourcefiles/IOM_Report.pdf |publisher = National Academy Press |location = Washington, D.C. |date = 1999 |access-date = 28 July 2017 |archive-url = https://web.archive.org/web/20180123184348/https://medicalmarijuana.procon.org/sourcefiles/IOM_Report.pdf |archive-date = 23 January 2018 }}</ref> In 1996, California became the first U.S. state to legalize medical cannabis in defiance of federal law.<ref>{{cite web |title = History of Marijuana as Medicine – 2900 BC to Present |url = http://medicalmarijuana.procon.org/view.timeline.php?timelineID=000026 |website = ProCon.org |access-date = 27 July 2017 |archive-date = 15 July 2017 |archive-url = https://web.archive.org/web/20170715175551/http://medicalmarijuana.procon.org/view.timeline.php?timelineID=000026 |url-status = live }}</ref> In 2001, Canada became the first country to adopt a system regulating the medical use of cannabis.<ref>{{cite news |title = Marijuana's journey to legal health treatment: the Canadian experience |url = http://www.cbc.ca/news/health/marijuana-s-journey-to-legal-health-treatment-the-canadian-experience-1.799488 |access-date = 27 July 2017 |work = CBC News |date = 17 August 2009 |archive-date = 14 June 2017 |archive-url = https://web.archive.org/web/20170614170017/http://www.cbc.ca/news/health/marijuana-s-journey-to-legal-health-treatment-the-canadian-experience-1.799488 |url-status = live }}</ref>
<gallery class="center" caption="" widths="200px" heights="150px"> File:Da-ma.png|The use of cannabis, at least as fiber, has been shown to go back at least 10,000 years in Taiwan. "Dà má" (Pinyin pronunciation) is the Chinese expression for cannabis, the first character meaning "big" and the second character meaning "hemp". File:Drug bottle containing cannabis.jpg|''Cannabis indica'' fluid extract, American Druggists Syndicate, pre-1937 File:CannabisAmericana JLHopkins B.jpg|An advertisement for ''cannabis americana'' distributed by a pharmacist in New York in 1917 File:PEbers c41-bc.jpg|The Ebers Papyrus ({{circa|1550 BCE}}) from Ancient Egypt has a prescription for medical marijuana applied directly for inflammation. </gallery>
== Society and culture ==
=== Legal status === {{See also|Legality of cannabis by country}}
[[File:Map-of-world-medical-cannabis-laws.svg|thumb|right|380px|alt=Map of world medical cannabis laws| '''Legal status of (whole-plant) medical cannabis worldwide''' (only ''de jure''; may not reflect actual access in these countries) ---- {{legend|#0ea817|Legal as authorized by a physician}} {{legend|#0d00f2|Legal for any use (no prescription required)}} ---- <small>See also countries that have decriminalized or where enforcement is limited.</small> ]]
Countries that have legalized the medical use of cannabis include Argentina,<ref>{{cite news |last1=Politi |first1=Daniel |title=Argentina to Allow Medicinal Marijuana to Be Grown at Home |url=https://www.nytimes.com/2020/11/12/world/americas/argentina-cannabis-marijuana.html |access-date=22 January 2023 |work=The New York Times |date=12 November 2020 |archive-date=23 January 2023 |archive-url=https://web.archive.org/web/20230123041514/https://www.nytimes.com/2020/11/12/world/americas/argentina-cannabis-marijuana.html |url-status=live }}</ref> Australia,<ref>{{cite news |last1=Jolly |first1=William |title=Medicinal Marijuana Legal In Australia |url=https://www.canstar.com.au/health-insurance/victoria-legalises-medicinal-marijuana/ |access-date=16 July 2018 |work=Canstar |date=28 February 2018 |archive-date=17 July 2018 |archive-url=https://web.archive.org/web/20180717013204/https://www.canstar.com.au/health-insurance/victoria-legalises-medicinal-marijuana/ |url-status=live }}</ref> Brazil,<ref>{{cite news |last1=Ponieman |first1=Natan |title=Brazil Regulates Sale Of Medical Marijuana Products |url=https://www.benzinga.com/markets/cannabis/19/12/14924387/brazil-regulates-sale-of-medical-marijuana-products |access-date=10 December 2019 |work=Benzinga |date=3 December 2019 |archive-date=14 March 2021 |archive-url=https://web.archive.org/web/20210314045550/https://www.benzinga.com/markets/cannabis/19/12/14924387/brazil-regulates-sale-of-medical-marijuana-products |url-status=live }}</ref> Canada,<ref name="Motley">{{cite news|last1=Williams|first1=Sean|title=10 Countries (Aside From the U.S.) Where Some Form of Medical Marijuana Is Legal|url=https://www.fool.com/investing/general/2016/05/15/10-countries-aside-from-the-us-where-some-form-of.aspx|access-date=5 November 2017|work=The Motley Fool|date=15 May 2016|archive-date=11 November 2017|archive-url=https://web.archive.org/web/20171111152109/https://www.fool.com/investing/general/2016/05/15/10-countries-aside-from-the-us-where-some-form-of.aspx|url-status=live}}</ref> Chile,<ref name="Motley" /> Colombia,<ref name="Motley" /> Costa Rica,<ref>{{cite news |title=Costa Rica legalizes medicinal marijuana use, hemp growing |url=https://apnews.com/article/health-caribbean-marijuana-recreational-marijuana-costa-rica-7fc0e4e7b8881613210164f6acf6d9e8 |access-date=22 January 2023 |work=Associated Press |date=2 March 2022 |archive-date=7 March 2022 |archive-url=https://web.archive.org/web/20220307050530/https://apnews.com/article/health-caribbean-marijuana-recreational-marijuana-costa-rica-7fc0e4e7b8881613210164f6acf6d9e8 |url-status=live }}</ref> Croatia,<ref>{{cite news|last1=Veselica|first1=Lajla|title=Croatia legalises marijuana for medical use|url=https://www.yahoo.com/news/croatia-allows-marijuana-medical-114920214.html|access-date=4 November 2017|work=Yahoo News|agency=AFP|date=15 October 2015|archive-date=14 March 2021|archive-url=https://web.archive.org/web/20210314045549/https://www.yahoo.com/news/croatia-allows-marijuana-medical-114920214.html}}</ref> Cyprus,<ref>{{cite news |title=Cyprus begins to distribute medical cannabis |url=http://in-cyprus.com/cyprus-begins-to-distribute-medical-cannabis |access-date=11 November 2017 |work=InCyprus |date=22 May 2017 |archive-url=https://web.archive.org/web/20170609034857/http://in-cyprus.com/cyprus-begins-to-distribute-medical-cannabis |archive-date=9 June 2017}}</ref> Czech Republic,<ref name="Motley" /> Finland,<ref>{{cite web |title= Legal status of cannabis in Finland – An overview |url= https://sensiseeds.com/en/blog/legal-status-cannabis-finland-overview |website= Sensi Seeds |date= 18 May 2016 |access-date= 4 November 2017 |archive-date= 14 March 2021 |archive-url= https://web.archive.org/web/20210314045550/https://sensiseeds.com/en/blog/countries/cannabis-in-finland-laws-use-history/ |url-status= live }}</ref> Germany,<ref>{{cite news |last1= Senthilingam |first1= Meera |title= Germany joins the global experiment on marijuana legalization |work= CNN.com |url= http://www.cnn.com/2016/12/29/health/global-marijuana-cannabis-laws/index.html |access-date= 4 November 2017 |date= 6 March 2017 |archive-date= 14 March 2021 |archive-url= https://web.archive.org/web/20210314045553/https://www.cnn.com/2016/12/29/health/global-marijuana-cannabis-laws/index.html |url-status= live }}</ref> Greece,<ref>{{cite news |last1= Revesz |first1=Rachael |title=Greece legalises marijuana for medical purposes |url= https://www.independent.co.uk/news/world/europe/greece-marijuana-legal-medical-cannabis-weed-law-passes-a7821771.html |archive-url=https://ghostarchive.org/archive/20220512/https://www.independent.co.uk/news/world/europe/greece-marijuana-legal-medical-cannabis-weed-law-passes-a7821771.html |archive-date=12 May 2022 |url-access=subscription |url-status=live |access-date=4 November 2017 |work= The Independent |date=3 July 2017}}</ref> Israel,<ref>{{cite news |last1=Schwartz |first1=Yardena |title=How the Booming Israeli Weed Industry Is Changing American Pot |work=Rollingstone.com |url=https://www.rollingstone.com/culture/features/how-booming-israeli-weed-industry-is-changing-american-pot-w499117 |access-date=4 November 2017 |date=24 August 2017 |archive-date=4 November 2017 |archive-url=https://web.archive.org/web/20171104043420/http://www.rollingstone.com/culture/features/how-booming-israeli-weed-industry-is-changing-american-pot-w499117 |url-status=live }}</ref> Italy,<ref>{{cite news |last=Samuels |first=Gabriel |title= Italian army aims to produce "the best-quality" medical marijuana after finding current batches deficient |url= https://www.independent.co.uk/news/world/europe/cannabis-italy-army-medical-marijuana-italian-military-produces-best-quality-weed-a7156176.html |archive-url=https://ghostarchive.org/archive/20220512/https://www.independent.co.uk/news/world/europe/cannabis-italy-army-medical-marijuana-italian-military-produces-best-quality-weed-a7156176.html |archive-date=12 May 2022 |url-access=subscription |url-status=live |access-date=4 November 2017 |work=The Independent |date=26 July 2016}}</ref> Jamaica,<ref>{{cite news |last1=Bud |first1=Monterey |title=Jamaica's Kaya Farms Becomes First Medical Marijuana Dispensary To Open |url=https://www.marijuana.com/news/2018/03/jamaicas-kaya-farms-becomes-first-medical-marijuana-dispensary-to-open |access-date=16 July 2018 |work=marijuana.com |date=19 March 2018 |archive-date=14 March 2021 |archive-url=https://web.archive.org/web/20210314045550/https://weedmaps.com/news/ |url-status=live }}</ref> Lebanon,<ref>{{cite news |url=https://www.nytimes.com/reuters/2020/04/21/world/middleeast/21reuters-lebanon-crisis-cannabis.html |title=Lebanon Legalizes Cannabis Farming for Medicinal Use |work=The New York Times |agency=Reuters |date=21 April 2020 |access-date=25 April 2020 |archive-date=23 April 2020 |archive-url=https://web.archive.org/web/20200423112646/https://www.nytimes.com/reuters/2020/04/21/world/middleeast/21reuters-lebanon-crisis-cannabis.html |url-status=live }}</ref> Luxembourg,<ref>{{cite news |last1= Pritchard |first1= Heledd |title= Cannabis for medical use legalised in Luxembourg |url= https://luxtimes.lu/luxembourg/34274-cannabis-for-medical-use-legalised-in-luxembourg |access-date= 8 July 2018 |work= Luxembourg Times |date= 29 June 2018 |archive-date= 29 June 2018 |archive-url= https://web.archive.org/web/20180629104554/https://luxtimes.lu/luxembourg/34274-cannabis-for-medical-use-legalised-in-luxembourg |url-status= live }}</ref> Malta,<ref>{{cite news |last1=Pace |first1=Maria |title=Malta has officially legalised medical cannabis |url=https://www.maltatoday.com.mt/news/national/85616/malta_has_officially_legalised_medical_cannabis |access-date=24 August 2018 |work=Malta Today |date=27 March 2018 |archive-date=1 July 2021 |archive-url=https://web.archive.org/web/20210701160703/https://www.maltatoday.com.mt/news/national/85616/malta_has_officially_legalised_medical_cannabis |url-status=live }}</ref> Morocco,<ref>{{cite news |title=Morocco: Bill to legalise cannabis enters into force |url=https://www.middleeastmonitor.com/20210731-morocco-bill-to-legalise-cannabis-enters-into-force/ |access-date=22 January 2023 |work=Middle East Monitor |date=31 July 2021 |archive-date=11 August 2021 |archive-url=https://web.archive.org/web/20210811195407/https://www.middleeastmonitor.com/20210731-morocco-bill-to-legalise-cannabis-enters-into-force/ |url-status=live }}</ref> the Netherlands,<ref name="Motley" /> New Zealand,<ref>{{cite news |last1=Ainge Roy |first1=Eleanor |title=New Zealand passes laws to make medical marijuana widely available |url=https://www.theguardian.com/world/2018/dec/11/new-zealand-passes-laws-to-make-medical-marijuana-widely-available |access-date=20 January 2019 |work=The Guardian |date=11 December 2018 |archive-date=13 January 2019 |archive-url=https://web.archive.org/web/20190113005629/https://www.theguardian.com/world/2018/dec/11/new-zealand-passes-laws-to-make-medical-marijuana-widely-available |url-status=live }}</ref> North Macedonia,<ref>{{cite news |last1=Marusic |first1=Sinisa Jakov |title=Macedonia Allows Medical Marijuana in Pharmacies |url=http://www.balkaninsight.com/en/article/macedonia-allows-medical-marijuana-in-pharmacies-05-31-2016 |access-date=4 November 2017 |work=Balkan Insight |date=1 June 2016 |archive-date=31 October 2017 |archive-url=https://web.archive.org/web/20171031051345/http://www.balkaninsight.com/en/article/macedonia-allows-medical-marijuana-in-pharmacies-05-31-2016 |url-status=live }}</ref> Panama,<ref>{{cite news |title=El gobierno de Panamá legalizó el uso medicinal y terapéutico del cannabis |url=https://www.infobae.com/america/america-latina/2021/10/14/el-gobierno-de-panama-legalizo-el-uso-medicinal-y-terapeutico-del-cannabis/ |access-date=22 January 2023 |work=Infobae |date=14 October 2021 |archive-date=17 October 2021 |archive-url=https://web.archive.org/web/20211017212957/https://www.infobae.com/america/america-latina/2021/10/14/el-gobierno-de-panama-legalizo-el-uso-medicinal-y-terapeutico-del-cannabis/ |url-status=live }}</ref> Peru,<ref>{{cite news |last1=Collyns |first1=Dan |title=Peru legalises medical marijuana in move spurred by mother's home lab |url=https://www.theguardian.com/world/2017/oct/20/peru-marijuana-cannabis-legal-terminally-ill-children |access-date=4 Nov 2017 |work=The Guardian |date=20 October 2017 |archive-date=3 July 2018 |archive-url=https://web.archive.org/web/20180703075436/https://www.theguardian.com/world/2017/oct/20/peru-marijuana-cannabis-legal-terminally-ill-children |url-status=live }}</ref> Poland,<ref>{{cite news |title=Medical use of cannabis officially legal in Poland |url=http://www.thenews.pl/1/9/Artykul/333153,Medical-use-of-cannabis-officially-legal-in-Poland |access-date=4 November 2017 |work=Radio Poland |agency=PAP |date=11 February 2017 |archive-date=14 March 2021 |archive-url=https://web.archive.org/web/20210314045554/https://connect.facebook.net/en_US/fbds.js }}</ref> Portugal,<ref>{{cite news |last1=Lamers |first1=Matt |title=Portugal passes medical cannabis law, opens domestic market |url=https://mjbizdaily.com/portugal-passes-medical-cannabis-law-opens-domestic-market/ |access-date=24 August 2018 |work=Marijuana Business Daily |date=21 June 2018 |archive-date=5 September 2019 |archive-url=https://web.archive.org/web/20190905191222/https://mjbizdaily.com/portugal-passes-medical-cannabis-law-opens-domestic-market/ |url-status=live }}</ref> Rwanda,<ref>{{cite news |last1=Mwai |first1=Collins |title=10 things to know after Rwanda gives the green light for medical marijuana |url=https://www.newtimes.co.rw/article/187172/News/10-things-to-know-after-rwanda-gives-the-green-light-for-medical-marijuana |access-date=22 January 2023 |work=The New Times |date=29 June 2021 |archive-date=23 January 2023 |archive-url=https://web.archive.org/web/20230123022218/https://www.newtimes.co.rw/article/187172/News/10-things-to-know-after-rwanda-gives-the-green-light-for-medical-marijuana |url-status=live }}</ref> Sri Lanka,<ref>{{citation |title=South Asia Regional Profile |url=https://www.unodc.org/pdf/india/publications/south_Asia_Regional_Profile_Sept_2005/13_srilanka.pdf |access-date=2 February 2019 |publisher=United Nations Office on Drugs and Crime |date=15 September 2005 |archive-date=23 September 2020 |archive-url=https://web.archive.org/web/20200923171657/https://www.unodc.org/pdf/india/publications/south_Asia_Regional_Profile_Sept_2005/13_srilanka.pdf |url-status=live }}</ref> Switzerland,<ref>{{cite news |title=Switzerland to legalise medicinal cannabis from Monday |url=https://www.thelocal.ch/20220728/switzerland-to-legalise-medicinal-cannabis-from-monday |access-date=22 January 2023 |work=The Local |date=28 July 2022 |archive-url=https://web.archive.org/web/20220809105423/https://www.thelocal.ch/20220728/switzerland-to-legalise-medicinal-cannabis-from-monday/ |archive-date=9 August 2022}}</ref> Thailand,<ref>{{cite news |last1=Mosbergen |first1=Dominique |title=Thailand Approves Medical Marijuana In Regional First |url=https://www.huffingtonpost.com/entry/thailand-medical-marijuana_us_5c22e6aae4b0407e907e7c18 |access-date=20 January 2019 |work=HuffPost |date=25 December 2018 |archive-date=19 January 2019 |archive-url=https://web.archive.org/web/20190119155356/https://www.huffingtonpost.com/entry/thailand-medical-marijuana_us_5c22e6aae4b0407e907e7c18 |url-status=live }}</ref> the United Kingdom,<ref>{{cite news |title=Medicinal cannabis products to be legalised |url=https://www.bbc.co.uk/news/health-44968386 |access-date=28 July 2018 |work=BBC |date=26 July 2018 |archive-date=28 July 2018 |archive-url=https://web.archive.org/web/20180728045627/https://www.bbc.co.uk/news/health-44968386 |url-status=live }}</ref> and Uruguay.<ref name="Motley" /> Other countries have more restrictive laws that allow only the use of isolated cannabinoid drugs such as Sativex or Epidiolex.<ref>{{cite web |title=Sativex (delta-9-tetrahydrocannabinol and cannabidiol) |url= https://www.gwpharm.com/products-pipeline/sativex-delta-9-tetrahydrocannabinol-and-cannabidiol |website=GW Pharmaceuticals |access-date=5 November 2017 |archive-url=https://web.archive.org/web/20171210062733/https://www.gwpharm.com/products-pipeline/sativex-delta-9-tetrahydrocannabinol-and-cannabidiol |archive-date=10 December 2017}}</ref><ref>{{citation |title=Medical use of cannabis and cannabinoids |url=http://www.emcdda.europa.eu/system/files/publications/10171/20185584_TD0618186ENN_PDF.pdf |publisher=European Monitoring Centre for Drugs and Drug Addiction |date=December 2018 |access-date=11 December 2019 |archive-date=28 June 2021 |archive-url=https://web.archive.org/web/20210628171058/https://www.emcdda.europa.eu/system/files/publications/10171/20185584_TD0618186ENN_PDF.pdf |url-status=live }}</ref> Countries with the most relaxed policies include Canada,<ref>{{cite news |last=Sapra |first=Bani |title=Canada becomes second nation in the world to legalize marijuana |url=https://www.cnn.com/2018/06/20/health/canada-legalizes-marijuana/index.html |access-date=3 July 2018 |work=CNN |date=20 June 2018 |archive-date=12 February 2019 |archive-url=https://web.archive.org/web/20190212125138/https://www.cnn.com/2018/06/20/health/canada-legalizes-marijuana/index.html |url-status=live }}</ref> the Netherlands,<ref name="Motley" /> Thailand,<ref>{{cite news |last1=Ives |first1=Mike |title=Weed Is Now Legal in Thailand. How Long Will the High Times Last? |url=https://www.nytimes.com/2022/11/10/world/asia/thailand-weed-cannabis-law.html |access-date=22 January 2023 |work=The New York Times |date=10 November 2022 |archive-url=https://web.archive.org/web/20221127104321/https://www.nytimes.com/2022/11/10/world/asia/thailand-weed-cannabis-law.html |archive-date=27 November 2022}}</ref> and Uruguay,<ref name="Motley" /> where cannabis can be purchased without need for a prescription. In Mexico, THC content of medical cannabis is limited to one percent.<ref>{{cite news |last1= Janikian |first1= Michelle |title= Legal Pot In Mexico: Everything You Need to Know |url= https://www.rollingstone.com/culture/features/legal-pot-in-mexico-everything-you-need-to-know-w503038 |access-date= 5 November 2017 |magazine= Rolling Stone |date= 14 September 2017 |archive-date= 11 November 2017 |archive-url= https://web.archive.org/web/20171111151947/http://www.rollingstone.com/culture/features/legal-pot-in-mexico-everything-you-need-to-know-w503038 |url-status= live }}</ref> In the United States, the legality of medical cannabis varies by state.<ref name="NCSL" />
However, in many of these countries, access may not always be possible under the same conditions.
