Cannabis (drug)#"Munchies"

{{main|Etymology of cannabis}}

Cannabis is a Scythian word.{{cite book |last1=Gray |first1=Stephen |title=Cannabis and Spirituality: An Explorer's Guide to an Ancient Plant Spirit Ally |date=9 December 2016 |publisher=Simon and Schuster |isbn=978-1-62055-584-2 |page=69 |url=https://books.google.com/books?id=GmEoDwAAQBAJ&pg=PT69 |language=en |quote=Cannabis is called kaneh bosem in Hebrew, which is now recognized as the Scythian word that Herodotus wrote as kánnabis (or cannabis).}}{{cite book | last1=Riegel | first1=A. | last2=Ellens | first2=J.H. | title=Seeking the Sacred with Psychoactive Substances: Chemical Paths to Spirituality and to God [2 volumes] | publisher=Bloomsbury Publishing | series=Psychology, Religion, and Spirituality | year=2014 | isbn=979-8-216-14310-9 | url=https://books.google.com/books?id=V6nOEAAAQBAJ&pg=PT80 | access-date=2024-06-03 | page=80}}{{cite book |last1=Duncan |first1=Perry M. |title=Substance Use Disorders: A Biopsychosocial Perspective |date=17 September 2020 |publisher=Cambridge University Press |isbn=978-0-521-87777-0 |page=441 |url=https://books.google.com/books?id=X7H2DwAAQBAJ&pg=PA441|language=en |quote=Cannabis is a Scythian word (Benet 1975).}} The ancient Greeks learned of the use of cannabis by observing Scythian funerals, during which cannabis was consumed. In Akkadian, cannabis was known as qunubu ({{lang|akk|𐎯𐎫𐎠𐎭𐏂}}). The word was adopted in to the Hebrew as qaneh bosem ({{lang|he|קָנֶה בֹּשׂם}}).

{{Main|Medical cannabis}}

File:Cannabis Indica 01.jpg

Medical cannabis, or medical marijuana, refers to the use of cannabis to treat disease or improve symptoms; however, there is no single agreed-upon definition (e.g., cannabinoids derived from cannabis and synthetic cannabinoids are also used).{{Cite journal |vauthors=Murnion B |date=December 2015 |title=Medicinal cannabis |journal=Australian Prescriber |volume=38 |issue=6 |pages=212–15 |doi=10.18773/austprescr.2015.072 |pmc=4674028 |pmid=26843715 |issn=0312-8008}}{{Cite web |date=July 2015 |title=What is medical marijuana? |url=https://www.drugabuse.gov/publications/drugfacts/marijuana-medicine |access-date=19 April 2016 |website=National Institute of Drug Abuse |quote=The term medical marijuana refers to using the whole unprocessed marijuana plant or its basic extracts to treat a disease or symptom.}}{{Cite book |last=Backes |first=Michael |url=https://books.google.com/books?id=7z2FwBywoJ0C&pg=PT46 |title=Cannabis Pharmacy: The Practical Guide to Medical Marijuana |publisher=Hachette Books |date=2014 |isbn=978-1-60376-334-9 |page=46 |name-list-style=vanc}} The rigorous scientific study of cannabis as a medicine has been hampered by production restrictions and by the fact that it is classified as an illegal drug by many governments.{{Cite journal |date=September 2015 |title=Release the strains |journal=Nature Medicine |volume=21 |issue=9 |pages=963 |doi=10.1038/nm.3946 |pmid=26340110 |doi-access=free}} There is some evidence suggesting cannabis can be used to reduce nausea and vomiting during chemotherapy, to improve appetite in people with HIV/AIDS, or to treat chronic pain and muscle spasms. Evidence for its use for other medical applications is insufficient for drawing conclusions about safety or efficacy.{{Cite journal |vauthors=Borgelt LM, Franson KL, Nussbaum AM, Wang GS |date=February 2013 |title=The pharmacologic and clinical effects of medical cannabis |journal=Pharmacotherapy |volume=33 |issue=2 |pages=195–209 |citeseerx=10.1.1.1017.1935 |doi=10.1002/phar.1187 |pmid=23386598 |s2cid=8503107}}{{Cite journal |vauthors=Whiting PF, Wolff RF, Deshpande S, Di Nisio M, Duffy S, Hernandez AV, Keurentjes JC, Lang S, Misso K, Ryder S, Schmidlkofer S, Westwood M, Kleijnen J |date=23 June 2015 |title=Cannabinoids for Medical Use: A Systematic Review and Meta-analysis |journal=JAMA |volume=313 |issue=24 |pages=2456–73 |doi=10.1001/jama.2015.6358 |pmid=26103030 |doi-access=free |hdl=10757/558499|hdl-access=free }}{{Cite journal |vauthors=Jensen B, Chen J, Furnish T, Wallace M |date=October 2015 |title=Medical Marijuana and Chronic Pain: a Review of Basic Science and Clinical Evidence |journal=Current Pain and Headache Reports |volume=19 |issue=10 |pages=50 |doi=10.1007/s11916-015-0524-x |pmid=26325482 |s2cid=9110606}} There is evidence supporting the use of cannabis or its derivatives in the treatment of chemotherapy-induced nausea and vomiting, neuropathic pain, and multiple sclerosis. Lower levels of evidence support its use for AIDS wasting syndrome, epilepsy, rheumatoid arthritis, and glaucoma.

The medical use of cannabis is legal only in a limited number of territories, including Canada, Belgium, Australia, the Netherlands, New Zealand,{{Cite news |last=Ainge Roy |first=Eleanor |date=11 December 2018 |title=New Zealand passes laws to make medical marijuana widely available |work=The Guardian |url=https://www.theguardian.com/world/2018/dec/11/new-zealand-passes-laws-to-make-medical-marijuana-widely-available |access-date=20 January 2019}}{{Cite web |last=Schulz |first=Chris |date=30 June 2022 |title=You can get actual weed from the doctor now |url=https://thespinoff.co.nz/business/30-06-2022/you-can-get-actual-weed-from-the-doctor-now |website=The Spinoff}} Spain, and many U.S. states. This usage generally requires a prescription, and distribution is usually done within a framework defined by local laws.

According to DEA Chief Administrative Law Judge, Francis Young, "cannabis is one of the safest therapeutically active substances known to man".{{Cite web |url=https://www.safeaccessnow.org/cannabis_safety |title=Information on Cannabis Safety |website=Americans for Safe Access}} Being under the effects of cannabis is usually referred to as being "high".{{Cite book |last=Ernest Small |url=https://books.google.com/books?id=oo2KDQAAQBAJ&pg=PT339 |title=Cannabis: A Complete Guide |publisher=CRC Press |date=2016 |isbn=978-1-315-35059-2}} Cannabis consumption has both psychoactive and physiological effects.{{Cite book |last1=Onaivi |first1=Emmanuel S. |url=https://books.google.com/books?id=BxfLB4n3uoMC&pg=PA58 |title=Endocannabinoids: The Brain and Body's Marijuana and Beyond |last2=Sugiura |first2=Takayuki |last3=Di Marzo |first3=Vincenzo |publisher=Taylor & Francis |date=2005 |isbn=978-0-415-30008-7 |page=58 |name-list-style=vanc}} The "high" experience can vary widely, based (among other things) on the user's prior experience with cannabis, and the type of cannabis consumed.{{Cite encyclopedia |title=Desired and Undesired Effects of Cannabis on the Human Mind and Psychological Well-Being |encyclopedia=Handbook of Cannabis |publisher=Oxford University Press |date=2014 |editor-last=Pertwee |editor-first=Roger G. |last2=Morgan |first2=Celia J.A. |last1=Curran |first1=H. Valerie}}{{rp|p647}} When smoking cannabis, a euphoriant effect can occur within minutes of smoking.{{Cite journal |last=Ashton |first=C.Heather |date=2001 |title=Pharmacology and Effects of Cannabis: A Brief Review |journal=British Journal of Psychiatry |volume=178 |issue=2 |pages=101–06 |doi=10.1192/bjp.178.2.101 |pmid=11157422 |s2cid=15918781 |doi-access=free}}{{rp|p104}} Aside from a subjective change in perception and mood, the most common short-term physical and neurological effects include increased heart rate, increased appetite, impairment of short-term and working memory, and impairment of psychomotor coordination.{{Cite book |url=https://books.google.com/books?id=1AWGDhIOvk0C&pg=PA144 |title=Cannabis in Medical Practice: A Legal, Historical, and Pharmacological Overview of the Therapeutic Use of Marijuana |publisher=University of Virginia Medical Center |date=1997 |isbn=978-0-7864-8390-7 |editor-last=Mathre |editor-first=Mary Lynn |pages=144– |name-list-style=vanc}}{{Cite book |title=Cannabinoids |vauthors=Riedel G, Davies SN |date=2005 |isbn=978-3-540-22565-2 |series=Handbook of Experimental Pharmacology |volume=168 |pages=445–77 |chapter=Cannabinoid function in learning, memory and plasticity |doi=10.1007/3-540-26573-2_15 |pmid=16596784 |issue=168}}

Additional desired effects from consuming cannabis include relaxation, a general alteration of conscious perception, increased awareness of sensation, increased libido{{Cite journal |vauthors=Osborne GB, Fogel C |date=2008 |title=Understanding the motivations for recreational marijuana use among adult Canadians |url=http://cannabislink.ca/info/MotivationsforCannabisUsebyCanadianAdults-2008.pdf |journal=Substance Use & Misuse |volume=43 |issue=3–4 |pages=539–72; discussion 573–79, 585–87 |doi=10.1080/10826080701884911 |pmid=18365950 |s2cid=31053594}} and distortions in the perception of time and space. At higher doses, effects can include altered body image, auditory or visual illusions, pseudohallucinations and ataxia from selective impairment of polysynaptic reflexes.{{Citation needed|date=June 2020}} In some cases, cannabis can lead to dissociative states such as depersonalization{{Cite web |title=Medication-Associated Depersonalization Symptoms |url=http://www.medscape.com/viewarticle/468728 |website=Medscape}}{{Cite journal |vauthors=Shufman E, Lerner A, Witztum E |date=April 2005 |title=[Depersonalization after withdrawal from cannabis usage] |url=http://www.ima.org.il/Ima/FormStorage/Type3/05-04-07.pdf |journal=Harefuah |language=he |volume=144 |issue=4 |pages=249–51, 303 |pmid=15889607 |archive-url=https://web.archive.org/web/20050430224332/http://www.ima.org.il/Ima/FormStorage/Type3/05-04-07.pdf |archive-date=30 April 2005}} and derealization.{{Cite journal |vauthors=Johnson BA |date=February 1990 |title=Psychopharmacological effects of cannabis |journal=British Journal of Hospital Medicine |volume=43 |issue=2 |pages=114–16, 118–20, 122 |pmid=2178712}}

{{Main|Entheogenic use of cannabis}}

Cannabis has held sacred status in several religions and has served as an entheogen – a chemical substance used in religious, shamanic, or spiritual contexts{{Cite journal |last1=Souza |first1=Rafael Sampaio Octaviano de |last2=Albuquerque |first2=Ulysses Paulino de |last3=Monteiro |first3=Júlio Marcelino |last4=de Amorim |first4=Elba Lúcia Cavalcanti |name-list-style=vanc |date=2008 |title=Brazilian Archives of Biology and Technology – Jurema-Preta (Mimosa tenuiflora [Willd.] Poir.): a review of its traditional use, phytochemistry and pharmacology |journal=Brazilian Archives of Biology and Technology |volume=51 |issue=5 |pages=937–47 |doi=10.1590/S1516-89132008000500010 |doi-access=free}} – in the Indian subcontinent since the Vedic period. The earliest known reports regarding the sacred status of cannabis in the Indian subcontinent come from the Atharva Veda, estimated to have been composed sometime around 1400 BCE.{{Cite book |last=Courtwright |first=David |url=https://books.google.com/books?id=GHqV3elHYvMC&q=Forces+of+Habit |title=Forces of Habit: Drugs and the Making of the Modern World |publisher=Harvard University Press |date=2001 |isbn=978-0-674-00458-0 |name-list-style=vanc}}

The Hindu god Shiva is described as a cannabis user, known as the "Lord of bhang".{{Cite book |last=Iversen |first=Leslie L. |url=https://archive.org/details/scienceofmarijua00iver |title=The Science of Marijuana |publisher=Oxford University Press |date=2000 |isbn=978-0-19-515110-7 |url-access=registration |name-list-style=vanc}}{{rp|p19}}

In modern culture, the spiritual use of cannabis has been spread by the disciples of the Rastafari movement who use cannabis as a sacrament and as an aid to meditation.

{{Main|Cannabis consumption}}

File:Unrolled joint.jpg{{Cookbook|Cannabis}}

Many different ways to consume cannabis involve heat to decarboxylate THCA into THC;{{Cite book |last=Golub |first=Andrew |url=https://books.google.com/books?id=KFMtFv2tmbYC&pg=PA82 |title=The Cultural/Subcultural Contexts of Marijuana Use at the Turn of the Twenty-First Century |publisher=Routledge |date=2012 |isbn=978-1-136-44627-6 |page=82 |name-list-style=vanc}}{{Cite web |title=Why Does Cannabis Have to be Heated? |url=https://patriotcare.org/why-cannabis-heated/ |website=patriotcare.org}} common modes include:

• Smoking, involves burning and inhaling cannabinoids ("smoke") from small pipes, bongs (portable versions of hookahs with a water chamber), paper-wrapped joints, tobacco-leaf-wrapped blunts, or the like.{{Cite book |last1=Tasman |first1=Allan |url=https://books.google.com/books?id=vVG7zz7eaxcC&pg=RA9-PT2217 |title=Psychiatry |last2=Kay |first2=Jerald |last3=Lieberman |first3=Jeffrey A. |last4=First |first4=Michael B. |last5=Maj |first5=Mario |publisher=John Wiley & Sons |date=2011 |isbn=978-1-119-96540-4 |page=9 |name-list-style=vanc}}
• Vaporizing, heating various forms of cannabis to {{convert|165|–|190|°C|°F}},{{Cite book |last=Rosenthal |first=Ed |url=https://books.google.com/books?id=obbSwmSB6okC&pg=PT15 |title=Ask Ed: Marijuana Gold: Trash to Stash |publisher=Perseus Books Group |date=2002 |isbn=978-1-936807-02-4 |page=15 |name-list-style=vanc}} causing the active ingredients to form vapor without combustion of the plant material (the boiling point of THC is {{convert|157|°C|°F}} at atmospheric pressure).{{Cite web |title=Cannabis and Cannabis Extracts: Greater Than the Sum of Their Parts? |url=http://www.cannabis-med.org/data/pdf/2001-03-04-7.pdf |archive-url=https://web.archive.org/web/20170622203721/http://www.cannabis-med.org/data/pdf/2001-03-04-7.pdf |archive-date=22 June 2017 |access-date=7 April 2014 |publisher=Cannabis-med.org}}
• Edibles, adding cannabis as an ingredient to a wide variety of foods, including butter and baked goods. In India it is commonly consumed as the beverage bhang.
• Cannabis tea, prepared with attention to the lipophilic quality of THC, which is only slightly water-soluble (2.8 mg per liter),{{PubChem|16078|Dronabinol}} often involving cannabis in a saturated fat.{{Cite book |last1=Gieringer |first1=Dale |url=https://books.google.com/books?id=OuAHxDKcpS8C&pg=PA182 |title=Marijuana medical handbook: practical guide to therapeutic uses of marijuana |last2=Rosenthal |first2=Ed |publisher=QUICK AMER Publishing Company |date=2008 |isbn=978-0-932551-86-3 |page=182 |name-list-style=vanc}}
• Tincture of cannabis, sometimes known as green dragon, is an alcoholic cannabis concentrate.
• Capsules, typically containing cannabis oil, and other dietary supplement products, for which some 220 were approved in Canada in 2018.{{Cite web |date=11 July 2018 |title=Health products containing cannabis or for use with cannabis: Guidance for the Cannabis Act, the Food and Drugs Act, and related regulations |url=https://www.canada.ca/en/health-canada/services/drugs-health-products/drug-products/applications-submissions/guidance-documents/guidance-cannabis-act-food-and-drugs-act-related-regulations/document.html |access-date=19 October 2018 |publisher=Government of Canada}}

{{main|Annual cannabis use by country}}

{{Global estimates of illicit drug users}}

In 2013, between 128 and 232 million people used cannabis (2.7% to 4.9% of the global population between the ages of 15 and 65).{{Cite book |title=World Drug Report 2015 |page=23 |chapter=Status and Trend Analysis of {{sic|nolink=y|Illict}} Drug Markets |access-date=26 June 2015 |chapter-url=http://www.unodc.org/documents/wdr2015/WDR15_Drug_use_health_consequences.pdf}} Cannabis is by far the most widely used illicit substance,{{Cite book |last1=Caulkins |first1=Jonathan P. |url=https://archive.org/details/marijuanalegaliz0000unse/page/16 |title=Marijuana Legalization: What Everyone Needs to Know |last2=Hawken |first2=Angela |last3=Kilmer |first3=Beau |last4=Kleiman |first4=Mark A.R. |publisher=Oxford University Press |date=2012 |isbn=978-0199913732 |page=[https://archive.org/details/marijuanalegaliz0000unse/page/16 16] |name-list-style=vanc}} with the highest use among adults ({{as of|2018|lc=y}}) in Zambia, the United States, Canada, and Nigeria.{{Cite web |title=UNODC Statistics Online |url=https://data.unodc.org/ |access-date=9 September 2018 |website=data.unodc.org}}

Between 1973 and 1978, eleven states decriminalized marijuana.{{Cite journal |last=Joshua |first=Clark Davis |name-list-style=vanc |date=2015 |title=The business of getting high: head shops, countercultural capitalism, and the marijuana legalization movement |journal=The Sixties |volume=8 |pages=27–49 |doi=10.1080/17541328.2015.1058480 |s2cid=142795620 |hdl-access=free |hdl=11603/7422}} In 2001, Nevada reduced marijuana possession to a misdemeanor and since 2012, several other states have decriminalized and even legalized marijuana.

In 2018, surveys indicated that almost half of the people in the United States had tried marijuana, 16% had used it in the past year, and 11% had used it in the past month.{{Cite web |date=22 November 2018 |title=6 facts about marijuana |url=https://www.pewresearch.org/fact-tank/2019/11/22/facts-about-marijuana/ |access-date=24 September 2020}} In 2014, surveys said daily marijuana use amongst US college students had reached its highest level since records began in 1980, rising from 3.5% in 2007 to 5.9% in 2014 and had surpassed daily cigarette use.{{Cite web |title=Daily marijuana use among college students highest since 1980 |url=https://record.umich.edu/articles/daily-marijuana-use-among-college-students-highest-1980 |website=The University Record}}

In the US, men are over twice as likely to use marijuana as women, and 18{{ndash}}29-year-olds are six times more likely to use as over-65-year-olds.{{Cite news |last=McCarthy |first=Justin |date=22 July 2015 |title=More Than Four in 10 Americans Say They Have Tried Marijuana |work=Gallup |url=https://news.gallup.com/poll/184298/four-americans-say-tried-marijuana.aspx}} In 2015, a record 44% of the US population has tried marijuana in their lifetime, an increase from 38% in 2013 and 33% in 1985.

Marijuana use in the United States is three times above the global average, but in line with other Western democracies. Forty-four percent of American 12th graders have tried the drug at least once, and the typical age of first-use is 16, similar to the typical age of first-use for alcohol but lower than the first-use age for other illicit drugs.

