Cannabis Drug Interactions, Uses, Effectiveness, Safety & More
What is this page for?
First and foremost: how Cannabis interacts with medications. The heart of this page is the interaction list — every drug Cannabis is known to interact with, and how serious each one is.
But these pages have grown well beyond that into a full monograph — what Cannabis is, what people use it for and how strong the evidence is, its safety and side effects, and answers to the questions we’re asked most — written and reviewed by the clinical staff at HelloPharmacist. It’s educational information from our licensed clinical databases, not medical advice, and we don’t sell or endorse products. Our editorial policy
Check Cannabis against your medication
Add one medicationCannabis Drug Interactions: The Bottom Line
From the HelloPharmacist Editorial Team · Updated July 2026Based on the available evidence, the overall risk of a clinically significant Cannabis drug interaction is moderate, with a few combinations that deserve real caution even though most listed interactions are theoretical. Nearly all interactions are rated moderate and rest on lab research rather than human studies, but a small number, including one major interaction, are backed by reports in people.
The clearest concern is warfarin: human case reports and lab findings suggest cannabis can raise warfarin's effects and the risk of bleeding. Cannabis also has sedating effects, so combining it with alcohol or other sedating medications may add up, causing more drowsiness and impaired coordination. In clinical reports, a cannabis component raised blood levels of certain seizure and mood medications, such as clobazam, topiramate, and citalopram. Chronic use may also change how the body responds to anesthesia before surgery.
The long list of interactions does not mean every combination is harmful. Most entries are theoretical, based on how cannabis might affect enzymes and transporters the body uses to clear medications. In fact, human research found that cannabis did not change blood levels or effects of several antipsychotic medications, showing that predicted interactions do not always play out in people.
Based on HelloPharmacist’s Cannabis interaction data and reviewed under our editorial standards.
Drugs that interact with Cannabis
1137 medications have a known interaction with Cannabis, graded by severity. Select any drug for the full evidence-based detail.
2 major interactions. These combinations can be clinically significant — best avoided, or used only with close professional supervision. Always check with your pharmacist before combining them with Cannabis.
Don’t want to scroll the list? Just ask.
Tell us the medications you take and we’ll check each one against Cannabis using our pharmacist-reviewed interaction data.
AI summaries are generated from our Cannabis interaction data for education only — always confirm with your pharmacist. How we use AI
No drugs match “”.
What Severity, Likelihood & Evidence Mean
Severity — How Serious It Can Be
- Major. Clinically significant; generally best avoided, or used only under direct professional supervision.
- Moderate. May need monitoring, a dose adjustment, or separating the times you take each one.
- Minor. Generally not clinically significant, but still worth noting and mentioning to your pharmacist.
- No known interaction. Checked against our sources with nothing documented — not the same as proven safety.
Likelihood — How Well It’s Documented
- Likely. Well-controlled human studies have demonstrated the likely existence of this interaction
- Probable. Interaction has not been documented in well-controlled studies, however, the interaction has been demonstrated in some small human studies or in controlled animal studies in conjunction with multiple case reports.
- Possible. Interaction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists
- Unlikely. Interaction has been demonstrated in animal or in lab research but has been shown not to occur in humans.
Where This Data Comes From
- Interaction records are evidence-graded and sourced from the Natural Medicines database (TRC Healthcare), the same reference used by pharmacists and hospitals.
- Each drug listed above links to the full report for that exact Cannabis combination — clinical detail, likelihood, evidence level, and citations.
- Content is reviewed by licensed HelloPharmacist pharmacists — see our data sources and editorial standards.
The kinds of drugs Cannabis affects
Every type of medication (drug category) Cannabis is known to interact with. Open any category for the detail — or search your exact drug in the checker above.
Warfarin (Coumadin)
Concomitant use with cannabis seems to increase the levels and clinical effects of warfarin.
In vitro research shows that the cannabis constituents delta-9-tetrahydrocannabinol (THC), cannabidiol (CBD), and cannabinol inhibit the cytochrome P450 2C9 (CYP2C9)-mediated 7-hydroxylation of S-warfarin in a concentration-dependent manner.
