Marijuana (Cannabis sativa)

• Background
• Related terms
• Evidence
• Dosing
• Safety
• Methodology
• Selected references

• RSS Feeds

Marijuana (Cannabis sativa)

Background

Marijuana, hemp, and cannabis are common names for plants of the genus Cannabis . The term hemp is often used for cannabis strains grown specifically for production of paper, rope, and cloth. Other cannabis strains are used to make recreational and medicinal drugs. The major difference between the main types of cannabis plants is the amount of the psychoactive compound tetrahydrocannabinol (THC) they contain.

Cannabis has been used medicinally for approximately 5,000 years. The most widely used components of the herb in traditional medicine are the seed and seed oil. Cannabis sativa is widely used recreationally (inhaled or taken by mouth) to achieve increased feelings of well-being.

Cannabis has been studied for the treatment of a number of conditions, including eczema, epilepsy, chronic pain, insomnia, and symptoms of multiple sclerosis. The most significant benefits have been found in the treatment of chronic pain and symptoms of multiple sclerosis.

The two most studied cannabinoid compounds of Cannabis sativa are the psychoactive tetrahydrocannabinol (THC) and the nonpsychoactive cannabidiol (CBD).

Related terms

Ageef, ageeve, almindelig hamp (Danish), anashca, asa (Japanese), asanomi, bang (Arabic - Egypt), banji, bhaang (Hindi, Nepali), bhaango (Nepali), bhang (Hindi), blunt, bud, cáñamo (Spanish), canapa (Italian), canapa indiana (Italian), canapa indica (Italian), canape (Italian), cânhamo (Portuguese), Cannabaceae (family), cannabidiols, cannabinoid, cannabis, Cannabis sativa spp., cares (Nepali), CBD-DMH, Cesamet®, chanvre (French), chanvre cultivé (French), chanvre de l'Inde (French), chanvre indien (French), chanvrier (French), charas (Hindi), churras (Hindi), dà má (Chinese), da ma cao (Chinese), da ma ren (Chinese), dagga (Afrikaans), delta-9THC-cannabidiol, dope, dronabinol, echter Hanf (German), esrar, Finola®, gaanjaa (Nepali), gaga, gajiimaa (Nepali), ganja (Sanskrit, Hindi, Nepali, Urdu), ganjika (Sanskrit), grass, grifa (Spanish), hachís (Spanish), hamp (Danish, Norwegian), hampa (Swedish), hampjurt (Icelandic), hamppu (Finnish), Hanf (German), harilik kanep (Estonian), Haschischpflanze (German), hash, hashish, hashish qinnib (Arabic), hemp, hemp ale, hemp flour, Hemp Foods Australia®, Hemp Liquid Gold, hemp nut butter, hemp oil, Hemp Organics, hemp plant, hemp protein powder, hemp seed meal, hemp seed nut butter spread, hemp seed nuts, hemp seed oil, hempseed, hempseed oil, hemp-seeds, hempzels, hennep (Dutch), HU-331, huo ma (Chinese), huo ma cao (Chinese), huo ma ren (Chinese), Indian hamp, Indian hemp, indiiskaia konoplia (Russian), indische hennep (Dutch), indisk hamp (Danish), industrial hemp, joint, kannabisu (Japanese), kenevir (Turkish), kendir (Turkish), kief, kif (Arabic - Morocco), konopí seté (Czech), konopie (Polish), konopie siewne (Polish), konoplia sornaia (Russian), konoplja (Slovenian), Kultur-Hanf (German), maconha (Portuguese), Manitoba Harvest, mariguana, marihuana, marijuana, Marinol®, Mary Jane, mashinin (Japanese), nabilone, navadna konoplja (Slovenian), Nutiva®, O-1918, Organic Hemp Protein Powder, porkanchaa (Thai), pot, PVL's Certified Organic Protein Powders, qinnib (Arabic), riesen Hanf (German), roasted hemp, Sativex®, sawi, shâhdânag (Arabic), sharâneq (Arabic), shelled hempseed, sinsemilla, taima (Japanese), tetrahydrocannabinol, THC, tîl (Arabic), unika-b, vadkender (Hungarian), vetési kinder (Hungarian), weed, wild hemp, wilder Hanf (German), ye da ma (Chiense), ye ma (Chinese).

