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Medical Marijuana: A Brief Overview

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Contact Hours: 3

This educational activity is credited for 3 contact hours at completion of the activity.

Course Purpose

The purpose of this course is to provide an overview of medical marijuana, its active ingredients, strains, delivery methods, legal status,  and differences from recreational marijuana.

Overview

Medical marijuana, also called medical cannabis therapy, refers to using the cannabis plant or its derivatives for therapeutic purposes to treat specific medical conditions and alleviate symptoms. In modern years there has been a resurgence of support for medical marijuana following anecdotal evidence and patient testimonials supporting its efficacy. Since the 1990s, several states in the United States (US) have passed legislation legalizing medical marijuana use, paving the way for further research to supplement the current limited clinical data. Still, controversy surrounds its safe administration and long-term side effects. This course discusses medical marijuana in detail, examining its active ingredients, strains, delivery methods, and differences from recreational marijuana. This course also delves into the benefits, adverse reactions, legal status, and nursing considerations of medical marijuana and cannabidiol in the US.

Course Objectives

Upon completion of the independent study, the learner will be able to:

  • Review the mechanism of action of medical marijuana.
  • Summarize federal vs state laws as they relate to medical marijuana use.
  • Differentiate between the two species of the cannabis plant and understand their effects.
  • Review medial dispensary requirements for dispensing medical marijuana.
  • Understand the difference between medical marijuana and recreational marijuana.
  • Understand the healthcare professional’s role in conducting a comprehensive assessment, providing patient education regarding medical marijuana use, and
  • monitoring a patient’s response to medical marijuana.

Policy Statement

This activity has been planned and implemented in accordance with the policies of FastCEForLess.com.

Disclosures

Fast CE For Less, Inc and its authors have no disclosures. There is no commercial support.

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Definitions
1970 Controlled Substances Act (CSA)A unified legal framework to regulate certain drugs that are deemed to pose a risk of abuse and dependence.
Cannabidiol (CBD)A natural remedy that is  used to treat seizures due to certain medical conditions (such as Lennox-Gestalt syndrome, Dravet syndrome, tuberous sclerosis complex – TSC).
Cannabigerol (CBG)A type of cannabinoid found in the cannabis plant. It’s often referred to as the mother of all cannabinoids.
Cannabinoid Hyperemesis SyndromeA condition caused by long-term cannabis (marijuana) use that results in recurring episodes of nausea, vomiting, dehydration, and abdominal pain. 
Cannabinoid ReceptorsLocated throughout the body, are part of the endocannabinoid system of vertebrates; a class of cell membrane receptors in the G protein-coupled receptor superfamily.
CannabinoidsAny of a group of closely related compounds which include cannabinol and the active constituents of cannabis.
Cannabinol (CBN)A cannabinoid found in the cannabis sativa plant. It can also be produced synthetically.
Cannabis (Marijuana)Refers to the dried leaves, flowers, stems, and seeds from the Cannabis sativa or Cannabis indica plant.
Cannabis IndicaA plant species in the family Cannabaceae indigenous to the Hindu Kush mountains of Southern Asia which produces large amounts of tetrahydrocannabinol (THC) and tetrahydrocannabivarin (THCV).
Cannabis RuderalisA variety, subspecies, or species of Cannabis native to Central and eastern Europe or Russia. It contains a relatively low quantity of psychoactive  compound tetrahydrocannabinol (THC).
Cannabis SativaHerbaceous flowering plant indigenous to Eastern Asia, but now of cosmopolitan distribution due to widespread cultivation. 
Delta-6-Tetrahydrocannabinol (THC)The primary psychoactive cannabinoid extracted from the cannabis (marijuana) plant
DopamineA type of neurotransmitter that the nervous system uses to send messages between nerve cells.
Dravet SyndromeA rare type of epilepsy that starts in the first year of a baby’s life.
Endocannabinoid System (ECS)A complex cell-signaling system identified in the early 1990s by researchers exploring THC, a well-known cannabinoid. 
EndocannabinoidsNaturally occurring, lipid-based neurotransmitters. 
EpilepsyA neurological disorder that causes seizures or unusual sensations and behaviors.
Federal Drug Administration (FDA)Responsible for protecting the public health by ensuring the safety, efficacy, and security of human and veterinary drugs, biological products, and medical devices.
HydroponicsA way of growing plants without soil, using water and nutrients instead.
Lennox-Gastaut SyndromeA severe condition characterized by recurrent seizures (epilepsy) that begin early in life.
Marihuana Tax Act Of 1937A United States Act that placed a tax on the sale of cannabis. 
MarijuanaA plant that produces a psychoactive drug from its leaves and flowers.
Medical Cannabis TherapyThe U.S. Food and Drug Administration (FDA) has not approved the use of cannabis as a treatment for any medical condition. However, the FDA has approved the cannabinoids cannabidiol (Epidiolex) and dronabinol (Marinol, Syndros).
Medical MarijuanaA term for derivatives of the Cannabis sativa plant that are used to ease symptoms caused by certain medical conditions.
Schedule I Controlled SubstanceSubstances that have no currently accepted medical use in the United States, a lack of accepted safety for use under medical supervision, and a high potential for abuse.
SerotoninA neurotransmitter that helps relay messages from one area of the brain to another.
TerpenesNaturally occurring chemical compounds found in plants and some animals. 
Introduction

