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Quit Marijuana The Complete Guide Summary


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Cannabis and related disorders

Cannabis, more commonly called marijuana, refers to the several varieties of Cannabis sativa, or Indian hemp plant, that contains the psychoactive drug delta-9-tetrahydrocannabinol (THC). Cannabis-related disorders refer to problems associated with the use of substances derived from this plant. -o Amotivational syndrome Loss of ambition associated with chronic cannabis (marijuana) use. S2 Cannabis The collective name for several vari-b Cannabis abuse Periodic use of cannabis, less serious than dependence, but still capable of causing problems for the user. Cannabis dependence The compulsive need to use cannabis, leading to problems. Cannabis intoxication The direct effects of acute cannabis use and the reactions that accompany those effects. Delta-9-tetrahydrocannabinol(THC) The primary active ingredient in marijuana. Endocannabinoids Cannabis-like compounds produced naturally in the human body. Hashish The dark, blackish resinous material that exudes from the leaves of the Indian...


The Cannabis sativa plant and its close relatives are used to make hashish and marijuana, which are illicit and psychoactive substances with widespread consumption in society. The major active compound in these substances is tetrahydrocannabinol (THC), although marijuana is a heterogeneous mixture of chemicals. Many ophthalmologists who care for glaucoma patients have been asked by their patients about the ocular hypotensive effect of marijuana and its potential for therapy of glaucoma. Ocular effects of marijuana include decrease in pupillary size with preservation of normal responsiveness to light, decrease in tear secretion, conjunctival hyper-emia, and decrease in IOP.54 In one study, IOP was reduced in 9 of 11 normal subjects, with a mean decrease of 25 , 1 hour after pipe smoking 2 g of marijuana containing approximately 18 mg THC.55 When patients with ocular hypertension or glaucoma were tested, 7 of 11 showed a reduction in IOP averaging 30 .56 In 31 glaucomatous eyes in 18...

Mental Illness and Substance Abuse

Homeless adolescents also have very high rates of mental health problems and substance abuse. In a study from Seattle, 83 of street youths had been physically and or sexually victimized after leaving home, and 18 met criteria for posttraumatic stress disorder (Stewart, et al., 2004). Across the U.S., 55 of street youth and 34 of shelter youth had used illicit drugs other than marijuana since leaving home, in comparison to 13 of youth who had never been runaway or homeless (Greene, et al., 1997). Street youth use a wide range of drugs, including hallucinogens, amphetamines, sedative tranquilizers, inhalants, cocaine, and opiates. Unfortunately, the initiation of injection drug use is quite common, with an incidence rate of 8.2 per 100 person-years among street youth in Montreal (Roy, et al., 2003).

Mesopotamian Medicine

Of the 30,000 clay tablets with cuneiform writing that were recovered in the library at Ninevah from ca 2000 BC, 800 are related to medical matters. The medical armamentarium of Sumerian physicians consisted of more than 120 minerals and 250 herbs including cannabis, mustard, mandragora, belladonna, and henbane (45). A terracotta statuette showing enormously fat thighs and arms was found at Susa in the middle Elamite period in the 12th century BC (46,47), indicates the continuing representation of obesity in artifacts of the female body.

Drug Use Epidemiology

According to the 2002 NSDUH, approximately 108 million persons over age 12 had used an illicit drug in their lifetime and in the U.S. 35.1 million had used an illicit drug in the past year (Substance Abuse and Mental Health Services Administration and Office of Applied Studies, 2003b). The most frequently reported illicit drug used was marijuana (40.4 reported lifetime use, 11.0 past year use). In terms of lifetime use, cocaine and hallucinogens were also quite prevalent (14.4 and 14.6 , respectively), while amphetamines (9.0 ) and heroin (1.6 ) were less so. In 2003, drug use was especially prevalent among adolescents. According to 2003 estimates from the MTF Study, a study of public and private high school and middle school students in the U.S., 51.1 of high school seniors had used an illicit drug in their lifetime and 39.3 had used an illicit drug in the last year (Johnston, et al., 2004). In terms of lifetime use, the most commonly reported illicit drug was marijuana (46.1 ),...

