This is a power point slide presentation of the effects of marijuana

1. Marijuana
Presenter: Alinetu Raymond
Tutor: Dr. Douglas Rappaport

2. Introduction
• Marijuana or cannabis consists of the dried leaves and flowers of the
hemp plant Cannabis sativa.
• Hashish is prepared from the dried resin from the flower tops of this
plant.
• The psychoactive ingredient in marijuana is tetrahydrocannabinol
(THC).
• Marijuana is most often smoked but can also be ingested.

3. Perspective: Background and Epidemiology
• Marijuana was probably the most common illegal drug in Uganda.
• It was used medicinally in ancient times for conditions such as colic
and asthma, and in poultry farming and by traditional healers.
• Recreational use of marijuana continues to be common.

4. Principles of Disease:
Pharmacology and Pathophysiology
• Tetrahydrocannabinol (THC) is the main active agent of the more than
61 cannabinol compounds and approximately 300 other substances
present in the cannabis plant.
• Marijuana smoke also contains carbon monoxide, cyanide, acetone,
and phenol but not nicotine.
• The most efficient route of THC delivery is by inhalation. Fifty percent
of smoked THC is absorbed compared with 6% by ingestion.

5. Dose and Action
• Typical Hallucinogenic dose
• 5-15mg of THC
• Peak blood concentration
• 8 minutes
• Duration of action
• 2-4 hours (smoked)
• 6-12 hours (ingestion)

6. Uses
Recreation
Marijuana is used for treatment of medical conditions such as:
• Glaucoma
• Chemotherapy-related nausea and
• Promote weight gain in patients with
• human immunodeficiency virus (HIV) infection and
• acquired immunodeficiency syndrome (AIDS)

7. Clinical Presentation
• alteration of mood, relaxation and
• euphoria.
The only reliable physiologic effects are:
• a mild increase in heart rate and conjunctival injection.
Pupillary changes usually do not occur. Other acute peripheral changes
include
• urinary retention, decreased testosterone levels, and decreased
intraocular pressure.
• Short-term memory is impaired, and the ability to perform complex tasks
may be adversely affected

8. In children
• Hypothermia
• Ataxia
• Nystagmus
• Tremor
• Tachycardia
• injected conjunctiva, and
• labile affect.
Oral ingestion of potent marijuana in children can produce rapid onset
of drowsiness, hypotonia, and lethargy, which can lead to coma and
airway obstruction

9. In chronic use
• Cyclic vomiting syndrome/ cannabinoid hyperemesis syndrome, is
increasingly recognized as an entity associated with cannabinoid
overuse; characterized by:
• cyclical vomiting,
• diffuse abdominal pain

10. Laboratory Tests
High lipid solubility results in extensive deposition within body fat and slow
excretion in the urine.
• After a single use, THC is detected by commercially available urine screens
for up to 3 days.
• With long-term use, cannabinoids can be detected up to 1-3 months after
abstinence.
• False-positive urine cannabinoid screening can occur due to use of
ibuprofen, naproxen, pantoprazole, or efavirenz

11. Management in Acute use
• Reassurance
• Benzodiazepines (for severe symptoms)
• Hot shower
• Antiemetics

12. Management in chronic use
• Capsaicin (topical preparation) - first-line treatment.
• Antipsychotics (haloperidol and olanzapine) provide symptom relief
• Education
• Antiemetics

13. Medical complications
which are rare, include:
• panic reactions
• brief toxic psychoses
• pneumomediastinum, and
• pneumothorax.

14. References
• Tintinalli's textbook of emergency medicine
• Rosens