Medical marijuana, also called medical cannabis therapy, refers to using the cannabis plant or its derivatives for therapeutic purposes to treat specific medical conditions and alleviate symptoms.1

Used for centuries, the earliest documented use of cannabis for medical purposes dates back millennia to ancient Chinese texts, such as the Pen Ts’ao Ching and the Hindu Atharvaveda from India.2 In these texts, cannabis is mentioned as a medicinal herb remedy for various ailments, including pain, gastrointestinal disorders, and psychiatric conditions.1,2 Historical evidence also shows that even ancient Egyptians and Greeks recognized cannabis for its therapeutic properties, using it to address various health issues such as epilepsy and muscle spasms.1,2

In the 19th century, cannabis-based remedies became prevalent across the globe for treating a myriad of illnesses, from asthma to loss of appetite.2 However, by the turn of the century, medical marijuana eventually became subject to legal restrictions, culminating with the Marihuana Tax Act of 1937. This law prohibited marijuana across the country, making it a criminal offense to cultivate, possess, or use.1,2

In modern years there has been a resurgence of support for medical marijuana following anecdotal evidence and patient testimonials supporting its efficacy.2 Since the 1990s, several states in the United States (US) have passed legislation legalizing medical marijuana use, paving the way for further research to supplement the current limited clinical data.2 Still, controversy surrounds its safe administration and long-term side effects.1,3,4

This course discusses medical marijuana in detail, examining its active ingredients, strains, delivery methods, and differences from recreational marijuana. This course also delves into the benefits, adverse reactions, legal status, and nursing considerations of medical marijuana and cannabidiol in the US.

Marijuana Description

Marijuana is the name of the psychoactive drug from the dried flower, bud, leaves, stems, and seeds of the cannabis plant.1 These components contain over 80 known active ingredients called cannabinoids, which are responsible for causing marijuana’s mental and physical effects.4

Used both recreationally and medically, the World Health Organization (WHO) estimates that up to 5% of the global population uses marijuana, making it the most grown, trafficked, and used psychoactive substance in the world.1,5

In the US, it is used by approximately 22 million Americans aged 12 and above. According to the National Survey on Drug Use and Health (NSDU), 35% of adults aged 18 – 25 reportedly used marijuana in some capacity during their lifetime.1,6

It is important to note that the Federal Drug Administration (FDA)has not approved the cannabis plant itself for medical use, only certain cannabinoids in it.5

Active Ingredients in Marijuana

The two most well-known cannabinoids and potent compounds in the cannabis plant are delta-6-tetrahydrocannabinol (THC) and cannabidiol (CBD).1,7 Delta-6-tetrahydrocannabinol (THC) is responsible for the psychoactive effects of marijuana and has potential pain-relieving properties, while cannabidiol (CBD)does not produce a euphoric effect.7,8 Instead, CBD is known for its anxiolytic, anti-inflammatory, and anticonvulsant properties.1,7,8

Other minor cannabinoids like cannabigerol (CBG) and cannabinol (CBN) are also present in varying amounts and may contribute to specific therapeutic effects such as pain relief.7,8