Drug Use And Urban Environments

Another analysis of the MTF data suggested temporal changes in urban versus rural differences between 1976 and 1992 (Cronk and Sarvela, 1997). During the late 1970s and 1980s, rates of marijuana and cocaine use were higher among urban than rural adolescents. However, by the early 1990s use of these drugs among rural adolescents matched or exceeded those of their urban counterparts. Data from the National Survey on Drug Use and Health (table 2) reveals different trends for persons over the age of 18 (Substance Abuse and Mental Health Services Administration and Office of Applied Studies, 2004). Large metropolitan counties (defined as having one million or more residents) had higher lifetime and annual rates of marijuana, inhalant, hallucinogen, and cocaine use as compared to small metropolitan counties (defined as having less than one million residents) and non-metropolitan counties (defined as urbanized, less urbanized and rural counties). With the findings from the MTF study, this...

History of substance use

Ask about the use of alcohol, smoking and other drugs (e.g. marijuana, cocaine, opiates, sedative-hypnotic agents, stimulants, solvents, and hallucinogens). Ask when it was first used, the amounts consumed and the routes of administration. Is there any evidence of dependence (craving, tolerance, inability to stop or control use, physiological withdrawal state, drug-related harm, reduction of interests and activities unrelated to drug use) Ask about periods of abstinence and related offences.

Psychiatric and physical complications

A typical case would be a young person with a chronic psychotic illness, precipitated and maintained by cannabis use. It may strike the patient as unfair that he should be advised against this drug, which his friends can perhaps take without apparent ill effect. However, cannabis is undeniably a potent exacerbating factor in psychosis. The government has also confused the issue recently, downgrading the legal classification of cannabis, and issuing unclear guidance as to how the police should deal with a person possessing it. In fact, it remains illegal and harmful, especially to psychiatric patients.

Experimental Assessment Of Truth

The randomized response technique (RRT) was first suggested by Warner (1965). He based his technique on the notion that arguably the most promising method to encourage honest responding in surveys is to collect data anonymously To credibly ensure respondents' anonymity, Warner directed the respondents to answer to one of two logical opposites, depending on the outcome of a randomizing device that selects the question to be answered with probability p and (1 - p), respectively. For example, a randomized response survey may consist of the following set of questions pertaining to a stigmatized Group A (which may consist, e.g., of tax evaders or marijuana consumers)

Psychological and social effects

Cannabis usually produces sedation, but it can exaggerate an unpleasant pre-existing mood state of anger, depression, or anxiety. Psychotic symptoms, including perceptual distortions, visual hallucinations, and confusion, can occur. The use of cannabis is often implicated in worsening the clinical course of schizophrenia, precipitating onset or relapse and retarding recovery. Sustained

Poststabilization Patient Assessment

One test that is unlikely to be of benefit in evaluating potential victims of toxin-related disasters is the toxicology screen. Such screens typically test for drugs of abuse (cocaine, amphetamines, LSD, PCP, marijuana), which are unlikely to be used in terrorist attacks. Even a positive result would be unhelpful, as it would likely be an incidental finding. The toxicology screen, therefore, really has no role in the routine management of poisoned patients in the disaster setting.

Trial Judges as Decision Makers

Trial judges, as human beings, reflect their own past experiences, assumptions, and biases, when 'filling in the gaps' and forming a story to explain a defendant's actions. It is true that trial judges have only rarely been placed in experimental situations as subjects of psychological research. What we do know from a limited number of studies is that judges, like jurors, may have widely differing verdicts in response to identical information. Austin and Williams (1977) asked district court judges (i.e. trial judges) in the state of Virginia to respond to the same hypothetical cases by recommending a verdict and sentence. In the case involving the charge of possession of marijuana by a minor, 29 of the judges concluded the defendant was not guilty and 18 concluded that she was guilty. The sentences given by the latter 18 judges ranged from probation (eight judges) to a fine, to a jail term (three judges).