A 2022 Gallup poll concluded Americans are smoking more marijuana than cigarettes for the first time.{{Cite news |title=For the first time, Americans are smoking more marijuana than cigarettes, poll finds |work=cbsnews.com |url=https://www.cbsnews.com/news/marijuana-more-popular-than-cigarettes-in-us-gallup-poll/}}

{{Further|Effects of cannabis}}

File:Bodily effects of cannabis.svg

Acute negative effects may include anxiety and panic, impaired attention and memory, an increased risk of psychotic symptoms,{{efn|Psychotic episodes are well-documented and typically resolve within minutes or hours, while symptoms may last longer.{{Cite web |title=Sativex Oral Mucosal Spray Public Assessment Report. Decentralized Procedure. |url=http://www.mhra.gov.uk/home/groups/par/documents/websiteresources/con084961.pdf |access-date=7 May 2015 |publisher=United Kingdom Medicines and Healthcare Products Regulatory Agency |page=93 |quote=There is clear evidence that recreational cannabis can produce a transient toxic psychosis in larger doses or in susceptible individuals, which is said to characteristically resolve within a week or so of absence (Johns 2001). Transient psychotic episodes as a component of acute intoxication are well-documented (Hall et al 1994)}} The use of a single joint can temporarily induce some psychiatric symptoms.{{Cite news |last=Hunt |first=Katie |date=17 March 2020 |title=Single cannabis joint linked with temporary psychiatric symptoms, review finds |work=CNN |url=https://www.cnn.com/2020/03/17/health/cannabis-psychiatric-symptoms-wellness/index.html |access-date=21 March 2020}}}} the inability to think clearly, and an increased risk of accidents.{{Cite journal |vauthors=Hall W, Solowij N |date=November 1998 |title=Adverse effects of cannabis |journal=Lancet |volume=352 |issue=9140 |pages=1611–16 |doi=10.1016/S0140-6736(98)05021-1 |pmid=9843121 |s2cid=16313727}}{{Cite book |last1=Oltmanns |first1=Thomas |title=Abnormal Psychology |last2=Emery |first2=Robert |publisher=Pearson |date=2015 |isbn=978-0205970742 |location=New Jersey |page=294 |name-list-style=vanc}}{{Cite journal |vauthors=D'Souza DC, Sewell RA, Ranganathan M |date=October 2009 |title=Cannabis and psychosis/schizophrenia: human studies |journal=European Archives of Psychiatry and Clinical Neuroscience |volume=259 |issue=7 |pages=413–31 |doi=10.1007/s00406-009-0024-2 |pmc=2864503 |pmid=19609589}} Cannabis impairs a person's driving ability, and THC was the illicit drug most frequently found in the blood of drivers who have been involved in vehicle crashes. Those with THC in their system are from three to seven times more likely to be the cause of the accident than those who had not used either cannabis or alcohol, although its role is not necessarily causal because THC stays in the bloodstream for days to weeks after intoxication.{{Cite web |last=Abuse |first=National Institute on Drug |title=Does marijuana use affect driving? |url=https://www.drugabuse.gov/publications/research-reports/marijuana/does-marijuana-use-affect-driving |access-date=18 December 2019 |website=www.drugabuse.gov}}{{Cite journal |vauthors=Li MC, Brady JE, DiMaggio CJ, Lusardi AR, Tzong KY, Li G |date=4 October 2011 |title=Marijuana use and motor vehicle crashes |journal=Epidemiologic Reviews |volume=34 |issue=1 |pages=65–72 |doi=10.1093/epirev/mxr017 |pmc=3276316 |pmid=21976636}}{{efn|A 2016 review also found a statistically significant increase in crash risk associated with marijuana use, but noted that this risk was "of low to medium magnitude."{{Cite journal |vauthors=Rogeberg O, Elvik R |date=August 2016 |title=The effects of cannabis intoxication on motor vehicle collision revisited and revised |url=https://zenodo.org/record/897625 |journal=Addiction |volume=111 |issue=8 |pages=1348–59 |doi=10.1111/add.13347 |pmid=26878835}} The increase in risk of motor vehicle crash for cannabis use is between 2 and 3 times relative to baseline, whereas that for comparable doses of alcohol is between 6 and 15 times.{{Cite journal |vauthors=Hall W |date=January 2015 |title=What has research over the past two decades revealed about the adverse health effects of recreational cannabis use? |url=https://espace.library.uq.edu.au/view/UQ:346328/Hall_2014_20ycann_OA_post.pdf |journal=Addiction |volume=110 |issue=1 |pages=19–35 |doi=10.1111/add.12703 |pmid=25287883}}}}

Some immediate undesired side effects include a decrease in short-term memory, dry mouth, impaired motor skills, reddening of the eyes,{{Cite book |last1=Hall |first1=Wayne |url=https://archive.org/details/CannabisUseAndDependence |title=Cannabis Use and Dependence: Public Health and Public Policy |last2=Pacula |first2=Rosalie Liccardo |publisher=Cambridge University Press |date=2003 |isbn=978-0-521-80024-2 |page=[https://archive.org/details/CannabisUseAndDependence/page/n35 38] |url-access=registration |name-list-style=vanc}} dizziness, feeling tired and vomiting. Some users may experience an episode of acute psychosis, which usually abates after six hours, but in rare instances, heavy users may find the symptoms continuing for many days.

Legalization has increased the rates at which children are exposed to cannabis, particularly from edibles. While the toxicity and lethality of THC in children is not known, they are at risk for encephalopathy, hypotension, respiratory depression severe enough to require ventilation, somnolence and coma.{{Cite journal |last1=Wong |first1=Kei U. |last2=Baum |first2=Carl R. |date=November 2019 |title=Acute Cannabis Toxicity |journal=Pediatric Emergency Care |language=en-US |volume=35 |issue=11 |pages=799–804 |doi=10.1097/PEC.0000000000001970 |issn=0749-5161 |pmid=31688799 |s2cid=207897219}}{{Cite journal |last1=Claudet |first1=Isabelle |last2=Le Breton |first2=Mathilde |last3=Bréhin |first3=Camille |last4=Franchitto |first4=Nicolas |date=April 2017 |title=A 10-year review of cannabis exposure in children under 3-years of age: do we need a more global approach? |journal=European Journal of Pediatrics |volume=176 |issue=4 |pages=553–56 |doi=10.1007/s00431-017-2872-5 |issn=1432-1076 |pmid=28210835 |s2cid=11639790}}

There is no clear evidence for a link between cannabis use and deaths from cardiovascular disease, but a 2019 review noted that it may be an under-reported, contributory factor or direct cause in cases of sudden death, due to the strain it can place on the cardiovascular system. Some deaths have also been attributed to cannabinoid hyperemesis syndrome.{{Cite journal |vauthors=Drummer OH, Gerostamoulos D, Woodford NW |date=May 2019 |title=Cannabis as a cause of death: A review |journal=Forensic Sci Int |volume=298 |pages=298–306 |doi=10.1016/j.forsciint.2019.03.007 |pmid=30925348 |s2cid=87511682}} There is an association between cannabis use and suicide, particularly in younger users.{{cite journal |vauthors=Shamabadi A, Ahmadzade A, Pirahesh K, Hasanzadeh A, Asadigandomani H |title=Suicidality risk after using cannabis and cannabinoids: An umbrella review |journal=Dialogues Clin Neurosci |volume=25 |issue=1 |pages=50–63 |date=December 2023 |pmid=37427882 |pmc=10334849 |doi=10.1080/19585969.2023.2231466 |url= | s2cid = 259499926}}

A 16-month survey of Oregon and Alaska emergency departments found a report of the death of an adult who had been admitted for acute cannabis toxicity.{{Cite journal |vauthors=Takakuwa KM, Schears RM |date=February 2021 |title=The emergency department care of the cannabis and synthetic cannabinoid patient: a narrative review |journal=Int J Emerg Med |type=Review |volume=14 |issue=1 |pages=10 |doi=10.1186/s12245-021-00330-3 |pmc=7874647 |pmid=33568074 |doi-access=free }}

A recent study in 2025 suggests that individuals diagnosed with cannabis use disorder—characterized by an inability to stop using cannabis despite its negative effects—face a nearly threefold increase in mortality rates compared to those without the condition over a five-year period.{{Cite news |last=Rabin |first=Roni Caryn |date=2025-02-06 |title=Marijuana Dependence Linked to Higher Risk of Death |url=https://www.nytimes.com/2025/02/06/health/cannabis-marijuana-death-psychosis.html |access-date=2025-02-08 |work=The New York Times |language=en-US |issn=0362-4331}} The research indicates that people with this disorder are ten times more likely to die by suicide than the general population.{{Cite journal |last=Myran |first=Daniel T. |last2=Pugliese |first2=Michael |last3=McDonald |first3=André J. |last4=Xiao |first4=Jennifer |last5=Fischer |first5=Benedikt |last6=Finkelstein |first6=Yaron |last7=Tanuseputro |first7=Peter |last8=Firth |first8=Joseph |last9=Pakpour |first9=Amir |last10=Hsu |first10=Chih-Wei |last11=Chang |first11=Wing-Chung |last12=Solmi |first12=Marco |date=2025-02-06 |title=Cannabis Use Disorder Emergency Department Visits and Hospitalizations and 5-Year Mortality |url=https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2829914?&utm_source=BulletinHealthCare&utm_medium=email&utm_term=020725&utm_content=NON-MEMBER&utm_campaign=article_alert-morning_rounds_daily&utm_uid=5590102 |journal=JAMA Network Open |volume=8 |issue=2 |pages=e2457852 |doi=10.1001/jamanetworkopen.2024.57852 |issn=2574-3805|pmc=11803479 }} Additionally, they have a higher risk of death from trauma, drug poisoning, and lung cancer. In a separate study researchers found an increase in schizophrenia and psychosis cases in Canada linked to cannabis use disorder following the drug’s legalization.{{Cite journal |last=Myran |first=Daniel T. |last2=Pugliese |first2=Michael |last3=Harrison |first3=Lyndsay D. |last4=Solmi |first4=Marco |last5=Anderson |first5=Kelly K. |last6=Fiedorowicz |first6=Jess G. |last7=Finkelstein |first7=Yaron |last8=Manuel |first8=Doug |last9=Taljaard |first9=Monica |last10=Webber |first10=Colleen |last11=Tanuseputro |first11=Peter |date=2025-02-04 |title=Changes in Incident Schizophrenia Diagnoses Associated With Cannabis Use Disorder After Cannabis Legalization |url=https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2829840?&utm_source=BulletinHealthCare&utm_medium=email&utm_term=020725&utm_content=NON-MEMBER&utm_campaign=article_alert-morning_rounds_daily&utm_uid=5590102&utm_effort=DAMR01 |journal=JAMA Network Open |volume=8 |issue=2 |pages=e2457868 |doi=10.1001/jamanetworkopen.2024.57868 |issn=2574-3805|pmc=11795325 }}

{{main|Long-term effects of cannabis}}

File:Rational harm assessment of drugs radar plot.svg regarding 20 popular recreational drugs. Cannabis was ranked 11th in dependence, 17th in physical harm, and 10th in social harm.{{Cite journal |vauthors=Nutt D, King LA, Saulsbury W, Blakemore C |date=March 2007 |title=Development of a rational scale to assess the harm of drugs of potential misuse |journal=Lancet |volume=369 |issue=9566 |pages=1047–53 |doi=10.1016/s0140-6736(07)60464-4 |pmid=17382831 |s2cid=5903121}}]]

A 2015 meta-analysis found that, although a longer period of abstinence was associated with smaller magnitudes of impairment, both retrospective and prospective memory were impaired in cannabis users. The authors concluded that some, but not all, of the deficits associated with cannabis use were reversible.{{Cite journal |vauthors=Schoeler T, Kambeitz J, Behlke I, Murray R, Bhattacharyya S |date=January 2016 |title=The effects of cannabis on memory function in users with and without psychotic disorder: findings from a combined meta-analysis |url=https://epub.ub.uni-muenchen.de/43978/ |journal=Psychological Medicine |volume=46 |issue=1 |pages=177–88 |doi=10.1017/S0033291715001646 |pmid=26353818 |s2cid=23749219}} A 2012 meta-analysis found that deficits in most domains of cognition persisted beyond the acute period of intoxication, but was not evident in studies where subjects were abstinent for more than 25 days.{{Cite journal |vauthors=Schreiner AM, Dunn ME |date=October 2012 |title=Residual effects of cannabis use on neurocognitive performance after prolonged abstinence: a meta-analysis |journal=Experimental and Clinical Psychopharmacology |volume=20 |issue=5 |pages=420–29 |doi=10.1037/a0029117 |pmid=22731735 |s2cid=207618350 |quote=Therefore, results indicate evidence for small neurocognitive effects that persist after the period of acute intoxication...As hypothesized, the meta-analysis conducted on studies eval- uating users after at least 25 days of abstention found no residual effects on cognitive performance...These results fail to support the idea that heavy cannabis use may result in long-term, persistent effects on neuropsychological functioning.}} Few high quality studies have been performed on the long-term effects of cannabis on cognition, and the results were generally inconsistent.{{Cite journal |vauthors=Gonzalez R, Carey C, Grant I |date=November 2002 |title=Nonacute (residual) neuropsychological effects of cannabis use: a qualitative analysis and systematic review |journal=Journal of Clinical Pharmacology |volume=42 |issue=S1 |pages=48S–57S |doi=10.1002/j.1552-4604.2002.tb06003.x |pmid=12412836 |s2cid=37826919}} Furthermore, effect sizes of significant findings were generally small. One review concluded that, although most cognitive faculties were unimpaired by cannabis use, residual deficits occurred in executive functions.{{Cite journal |vauthors=Crean RD, Crane NA, Mason BJ |date=March 2011 |title=An evidence based review of acute and long-term effects of cannabis use on executive cognitive functions |journal=Journal of Addiction Medicine |volume=5 |issue=1 |pages=1–8 |doi=10.1097/ADM.0b013e31820c23fa |pmc=3037578 |pmid=21321675 |quote=Cannabis appears to continue to exert impairing effects in executive functions even after 3 weeks of abstinence and beyond. While basic attentional and working memory abilities are largely restored, the most enduring and detectable deficits are seen in decision-making, concept formation and planning.}} Impairments in executive functioning are most consistently found in older populations, which may reflect heavier cannabis exposure, or developmental effects associated with adolescent cannabis use.{{Cite journal |vauthors=Broyd SJ, van Hell HH, Beale C, Yücel M, Solowij N |date=April 2016 |title=Acute and Chronic Effects of Cannabinoids on Human Cognition-A Systematic Review |url=http://ro.uow.edu.au/sspapers/2164 |journal=Biological Psychiatry |volume=79 |issue=7 |pages=557–67 |doi=10.1016/j.biopsych.2015.12.002 |pmid=26858214 |s2cid=9858298}} One review found three prospective cohort studies that examined the relationship between self-reported cannabis use and intelligence quotient (IQ). The study following the largest number of heavy cannabis users reported that IQ declined between ages 7–13 and age 38. Poorer school performance and increased incidence of leaving school early were both associated with cannabis use, although a causal relationship was not established.{{Cite journal |vauthors=Curran HV, Freeman TP, Mokrysz C, Lewis DA, Morgan CJ, Parsons LH |date=May 2016 |title=Keep off the grass? Cannabis, cognition and addiction |url=http://discovery.ucl.ac.uk/1489385/1/Curran%2520et%2520al%2520NRN-2016%2520pdf.pdf |journal=Nature Reviews. Neuroscience |volume=17 |issue=5 |pages=293–306 |doi=10.1038/nrn.2016.28 |pmid=27052382 |s2cid=1685727 |archive-url=https://web.archive.org/web/20170922191943/http://discovery.ucl.ac.uk/1489385/1/Curran%2520et%2520al%2520NRN-2016%2520pdf.pdf |archive-date=22 September 2017 |access-date=27 December 2018 |hdl-access=free |hdl=10871/24746}} Cannabis users demonstrated increased activity in task-related brain regions, consistent with reduced processing efficiency.{{Cite journal |vauthors=Ganzer F, Bröning S, Kraft S, Sack PM, Thomasius R |date=June 2016 |title=Weighing the Evidence: A Systematic Review on Long-Term Neurocognitive Effects of Cannabis Use in Abstinent Adolescents and Adults |journal=Neuropsychology Review |volume=26 |issue=2 |pages=186–222 |doi=10.1007/s11065-016-9316-2 |pmid=27125202 |s2cid=4335379}}

A reduced quality of life is associated with heavy cannabis use, although the relationship is inconsistent and weaker than for tobacco and other substances.{{Cite journal |vauthors=Goldenberg M, IsHak WW, Danovitch I |date=January 2017 |title=Quality of life and recreational cannabis use |journal=The American Journal on Addictions |volume=26 |issue=1 |pages=8–25 |doi=10.1111/ajad.12486 |pmid=28000973 |s2cid=40707053}} The direction of cause and effect, however, is unclear.

The long-term effects of cannabis are not clear. There are concerns surrounding memory and cognition problems, risk of addiction, and the risk of schizophrenia in young people.