==== International law ==== {{See also|Removal of cannabis and cannabis resin from Schedule IV of the Single Convention on narcotic drugs, 1961}}
Cannabis and its derivatives are subject to regulation under three United Nations drug control treaties: the 1961 Single Convention on Narcotic Drugs, the 1971 Convention on Psychotropic Substances, and the 1988 Convention Against Illicit Traffic in Narcotic Drugs and Psychotropic Substances.<ref>{{cite journal |last1=Habibi |first1=Roojin |last2=Hoffman |first2=Steven J. |title=Legalizing Cannabis Violates the UN Drug Control Treaties, But Progressive Countries Like Canada Have Options |journal=Ottawa Law Review |date=March 2018 |volume=49 |issue=2 |url=https://www.researchgate.net/publication/323697447 |access-date=8 January 2021 |archive-date=28 August 2021 |archive-url=https://web.archive.org/web/20210828161532/https://www.researchgate.net/publication/323697447_Legalizing_Cannabis_Violates_the_UN_Drug_Control_Treaties_But_Progressive_Countries_Like_Canada_Have_Options |url-status=live }}</ref>
Cannabis and cannabis resin are classified as a Schedule I drug under the Single Convention treaty, meaning that medical use is considered "indispensable for the relief of pain and suffering" but that it is considered to be an addictive medication with risks of abuse.<ref>{{cite web |title=Classification of controlled drugs |url=https://www.emcdda.europa.eu/publications/topic-overviews/classification-of-controlled-drugs/html_en |website=European Monitoring Centre for Drugs and Drug Addiction |access-date=7 January 2021 |archive-date=8 January 2021 |archive-url=https://web.archive.org/web/20210108164743/https://www.emcdda.europa.eu/publications/topic-overviews/classification-of-controlled-drugs/html_en |url-status=live }}</ref> Countries have an obligation to provide access and sufficient availability of drugs listed in Schedule I for the purposes of medical uses.<ref>{{Cite book |last=International Narcotics Control Board |url=https://syntheticdrugs.unodc.org/uploads/syntheticdrugs/res/library/access_html/2010.pdf |title=Report of the International Narcotics Control Board on the Availability of Internationally Controlled Drugs: Ensuring Adequate Access for Medical and Scientific Purposes |publisher=United Nations |year=2010 |location=Vienna}}</ref><ref>{{Cite web |last=IGHRDP |last2=UNDP |author2-link=United Nations Development Programme |last3=UNAIDS |author3-link=Joint United Nations Programme on HIV/AIDS |last4=OHCHR |author4-link=Office of the United Nations High Commissioner for Human Rights |last5=WHO |author5-link=World Health Organization |date=2012 |title=Obligations arising from human rights standards: Access to controlled substances as medicines |url=https://www.humanrights-drugpolicy.org/guidelines/obligations-arising-from-human-rights-standards/access-to-controlled-substances-as-medicines/ |access-date=2024-08-30 |website=International Guidelines on Human Rights and Drug Policy |publisher=University of Essex}}</ref>
Prior to December 2020 cannabis and cannabis resin were also included in Schedule IV, a more restrictive level of control, which is for only the most dangerous drugs such as heroin and fentanyl.<ref>{{cite news |last1=Kaur |first1=Harmeet |title=The UN removes cannabis from a list of the most dangerous substances |url=https://www.cnn.com/2020/12/02/health/un-reclassifies-cannabis-scn-trnd/index.html |access-date=7 January 2021 |work=CNN |date=2 December 2020 |archive-date=12 December 2020 |archive-url=https://web.archive.org/web/20201212164024/https://www.cnn.com/2020/12/02/health/un-reclassifies-cannabis-scn-trnd/index.html |url-status=live }}</ref> They were removed after an independent scientific assessment by the World Health Organization in 2018–2019.