The Logic Of Classification

Due to accidents of history, certain other psychoactive substances and products do not fall into this pattern and are covered by legislation outwith the Misuse of Drugs Act, most notably alcohol and tobacco. It is worth noting however that there is little consensus over time, or in terms of geography, about what the most dangerous and least dangerous drugs are. Alcohol is forbidden in many middle-Eastern countries on the other hand, there have been recent moves in the UK to reclassify cannabis a substance described by the US Drugs Commissioner Harry Anslinger in the 1950s as one of the most dangerous and addictive substance known to mankind (Anslinger and Tomkins, 1953, pp. 21-22) from Class B to Class C. On the other hand, two reports on smoking by the US Surgeon General (1982, 1988) saw nicotine reclassified from the status of a non-addictive drug in 1982 to being comparable in addictive potential to heroin and cocaine by the time of the second report in 1988 (p. 9). Meanwhile,...

Substance abuse and related disorders

Substance-related disorders are disorders of intoxication, dependence, abuse, and substance withdrawal caused by various substances, both legal and illegal. These substances include alcohol, amphetamines, caffeine, inhalants, nicotine, prescription medications that may be abused (such as sedatives), opioids (morphine, heroin), marijuana (cannabis), cocaine, hallucinogens, and phencyclidine (PCP). cannabis-related disorders See also Addiction Alcohol and related disorders Amnestic disorders Amphetamines and related disorders Antianxiety drugs and abuse-related disorders Caffeine and related disorders Cannabis and related disorders Cocaine and related disorders Denial Disease concept of chemical dependency Hallucinogens and related disorders Inhalants and related disorders Nicotine and related disorders Opioids and related disorders Phencyclidine and related disorders Polysubstance dependence Sedatives and related disorders Substance Abuse Subtle

Causes and symptoms

A substance-induced psychotic disorder, by definition, is directly caused by the effects of drugs including alcohol, medications, and toxins. Psychotic symptoms can result from intoxication on alcohol, amphetamines (and related substances), cannabis (marijuana), cocaine, hallucinogens, inhalants, opioids, phencyclidine (PCP) See also Alcohol and related disorders Amphetamines and related disorders Antianxiety drugs and abuse-related disorders Cannabis and related disorders Cocaine and related disorders Hallucinogens and related disorders Inhalants and related disorders Opioids and related disorders Phencyclidine and related disorders Psychosis Sedatives and related disorders Substance abuse and related disorders Substance-induced anxiety disorders

Syndromes That Mimic Recurrence

Bleomycin Patients

Modest elevations of circulating human chorionic gonadotropin (hCG) can be nonspecific, and fluctuations that do not progressively increase may be difficult to interpret. False-positive elevations can occasionally be seen owing to radioimmunoassay cross reactivity with luteinizing hormone (LH)11 or in association with marijuana use12 although these phenomena are much less frequent since the introduction of the beta-subunit assay into routine clinical practice. In hypogonadal patients, administration of exogenous testosterone can lower circulating LH levels by feedback inhibition when cross reactivity is suspected.13 Restaging and further evaluation should be considered if hCG levels remain high despite the approaches mentioned above.1415

Reward Deficiency Syndrome

Individuals tend to be at risk of multiple addictive, impulsive and compulsive behavioural problems, such as severe alcoholism, cocaine, heroin, marijuana and nicotine addiction, pathological gambling, sex addiction, chronic violence, posttraumatic stress disorder, risk taking behaviours and antisocial behaviour. As such, the use of tyrosine as a precursor to dopamine has a theoretical basis for use in this condition (Blum etal 2000).


