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Cannabis is a genus of flowering herbs in the Cannabaceae family. Federal law defines dried plant material preparations of the subspecies Cannabis sativa as marijuana. The term cannabis refers to all products derived from Cannabis plants. The active compounds in cannabis are cannabinoids, which include delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD). THC is the psychoactive component, whereas CBD has no psychoactive effects. There are three Food and Drug Administration (FDA)-approved cannabis-related drugs. Dronabinol and nabilone (Cesamet) are approved for chemotherapy-induced nausea and vomiting; cannabidiol (Epidiolex) is approved for two pediatric epilepsy syndromes. FDA-approved cannabis-related drugs, marijuana, and cannabis formulations have been studied for the management of other conditions and symptoms (eg, cachexia, chemotherapy-induced nausea and vomiting, chronic pain, muscle spasticity) and have shown varying effectiveness. CBD formulations have been shown to be effective for certain forms of epilepsy. However, marijuana, cannabis-containing products, and cannabis-derived products in general are not approved by the FDA for any indication. Adverse effects include impaired executive function, cognition, and driving. Physicians can recommend use of marijuana under medical marijuana laws but cannot prescribe it, as it is classified as a Schedule I controlled substance. Laws regulating use of marijuana and cannabis products vary among states.

Case 4. Heather, a 39-year-old woman with fibromyalgia, comes to your office as a new patient. She has seen many physicians, including rheumatology, pain management, and psychiatry subspecialists, for chronic pain, fatigue, and poor concentration. One subspecialist recommended that she try using marijuana through the state medical marijuana program. Since Heather started using it, she has noticed considerable improvement in her symptoms. She has been able to reduce her previous daily use of oxycodone to only occasional use. She also has discontinued use of fluoxetine. (Fibromyalgia is an off-label use of fluoxetine.) Heather recently moved to your state and wants to know where she can obtain medical marijuana in your community.

Definitions

Cannabis is a genus of flowering herbs in the Cannabaceae family.98 There are two main subspecies, Cannabis sativa and C indica.99 Federal law defines dried plant material preparations of C sativa as marijuana. The term cannabis generally refers to all drugs, agents, substances, and products derived from Cannabis plants.100

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