Medical Marijuana (Cannabis)

Tetrahydrocannabinol (THC), a component of marijuana, acts both centrally and peripherally on endogenous cannabinoid receptors. Activation of cannabinoid receptors affects serotonin release, increases catecholamines, inhibits parasympathetic activity and inhibits prostaglandin biosynthesis.

Marijuana can be used to decrease intraocular pressure, analgesia, anti-vomiting (antiemetic) effects and as an appetite stimulant.

Marijuana is available under the following different brand names: Cannabis, Ganja, Hash, Hashish, Hemp, Mary Jane, Pot, Reefer, and Weed.

The United States (U.S.) Drug Enforcement Administration (DEA) classifies marijuana as a Schedule 1 substance under the Controlled Substances Act (CSA). Schedule I drugs are recognized as having a high potential for abuse with insufficient evidence for safety and efficacy with no currently accepted medical use for treatment in the U.S.

Marijuana is not approved by the U.S. Food and Drug Administration (FDA) for medical use in the U.S. and remains classified as an illicit drug by the DEA. However, several states have adopted individual State Medical Marijuana Laws including: Alaska, California, Colorado, Hawaii, Maine, Maryland, Michigan, Montana, Nevada, New Mexico, Oregon, Rhode Island, Washington, and Vermont.

In October of 2009 the U.S. Justice Department announced that it will no longer enforce federal drug laws on persons who use marijuana for medicinal purposes or their sanctioned suppliers, as long as state laws are followed.

Dosages of Marijuana Should Be Given As Follows:

Oral

• Tincture: 5-15 drops or 1-3 drops of fluid extract.

Inhalation

• 1-3 grains (65-195mg) cannabis for smoking, potency highly variable.
• Drug deteriorates rapidly

Wasting Syndrome (Orphan)

• Treatment of HIV-associated wasting syndrome.

The dosing of marijuana preparations is highly dependent on a variety of factors, including growing and harvesting conditions, plant parts isolated.

Side effects associated with use of marijuana, includes the following:

• Tolerance
• Psychological or physical dependence
• Withdrawal symptoms
• Altered senses
• Dizziness
• Drowsiness (somnolence)
• Fatigue
• Reduced coordination
• Cognitive impairment
• Impaired balance
• Euphoria
• Paranoia
• Hallucinations
• Mood alterations
• Panic
• Anxiety
• Low blood pressure (hypotension)
• High blood pressure (hypertension)
• Rapid heart rate (tachycardia)
• Flushing
• Fainting (syncope)
• Dry mouth (xerostomia)
• Nausea
• Vomiting
• Distortion of taste (dysgeusia)
• Tooth discoloration
• Loss of appetite
• Increased appetite
• Oral thrush
• Diarrhea
• Constipation
• Urinary retention
• Skin rash
• Dry eyes
• Blurred vision
• Cough
• Sore throat (pharyngitis)

If your doctor has directed you to use this medication, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider or pharmacist first.

Drug Interactions

May potentiate CNS depression w/ concomitant use with CNS depressants (e.g., barbiturates, ethanol, anxiolytics, sedatives, and hypnotics, sedating H1-blockers, SSRIs, and TCAs).

Use of marijuana with sedating anticholinergics may result in additive tachycardia and drowsiness.

Other: cocaine, disulfiram, ethanol, protease inhibitors, sildenafil, theophylline, cyclophosphamide, doxorubicin.

Cannabidiol, an inactive constituent of cannabis, may weakly inhibit cytochrome P450 enzymes (CYP1A2, 2C19, 2D6, & 3A4).

Cannabis is also a minor substrate for CYP2C9, 2C19, 2D6, 3A4.

Severe interactions of marijuana include:

• Astemizole
• Cisapride
• Pimozide
• Terfenadine

Marijuana has serious interactions with at least 21 different drugs.

Marijuana has moderate interactions with at least 286 different drugs.

Marijuana has mild interactions with at least 84 different drugs.

This document does not contain all possible interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist. Check with your physician if you have health questions or concerns.

Warnings

This medication contains marijuana. Do not take cannabis, ganja, hash, hashish, hemp, Mary Jane, pot, reefer, or weed, if you are allergic to marijuana or any ingredients contained in this drug.

Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center immediately.

Contraindications

• Hypersensitivity
• Co-administration with dronabinol (Cannabis derivative)

Effects of Drug Abuse

Effects associated with use of marijuana, includes the following conditions: tolerance, psychological or physical dependence, withdrawal symptoms, altered sensorium, dizziness, drowsiness (somnolence), fatigue, reduced coordination, cognitive, impairment, impaired balance, euphoria, paranoia, hallucinations, mood alterations, panic, anxiety, low blood pressure (hypotension), high blood pressure (hypertension), rapid heart rate (tachycardia), flushing, fainting (syncope), dry mouth (xerostomia), nausea, vomiting, distortion of taste (dysgeusia), tooth discoloration, anorexia, increased appetite, oral candidiasis, diarrhea, constipation, urinary retention, skin rash, dry eyes, blurred vision, allergy, cough and sore throat (pharyngitis).

Cautions

Use caution if there is a history of substance abuse or mental illness, hepatic disease, cardiovascular disease, seizure disorder, in use with geriatric patients or when operating machinery or driving. Non-pharmaceutical preparations may be contaminated with fungus, which may be hazardous to patients with compromised immune systems.

Pregnancy and Lactation

There is insufficient data regarding safety to the fetus in pregnancy, therefore avoid use in pregnancy.

THC found in Marijuana is reported to be concentrated and is secreted into breast milk, therefore avoid use when lactating.