Month prior to the survey, and the chances of receiving a diagnosis of substance abuse or dependence at some point in one's life is 16.7 for people over age 18. The lifetime chances of developing alcohol abuse or dependence is 13.8 for nonalcohol substances, 6.2 . As of 1995, 6.1 of the population age 12 and older currently used illicit drugs. The most commonly used substances are alcohol and cigarettes, as well as marijuana, hashish, and cocaine. Unfortunately, substance abuse has been on the rise among children and adolescents since 1993. related disorders Cannabis and related disorders Denial Disease concept of chemical dependency Dual diagnosis Internet addiction disorder Nicotine and related disorders Opioids and related disorders Relapse and relapse prevention Sedatives and related disorders Self-help groups Substance abuse and related disorders Support groups Wernicke-Korsakoff syndrome

Brain biochemistry

Other evidence supporting a role for dopamine includes the fact that drugs, such as amphetamines, which stimulate dopamine, can precipitate a schizophrenia-like condition (amphetamine psychosis). This point is somewhat vitiated, however, by the fact that such conditions can also be produced by other illicit drugs, including cannabis and LSD, which affect different neurotransmitter systems.

Communicable Disease

Behavioral studies including immigrant populations also indicate the need for health care providers to screen patients for risk behaviors in order to determine the need for additional counseling and or testing and treatment. A survey study of 1,789 students at two high schools in northern California during 1988 and 1989 found that the mean number of risk behaviors was highest among latino immigrant students, as compared with native-born latinos and native non-latino white students (Brindis, et al., 1995). Eight different risk behaviors had been included in the assessment the use of alcohol, marijuana, cigarette, and other illicit substances self-violence drunk driving unintended pregnancy and violence. Rates of sexual activity were particularly high among the immigrant students as compared to the others. The authors hypothesized that the level of risk was related to the duration of residence in the U.S., with those residing longer engaging in increasing sexual activity. A number of...

Operant Techniques

In the field of substance-abuse treatment research, token economies (voucher-based incentives) are regarded as a promising treatment intervention (Higgens, Alessi & Dantona, 2000). Biochemically verified abstinence from recent drug use is rewarded with vouchers exchangeable for retail items meeting a predetermined therapeutic goal. This voucher-based incentive is often combined with an intensive behavioural treatment known as the community reinforcement approach (CRA) developed by Hunt & Azrin (1973). In their overview of research on the voucher-incentive approach, Higgens, Alessi and Dantona (2000) conclude it to be effective in the treatment of cocaine dependence and a promising treatment intervention regarding other substance-use disorders (alcohol, marijuana, nicotine and opioid dependence). However, the effectiveness of this type of intervention has been tested mainly in specialized research clinics and its usefulness in everyday drug-abuse treatment practice remains to be...


Recent research has further identified that alkamides from echinacea modulate TNF-alpha mRNA expression in human monocytes macrophages via the cannabinoid type 2 (CB2) receptor (Raduner et al 2006). Two alkamides that bind to the CB2 receptor more strongly than the endogenous cannabinoids have been identified. They also bind to CB1. Alkamides also potently inhibit lipopolysaccharide-induced inflammation in human whole blood and exert modulatory effects on cytokine expression in vitro. Cytokine modulation was also observed for two different echinacea extracts in a study using cytokine antibody arrays to investigate the changes in the proinflammatory cytokines and chemokines released from a cultured line of human bronchial epithelial cells exposed to rhinovirus 14 (Sharma et al 2006). Virus infection stimulated the release of at least 31 cytokine-related molecules, an effect that was reversed by simultaneous exposure to either of the two echinacea extracts, although the patterns of...

Other Substances

Other substance-related disorders with brief description of cultural variants in the DSM-IV (1994) include Amphetamine-Related Disorders, Cannabis-Related Disorders, Cocaine-Related Disorders, Hallucinogen-Related Disorders, Cocaine-Related Disorders, Inhalant-Related Disorders, Nicotine-Related Disorders, and Opioid-Related Disorders. In general, the DSM-IV does not consider these disorders as unique to specific cultures. Cultural acceptability of such disorders, however, might vary across cultures. For example, the hallucinogen peyote is culturally accepted by many American Indians during their religious services, but they rarely abuse this substance some members in the Southeast Asian community accept opium use, but they do not sanction or promote the use of this substance among members of this community (Westermeyer, 1995).