Although global abnormalities in white matter and grey matter are not consistently associated with cannabis use,{{Cite journal |vauthors=Hampton WH, Hanik I, Olson IR |date=2019 |title=[Substance Abuse and White Matter: Findings, Limitations, and Future of Diffusion Tensor Imaging Research] |journal=Drug and Alcohol Dependence |language=en |volume=197 |issue=4 |pages=288–298 |doi=10.1016/j.drugalcdep.2019.02.005 |pmc=6440853 |pmid=30875650 |quote=Given that [the human] central nervous system is an intricately balanced, complex network of billions of neurons and supporting cells, some might imagine that extrinsic substances could cause irreversible brain damage. Our review paints a less gloomy picture of the substances reviewed, however. Following prolonged abstinence, abusers of alcohol (Pfefferbaum et al., 2014) or opiates (Wang et al., 2011) have white matter microstructure that is not significantly different from nonusers. There was also no evidence that the white matter microstructural changes observed in longitudinal studies of cannabis, nicotine, or cocaine were completely irreparable. It is therefore possible that, at least to some degree, abstinence can reverse effects of substance abuse on white matter. The ability of white matter to “bounce back” very likely depends on the level and duration of abuse, as well as the substance being abused.}} reduced hippocampal volume is consistently found.{{Cite journal |last1=Yücel |first1=M |last2=Lorenzetti |first2=V |last3=Suo |first3=C |last4=Zalesky |first4=A |last5=Fornito |first5=A |last6=Takagi |first6=M J |last7=Lubman |first7=D I |last8=Solowij |first8=N |date=January 2016 |title=Hippocampal harms, protection and recovery following regular cannabis use |journal=Translational Psychiatry |volume=6 |issue=1 |pages=e710– |doi=10.1038/tp.2015.201 |pmc=5068875 |pmid=26756903}} Amygdala abnormalities are sometimes reported, although findings are inconsistent.{{Cite journal |vauthors=Rocchetti M, Crescini A, Borgwardt S, Caverzasi E, Politi P, Atakan Z, Fusar-Poli P |date=November 2013 |title=Is cannabis neurotoxic for the healthy brain? A meta-analytical review of structural brain alterations in non-psychotic users |journal=Psychiatry and Clinical Neurosciences |volume=67 |issue=7 |pages=483–92 |doi=10.1111/pcn.12085 |pmid=24118193 |s2cid=8245635 |doi-access=free}}{{Cite journal |vauthors=Batalla A, Bhattacharyya S, Yücel M, Fusar-Poli P, Crippa JA, Nogué S, Torrens M, Pujol J, Farré M, Martin-Santos R |date=2013 |title=Structural and functional imaging studies in chronic cannabis users: a systematic review of adolescent and adult findings |journal=PLOS ONE |volume=8 |issue=2 |pages=e55821 |bibcode=2013PLoSO...855821B |doi=10.1371/journal.pone.0055821 |pmc=3563634 |pmid=23390554 |quote=The most consistently reported brain alteration was reduced hippocampal volume which was shown to persist even after several months of abstinence in one study and also to be related to the amount of cannabis use Other frequently reported morphological brain alterations related to chronic cannabis use were reported in the amygdala the cerebellum and the frontal cortex...These findings may be interpreted as reflecting neuroadaptation, perhaps indicating the recruitment of additional regions as a compensatory mechanism to maintain normal cognitive performance in response to chronic cannabis exposure, particularly within the prefrontal cortex area. |doi-access=free}}{{Cite journal |vauthors=Weinstein A, Livny A, Weizman A |date=2016 |title=Brain Imaging Studies on the Cognitive, Pharmacological and Neurobiological Effects of Cannabis in Humans: Evidence from Studies of Adult Users |journal=Current Pharmaceutical Design |volume=22 |issue=42 |pages=6366–79 |doi=10.2174/1381612822666160822151323 |pmid=27549374 |quote=1) The studies reviewed so far demonstrated that chronic cannabis use has been associated with a volume reduction of the hippocampus...3) The overall conclusion arising from these studies is that recent cannabis users may experience subtle neurophysiological deficits while performing on working memory tasks, and that they compensate for these deficits by "working harder" by using additional brain regions to meet the demands of the task.}}

Cannabis use is associated with increased recruitment of task-related areas, such as the dorsolateral prefrontal cortex, which is thought to reflect compensatory activity due to reduced processing efficiency.{{Cite journal |vauthors=Blest-Hopley G, Giampietro V, Bhattacharyya S |date=May 2018 |title=Residual effects of cannabis use in adolescent and adult brains – A meta-analysis of fMRI studies |url=https://kclpure.kcl.ac.uk/portal/files/88441182/Residual_effects_of_cannabis_BLEST_HOPLEY_Publishedonline10March2018_GREEN_AAM_CC_BY_NC_ND_.pdf |journal=Neuroscience and Biobehavioral Reviews |volume=88 |pages=26–41 |doi=10.1016/j.neubiorev.2018.03.008 |pmid=29535069 |s2cid=4402954 |quote=This may reflect the multitude of cognitive tasks employed by the various studies included in these meta-analyses, all of which involved performing a task thereby requiring the participant to reorient their attention and attempt to solve the problem at hand and suggest that greater engagement of this region indicates less efficient cognitive performance in cannabis users in general, irrespective of their age.}} Cannabis use is also associated with downregulation of CB₁ receptors. The magnitude of down regulation is associated with cumulative cannabis exposure, and is reversed after one month of abstinence.{{Cite journal |vauthors=Parsons LH, Hurd YL |date=October 2015 |title=Endocannabinoid signalling in reward and addiction |journal=Nature Reviews. Neuroscience |volume=16 |issue=10 |pages=579–94 |doi=10.1038/nrn4004 |pmc=4652927 |pmid=26373473}}{{Cite journal |vauthors=Zehra A, Burns J, Liu CK, Manza P, Wiers CE, Volkow ND, Wang GJ |date=March 2018 |title=Cannabis Addiction and the Brain: a Review |journal=Journal of Neuroimmune Pharmacology |volume=13 |issue=4 |pages=438–52 |doi=10.1007/s11481-018-9782-9 |pmc=6223748 |pmid=29556883}} There is limited evidence that chronic cannabis use can reduce levels of glutamate metabolites in the human brain.{{Cite journal |vauthors=Colizzi M, McGuire P, Pertwee RG, Bhattacharyya S |date=May 2016 |title=Effect of cannabis on glutamate signalling in the brain: A systematic review of human and animal evidence |url=https://kclpure.kcl.ac.uk/portal/en/publications/effect-of-cannabis-on-glutamate-signalling-in-the-brain-a-systematic-review-of-human-and-animal-evidence(9b3d72d2-d3ae-44a6-b9a5-4c13e9690b9d).html |journal=Neuroscience and Biobehavioral Reviews |volume=64 |pages=359–81 |doi=10.1016/j.neubiorev.2016.03.010 |pmid=26987641 |s2cid=24043856}}

{{Main|Cannabis dependence}}

About 9% of those who experiment with marijuana eventually become dependent according to DSM-IV (1994) criteria. A 2013 review estimates daily use is associated with a 10–20% rate of dependence. The highest risk of cannabis dependence is found in those with a history of poor academic achievement, deviant behavior in childhood and adolescence, rebelliousness, poor parental relationships, or a parental history of drug and alcohol problems.{{Cite journal |vauthors=Hall W, Degenhardt L |date=October 2009 |title=Adverse health effects of non-medical cannabis use |journal=Lancet |volume=374 |issue=9698 |pages=1383–91 |doi=10.1016/s0140-6736(09)61037-0 |pmid=19837255 |s2cid=31616272}} Of daily users, about 50% experience withdrawal upon cessation of use (i.e. are dependent), characterized by sleep problems, irritability, dysphoria, and craving. Cannabis withdrawal is less severe than withdrawal from alcohol.{{Cite journal |vauthors=Subbaraman MS |date=2014 |title=Can cannabis be considered a substitute medication for alcohol? |journal=Alcohol and Alcoholism |volume=49 |issue=3 |pages=292–98 |doi=10.1093/alcalc/agt182 |pmc=3992908 |pmid=24402247}}

According to DSM-5 criteria, 9% of those who are exposed to cannabis develop cannabis use disorder, compared to 20% for cocaine, 23% for alcohol and 68% for nicotine. Cannabis use disorder in the DSM-5 involves a combination of DSM-IV criteria for cannabis abuse and dependence, plus the addition of craving, without the criterion related to legal troubles.

{{See also|Long-term effects of cannabis#Mental health}}

From a clinical perspective, two significant school of thought exists for psychiatric conditions associated with cannabis (or cannabinoids) use: transient, non-persistent psychotic reactions, and longer-lasting, persistent disorders that resemble schizophrenia. The former is formally known as acute cannabis-associated psychotic symptoms (CAPS).{{Cite journal |last1=Schoeler |first1=Tabea |last2=Baldwin |first2=Jessie R. |last3=Martin |first3=Ellen |last4=Barkhuizen |first4=Wikus |last5=Pingault |first5=Jean-Baptiste |date=2024-06-03 |title=Assessing rates and predictors of cannabis-associated psychotic symptoms across observational, experimental and medical research |journal=Nature Mental Health |volume=2 |issue=7 |language=en |pages=865–876 |doi=10.1038/s44220-024-00261-x |issn=2731-6076|doi-access=free |pmid=39005547 |pmc=11236708 }}

At an epidemiological level, a dose–response relationship exists between cannabis use and increased risk of psychosis and earlier onset of psychosis.{{Cite journal |vauthors=Leweke FM, Mueller JK, Lange B, Rohleder C |date=April 2016 |title=Therapeutic Potential of Cannabinoids in Psychosis |journal=Biological Psychiatry |volume=79 |issue=7 |pages=604–12 |doi=10.1016/j.biopsych.2015.11.018 |pmid=26852073 |s2cid=24160677 |quote=Epidemiological data indicate a strong relationship between cannabis use and psychosis and schizophrenia beyond transient intoxication with an increased risk of any psychotic outcome in individuals who had ever used cannabis}}{{Cite journal |vauthors=Marconi A, Di Forti M, Lewis CM, Murray RM, Vassos E |date=September 2016 |title=Meta-analysis of the Association Between the Level of Cannabis Use and Risk of Psychosis |journal=Schizophrenia Bulletin |volume=42 |issue=5 |pages=1262–69 |doi=10.1093/schbul/sbw003 |pmc=4988731 |pmid=26884547}}{{Cite journal |vauthors=Moore TH, Zammit S, Lingford-Hughes A, Barnes TR, Jones PB, Burke M, Lewis G |date=July 2007 |title=Cannabis use and risk of psychotic or affective mental health outcomes: a systematic review |url=http://orca.cf.ac.uk/619/1/Appendix%201%20%28search%20strategy%29%20Cannabis%20use%20and%20risk%20of%20developing%20psychotic%20or%20affective%20mental%20health%20outcomes%20a%20systematic%20review.pdf |journal=Lancet |volume=370 |issue=9584 |pages=319–28 |doi=10.1016/S0140-6736(07)61162-3 |pmid=17662880 |s2cid=41595474}}{{Cite journal |vauthors=Semple DM, McIntosh AM, Lawrie SM |date=March 2005 |title=Cannabis as a risk factor for psychosis: systematic review |journal=Journal of Psychopharmacology |volume=19 |issue=2 |pages=187–94 |doi=10.1177/0269881105049040 |pmid=15871146 |s2cid=44651274}}{{Cite journal |vauthors=Large M, Sharma S, Compton MT, Slade T, Nielssen O |date=June 2011 |title=Cannabis use and earlier onset of psychosis: a systematic meta-analysis |journal=Archives of General Psychiatry |volume=68 |issue=6 |pages=555–61 |doi=10.1001/archgenpsychiatry.2011.5 |pmid=21300939 |doi-access=free}} Although the epidemiological association is robust, evidence to prove a causal relationship is lacking.{{Cite journal |vauthors=McLaren JA, Silins E, Hutchinson D, Mattick RP, Hall W |date=January 2010 |title=Assessing evidence for a causal link between cannabis and psychosis: a review of cohort studies |journal=The International Journal on Drug Policy |volume=21 |issue=1 |pages=10–19 |doi=10.1016/j.drugpo.2009.09.001 |pmid=19783132 |quote=The contentious issue of whether cannabis use can cause serious psychotic disorders that would not otherwise have occurred cannot be answered based on the existing data}}

Cannabis may also increase the risk of depression, but insufficient research has been performed to draw a conclusion.{{Cite journal |vauthors=Lev-Ran S, Roerecke M, Le Foll B, George TP, McKenzie K, Rehm J |date=March 2014 |title=The association between cannabis use and depression: a systematic review and meta-analysis of longitudinal studies |journal=Psychological Medicine |volume=44 |issue=4 |pages=797–810 |doi=10.1017/S0033291713001438 |pmid=23795762 |s2cid=36763290}} Cannabis use is associated with increased risk of anxiety disorders, although causality has not been established.{{Cite journal |vauthors=Kedzior KK, Laeber LT |date=May 2014 |title=A positive association between anxiety disorders and cannabis use or cannabis use disorders in the general population – a meta-analysis of 31 studies |journal=BMC Psychiatry |volume=14 |pages=136 |doi=10.1186/1471-244X-14-136 |pmc=4032500 |pmid=24884989 |doi-access=free }}

A review in 2019 found that research was insufficient to determine the safety and efficacy of using cannabis to treat schizophrenia, psychosis, or other mental disorders.{{Cite journal |last1=Black |first1=Nicola |last2=Stockings |first2=Emily |last3=Campbell |first3=Gabrielle |last4=Tran |first4=Lucy T. |last5=Zagic |first5=Dino |last6=Hall |first6=Wayne D. |last7=Farrell |first7=Michael |last8=Degenhardt |first8=Louisa |date=December 2019 |title=Cannabinoids for the treatment of mental disorders and symptoms of mental disorders: a systematic review and meta-analysis |journal=The Lancet. Psychiatry |volume=6 |issue=12 |pages=995–1010 |doi=10.1016/S2215-0366(19)30401-8 |pmc=6949116 |pmid=31672337}}{{Cite journal |last1=VanDolah |first1=Harrison J. |last2=Bauer |first2=Brent A. |last3=Mauck |first3=Karen F. |date=September 2019 |title=Clinicians' Guide to Cannabidiol and Hemp Oils |journal=Mayo Clinic Proceedings |volume=94 |issue=9 |pages=1840–51 |doi=10.1016/j.mayocp.2019.01.003 |pmid=31447137 |doi-access=free}} Another found that cannabis during adolescence was associated with an increased risk of developing depression and suicidal behavior later in life, while finding no effect on anxiety.{{Cite journal |last1=Gobbi |first1=Gabriella |author-link=Gabriella Gobbi |last2=Atkin |first2=Tobias |last3=Zytynski |first3=Tomasz |last4=Wang |first4=Shouao |last5=Askari |first5=Sorayya |last6=Boruff |first6=Jill |last7=Ware |first7=Mark |last8=Marmorstein |first8=Naomi |last9=Cipriani |first9=Andrea |last10=Dendukuri |first10=Nandini |last11=Mayo |first11=Nancy |date=13 February 2019 |title=Cannabis Use in Adolescence and Risk of Depression, Anxiety, and Suicidality in Young Adulthood |journal=JAMA Psychiatry |volume=76 |issue=4 |pages=426–34 |doi=10.1001/jamapsychiatry.2018.4500 |pmc=6450286 |pmid=30758486}}

Heavy, long-term exposure to marijuana may have physical, mental, behavioral and social health consequences. It may be "associated with diseases of the liver (particularly with co-existing hepatitis C), lungs, heart, and vasculature".{{Cite journal |vauthors=Gordon AJ, Conley JW, Gordon JM |date=December 2013 |title=Medical consequences of marijuana use: a review of current literature |url=https://zenodo.org/record/1232874 |journal=Current Psychiatry Reports |volume=15 |issue=12 |pages=419 |doi=10.1007/s11920-013-0419-7 |pmid=24234874 |s2cid=29063282}} A 2014 review found that while cannabis use may be less harmful than alcohol use, the recommendation to substitute it for problematic drinking was premature without further study.{{Cite journal |vauthors=Subbaraman MS |date=8 January 2014 |title=Can cannabis be considered a substitute medication for alcohol? |journal=Alcohol and Alcoholism |volume=49 |issue=3 |pages=292–98 |doi=10.1093/alcalc/agt182 |pmc=3992908 |pmid=24402247}} Various surveys conducted between 2015 and 2019 found that many users of cannabis substitute it for prescription drugs (including opioids), alcohol, and tobacco; most of those who used it in place of alcohol or tobacco either reduced or stopped their intake of the latter substances.{{Cite news |last=Armentano |first=Paul |date=5 February 2019 |title=Marijuana access is associated with decreased use of alcohol, tobacco and other prescription drugs |work=The Hill |url=https://thehill.com/opinion/healthcare/428593-marijuana-access-is-associated-with-decreased-use-of-alcohol-tobacco-and}}

Cannabinoid hyperemesis syndrome (CHS) is a severe condition seen in some chronic cannabis users where they have repeated bouts of uncontrollable vomiting for 24–48 hours.

Four cases of death have been reported as a result of CHS.{{Cite journal |last1=Nourbakhsh |first1=Mahra |last2=Miller |first2=Angela |last3=Gofton |first3=Jeff |last4=Jones |first4=Graham |last5=Adeagbo |first5=Bamidele |date=2019 |title=Cannabinoid Hyperemesis Syndrome: Reports of Fatal Cases |journal=Journal of Forensic Sciences |language=en |volume=64 |issue=1 |pages=270–74 |doi=10.1111/1556-4029.13819 |issn=1556-4029 |pmid=29768651 |s2cid=21718690|doi-access=free }}{{Cite web |last=Rudavsky |first=Shari |title=He loved weed. Then the vomiting began. Months later, he died |url=https://www.usatoday.com/story/news/nation/2019/09/20/indiana-boy-17-died-smoking-weed-chs-blame-what-chs/2387571001/ |access-date=2 August 2021 |website=USA Today |language=en-US}}

A limited number of studies have examined the effects of cannabis smoking on the respiratory system.{{Cite book |last1=Maisto |first1=Stephen |url=https://books.google.com/books?id=5F08AwAAQBAJ&pg=PA278 |title=Drug Use and Abuse |last2=Galizio |first2=Mark |last3=Connors |first3=Gerard |publisher=Cengage Learning |date=2014 |isbn=978-1-305-17759-8 |page=278 |name-list-style=vanc}} Chronic heavy marijuana smoking is associated with respiratory infections,{{Cite web |date=22 July 2019 |title=Commonly Abused Drugs Charts: Marijuana (Cannabis) |url=https://www.drugabuse.gov/drugs-abuse/commonly-abused-drugs-charts#marijuana-cannabis- |access-date=20 January 2020 |publisher=National Institute on Drug Abuse, US National Institutes of Health}} coughing, production of sputum, wheezing, and other symptoms of chronic bronchitis. The available evidence does not support a causal relationship between cannabis use and chronic obstructive pulmonary disease.{{Cite journal |vauthors=Owen KP, Sutter ME, Albertson TE |date=February 2014 |title=Marijuana: respiratory tract effects |journal=Clinical Reviews in Allergy & Immunology |volume=46 |issue=1 |pages=65–81 |doi=10.1007/s12016-013-8374-y |pmid=23715638 |s2cid=23823391}} Short-term use of cannabis is associated with bronchodilation.{{Cite journal |vauthors=Tetrault JM, Crothers K, Moore BA, Mehra R, Concato J, Fiellin DA |date=February 2007 |title=Effects of marijuana smoking on pulmonary function and respiratory complications: a systematic review |journal=Archives of Internal Medicine |volume=167 |issue=3 |pages=221–28 |doi=10.1001/archinte.167.3.221 |pmc=2720277 |pmid=17296876}} Other side effects of cannabis use include cannabinoid hyperemesis syndrome (CHS), a condition which involves recurrent nausea, cramping abdominal pain, and vomiting.{{Cite journal |vauthors=Sorensen CJ, DeSanto K, Borgelt L, Phillips KT, Monte AA |date=March 2017 |title=Cannabinoid Hyperemesis Syndrome: Diagnosis, Pathophysiology, and Treatment-a Systematic Review |journal=Journal of Medical Toxicology |volume=13 |issue=1 |pages=71–87 |doi=10.1007/s13181-016-0595-z |pmc=5330965 |pmid=28000146}}