Member nations of the UN Commission on Narcotic Drugs voted 27–25 to remove it from Schedule IV on 2 December 2020,<ref>{{cite news |last1=Kwai |first1=Isabella |title=U.N. Reclassifies Cannabis as a Less Dangerous Drug |url=https://www.nytimes.com/2020/12/02/world/europe/cannabis-united-nations-drug-policy.html |access-date=7 January 2021 |work=The New York Times |date=2 December 2020 |archive-date=10 January 2021 |archive-url=https://web.archive.org/web/20210110040927/https://www.nytimes.com/2020/12/02/world/europe/cannabis-united-nations-drug-policy.html |url-status=live }}</ref> following a World Health Organization recommendation for removal in January 2019.<ref>{{cite news |title=WHO recommends rescheduling of cannabis |url=https://www.emcdda.europa.eu/news/2019/who-recommends-rescheduling-of-cannabis_en |access-date=7 January 2021 |work=European Monitoring Centre for Drugs and Drug Addiction |date=25 March 2019 |archive-date=28 December 2020 |archive-url=https://web.archive.org/web/20201228094221/https://www.emcdda.europa.eu/news/2019/who-recommends-rescheduling-of-cannabis_en |url-status=live }}</ref><ref>{{cite news |last1=Georgiou |first1=Aristos |title=WHO Recommends Rescheduling Cannabis in International Law for First Time in History |url=https://www.newsweek.com/who-recommends-rescheduling-cannabis-international-law-first-time-history-1324613 |access-date=7 January 2021 |work=Newsweek |date=8 February 2019 |archive-date=20 December 2020 |archive-url=https://web.archive.org/web/20201220172821/https://www.newsweek.com/who-recommends-rescheduling-cannabis-international-law-first-time-history-1324613 |url-status=live }}</ref>
==== United States ==== {{See also|Medical cannabis in the United States}}
In the United States, the use of cannabis for medical purposes is legal in 38 states, four out of five permanently inhabited U.S. territories, and the District of Columbia.<ref name="NCSL">{{cite web |title = State Medical Marijuana Laws |url = http://www.ncsl.org/research/health/state-medical-marijuana-laws.aspx |website = National Conference of State Legislatures |date = 12 September 2022 |access-date = 6 October 2022 |archive-date = 11 December 2018 |archive-url = https://web.archive.org/web/20181211125951/http://www.ncsl.org/research/health/state-medical-marijuana-laws.aspx |url-status = live }}</ref> An additional 10 states have more restrictive laws allowing the use of low-THC products.<ref name="NCSL" /> Cannabis remains illegal at the federal level under the Controlled Substances Act, which classifies it as a Schedule I drug with a high potential for abuse and no accepted medical use. In December 2014, however, the Rohrabacher–Farr amendment was signed into law, prohibiting the Justice Department from prosecuting individuals acting in accordance with state medical cannabis laws.<ref>{{cite news |last1 = Ingraham |first1 = Christopher |title = Jeff Sessions personally asked Congress to let him prosecute medical-marijuana providers |url = https://www.washingtonpost.com/news/wonk/wp/2017/06/13/jeff-sessions-personally-asked-congress-to-let-him-prosecute-medical-marijuana-providers/ |access-date = 9 July 2017 |newspaper = The Washington Post |date = 13 June 2017 |archive-date = 4 July 2017 |archive-url = https://web.archive.org/web/20170704095547/https://www.washingtonpost.com/news/wonk/wp/2017/06/13/jeff-sessions-personally-asked-congress-to-let-him-prosecute-medical-marijuana-providers/ |url-status = live }}</ref>
In the US, the FDA has approved two oral cannabinoids for use as medicine in 1985:<ref>{{cite news |last1=Clark |first1=Amy |date=16 May 2006 |title="New" Pot Pill For Chemo Patients |url=http://www.cbsnews.com/news/new-pot-pill-for-chemo-patients/ |url-status=live |archive-url=https://web.archive.org/web/20170728172927/http://www.cbsnews.com/news/new-pot-pill-for-chemo-patients/ |archive-date=28 July 2017 |access-date=26 July 2017 |work=CBS News |agency=Associated Press}}</ref> dronabinol (pure delta-9-THC; brand name Marinol) and nabilone (a synthetic neocannabinoid; brand name Cesamet).<ref name="Borgelt2013" /> In the US, they are both listed as Schedule II, indicating high potential for side effects and addiction.<ref name="Svrakic2012" /><ref>{{cite web |title=Final Rule: Placement of FDA-Approved Products of Oral Solutions Containing Dronabinol [(-)-delta-9-trans-tetrahydrocannabinol (delta-9-THC)] in Schedule II |url=https://www.deadiversion.usdoj.gov/fed_regs/rules/2017/fr1122_6.htm |archive-url=https://web.archive.org/web/20180328121003/https://www.deadiversion.usdoj.gov/fed_regs/rules/2017/fr1122_6.htm |archive-date=28 March 2018 |access-date=2 February 2018 |website=U.S. Department of Justice}}</ref>
====Germany==== {{Main|Cannabis in Germany}}
After the April 2024 Cannabis Act legalized medical cannabis, telemedicine platforms such as Bloomwell and DoktorABC reported a surge in online consultations and medical cannabis prescriptions. This sparked policy debate over remote prescribing standards, with an amendment to the law scheduled for a vote in 2026.<ref>{{cite news |last1=Matussek |first1=Karin |last2=Wind |first2=Sonja |title=Online Cannabis Sales Are Booming in Germany—and the Government Is Racing to Catch Up |url=https://www.bloomberg.com/news/features/2026-02-07/online-cannabis-sales-are-booming-in-germany |access-date=9 March 2026 |work=Bloomberg |date=7 February 2026}}</ref><ref>{{cite news |last1=Stevens |first1=Ben |title=German Cannabis Imports Double in 2024, but Political Pressure Builds On Flourishing Medical Market |url=https://businessofcannabis.com/german-cannabis-imports-double-in-2024-but-political-pressure-builds-on-flourishing-medical-market/ |access-date=9 March 2026 |work=Business of Cannabis |date=26 February 2025}}</ref><ref>{{cite news |last1=Hogg |first1=Bernadette |title=Germany restricts online cannabis sales amid import boom |url=https://www.reuters.com/business/healthcare-pharmaceuticals/germany-restrict-online-cannabis-sales-curb-ballooning-imports-2025-10-08/ |access-date=9 March 2026 |work=Reuters |date=8 October 2025}}</ref>
=== Economics ===
==== Distribution ==== [[File:Discount Medical Marijuana - 2.jpg|thumb|right|Medical marijuana dispensary in Denver, Colorado ]]
The method of obtaining medical cannabis varies by region and by legislation. In the US, most consumers grow their own or buy it from cannabis dispensaries in states where it is legal.<ref name=Borgelt2013 /><ref name=BaltSun>{{cite news |url = http://www.baltimoresun.com/news/maryland/sun-investigates/bs-md-medical-marijuana-fees-20141011,0,3253557.story?page=1 |title = Medical marijuana fees stir debate in Maryland |newspaper = The Baltimore Sun |author = Timothy B. Wheeler |date = 11 October 2014 |access-date = 12 October 2014 |archive-date = 16 October 2014 |archive-url = https://web.archive.org/web/20141016223445/http://www.baltimoresun.com/news/maryland/sun-investigates/bs-md-medical-marijuana-fees-20141011,0,3253557.story?page=1 }}</ref> Marijuana vending machines for selling or dispensing cannabis are in use in the United States and are planned to be used in Canada.<ref name=FirstForeignMarket>{{cite news |url = https://nationalpost.com/news/canada/pot-vending-machines-to-start-rolling-into-canada-after-firm-partners-with-u-s-company |title = The pot vending machine's first foreign market? Canada, of course, "a seed for the rest of the world" |newspaper = National Post |author = Blackwell, Tom |date = 16 October 2013 |access-date = 4 December 2013 }}</ref> In 2014, the startup Meadow began offering on-demand delivery of medical marijuana in the San Francisco Bay Area, through their mobile app.<ref>{{cite web |url = https://techcrunch.com/2014/10/14/uber-for-weed-startup-meadow-lights-up-in-san-francisco/ |title = Uber-For-Weed Startup Meadow Lights Up In San Francisco |date = 14 October 2014 |publisher = AOL |work = TechCrunch |access-date = 22 January 2016 |archive-date = 23 January 2016 |archive-url = https://web.archive.org/web/20160123174609/http://techcrunch.com/2014/10/14/uber-for-weed-startup-meadow-lights-up-in-san-francisco/ |url-status = live }}</ref>