Additionally, there are multiple case reports of patients chronically taking warfarin that developed a spike in international normalized ratio (INR) after using cannabis in various forms, including smoking cannabis, taking medical cannabis orally, or drinking water infused with cannabis flower. One patient smoked 2-2.5 grams in one week and another patient had doubled the amount of THC consumed from 7.5 mg to 14.7 mg daily for one week.
Alcohol (Ethanol)
Theoretically, cannabis might have additive effects when used with alcohol.
Cannabis can have CNS depressant effects, similar to synthetic delta-9-tetrahydrocannabinol (THC). Theoretically, concomitant use of alcohol with cannabis can have additive effects including psychomotor impairment, sedation, and changes in mood and behavior.
Anesthesia
Cannabis use might alter the safety and clinical effects of various forms of anesthesia.
A small clinical study shows that higher doses of propofol may be needed to achieve relaxation and loss of consciousness in chronic cannabis users compared with nonusers. Another small clinical study shows that use of cannabis within 72 hours prior to undergoing surgery requiring atropine anesthesia may increase the risk of sustained postoperative tachycardia. The exact mechanisms of these interactions are unclear. Obtain a patient's history of cannabis use preoperatively and advise patients to discontinue cannabis use for at least 2 weeks prior to undergoing surgery.
Anticoagulant/Antiplatelet Drugs
Theoretically, cannabis might increase the risk of bleeding when used concomitantly with anticoagulant/antiplatelet drugs.
In vitro research shows that the cannabis constituents delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) inhibit platelet aggregation.
Barbiturates
Theoretically, cannabis might increase the levels and adverse effects of barbiturates.
Some research shows that synthetic delta-9-tetrahydrocannabinol (THC) increases the elimination half-life of pentobarbital by 4 hours when dosed concomitantly.
Cns Depressants
Theoretically, cannabis might have additive effects if used with other CNS depressants.
Cannabis can have CNS depressant effects. Combining cannabis with other CNS depressants might result in additive or synergistic effects. A small clinical trial in healthy adults shows that inhaling a high-grade cannabis (Bedrocan International B.V., Veendam, The Netherlands) 100 mg, containing delta-9-tetrahydrocannabinol 21.8% and cannabinol 0.1%, modestly increases subjective feelings of sedation when compared with cannabis alone.
Cytochrome P450 2C19 (Cyp2C19) Substrates
Cannabis may increase levels of drugs metabolized by CYP2C19.
Research shows that cannabidiol (CBD), a constituent of cannabis, inhibits CYP2C19. In clinical studies and case reports, cannabidiol use resulted in significant increases in the serum levels of topiramate, methadone, citalopram, omeprazole, and N-desmethylclobazam, the primary active metabolite of clobazam. These chemicals are metabolized by CYP2C19. Concomitant use of cannabis with CYP2C19 substrates may increase the risk for adverse effects from these substrates.
Cytochrome P450 2C9 (Cyp2C9) Inducers
Theoretically, drugs that are CYP2C9 inducers might decrease the effects of cannabis.
Delta-9-tetrahydrocannabinol (THC), an active constituent of cannabis, is a substrate of CYP2C9 enzymes.
Cytochrome P450 2C9 (Cyp2C9) Inhibitors
Theoretically, drugs that are CYP2C9 inhibitors might increase the adverse effects of cannabis.
Delta-9-tetrahydrocannabinol (THC), an active constituent of cannabis, is a substrate of CYP2C9 enzymes.
Cytochrome P450 2C9 (Cyp2C9) Substrates
Theoretically, cannabis might increase the levels and adverse effects of CYP2C9 substrates.
In vitro research shows that the cannabis constituents delta-9-tetrahydrocannabinol (THC), cannabidiol (CBD), and cannabinol moderately inhibit the CYP2C9-mediated 7-hydroxylation of S-warfarin in a concentration-dependent manner. In vitro research also shows that cannabis extracts modestly inhibit the CYP2C9 metabolism of tolbutamide; extracts providing the specific cannabinoids CBD and cannabigerol (CBG) had stronger inhibitory effects than extracts containing THC and CBD.