Cannabis smoke contains thousands of organic and inorganic chemical compounds. This tar is chemically similar to that found in tobacco smoke,{{Cite journal |vauthors=Hashibe M, Straif K, Tashkin DP, Morgenstern H, Greenland S, Zhang ZF |date=April 2005 |title=Epidemiologic review of marijuana use and cancer risk |journal=Alcohol |volume=35 |issue=3 |pages=265–75 |doi=10.1016/j.alcohol.2005.04.008 |pmid=16054989}} and over fifty known carcinogens have been identified in cannabis smoke,{{Cite web |date=20 September 2010 |title=Does smoking cannabis cause cancer? |url=http://cancerhelp.cancerresearchuk.org/about-cancer/cancer-questions/does-smoking-cannabis-cause-cancer |archive-url=https://web.archive.org/web/20120729115046/http://cancerhelp.cancerresearchuk.org/about-cancer/cancer-questions/does-smoking-cannabis-cause-cancer |archive-date=29 July 2012 |access-date=9 January 2013 |publisher=Cancer Research UK}} including; nitrosamines, reactive aldehydes, and polycyclic aromatic hydrocarbons, including benz[a]pyrene.{{Cite web |last=Tashkin |first=Donald |date=March 1997 |title=Effects of marijuana on the lung and its immune defenses |url=http://www.ukcia.org/research/EffectsOfMarijuanaOnLungAndImmuneDefenses.php |access-date=23 June 2012 |publisher=UCLA School of Medicine}} Cannabis smoke is also inhaled more deeply than tobacco smoke.{{Cite journal |vauthors=Gates P, Jaffe A, Copeland J |date=July 2014 |title=Cannabis smoking and respiratory health: consideration of the literature |journal=Respirology |volume=19 |issue=5 |pages=655–62 |doi=10.1111/resp.12298 |pmid=24831571 |s2cid=29423964|doi-access=free }} {{as of|2015}}, there is no consensus regarding whether cannabis smoking is associated with an increased risk of cancer.{{Cite journal |vauthors=Huang YH, Zhang ZF, Tashkin DP, Feng B, Straif K, Hashibe M |date=January 2015 |title=An epidemiologic review of marijuana and cancer: an update |journal=Cancer Epidemiology, Biomarkers & Prevention |volume=24 |issue=1 |pages=15–31 |doi=10.1158/1055-9965.EPI-14-1026 |pmc=4302404 |pmid=25587109}} Light and moderate use of cannabis is not believed to increase risk of lung or upper airway cancer. Evidence for causing these cancers is mixed concerning heavy, long-term use. In general there are far lower risks of pulmonary complications for regular cannabis smokers when compared with those of tobacco.{{Cite journal |vauthors=Tashkin DP |date=June 2013 |title=Effects of marijuana smoking on the lung |journal=Annals of the American Thoracic Society |volume=10 |issue=3 |pages=239–47 |doi=10.1513/annalsats.201212-127fr |pmid=23802821 |s2cid=20615545}} A 2015 review found an association between cannabis use and the development of testicular germ cell tumors (TGCTs), particularly non-seminoma TGCTs.{{Cite journal |vauthors=Gurney J, Shaw C, Stanley J, Signal V, Sarfati D |date=November 2015 |title=Cannabis exposure and risk of testicular cancer: a systematic review and meta-analysis |journal=BMC Cancer |volume=15 |issue=1 |pages=897 |doi=10.1186/s12885-015-1905-6 |pmc=4642772 |pmid=26560314 |doi-access=free }} Another 2015 meta-analysis found no association between lifetime cannabis use and risk of head or neck cancer.{{Cite journal |vauthors=de Carvalho MF, Dourado MR, Fernandes IB, Araújo CT, Mesquita AT, Ramos-Jorge ML |date=December 2015 |title=Head and neck cancer among marijuana users: a meta-analysis of matched case-control studies |journal=Archives of Oral Biology |volume=60 |issue=12 |pages=1750–55 |doi=10.1016/j.archoralbio.2015.09.009 |pmid=26433192}} Combustion products are not present when using a vaporizer, consuming THC in pill form, or consuming cannabis foods.{{Cite journal |vauthors=Loflin M, Earleywine M |date=2015 |title=No smoke, no fire: What the initial literature suggests regarding vapourized cannabis and respiratory risk |journal=Canadian Journal of Respiratory Therapy |volume=51 |issue=1 |pages=7–9 |pmc=4456813 |pmid=26078621}}

There is concern that cannabis may contribute to cardiovascular disease,{{Cite book |url=https://books.google.com/books?id=_pDgBQAAQBAJ&pg=PA88 |title=Comorbidity of Mental and Physical Disorders |vauthors=Riecher-Rössler A |publisher=Karger Medical and Scientific Publishers |date=2014 |isbn=978-3-318-02604-7 |page=88}} but {{as of|2018|lc=y}}, evidence of this relationship was unclear.{{Cite journal |vauthors=Ravi D, Ghasemiesfe M, Korenstein D, Cascino T, Keyhani S |date=February 2018 |title=Associations Between Marijuana Use and Cardiovascular Risk Factors and Outcomes: A Systematic Review |journal=Annals of Internal Medicine |volume=168 |issue=3 |pages=187–94 |doi=10.7326/M17-1548 |pmc=6157910 |pmid=29357394}} Research in these events is complicated because cannabis is often used in conjunction with tobacco, and drugs such as alcohol and cocaine that are known to have cardiovascular risk factors.{{Cite journal |vauthors=Thomas G, Kloner RA, Rezkalla S |date=January 2014 |title=Adverse cardiovascular, cerebrovascular, and peripheral vascular effects of marijuana inhalation: what cardiologists need to know |journal=The American Journal of Cardiology |volume=113 |issue=1 |pages=187–90 |doi=10.1016/j.amjcard.2013.09.042 |pmid=24176069 |doi-access=free}} Smoking cannabis has also been shown to increase the risk of myocardial infarction by 4.8 times for the 60 minutes after consumption.{{Cite journal |vauthors=Franz CA, Frishman WH |date=9 February 2016 |title=Marijuana Use and Cardiovascular Disease |journal=Cardiology in Review |volume=24 |issue=4 |pages=158–62 |doi=10.1097/CRD.0000000000000103 |pmid=26886465 |s2cid=205566342}}

There is preliminary evidence that cannabis interferes with the anticoagulant properties of prescription drugs used for treating blood clots.{{Cite journal |last1=Greger |first1=Jessica |last2=Bates |first2=Vernice |last3=Mechtler |first3=Laszlo |last4=Gengo |first4=Fran |date=2020 |title=A review of cannabis and interactions with anticoagulant and antiplatelet agents |journal=The Journal of Clinical Pharmacology |volume=60 |issue=4 |pages=432–38 |doi=10.1002/jcph.1557 |pmid=31724188 |s2cid=208019237}} {{as of|2019}}, the mechanisms for the anti-inflammatory and possible pain relieving effects of cannabis were not defined, and there were no governmental regulatory approvals or clinical practices for use of cannabis as a drug.

Emergency room (ER) admissions associated with cannabis use rose significantly from 2012 to 2016; adolescents from age 12–17 had the highest risk.{{Cite journal |last1=Shen |first1=Jay J. |last2=Shan |first2=Guogen |last3=Kim |first3=Pearl C. |last4=Yoo |first4=Ji Won |last5=Dodge-Francis |first5=Carolee |last6=Lee |first6=Yong-Jae |date=2019 |title=Trends and Related Factors of Cannabis-Associated Emergency Department Visits in the United States: 2006–2014 |journal=Journal of Addiction Medicine |language=en-US |volume=13 |issue=3 |pages=193–200 |doi=10.1097/ADM.0000000000000479 |issn=1932-0620 |pmid=30418337 |s2cid=53286585}} At one Colorado medical center following legalization, approximately two percent of ER admissions were classified as cannabis users. The symptoms of one quarter of these users were partially attributed to cannabis (a total of 2567 out of 449,031 patients); other drugs were sometimes involved. Of these cannabis admissions, one quarter were for acute psychiatric effects, primarily suicidal ideation, depression, and anxiety. An additional third of the cases were for gastrointestinal issues including cannabinoid hyperemesis syndrome.{{Cite journal |last1=Shelton |first1=Shelby K. |last2=Mills |first2=Eleanor |last3=Saben |first3=Jessica L. |last4=Devivo |first4=Michael |last5=Williamson |first5=Kayla |last6=Abbott |first6=Diana |last7=Hall |first7=Katelyn E. |last8=Monte |first8=Andrew A. |date=2020 |title=Why do patients come to the emergency department after using cannabis? |journal=Clinical Toxicology |volume=58 |issue=6 |pages=453–59 |doi=10.1080/15563650.2019.1657582 |issn=1556-9519 |pmc=7073292 |pmid=31526057}}

According to the United States Department of Health and Human Services, there were 455,000 emergency room visits associated with cannabis use in 2011. These statistics include visits in which the patient was treated for a condition induced by or related to recent cannabis use. The drug use must be "implicated" in the emergency department visit, but does not need to be the direct cause of the visit. Most of the illicit drug emergency room visits involved multiple drugs.{{Cite web |date=2011 |title=National Estimates of Drug-Related Emergency Department Visits |url=http://www.samhsa.gov/data/sites/default/files/DAWN2k11ED/DAWN2k11ED/DAWN2k11ED.pdf |access-date=8 May 2015 |website=Drug Abuse Warning Network |publisher=U.S. Department of Health and Human Services |archive-date=4 April 2015 |archive-url=https://web.archive.org/web/20150404013607/http://www.samhsa.gov/data/sites/default/files/DAWN2k11ED/DAWN2k11ED/DAWN2k11ED.pdf |url-status=dead }} In 129,000 cases, cannabis was the only implicated drug.{{Cite journal |vauthors=Volkow ND, Baler RD, Compton WM, Weiss SR |date=June 2014 |title=Adverse health effects of marijuana use |journal=The New England Journal of Medicine |volume=370 |issue=23 |pages=2219–27 |doi=10.1056/NEJMra1402309 |pmc=4827335 |pmid=24897085}}

{{excerpt|Cannabis in pregnancy|paragraph=1}}

A 2022 study found that smoking cannabis using a bong can greatly increase background levels of fine particulate matter, a carcinogen, in an enclosed space such as a living room. After 15 minutes, mean levels of particulate matter were more than twice the Environmental Protection Agency hazardous air quality threshold, and after 140 minutes, the concentrations were four times greater than those generated by smoking tobacco using a cigarette or hookah. This suggests secondhand cannabis smoke from bongs may present a health risk to non-smokers.{{cite journal |last1=Nguyen |first1=Patton Khuu |last2=Hammond |first2=S. Katharine |title=Fine Particulate Matter Exposure From Secondhand Cannabis Bong Smoking |journal=JAMA |date=March 30, 2022 |url=https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2790510 |access-date=28 January 2025}}

{{see also|Effects of cannabis#Biochemical mechanisms in the brain}}

THC is a weak partial agonist at CB₁ receptors, while CBD is a CB₁ receptor antagonist.{{cite journal |last1=Bow |first1=Eric |title=The Structure–Function Relationships of Classical Cannabinoids: CB1/CB2 Modulation |journal=Perspectives in Medicinal Chemistry |date=2016 |volume=8 |pages=17–39 |doi=10.4137/PMC.S32171|pmid=27398024 |pmc=4927043 }}{{cite journal |last1=Thomas |first1=A |title=Cannabidiol displays unexpectedly high potency as an antagonist of CB1 and CB2 receptor agonists in vitro. |journal=Br J Pharmacol |date=2007 |volume=150 |issue=5 |pages=613–623 |doi=10.1038/sj.bjp.0707133 |pmid=17245363 |url=https://doi.org/10.1038/sj.bjp.0707133|pmc=2189767 }}

The CB₁ receptor is found primarily in the brain as well as in some peripheral tissues, and the CB₂ receptor is found primarily in peripheral tissues, but is also expressed in neuroglial cells.{{Cite journal |vauthors=Wilson RI, Nicoll RA |date=April 2002 |title=Endocannabinoid signaling in the brain |journal=Science |volume=296 |issue=5568 |pages=678–82 |bibcode=2002Sci...296..678W |doi=10.1126/science.1063545 |pmid=11976437 |s2cid=21573145}} THC appears to alter mood and cognition through its agonist actions on the CB₁ receptors, which inhibit a secondary messenger system (adenylate cyclase) in a dose-dependent manner.

Via CB₁ receptor activation, THC indirectly increases dopamine release and produces psychotropic effects.{{Cite journal |vauthors=Oleson EB, Cheer JF |date=August 2012 |title=A brain on cannabinoids: the role of dopamine release in reward seeking |journal=Cold Spring Harbor Perspectives in Medicine |volume=2 |issue=8 |pages=a012229 |doi=10.1101/cshperspect.a012229 |pmc=3405830 |pmid=22908200}} CBD also acts as an allosteric modulator of the μ- and δ-opioid receptors.{{Cite journal |vauthors=Kathmann M, Flau K, Redmer A, Tränkle C, Schlicker E |date=February 2006 |title=Cannabidiol is an allosteric modulator at mu- and delta-opioid receptors |journal=Naunyn-Schmiedeberg's Archives of Pharmacology |volume=372 |issue=5 |pages=354–61 |doi=10.1007/s00210-006-0033-x |pmid=16489449 |s2cid=4877869}} THC also potentiates the effects of the glycine receptors.{{Cite journal |vauthors=Hejazi N, Zhou C, Oz M, Sun H, Ye JH, Zhang L |date=March 2006 |title=Delta9-tetrahydrocannabinol and endogenous cannabinoid anandamide directly potentiate the function of glycine receptors |journal=Molecular Pharmacology |volume=69 |issue=3 |pages=991–97 |doi=10.1124/mol.105.019174 |pmid=16332990 |s2cid=21801428}} It is unknown if or how these actions contribute to the effects of cannabis.{{Cite journal |vauthors=Xiong W, Cheng K, Cui T, Godlewski G, Rice KC, Xu Y, Zhang L |date=May 2011 |title=Cannabinoid potentiation of glycine receptors contributes to cannabis-induced analgesia |journal=Nature Chemical Biology |volume=7 |issue=5 |pages=296–303 |doi=10.1038/nchembio.552 |pmc=3388539 |pmid=21460829}}

The high lipid-solubility of cannabinoids results in their persisting in the body for long periods of time.{{Cite book |last1=Hall |first1=Wayne |url=https://archive.org/details/CannabisUseAndDependence |title=Cannabis Use and Dependence: Public Health and Public Policy |last2=Pacula |first2=Rosalie Liccardo |publisher=Cambridge University Press |date=2003 |isbn=978-0-521-80024-2 |page=[https://archive.org/details/CannabisUseAndDependence/page/n12 15] |url-access=registration |name-list-style=vanc}} Even after a single administration of THC, detectable levels of THC can be found in the body for weeks or longer (depending on the amount administered and the sensitivity of the assessment method). Investigators have suggested that this is an important factor in marijuana's effects, perhaps because cannabinoids may accumulate in the body, particularly in the lipid membranes of neurons.{{Cite journal |last=Hollister |first=Leo E. |display-authors=etal |name-list-style=vanc |date=March 1986 |title=Health aspects of cannabis |url=http://www.lycaeum.org/drugwar/marij1.html |journal=Pharma Review |volume=38 |issue=38 |pages=1–20 |pmid=3520605 |archive-url=https://archive.today/20130415094338/http://www.lycaeum.org/drugwar/marij1.html |archive-date=15 April 2013 |access-date=17 February 2011}}

{{See also|Difference between C. indica and C. sativa}}

The main psychoactive component of cannabis is tetrahydrocannabinol (THC), which is formed via decarboxylation of tetrahydrocannabinolic acid (THCA) from the application of heat. Raw leaf is not psychoactive because the cannabinoids are in the form of carboxylic acids.{{citation needed|date=December 2021}} THC is one of the 483 known compounds in the plant,{{Cite book |last=Russo |first=Ethan B. |url=https://books.google.com/books?id=qH-2Lj9x7L4C&pg=PP28 |title=Cannabis and Cannabinoids: Pharmacology, Toxicology, and Therapeutic Potential |publisher=Routledge |date=2013 |isbn=978-1-136-61493-4 |page=28 |name-list-style=vanc}} including at least 65 other cannabinoids,{{Cite book |last=Newton |first=David E. |url=https://books.google.com/books?id=iWMf95ze8QEC&pg=PA7 |title=Marijuana: a reference handbook |date=2013 |publisher=ABC-CLIO |isbn=9781610691499 |location=Santa Barbara, Calif. |page=7 |name-list-style=vanc}} such as cannabidiol (CBD).

{{Main|Cannabis drug testing}}

THC and its major (inactive) metabolite, THC-COOH, can be measured in blood, urine, hair, oral fluid or sweat using chromatographic techniques as part of a drug use testing program or a forensic investigation of a traffic or other criminal offense.{{Cite book |last=Barceloux |first=Donald G. |title=Medical Toxicology of Drug Abuse: Synthesized Chemicals and Psychoactive Plants |publisher=John Wiley & Sons |date=2012 |isbn=978-1-118-10605-1 |pages=910– |chapter=Chapter 60: Marijuana (Cannabis sativa L.) and synthetic cannabinoids |access-date=14 July 2013 |chapter-url=https://books.google.com/books?id=9JLiJcjdqkcC&pg=PA910 |name-list-style=vanc}} The concentrations obtained from such analyses can often be helpful in distinguishing active use from passive exposure, elapsed time since use, and extent or duration of use. These tests cannot, however, distinguish authorized cannabis smoking for medical purposes from unauthorized recreational smoking.{{Cite book |last=Baselt |first=Randall Clint |title=Disposition of Toxic Drugs and Chemicals in Man |publisher=Biomedical Publications |date=2008 |isbn=978-0-9626523-7-0 |pages=1513–18 |name-list-style=vanc}} Commercial cannabinoid immunoassays, often employed as the initial screening method when testing physiological specimens for marijuana presence, have different degrees of cross-reactivity with THC and its metabolites.{{Cite book |last1=Shaw |first1=Leslie M. |url=https://books.google.com/books?id=pXvFGqz44pYC&pg=PA51 |title=The Clinical Toxicology Laboratory: Contemporary Practice of Poisoning Evaluation |last2=Kwong |first2=Tai C. |publisher=Amer. Assoc. for Clinical Chemistry |date=2001 |isbn=978-1-890883-53-9 |page=51 |name-list-style=vanc}} Urine contains predominantly THC-COOH, while hair, oral fluid and sweat contain primarily THC. Blood may contain both substances, with the relative amounts dependent on the recency and extent of usage.

The Duquenois–Levine test is commonly used as a screening test in the field, but it cannot definitively confirm the presence of cannabis, as a large range of substances have been shown to give false positives.{{Cite web |title=The Non-Specificity of the Duquenois-Levine Field Test for Marijuana |url=https://www.researchgate.net/publication/266888426 |website=ResearchGate}} Researchers at John Jay College of Criminal Justice reported that dietary zinc supplements can mask the presence of THC and other drugs in urine.{{Cite journal |vauthors=Venkatratnam A, Lents NH |date=July 2011 |title=Zinc reduces the detection of cocaine, methamphetamine, and THC by ELISA urine testing |journal=Journal of Analytical Toxicology |volume=35 |issue=6 |pages=333–40 |doi=10.1093/anatox/35.6.333 |pmid=21740689 |doi-access=free}} However, a 2013 study conducted by researchers at the University of Utah School of Medicine refute the possibility of self-administered zinc producing false-negative urine drug tests.{{Cite journal |vauthors=Lin CN, Strathmann FG |date=10 July 2013 |title=Elevated urine zinc concentration reduces the detection of methamphetamine, cocaine, THC and opiates in urine by EMIT |journal=Journal of Analytical Toxicology |volume=37 |issue=9 |pages=665–69 |doi=10.1093/jat/bkt056 |pmid=23843421 |doi-access=free}}

File:Cannab2 new.png

File:Macro cannabis bud.jpg

CBD is a 5-HT_1A receptor agonist, which is under laboratory research to determine if it has an anxiolytic effect.{{Cite book |url=https://www.nap.edu/catalog/6376/marijuana-and-medicine-assessing-the-science-base |title=Marijuana and Medicine: Assessing The Science Base |vauthors=Joy JE, Watson SJ, Benson JA |publisher=National Academy of Sciences Press |date=1999 |isbn=978-0-585-05800-9 |location=Washington, D.C. |doi=10.17226/6376 |pmid=25101425}} It is often claimed that sativa strains provide a more stimulating psychoactive high while indica strains are more sedating with a body high.{{Cite web |last=Elliott |first=Steve |name-list-style=vanc |title=The Ultimate Guide on Indicas vs. Sativas |url=https://herb.co/marijuana/news/indica-vs-sativa-whats-the-difference |access-date=22 June 2018 |website=Herb}} However, this is disputed by researchers.{{Cite journal |vauthors=Piomelli D, Russo EB |date=2016 |title=The Cannabis sativa Versus Cannabis indica Debate: An Interview with Ethan Russo, MD |journal=Cannabis and Cannabinoid Research |volume=1 |issue=1 |pages=44–46 |doi=10.1089/can.2015.29003.ebr |pmc=5576603 |pmid=28861479}}

A 2015 review found that the use of high CBD-to-THC strains of cannabis showed significantly fewer positive symptoms, such as delusions and hallucinations, better cognitive function and both lower risk for developing psychosis, as well as a later age of onset of the illness, compared to cannabis with low CBD-to-THC ratios.{{Cite journal |vauthors=Iseger TA, Bossong MG |date=March 2015 |title=A systematic review of the antipsychotic properties of cannabidiol in humans |journal=Schizophrenia Research |volume=162 |issue=1–3 |pages=153–61 |doi=10.1016/j.schres.2015.01.033 |pmid=25667194 |s2cid=3745655}}

According to the United Nations Office on Drugs and Crime (UNODC), "the amount of THC present in a cannabis sample is generally used as a measure of cannabis potency."{{Cite web |date=29 June 2009 |title=Why Does Cannabis Potency Matter? |url=http://www.unodc.org/unodc/en/frontpage/2009/June/why-does-cannabis-potency-matter.html |publisher=United Nations Office on Drugs and Crime}} The three main forms of cannabis products are the flower/fruit, resin (hashish), and oil (hash oil). The UNODC states that cannabis often contains 5% THC content, resin "can contain up to 20% THC content", and that "Cannabis oil may contain more than 60% THC content."