Almost 70% of medical cannabis is exported from the United Kingdom, according to a 2017 United Nations report, with much of the remaining amount coming from Canada and the Netherlands.<ref>{{Cite web|date=2018-03-07|title=The UK is the world's largest producer of legal Cannabis, UN body finds|url=https://www.independent.co.uk/news/uk/home-news/cannabis-legal-uk-worlds-largest-producer-marijuana-weed-un-body-findings-a8243921.html |archive-url=https://ghostarchive.org/archive/20220512/https://www.independent.co.uk/news/uk/home-news/cannabis-legal-uk-worlds-largest-producer-marijuana-weed-un-body-findings-a8243921.html |archive-date=12 May 2022 |url-access=subscription |url-status=live|access-date=2020-12-07|website=The Independent|language=en}}</ref>
==== Insurance ==== In the United States, health insurance companies may not pay for a medical marijuana prescription as the Food and Drug Administration must approve any substance for medicinal purposes. Before this can happen, the FDA must first permit the study of the medical benefits and drawbacks of the substance, which it has not done since it was placed on Schedule I of the Controlled Substances Act in 1970. Therefore, all expenses incurred fulfilling a medical marijuana prescription will possibly be incurred as out-of-pocket.<ref>{{cite web |url = http://www.insurancecompliancecorner.com/the-medical-marijuana-debate/ |title = The Medical Marijuana Debate |last1 = Clark |first1 = Tonya Body |date = 10 February 2015 |website = Compliance Corner |publisher = Wolters Kluwer Financial Services |access-date = 26 February 2015 |archive-date = 26 February 2015 |archive-url = https://web.archive.org/web/20150226193755/http://www.insurancecompliancecorner.com/the-medical-marijuana-debate/ }}</ref> However, the New Mexico Court of Appeals has ruled that workers' compensation insurance must pay for prescribed marijuana as part of the state's Medical Cannabis Program.<ref>{{cite web |url = http://nmpoliticalreport.com/4483/court-employer-cant-block-workers-comp-for-medical-marijuana/ |title = Court: Employer can't block workers' comp for medical marijuana |last1 = Peters |first1 = Joey |date = 29 June 2015 |website = NM Political Report |access-date = 30 June 2015 |archive-date = 30 June 2015 |archive-url = https://web.archive.org/web/20150630061942/http://nmpoliticalreport.com/4483/court-employer-cant-block-workers-comp-for-medical-marijuana/ |url-status = live }}</ref>
=== Positions of medical organizations === Medical organizations that have issued statements in support of allowing access to medical cannabis include the American Nurses Association,<ref name="ANA">{{citation |title = Therapeutic Use of Marijuana and Related Cannabinoids |url = https://www.nursingworld.org/~4ad4a8/globalassets/docs/ana/therapeutic-use-of-marijuana-and-related-cannabinoids.pdf |publisher = American Nurses Association |date = 2016 |access-date = 13 May 2018 |archive-date = 21 September 2020 |archive-url = https://web.archive.org/web/20200921162957/https://www.nursingworld.org/~4ad4a8/globalassets/docs/ana/therapeutic-use-of-marijuana-and-related-cannabinoids.pdf |url-status = live }}</ref> American Public Health Association,<ref>{{cite web |title = Resolution on Medical Marijuana |url = http://druglibrary.org/schaffer/hemp/medical/apha.htm |website = druglibrary.org |access-date = 30 July 2017 |archive-date = 19 October 2017 |archive-url = https://web.archive.org/web/20171019170836/http://druglibrary.org/schaffer/hemp/medical/apha.htm |url-status = live }}</ref> American Medical Student Association,<ref>{{cite web |title = House of Delegates 2017, Resolution: A8 |url = http://www.amsa.org/wp-content/uploads/2015/05/A8-Principles-Regarding-Illegal-drugs-alcohol-and-tobacco-1.pdf |website = amsa.org |publisher = American Medical Student Association |access-date = 30 July 2017 |archive-date = 1 August 2017 |archive-url = https://web.archive.org/web/20170801124633/http://www.amsa.org/wp-content/uploads/2015/05/A8-Principles-Regarding-Illegal-drugs-alcohol-and-tobacco-1.pdf |url-status = live }}</ref> National Multiple Sclerosis Society,<ref>{{cite web |title = Medical Marijuana (Cannabis) FAQs |url = http://www.nationalmssociety.org/Treating-MS/Complementary-Alternative-Medicines/Marijuana/Marijuana-FAQs |website = National Multiple Sclerosis Society |access-date = 30 July 2017 |archive-date = 31 July 2017 |archive-url = https://web.archive.org/web/20170731163441/http://www.nationalmssociety.org/Treating-MS/Complementary-Alternative-Medicines/Marijuana/Marijuana-FAQs |url-status = live }}</ref> Epilepsy Foundation,<ref>{{cite press release |last1 = Gattone |first1 = Philip M. |last2 = Lammert |first2 = Warreb |title = Epilepsy Foundation Calls for Increased Medical Marijuana Access and Research |url = http://www.epilepsy.com/article/2014/2/epilepsy-foundation-calls-increased-medical-marijuana-access-and-research |access-date = 30 July 2017 |location = Washington, D.C. |publisher = Epilepsy Foundation |date = 20 February 2014 |archive-date = 31 July 2017 |archive-url = https://web.archive.org/web/20170731185604/http://www.epilepsy.com/article/2014/2/epilepsy-foundation-calls-increased-medical-marijuana-access-and-research |url-status = live }}</ref> and Leukemia & Lymphoma Society.<ref>{{cite web |title = Medical Marijuana Use and Research |url = https://www.maps.org/research-archive/mmj/lnls-res.pdf |website = maps.org |publisher = Leukemia & Lymphoma Society |access-date = 30 July 2017 |archive-date = 19 October 2017 |archive-url = https://web.archive.org/web/20171019171337/https://www.maps.org/research-archive/mmj/lnls-res.pdf |url-status = live }}</ref>
Organizations that oppose the legalization of medical cannabis include the American Academy of Pediatrics (AAP)<ref name="AAP">{{citation |title = American Academy of Pediatrics Reaffirms Opposition to Legalizing Marijuana for Recreational or Medical Use |url = https://www.aap.org/en-us/about-the-aap/aap-press-room/Pages/American-Academy-of-Pediatrics-Reaffirms-Opposition-to-Legalizing-Marijuana-for-Recreational-or-Medical-Use.aspx |access-date = 30 July 2017 |publisher = American Academy of Pediatrics |date = 26 January 2015 |archive-date = 26 April 2018 |archive-url = https://web.archive.org/web/20180426075849/https://www.aap.org/en-us/about-the-aap/aap-press-room/pages/American-Academy-of-Pediatrics-Reaffirms-Opposition-to-Legalizing-Marijuana-for-Recreational-or-Medical-Use.aspx }}</ref> and American Psychiatric Association.<ref>{{cite web |title = Position Statement on Marijuana as Medicine |url = https://www.psychiatry.org/file%20library/about-apa/organization-documents-policies/policies/position-2013-marijuana-as-medicine.pdf |website = American Psychiatric Association |access-date = 30 July 2017 |archive-date = 31 July 2017 |archive-url = https://web.archive.org/web/20170731152505/https://www.psychiatry.org/file%20library/about-apa/organization-documents-policies/policies/position-2013-marijuana-as-medicine.pdf }}</ref> However, the AAP also supports rescheduling for the purpose of facilitating research.<ref name="AAP" />