Cytochrome P450 2E1 (Cyp2E1) Substrates
Theoretically, cannabis might decrease the levels and clinical effects of CYP2E1 substrates.
In vitro research shows that cannabis can induce the activity of CYP2E1, which might increase the metabolism of CYP2E1 substrates.
Cytochrome P450 3A4 (Cyp3A4) Inducers
Theoretically, CYP3A4 inducers might reduce the levels and clinical effects of cannabis.
Delta-9-tetrahydrocannabinol (THC), an active constituent of cannabis, is a substrate of CYP3A4 enzymes.
Cytochrome P450 3A4 (Cyp3A4) Inhibitors
Theoretically, CYP3A4 inhibitors might increase the levels and adverse effects of cannabis.
Delta-9-tetrahydrocannabinol (THC), an active constituent of cannabis, is a substrate of CYP3A4 enzymes.
Cytochrome P450 3A4 (Cyp3A4) Substrates
Theoretically, cannabis may increase the levels and adverse effects of CYP3A4 substrates.
In vitro research shows that cannabis can inhibit the activity of CYP3A4 enzymes, which might decrease the metabolism of CYP3A4 substrates. In vitro research also shows that cannabis extracts modestly inhibit the CYP3A4 metabolism of testosterone; extracts providing the specific cannabinoids CBD and cannabigerol (CBG) had stronger inhibitory effects than extracts containing THC and CBD.
P-Glycoprotein Substrates
Theoretically, cannabis might alter levels of drugs that are substrates of P-glycoprotein (P-gp).
Most in vitro research suggests that constituents of cannabis, including cannabidiol (CBD) and delta-9-tetrahydrocannabinol (THC), can inhibit P-gp and increase the accumulation of probe compounds by reducing P-gp mediated drug efflux. In vitro studies in kidney cell lines show that a 1-hour exposure to CBD and THC inhibits P-gp. Cannabis may also alter the expression of P-gp, although this effect appears to vary based on duration of exposure. Some in vitro research in lymphoblastoid leukemia cell lines indicates that a 1-hour exposure to cannabinoids does not affect P-gp expression, while a prolonged 72-hour exposure decreases P-gp expression. Other in vitro research in these cell lines shows that a 4-hour exposure to THC and CBD induces P-gp gene expression, while exposure for longer than 4 hours and up to 48 hours does not induce P-gp gene expression.
Theophylline
Smoking cannabis while taking theophylline might reduce the levels and clinical effects of theophylline.
Similar to smoking tobacco, smoking cannabis seems to increase the metabolism of theophylline.
Thrombolytic Drugs
Cannabis might augment the effects of thrombolytic drugs and increase the risk of severe bleeding.
A case of cerebral hemorrhage has been reported for a 51-year-old female and chronic cannabis user who had consumed a large amount of cannabis prior to receiving recombinant tissue plasminogen activator (rtPA) for ischemic stroke. Hemorrhage had been ruled out prior to providing the rtPA. The exact mechanism of this interaction is unclear.
Antipsychotic Drugs
Cannabis does not seem to affect blood levels or effects of some antipsychotic drugs.
Human research shows that cannabis use does not affect blood levels or clinical effects of amisulpride, aripiprazole, or olanzapine in patients with schizophrenia and related disorders.
Cannabis: Uses, Safety & Side Effects
Cannabis contains many active compounds, mainly THC (which causes a 'high') and CBD (which does not). Some uses, such as chemotherapy-related nausea, certain seizure disorders, and muscle spasticity, have meaningful evidence, while many other popular uses are not well proven. It can cause real side effects and impairment, so talk to your doctor or pharmacist and follow your local laws before using it.
- Scientific name
- Cannabis sativa
- Family
- Cannabaceae
- Part used
- Dried flowers (buds), leaves, and extracted resins/oils
- Common forms
- Dried flower for smoking or vaporizing, edibles, oils and tinctures, capsules, topical creams, prescription products (e.g., dronabinol, nabilone, cannabidiol)
- Chronic pain
- Nausea and vomiting from chemotherapy
- Muscle spasticity (e.g., multiple sclerosis)
- Anxiety and stress
- Sleep problems
- Appetite stimulation
Popular and traditional uses — not proof it works. See “Uses & effectiveness” below for the evidence.