Studies have found that the potency of illicit cannabis has greatly increased since the 1970s, with THC levels rising and CBD levels dropping.{{Cite web |date=16 November 2020 |title=Cannabis strength soars over past half century |url=https://www.sciencedaily.com/releases/2020/11/201116092241.htm |website=ScienceDaily}}{{Cite journal |vauthors=ElSohly MA, Mehmedic Z, Foster S, Gon C, Chandra S, Church JC |date=2016 |title=Changes in Cannabis Potency Over the Last 2 Decades (1995–2014): Analysis of Current Data in the United States |journal=Biological Psychiatry |volume=79 |issue=7 |pages=613–619 |doi=10.1016/j.biopsych.2016.01.004 |pmc=4987131 |pmid=26903403}}{{Cite journal |vauthors=Cascini F, Aiello C, Di Tanna G |date=March 2012 |title=Increasing delta-9-tetrahydrocannabinol (Δ-9-THC) content in herbal cannabis over time: systematic review and meta-analysis |journal=Current Drug Abuse Reviews |volume=5 |issue=1 |pages=32–40 |doi=10.2174/1874473711205010032 |pmid=22150622 |s2cid=24350419}} It is unclear, however, whether the increase in THC content has caused people to consume more THC or if users adjust based on the potency of the cannabis. It is likely that the higher THC content allows people to ingest less tar. At the same time, CBD levels in seized samples have lowered, in part because of the desire to produce higher THC levels and because more illegal growers cultivate indoors using artificial lights. This helps avoid detection but reduces the CBD production of the plant.{{Cite news |last=Smith |first=Dana |name-list-style=vanc |date=17 January 2014 |title=Cannabis and memory loss: dude, where's my CBD? |work=The Guardian |url=https://www.theguardian.com/science/blog/2014/jan/17/cannabis-memory-loss-cbd}}

Australia's National Cannabis Prevention and Information Centre (NCPIC) states that the buds (infructescences) of the female Cannabis plant contain the highest concentration of THC, followed by the leaves. The stalks and seeds have "much lower THC levels".{{Cite web |title=Cannabis Potency |url=http://ncpic.org.au/ncpic/publications/factsheets/article/cannabis-potency |url-status=dead |archive-url=https://web.archive.org/web/20111206100249/http://ncpic.org.au/ncpic/publications/factsheets/article/cannabis-potency |archive-date=6 December 2011 |access-date=13 December 2011 |publisher=National Cannabis Prevention and Information Centre}} The UN states that the leaves can contain ten times less THC than the buds, and the stalks 100 times less THC.

After revisions to cannabis scheduling in the UK, the government moved cannabis back from a class C to a class B drug. A purported reason was the appearance of high potency cannabis. They believe skunk accounts for between 70% and 80% of samples seized by police{{Cite news |date=7 May 2008 |title=BBC: Cannabis laws to be strengthened. May 2008 20:55 UK |work=BBC News |url=http://news.bbc.co.uk/1/hi/uk_politics/7386889.stm |access-date=20 September 2010}} (despite the fact that skunk can sometimes be incorrectly mistaken for all types of herbal cannabis).{{Cite journal |display-authors=8 |vauthors=Di Forti M, Morgan C, Dazzan P, Pariante C, Mondelli V, Marques TR, Handley R, Luzi S, Russo M, Paparelli A, Butt A, Stilo SA, Wiffen B, Powell J, Murray RM |date=December 2009 |title=High-potency cannabis and the risk of psychosis |journal=The British Journal of Psychiatry |volume=195 |issue=6 |pages=488–91 |doi=10.1192/bjp.bp.109.064220 |pmc=2801827 |pmid=19949195}}{{Cite news |last=Hope |first=Christopher |date=6 February 2008 |title=Use of extra strong 'skunk' cannabis soars |work=The Daily Telegraph |location=London |url=https://www.telegraph.co.uk/news/uknews/1577798/Use-of-extra-strong-skunk-cannabis-soars.html |url-status=live |url-access=subscription |archive-url=https://ghostarchive.org/archive/20220110/https://www.telegraph.co.uk/news/uknews/1577798/Use-of-extra-strong-skunk-cannabis-soars.html |archive-date=10 January 2022}}{{cbignore}} Extracts such as hashish and hash oil typically contain more THC than high potency cannabis infructescences.{{Cite book |last=Doweiko |first=Harold |url=https://books.google.com/books?id=RWMIAAAAQBAJ&pg=PA124 |title=Concepts of Chemical Dependency |publisher=Cengage Learning |date=2011 |isbn=978-1-133-17081-5 |page=124 |name-list-style=vanc}}

{{See also |Synthetic cannabinoids#Hemp (or low potent cannabis) buds}}

Hemp buds (or low-potency cannabis buds) laced with synthetic cannabinoids started to be sold as cannabis street drug in 2020.{{Cite news |title=Fake Hanf: Ein Drogentrend schwappt in die Schweiz – was du darüber wissen musst |language=de |work=Watson|url=https://www.watson.ch/schweiz/international/986556231-fake-cannabis-ein-drogentrend-schwappt-in-die-schweiz-mit-folgen}}{{Cite news |title=Fake Hanf: Tödliches Marihuana hat bereits 61 Menschen getötet |language=de |work=Watson|url=https://www.watson.ch/schweiz/drogen/165953741-fake-hanf-toedliches-marihuana-hat-bereits-61-menschen-getoetet}}{{Cite news |title=Fake Hanf mit synthetischen Cannabinoiden besprüht |language=de |work=drugcom |url=https://www.drugcom.de/news/fake-hanf-mit-synthetischen-cannabinoiden-besprueht/}}{{Cite web |date=14 August 2020 |title=Tödlicher Fake Hanf – Chemisch behandelte Hanfblüten – niemand kann sie erkennen |url=https://www.srf.ch/news/schweiz/toedlicher-fake-hanf-chemisch-behandelte-hanfblueten-niemand-kann-sie-erkennen |website=Schweizer Radio und Fernsehen (SRF) |language=de}}

The short-term effects of cannabis can be altered if it has been laced with opioid drugs such as heroin or fentanyl.[https://www.medpagetoday.com/primarycare/opioids/74071 "Growing Array of Street Drugs Now Laced with Fentanyl"], MedPageToday, 17 July 2018 The added drugs are meant to enhance the psychoactive properties, add to its weight, and increase profitability, despite the increased danger of overdose.[https://www.baltimoresun.com/news/opinion/oped/bs-ed-op-1207-fentanyl-opioid-20181206-story.html "Is the opioid epidemic now the fentanyl epidemic?"] {{Webarchive|url=https://web.archive.org/web/20181218145559/https://www.baltimoresun.com/news/opinion/oped/bs-ed-op-1207-fentanyl-opioid-20181206-story.html |date=18 December 2018 }}, The Baltimore Sun, 7 December 2018{{efn|Advocates of legalizing marijuana for recreational use, such as former Illinois state Senator Heather Steans, say that legalizing it would help reduce such hazardous added drugs: "Over 95 percent are buying it on the black market. You don't know what you're buying. It's not a safe product. We've seen it laced with rat poison, fentanyl, all sorts of things. It's funding the cartels and other criminal activity."[https://www.sj-r.com/news/20181215/medical-officials-oppose-effort-to-legalize-recreational-use-of-marijuana "Medical officials oppose effort to legalize recreational use of marijuana"], State Journal-Register, (Springfield, IL), 15 December 2018}}

{{gallery |mode=packed |align=center |height=160

|File:Marijuana-Cannabis-Weed-Bud-Gram.jpg|Dried flower buds (marijuana)

|File:Kief (yellow).jpg|A gram of kief

|File:Hashish-2.jpg|Hashish

|File:Drop of cannabis oil.jpg|Hash oil

|File:Cannabis Butter.JPG|Infusion (dairy butter)

}}

{{further|Marijuana (word)|l1=Marijuana (word)}}

Marijuana or marihuana (herbal cannabis){{Cite book |url=https://archive.org/details/spanishwordhisto00houg |title=Spanish Word Histories and Mysteries: English Words That Come From Spanish |publisher=Houghton Mifflin Harcourt |date=2007 |isbn=978-0-547-35021-9 |page=[https://archive.org/details/spanishwordhisto00houg/page/142 142] |url-access=registration}} consists of the dried flowers and fruits and subtending leaves and stems of the female cannabis plant.{{Cite book |last1=Potter |first1=Gary |url=https://books.google.com/books?id=ENOhAgAAQBAJ&pg=PA17 |title=World Wide Weed: Global Trends in Cannabis Cultivation and its Control |last2=Bouchard |first2=Martin |last3=Decorte |first3=Tom |publisher=Ashgate Publishing, Ltd. |date=2013 |isbn=978-1-4094-9438-6 |edition=revised |page=17 |name-list-style=vanc}}{{Cite book |last1=Hall |first1=Wayne |url=https://archive.org/details/CannabisUseAndDependence |title=Cannabis Use and Dependence: Public Health and Public Policy |last2=Pacula |first2=Rosalie Liccardo |publisher=Cambridge University Press |date=2003 |isbn=978-0-521-80024-2 |page=[https://archive.org/details/CannabisUseAndDependence/page/n10 13] |url-access=registration |name-list-style=vanc}}{{Cite book |last=United Nations Office on Drugs and Crime |url=https://books.google.com/books?id=4rFqzQEACAAJ&pg=PA15 |title=Recommended Methods for the Identification and Analysis of Cannabis and Cannabis Products |publisher=United Nations Publications |date=2009 |isbn=978-92-1-148242-3 |page=15}}{{Cite book |last=Houck |first=Max M. |url=https://books.google.com/books?id=POpDBAAAQBAJ&pg=PA131 |title=Forensic Chemistry |date=2015 |publisher=Elsevier Science |isbn=978-0-12-800624-5 |page=131 |name-list-style=vanc}} This is the most widely consumed form, containing 3% to 20% THC,{{Cite book |last1=Adler |first1=Patricia A. |url=https://books.google.com/books?id=_s_9tfNlfGkC&pg=PA330 |title=Drugs and the American Dream: An Anthology |last2=Adler |first2=Peter |last3=O'Brien |first3=Patrick K. |publisher=John Wiley & Sons |date=2012 |isbn=978-0-470-67027-9 |pages=330– |name-list-style=vanc}} with reports of up to 33% THC.{{Cite book |last1=Mosher |first1=Clayton J. |url=https://books.google.com/books?id=2UQXBAAAQBAJ&pg=PA17 |title=Drugs and Drug Policy: The Control of Consciousness Alteration |last2=Akins |first2=Scott M. |publisher=Sage Publications |date=2013 |isbn=978-1-4833-2188-2 |page=17 |name-list-style=vanc}} This is the stock material from which all other preparations are derived. Although herbal cannabis and industrial hemp derive from the same species and contain the psychoactive component (THC), they are distinct strains with unique biochemical compositions and uses. Hemp has lower concentrations of THC and higher concentrations of CBD, which gives lesser psychoactive effects.{{Cite web |title=Hemp Facts |url=http://www.naihc.org/hemp_information/hemp_facts.html |archive-url=https://web.archive.org/web/20121127055208/http://naihc.org/hemp_information/hemp_facts.html |archive-date=27 November 2012 |access-date=9 January 2013 |publisher=Naihc.org}}{{Cite book |last=Earleywine |first=Mitch |url=https://books.google.com/books?id=QUn92XLQqf8C&pg=PA3 |title=Understanding Marijuana: A New Look at the Scientific Evidence |date=2002 |publisher=Oxford University Press |isbn=978-0-19-988143-7 |page=3}}

{{Main|Kief}}

Kief is a powder, rich in trichomes,{{Cite book |last=Rosenthal |first=Ed |url=https://books.google.com/books?id=H_QDJ7CWf2sC&pg=PA116 |title=Ask Ed: Marijuana Gold: Trash to Stash |publisher=QUICK AMER Publishing Company |date=2002 |isbn=978-0-932551-52-8 |page=116 |name-list-style=vanc}} which can be sifted from the leaves, flowers and fruits of cannabis plants and either consumed in powder form or compressed to produce cakes of hashish.{{Cite web |date=9 March 2005 |title=Kief |url=http://www.cannabisculture.com/articles/4220.html |archive-url=https://web.archive.org/web/20090605025019/http://www.cannabisculture.com/articles/4220.html |archive-date=5 June 2009 |access-date=2 January 2010 |publisher=Cannabisculture.com}} The word "kif" derives from colloquial Arabic {{lang|ar|كيف}} {{transliteration|ar|2=kēf/kīf}}, meaning pleasure.{{Cite book |last=Bukszpan |first=David |url=https://books.google.com/books?id=eA8vlPcMXTUC&pg=PA94 |title=Is That a Word?: From AA to ZZZ, the Weird and Wonderful Language of SCRABBLE |publisher=Chronicle Books |date=2012 |isbn=978-1-4521-0824-7 |page=94 |name-list-style=vanc}}

{{Main|Hashish}}

File:Legal hashish shop in Kathmandu, Nepal in 1973.jpg, Nepal in 1973]]

Hashish (also spelled hasheesh, hashisha, or simply hash) is a concentrated resin cake or ball produced from pressed kief, the detached trichomes and fine material that falls off cannabis fruits, flowers and leaves,{{Cite web |title=Hashish |url=http://dictionary.reference.com/browse/Hashish |publisher=dictionary.reference.com}} or from scraping the resin from the surface of the plants and rolling it into balls. It varies in color from black to golden brown depending upon purity and variety of cultivar it was obtained from.{{Cite encyclopedia |title=Is cannabis becoming more potent? |encyclopedia=Marijuana and Madness (Second Edition) |publisher=Cambridge University Press |date=2012 |editor-last=Castle |editor-first=David |page=35 |last2=Mehmedic |first2=Zlato |last3=Chandra |first3=Suman |last4=ElSohly |first4=Mahmoud |last1=Slade |first1=Desmond |editor2-last=Murray |editor2-first=Robin M. |editor3-last=Cyril D'Souza |editor3-first=Deepak}} It can be consumed orally or smoked, and is also vaporized, or 'vaped'.{{Cite book |last=Goldberg |first=Raymond |url=https://books.google.com/books?id=U9TjZHWVGoIC&pg=PA255 |title=Drugs Across the Spectrum |publisher=Cengage Learning |date=2012 |isbn=978-1-133-59416-1 |edition=7th |page=255 |name-list-style=vanc}} The term "rosin hash" refers to a high quality solventless product obtained through heat and pressure.Alchimia Blog, [http://www.alchimiaweb.com/blogen/rosin-hash/ Rosin Hash]

{{main|Tincture of cannabis}}

Cannabinoids can be extracted from cannabis plant matter using high-proof spirits (often grain alcohol) to create a tincture, often referred to as "green dragon".{{rp|p17}} Nabiximols is a branded product name from a tincture manufacturing pharmaceutical company.{{Cite book |last1=Cohen |first1=Jeffrey A. |url=https://books.google.com/books?id=LxQkUu2tfXcC&pg=PA670 |title=Multiple Sclerosis Therapeutics |last2=Rudick |first2=Richard A. |publisher=Cambridge University Press |date=2011 |isbn=978-1-139-50237-5 |page=670 |name-list-style=vanc}}

{{Main|Hash oil}}

Hash oil is a resinous matrix of cannabinoids obtained from the cannabis plant by solvent extraction,{{Cite book |last=King |first=Leslie A. |url=https://books.google.com/books?id=x9Z1QZ5NIEIC&pg=PA78 |title=Forensic Chemistry of Substance Misuse: A Guide to Drug Control |publisher=Royal Society of Chemistry |date=2009 |isbn=978-0-85404-178-7 |page=78 |name-list-style=vanc}} formed into a hardened or viscous mass.{{Cite web |date=24 February 2014 |title=Dabs – marijuana's explosive secret |url=https://www.cnbc.com/2014/02/26/dabsmarijuanas-explosive-secret.html |access-date=28 February 2014 |publisher=CNBC}} Hash oil can be the most potent of the main cannabis products because of its high level of psychoactive compound per its volume, which can vary depending on the plant's mix of essential oils and psychoactive compounds.{{Cite book |url=https://archive.org/details/worlddrugreport20000unse |title=World Drug Report |publisher=United Nations Publications |date=2009 |isbn=9789211482409 |page=[https://archive.org/details/worlddrugreport20000unse/page/98 98] |url-access=registration}} Butane and supercritical carbon dioxide hash oil have become popular in recent years.Alison Hallett for Wired. 20 February 2013 [https://www.wired.com/2013/02/hash-oil-explosion/How Hash Oil is Blowing Up Across the U.S. – Literally]

There are many varieties of cannabis infusions owing to the variety of non-volatile solvents used.{{Cite book |last=Kintz |first=Pascal |url=https://books.google.com/books?id=YgnUAgAAQBAJ&pg=PA141 |title=Toxicological Aspects of Drug-Facilitated Crimes |publisher=Elsevier Science |date=2014 |isbn=978-0-12-416969-2 |page=141 |name-list-style=vanc}} The plant material is mixed with the solvent and then pressed and filtered to express the oils of the plant into the solvent. Examples of solvents used in this process are cocoa butter, dairy butter, cooking oil, glycerine, and skin moisturizers. Depending on the solvent, these may be used in cannabis foods or applied topically.{{Cite book |last=McDonough |first=Elise |url=https://books.google.com/books?id=W-vas6K75YYC&pg=PA17 |title=The Official High Times Cannabis Cookbook: More Than 50 Irresistible Recipes That Will Get You High |publisher=Chronicle Books |date=2012 |isbn=978-1-4521-0133-0 |page=17 |name-list-style=vanc}}

{{main|Marihuana prensada}}

{{lang|es|Marihuana prensada}} ('pressed marijuana') is a cannabis-derived product widespread among the lower classes of South America,{{Cite book |last=Sociedad de Psiquiatría y Neurología de la infancia y la Adolescencia |url=https://books.google.com/books?id=3dViDwAAQBAJ |title=Marihuana: Consensos y evidencias sobre su impacto en la salud |publisher=Editorial Forja |date=2016 |isbn=9789563382600 |pages=35 |language=es |access-date=17 July 2021}} especially from the 90s. Locally it is known as "{{lang|es|paraguayo}}" or "{{lang|es|paragua}}", since its main producer is Paraguay.{{Cite book |last=Trejos Rosero |first=Luis Fernando |title=Fronteras: fuentes de conflicto y cooperación |date=2016 |others=Luis Fernando Trejos Rosero, Universidad del Norte. Departamento de Ciencia Política y Relaciones Internacionales |isbn=978-958-741-689-3 |location=Barranquilla, Colombia |pages=[https://books.google.com/books?id=uSajDwAAQBAJ&pg=PA111 111] |language=es |oclc=979988717}} Marijuana is dried and mixed with binding agents that make it toxic and highly harmful to health.{{Cite news |last=Stuardo |first=S. |date=5 September 2015 |title=Marihuana prensada: El lado negro de la hierba canábica |language=es |work=BioBioChile |url=https://www.biobiochile.cl/noticias/2015/09/05/marihuana-prensada-el-lado-negro-de-la-hierba-canabica.shtml |access-date=17 June 2021}} It is cut into the shape of bricks (ladrillos) and sold for a low price in Argentina, Brazil, Chile, Peru, Venezuela, and even the United States.{{Cite book |last=Wicht |first=J. J. |url=https://books.google.com/books?id=ecq-AAAAIAAJ |title=Por un Perú mejor: exposiciones y debates del Primer Programa de Alta Especialización para Parlamentarios |date=1991 |location=Universidad del Pacífico. Centro de Investigación, Asociación Acción y Pensamiento Democrático (Lima, Peru), Konrad-Adenauer-Stiftung. Internationales Institut |pages=206 |language=es |access-date=17 June 2021}}

