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Cannabis is undisputedly the most commonly used illicit across the globe and estimates show that dependent use is increasingly common. In this chapter, surveys and research data are used to demonstrate cannabis's place in the world. Naturally produced cannabis comes in the form of the dried leaves and the flowering heads of the marijuana plant. The method of consumption of cannabis (inhalation or ingestion) is known to play a role in the length and intensity of the psychoactive effect, as does the quantity of cannabis used at any one time. The pharmacokinetics of cannabis is also discussed, along with tolerance and general recreational use. In recreational users the difference in THC concentration between peak and trough plasma concentration is greater than that observed in chronic users. The major equipotent metabolite 11-hydroxy-THC and the THC-COOH metabolite are both detectable for a considerable time after a cannabis cigarette. Medicinal cannabinoids have been shown to demonstrate therapeutic potential. Prescribed in low doses they generally do not produce the debilitating effects of THC inhaled by smoking. Various analogues of cannabis have been manufactured commercially for medical purposes and are discussed in more depth in this chapter. Over the last few years, synthetic cannabinoid receptor agonists have been detected in samples of smoking mixes such as “Spice”, and are reported to have pharmacology similar to that of cannabis. Quality control and continuity seem to be a challenge within this now booming area of the cannabis market. Many of the mixtures available under different brand names contain the same compounds, with many compounds reported to be significantly more potent than natural THC. Along with extended duration of action, growing reports of tolerance and physical withdrawal following regular use, it is looking as though synthetic cannabinoids may produce more severe adverse effects. It is also worth noting that smoking these synthetic mixes does not cause a positive drug test for cannabis or other illegal drugs, although some bespoke methodology has enabled detection. Further work to investigate the pharmacokinetic and pharmacodynamic properties of these compounds is required.

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