Other key components of medical marijuana are terpenes, which are aromatic compounds that contribute to its distinctive aroma and flavor. Studies suggest that these chemicals may also interact with cannabinoids to enhance their therapeutic effects improving relaxation, upliftment, and stress relief potential.1,7,8 By isolating these active compounds, medical research has developed synthetic medications like dronabinol and nabiximols for more targeted treatments.1

Species and Variations

Medical marijuana comes from two species of the cannabis plant, cannabis sativa,and cannabis indica.9 Pure Sativa species are comparatively tall, reaching as high as 12 ft, with long branches and large, narrow-bladed leaves. Marijuana made from these plants has more energizing and uplifting effects, making it potentially beneficial for mood disorders and boosting focus. 9

Pure Indicaspecies are shorter and more bush-like with wider leaves. Marijuana from this plant has been seen to be more relaxing and sedative, making it suitable for managing pain, insomnia, and anxiety.9

There is a third species of the cannabis plant known as cannabis ruderalis, which is very short but only has trace amounts of THC. Therefore it is neither used commonly for medicinal or recreational purposes. 9 However, because of its auto-flowering biological traits, it is crossbred with Sativa and indica strains to produce more hybrid variations (or strains). These strains have varying cannabinoid levels, thus producing varying psychoactive effects.9 Some of the most used marijuana strains include Acapulco Gold, Bedrocan, Blue Dream, Charlotte’s Web, Skunk, Kush, and Sour Diesel.

Mechanism of Action

To understand the mechanism of action of marijuana, it is important first to understand the role of the body’s endocannabinoid system (ECS). This system assists in regulating various physiological processes and maintaining homeostasis in the body. The primary components of this system include endocannabinoids, cannabinoid receptors,and enzymes.1

  • Endocannabinoids are naturally occurring cannabinoids produced by the body. The levels of endocannabinoids are controlled by specialized enzymes responsible for their biosynthesis, deactivation, and signaling.1
  • Cannabinoid receptors, such as CB1 and CB2 receptors. CB1 receptors are found in the brain and are a part of regulating pain perception, mood, memory, appetite, and coordination. CB2 receptors are seen in the peripheral nervous system and immune cells. They influence pain perception and inflammation. These receptors are also found in lower levels in the liver, lungs, and kidneys.1

When marijuana is consumed, the cannabinoids in the plant interact with the body’s endocannabinoid system, binding (or partially binding) to cannabinoid receptors, activating them, and leading to various physiological effects.1,8 If these receptors are activated in the brain, they can influence the release of various neurotransmitters, such as dopamine and serotonin, impacting mood, appetite, and cognition. If they activate receptors in the nervous system, they can modulate pain perception, leading to potential analgesic effects.1,8

Where Marijuana is Grown

While cannabis generally grows outdoors, it can also be grown indoors in a special soil medium under artificial light. Though this is more expensive and complex than growing outdoors, it allows for better control and faster growth. Cannabis plants can also be grown successfully indoors using hydroponics.10

Medical marijuana is grown in various regions worldwide, but its cultivation is subject to regulations and licensing requirements to ensure quality control, safety, and compliance with local laws.1,10 In the US, it is mainly grown in states that have established medical cannabis legislation and cultivation, distribution, and usage frameworks. For example, Illinois bans outdoor cultivation and requires marijuana to be grown in an enclosed, locked facility. Other states, like Michigan or Alaska, leave decisions about outdoor growing to local governments. California, Vermont, and Massachusetts provide licenses for outdoor cultivation, often tiered based on the size of the operation.11

As of 2022, all but two US states with medical marijuana-use laws allow home cultivation that regulates the number of plants per qualified patient home.11,12

Delivery Methods

Medical marijuana can be administered using various delivery methods, each offering different pharmacokinetics and effects. Common methods include: 13

  • Inhalation through smoking or vaporization. This method fills the lungs with airborne cannabinoids, which pulmonary capillaries absorb to enter the bloodstream quickly for rapid onset. However, the duration of action is relatively short as the body quickly breaks down the compounds.
  • Oral ingestion with edibles, capsules, oils, and tinctures for a slower onset of effects but a more prolonged duration of action.
  • Sublingual absorption, which places tinctures or sprays under the tongue. This area has a rich network of capillaries, thus facilitating rapid absorption into the bloodstream.13
  • Topical application using creams, balms, and patches applied to the skin for localized relief without the psychoactive effects.
Benefits, Side Effects, and Laws Regarding Medical Marijuana Use

