Cannabis Flashcards

Question

Tell me about **Cannabis edibles**

Answer 1

**Cannabis edible** are various products (e.g., sweets/ candy, baked products- cakes, cookies, chocolate, drink, etc) containing cannabis material (notionally low %THC)

Answer 2

* Inhalation/ smoking * Ingestion

Answer 3

o In Europe, Australia and the Americans, cannabis is usually smoked, being rolled in cigarette rolling paper, termed a spliff or joint (the other term was reefer), or the smoke draw through bongs or pipes o The loose herbal material burns relatively easily and may be smoked pure or often mixed with tobacco as a bulking agent for titrating the dose and to help the joint burn smoothly o Hashish does not burn easily and also because the amount required to produce intoxication is quite small, it is usually crumbled for mixing with tobacco o The oil, which is thick, may be smeared across cigarette rolling paper and then rolled with tobacco, or the oil placed on a hot knife that is then held under the nose so that the fumes can be inhaled o “dabbing” rigs used for heating of hash oil liquid for inhalation

Answer 4

o In India, the Middle East and North Africa, it is a tradition to take cannabis orally, prepared as an infusion to drink o Oral administration is not so popular elsewhere because the psychoactive effects are slow to begin. In the West, ingestion is often preparing cannabis in food, typically cakes or biscuits o The effects can be unpredictable, and once swallowed there is no going back, unlink with smoking where users can choose how much to smoke depending on how intoxicated, or ‘stoned’ they being to feel, not least depending on the strength of the cannabis used

Answer 5

* **CB1**-mostly found in the brain * **CB2-** In peripheral tissues (especially immune system but some types of pain) * Receptors on cell surface coupled to G-proteins that control cAMP formation

Answer 6

The **endocannabinoids** are similar in structure to endogenous fatty acids such as arachidonic acid, but the acid groups are substituted with an ethanolamine, such as anandamide

Answer 7

The two most characterised endocannabinoids are **anandamide** (below) and **2-arachidonoylglycerol**. The role of endocannabinoids is still unclear but include effects on appetite and memory, analgesia, addictive behaviour

Answer 8

* **THC binds to both CB1 and CB2** cannabinoid receptors and is a **partial agonist**, whereas CBD has minimal affinity for CB1 receptors. Conversely, “synthetic cannabinoids” are invariably full agonists to CB1 and CB2 receptors * Cannabis’ (Esp. THC) interaction with other major neurotransmitter systems (e.g., dopamine, opioid) is mainly indirect through the interplay of these systems with the endocannabinoid system

Answer 9

* In neuropsychopharmacology investigations, there are indications that combining doses of CBD with THC alleviates the initial aversive effects associated with initial administration of THC alone but will probably not alter THCs intoxicating properties. * It follows that cannabis used may be at an increased risk of acute adverse psychological reactions when using potent forms of cannabis with a decreased CBD content

Answer 10

*** THC** is the main psychoactive ingredient, which produced a euphoric effect or ‘high’, and merriment within the initial stages, followed by relaxation, disinhibition, and sociability * There are also effects on perception that accompany the ‘high’ and often contribute to it, including colours may seem brighter, music more vivid, emotions more poignant and meaningful

Answer 11

* **THC** can induce psychotic symptoms, although the incidence is rare, and in contrast **CBD** has anxiolytic and possible anti-psychotic properties. No scientific evidence for cannabinoid “entourage” effect

Answer 12

* **Absorption** occurs **immediately after first inhalation**. Peak plasma levels are generally reached within 3-10 mins. Variable bioavailability (10-56%) affected by dose, history of use, individual differences in physiology, and smoking topography/ efficiency * with oral administration, about 90-95% is absorbed but first pass metabolism accounts for why the blood concentrations are 25-30% of those obtained by smoking * the onset of the effect is delayed because of slow absorption (0.5 to 2 hours), with peak plasma concentrations of THC not reached until 1 to 3 hours after ingestion

Answer 13

* poor correlation between plasma THC levels and THC-like subjective effects. Effects continue (any may be stronger) during **distribution** and elimination phases * THC is lipophilic, binds to plasma proteins, and is quickly distributed to organs and tissues. Body fat serves as a reservoir

Answer 14

* 11-hydroxy-THC (11-OH-THC) and 11-nor-carboxy-THC (THC-COOH) are the **primary metabolites** of THC. 11-OH-THC is psychoactive, is equipotent to THC, and may extend duration of intoxication (important if taken orally). THC-COOH is not psychoactive

Answer 15

* Metabolites are eliminated in the faeces (65-80%) and urine (20-35%). Mainly THC-COOH-glucuronide in urine. Elimination half-life depends on history of use, but roughly 1.3 days for infrequent users and up to 2 weeks in heavy users. As a considerable proportion of the metabolites are in the faeces, enterohepatic re-circulation may occur, which contributes to the long plasma half-life of THC, together with its slow release from lipophilic compartments.