{{main|History of cannabis|Timeline of cannabis law|Religion and drugs}}

File:Jirzankal Cemetery map (Cannabis site).png

Cannabis is indigenous to Central or South Asia{{Cite book |last=ElSohly |first=Mahmoud A. |url=https://books.google.com/books?id=fxoJPVNKYUgC&pg=PA8 |title=Marijuana and the Cannabinoids |publisher=Springer |date=2007 |isbn=978-1-59259-947-9 |page=19 |name-list-style=vanc}} and its uses for fabric and rope dates back to the Neolithic age in China and Japan.{{Cite book |last1=Stafford |first1=Peter G. |url=https://books.google.com/books?id=o4_pLqCOyDsC&pg=PA157 |title=Psychedelics Encyclopedia |last2=Bigwood |first2=Jeremy |publisher=Ronin Publishing |date=1992 |isbn=978-0-914171-51-5 |page=157 |name-list-style=vanc}}{{Cite book |title=Prehistoric Textiles: The Development of Cloth in the Neolithic and Bronze Ages with Special Reference to the Aegean |vauthors=Barber EJ |publisher=Princeton University Press |date=1992 |pages=17}} It is unclear when cannabis first became known for its psychoactive properties. The oldest archeological evidence for the burning of cannabis was found in Romanian kurgans dated 3,500 BC, and scholars suggest that the drug was first used in ritual ceremonies by Proto-Indo-European tribes living in the Pontic-Caspian steppe during the Chalcolithic period, a custom they eventually spread throughout Western Eurasia during the Indo-European migrations.{{Cite book |last=Anthony |first=David W. |url=https://books.google.com/books?id=mTxQmQEACAAJ |title=The Horse, the Wheel, and Language: How Bronze-Age Riders from the Eurasian Steppes Shaped the Modern World |date=2007 |publisher=Princeton University Press |isbn=978-0-691-05887-0 |pages=362 |language=en}}{{Cite book |last=Ellens |first=J. Harold |url=https://books.google.com/books?id=nBvFBAAAQBAJ |title=Seeking the Sacred with Psychoactive Substances: Chemical Paths to Spirituality and to God |date=2014 |publisher=ABC-CLIO |isbn=978-1440830884 |pages=24, 31 |language=en}} Some research suggests that the ancient Indo-Iranian drug soma, mentioned in the Vedas, sometimes contained cannabis. This is based on the discovery of a basin containing cannabis in a shrine of the second millennium BC in Turkmenistan.{{Cite book |last=Rudgley |first=Richard |title=The Encyclopedia of Psychoactive Substances |publisher=Little, Brown and Company |date=1998 |isbn=978-0-349-11127-8 |chapter=Soma |chapter-url=http://www.huxley.net/soma/index.html |name-list-style=vanc}}

Cannabis was known to the ancient Assyrians, who discovered its psychoactive properties through the Iranians.{{Cite book |last=Franck |first=Mel |title=Marijuana Grower's Guide |publisher=Red Eye Press |date=1997 |isbn=978-0-929349-03-9 |page=3 |name-list-style=vanc}} Using it in some religious ceremonies, they called it qunubu (meaning "way to produce smoke"), a probable origin of the modern word cannabis.{{Cite book |last=Rubin |first=Vera D. |title=Cannabis and Culture |publisher=Campus Verlag |date=1976 |isbn=978-3-593-37442-0 |page=305 |name-list-style=vanc}} The Iranians also introduced cannabis to the Scythians, Thracians and Dacians, whose shamans (the kapnobatai{{snd}}"those who walk on smoke/clouds") burned cannabis infructescences to induce trance.{{Cite book |last=Cunliffe |first=Barry W. |title=The Oxford Illustrated History of Prehistoric Europe |publisher=Oxford University Press |date=2001 |isbn=978-0-19-285441-4 |page=405 |name-list-style=vanc}} The plant was used in China before 2800 BC, and found therapeutic use in India by 1000 BC, where it was used in food and drink, including bhang.{{Cite book |last=Schultes |first=Richard Evans |url=https://archive.org/details/hallucinogenicpl00schu_0/page/34 |title=Hallucinogenic Plants |publisher=Golden Press |others=Illustrated by Elmer W. Smith |date=1976 |isbn=978-0-307-24362-1 |location=New York |page=[https://archive.org/details/hallucinogenicpl00schu_0/page/34 34]}}{{Cite web |last=Staelens, Stefanie |date=10 March 2015 |title=The Bhang Lassi Is How Hindus Drink Themselves High for Shiva |url=https://munchies.vice.com/en_us/article/kbx94a/httpmunchies-vice-comarticlesthe-bhang-lassi-is-how-hindus-drink-themselves-high-for-shiva |access-date=10 August 2017 |website=Vice.com}}

File:Cannabissativadior.jpg, {{circa}} 512 CE]]

Cannabis has an ancient history of ritual use and has been used by religions around the world. It has been used as a drug for both recreational and entheogenic purposes and in various traditional medicines for centuries.{{Cite book |last=Vij |url=https://books.google.com/books?id=Vp8FAsnfGF4C&pg=PT672 |title=Textbook Of Forensic Medicine And Toxicology: Principles And Practice |publisher=Elsevier India |date=2012 |isbn=978-81-312-1129-8 |page=672}}See also article on Marijuana as a word.{{ShorterOxfordEnglishDictionary}} The earliest evidence of cannabis smoking has been found in the 2,500-year-old tombs of Jirzankal Cemetery in the Pamir Mountains in Western China, where cannabis residue were found in burners with charred pebbles possibly used during funeral rituals.{{Cite journal |vauthors=Ren M, Tang Z, Wu X, Spengler R, Jiang H, Yang Y, Boivin N |date=June 2019 |title=The origins of cannabis smoking: Chemical residue evidence from the first millennium BCE in the Pamirs |journal=Science Advances |volume=5 |issue=6 |pages=eaaw1391 |bibcode=2019SciA....5.1391R |doi=10.1126/sciadv.aaw1391 |pmc=6561734 |pmid=31206023}}{{Cite web |last=Donahue |first=Michelle |date=12 June 2019 |title=Earliest evidence for cannabis smoking discovered in ancient tombs |url=https://www.nationalgeographic.com/culture/2019/06/earliest-evidence-cannabis-marijuana-smoking-china-tombs/ |archive-url=https://web.archive.org/web/20190613054237/https://www.nationalgeographic.com/culture/2019/06/earliest-evidence-cannabis-marijuana-smoking-china-tombs/ |url-status=dead |archive-date=13 June 2019 |website=National Geographic}} Hemp seeds discovered by archaeologists at Pazyryk suggest early ceremonial practices like eating by the Scythians occurred during the 5th to 2nd century BC, confirming previous historical reports by Herodotus.{{Cite book |last=Walton |first=Robert P. |title=Marijuana, America's New Drug Problem |publisher=JB Lippincott |date=1938 |page=6 |name-list-style=vanc}} It was used by Muslims in various Sufi orders as early as the Mamluk period, for example by the Qalandars.{{Cite book |last=Taymiyya |first=Ibn |title=Le haschich et l'extase |publisher=Albouraq |date=2001 |isbn=978-2-84161-174-4 |location=Beyrouth |language=FR |author-link=Ibn Taymiyya |name-list-style=vanc}} Smoking pipes uncovered in Ethiopia and carbon-dated to around {{circa}} AD 1320 were found to have traces of cannabis.{{Cite book |last=Rubin |first=Vera |url=https://books.google.com/books?id=gCRNRGOhNA4C&pg=PA77 |title=Cannabis and Culture |publisher=Walter de Gruyter |date=1975 |isbn=978-3-11-081206-0 |pages=77– |quote=Cannabis Smoking in 13th-14th Century Ethiopia: Chemical Evidence |name-list-style=vanc}}

Cannabis was introduced to the New World by the Spaniards in 1530–1545.{{Cite book |last=Booth |first=Martin |title=Cannabis: A History |publisher=Picador |date=2004 |pages=38}}{{Cite book |last=David E. Newton |title=Marijuana: A Reference Handbook, 2nd Edition |date=2017 |page=325}}{{Cite book |last=Eileen Konieczny, Lauren Wilson |title=Healing with CBD |date=2018}} Following an 1836–1840 travel in North Africa and the Middle East, French physician Jacques-Joseph Moreau wrote on the psychological effects of cannabis use; he founded the Paris' Club des Hashischins in 1844.{{Cite web |last=Pilkington |first=Mark |date=2005-07-27 |title=Clouds of smoke |url=http://www.theguardian.com/science/2005/jul/28/farout |access-date=2022-11-10 |website=The Guardian |language=en}} In 1842, Irish physician William Brooke O'Shaughnessy, who had studied the drug while working as a medical officer in Bengal with the East India Company, brought a quantity of cannabis with him on his return to Britain, provoking renewed interest in the West.{{Cite book |last=Iversen |first=Leslie L. |url=https://books.google.com/books?id=sshsCAAAQBAJ&pg=PT110 |title=The Science of Marijuana |publisher=Oxford University Press |date=2007 |isbn=978-0-19-988693-7 |pages=110– |name-list-style=vanc}} Examples of classic literature of the period featuring cannabis include Les paradis artificiels (1860) by Charles Baudelaire and The Hasheesh Eater (1857) by Fitz Hugh Ludlow.

File:Killerdrug.jpg

Cannabis was criminalized in some countries beginning in the 14th century and was illegal in most countries by the middle of the 20th century. The colonial government of Mauritius banned cannabis in 1840 over concerns on its effect on Indian indentured workers;{{Cite book |url=https://books.google.com/books?id=0ktHAQAAMAAJ&pg=PA541 |title=A Collection of the Laws of Mauritius and Its Dependencies |publisher=By the authority of the Government |date=1867 |pages=541–}} the same occurred in Singapore in 1870.{{Cite book |last=Bunyapraphatsōn |first=Nanthawan |url=https://books.google.com/books?id=ifDwAAAAMAAJ |title=Medicinal and poisonous plants |publisher=Backhuys Publishers |date=1999 |isbn=978-90-5782-042-7 |page=169 |name-list-style=vanc}} In the United States, the first restrictions on sale of cannabis came in 1906 (in the District of Columbia).{{Cite web |title=Statement of Dr. William C. Woodward |url=http://www.druglibrary.org/schaffer/hemp/taxact/woodward.htm |access-date=20 September 2010 |publisher=Drug library |quote=The District of Columbia law, insofar as it relates to Cannabis, is a part of an act passed by Congress in 1906 entitled "An act to regulate the practice of pharmacy and the sale of poisons in the District of Columbia, and for other purposes", approved May 17, 1906, and originally published as 34 Statutes, 175, which is now to be found in the District Code, section 191 and following. It limits the sale of Cannabis, its derivatives and its preparations to pharmacists and persons who are authorized assistants to pharmacists.}} Canada criminalized cannabis in The Opium and Narcotic Drug Act, 1923,{{Cite canlaw |short title=The Opium and Narcotic Drug Act, 1923 |abbr=S.C. |year=1923 |chapter=22 |link=https://archive.org/stream/actsofparl1923v01cana#page/134/mode/2up}} before any reports of the use of the drug in Canada, but eventually legalized its consumption for recreational and medicinal purposes in 2018.

In 1925, a compromise was made at an international conference in The Hague about the International Opium Convention that banned exportation of "Indian hemp" to countries that had prohibited its use, and requiring importing countries to issue certificates approving the importation and stating that the shipment was required "exclusively for medical or scientific purposes". It also required parties to "exercise an effective control of such a nature as to prevent the illicit international traffic in Indian hemp and especially in the resin".{{Cite web |date=1925 |title=Opium as an international problem |url=http://www.druglibrary.org/schaffer/history/e1920/willoughby.htm |access-date=20 September 2010 |publisher=The Johns Hopkins Press |vauthors=Willoughby WW |location=Baltimore}}{{Google books|GJm-XDLJe1QC|Opium as an international problem: the Geneva conferences – Westel Woodbury Willoughby}} In the United States in 1937, the Marihuana Tax Act was passed,{{USStatute|75|238|50|551|1937|8|2}} and prohibited the production of hemp in addition to cannabis.

File:Drug bottle containing cannabis.jpg

In 1972, the Dutch government divided drugs into more- and less-dangerous categories, with cannabis being in the lesser category. Accordingly, possession of {{convert|30|g}} or less was made a misdemeanor.{{Cite book |last=Booth |first=Martin |url=https://books.google.com/books?id=O7AoY6ljSygC&pg=PA338 |title=Cannabis: A History |date=2004 |publisher=Picador |isbn=978-0-312-42494-7 |pages=338 |name-list-style=vanc}} Cannabis has been available for recreational use in coffee shops since 1976.{{Cite book |last=Michael Tonry |url=https://books.google.com/books?id=TMauCgAAQBAJ&pg=PT261 |title=Crime and Justice |publisher=University of Chicago Press |date=2015 |isbn=978-0-226-34102-6 |series=A Review of Research |volume=44 |pages=261–}} Cannabis products are only sold openly in certain local "coffeeshops" and possession of up to {{convert|5|g}} for personal use is decriminalized, however: the police may still confiscate it, which often happens in car checks near the border. Other types of sales and transportation are not permitted, although the general approach toward cannabis was lenient even before official decriminalization.{{Citation |title=Use drop-down menu on site to view Netherlands entry.) |url=http://eldd.emcdda.europa.eu/html.cfm/index5174EN.html |access-date=17 February 2011 |archive-url=https://web.archive.org/web/20100507181022/http://eldd.emcdda.europa.eu/html.cfm/index5174EN.html |publisher=Eldd.emcdda.europa.eu |archive-date=7 May 2010}}{{Citation |title=Drugs Policy in the Netherlands |url=http://www.ukcia.org/research/dutch.php |access-date=17 February 2011 |archive-url=https://web.archive.org/web/20170802141845/http://www.ukcia.org/research/dutch.php |publisher=Ukcia.org |archive-date=2 August 2017}}{{Cite news |date=27 May 2011 |title=Amsterdam Will Ban Tourists from Pot Coffee Shops |work=Atlantic Wire |url=http://www.theatlanticwire.com/global/2011/05/amsterdam-ban-pot-sales-tourists/38248/ |access-date=23 June 2011 |archive-url=https://web.archive.org/web/20110528221704/http://www.theatlanticwire.com/global/2011/05/amsterdam-ban-pot-sales-tourists/38248/ |archive-date=28 May 2011}}

In Uruguay, President Jose Mujica signed legislation to legalize recreational cannabis in December 2013, making Uruguay the first country in the modern era to legalize cannabis. In August 2014, Uruguay legalized growing up to six plants at home, as well as the formation of growing clubs (Cannabis social club), and a state-controlled marijuana dispensary regime.

{{as of|2018|October|17}}, when recreational use of cannabis was legalized in Canada, dietary supplements for human use and veterinary health products containing not more than 10 parts per million of THC extract were approved for marketing; Nabiximols (as Sativex) is used as a prescription drug in Canada.

The United Nations' World Drug Report stated that cannabis "was the world's most widely produced, trafficked, and consumed drug in the world in 2010", and estimated between 128 million and 238 million users globally in 2015.{{Cite news |last=Dockterman |first=Eliana |name-list-style=vanc |date=29 June 2012 |title=Marijuana Now the Most Popular Drug in the World |work=Time NewsFeed |publisher=Time Inc |url=https://newsfeed.time.com/2012/06/29/marijuana-now-the-most-popular-drug-in-the-world/ |access-date=16 March 2013}}{{Cite book |title=World Drug Report 2017 |publisher=United Nation Office on Drugs and Crime (UNODC) |chapter=Factsheet |chapter-url=https://www.unodc.org/wdr2017/index.html}}

{{main|Cannabis culture}}

{{see also|Drug culture|420 (cannabis culture)}}

File:Process of making bhang in Punjab, India.jpg in a village in Punjab, India. On the Indian festival of colors, Holi, it is a customary addition to some intoxicating drinks.{{Cite journal |last=Ayyagari |first=Shalini |name-list-style=vanc |date=2007 |title="Hori Hai": A Festival of Colours!! (review) |journal=Asian Music |publisher=Johns Hopkins University Press |volume=38 |issue=2 |pages=151–53 |doi=10.1353/amu.2007.0029 |s2cid=192201145}}]]

Cannabis has been one of the most used psychoactive drugs in the world since the late 20th century, following only tobacco and alcohol in popularity.Rubin, 1975. p. 1 According to Vera Rubin, the use of cannabis has been encompassed by two major cultural complexes over time: a continuous, traditional folk stream, and a more circumscribed, contemporary configuration.Rubin, 1975. p. 3 The former involves both sacred and secular use, and is usually based on small-scale cultivation: the use of the plant for cordage, clothing, medicine, food, and a "general use as an euphoriant and symbol of fellowship."Rubin, 1975. p. 4 The second stream of expansion of cannabis use encompasses "the use of hemp for commercial manufacturers utilizing large-scale cultivation primarily as a fiber for mercantile purposes"; but it is also linked to the search for psychedelic experiences (which can be traced back to the formation of the Parisian Club des Hashischins).

{{Main|Legality of cannabis}}

{{See also|Prohibition of drugs|Drug liberalization}}

[[File:Map-of-world-cannabis-laws.svg|thumb|upright=1.5|alt=Map of world cannabis laws|

Legal status of cannabis possession for non-medical use

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{{legend|#0d00f2|Legal}}

{{legend|#ffb700|Illegal but decriminalized}}

{{legend|#ff9e9e|Illegal but often unenforced}}

{{legend|#ff3c3c|Illegal}}

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See also countries that have legalized medical use of cannabis.]]

Since the beginning of the 20th century, most countries have enacted laws against the cultivation, possession or transfer of cannabis.{{Cite book |last=Levinson |first=David |url=https://books.google.com/books?id=aiQ09D7nWxYC&pg=PA572 |title=Encyclopedia of Crime and Punishment |publisher=Sage Publications |date=2002 |isbn=978-0-7619-2258-2 |page=572 |name-list-style=vanc}} These laws have had an adverse effect on cannabis cultivation for non-recreational purposes, but there are many regions where handling of cannabis is legal or licensed. Many jurisdictions have lessened the penalties for possession of small quantities of cannabis so that it is punished by confiscation and sometimes a fine, rather than imprisonment, focusing more on those who traffic the drug on the black market.

