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Cannabis

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A bud of BC bud, bud'.
Our secret stash of
Drugs
Icon drugs.svg
Highs and lows
It's good for the flu

Good for asthma,
Good for tuberculosis,

Even…[note 1]
—"Bush Doctor" Peter Tosh, "Legalize It" lyrics (1976)[1]

Cannabis (also commonly known as Marijuana, Weed, Pot, etc.) is a plant (Cannabis spp.) that contains a complex of psychoactive substances, the most notable of these being tetrahydrocannabinol (usually shortened to THC). The primary species used as drugs are C. indica and C. sativa. C. ruderalis, which has a low THC content, has been used in some cross-breeding.[2]

Cannabis woo is an umbrella term for various claims regarding the positive effects of cannabis cultivation and use. These generally fall into three basic areas:

  1. Claims concerning psychoactivity (occasionally extending all the way to Terrence McKennaWikipedia-esque soul-babble)
  2. Health claims (often promoted as a panacea,[3] sometimes amounting to a quack cancer cure)
  3. Ecological claims (positive instead of negative predictions from the same scientific illiterates who detest GMO's)
Map showing legal status of cannabis in the United States
  Legal for recreational use
  Legal for medical use
  Illegal
D=Decriminalized

In the United States, cannabis currently falls into a legal gray-area: it is illegal at the federal level, but it is legal in 24 states (e.g., Colorado) as well as Guam, Washington, D.C., the Northern Mariana Islands, and the U.S. Virgin Islands and decriminalized in another 7. Medical marijuana is fully legal in 14 other states that don't have legal recreational marijuana, as well as in Puerto Rico. Hemp-derived products are federally legal following the passage of the Agriculture Improvement Act of 2018,Wikipedia although states may have their own laws regarding these. So far, the only countries that have legalized recreational use nationwide are Uruguay, Canada, South Africa, Georgia (no, not that one), Malta, Mexico, Thailand, and Luxembourg. In some other countries, such as the Netherlands, it is not legal but it is tolerated. As of late 2023, Netherlands began a trial with legally licencing domestically-grown cannabis.

Cannabis woo has been associated with other types of woo, such as aromatherapy[4] and chakras.[5]

Cannabis enthusiasts claim a startling assortment of things that marijuana is just about the best thing ever for, and none of this is because they want to get high as hell, maaaaan. (Of course, getting high might make you feel like your problems are solved, or alleviated.) Those who choose not to light up, yet have to contend with the stench and the people who get stoned, may be somewhat less starstruck.

Health claims[edit]

Italian advertisement from 1881: Just breathe the smoke of Cannabis indica cigarillos to stop the most violent attacks of asthma, nervous cough, colds, extinction of voice, facial neuralgia, insomnia, and to combat all laryngeal coughs and respiratory ailments.

Health claims, particularly in the medical marijuana jurisdictions, tend towards the dietary supplement realm even though marijuana is not covered by the Dietary Supplement Health and Education Act of 1994 (DSHEA) because it is illegal at the Federal level. Some health claims even have the Quack Miranda Warning,[6][5] which was an unintended byproduct of DSHEA.

Let's start with some background on marijuana chemistry. Relevant chemicals in marijuana fall into two broad classes: cannabinoids (which in plants are specific to the Cannabis genus) and terpenoids (which are widespread in many plants).[7][8] Humans and other animals, produce endocannabinoids, which are different than but in the same chemical class as those cannabinoids found in cannabis. The main psychoactive chemical in marijuana is tetrahydrocannabinol (THC). Another important cannabinoid is cannabidiol (CBD), which is not psychoactive but has many claimed health benefits. Terpenoids in cannabis include ocimene, myrcene, β-caryophyllene, limonene, pinene, myrcene, linalool.

There are two major problems with evaluating medical claims for cannabis:

  1. There is a large variability of the chemical content of cannabis, particularly since cannabis has been bred for different pharmacological properties. From the medical marijuana supplier perspective, this ranges from plants with high-THC/low-CBD to low-THC/high-CBD, as well as variations in terpenoid content.[6][5] These chemicals may have either synergistic or antagonistic effects with regard to a particular medical treatment, so assessing the effectiveness of medical marijuana as a whole is difficult due to the quantitative chemical variability.
  2. In general, the quality of medical evidence forms a scale, or hierarchy of evidence, ranging from in vitro cell studies (lowest evidence) to animal bioassays (in vivo) to human retrospective studies to human prospective studies to meta-analyses and reviews of all direct evidence. It is difficult and expensive to conduct large-scale, long-term human studies, and the ability of researchers to conduct these has often been hampered by illegality of cannabis. Cannabis advocates may make claims based on in vitro studies of single chemicals, but this is never convincing evidence for human health — it is merely suggestive for further research.
  3. "So far, researchers haven't conducted enough large-scale clinical trials that show that the benefits of the marijuana plant (as opposed to its cannabinoid ingredients) outweigh its risks in patients it's meant to treat."[9]

Another problem with research on the medical effects on cannabis is that for the rare cases of US Federal Government-funded research, the cannabis is required to be sourced from the Federal Government.[10] Such cannabis by today's commercial marijuana standards is considered to be low-grade (ditch weed), and is not comparable in terms of chemical content to what most people actually smoke or ingest.[10]

Toxicity[edit]

Cannabis and THC are generally considered to have low toxicity, particularly compared to other recreational drugs. One method of assessing toxicity is using the Margin of Exposure (MOE) method, where MOE = Human exposure / Animal median lethal dose. For example, for alcohol and nicotine, the MOE is low (<10), meaning the risk is high with the exposure dose close to the lethal dose. For THC, the MOE is high (>10,000), meaning the risk of death is low.[11]

It has often been claimed (including by former-Presidential candidate Gary Johnson) that no one has ever died from a marijuana overdose.[12][13] The first problem with this claim is that it does not clearly state whether the lack of mortality is from direct causes (toxicity), or from indirect causes (i.e., from judgment or psychomotor impairment).[13]

Too often individuals cite that individuals haven’t died from cannabis — I don't think that's true. It certainly can be argued that cannabis use has contributed to the deaths of individuals, such as due to impairment during driving.
—Dr. Ryan Vandrey, a researcher at Johns Hopkins University who specializes in the behavioral effects of marijuana[13]

Cannabis has been cited as the sole cause of at least some traffic fatalities.[14][15] After cannabis legalization in Colorado, traffic fatalities in which cannabis was at least partly-responsible increased to 94 in 2014, a not-insignificant number compared to alcohol-related traffic fatalities for that year (170 fatalities).[14] Cannabis does impair judgment, motor coordination, and reaction time,[14][16][17] and its effect on impairment is either additive or synergistic with alcohol.[17]

Cannabis has been associated with at least 7 cases of heart attacks in different people (at least 4 of whom had normal coronary vasculature) and possibly some deaths, and cannabis is known to have several vascular effects that may be causative (e.g., tachycardia, hypertension, bradycardia, and hypotension).[18][19][20][21][22]

Pain and spasticity[edit]

Cannabis depicted in a Byzantine Greek manuscript from 512 CE.