The American Medical Association<ref>{{citation |title = Use of Cannabis for Medicinal Purposes |url = https://www.ama-assn.org/sites/default/files/media-browser/public/about-ama/councils/Council%20Reports/council-on-science-public-health/i09-csaph-medical-marijuana.pdf |publisher = American Medical Association |date = 2009 |access-date = 1 July 2017 |archive-date = 19 October 2017 |archive-url = https://web.archive.org/web/20171019170230/https://www.ama-assn.org/sites/default/files/media-browser/public/about-ama/councils/Council%20Reports/council-on-science-public-health/i09-csaph-medical-marijuana.pdf }}</ref> and American College of Physicians<ref>{{citation |title = Supporting Research into the Therapeutic Role of Marijuana |url = https://www.acponline.org/acp_policy/policies/supporting_research_therapeutic_role_of_marijuana_2016.pdf |publisher = American College of Physicians |date = February 2016 |access-date = 1 August 2017 |archive-date = 3 August 2020 |archive-url = https://web.archive.org/web/20200803220748/https://www.acponline.org/acp_policy/policies/supporting_research_therapeutic_role_of_marijuana_2016.pdf |url-status = live }}</ref> do not take a position on the legalization of medical cannabis, but have called for the Schedule I classification to be reviewed. The American Academy of Family Physicians<ref name="AAFP">{{cite news |title=AAFP Releases Marijuana, Cannabinoids Position Paper |url=https://www.aafp.org/news/health-of-the-public/20190920cannabispaper.html |access-date=6 October 2019 |work=American Academy of Family Physicians |date=20 September 2019 |archive-date=28 September 2019 |archive-url=https://web.archive.org/web/20190928025405/https://www.aafp.org/news/health-of-the-public/20190920cannabispaper.html |url-status=live }}</ref> and American Society of Addiction Medicine<ref>{{cite press release |date=13 October 2020 |title=ASAM Issues New Public Policy Statement on Cannabis |url=https://www.asam.org/Quality-Science/publications/magazine/read/asam-advocacy-blog/2020/10/13/asam-issues-new-public-policy-statement-on-cannabis |location=Rockville, MD |publisher=American Society of Addiction Medicine |access-date=1 November 2020 |archive-date=8 November 2020 |archive-url=https://web.archive.org/web/20201108221433/https://www.asam.org/Quality-Science/publications/magazine/read/asam-advocacy-blog/2020/10/13/asam-issues-new-public-policy-statement-on-cannabis }}</ref> also do not take a position, but do support rescheduling to better facilitate research. The American Heart Association says that "many of the concerning health implications of cannabis include cardiovascular diseases" but that it supports rescheduling to allow "more nuanced ... marijuana legislation and regulation" and to "reflect the existing science behind cannabis".<ref>{{cite journal |author=American Heart Association |title=Medical Marijuana, Recreational Cannabis, and Cardiovascular Health |journal=Circulation |date=5 August 2020 |volume=142 |issue=10 |pages=e131–52 |doi=10.1161/CIR.0000000000000883 |pmid=32752884 |doi-access=free }}</ref> The American Cancer Society<ref name="ACS">{{cite web |title = Marijuana and Cancer |url = https://www.cancer.org/treatment/treatments-and-side-effects/complementary-and-alternative-medicine/marijuana-and-cancer.html |website = American Cancer Society |access-date = 12 July 2017 |archive-date = 22 June 2017 |archive-url = https://web.archive.org/web/20170622082320/https://www.cancer.org/treatment/treatments-and-side-effects/complementary-and-alternative-medicine/marijuana-and-cancer.html |url-status = live }}</ref> and American Psychological Association<ref name="APA">{{cite news |title = Marijuana research: Overcoming the barriers |url = http://advocacy.apascience.org/blog/2017/9/13/marijuana-research-overcoming-the-barriers |access-date = 9 October 2017 |work = American Psychological Association |date = 14 September 2017 |archive-date = 4 October 2017 |archive-url = https://web.archive.org/web/20171004035308/http://advocacy.apascience.org/blog/2017/9/13/marijuana-research-overcoming-the-barriers }}</ref> have noted the obstacles that exist for conducting research on cannabis, and have called on the federal government to better enable scientific study of the drug.
Cancer Research UK say that while cannabis is being studied for therapeutic potential, "claims that there is solid "proof" that cannabis or cannabinoids can cure cancer is highly misleading to patients and their families, and builds a false picture of the state of progress in this area".<ref>{{cite web|url=http://scienceblog.cancerresearchuk.org/2012/07/25/cannabis-cannabinoids-and-cancer-the-evidence-so-far/|title=Cannabis, cannabinoids and cancer – the evidence so far|last=Arney|first=Kat|date=25 July 2012|publisher=Cancer Research UK|archive-url=https://web.archive.org/web/20140211145440/http://scienceblog.cancerresearchuk.org/2012/07/25/cannabis-cannabinoids-and-cancer-the-evidence-so-far/|archive-date=11 February 2014}}</ref>
=== Nonproprietary names === There are three International Nonproprietary Name (INN) granted for cannabinoids: two plant-derived phytocannabinoids and one neocannabinoid:
* Dronabinol is the INN for delta-9-THC<ref>{{Cite journal |last=World Health Organization |date=1984 |title=List of Proposed INNs No. 51 |url=https://cdn.who.int/media/docs/default-source/international-nonproprietary-names-(inn)/pl51.pdf?sfvrsn=3ded55af_9&download=true |journal=WHO Chronicle |volume=38 |issue=2 |page=6}}</ref><ref>{{Cite journal |last=World Health Organization |date=1984 |title=List of Recommended INNs No. 24 |url=https://cdn.who.int/media/docs/default-source/international-nonproprietary-names-(inn)/rl24.pdf?sfvrsn=99779214_6&download=true |journal=WHO Chronicle |volume=38 |issue=6 |page=4}}</ref> (there is a common confusion according to which the word "dronabinol" would only refer to synthetic delta-9-THC, which is incorrect<ref>{{Cite journal |last=Riboulet-Zemouli |first=Kenzi |date=2020 |title='Cannabis' ontologies I: Conceptual issues with Cannabis and cannabinoids terminology |journal=Drug Science, Policy and Law |language=en |volume=6 |page=205032452094579 |article-number=2050324520945797 |doi=10.1177/2050324520945797 |issn=2050-3245|doi-access=free }}</ref>). * Cannabidiol is also the official INN for the molecule, granted in 2017.<ref>{{Cite journal |last=World Health Organization |date=2017 |title=List of Recommended INNs No. 77 |url=https://cdn.who.int/media/docs/default-source/international-nonproprietary-names-(inn)/rl77.pdf?sfvrsn=c1e6fc91_6&download=true |journal=WHO Drug Information |volume=31 |issue=1 |page=75}}</ref> * Nabilone is the INN for a synthetic cannabinoid analog (not present in ''Cannabis'' plants).