In some areas where cannabis use had been historically tolerated, new restrictions were instituted, such as the closing of cannabis coffee shops near the borders of the Netherlands,{{Cite web |date=27 November 2007 |title=Many Dutch coffee shops close as liberal policies change, Exaptica |url=http://www.expatica.com/nl/leisure/arts_culture/many-dutch-coffee-shops-close-as-liberal-policies-change-46376.html |archive-url=https://web.archive.org/web/20110429192229/http://www.expatica.com/nl/leisure/arts_culture/many-dutch-coffee-shops-close-as-liberal-policies-change-46376.html |archive-date=29 April 2011 |access-date=20 September 2010 |publisher=Expatica.com}} and closing of coffee shops near secondary schools in the Netherlands.[http://www.rnw.nl/internationaljustice/news/international/6061587/43-Amsterdam-coffee-shops-to-close-doors "43 Amsterdam coffee shops to close door"], Radio Netherlands, Friday 21 November 2008 {{webarchive |url=https://web.archive.org/web/20081202130012/http://www.rnw.nl/internationaljustice/news/international/6061587/43-Amsterdam-coffee-shops-to-close-doors |date=2 December 2008 }} In Copenhagen, Denmark in 2014, mayor Frank Jensen discussed possibilities for the city to legalize cannabis production and commerce.{{Cite news |last=O'Sullivan |first=Feargus |name-list-style=vanc |date=3 March 2014 |title=Why the Mayor of Copenhagen Wants to Get Into the Marijuana Business |work=Bloomberg.com |url=https://www.citylab.com/equity/2014/03/why-mayor-copenhagen-wants-get-marijuana-business/8527/ |access-date=23 January 2018}}

Some jurisdictions use free voluntary or mandatory treatment programs for frequent known users. Simple possession can carry long prison terms in some countries, particularly in East Asia, where the sale of cannabis may lead to a sentence of life in prison or even execution. Political parties, non-profit organizations, and causes based on the legalization of medical cannabis or legalizing the plant entirely (with some restrictions) have emerged in such countries as China and Thailand.{{Cite web |last=Johnston |first=Ian |name-list-style=vanc |date=5 January 2014 |title=As cannabis is widely legalised, China cashes in on an unprecedented boom |url=https://www.independent.co.uk/news/world/asia/as-cannabis-is-widely-legalised-china-cashes-in-on-an-unprecedented-boom-9039191.html |access-date=23 January 2018 |publisher=Independent}}{{Cite web |last=Liljas |first=Per |name-list-style=vanc |date=3 June 2017 |title=Could Thailand, which gave world the bong, legalise cannabis for medicinal use? After failed war on drugs, attitudes have softened |url=http://www.scmp.com/magazines/post-magazine/long-reads/article/2097464/could-thailand-which-gave-world-bong-legalise |access-date=23 January 2018 |publisher=Post Magazine}}

In December 2012, the U.S. state of Washington became the first state to officially legalize cannabis in a state law (Washington Initiative 502) (but still illegal by federal law),{{Cite news |date=7 December 2012 |title=Marijuana goes legal in Washington state amid mixed messages |work=Reuters |url=https://www.reuters.com/article/uk-usa-marijuana-washington-idUSLNE8B502120121207 |url-status=live |access-date=14 December 2012 |archive-url=https://web.archive.org/web/20150924172450/http://www.reuters.com/article/2012/12/07/uk-usa-marijuana-washington-idUSLNE8B502120121207 |archive-date=24 September 2015}} with the state of Colorado following close behind (Colorado Amendment 64).{{Cite news |last=Duke |first=Alan |name-list-style=vanc |date=8 November 2012 |title=2 states legalize pot, but don't 'break out the Cheetos' yet |publisher=CNN.com |url=http://www.cnn.com/2012/11/07/politics/marijuana-legalization/index.html |access-date=2 January 2013}} On 1 January 2013, the first cannabis "club" for private marijuana smoking (no buying or selling, however) was allowed for the first time in Colorado.{{Cite web |date=1 January 2013 |title=Marijuana clubs ring in new year in Colorado as legalized pot smoking begins |url=https://abcnews.go.com/US/marijuana-clubs-ring-year-colorado-legalized-pot-smoking/story?id=18108083 |access-date=2 January 2013 |publisher=Abcnews.go.com}} The California Supreme Court decided in May 2013 that local governments can ban medical cannabis dispensaries despite a state law in California that permits the use of cannabis for medical purposes. At least 180 cities across California have enacted bans in recent years.{{Cite news |last=Mintz |first=Horward |name-list-style=vanc |date=6 May 2013 |title=Medical pot: California Supreme Court allows cities to ban weed dispensaries |work=Marin Independent Journal |url=http://www.marinij.com/digitalfirstmedia/ci_23184556/ |archive-url=https://web.archive.org/web/20131102202631/http://www.marinij.com/digitalfirstmedia/ci_23184556/ |archive-date=2 November 2013}} File:President Biden Discusses Taking the Next Step to Reclassify Marijuana (tDWWZ1zGNwg).webm discussess rescheduling of cannabis.]]

On 30 April 2024, the United States Department of Justice announced it would move to reclassify cannabis from a Schedule I to a Schedule III controlled substance.{{Cite web |date=2024-04-30 |title=US drug control agency will move to reclassify marijuana in a historic shift, AP sources say |url=https://apnews.com/article/marijuana-biden-dea-criminal-justice-pot-f833a8dae6ceb31a8658a5d65832a3b8 |access-date=2024-04-30 |website=AP News |language=en}}{{Cite web |title=Biden administration plans to drastically change federal rules on marijuana |url=https://www.usatoday.com/story/news/nation/2024/04/30/dea-reclassifies-marijuana-reports/72865632007/ |access-date=2024-04-30 |website=USA TODAY |language=en-US}}

In December 2013, Uruguay became the first country to legalize growing, sale and use of cannabis.{{Cite news |last=Baker |first=Vicky |name-list-style=vanc |date=11 December 2013 |title=Marijuana laws around the world: what you need to know |work=The Guardian |url=https://www.theguardian.com/travel/2013/dec/11/uruguay-marijuana-laws-around-world}} After a long delay in implementing the retail component of the law, in 2017 sixteen pharmacies were authorized to sell cannabis commercially.{{Cite news |last=Castaldi |first=Malena |date=19 July 2017 |title=Uruguay pharmacies start selling cannabis straight to consumers |work=Reuters |location=Montevideo |url=https://www.reuters.com/article/us-uruguay-cannabis-idUSKBN1A41MH}} On 19 June 2018, the Canadian Senate passed a bill and the Prime Minister announced the effective legalization date as 17 October 2018.{{Cite web |last=Scotti |first=Monique |date=20 June 2018 |title=Marijuana to be legal in Canada starting October 17, Trudeau confirms |url=https://globalnews.ca/news/4285946/marijuana-legal-date-october-17-canada-trudeau-confirms/}} Canada is the second country to legalize the drug.{{Cite web |last=Sapra |first=Bani |date=20 June 2018 |title=Canada becomes second nation in the world to legalize marijuana |url=https://www.cnn.com/2018/06/20/health/canada-legalizes-marijuana/index.html |website=CNN}}

In November 2015, Uttarakhand became the first state of India to legalize the cultivation of hemp for industrial purposes.{{Cite web |date=27 November 2015 |title=Uttarakhand To Become First Indian State To Legalise Cannabis Cultivation |url=http://www.indiatimes.com/news/india/uttarakhand-to-become-first-indian-state-to-legalise-cannabis-cultivation-247769.html |access-date=12 March 2017 |website=Indiatimes |language=en}} Usage within the Hindu and Buddhist cultures of the Indian subcontinent is common, with many street vendors in India openly selling products infused with cannabis, and traditional medical practitioners in Sri Lanka selling products infused with cannabis for recreational purposes and well as for religious celebrations. Indian laws criminalizing cannabis date back to the colonial period. India and Sri Lanka have allowed cannabis to be taken in the context of traditional culture for recreational/celebratory purposes and also for medicinal purposes.{{Cite web |title=South Asia Regional Profile Report |url=https://www.unodc.org/pdf/india/publications/south_Asia_Regional_Profile_Sept_2005/13_srilanka.pdf |website=UNODC}}

On 17 October 2015, Australian health minister Sussan Ley presented a new law that will allow the cultivation of cannabis for scientific research and medical trials on patients.Alchimia Blog, [https://www.alchimiaweb.com/blogen/medical-marijuana-news-december-2015/ Medical marijuana news, December 2015]

On 17 October 2018, Canada legalized cannabis for recreational adult use{{Cite news |last=Butler |first=Patrick |date=17 October 2018 |title=Cannabis is legal in Canada – here's what you need to know |work=CBC |url=https://www.cbc.ca/news/canada/marijuana-faq-legalization-need-to-know-1.4862207/ |access-date=1 November 2018}} making it the second country in the world to do so after Uruguay and the first G7 nation.{{Cite news |last=Sapra |first=Bani |date=20 June 2018 |title=Canada becomes second nation in the world to legalize marijuana |work=CNN |url=https://www.cnn.com/2018/06/20/health/canada-legalizes-marijuana/index.html |access-date=1 November 2018}} This legalization comes with regulation similar to that of alcohol in Canada, age restrictions, limiting home production, distribution, consumption areas and sale times.{{cite web |title=Cannabis Act (S.C. 2018, c. 16) |url=https://laws-lois.justice.gc.ca/eng/acts/C-24.5/index.html |website=Justice Canada |publisher=Government of Canada |access-date=24 November 2018 |archive-date=25 March 2022 |archive-url=https://web.archive.org/web/20220325210722/https://laws-lois.justice.gc.ca/eng/acts/c-24.5/index.html |url-status=live }} Laws around use vary from province to province including age limits, retail structure, and growing at home. The Canadian Licensed Producer system aims to become the Gold Standard in the world for safe and secure cannabis production,{{Cite web |date=5 July 2018 |title=This Application Seems Rigorous. Are All These Hoops Necessary? |url=https://licensedproducerscanada.ca/faq/application-seems-rigorous-hoops-necessary |access-date=1 November 2018 |website=LicensedProducersCanada.com}} including provisions for a robust craft cannabis industry where many expect opportunities for experimenting with different strains.{{Cite web |date=October 2018 |title=Will Craft Cannabis Growers in Canada Succeed Like Craft Brewers? |url=https://licensedproducerscanada.ca/faq/will-craft-cannabis-growers-in-canada-succeed-like-craft-brewers |access-date=1 November 2018 |website=LicensedProducersCanada.com}}

As the drug has increasingly been seen as a health issue instead of criminal behavior, cannabis has also been legalized or decriminalized in: Czech Republic,{{Citation |last=Parliament of the Czech Republic |title=Explanatory Report to Act No. 112/1998 Coll., which amends the Act No. 140/1961 Coll., the Criminal Code, and the Act No. 200/1990 Coll., on misdemeanors |date=1998 |place=Prague |language=cs}} "Podle čl. 36 Jednotné úmluvy o omamných látkách ze dne 31. března 1961 (č. 47/1965 Sb.) se signatáři zavazují k trestnímu postihu tam uvedených forem nakládání s drogami včetně jejich držby. Návrh upouští od dosavadní beztrestnosti držby omamných a psychotropních látek a jedů pro svoji potřebu. Dosavadní beztrestnost totiž eliminuje v řadě případů možnost postihu dealerů a distributorů drog." Colombia,{{Cite web |last=Castaneda |first=Jorge G |name-list-style=vanc |date=31 March 2012 |title=The summit of muted intentions |url=http://www.aljazeera.com/indepth/opinion/2012/03/2012327125714281880.html |website=aljazeera.com}}{{Cite web |date=25 May 2016 |title=Congreso aprobó, en último debate, uso medicinal de la marihuana |url=http://www.noticiasrcn.com/nacional-pais/congreso-aprobo-ultimo-debate-uso-medicinal-marihuana}} Ecuador,[http://www.elcomercio.com/seguridad/Dosis-maximas-droga-consumo-vigentes_0_941905849.html "Dosis máximas de droga para consumo ya están vigentes"] {{webarchive |url=https://web.archive.org/web/20130624025336/http://www.elcomercio.com/seguridad/Dosis-maximas-droga-consumo-vigentes_0_941905849.html |date=24 June 2013 }} at El Comercio.com.[http://www.elnuevoherald.com/2013/06/21/1505650/ecuador-aprueban-tenencia-de-drogas.html "Ecuador: Aprueban tenencia de drogas para consumo"] {{webarchive|url=https://web.archive.org/web/20130625023421/http://www.elnuevoherald.com/2013/06/21/1505650/ecuador-aprueban-tenencia-de-drogas.html |date=25 June 2013 }} at El Nuevo Herald{{Cite web |title=Ecuador could regulate the drug industry |url=http://www.telegrafo.com.ec/english-bulletin/item/ecuador-could-regulate-drug-sales.html |archive-url=https://archive.today/20130624225110/http://www.telegrafo.com.ec/english-bulletin/item/ecuador-could-regulate-drug-sales.html |archive-date=24 June 2013}} Portugal,{{Cite web |date=1 June 2011 |title=Drug policy profiles – Portugal |url=http://www.emcdda.europa.eu/system/files/publications/642/PolicyProfile_Portugal_WEB_Final_289201.pdf |access-date=5 February 2017}} South Africa{{Cite news |last=Lindeque |first=Mia |title=Dagga users celebrate following ConCourt ruling on private use |language=en |url=https://ewn.co.za/2018/09/18/dagga-users-celebrate-following-concourt-ruling-on-private-use |access-date=3 November 2018}} and Canada. Medical marijuana was legalized in Mexico in mid-2017 and legalized for recreational use in June 2021.{{Cite web |last=Williams |first=Sean |date=28 April 2019 |title=Mexico Aims to Legalize Recreational Marijuana Before October |url=https://www.fool.com/investing/2019/04/28/mexico-aims-to-legalize-recreational-marijuana-bef.aspx |access-date=29 April 2019 |website=The Motley Fool |language=en}}{{Cite web |url=http://www.elpensador.com.mx/2009/10/17/Ley-de-Narcomenudeo/ |title=Ley de Narcomenudeo |first=Manuel |last=Vélez |date=17 October 2009 |website=El Pensador |archive-url=https://web.archive.org/web/20120327044314/http://www.elpensador.com.mx:80/2009/10/17/Ley-de-Narcomenudeo/ |archive-date=27 March 2012}}{{Cite news |date=2021-06-28 |title=Mexico marijuana: Top court decriminalises recreational use of cannabis |language=en-GB |work=BBC News |url=https://www.bbc.com/news/world-latin-america-57645016 |archive-url=https://web.archive.org/web/20240120042948/https://www.bbc.com/news/world-latin-america-57645016 |archive-date=20 January 2024}}

Germany legalized cannabis for recreational use in April 2024.{{Cite news |date=2024-04-01 |title=Germany becomes largest EU country to legalize cannabis for recreational use |url=https://www.lemonde.fr/en/germany/article/2024/04/01/germany-becomes-largest-eu-country-to-legalize-cannabis-for-recreational-use_6667013_146.html |access-date=2024-04-19 |work=Le Monde.fr |language=en}}

As of 2022, Uruguay and Canada are the only countries that have fully legalized the cultivation, consumption and bartering of recreational cannabis nationwide.{{Cite news |last=Ross |first=Selena |date=6 June 2018 |title=All eyes on Canada as first G7 nation prepares to make marijuana legal |work=The Guardian |url=https://www.theguardian.com/world/2018/jun/06/all-eyes-on-canada-as-first-g7-nation-prepares-to-make-marijuana-legal |access-date=10 July 2018}}{{Cite news |last=Sapra |first=Bani |date=20 June 2018 |title=Canada becomes second nation in the world to legalize marijuana |work=CNN |url=https://www.cnn.com/2018/06/20/health/canada-legalizes-marijuana/index.html}} In the United States, 24 states, 3 territories, and the District of Columbia have legalized the recreational use of cannabis – though the drug remains illegal at the federal level.{{Cite web |title=Marijuana Overview |url=http://www.ncsl.org/research/civil-and-criminal-justice/marijuana-overview.aspx |access-date=29 August 2019 |website=National Conference of State Legislatures |archive-date=24 June 2018 |archive-url=https://web.archive.org/web/20180624085932/http://www.ncsl.org/research/civil-and-criminal-justice/marijuana-overview.aspx |url-status=dead }} Laws vary from state to state when it comes to the commercial sale. Court rulings in Georgia and South Africa have led to the legalization of cannabis consumption, but not legal sales. A policy of limited enforcement has also been adopted in many countries, in particular Spain and the Netherlands where the sale of cannabis is tolerated at licensed establishments.{{Cite news |last=Smith |first=Tasha |date=5 June 2018 |title="New Amsterdam" No More? Spain's Cannabis Clubs Fight to Stay Open |work=Merry Jane |url=https://merryjane.com/culture/spains-cannabis-social-clubs-feature-june-2018 |access-date=23 August 2018}}{{Cite news |last=Haines |first=Gavin |date=21 February 2017 |title=Everything you need to know about marijuana smoking in the Netherlands |work=The Telegraph |url=https://www.telegraph.co.uk/travel/destinations/europe/netherlands/amsterdam/articles/everything-you-need-to-know-about-smoking-marijuana-in-the-netherlands/ |url-status=live |url-access=subscription |access-date=22 July 2018 |archive-url=https://ghostarchive.org/archive/20220110/https://www.telegraph.co.uk/travel/destinations/europe/netherlands/amsterdam/articles/everything-you-need-to-know-about-smoking-marijuana-in-the-netherlands/ |archive-date=10 January 2022}}{{cbignore}} Contrary to popular belief, cannabis is not legal in the Netherlands,{{Cite web |date=20 May 2020 |title=The Legal Situation of Cannabis in the Netherlands |url=https://straininsider.com/legal-situation-cannabis-netherlands/ |url-status=dead |archive-url=https://web.archive.org/web/20200618065204/https://straininsider.com/legal-situation-cannabis-netherlands/ |archive-date=18 June 2020 |access-date=2 June 2020}} but it has been decriminalized since the 1970s. In 2021, Malta was the first European Union member to legalize the use of cannabis for recreational purposes.{{Cite news |last=Bubola |first=Emma |date=15 December 2021 |title=Malta Becomes First E.U. Country to Legalize Marijuana |work=The New York Times |url=https://www.nytimes.com/2021/12/15/world/europe/malta-eu-marijuana-legalize.html |url-access=limited |archive-url=https://ghostarchive.org/archive/20211228/https://www.nytimes.com/2021/12/15/world/europe/malta-eu-marijuana-legalize.html |archive-date=2021-12-28}}{{cbignore}} In Estonia, it is only legal to sell cannabis products with a THC content of less than 0.2%, although products may contain more cannabidiol.{{Cite web |last=Massa |first=Silja |date=29 June 2019 |title=Kevytkannabis saapui Viroon – Suomalaisturistin ei kannata ostaa tuliaisiksi Virossa laillisia tuotteita |url=https://yle.fi/uutiset/3-10853221 |access-date=25 September 2022 |website=Yle |language=fi}} Lebanon has recently become the first Arab country to legalize the plantation of cannabis for medical use.{{Cite news |date=21 April 2020 |title=Lebanon legalizes cannabis farming for medicinal use |work=Reuters |url=https://www.reuters.com/article/us-lebanon-crisis-cannabis/lebanon-legalizes-cannabis-farming-for-medicinal-use-idUSKCN2232YI}}

Penalties for illegal recreational use ranges from confiscation or small fines to jail time and even death.{{Cite web |date=6 February 2020 |title=Is Weed Legal in Japan? And Other Vacation Info for Cannabis Users |url=https://www.vice.com/en_us/article/wxexym/weed-legal-indonesia-bali-japan}} In some countries citizens can be punished if they have used the drug in another country, including Singapore and South Korea.{{Cite news |title=Here are the absolute worst places on earth to be caught with weed |url=https://thegrowthop.com/cannabis-news/here-are-the-absolute-worst-places-on-earth-to-be-caught-with-weed |website=thegrowthop}}{{Cite web |date=23 October 2018 |title=Bong arm of the law: South Korea says it will arrest citizens who smoke weed in Canada |url=https://www.theguardian.com/world/2018/oct/23/bong-arm-of-the-law-south-korea-says-it-will-arrest-citizens-who-smoke-weed-in-canada |website=TheGuardian.com}}

{{Main|Cannabis cultivation|Cannabis industry|Cannabis product testing}}

File:Woman selling Cannabis and Bhang in Guwahati, Assam, India.jpg in Guwahati, Assam, India]]

{{lang|es|Sinsemilla}} (Spanish for "without seed") is the dried, seedless (i.e. parthenocarpic) infructescences of female cannabis plants. Because THC production drops off once pollination occurs, the male plants (which produce little THC themselves) are eliminated before they shed pollen to prevent pollination, thus inducing the development of parthenocarpic fruits gathered in dense infructescences. Advanced cultivation techniques such as hydroponics, cloning, high-intensity artificial lighting, and the sea of green method are frequently employed as a response (in part) to prohibition enforcement efforts that make outdoor cultivation more risky.