A 2015 review of human studies in The Journal of the American Medical Association found that there was high-quality evidence for treatment of chronic pain, neuropathic pain, and spasticity from multiple sclerosis (MS).[23] The author also concluded that "Medical marijuana is used to treat a host of indications, a few of which have evidence to support treatment with marijuana and many that do not."[23]

A large, multi-faceted literature review by the National Academies of Sciences, Engineering, and Medicine (NASEM) also concluded:[24]

  • In adults with chronic pain, patients who were treated with cannabis or cannabinoids are more likely to experience a clinically significant reduction in pain symptoms.
  • In adults with multiple sclerosis (MS)-related spasticity, short-term use of oral cannabinoids improves patient-reported spasticity symptoms.

The review also concluded that the effects were modest.[24] However, separate studies have shown that US states with medical marijuana have reduced opioid prescriptions[25][26] and 25% fewer opioid-related deaths.[25][27]

Nausea[edit]

A 2015 review of randomized controlled trials in humans found that the majority of the studies were at risk of bias due to not being double blind, or from attrition of test subjects. Nonetheless, the authors concluded that marijuana-based medications may be useful for treating nausea.[28] The NASEM report also concluded, "In adults with chemotherapy induced nausea and vomiting, oral cannabinoids are effective antiemetics," and that the effects were modest.[24]

Glaucoma[edit]

Cannabis treatment for intraocular pressure from glaucoma is widely cited as effective, particularly because the first authorized usage of medical marijuana since its criminalization was based on a court case by Robert Randall in 1976.[29] There is some supporting scientific evidence that cannabis is efficacious for at least some types of glaucoma, based on small studies on humans. The effect on intraocular pressure is relatively brief, and there are other pharmaceutical treatments available for glaucoma that have been tested for safety and efficacy.[30][31] The American Glaucoma Society[32] and the Canadian Ophthalmological Society[33] oppose medical marijuana usage for glaucoma treatment due to extensive adverse effects.[30]

Mental health[edit]

The 2017 NASEM review concluded:[24]

  • Cannabis use is likely to increase the risk of developing schizophrenia and other psychoses; the higher the use the greater the risk.
  • In individuals with schizophrenia and other psychoses, a history of cannabis use may be linked to better performance on learning and memory tasks.
  • Cannabis use does not appear to increase the likelihood of developing depression, anxiety, and posttraumatic stress disorder.
  • For individuals diagnosed with bipolar disorders, near daily cannabis use may be linked to greater symptoms of bipolar disorder than non-users.
  • Heavy cannabis users are more likely to report thoughts of suicide than non-users.
  • Regular cannabis use is likely to increase the risk for developing social anxiety disorder.

Psychosis is associated with cannabis users who favor high THC/low CBD varieties.[34] There is also evidence that psychosis is associated with highly-concentrated forms of marijuana (e.g., "dabs", "shatter" and "wax"), as well as with substances with synthetic cannabinoids (a.k.a., "spice").[34] The erroneous idea that dabs are "safe" has been propagated by parts of the cannabis industry without addressing the known risks of consuming high levels of THC.[35][34]

General[edit]

Claim: "The combination of THC and terpenes modulates each strain to have its own effect, flavor, energy and medical uses."[6]

Research findings: This is sufficiently vague that it is basically true,[36] but not very informative.

Cannabinoids[edit]

Because of the evidence above from studies on whole cannabis, the focus below on specific chemicals will be on claims other than for treatment of pain, nausea, glaucoma, depression and MS. There is reasonable evidence of cannabis efficacy for these claims, though the efficacy regarding a specific chemical may be another matter. Furthermore, the focus below will be on claims regarding specific diseases (e.g. cancer) or implying the treatment of diseases (e.g., anti-proliferative implies cancer treatment), rather than vague disease-related claims (e.g., antimicrobial).

Cannabichromene (CBC)[edit]

Cannabichromene

Claims: treatment of anxiety and stress, anti-viral, cancer, bone growth[37]

Research findings:

  • Anxiety: see above
  • Stress: no studies in PubMed
  • Anti-viral: no studies in PubMed
  • Cancer: CBC had some effect against breast tumors in vitro.[38] The evidence is suggestive for further research.
  • Bone growth: no studies in PubMed

Cannabidiol (CBD)[edit]

See the main article on this topic: CBD
Cannabidiol

Claims: treatment of MS, epilepsy, diabetes (by lowering blood sugar), stress, insomnia[37]

Research findings:

  • Diabetes: CBD was effective in lowering the incidence of diabetes in mice in two studies.[39][40][41] Two studies in humans showed a possible protective effect from marijuana on diabetes onset (association but not necessarily causation).[42][43]
  • Epilepsy: A 2015 review found that purified CBD showed promise in uncontrolled studies, but that controlled studies were lacking. Questions remain about safety and efficacy.[44][45] A 2017 trial study of 120 patients found that children with a type of childhood epilepsy known as Dravet Syndrome had a greater reduction in convulsions when treated with CBD than placebo.[46] In 2018, an FDA panel recommended CBD as the very narrowly defined treatment, specifically for "seizures caused by Lennox-Gastaut syndrome (LGS) and Dravet syndrome in patients aged 2 and older."[47]

There is a lot of interest in potential medical uses of CBD, but as of 2024, treatment of Lennox-Gastaut Syndrome and Dravet Syndrome-type epilepsy, and the only FDA-approved treatment.[48][49]

Cannabidiolic Acid (CBD-A)[edit]

Cannabidiolic Acid

Claims: treatment of inflammation and cancer[37]

Research findings:

  • Cancer: There are a few in vitro studies, so the evidence is only suggestive that more research is needed.[50]

Cannabigerol (CBG)[edit]

Cannabigerol

Claims: stimulates the growth of new brain and bone cells, antibacterial, anti-tumor (cancer), treatment of insomnia[37]

Research findings:

  • Brain growth: Ordinarily, one does not want to stimulate cell growth because it could increase the risk of cancer. The idea that this is a good thing seems to imply that the claimants (Steephill Labs)[37] are referring to Huntington's disease, a progressive disease of the brain that causes degeneration of nerve cells.[51] A CBG derivative — not CBG itself — was tested in mice with a Huntington's-like disease — not Huntington's itself, and the results showed promise.[52] A different study of CBG itself in mice that did not have any disease also showed some neuroprotection.[53] No studies have been conducted on humans, the evidence of CBG being effective on Huntington's is weak.
  • Bone growth: no publications on CBG and bone in PubMed between 1966 and 2023
  • Cancer: a study of CBG on a mouse model of colon cancer (in vivo) showed that CBG hampered tumor progression.[54] No studies have been conducted on humans.
  • Insomnia: No studies in PubMed

Cannabinol (CBN)[edit]

Cannabinol

Claims: treatment of insomnia, nausea and convulsions[37]

Research findings:

  • Insomnia: A 2014 review of cannabinoid administration on sleep found that there were "various effects of cannabinoid administration on several aspects of sleep", and that because of methodological issues, it was not possible to make a conclusion.[55]
  • Convulsions: Only 1 reference was found in the US National Library of Medicine PubMed database (between 1966 and 2016) on CBN and convulsions in humans: a single page in an obscure journal.[56] A study on CBD on induced seizures in rats showed that it was an effective anticonvulsant.[57] One would have to conclude that the evidence is weak.
  • Nausea: see above

Tetrahydrocannabinol (THC)[edit]

(−)-trans9-Tetrahydrocannabinol

Claims: "THC has been shown to be effective in the treatment of a variety of ailments and disorders including pain, tumors (cancer), nausea and ADHD."[37] Kelly Hauf claimed to have cured herself of oligodendroglioma brain cancer by treating herself with cannabis oil.[58] She now runs a website that reports testimonials, a single case study, and in vivo studies. The website is also anti-chemotherapy.[59]

Research findings:

  • Cancer: The best evidence of treatment of cancer with marijuana chemicals is suggestive but not convincing, because it relies on in vitro studies.[60] A phase 1 clinical trial on a THC-CBD mixture for treatment of brain (and spinal cord) tumours is currently underway.[61][62]
  • ADHD: In humans, marijuana exposure to the developing embryo and fetus "is associated "with a plethora of neurobehavioural deficiencies…" There is evidence that the deficiencies are due to THC. The deficiencies include anencephaly, ADHD, memory impairment, and learning disability.[63]
  • Pain: see above

Terpenoids[edit]

α-Bisabolol[edit]

Claims: anti-inflammatory, anti-irritant, antioxidant, anti-microbial, analgesic[64]

β-Caryophyllene[edit]

β-Caryophyllene

Claims: treatment of sepsis and inflammation, infections (bacterial and fungal), alcoholism, and cancer[37][65]

Guaiol[edit]

Claims: antimicrobial, anti-inflammatory[66]

Humulene[edit]

Humulene

Claims: treatment of cancer, infections (bacterial), inflammation, and appetite suppression[37][65]

Research findings:

  • Cancer: A small, short study of injected tumor cells in mice found some inhibitory effects of α-humulene.[67] Given the shortcomings of this study (injected tumors, small number of animals), the relevance to humans is minimal. In vitro studies on humulene have also been conducted.

d-Limonene[edit]

d-Limonene

Claims: treatment of gastric reflux, antibacterial, antifungal, depression, anxiety, and cancer[37][68][69]

Research findings:

  • Gastric reflux: a single, small unpublished study reported positive results in humans.[70] This is not convincing evidence because the study was not peer-reviewed (e.g., the study methods could have been defective, or there could have been bias in the study).
  • Cancer: d-limonene was tested in a small phase I trial and a limited phase II for treatment of cancer patients; effectiveness of the treatment was not reported as only tolerance of d-limonene was tested.[71] d-limonene inhibited a liver carcinogenesis mechanism in vitro,[72][7][8] but this is only suggestive of further research. Furthermore, d-limonene caused kidney tumors in male rats at high doses.[73][74]
  • Depression and anxiety: see above

Linalool[edit]

Linalool

Claims: treatment of insomnia, psychosis, anxiety, epilepsy, depression, and pain[37][64]

Research findings:

  • Psychosis: A 2015 review found that marijuana containing high levels of THC was associated with psychosis in users.[75] Linalool may or may not counteract the psychotic effects of THC, but it would seem to be wise to avoid marijuana (and THC) as a psychosis treatment.
  • Depression and anxiety: see above
  • Pain: see above

β-Myrcene[edit]

β-Myrcene

Claims: treatment of cancer, inflammation, pain, insomnia, infection and spasms[37][64]

Research findings:

  • Cancer: β-Myrcene inhibited a liver carcinogenesis mechanism in vitro,[72][7][8] but this is only suggestive of further research.
  • Pain: see above

trans-Nerolidol[edit]

trans-Nerolidol

Claims: inhibits growth of leishmaniasis, antiparasitic, antifungal, antimicrobial[65]

Research findings:

  • Leishmaniasis: A mixture of cis- and trans-nerolidol was effective at inhibiting the growth of Leishmania spp. in vitro.[76] The results would only warrant further research.

Ocimene[edit]

Claims: antiviral, antifungal, antiseptic, decongestant, antibacterial[66]

α-Pinene[edit]

α-Pinene

Claims: treatment of asthma and inflammation[37]

Terpinolene[edit]

Claims: anticancer, antioxidant, sedative, antibacterial, antifungal[66]

Psychoactive claims[edit]

Claim: God gave us cannabinoid receptors so we could smoke pot all day.[77] "supertiger" argued, "That's right folks, our brains actually have receptors specifically active to THC. Did God create man with cannabinoid receptors to never use them?" and cited Ezekiel 34:29 and Isaiah 18:4-5.[77] This is basically an appeal to nature while asserting that Goddidit.

Reality: Cannibinoid receptors are activated by endocannabinoids,Wikipedia i.e., cannibinoid chemicals that are naturally produced by the human body (e.g. arachidonoylethanolamine). Activation of cannibinoid receptors causes several physiological functions including gastrointestinal activity, cardiovascular activity and bone growth.[78][79]

Human cannabinoid receptors CB1 and CB2

So, why then are there cannabinoids in cannabis; did God put them there because he liked stoners? No. The most likely answer is that wild Cannabis species with higher levels of THC deter grazing by herbivores. Yes, cannabinoids are one of many[80][81][82] natural pesticides produced by plants,[83] just like others — such as caffeine and capsaicin (the active ingredient in chilis) — that we clever apes have found useful and/or enjoyable.

Ecological claims[edit]

Cannabis has sometimes been greenwashed as being particularly ecologically sound, either explicitly[84] or implicitly (e.g., just by associating it with the color "green"). While this may be true of ditch weed (e.g. uncultivated marijuana with low THC/CBD content) or commercial hemp, it is not very likely for what one is likely to purchase for psychoactive and/or medical purposes. Commercial cannabis is either farmed outdoors (often requiring synthetic pesticides), or indoors (requiring large amounts of electricity for lighting). In California, particularly but not exclusively[85] pre-legalization, outdoor marijuana has often been grown illegally on public land, which both deprives the public of access (since it's heavily guarded) and degrades ecosystems with clearing and pollution.[86]

Risks[edit]

Bodily effects of cannabis use.

For many people, knowing the actual risks of cannabis is difficult. On the one hand, there are those who say it is extremely addictive and causes cancer and mental illness; on the other hand, there are those who say it is not addictive and can remedy cancer and mental illness. To add to the confusion, both camps can quote a large amount of scientific literature supporting their claims. There are two main reasons the scientific evidence behind the risks of cannabis can seem so contradictory: first, prohibition makes studying cannabis' effects tricky for researchers, and second, media often report studies that have major implications, but not the many subsequent studies that undermine them. For instance, a recent study that reported cannabis use causes an irreversible and large IQ drop was heavily reported, but the many subsequent studies that failed to replicate its findings were not.[87] This is not just a problem when it comes to cannabis, but all media reporting on science.