Types of Sleep

REM sleep is also called paradoxical sleep because some areas of the brain are active. As its name implies, the eyes can be seen rapidly moving beneath the eyelids. Cats and dogs in REM sleep sometimes twitch their limbs. In humans, REM sleep usually lasts from five to fifteen minutes. This dream sleep is apparently very important. If a person lacks REM sleep for just one night, sleep on the next night makes up for it. During REM sleep, heart and respiratory rates are irregular. Certain drugs, such as marijuana and alcohol, interfere with REM sleep. Table 11.6 describes several disorders of sleep.

Cannabinoid System

The cannabinoids affect both feeding responses and energy balance through mechanisms that are distinctive from those of the melanocortins. The cannabinoid system19 includes two GPCRs, cannabinoid receptors-1 (CB1) and -2 (CB2) transporters and hydrolyzing enzymes responsible for metabolizing lipophilic natural ligands and the endocannabinoids, anandamide and 2-arachidonoyl glycerol.2021 These endogenous ligands exert potent orexigenic effects and impact reward centers in the brain, thereby eliciting responses that enhance feeding stimuli and palatability. CB1 is expressed centrally in areas responsible for hedonic responses (e.g., nucleus accumbens and hippocampus) and energy homeostasis (hypothalamus and nucleus of the solitary tract) and in epidydimal fat depots where it stimulates lipogenesis.22

Physical effects

Cannabis has many physiological effects, including cardiovascular ones, which may be dangerous in people with heart disease. Cannabis taken in pregnancy is thought to be teratogenic. Chronic effects include those of the associated tobacco smoking. Cannabis has analgesic and other properties, which have been the subject of randomised trials. For example, it has been tried in multiple sclerosis, but so far has not been considered to be an improvement on existing treatments (Robson, 2001).


PCP became an illicit street drug in the mid-1960s. It was most commonly found in large cities such as New York and San Francisco, and even today, most users tend to live in urban areas. Into the 1970s, PCP appeared mainly as a contaminant of other illict drugs, especially marijuana and cocaine. This complicated diagnosis of PCP use, as many people did not know that they had ingested the drug. PCP is a Schedule II drug under the Controlled Substances Act. In its pure form, it is a white powder that dissolves easily in water. Once dissolved, the solution can be sprayed on tobacco or marijuana cigarettes. Less pure forms range from yellowish-tan to brown and can be a sticky mass. On the street PCP has many names including angel dust, devil dust, tranq, hog, crazy Eddie, rocket fuel, embalming fluid, wack, and ozone. Ketamine, which is legal and not regulated as a Schedule III controlled substance, also used illicitly, is known on the street as K, special K, and cat valium. Crack cocaine...


What about THC (dronabinol) Dronabinol, the main active ingredient in marijuana, has been licensed in the US since 1985 as Marinol , and may be prescribed for pharmacy formulation as drops or hard gel capsules. This drug is certainly attractive for many patients and is sometimes actively demanded. Prescription should be carefully considered, particularly in view of the significant cost (approx. 600 Euros per month for the usual dose of 5 mg tid). The effect on wasting syndrome is moderate at best, if detectable at all (Beal 1995). It is probably even weaker than megestrol acetate (Timpone 1997).

Other GPCRs

Cannabinoid receptor subtypes CB1 and CB2 are activated by endogenous lipids such as anandamide, known collectively as endocannabinoids. Similar to the opioid system, the effects of exogenous ligands for these receptors, including the active components of marijuana (cannabis), were studied long before identification of the It is now becoming clear that effective analgesia can be separated from psychotropic effects by selective modulation of CB receptors. Data from animal models demonstrated high efficacy analgesia in response to all types of nociception (acute and inflammatory states) tested with a number of agents currently under investigation.169170 Clinical trials using synthetic cannabinoids and extracts of whole plant cannabis (including delta-9-tetrahydocannabinol and cannabidiol) have shown mixed results for efficacy in treating pain and muscle spasticity associated with multiple sclerosis and various neuropathic pain conditions.170174 The results of future trials using more...