Can cause impairment, dependence, and mental health effects; use carefully and under medical guidance where legal.
When used orally or inhaled. Constituents in cannabis pass through the placenta and can reduce fetal growth and increase the risk for preterm birth. C...
Read the full pregnancy detailWhen used orally or inhaled. Delta-9-tetrahydrocannabinol (THC) is concentrated and excreted in breast milk for longer than 6 weeks after cessation of...
Read the full breastfeeding detailPregnancy & breastfeeding ratings are from Natural Medicines (Therapeutic Research Center). Safety guidance is general; always confirm with your pharmacist or doctor for your situation.
Overview
Cannabis, often called marijuana, is a plant that has been used for thousands of years for both medicine and recreation. It contains more than 100 natural compounds called cannabinoids. The two most studied are THC (tetrahydrocannabinol), which causes the 'high' people feel, and CBD (cannabidiol), which does not cause a high.
The plant grows in many parts of the world and is cultivated in many forms. People take it in different ways, including smoking or vaping dried flower, eating edibles, using oils and tinctures, or applying topical products to the skin. Some cannabis-based medicines are also available by prescription.
Laws about cannabis vary widely from place to place. In some areas it is legal for medical or recreational use, while in others it remains illegal. Always check the laws where you live.
How it works
Cannabinoids act on the body's endocannabinoid system, a network of receptors (mainly called CB1 and CB2) found in the brain, nerves, and immune system. This system helps regulate things like pain, mood, appetite, and memory.
THC mainly attaches to CB1 receptors in the brain, which is why it can affect mood, perception, and cause a high. CBD works differently and does not strongly activate these receptors; it is thought to influence the system in more indirect ways and may affect inflammation and nerve signaling.
Much of what we know about how these compounds work comes from laboratory and animal research, and scientists are still learning how the many compounds in cannabis interact in people.
Does Cannabis work?
How to read these evidence grades
Natural Medicines’ 7-point scale. We show each rating’s label word-for-word.
Possibly Effective Multiple sclerosis (MS)
A non-US prescription drug spray (Sativex) and oral cannabis extract seem to modestly reduce spasticity in patients with MS.
Possibly Effective Neuropathic pain
Inhaled cannabis seems to temporarily reduce neuropathic pain in some patients, although the optimal dose remains unclear.
Also studied for 28 conditions — evidence insufficient to rate
Insufficient Reliable Evidence To Rate Alcohol use disorder
It is unclear if smoked cannabis with a high concentration of cannabidiol is beneficial for reducing alcohol use in patients with alcohol use disorder.
Insufficient Reliable Evidence To Rate Alzheimer disease
It is unclear if cannabis is beneficial for Alzheimer disease.
Insufficient Reliable Evidence To Rate Amyotrophic lateral sclerosis (ALS, Lou Gehrig's disease)
It is unclear if smoking cannabis improves symptoms of ALS.
Insufficient Reliable Evidence To Rate Back pain
It is unclear if oral cannabis extract is beneficial for chronic low back pain.
Insufficient Reliable Evidence To Rate Blepharospasm
It is unclear if oral cannabis extract is beneficial for blepharospasm previously unresponsive to botulism toxin injections.
Insufficient Reliable Evidence To Rate Cachexia
It is unclear if oral cannabis extract improves appetite in patients with cancer-related anorexia-cachexia syndrome.
Insufficient Reliable Evidence To Rate Cancer-related anorexia
It is unclear if non-inhaled cannabis is beneficial for cancer-related anorexia.
Insufficient Reliable Evidence To Rate Cancer-related pain
It is unclear if oral or inhaled cannabis products are beneficial for patients with cancer-related pain. The evidence is mixed.
Insufficient Reliable Evidence To Rate Chemotherapy-induced nausea and vomiting (CINV)
It is unclear if oral cannabis or an oromucosal cannabis extract spray are beneficial for the prevention of CINV.
