Classification: Depressant, stimulant or hallucinogen

Background: Cannabis sativa plants that contain more than 0.3% THC are classified as marijuana. THC is the main psychoactive cannabinoid found in marijuana and can have depressant, hallucinogenic and stimulant properties.

Prescription Products: Dronabinol (Marinol®, Syndros®), a synthetic THC approved for the treatment of loss of appetite (anorexia) in people with AIDS (Acquired Immune Deficiency Syndrome) who have lost weight and severe nausea and vomiting caused by anti-cancer medicine (chemotherapy-induced nausea and vomiting or CINV).

Nabilone (Cesamet®) is a synthetic cannabinoid for the treatment of CINV.

Nabiximols (Sativex®) is available in many countries—but not the U.S.—for the treatment of spasticity in multiple sclerosis and chronic pain.

OTC Products: The use and possession of marijuana is illegal under federal law in the U.S. The medical use of marijuana with a medical recommendation and recreational use have been legalized in several U.S. states, U.S. territories, and the federal District of Columbia (D.C.).

Street Names: Aunt Mary, BC Bud, Blunts, Boom, Chronic, Dope, Gangster, Ganja, Grass, Hash, Herb, Hydro, Indo, Joint, Kif, Mary Jane, Mota, Pot, Reefer, Sinsemilla, Skunk, Smoke, Weed, and Yerba.

Appearance: Marijuana is a dry, shredded green/brown mix of flowers, stems, seeds, and leaves from the Cannabis sativa plant. The mixture typically is green, brown or gray in color and may resemble tobacco. More recent formulations may also include THC extracts (oils/waxes/resins).

Modes of Use: Smoking, vaporizing devices, mixed or infused in food or drink, capsules or supplements, topical creams or ointments.

Physiological Effects: Decreased blood pressure, increased heart rate, dizziness, nausea, tachycardia, confusion, anxiety, paranoia, drowsiness, respiratory ailments.

Psychological Effects: Disinhibition, relaxation, increased sociability, talkativeness, altered senses, altered sense of time, changes in mood, difficulty with thinking and problem-solving, impaired memory, impaired judgment, reduced coordination, agitation, paranoia, confusion, hallucinations (when taken in high doses), delusions (when taken in high doses), psychosis (risk is highest with regular use of high potency marijuana.)

Toxicity: No deaths from overdose of marijuana have been reported.

Metabolism and Detection: Using marijuana will result in positive test results for THC or its primary metabolite, Delta-9-Carboxy-Tetrahydrocannabinol (Delta-9-THC-COOH), in urine, oral fluid, hair and whole blood.

Interpretation of Results: THC can persist in urine long after use, from two days for the occasional user to six weeks or more for the chronic user. A patient’s creatinine level can be used to normalize THC levels to the patient’s hydration state to determine if THC levels are consistent with new or previous use.

Detection Time in Urine: Days to weeks depending on frequency of use.

Detection Time in Oral Fluid: 1-3 days

Background: Cannabis sativa plants that contain less than 0.3% THC are classified as hemp. The main cannabinoid found in hemp is cannabidiol (CBD), which is non-psychoactive. Oil extracted from hemp seeds is used as a food supplement or for its purported therapeutic effects. CBD has been shown to have analgesic, anticonvulsant, muscle relaxant, anxiolytic, neuroprotective, antioxidant and anti-psychotic activity. CBD can be consumed in oils, tinctures and other edibles. It is also found in lotions and beauty products.

Prescription Products: Epidiolex is a liquid CBD extract approved by the FDA for use in children who have seizures caused by two rare genetic disorders.

OTC Products: Hemp-derived CBD (<0.3% THC) is legal under federal law in the U.S. Legal use, possession and sale of OTC CBD products differs across states. 

Metabolism and Detection: The main primary metabolite of CBD is 7-hydroxy-cannabidiol. Specific drug tests designed to detect CBD or metabolites would be required. Tests designed to detect THC or metabolites will not detect CBD.

Use of hemp or hemp-derived CBD preparations should not result in positive test results for THC. However, since CBD preparations are largely unregulated, they may contain delta-9 THC. In some cases, the THC content may be higher than indicated. Additionally, studies have shown that even low levels of THC in hemp and CBD products may accumulate with repeated use and cause an unexpected positive THC result. 

Modes of Use: Oils, extracts, capsules, patches, vapes, and topical preparations for use on skin.

Physiological Effects: Pain relief, anticonvulsant, drowsiness, sedation, gastrointestinal issues, dry mouth.

Psychological Effects: Relaxation, decreased anxiety and depression.

Toxicity: Signs of liver injury have also been reported with high doses of the prescription form of CBD, Epidiolex.

Background: Alternative cannabinoids are synthetically derived by chemically modifying CBD and other cannabinoids extracted from hemp. Due to the structural similar to Delta-9 THC, effects of these alternative cannabinoids are similar to traditional marijuana.

Prescription Products: Alternative cannabinoids have not been evaluated or approved by the FDA.

OTC Products: Because alternative cannabinoids are derived from hemp, they are considered legal under federal law in the U.S. Legal use, possession and sale of these products differs across states.

Modes of Use: Smoking, vaporizing devices, capsules, mixed or infused in liquids, tinctures, oils and edibles, topical creams or ointments.

Physiological Effects: Stimulation of appetite, pain relief, drowsiness, bradycardia, numbness, tachycardia, dizziness, vomiting, discoordination, loss of consciousness.

Psychological Effects: Confusion, anxiety, depression, elevated mood, relaxation, euphoria, difficulty concentrating, alerted sense of time, hallucinations, memory loss, delayed reaction time.

Toxicity: The FDA has received adverse event reports involving delta-8 THC-containing products. Adverse events included, but were not limited to, hallucinations, vomiting, tremor, anxiety, dizziness, confusion, and loss of consciousness. One pediatric death case has been reported.

Metabolism and Detection: Due to structural similarities with Delta-9 THC, immunoassay screens are likely to generate positive results due to the presence of alternative cannabinoids. However, dedicated definitive tests (LC-MS/MS or GC-MS) would be required to confirm the presence of alternative cannabinoids.