Peter A Netland

Hypertensive drugs are commonly prescribed medications that may affect intraocular pressure (IOP). Although not prescribed by physicians, alcohol and marijuana are frequently self-administered substances that may also affect IOP. This chapter is not intended as an exhaustive review of the effects of all systemically administered drugs on the eye, but instead focuses on drugs widely used in the general population that can influence IOP.


Use of certain recreational drugs may induce hallucinations, including amphetamines and cocaine, hallucinogens (such as lysergic acid diethylamide or LSD), phencyclidine (PCP), and cannabis or marijuana. For example, visual hallucinations are commonly associated with substance use. Individuals may report false perceptions of little people or animals (sometimes referred to as Lilliputian hallucinations). In addition, withdrawal from some recreational drugs can produce hallucinations, including withdrawal from alcohol, sedatives, hypnotics, or anxiolytics. Withdrawal from alcohol, for instance, commonly causes visual hallucinations, especially at nighttime.

Piotr Popik MD PhD

Alcohol and other drugs of abuse produce dependence, a chronic and relapsing disorder that is an enormously destructive public health problem. In the United States, mortality that can be attributed to these disorders is greater than mortality attributable to all other factors combined (1). Currently, there are a limited number of available medications to treat alcohol, opioid, and nicotine dependence, and no medication to treat cocaine, other stimulants, or cannabis dependence. Success rate of available treatments is relatively low, only 30-50 of patients remain abstinent at 1 yr after completion of the most successful treatment programs (2,3). Despite recent advances in the understanding of the neurobiolog-ical basis for these disorders and the development of new psychotherapeutic approaches, there is a lack of viable pharmacological treatments. At the same time, societal and political pressures continue for the development of effective and inexpensive treatments. Substances that are...

Assay Specificity

Drug-monitoring programs in clinical chemistry also use nonspecific antibodies to detect drugs of abuse, such as cannabinoids, opiates, and bezodiazep-ines. References are listed in Table 4 in Sec. VIII. Investigators deliberately pooled and mixed antisera against several analytes to develop a common IA method for multiple analytes. For example, antiserum against testosterone (T) and antiserum against 5a-dihydrotestosterone (DHT) were used to analyze samples for both T and DHT simultaneously (182). A multivariable (three-dimensional) standard curve was created which allowed the independent estimation of T and DHT concentrations when both T and DHT were present in samples. The method is valid as long as both assays are precise, and the procedure avoided the need for tedious, time-consuming chromatographic separation.


In another recent study, Raymond et al. (25) found that 93 of individuals with pedophilia had at least one lifetime comorbid axis I diagnosis. Highest were comorbid mood and anxiety disorders. There was high co-occurrence of alcohol and cannabis use disorders, and 60 had comorbid personality disorders, in particular obsessive-compulsive, antisocial, avoidant, and narcissistic. Contrary to commonly held assumptions, there was a relatively low incidence 23 of antisocial personality disorder.

RCH30 rch2oh

Extensive studies with cannabinoids have demonstrated that hydroxylations occur at various positions in the molecule however, little appears to have been done at an enzyme level. The literature on this subject is extensive, and the references given (for A tetrahydrocannabinol) are illustrative.


Drug interactions involving drugs of abuse are of particular concern due to an increased risk of life threatening side effects. However, not surprisingly, data in this area are sparse. Several fatal cases with regard to the simultaneous intake of RTV and ecstasy (MDMA) or gammahydroxybutyrate (GHB) have been reported in the literature (Hales 2000, Harrington 1999). Metabolic inhibition of amphetamines, MDMA and phencyclidine (PCP), can result in hypothermia, hypertension, arrhythmias, tachycardias and cramps. Reduced metabolism of ketamine can result in respiratory depression, hallucinations and unconsciousness. Increased LSD plasma concentrations are associated with hallucinations, psychosis, agitation and flashbacks, and GHB with cramps, bradycardia, unconsciousness or respiratory depression. Cocaine, in the presence of NNRTIs, is metabolized more rapidly so that the liver toxic metabolite norcocaine can accumulate (Antoniou 2002). Marijuana (tet-rahydrocannibinol, THC) probably has...

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