Evidence

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Grading rationale

Uses based on tradition or theory

The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Acne, addiction, allergies, Alzheimer's disease, angina (chest pain), angioedema (swelling under the skin), arthritis, antiaging, antidepressant, anti-inflammatory, antioxidant, anxiety prevention, appetite stimulant, asthma, attention-deficit hyperactivity disorder (ADHD), autoimmune diseases, bipolar disorder (mental disorder), blood thinner, bronchodilation (widens airways and eases breathing), burns, cancer, candidiasis (yeast infection), circulation improvement, constipation, cough, detoxification (removal of toxins), diabetes, digestive aid, diuretic (improves urine flow), dystonia (muscle disorder), energy metabolism, fatigue, gastric acid secretion stimulation (increases stomach acid), general health maintenance, genitourinary tract disorders (disorders of the reproductive and urinary systems), hair growth promoter, heart disease, high blood pressure, hormone regulation, immune suppression, increased muscle mass, increasing breast milk, inflammatory bowel disease (Crohn's disease and ulcerative colitis), intermittent claudication (pain in arms or legs due to inadequate oxygen), interstitial cystitis (bladder disorder), irregular heartbeat, leukemia (cancer of blood cells), lipid lowering (cholesterol and triglycerides), liver protection, lymph flow enhancement, menopausal symptoms, migraine, muscle relaxation, nausea and vomiting, nerve disorders, neural tube defects (birth defects), osteoporosis (bone loss), painful menstruation, pregnancy and labor, psychosis, rheumatism (joint disease), sedative, sexual performance, skin conditions, spinal cord injury, stomach spasms, stroke, tendonitis, uterine stimulant, varicose veins, vitamin C deficiency, weight gain (patients with HIV or cancer), wound healing.

Dosing

The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.

Adults (18 years and older)

For nausea and vomiting, five milligrams/m ² of body mass of dronabinol (Marinol®) has been taken by mouth before and after chemotherapy, for a total of 4-6 doses daily.

For weight loss and malnutrition associated with cancer, 2.5 milligrams of tetrahydrocannabinol (THC) with or without one milligram of cannabidiol has been taken by mouth for six weeks.

For eczema, hemp seed oil has been taken by mouth for 20 weeks.

For chronic pain, 2.5-120 milligrams of cannabis has been taken by mouth in divided doses.

For epilepsy, 200-300 milligrams of cannabidiol (CBD) has been taken by mouth daily for up to 4.5 months.

For insomnia, 160 milligrams of cannabidiol (CBD) has been taken by mouth.

For symptoms of multiple sclerosis, 2.5-10 milligrams of dronabinol (Marinol®) has been taken by mouth daily for three weeks. Capsules containing 15-30 milligrams of cannabis extract has been taken by mouth for 14 days. Two and one-half milligrams of tetrahydrocannabinol (THC), together with 0.9 milligrams of cannabidiol (CBD), has been taken by mouth. Cannabinoid-based Sativex® mouth spray has been used at a dose of 2.5-120 milligrams in divided doses. Eight sprays in three hours and up to 48 sprays in 24 hours have been used.

For schizophrenia, 40-1,280 milligrams of cannabidiol (CBD) has been taken by mouth daily for up to four weeks.

For glaucoma (high fluid pressure in the eye), single doses of five milligrams of tetrahydrocannabinol (THC) or 40 milligrams of cannabidiol (CBD) placed under the tongue have been used.

Children (under 18 years old)

There is no proven safe or effective dose for cannabis or cannabis-containing products in children.

Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Allergies

Avoid with known allergy or hypersensitivity to cannabis, cannabinoids, or plants of the Cannabaceae family. Symptoms similar to hay fever and asthma have been reported.

Side Effects and Warnings

Cannabis may lower blood sugar levels. Caution is advised in patients with diabetes or hypoglycemia, and in those taking drugs, herbs, or supplements that affect blood sugar. Blood glucose levels may need to be monitored by a qualified healthcare professional, including a pharmacist, and medication adjustments may be necessary.

Cannabis may increase the risk of bleeding. Caution is advised in patients with bleeding disorders or those taking drugs that may increase the risk of bleeding. Dosing adjustments may be necessary.

Cannabis may cause low blood pressure. Caution is advised in patients taking herbs or supplements that lower blood pressure.

Drowsiness or sedation may occur. Use caution if driving or operating heavy machinery, if taking sedatives, barbiturates, or central nervous system depressants, or if consuming alcohol.