It is believed that cannabis is nowhere near as dangerous as heroin or cocaine, and is also much safer than legal drugs alcohol and tobacco. However, there are other illegal drugs, such as psilocybin and LSD, which are considered safer than cannabis.[88]

Adverse effects[edit]

As previously mentioned, cannabis impairs awareness and thus it is very dangerous to drive or operate machinery while under its influence. And while subjective, the smell can be extremely off-putting.

Dependence[edit]

Cannabis dependence occurs in about 20% of cannabis users.[89] Cessation by a dependent user causes withdrawal, usually characterized by anxiety, cravings, low mood, and disturbed sleep. These symptoms usually last a couple of days to a week.[90] Symptoms tend to be mild, comparable to withdrawal symptoms experienced when quitting caffeine. (While this is clearly not a good thing, anyone tempted to cite it as a reason to ban cannabis should compare it to the effects of quitting smokingWikipedia or alcohol.Wikipedia) A meta-analysis of 21,000 people diagnosed with cannabis use disorder (the medical term for cannabis addiction), found that about 50% of the risk associated with cannabis addiction was genetic, the same genetic links that are associated with risk-taking behavior and nicotine addiction.[89][91] Cannabis addiction was also positively correlated with other mental disorders: ADHD, major depression, and schizophrenia, with no evidence found of a causational effect.[91] Also, teenage onset of use is linked to higher levels of dependency (just as with alcohol or nicotine) as well as higher levels of psychiatric disorders.[92][93]

Effect on the young[edit]

Cannabis use during pregnancy "is associated with decreased attention span and behavioral problems." Additionally, children exposed to cannabis in utero also are reported to have "lower scores on tests of visual problem solving, visual-motor coordination, and visual analysis" than children who were not exposed.[94]

Although a 2012 study purported to find that cannabis use in adolescents leads to a drop in IQ, subsequent studies have found no such effect. But a UK study did find a 3% drop in school exams taken at age 16.[87]

Relationship with mental illness[edit]

The link between cannabis use and mental illness is controversial and hotly debated. Cannabis use is associated with anxiety disorders,[95] but not depressive disorders.[96] Correlation does not imply causation, however, especially when cannabis is so heavily associated with relieving stress. Many sufferers of depression and anxiety who self-medicate with cannabis believe it helps them more than many other remedies.

The relationship between cannabis and psychotic illnesses is more controversial and intricate. It is thought that cannabis with a high concentration of THC (i.e. cannabis that is smoked to get high) worsens pre-existing psychotic illnesses,[97] but cannabis with a lower concentration of THC and higher concentration of CBD can help remedy psychosis.[98] It is thought that, for people with a genetic predisposition towards psychotic illness, heavy use of cannabis with a high concentration of THC can "nudge" them into psychosis.[99]

Lung damage[edit]

Smoking cannabis can cause bronchitis episodes.[100] Sharing water pipes and smoking with multiple people in a confined area ("hotboxing") can contribute to the spread of respiratory disease.[101]

If medical marijuana is taken by smoking it, this presents the usual problems from a scientific perspective, that is the harm done to the lungs&nbsp— pot smoke actually contains more "tar" (i.e. aromatic carcinogens like pyrenes) than cigarettes; while usually less smoke is inhaled, whatever smoke is inhaled is inhaled more deeply than cigarette smoke. Cannabis has not been proven to cause lung cancer,[102] but bronchitis among other irritations is quite possible. This particular problem can be reduced or avoided by using a vaporizer or putting the marijuana in food or using consumables such as chocolate containing THC. Also, researchers are working on isolating specific active compounds in order to make them deliverable via pill.[103]

Relationship with cancer[edit]

Perhaps the most hotly-debated risk of cannabis use is its effect on cancer. Like many plants, cannabis contains chemicals that in isolation are tumorigenic[104] and anti-tumorigenic[105] in vitro (in the lab dish): this is not convincing evidence with regard to human health. For example, both aristolochia and coffee contain tumorigenic and anti-tumorigenic chemicals, yet aristolochia is a very potent human carcinogen but coffee improves human health and reduces the risk of some cancers.[106][107]

Due at least in part to the illegality of cannabis, there has been a dearth of large-scale, high quality epidemiology studies on cannabis and cancer.[108] A 2015 review of 34 epidemiologic studies found no clear evidence for head and neck cancers, an association with testicular cancer in three relatively small case-control studies, and insufficient evidence for other cancers.[108] It was noted that the majority of the studies were case-control (retrospective) with inherent study weaknesses, and the authors recommended that a large-scale prospective study be conducted.[108] A 2015 large-scale case-control study of cannabis use and bladder cancer that was not reported in the 2015 review found that cannabis was associated with a reduced incidence of bladder cancer, but no cause-and-effect relationship could be established.[109]

Harm reduction experts have recommended eating or vaporizing cannabis as a way to avoid or minimize possible carcinogenic chemicals in the smoke.[110]

Gateway drug hypothesis[edit]

See the main article on this topic: Gateway drug theory

Flammability[edit]

Regardless of all else, anyone foolish enough to light up in places known to contain large amounts of flammable substances (such as gas stations or in front of racks of propane tanks) is quite literally playing with fire.[citation NOT needed]

Medical marijuana[edit]

Medical marijuana[111] is the use of marijuana for medicinal purposes, largely to relieve conditions such as glaucoma,[note 2] nausea associated with chemotherapy, and appetite loss in AIDS patients. It is well-established to relieve chronic pain[112] without the intense physical dependency that comes with opiates or other CNS depressants. Cannabis has also been shown to assist in management of many gastrointestinal disorders, including Crohn's disease, irritable bowel disorder, and more.[113]

The issue is a hotly contested one (in the United States) because many states have specifically legalized this use of cannabis, while the federal government continues to insist on classifying cannabis as a dangerous "narcotic" with no medical value ("Schedule I"), and criminally prosecuting those who grow, sell, and use the plant.

Pros[edit]

Stoned, but tidy.

A common argument in favour of medical marijuana is a moral one: that the government should not be dictating what an informed person can and cannot put into their own body, and should not be treating those who choose to use one substance or another as criminals. However, see health freedom; depending on who is making the argument, this argument is sometimes the edge of a slippery slope.

While cannabis has many of alternative medicine's anecdotal evidence for symptomatic relief (just ask any pothead about the munchies, regarding use as an appetite stimulant), its effectiveness has also been proven in numerous controlled studies.[113][114][115][116] This even includes the aforementioned munchies.[117]

While cannabis use is not without risk, it is far less dangerous as a medical painkiller than opioids.[118]

In terms of the substances' abilities to cause dependence, the numbers seem superficially similar — about 9% of all marijuana users, medical or recreational, become addicted[90] and about 10% of those prescribed medical opioids become addicted to them.[119] However, the cannabis data is heavily weighted towards recreational users, who are self-selected for substance dependence by the fact that they are using the substance without a legitimate medical need, and also by the fact that in recreational use, cannabis is often mixed with highly addictive drugs like tobacco or alcohol. In comparison, about 80% of heroin addicts have previously been prescribed opioid painkillers,[120] with most of the remaining 20% being the family members of those prescribed medical opioids, showing the potential for opioid addictions to escalate.