Nabiximols is the generic name (but not recognized as an INN) of a mixture of Cannabidiol and Dronabinol. Its most common form is the oromucosal spray derived from two strains of ''Cannabis sativa'' and containing THC and CBD traded under the brand name Sativex®.<ref name="Svrakic2012" /> It is not approved in the United States, but is approved in several European countries, Canada, and New Zealand as of 2013.<ref name="Borgelt2013" />
{| class="wikitable" |- ! Generic<br />name ! Brand <br /> name(s) ! Country (non-exhaustive) ! Licensed indications |- | Nabilone | Cesamet | rowspan="2" | U.S., Canada | rowspan="2" | Antiemetic (treatment of nausea or vomiting) associated with chemotherapy that has failed to respond adequately to conventional therapy<ref name=Borgelt2013 /> |- | rowspan="2"| Dronabinol |Marinol |- |Syndros | U.S. | Anorexia associated with AIDS–related weight loss<ref name=Borgelt2013 /> |- |Nabiximols |Sativex | Canada, New Zealand,<br />majority of the EU<ref>{{cite journal | vauthors = Abuhasira R, Shbiro L, Landschaft Y | title = Medical use of cannabis and cannabinoids containing products – Regulations in Europe and North America | journal = European Journal of Internal Medicine | volume = 49 | pages = 2–6 | date = March 2018 | pmid = 29329891 | doi = 10.1016/j.ejim.2018.01.001 }}</ref> | Limited treatment for spasticity and neuropathic pain associated with multiple sclerosis and intractable cancer pain.<ref name=Borgelt2013 /> |}
As an antiemetic, these medications are usually used when conventional treatment for nausea and vomiting associated with cancer chemotherapy fail to work.<ref name=Borgelt2013 />
Nabiximols is used for treatment of spasticity associated with MS when other therapies have not worked, and when an initial trial demonstrates "meaningful improvement".<ref name=Borgelt2013 /> Trials for FDA approval in the US are underway.<ref name=Borgelt2013 /> It is also approved in several European countries for overactive bladder and vomiting.<ref name=Svrakic2012 /> When sold under the trade name Sativex as a mouth spray, the prescribed daily dose in Sweden delivers a maximum of 32.4 mg of THC and 30 mg of CBD; mild to moderate dizziness is common during the first few weeks.<ref>{{cite web |url = http://www.fass.se/LIF/product?1&docType=6&specId&userType&nplId=20101019000051 |title = Produkt – FASS Allmänhet |work = fass.se |access-date = 26 December 2013 |archive-date = 19 October 2017 |archive-url = https://web.archive.org/web/20171019170842/http://www.fass.se/LIF/product?1&docType=6&specId&userType&nplId=20101019000051 |url-status = live }}</ref>
Relative to inhaled consumption, peak concentration of oral THC is delayed, and it may be difficult to determine optimal dosage because of variability in patient absorption.<ref name=Borgelt2013 />
In 1964, Albert Lockhart and Manley West began studying the health effects of traditional cannabis use in Jamaican communities. They developed, and in 1987 gained permission to market, the pharmaceutical "Canasol", one of the first cannabis extracts.<ref name="FFY">{{cite web | first=Farid F. | last=Youssef | title=Cannabis Unmasked: What it is and why it does what it does | work=UWIToday | date=June 2010 | url=https://sta.uwi.edu/uwitoday/archive/june_2010/article9.asp | access-date=11 May 2021 | archive-date=17 March 2021 | archive-url=https://web.archive.org/web/20210317175037/https://sta.uwi.edu/uwitoday/archive/june_2010/article9.asp | url-status=live }}</ref>
== See also == {{portal|Cannabis|Medicine}} * Charlotte's Web (cannabis) * Chinese herbology * Tilden's Extract * Zenivol (ZTL-101) * Medicinal uses of fungi
== References == {{Reflist}}
== Further reading ==
{{Refbegin}} * {{cite book | title = The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research | date = 2017 | pmid = 28182367 | doi = 10.17226/24625 | url = http://nationalacademies.org/hmd/reports/2017/health-effects-of-cannabis-and-cannabinoids.aspx | publisher =The National Academies Press | author-link1 = National Academies of Sciences, Engineering, and Medicine | isbn = 978-0-309-45304-2 | last1 = National Academies Of Sciences | first1 = Engineering | last2 = Health Medicine | first2 = Division | author3 = Board on Population Health Public Health Practice | author4 = Committee on the Health Effects of Marijuana: An Evidence Review Research Agenda | access-date = 7 February 2017 | archive-date = 14 July 2020 | archive-url = https://web.archive.org/web/20200714035337/https://www.nationalacademies.org/hmd/Reports/2017/health-effects-of-cannabis-and-cannabinoids.aspx | url-status = live }} {{Refend}}
== External links ==
{{Commons category|Medical cannabis}} , links to websites about medical cannabis * [http://www.cancer.gov/cancertopics/pdq/cam/cannabis/patient Information on Cannabis and Cannabinoids] from the U.S. National Cancer Institute * [http://www.hc-sc.gc.ca/dhp-mps/marihuana/med/infoprof-eng.php Information on cannabis (marihuana, marijuana) and the cannabinoids] from Health Canada * [https://web.archive.org/web/20090327124100/http://www.cmcr.ucsd.edu/geninfo/news.htm The Center for Medicinal Cannabis Research of the University of California] * [http://www.cnn.com/specials/health/medical-marijuana ''Medical Marijuana''] – a 2014–2015 three-part CNN documentary produced by Sanjay Gupta * {{NYTtopic|subjects/m/marijuana|Marijuana and Medical Marijuana}}
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