Cannabis may interfere with the way the body processes certain drugs, herbs, or supplements using the liver's cytochrome P450 enzyme system. As a result, the levels of these agents may change in the blood and may cause increased or decreased effects or potentially serious adverse reactions. Patients taking any medications should check the package insert and speak with a qualified healthcare professional, including a pharmacist, about possible interactions.

Use with caution in foods or supplements containing cannabis seeds or oil.

Use with caution in patients with liver disease, glaucoma, immune disorders, or a history of drug abuse or addictive behavior, or in patients taking agents for any of these conditions.

Use with caution in patients taking estrogen therapy, agents that may damage the liver, antipyrine, or p-glycoprotein-regulated drugs.

Avoid in individuals with asthma or byssinosis (lung disease).

Avoid inhalation or intravenous injection of cannabis.

Avoid use of cannabis products obtained illegally.

Avoid in patients who are pregnant or breastfeeding.

Avoid in patients with a known allergy or hypersensitivity to cannabis, cannabinoids, or plants of the Cannabaceae family.

Pregnancy and Breastfeeding

Avoid in women who are pregnant or breastfeeding. Research suggests the presence of significant risks to the fetus or developing infant or child.

Methodology

This patient information is based on a professional level monograph edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Monograph methodology

Selected references

1. Aggarwal SK, Carter GT, Sullivan MD, et al. Medicinal use of cannabis in the United States: historical perspectives, current trends, and future directions. J Opioid Manag 2009;5(3):153-68.
2. Berman JS, Symonds C, Birch R. Efficacy of two cannabis based medicinal extracts for relief of central neuropathic pain from brachial plexus avulsion: results of a randomised controlled trial. Pain 2004;112(3):299-306.
3. Iskedjian M, Bereza B, Gordon A, et al. Meta-analysis of cannabis based treatments for neuropathic and multiple sclerosis-related pain. Curr Med Res Opin 2007;23(1):17-24.
4. Karst M, Salim K, Burstein S, et al. Analgesic effect of the synthetic cannabinoid CT-3 on chronic neuropathic pain: a randomized controlled trial. JAMA 2003;290(13):1757-62.
5. Lozano I. [Therapeutic use of Cannibis Sativa L. in Arab medicine.] Asclepio 1997;49(2):199-208.
6. Martín-Sánchez E, Furukawa TA, Taylor J, et al. Systematic review and meta-analysis of cannabis treatment for chronic pain. Pain Med 2009;10(8):1353-68.
7. Perez J, Ribera MV. Managing neuropathic pain with Sativex: a review of its pros and cons. Expert Opin Pharmacother 2008;9(7):1189-95.
8. Perras C. Sativex for the management of multiple sclerosis symptoms. Issues Emerg Health Technol 2005;(72):1-4.
9. Rahn EJ, Hohmann AG. Cannabinoids as pharmacotherapies for neuropathic pain: from the bench to the bedside. Neurotherapeutics 2009;6(4):713-37.
10. Rog DJ, Nurmikko TJ, Young CA. Oromucosal delta9-tetrahydrocannabinol/cannabidiol for neuropathic pain associated with multiple sclerosis: an uncontrolled, open-label, 2-year extension trial. Clin Ther 2007;29(9):2068-79.
11. Rog DJ, Nurmikko TJ, Friede T, et al. Randomized, controlled trial of cannabis-based medicine in central pain in multiple sclerosis. Neurology 2005;65(6):812-9.
12. Svendsen KB, Jensen TS, Bach FW. Does the cannabinoid dronabinol reduce central pain in multiple sclerosis? Randomised double blind placebo controlled crossover trial. BMJ 2004;329(7460):253.
13. Turcotte D, Le Dorze JA, Esfahani F, et al. Examining the roles of cannabinoids in pain and other therapeutic indications: a review. Expert Opin Pharmacother 2010;11(1):17-31.
14. Wade DT, Makela P, Robson P, et al. Do cannabis-based medicinal extracts have general or specific effects on symptoms in multiple sclerosis? A double-blind, randomized, placebo-controlled study on 160 patients. Mult Scler 2004;10(4):434-41.
15. Wade DT, Robson P, House H, et al. A preliminary controlled study to determine whether whole-plant cannabis extracts can improve intractable neurogenic symptoms. Clin Rehabil 2003;17(1):21-9.

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