In terms of potential lethality to the patient, the effective dose for an opioid to elinate one's pain is only about a tenth of the dose that would eliminate one's pain with cannabis, painkilling effects are experienced at less than a 10000th of the lethal overdose (though smaller overdoses can definitely make one think that one is dying). Doctors in US states with medical marijuana write fewer prescriptions for opioid painkillers.[25][121] In a later separate study, it was found that states with medical marijuana had a 25% lower rate of opioid overdose mortality, and that states with recently implemented medical marijuana laws had decreased opioid mortality over time.[25][122]

Policing of cannabis offences results in disproportionate abuse and incarceration of Black and other minority communities[123] — even the initial illegality of the drug was driven by racism, rather than by any objective medical harms.[124] Unfortunately, it does not necessarily follow that allowing medical use of cannabis will do anything to stop the War on Drugs — while US states where cannabis is legal have varying policies on it,[125] cannabis arrests often still continue, and those profiting from medical marijuana are disproportionately wealthy and white. Some Black activists are sceptical of legalisation for this reason, viewing it as a means to take money out of the pockets of largely poor, Black drug dealers and into the pockets of 27-year-old Harvard grads named Colby. However, many others support it, as a means to end mass incarceration and racism, often along with other policies such as forgiveness of those imprisoned for cannabis offences and social equity programs in the medical marijuana industry. Some of the more recent states to legalize, such as New York and Connecticut, have tried to address these issues with their legalization bills by including measures that assist minority communities that were the most affected by the War on Drugs as well as expunging prior marijuana convictions.[126][127]

Cons[edit]

Medical marijuana is sometimes also associated with alternative medicine and the use of herbs for medicinal purposes. In this case, there is the lack of a controlled, carefully measured dose of the plant's active compounds,[note 3] which can vary widely from plant ot plant.

The issue has implications for those of us who believe much (not necessarily all) of alternative medicine is quackery and woo. Believing that, for example, laetrile is ineffective bullshit does not necessarily mean believing that it should be illegal or that people should be prosecuted for using or selling it in the United States as they currently are. The same goes even more so for medical marijuana, which unlike laetrile does have some scientific studies showing it is effective for treating some specific conditions.[113]

There are potential adverse effects from cannabis, which can be mitigated:

  • Cannabis can be toxic: it has rarely caused death directly, but it can indirectly cause death from cognitive impairment while driving a vehicle.
  • Cannabis can cause a variety of mental disorders.
  • Teenage use of cannabis increases the likelihood of cannabis use disorder as well as psychiatric disorders.
  • Fetal exposure to cannabis from the mother can later reduce the child's visual-motor coordination and visual analysis capabilities.

Mitigations include:

  • Not being under the influence of cannabis while driving or using heavy machinery
  • Avoiding the use of high THC/low CBD varieties of cannabis, and not using concentrates
  • Waiting until after teenage years before using cannabis
  • Not using cannabis while pregnant

See also[edit]

External links[edit]

Notes[edit]

  1. The last "disease" has been variously reported as "numara thrombosis" or "umara composis", but your guess is as good as anyone's. A live version may have been "glaucomia" [sic].[1]
  2. Damage to the optic nerve, leading to eye damage and ultimately blindness.
  3. Not just THC, but CBD, CBN and who knows what else.

References[edit]