Benefits of Using Medical Marijuana

The most significant benefit of medical marijuana is its role in pain management.8

Medical marijuana potentially alleviates chronic pain in conditions like multiple sclerosis, arthritis, and neuropathy. Cannabinoids in marijuana, particularly THC and CBD, act as analgesics, relieving patients who have not responded well to conventional pain medications. Moreover, this benefit can help reduce opioid use and potential addiction.8,15

Similarly, cannabinoids in medical marijuana possess anti-inflammatory properties, which may help manage inflammatory conditions, such as rheumatoid arthritis and Crohn’s disease.8,16

Medical marijuana can effectively reduce nausea and vomiting caused by chemotherapy or other potent medical treatments. This effect has particularly benefited cancer patients undergoing chemotherapy, improving their overall tolerance during treatment.8,17 Additionally, it can help stimulate appetite, making it useful for individuals suffering from appetite loss or wasting associated with certain medical conditions or treatments.18 Some studies suggest that medical marijuana can also aid in treating certain neurological conditions, such as Parkinson’s disease and epilepsy. CBD has shown promise in reducing seizure frequency in some forms of epilepsy.1,8

 Side Effects of Medical Marijuana

Despite the advantages, medical marijuana has several disadvantages, with the most prominent beings the psychoactive effects caused by THC, which can include altered perception, impaired cognitive function, and mood changes.1

Other reported negative reactions with short-term medical marijuana use include dry mouth, increased heart rate, dizziness, bloodshot eyes, impairments in body movements and short-term memory, severe cyclic nausea and vomiting (cannabinoid hyperemesis syndrome), anxiety, suicidal ideations or tendencies, and psychotic symptoms.While these adverse effects are typically temporary, they may exacerbate existing medical conditions. Moreover, medical marijuana may interact with other medications, potentially affecting overall effectiveness or causing unwanted side effects.1

There are several long-term risks to prolonged marijuana use.1 Smoking medical marijuana can harm the respiratory system, like smoking tobacco, and may increase the risk of lung infections and cause other respiratory problems.19

Other potential long-term problems may include increased risk of pregnancy-related complications, testicular cancer, cardiovascular issues, stroke, severe cannabinoid hyperemesis syndrome, adolescent brain development issues, psychiatric disorders, addiction, and other substance-abuse disorders.1,7,20-24

While there is no documented case of an adult or adolescent dying of marijuana overdose, the consequences of high-potency use are still unknown.1 

Federal vs. State Laws

At the federal level, medical marijuana is listed as a Schedule I controlled substance under the 1970 Controlled Substances Act (CSA).11 Schedule I substances are defined as having a high risk for abuse and no accepted Federl Drug Administration (FDA) approved medical use. For context, LSD, heroin, and cocaine are also Schedule I substances. Therefore, under this classification, it is illegal under federal law to cultivate, manufacture, possess, distribute, or dispense marijuana, including medical marijuana.11

Despite this federal classification, states have legalized medical marijuana use in different capacities over the years. In 1996, under Proposition 215, California became the first state to legalize medical marijuana, a decision that led other states to follow suit.2

In 2014, medical marijuana achieved a landmark victory when Congress passed the Rohrabacher-Farr Amendment, now known as the Rohrabacher-Blumenauer Amendment. This law prohibits the Department of Justice from interfering with state medical marijuana laws, thereby protecting patients and businesses in states where medical marijuana is legal.2

As of July 2023, medical marijuana is legal in 38 states, including Alabama, Arizona, Alaska, Arkansas, Connecticut, California, Colorado, District of Columbia, Delaware, Florida, Hawaii, Illinois, Kentucky, Louisiana, Maine, Maryland, Michigan, Mississippi, Minnesota, Missouri, Montana, New Hampshire, Nevada, New Mexico, New Jersey, North Dakota, New York, Ohio, Oregon, Oklahoma, Rhode Island, Pennsylvania, Utah, South Dakota, Vermont, Virginia, Washington, and West Virginia.11

