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SOURCE

Source: Doering PL, Li RM. Substance-related disorders I: overview and depressants, stimulants, and hallucinogens. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach. 10th ed. New York, NY: McGraw-Hill; 2017. https://accesspharmacy.mhmedical.com/content.aspx?bookid=1861&sectionid=146064131. Accessed September 25, 2018.

CONDITION/DISORDER SYNONYMS

  • The principal psychoactive component of marijuana is THC.

    • Hashish, the dried resin of the top of the plant, is much more potent than the plant itself.

  • Synthetic cannabinoids

    • “K2”

    • “Spice”

    • “Aroma”

    • “Mr. Smiley”

    • “Zohai”

    • “Eclipse”

    • “Black Mamba”

    • “Red X Dawn”

    • “Blaze”

    • “Dream” 

DEFINITION

  • The Liaison Committee on Pain and Addiction, a collaborative effort of the American Academy of Pain Medicine, the American Pain Society, and the American Society of Addiction Medicine (ASAM), developed definitions related to the use of medications for the treatment of pain consistent with current understanding of relevant neurobiology, pharmacology, and appropriate clinical practice.

  • Substance-related disorders include disorders of

    • Addiction is a primary, chronic, neurobiologic disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations. It is characterized by behaviors that include one or more of the following five Cs: chronicity, impaired control over drug use, compulsive use, continued use despite harm, and craving.

    • Drug abuse is a maladaptive pattern of substance use characterized by repeated adverse consequences related to the repeated use of the substance.

    • Physical dependence is a state of adaptation that is manifested by a drug class–specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist.

    • Tolerance is a state of adaptation in which exposure to a drug induces changes that result in a diminution of one or more of the drug’s effects over time.

PATHOPHYSIOLOGY

  • Marijuana’s effect begins immediately after the drug enters the brain and last 1–3 hours.

  • If marijuana is consumed in food or drink, the short-term effects begin more slowly, usually within 30 min to 1 hour, and last longer, for as long as 4 hours.

  • Smoking marijuana delivers several times more of its major active ingredient, Δ-9-tetrahydrocannabinol (THC) into the blood than does eating or drinking the drug. 

EPIDEMIOLOGY

  • Most commonly used illicit drug in the United States

  • An estimated 22.2 million Americans aged 12 or older in 2014 were current users of marijuana.

  • The percentage of people aged 12 or older who were current marijuana users in 2014 was higher than the percentages from 2002 to 2013.

  • It is estimated that 3.8% of the world’s population used cannabis in the last year.

  • 1 in 10 marijuana users will become addicted to the drug.

RISK FACTORS

  • Exposure to marijuana at a young age

    • Developing brains are especially susceptible to all of the negative effects of marijuana and ...

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