  1. Legalize It lyrics
  2. Marijuana Horticulture: The Indoor/Outdoor Medical Grower's Bible by Jorge Cervantes (2006). Van Patten Publishing, 5th ed., p. 12. ISBN 9781878823236.
  3. International Classification of Diseases 9 - CM 1996 Chronic Conditions Treated With Cannabis Encountered Between 1990-2004 by Tod H. Mikuriya, 2004 (The American Alliance for Medical Cannabis).
  4. Terpenes: The Flavors of Cannabis Aromatherapy Leafly: The World's Cannabis Resource
  5. 5.0 5.1 5.2 Patient's Care Collective. The PCC7
  6. 6.0 6.1 6.2 Introducing: The PCC7 system Patient's Care Collective (archived from April 24, 2016).
  7. 7.0 7.1 7.2 Taming THC: potential cannabis synergy and phytocannabinoid-terpenoid entourage effects by Ethan B. Russo (2011) Br. J. Pharmacol. 163(7): 1344–1364. doi: 10.1111/j.1476-5381.2011.01238.x.
  8. 8.0 8.1 8.2 Cannabis and Cannabis Extracts: Greater Than the Sum of Their Parts? by J.M. McPartland & E.B. Russo (2001) J. Cannabis Ther. (3/4):103-132.
  9. Cannabis (Marijuana) Research Report: Is marijuana safe and effective as medicine? National Institute on Drug Abuse.
  10. 10.0 10.1 Government marijuana looks nothing like the real stuff. See for yourself. by Christopher Ingraham & Tauhid Chappell (March 13, 2017) The Washington Post.
  11. Comparative risk assessment of alcohol, tobacco, cannabis and other illicit drugs using the margin of exposure approach by Dirk W. Lachenmeiera & Jürgen Rehm (2015). Scientific Reports 5(8126). doi:10.1038/srep08126.
  12. Here Are All The People Who Have Died From A Marijuana Overdose by Nick Wing (09/03/2013 03:03 pm ET | Updated Sep 04, 2013) Huffington Post.
  13. 13.0 13.1 13.2 Is it true that marijuana hasn't caused any deaths, while prescription drugs have caused 100,000? by Joseph Cariz (August 16th, 2016 at 4:07 p.m.) PolitiFact.
  14. 14.0 14.1 14.2 Unpacking Pot’s Impact in Colorado by Vanessa Schipani (August 19, 2016) FactCheck.org
  15. The Legalization of Marijuana in Colorado: The Impact. Vol. 3 by Kevin Wong & Chelsey Clarke (2015) Rocky Mountain High Intensity Drug Trafficking Area.
  16. Does marijuana use affect driving? (April 2017) National Institute on Drug Abuse.
  17. 17.0 17.1 Cannabis Effects on Driving Skills by Rebecca L. Hartman & Marilyn A. Huestis (2014) Clin. Chem. 59(3):1-25.
  18. Cardiac arrest following cannabis use: a case report by Abdo H Sattout & Mark F Nicol (2009). Cases J. 2:208. doi:10.1186/1757-1626-2-208.
  19. Acute cardiovascular fatalities following cannabis use by L. Bachs & H. Mørland (2001) Forensic Sci. Int. 124(2-3):200-3.
  20. Is recent cannabis use associated with acute coronary syndromes? An illustrative case series. by I. Casier et al. (2014) Acta Cardiol. 69(2):131-6.
  21. Sudden unexpected death under acute influence of cannabis by B. Hartung et al. (2014) Forensic Sci. Int. 237:e11-3. doi:10.1016/j.forsciint.2014.02.001.
  22. 31-Year-Old British Woman Died of “Cannabis Poisoning”? Although this claim is based on official testimony from a pathologist during an inquiry into a mysterious death, scientific evidence makes such an explanation problematic, if not completely untenable. by Alex Kasprak (Jul 30th, 2017) Snopes.
  23. 23.0 23.1 Medical Marijuana for Treatment of Chronic Pain and Other Medical and Psychiatric Problems: A Clinical Review by K. P. Hill JAMA. 2015 Jun 23-30;313(24):2474-83. doi:10.1001/jama.2015.6199.
  24. 24.0 24.1 24.2 24.3 The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research by Committee on the Health Effects of Marijuana: An Evidence Review and Research Agenda; Board on Population Health and Public Health Practice; Health and Medicine Division; National Academies of Sciences, Engineering, and Medicine (2017) The National Academies Press. ISBN 9780309453042.
  25. 25.0 25.1 25.2 25.3 The opioid epidemic spurs a search for new, safer painkillers: Scientists test alternative drugs that relieve pain without the dangers of opioids by Laurel Hamers (1:00pm, May 30, 2017) Science News.
  26. Medical Marijuana Laws Reduce Prescription Medication Use In Medicare Part D by Ashley C. Bradford & W. David Bradford (2006) Health Aff. 35(7):1230-1236. doi:10.1377/hlthaff.2015.1661.
  27. Medical Cannabis Laws and Opioid Analgesic Overdose Mortality in the United States, 1999-2010 by Marcus A. Bachhuber et al. (2014). JAMA Intern. Med. 174(10):1668-1673. doi:10.1001/jamainternmed.2014.4005.
  28. Cannabinoids for nausea and vomiting in adults with cancer receiving chemotherapy by L. A. Smith et al. Cochrane Database Syst Rev. 2015 Nov 12;(11):CD009464. doi: 10.1002/14651858.CD009464.pub2.
  29. Robert Randall, 53; Sued for Marijuana (June 8, 2001) Associated Press via The New York Times.
  30. 30.0 30.1 Marijuana for Glaucoma: A Recipe for Disaster or Treatment? by Xiaoshen Sun et al. Yale J. Biol. Med. 2015 Sep; 88(3):265–269.
  31. A Guide to Glaucoma Medications Glaucoma Research Foundation.
  32. American Glaucoma Society position statement: marijuana and the treatment of glaucoma J. Glaucoma. 2010 Feb;19(2):75-6. doi:10.1097/IJG.0b013e3181d12e39.
  33. Canadian Ophthalmological Society policy statement on the medical use of marijuana for glaucoma Can. J. Ophthalmol. 2010 Aug;45(4):324-6. doi:10.3129/i10-069.
  34. 34.0 34.1 34.2 Traditional marijuana, high‐potency cannabis and synthetic cannabinoids: increasing risk for psychosis by Robin M. Murray et al. (2016) World Psychiatry 15(3):195–204. doi:10.1002/wps.20341.
  35. Are Dabs Bad for You? Side Effects of Dabbing Cannabis Concentrates (Published on July 5, 2021; Last updated August 3, 2022) Leafly.
  36. Taming THC: potential cannabis synergy and phytocannabinoid-terpenoid entourage effects by Ethan B. Russo (2011) Br. J. Pharmacol. 163(7): 1344–1364. doi:10.1111/j.1476-5381.2011.01238.x
  37. 37.00 37.01 37.02 37.03 37.04 37.05 37.06 37.07 37.08 37.09 37.10 37.11 37.12 Steephill Labs: Cannabinoid and terpenoid reference guide
  38. Antitumor activity of plant cannabinoids with emphasis on the effect of cannabidiol on human breast carcinoma by A. Ligresti et al. J. Pharmacol. Exp. Ther. 2006 Sep;318(3):1375-87.
  39. The Endocannabinoid System and Plant-Derived Cannabinoids in Diabetes and Diabetic Complications by Béla Horváth et al. Am. J. Pathol. 2012 Feb; 180(2): 432–442. doi: 10.1016/j.ajpath.2011.11.003.
  40. Cannabidiol lowers incidence of diabetes in non-obese diabetic mice by L. Weiss et al. Autoimmunity 2006 Mar;39(2):143-51.
  41. Neuroprotective and Blood-Retinal Barrier-Preserving Effects of Cannabidiol in Experimental Diabetes by Azza B. El-Remessy et al. Am. J. Pathol. 2006 Jan; 168(1): 235–244.
  42. The impact of marijuana use on glucose, insulin, and insulin resistance among US adults E. A. Penner et al. Am. J. Med. 2013 Jul;126(7):583-9. doi: 10.1016/j.amjmed.2013.03.002.