{{anchor|Skunk}}"Skunk" refers to several named strains of potent cannabis, grown through selective breeding and sometimes hydroponics. It is a cross-breed of Cannabis sativa and C. indica (although other strains of this mix exist in abundance). Skunk cannabis potency ranges usually from 6% to 15% and rarely as high as 20%. The average THC level in coffee shops in the Netherlands is about 18–19%.{{Cite web |title=World Drug Report 2006 |url=http://www.unodc.org/unodc/en/data-and-analysis/WDR-2006.html |publisher=United Nations Office on Drugs and Crime}} Ch. 2.3.

The average levels of THC in cannabis sold in the United States rose dramatically between the 1970s and 2000. This is disputed for various reasons, and there is little consensus as to whether this is a fact or an artifact of poor testing methodologies. According to Daniel Forbes writing for slate.com, the relative strength of modern strains are likely skewed because undue weight is given to much more expensive and potent, but less prevalent, samples.{{Cite web |last=Forbes |first=Daniel |name-list-style=vanc |date=19 November 2002 |title=The Myth of Potent Pot |url=http://www.slate.com/id/2074151 |publisher=Slate.com}} Some suggest that results are skewed by older testing methods that included low-THC-content plant material such as leaves in the samples, which are excluded in contemporary tests. Others believe that modern strains actually are significantly more potent than older ones.{{Cite web |last=Turco |first=Bucky |date=25 September 2017 |title=Why is Weed Getting More Potent |url=https://gizmodo.com/why-is-weed-getting-more-potent-1818662872 |website=Gizmodo}}

The main producing countries of cannabis are Afghanistan,{{Cite web |last=United Nations |title=World Drug Report 2013 |url=http://www.unodc.org/unodc/secured/wdr/wdr2013/World_Drug_Report_2013.pdf |access-date=13 December 2014 |publisher=United Nations Office on Drugs and Crime}} Canada,{{Cite web |title=Medical Use of Marijuana |url=http://www.hc-sc.gc.ca/dhp-mps/marihuana/index-eng.php |access-date=12 January 2015 |website=Health Canada}} China, Colombia,{{Cite press release |title=New Colombia Resources Inc Subsidiary, Sannabis, Produces First Batch of Medical Marijuana Based Products in Colombia to Fill Back Orders |publisher=PR Newswire |url=http://www.prnewswire.com/news-releases/new-colombia-resources-inc-subsidiary-sannabis-produces-first-batch-of-medical-marijuana-based-products-in-colombia-to-fill-back-orders-879870332.html |access-date=12 January 2015 |website=prnewswire.com}} India, Jamaica, Lebanon,{{Cite news |last=Moussaoui |first=Rana |name-list-style=vanc |date=25 November 2013 |title=Lebanon cannabis trade thrives in shadow of Syrian war |publisher=AFP |url=http://www.nzherald.co.nz/world/news/video.cfm?c_id=1503076&gal_cid=1503076&gallery_id=139379}} Mexico, Morocco, the Netherlands, Pakistan, Paraguay,{{Cite news |last=Garelli |first=Sanie Lopez |name-list-style=vanc |date=25 November 2008 |title=Mexico, Paraguay top pot producers, U.N. report says |work=CNN International |url=http://edition.cnn.com/2008/WORLD/americas/11/25/paraguay.mexico.marijuana/ |access-date=28 September 2013}} Spain, Thailand, Turkey, the United Kingdom,{{Cite web |last=Jackman |first=Robert |date=12 January 2019 |title=How Britain became the world's largest exporter of medical marijuana |url=https://www.spectator.co.uk/2019/01/how-britain-became-the-worlds-largest-expert-in-medical-marijuana/amp/ |access-date=27 December 2019 |website=The Spectator}} and the United States.

The price or street value of cannabis varies widely depending on geographic area and potency.{{Cite web |date=2005 |title=Cannabis: Wholesale, street prices and purity levels |url=http://www.unodc.org/pdf/WDR_2005/volume_2_chap7_cannabis.pdf |access-date=9 January 2013 |publisher=UNODC.org}} Prices and overall markets have also varied considerably over time.

• In 1997, cannabis was estimated to be overall the number four value crop in the US, and number one or two in many states, including California, New York, and Florida. This estimate is based on a value to growers of ~60% of retail value, or {{convert|3000|$/lb|$/kg}}.{{Cite web |title=Report on U.S. Domestic Marijuana Production |url=http://norml.org/index.cfm?Group_ID=4444 |archive-url=https://web.archive.org/web/20091226011927/http://www.norml.org//index.cfm?Group_ID=4444 |archive-date=26 December 2009 |access-date=2 January 2010 |publisher=NORML}}
• In 2006, cannabis was estimated to have been a $36 billion market.{{Cite web |date=20 December 2006 |title=Marijuana Called Top U.S. Cash Crop |url=https://abcnews.go.com/business/story?id=2735017&page=1 |publisher=2008 ABCNews Internet Ventures}} This estimate has been challenged as exaggerated. The UN World Drug Report (2008) estimated that 2006 street prices in the US and Canada ranged from about US$8.8 to $25 per gram (approximately $250 to $700 per ounce), depending on quality.{{Cite book |last=United Nations Office on Drugs and Crime |url=http://www.unodc.org/documents/wdr/WDR_2008/WDR_2008_eng_web.pdf |title=World drug report |publisher=United Nations Publications |date=2008 |isbn=978-92-1-148229-4 |page=268}} Typical U.S. retail prices were $10–15 per gram (approximately $280–420 per ounce).
• In 2017, the U.S. was estimated to constitute 90% of the worldwide $9.5 billion legal trade in cannabis.{{Cite web |last=Sharma |first=Rakesh |date=25 June 2019 |title=How Federal Legalization Could Transform The US Cannabis Market |url=https://www.investopedia.com/insights/how-federal-legalization-could-transform-us-cannabis-market/ |access-date=24 July 2019 |website=Investopedia |language=en}}

After some U.S. states legalized cannabis, street prices began to drop. In Colorado, the price of smokable buds (infructescences) dropped 40 percent between 2014 and 2019, from $200 per ounce to $120 per ounce ($7 per gram to $4.19 per gram).{{Cite web |last=Hughes |first=Trevor |date=23 May 2019 |title=As marijuana prices drop, growers push 'organic' cannabis – with a higher price tag |url=https://www.usatoday.com/story/news/2019/05/23/pot-growers-push-organic-cannabis-cleaner-option-but-buyers-remain-skeptical/1206364001/ |access-date=24 July 2019 |website=USA Today |language=en}}

The European Monitoring Centre for Drugs and Drug Addiction reports that typical retail prices in Europe for cannabis varied from €2 to €20 per gram in 2008, with a majority of European countries reporting prices in the range €4–10.{{Cite book |last=European Monitoring Centre for Drugs and Drug Addiction |url=http://www.emcdda.europa.eu/attachements.cfm/att_64227_EN_EMCDDA_AR08_en.pdf |title=Annual report: the state of the drugs problem in Europe |publisher=Office for Official Publications of the European Communities |date=2008 |isbn=978-92-9168-324-6 |location=Luxembourg |page=38 |access-date=1 July 2009 |archive-url=https://web.archive.org/web/20130425191815/http://www.emcdda.europa.eu/attachements.cfm/att_64227_EN_EMCDDA_AR08_en.pdf |archive-date=25 April 2013}}

{{See also|Gateway drug effect}}

The gateway hypothesis states that cannabis use increases the probability of trying "harder" drugs. The hypothesis has been hotly debated as it is regarded by some as the primary rationale for the United States prohibition on cannabis use.{{Cite web |date=2 December 2002 |title=RAND study casts doubt on claims that marijuana acts as a "gateway" to the use of cocaine and heroin |url=https://www.rand.org/news/press.02/gateway.html |archive-url=https://web.archive.org/web/20061104124529/https://www.rand.org/news/press.02/gateway.html |archive-date=4 November 2006 |publisher=RAND Corporation}}{{Cite book |last=Benavie |first=Arthur |url=https://books.google.com/books?id=DQxXDgLnKD8C&pg=PA90 |title=Drugs: America's Holy War |publisher=Routledge |date=2009 |isbn=978-0-7890-3840-1 |pages=90– |name-list-style=vanc}} A Pew Research Center poll found that political opposition to marijuana use was significantly associated with concerns about the health effects and whether legalization would increase cannabis use by children.{{Cite web |date=2 April 2014 |title=Public Views of Marijuana – Legalization, Decriminalization, Concerns |website=Pew Research Center for the People and the Press |url=http://www.people-press.org/2014/04/02/section-2-views-of-marijuana-legalization-decriminalization-concerns/}}

Some studies state that while there is no proof for the gateway hypothesis,{{Cite book |last1=Mosher |first1=Clayton J. |url=https://books.google.com/books?id=aDMvoMxx0-IC&pg=PA18 |title=Drugs and Drug Policy: The Control of Consciousness Alteration |last2=Akins |first2=Scott |publisher=Sage Publications |date=2007 |isbn=978-0-7619-3007-5 |page=18 |name-list-style=vanc}} young cannabis users should still be considered as a risk group for intervention programs.{{Cite journal |last=Saitz |first=Richard |name-list-style=vanc |date=18 February 2003 |title=Is marijuana a gateway drug? |url=http://general-medicine.jwatch.org/cgi/content/full/2003/218/1 |journal=Journal Watch |volume=2003 |issue=218 |page=1 |archive-url=https://web.archive.org/web/20030710150041/http://general-medicine.jwatch.org/cgi/content/full/2003/218/1 |archive-date=10 July 2003}} Other findings indicate that hard drug users are likely to be poly-drug users, and that interventions must address the use of multiple drugs instead of a single hard drug.{{Cite journal |vauthors=Degenhardt L, Coffey C, Carlin JB, Moran P, Patton GC |date=August 2007 |title=Who are the new amphetamine users? A 10-year prospective study of young Australians |journal=Addiction |volume=102 |issue=8 |pages=1269–79 |doi=10.1111/j.1360-0443.2007.01906.x |pmid=17624977}} Almost two-thirds of the poly drug users in the 2009–2010 Scottish Crime and Justice Survey used cannabis.{{Cite web |date=21 January 2011 |title=3 The Experience of Drug Users |url=http://www.scotland.gov.uk/Publications/2011/01/21134813/7 |access-date=5 November 2013 |website=2009/10 Scottish Crime and Justice Survey: Drug Use |publisher=The Scottish Government}}

The gateway effect may appear due to social factors involved in using any illegal drug. Because of the illegal status of cannabis, its consumers are likely to find themselves in situations allowing them to acquaint with individuals using or selling other illegal drugs.{{Cite journal |vauthors=Morral AR, McCaffrey DF, Paddock SM |date=December 2002 |title=Reassessing the marijuana gateway effect |journal=Addiction |volume=97 |issue=12 |pages=1493–504 |doi=10.1046/j.1360-0443.2002.00280.x |pmid=12472629 |s2cid=2833456}}{{Cite web |title=Marijuana Policy Project – FAQ |url=http://www.mpp.org/about/faq.html |archive-url=https://web.archive.org/web/20080622204803/http://www.mpp.org/about/faq.html |archive-date=22 June 2008}} Studies have shown that alcohol and tobacco may additionally be regarded as gateway drugs;{{Cite journal |vauthors=Torabi MR, Bailey WJ, Majd-Jabbari M |date=September 1993 |title=Cigarette smoking as a predictor of alcohol and other drug use by children and adolescents: evidence of the "gateway drug effect" |journal=The Journal of School Health |volume=63 |issue=7 |pages=302–06 |doi=10.1111/j.1746-1561.1993.tb06150.x |pmid=8246462}} however, a more parsimonious explanation could be that cannabis is simply more readily available (and at an earlier age) than illegal hard drugs.{{Citation needed|date=January 2024}} In turn, alcohol and tobacco are typically easier to obtain at an earlier age than is cannabis (though the reverse may be true in some areas), thus leading to the "gateway sequence" in those individuals, since they are most likely to experiment with any drug offered.

A related alternative to the gateway hypothesis is the common liability to addiction (CLA) theory. It states that some individuals are, for various reasons, willing to try multiple recreational substances. The "gateway" drugs are merely those that are (usually) available at an earlier age than the harder drugs. Researchers have noted in an extensive review that it is dangerous to present the sequence of events described in gateway "theory" in causative terms as this hinders both research and intervention.{{Cite journal |vauthors=Vanyukov MM, Tarter RE, Kirillova GP, Kirisci L, Reynolds MD, Kreek MJ, Conway KP, Maher BS, Iacono WG, Bierut L, Neale MC, Clark DB, Ridenour TA |date=June 2012 |title=Common liability to addiction and "gateway hypothesis": theoretical, empirical and evolutionary perspective |journal=Drug and Alcohol Dependence |type=Review |volume=123 |issue=Suppl 1 |pages=S3–17 |doi=10.1016/j.drugalcdep.2011.12.018 |pmc=3600369 |pmid=22261179}}

In 2020, the National Institute on Drug Abuse released a study backing allegations that marijuana is a gateway to harder drugs, though not for the majority of marijuana users.{{Cite web |date=July 2020 |title=Marijuana Research Report:Is marijuana a gateway drug? |url=https://www.drugabuse.gov/publications/research-reports/marijuana/marijuana-gateway-drug |access-date=7 November 2020 |publisher=National Institute on Drug Abuse}} The National Institute on Drug Abuse determined that marijuana use is "likely to precede use of other licit and illicit substances" and that "adults who reported marijuana use during the first wave of the survey were more likely than adults who did not use marijuana to develop an alcohol use disorder within 3 years; people who used marijuana and already had an alcohol use disorder at the outset were at greater risk of their alcohol use disorder worsening. Marijuana use is also linked to other substance use disorders including nicotine addiction." It also reported that "These findings are consistent with the idea of marijuana as a "gateway drug". However, the majority of people who use marijuana do not go on to use other, "harder" substances. Also, cross-sensitization is not unique to marijuana. Alcohol and nicotine also prime the brain for a heightened response to other drugs and are, like marijuana, also typically used before a person progresses to other, more harmful substances."

{{See also|Medical cannabis research}}

Research on cannabis is challenging since the plant is illegal in most countries.{{Cite journal |date=22 November 2004 |title=Marijuana Research: Current restrictions on marijuana research are absurd |url=http://www.scientificamerican.com/article.cfm?id=marijuana-research |journal=Scientific American |archive-url=https://web.archive.org/web/20101107192934/http://www.scientificamerican.com/article.cfm?id=marijuana-research |archive-date=7 November 2010 |access-date=15 January 2013}}{{Cite journal |vauthors=Ponto LL |date=May 2006 |title=Challenges of marijuana research |journal=Brain |volume=129 |issue=Pt 5 |pages=1081–83 |doi=10.1093/brain/awl092 |pmid=16627464 |doi-access=free}}{{Cite news |last=Jha |first=Alok |name-list-style=vanc |date=31 May 2012 |title=Ecstasy and cannabis should be freely available for study, says David Nutt |work=The Guardian |url=https://www.theguardian.com/science/2012/may/31/ecstasy-cannabis-study-david-nutt |access-date=15 January 2013}}{{Cite web |date=15 May 2012 |title=Medical Marijuana Policy in the United States |url=https://www.stanford.edu/group/hopes/cgi-bin/wordpress/2012/05/medical-marijuana-policy-in-the-united-states/#medical-marijuana-and-research |access-date=15 January 2013 |publisher=Stanford.edu}}{{Cite web |last=Conaboy |first=Chelsea |name-list-style=vanc |date=19 October 2012 |title=Research into marijuana's medical benefits limited; scientists cite challenge of studying an illegal drug |url=https://www.bostonglobe.com/lifestyle/health-wellness/2012/10/18/research-into-marijuana-medical-benefits-limited-scientists-cite-challenge-studying-illegal-drug/f6Ydip4xF5VfFWEV9mpwYJ/story.html |archive-url=https://web.archive.org/web/20121021003220/https://www.bostonglobe.com/lifestyle/health-wellness/2012/10/18/research-into-marijuana-medical-benefits-limited-scientists-cite-challenge-studying-illegal-drug/f6Ydip4xF5VfFWEV9mpwYJ/story.html |archive-date=21 October 2012 |access-date=15 January 2013 |website=Boston Globe}} Research-grade samples of the drug are difficult to obtain for research purposes, unless granted under authority of national regulatory agencies, such as the US Food and Drug Administration.{{Cite web |date=14 January 2020 |title=FDA and Cannabis: Research and Drug Approval Process |url=https://www.fda.gov/news-events/public-health-focus/fda-and-cannabis-research-and-drug-approval-process |access-date=21 January 2020 |publisher=US Food and Drug Administration}}

There are also other difficulties in researching the effects of cannabis. Many people who smoke cannabis also smoke tobacco.{{Cite journal |vauthors=Peters EN, Budney AJ, Carroll KM |date=August 2012 |title=Clinical correlates of co-occurring cannabis and tobacco use: a systematic review |journal=Addiction |volume=107 |issue=8 |pages=1404–17 |doi=10.1111/j.1360-0443.2012.03843.x |pmc=3377777 |pmid=22340422}} This causes confounding factors, where questions arise as to whether the tobacco, the cannabis, or both that have caused a cancer. Another difficulty researchers have is in recruiting people who smoke cannabis into studies. Because cannabis is an illegal drug in many countries, people may be reluctant to take part in research, and if they do agree to take part, they may not say how much cannabis they actually smoke.{{Cite web |date=30 August 2017 |title=Does smoking cannabis cause cancer? |url=http://www.cancerresearchuk.org/cancer-help/about-cancer/cancer-questions/does-smoking-cannabis-cause-cancer |url-status=dead |archive-url=https://web.archive.org/web/20131219150250/http://www.cancerresearchuk.org/cancer-help/about-cancer/cancer-questions/does-smoking-cannabis-cause-cancer |archive-date=19 December 2013 |access-date=26 December 2013 |website=Cancer Research UK (CRUK)}}

• Cannabis rights
• Glossary of cannabis terms
• List of books about cannabis
• List of celebrities who own cannabis businesses

Footnotes

{{notelist|30em}}

Citations

{{Reflist}}

• {{cite book |first1 =Martin |last1 =Booth |year=2004 |title=Cannabis: A History |edition= |location= |publisher=Picador |isbn=978-0-312-42494-7 |ref=none}}
• {{cite book |first1 =Bill |last1 =Drake |year=2002 |title=The Marijuana Food Handbook: A Guide for the Sensuous Connoisseur |edition= |location= |publisher=Ronin Publishing |isbn=978-0-914171-99-7 |ref=none}}
• {{cite book |first1 =Lester |last1 =Grinspoon |year=1994 |title=Marihuana Reconsidered |edition= |location= |publisher=Quick American Archives |isbn=978-0-932551-13-9 |ref=none}}

{{Wiktionary|Appendix:Cannabis slang}}

• {{Commons category inline|Cannabis}}
• {{Wiktionary inline|marijuana}}

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