Other states have limited accesses law, while only three states, namely, Kansas, Idaho, and Nebraska, do not allow the use of cannabis in any capacity.11

Cannabidiol (CBD)

Cannabidiol (CBD) is a naturally occurring active chemical found in both cannabis and hemp plants, but it is non-psychoactive, meaning it does not produce a “high.” Rather, it only expresses analgesic, anti-inflammatory, anticonvulsant, anxiolytic (anti-anxiety), neuroprotective, and antioxidant properties.25

Cannabidiol has gained significant attention in the medical community as it can potentially provide similar therapeutic relief as medical marijuana without the mind-alternating effects, thus making it a safer option.26 More studies are underway to fully understand its mechanisms of action and therapeutic potential.25,26

Currently, cannabidiol is FDA-approved in certain drugs that contain this cannabinoid for treating two severe forms of epilepsy, namely Dravet syndrome and Lennox-Gastaut syndrome.27

Benefits, Side Effects, and Laws Regarding CBD Use

Benefits of CBD Use

Research suggests that CBD is effective for treating certain cases of severe epilepsy. It may also benefit Huntington’s disease and multiple sclerosis (MS) patients by reducing pain and muscle tightness. Other benefits for patients with multiple sclerosis include reducing tiredness, improving bladder control, and mobility for overall quality of life. However, these are preliminary findings are yet to be verified.25,27

Cannabidiol has also been shown to help reduce symptoms in certain mood disorders, such as anxiety, post-traumatic stress disorder (PTSD), and depression.27

Side Effects of CBD Use

Cannabidiol usage may cause side effects in some patients. These effects may include low blood pressure, dry mouth, lightheadedness, dizziness, and drowsiness. There have also been occasional reports of increased suicidal thoughts or behavior and signs of liver injury with high doses of CBD.25

There is insufficient research to establish the long-term effects of CBD in topical applications, during pregnancy and breastfeeding, and in patients with certain medical conditions such as glaucoma, as studies have shown that CBD may, in fact, increase pressure in the eye leading to further deterioration.25,28

Federal vs. State Laws

As with medical cannabis use, there are still some discrepancies between federal and state laws regarding CBD. While some progress has been made in recent years, there is still much room for improvement.29

In December 2018, hemp and its derivatives, including CBD from hemp, were removed from the list of controlled substances by the signing of the Agriculture Improvement Act of 2018. Known as the Farm Bill, this act legalized the cultivation and production of hemp-derived CBD with less than 0.3% THC.2,29  However, CBD derived from cannabis plants with higher THC content remained a Schedule I controlled substance. The FDA also issued a statement clarifying that it was still illegal to market CBD as foods or dietary supplements.29

Eleven states have limited access to medical marijuana laws that allow low-THC and high-CBD products for medical reasons. Currently, these states include Georgia, Iowa, Indiana, Kentucky, Mississippi, North Carolina, South Carolina, Texas, Tennessee, Wyoming, and Wisconsin. 11,29

Differences Between Medical Marijuana and Recreational Marijuana

The primary differences between medical marijuana and recreational marijuana lie in their chemical composition, quality control, and intended use.14

Chemical Composition

Medical marijuana extracts and concentrates contain higher levels of cannabinoids and terpenes than traditional herbal preparations. Pharmaceutical companies use various extraction methods to isolate and purify specific compounds within the substance, thus offering higher potency, precise dosing, and the potential for targeted therapeutic effects.1,14

Recreational marijuana strains vary widely in chemical composition, with different levels of cannabinoids. In most cases, they have higher levels of THC and lower levels of CBD.14

Quality Control

Medical marijuana cultivation and distribution is subject to strict quality control and testing measures. Licensed medical marijuana producers must adhere to rigorous quality standards to ensure consistency, efficacy, and safety. This includes testing for contaminants and accurately labeling cannabinoid content.1,4,14

This high level of control is not seen in recreational marijuana. There is no regulation or standardization in the recreational market, resulting in inconsistencies in product quality and safety.4

Intended Use

Medical marijuana is specifically cultivated, processed, and dispensed for therapeutic purposes to alleviate symptoms and manage various medical conditions such as chronic pain and certain mood disorders. The primary focus of medical marijuana is on its potential medical benefits and improving patients’ quality of life.1