  43. Decreased prevalence of diabetes in marijuana users: cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) III by T. B. Rajavashisth et al. BMJ Open 2012 Feb 24;2:e000494. doi: 10.1136/bmjopen-2011-000494.
  44. Marijuana Use in Epilepsy: The Myth and the Reality by Kamil Detyniecki & Lawrence Hirsch. Curr Neurol. Neurosci. Rep. 2015 Oct;15(10):65. doi: 10.1007/s11910-015-0586-5.
  45. Cannabidiol in the Treatment of Epilepsy by Randi von Wrede et al. (2021) Clin. Drug Investig. 41(3):211–220. doi:10.1007/s40261-021-01003-y.
  46. Trial of Cannabidiol for Drug-Resistant Seizures in the Dravet Syndrome by Orrin Devinsky et al. (2017). N. Engl. J. Med. 376:2011-2020. doi:10.1056/NEJMoa1611618.
  47. FDA committee recommends first CBD product: Approval would be the first product actually demonstrated to work by Maggie Fox (Apr.19.2018 / 10:51 AM ET / Updated 4:37 PM ET) NBC News.
  48. FDA Regulation of Cannabis and Cannabis-Derived Products, Including Cannabidiol (CBD) U.S. Food & Drug Admministration.
  49. The CBD boom is way ahead of the science: Strict regulations have stunted research on cannabidiol, but that hasn’t hampered product popularity by Laura Sanders (6:00am, March 27, 2019) Science News.
  50. Down-regulation of cyclooxygenase-2 (COX-2) by cannabidiolic acid in human breast cancer cells by S. Takeda et al. J. Toxicol. Sci. 2014;39(5):711-6.
  51. Mayo Clinic: Huntington's disease
  52. VCE-003.2, a novel cannabigerol derivative, enhances neuronal progenitor cell survival and alleviates symptomatology in murine models of Huntington's disease by J. Díaz-Alonso et al. Sci. Rep. 2016 Jul 19;6:29789. doi: 10.1038/srep29789.
  53. Neuroprotective properties of cannabigerol in Huntington's disease: studies in R6/2 mice and 3-nitropropionate-lesioned mice by S. Valdeolivas et al. Neurotherapeutics. 2015 Jan;12(1):185-99. doi: 10.1007/s13311-014-0304-z.
  54. Colon carcinogenesis is inhibited by the TRPM8 antagonist cannabigerol, a Cannabis-derived non-psychotropic cannabinoid by E. Borrelli et al. Carcinogenesis. 2014 Dec;35(12):2787-97. doi: 10.1093/carcin/bgu205.
  55. The effects of cannabinoid administration on sleep: a systematic review of human studies by P. J. Gates et al. Sleep Med. Rev. 2014 Dec;18(6):477-87. doi: 10.1016/j.smrv.2014.02.005.
  56. Anticonvulsant effect of cannabidiol by F. R. Ames & S. Cridland. S. Afr. Med. J. 1986 Jan 4;69(1):14.
  57. Cannabidiol—antiepileptic drug comparisons and interactions in experimentally induced seizures in rats by P. Consroe & A. Wolkin. J. Pharmacol. Exp. Ther. 1977 Apr;201(1):26-32.
  58. Cure Your Own Cancer
  59. Cure Your Own Cancer: Chemo Kills
  60. The antitumor activity of plant-derived non-psychoactive cannabinoids by Sean D. McAllister et al. J. Neuroimmune Pharmacol. 2015 Jun; 10(2): 255–267.
  61. Is cannabis a treatment for brain tumours? Cancer Research UK
  62. A trial looking at Sativex with temozolomide for glioblastoma multiforme brain tumour (GWCA1208) Cancer Research UK
  63. Marijuana, Spice 'herbal high', and early neural development: implications for rescheduling and legalization by Delphine Psychoyosa & K. Yaragudri Vinod. Drug Test Anal. 2013 Jan; 5(1): 27–45. doi:10.1002/dta.1390.
  64. 64.0 64.1 64.2 Myrcene, Linalool, and Bisabolol: What are the Benefits of These Cannabis Terpenes? Leafly: The World's Cannabis Resource
  65. 65.0 65.1 65.2 Cannabis Terpenes: The Benefits of Humulene, Caryophyllene, and Trans-Nerolidol Leafly: The World's Cannabis Resource
  66. 66.0 66.1 66.2 Benefits of Cannabis Terpenes: Ocimene, Terpinolene, and Guaiol Leafly: The World's Cannabis Resource
  67. Antitumor Properties of the leaf essential oil of Zornia brasiliensis by E. V. Costa et al. Planta Med. 2015 May;81(7):563-7. doi: 10.1055/s-0035-1545842.
  68. What is Limonene and What are the Benefits of This Cannabis Terpene? Leafly: The World's Cannabis Resource
  69. The Best Cannabis Strains for Treating Depression by Bailey Rahn. Leafly: The World's Cannabis Resource
  70. Gastroesophageal Reflux Disease (GERD): A Review of Conventional and Alternative Treatments Lyn Patrick Altern. Med. Rev. 2011 Jun;16(2):116-33.
  71. Phase I and pharmacokinetic study of D-limonene in patients with advanced cancer. Cancer Research Campaign Phase I/II Clinical Trials Committee by D. M. Vigushin et al. Cancer Chemother Pharmacol. 1998;42(2):111-7.
  72. 72.0 72.1 In vitro inhibition of CYP2B1 monooxygenase by beta-myrcene and other monoterpenoid compounds by A. C. De Oliveira et al. Toxicol. Lett. 1997 Jun 16;92(1):39-46.
  73. Carcinogenic Potency Project: d-Limonene (archived from September 10, 2015).
  74. Toxicology and Carcinogenesis Studies OF d-Limonene (CAS NO. 5989-27-5) in F344/N Rats AND B6C3F1 Mice (Gavage Studies) National Toxicology Program (1990).
  75. The adverse health effects of synthetic cannabinoids with emphasis on psychosis-like effects by Jan GC van Amsterdam et al. Journal of Psychopharmacology 29(3) January 2015 DOI: 10.1177/0269881114565142.
  76. Antileishmanial activity of the terpene nerolidol by D. C. Arruda et al. Antimicrob. Agents Chemother. 2005 May;49(5):1679-87.
  77. 77.0 77.1 Why marijuana is truly God's gift to heal the nations Weedmaps (archived from August 19, 2017).
  78. Activated endocannabinoid system in coronary artery disease and antiinflammatory effects of cannabinoid 1 receptor blockade on macrophages by Sugamura K. et a. (2009)Circulation. 119 (1): 28–36. doi:10.1161/CIRCULATIONAHA.108.811992. PMID 19103987.
  79. Peripheral cannabinoid receptor, CB2, regulates bone mass by Ofek O. et al. (January 2006). Proc. Natl. Acad. Sci. U.S.A. 103 (3): 696–701. doi:10.1073/pnas.0504187103. PMC 1334629free to read. PMID 16407142
  80. Promising Directions of Study in Tropical Animal-Plant Interactions Daniel H. Janzen, Annals of the Missouri Botanical Garden Vol. 64, No. 4, Perspectives in Tropical Botany (1977), pp. 706-736.
  81. Dietary pesticides (99.99% all natural) by Bruce N. Ames, Margie Profet, and Lois Swirsky Gold (1990)Proceedings of the National Academy of Sciences USA 87: 7777-7781 (archived from August 1, 2014).
  82. Rodent carcinogens: Setting priorities by L. Swirsky Gold, Thomas H. Slone, Bonnie R. Stern, Neela B. Manley, and Bruce N. Ames (1992) Science 258: 261-265 (archived from November 29, 2014).
  83. The Drug Library: Cannabis as repellent and pesticide by John M. McPartland
  84. The Ecological Benefits of Marijuana Alan W. Bock
  85. California is changing how it goes after illegal cannabis farms: Here's what California counties had the most illegal cannabis plants in 2022 by Kurt Snibbe (April 16, 2023) Orange County Register.
  86. Illegal marijuana cultivation is devastating California's public lands by Christi Turner (March 6, 2014) High Country News.
  87. 87.0 87.1 No, marijuana use doesn’t lower your IQ by Christopher Ingraham (October 22, 2014 at 10:39 a.m. EDT) The Washington Post.