Answer 16

o Euphoria, laughter, and talkativeness o Appetite stimulation and may promote dry mouth, dizziness and increases in visual, olfactory, and auditory perceptions (hallucinations) o Time perception may be altered, and some users may experience anxiety and panic reactions o Red eyes

Answer 17

* Cannabis intoxication can impair attention and shirt-term memory function (causing driving impairment) and can precipitate psychotic reactions in vulnerable individuals * Note: whilst often linked to cannabis, the effects of synthetic cannabinoids are very different and not just “more potent/ pronounced then cannabis”. Synthetic cannabinoid receptor agonists (SCRAs) are discussed in separate lecture

Answer 18

1. Cannabis is one of the most common drugs detected in DUID cases 2. Zero tolerance approach in UK: blood 2ng/mL limit 3. People driving under the influence of cannabis are more likely to be involved in a car accident, but level of risk is not as great as with alcohol 4. Some studies show that cannabis use impairs reaction time, lane control, speedometer monitoring, hand and body steadiness, breaking stop time and promotes inappropriate responses in an emergency scenario 5. Cannabis and alcohol use combined shown to additively increase the lateral movement, but cannabis appeared to mitigate the potential for alcohol to cause increases in driving speed

Answer 19

* Cannabis is not associated with acute fatal “overdoses”, this is controversial and a 2017 consensus report by the National academies of science, engineering, and medicine (NASEM) concluded that there is insufficient evidence to support or refute associations between cannabis use and increased risk of all-cause mortality and overdose lethality in humans

Answer 20

Cannabis acutely increases heart rate and blood pressure but there is an uncertain association between cannabis use and heart attack o Some limited population evidence to suggest that smoking cannabis increases the risk of ischaemic stroke

Answer 21

* Several case reports of young children accidentally ingesting cannabis and undergoing respiratory depression, tachycardia, and temporary coma.

Answer 22

o Regular cannabis users may experience higher rates of chronic bronchitis o Acute cannabis use impairs certain types of cognitive function and can interfere with attention, learning and memory o Acute cannabis intoxication precipitating a short-lasting psychotic state which reverses once the effects of the drug have abated o Population studies have linked cannabis use to schizophrenia, with cannabis increasing the risk of developing the disorder in a dose-dependent manner, where heavier cannabis use increases the risk of developing schizophrenia, and that adolescent cannabis use may bring forward the age of schizophrenia onset but not cause it o Some evidence for cannabis use increasing manic symptom in bipolar disorder patients; a small increased risk of developing depression; suicidal ideation, suicide attempts and completions in heavy users; and the development of social anxiety disorders.

Answer 23

o Analysis for THC, THC-COOH, 11-OH-THC and to a lesser extent, CBD, CBN is commonplace using GC-MS/MS or LC-MS-MS o Cannabinoid concentrations often less than 100 ng/mL in blood, with THC-COOH higher than THC or 11-OH-THC o Typically, no THC in urine; THC-COOH and 11-OH-THC present as glucuronides. Immunoassay typically analyses for THC-COOH o Plasma/blood THC and metabolite concentrations can vary over-time (Huestis et al) and depend on many factors o Equally, post-mortem blood THC and metabolite concentrations can also vary over-time (Chu et al) with initial reductions the increases then reductions… o Aside from any statutory limit, virtually impossible to interpret the significance of cannabinoid concentrations in many situations (aside from indicating use at some point… but consider passive exposure)

Answer 24

* Cannabis is one of the most widely used and abused drugs in the world. Available as plant material, resin, oils/extracts and associated products * Many, many phytocannabinoids exist in the plant. Delat-9-THC is the primary “active” compoenent. Cannabidiol (CBD) is also important * Cannabis can produce various effects, including relaxation but also impairing effects with acute toxicity concerns. Cannabinoid tox analysis is important and widespread but often difficult to interpret the results. * “medical cannabis” is an on-going debate focused around THC and CBD and the plant itself and associated extracts/ oils. Has approval for some therapeutic indications in some countries. Only a few defined pharmaceutical preparations at present.