Recreational marijuana is used for non-medical purposes, primarily for its psychoactive effects. Users typically consume it for the “high” or euphoria induced by THC.1,3

Dispensaries

Medical marijuana dispensaries, or medical cannabis dispensaries, are specialized retail establishments that legally sell medical marijuana and related products to qualified patients with valid medical marijuana prescriptions. These dispensaries operate in regions where medical marijuana is legal and provide patients with medical cannabis products in a regulated environment.30

These facilities comply with state or regional laws that have legalized the medical use of marijuana. They are typically licensed and regulated by the local government to ensure adherence to specific requirements, including product quality, safety, and patient confidentiality.4

Products vary from location to location, but generally, dispensaries offer dried cannabis flowers, pre-rolled joints, edibles, tinctures, topicals, concentrates, and more. Each product may have different cannabinoid and terpene profiles, allowing patients to choose the most appropriate option for their medical needs.1

Before dispensing medical marijuana products, dispensaries must verify that patients have valid medical marijuana recommendations from qualified healthcare professionals. This process helps ensure that only eligible patients have access to medical marijuana. It also prevents unauthorized sales.31 The dispensary staff is also trained to provide information and assistance to patients. They help patients understand different strains, dosing options, and methods of administration, guiding them to make informed choices. Furthermore, they can provide educational resources and support to patients. This may include educational materials, workshops, or consultations to help patients use medical marijuana effectively and responsibly.31

It is important to note that medical marijuana dispensaries are distinct from recreational marijuana dispensaries, which cater to adults who use cannabis for non-medical purposes in regions where recreational marijuana is legal. Medical marijuana dispensaries are designed to serve patients with legitimate medical needs, ensuring they have access to cannabis-based treatments in a regulated and supportive environment.

Patients Likely to Use Medical Marijuana

Medical marijuana is typically used by patients seeking alternative treatments for specific medical conditions that have not responded well to conventional therapies. Generally, this includes patients suffering from chronic pain conditions.1

Medical marijuana may also be suitable for patients with inflammatory conditions such as rheumatoid arthritis, Crohn’s disease, and ulcerative colitis or cancer patients with chemotherapy-induced side effects such as pain, nausea, vomiting, and appetite loss.1,8 It may also be appropriate for patients with certain neurological or mental health conditions, such as epilepsy, multiple sclerosis, Parkinson’s disease, anxiety, depression, PTSD, and other mood disorders.1,8

Additionally, medical marijuana may be a suitable alternative for patients looking for natural treatment options, especially when conventional therapies have been ineffective or are associated with undesirable side effects. Older patients with chronic pain, sleep disturbances, and certain age-related neurodegenerative disorders may also consider medical marijuana use.1,8

It is important to note that as more research and clinical evidence emerge and attitudes toward medical marijuana become more widespread and accepted, the demographics of medical marijuana users may continue to evolve.

Conclusion

Medical marijuana is a centuries-old natural remedy with a longstanding historical significance. Despite its illegal drug status at the federal level, it has reemerged as a preferred therapy for many patients with chronic conditions unresponsive to conventional therapies. As it continues to gain popularity in healthcare, legislative efforts must evolve accordingly to control its use through guidelines that can ensure patient safety.

While much data supports the therapeutic benefits of medical marijuana, much is still unknown about its long-term effects. Numerous clinical trials are underway, studying its effects as researchers continue to examine this botanical therapy to learn more about its active compounds. These efforts look to isolate further and purify cannabis compounds to create more effective and reliable treatment options for more conditions.

Ultimately, as more patients look to medicinal cannabis for relief, healthcare providers must comply with legal regulations, educate their patients, regularly monitor and assess patient progress, and keep detailed documentation to keep patients safe and ensure optimal health outcomes.