  88. Drug harms in the UK: a multicriteria decision analysis by David J. Nutt et al. (2010) Lancet 376:1558–65. doi:10.1016/S0140-6736(10)61462-6.
  89. 89.0 89.1 I’m a marijuana enthusiast, but weed is getting a pass on health issues by Frances Story (December 26, 2023 at 5:45 a.m. EST) The Washington Post.
  90. 90.0 90.1 What has research over the past two decades revealed about the adverse health effects of recreational cannabis use? by Wayne Hall (2015) Addiction 110(1):19–35. doi:10.1111/add.12703 (archived from October 18, 2014.
  91. 91.0 91.1 A large-scale genome-wide association study meta-analysis of cannabis use disorder by Emma C. Johnson et al. (2020) Lancet Psychiatry 7(12):1032–1045. doi:10.1016/S2215-0366(20)30339-4.
  92. Recreational Cannabis Use By Teens Linked to Risk of Depression, Suicidality (May 5, 2023) Columbia University Department of Psychiatry.
  93. Nondisordered Cannabis Use Among US Adolescents by Ryan S. Sultan et al. (2023) JAMA Network Open 6(5):e2311294. doi:10.1001/jamanetworkopen.2023.11294.
  94. Marijuana Use During Pregnancy and Lactation Committee Opinion Number 722 (October 2017) American College of Obstetricians and Gynecologists.
  95. A positive association between anxiety disorders and cannabis use or cannabis use disorders in the general population- a meta-analysis of 31 studies by Karina Karolina Kedzior & Lisa Tabata Laeber (2014) BMC Psychiatry 14(136). doi:10.1186/1471-244X-14-136.
  96. Cannabis Use during Adolescent Development: Susceptibility to Psychiatric Illness by Benjamin Chadwick et al. (2013) Front. Psychiatry 4(129) doi:10.3389/fpsyt.2013.00129.
  97. Social Functioning Trajectories of Young First-Episode Psychosis Patients with and without Cannabis Misuse: A 30-Month Follow-Up Study by César González-Blanch et al. (April 7, 2015) PLoS ONE doi:10.1371/journal.pone.0122404.
  98. Does Cannabidiol Protect Against Adverse Psychological Effects of THC? by Raymond J. M. Niesink (2013) Front. Psychiatry 4:130. doi:10.3389/fpsyt.2013.00130.
  99. Proportion of patients in south London with first-episode psychosis attributable to use of high potency cannabis: a case-control study by Marta Di Forti et al. (2015) Lancet Psychiatry 2(3):233-238. doi:10.1016/S2215-0366(14)00117-5.
  100. Marijuana Use And Chronic Bronchitis by Christine Kingsley, Lung Institute.
  101. Legalizing Cannabis: A physician's primer on the pulmonary effects of marijuana by Denyse Lutchmansingh (2014) Curr. Respir. Care Rep. 3(4):200-205. doi:10.1007/s13665-014-0093-1.
  102. Study Finds No Cancer-Marijuana Connection by Marc Kaufman (May 26, 2006) The Washington Post.
  103. Marinol (Rev Sep 2004) U.S. Food & Drug Administration. In fact, pharmaceutical-grade THC has been sold under the brand name Marinol for a while.
  104. Does smoking cannabis cause cancer? Cancer Research UK (archived from July 29, 2012).
  105. Cannabis and Cannabinoids (PDQ®)–Patient Version: Antitumor activity National Cancer Institute.
  106. Some Traditional Herbal Medicines, Some Mycotoxins, Naphthalene and Styrene. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, Volume 82 (2002) World Health Organization, International Agency for Research on Cancer.
  107. Coffee, Caffeine, and Health Outcomes: An Umbrella Review by Giuseppe Grosso et al. (2017) Annual Review of Nutrition 37:131-156.
  108. 108.0 108.1 108.2 An Epidemiologic Review of Marijuana and Cancer: An Update by Yu-Hui Jenny Huang et al. (2015) Cancer Epidemiology, Biomarkers & Prevention 24(1):15–31. DOI:10.1158/1055-9965.EPI-14-1026.
  109. Association between cannabis use and the risk of bladder cancer: results from the California Men's Health Study by A. A. Thomas et al. (2015) Urology 85(2):388-92. DOI:10.1016/j.urology.2014.08.060.
  110. Cannabis / Marijuana Drugscience (archived from November 9, 2015).
  111. NIH page on medical marijuana
  112. Medical Marijuana for Treatment of Chronic Pain & Other Medical and Psychiatric Problems: A Clinical Review by Kevin P. Hill (2015) JAMA 313(24):2474-2483. doi:10.1001/jama.2015.6199.
  113. 113.0 113.1 113.2 Cannabinoids for Medical Use: A Systematic Review and Meta-analysis by Penny F. Whiting et al. (2015) JAMA 313(24):2456-2473. doi:10.1001/jama.2015.6358.
  114. Cannabis (medical marijuana) treatment for motor and non-motor symptoms of Parkinson disease: an open-label observational study (Clin Neuropharmacol. 2014 Mar-Apr;37(2):41-4. doi: 10.1097/WNF.0000000000000016.)
  115. The case for medical marijuana in epilepsy (Epilepsia. 2014 Jun;55(6):783-6. doi: 10.1111/epi.12610. Epub 2014 May 22)
  116. Medical marijuana in neurology by Itay Lotan (2014) Expert Rev. Neurother. 14(12):1453-65. doi:10.1586/14737175.2014.985209.
  117. A pilot study of the effects of cannabis on appetite hormones in HIV-infected adult men by Patricia K. Riggs et al. (2012) Brain Res. 1431:46-52. doi:10.1016/j.brainres.2011.11.001.
  118. Ranking the Harm of Psychoactive Drugs Including Prescription Analgesics to Users and Others – A Perspective of German Addiction Medicine Experts by Udo Bonnet et al. (2020) Front. Psychiatry 11:592199. doi:10.3389/fpsyt.2020.592199.
  119. Rates of opioid misuse, abuse, and addiction in chronic pain: a systematic review and data synthesis by Kevin E. Vowles (2015) Pain 156(4):569-576. doi:10.1097/01.j.pain.0000460357.01998.f1.
  120. [Predicting high-risk opioid prescriptions before they are given by Justine S. Hastings et al. (2020) PNAS 117(4):1917-1923. doi:10.1073/pnas.1905355117.
  121. Medical Marijuana Laws Reduce Prescription Medication Use In Medicare Part D by Ashley C. Bradford & W. David Bradford (2006) Health Aff. 35(7):1230-1236. doi:10.1377/hlthaff.2015.1661.
  122. Medical Cannabis Laws and Opioid Analgesic Overdose Mortality in the United States, 1999-2010 by Marcus A. Bachhuber et al. (2014). JAMA Intern. Med. 174(10):1668-1673. doi:10.1001/jamainternmed.2014.4005.
  123. [The Race/Ethnicity Disparity In Misdemeanor Marijuana Arrests In New York City by Andrew Golub et al. (2007) Criminol. Public Policy 6(1):131–164. doi:10.1111/j.1745-9133.2007.00426.x
  124. Racism and Its Effect on Cannabis Research by Robert Solomon (2020) Cannabis Cannabinoid Res. 5(1): 2-5. doi:10.1089/can.2019.0063.
  125. The United States of Weed: Curious about the status of cannabis? Here’s where legalization stands, state by state by Ryan Bort et al. (April 18, 2023) Rolling Stone.
  126. New York legalizes US’s most progressive recreational weed market: Records will be expunged, 50% of licences will go to equity applicants and corporate cannabis will be limited under a bill signed Wednesday by Gov. Cuomo by Jared Gnam (31 March 2021) Mugglehead Magazine.
  127. Recreational Cannabis is Legal in Connecticut: What to Know About Getting into the Business by Andrew Glassman (9 July 2021) JDSUPRA.