Marijuana is one of the most commonly abused drugs. It was used as early as 3000 bc in cultures as diverse as those found in the Middle East and Asia. The drug is known by a number of names, including hashish, ganja, and bhang. Low to moderate doses of the drug cause very few psychological and physiological symptoms. The pharmacologic actions and the long-term effects of chronic use are still unclear.
Delta-tetrahydrocannabinol (THC) is derived from the marijuana plant, Cannabis sativa. The drug can be smoked, eaten, or taken intravenously. Its potency varies greatly. When smoked, the peak plasma level of the drug is reached within 10 minutes, although psychological effects do not develop until 20 to 30 minutes. The effects can last up to 3 hours. However, THC is absorbed and accumulates in tissues such as the testes and the brain.
THC causes euphoria, feelings of relaxation, and heightened sexual arousal. Some individuals experience increased hunger; others report increased suspiciousness, paranoia, and aggressiveness, and still others become quite withdrawn socially.
Neurological signs and symptoms include confusion, disorientation, and an organic delusional syndrome. Some recurrent users develop short-term memory deficits. Nystagmus, ataxia, and tremors have also been reported. The drug can precipitate seizures in patients with known seizure disorders. Life-threatening neurological abnormalities are very rare.
Treatment of patients with acute toxic reactions involves reassurance that the problems will clear up within a few hours. Because of the possible high concentration of the drug in various tissues, the neurological effects of the drug may take up to 8 hours to clear. No specific drug is necessary, although a benzodiazapine may be useful. In patients in acute psychotic states, haloperidol 5 to 20 mg/ day in divided doses is recommended.
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