References
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  2. ProCon.org. (2019). Historical Timeline – Medical Marijuana – ProCon.org. Medical Marijuana. https://medicalmarijuana.procon.org/historical-timeline/
  3. Crane, M. (2000). Dangers of Marijuana: Long-Term Effects on the Brain and Body. American Addiction Centers. https://americanaddictioncenters.org/marijuana-rehab/long-term-effects
  4. FDA and Cannabis: Research and Drug Approval Process. (2019). U.S. Food and Drug Administration. https://www.fda.gov/news-events/public-health-focus/fda-and-cannabis-research-and-drug-approval-process         
  5. World Health Organization. (2022). Cannabis. Www.who.int. https://www.who.int/teams/mental-health-and-substance-use/alcohol-drugs-and-addictive-behaviours/drugs-psychoactive/cannabis
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  7. Cannabis and Cannabinoids. (2016). National Cancer Institute; Cancer.gov. https://www.cancer.gov/about-cancer/treatment/cam/hp/cannabis-pdq
  8. National Academies of Sciences, Engineering, and Medicine, Health and Medicine Division, & Board on Population Health and Public Health Practice. (2017, January 12). Therapeutic Effects of Cannabis and Cannabinoids. Nih.gov; National Academies Press (US). https://www.ncbi.nlm.nih.gov/books/NBK425767/
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  10. Chandra, S., Lata, H., & ElSohly, M. A. (2020). Propagation of Cannabis for Clinical Research: An Approach Towards a Modern Herbal Medicinal Products Development. Frontiers in Plant Science, 11. https://doi.org/10.3389/fpls.2020.00958
  11. National Conference of State Legislatures. (2022, September 12). State Medical Cannabis Laws. Www.ncsl.org. https://www.ncsl.org/health/state-medical-cannabis-laws
  12. Wadsworth, E., Schauer, G. L., & Hammond, D. (2022). Home cannabis cultivation in the United States and differences by state-level policy, 2019-2020. American Journal of Drug and Alcohol Abuse, 48(6), 701–711. https://doi.org/10.1080/00952990.2022.2132507
  13. Stella, B., Baratta, F., Della Pepa, C., Arpicco, S., Gastaldi, D., & Dosio, F. (2021). Cannabinoid Formulations and Delivery Systems: Current and Future Options to Treat Pain. Drugs, 81(13), 1513–1557. https://doi.org/10.1007/s40265-021-01579-x
  14. ‌Cash, M. C., Cunnane, K., Fan, C., & Romero-Sandoval, E. A. (2020). Mapping cannabis potency in medical and recreational programs in the United States. PLOS ONE, 15(3), e0230167. https://doi.org/10.1371/journal.pone.0230167
  15. Boehnke, K. F., Litinas, E., & Clauw, D. J. (2016). Medical Cannabis Use Is Associated With Decreased Opiate Medication Use in a Retrospective Cross-Sectional Survey of Patients With Chronic Pain. The Journal of Pain, 17(6), 739–744. https://doi.org/10.1016/j.jpain.2016.03.002
  16. Anil, S. M., Peeri, H., & Koltai, H. (2022). Medical Cannabis Activity Against Inflammation: Active Compounds and Modes of Action. Frontiers in Pharmacology, 13. https://doi.org/10.3389/fphar.2022.908198
  17. Smith, L. A., Azariah, F., Lavender, V. T., Stoner, N. S., & Bettiol, S. (2015). Cannabinoids for nausea and vomiting in adults with cancer receiving chemotherapy. Cochrane Database of Systematic Reviews, 11. https://doi.org/10.1002/14651858.cd009464.pub2
  18. Pinto, J. S., & Martel, F. (2022). Effects of Cannabidiol on Appetite and Body Weight: A Systematic Review. Clinical Drug Investigation. https://doi.org/10.1007/s40261-022-01205-y
  19. Joshi, M., Joshi, A., & Bartter, T. (2014). Marijuana and lung diseases. Current Opinion in Pulmonary Medicine, 20(2), 173–179. https://doi.org/10.1097/mcp.0000000000000026
  20. Curran, H. V., Freeman, T. P., Mokrysz, C., Lewis, D. A., Morgan, C. J. A., & Parsons, L. H. (2016). Keep off the grass? Cannabis, cognition and addiction. Nature Reviews. Neuroscience, 17(5), 293–306. https://doi.org/10.1038/nrn.2016.28
  21. Barber, P. A., Roberts, S., Spriggs, D. A., & Anderson, N. E. (2014). Adverse Cardiovascular, Cerebrovascular, and Peripheral Vascular Effects of Marijuana: What Cardiologists Need to Know. The American Journal of Cardiology, 113(6), 1086. https://doi.org/10.1016/j.amjcard.2014.01.400
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