Insufficient Reliable Evidence To Rate Cognitive function
It is unclear if medical cannabis is beneficial for cognitive function.
Insufficient Reliable Evidence To Rate Coronavirus disease 2019 (COVID-19)
Oral cannabis has only been evaluated in combination with other ingredients for management of long COVID-19 symptoms, its effect when used alone is unclear.
Insufficient Reliable Evidence To Rate Crohn disease
It is unclear if oral cannabis oil or smoked cigarettes containing cannabis flowers can improve Crohn disease symptoms.
Insufficient Reliable Evidence To Rate Depression
It is unclear if non-inhaled cannabis is beneficial for depression.
Insufficient Reliable Evidence To Rate Fibromyalgia
It is unclear if inhaled cannabis vapor might reduce fibromyalgia pain.
Insufficient Reliable Evidence To Rate Glaucoma
It is unclear if smoking cannabis affects glaucoma risk or severity.
Insufficient Reliable Evidence To Rate HIV/AIDS-related wasting
It is unclear if oral or smoked cannabis might attenuate wasting in patients with HIV.
Insufficient Reliable Evidence To Rate Hypertension
It is unclear if oral cannabis oil lowers blood pressure.
Insufficient Reliable Evidence To Rate Migraine headache
It is unclear if inhaled cannabis reduces migraine severity.
Insufficient Reliable Evidence To Rate Obsessive-compulsive disorder (OCD)
Although there is interest in using cannabis for OCD, there is insufficient reliable information about the clinical effects of cannabis for this condition.
Insufficient Reliable Evidence To Rate Parkinson disease
It is unclear if smoking cannabis or taking oral cannabis extract is beneficial for improving Parkinson disease symptoms.
Insufficient Reliable Evidence To Rate Post-traumatic stress disorder (PTSD)
It is unclear if smoking cannabis is beneficial for PTSD.
Insufficient Reliable Evidence To Rate Postoperative pain
It is unclear if oral cannabis extract is beneficial for improving pain following endodontic treatment.
Insufficient Reliable Evidence To Rate Pre-procedural anxiety
It is unclear if oral cannabis extract is beneficial for improving anxiety prior to endodontic treatment.
Insufficient Reliable Evidence To Rate Rheumatoid arthritis (RA)
It is unclear whether an oromucosal cannabis spray (Sativex) improves RA symptoms.
Insufficient Reliable Evidence To Rate Sickle cell disease
It is unclear if vaporized cannabis is beneficial for reducing chronic pain associated with sickle cell disease.
Insufficient Reliable Evidence To Rate Stress
It is unclear if cannabis is beneficial for reducing cancer-related stress.
Insufficient Reliable Evidence To Rate Tourette syndrome
Although there is interest in using cannabis for Tourette syndrome, there is insufficient reliable information about the clinical effects of cannabis for this condition.
Insufficient Reliable Evidence To Rate Ulcerative colitis
Small studies suggest that smoking cannabis flower may improve symptoms of ulcerative colitis; however, it is unclear if cannabis improves clinical response.
Source & disclaimer. Effectiveness ratings and evidence summaries are provided by Natural Medicines (Therapeutic Research Center) and shown as licensed. Where Natural Medicines hasn’t rated a use, HelloPharmacist’s pharmacists may add their own reviewed rating and evidence (each such entry is labeled). This is educational information, not medical advice — talk with your pharmacist or doctor before starting, stopping, or changing a supplement.
Safety & precautions
Cannabis can cause real side effects and impairment. It can slow reaction time and judgment, so you should not drive or operate machinery while using it.
People with a history of mental health conditions such as psychosis, schizophrenia, or bipolar disorder should be especially cautious, as cannabis may trigger or worsen these conditions. Those with heart disease should also be careful because cannabis can raise heart rate. Regular use can lead to dependence, and some people develop a problem called cannabis use disorder.
Pregnancy: Cannabis is not considered safe during pregnancy. THC crosses the placenta and may affect a baby's brain development and birth outcomes. Avoid it.
Breastfeeding: THC passes into breast milk and can reach the baby. Cannabis should be avoided while breastfeeding.
Children, teens, and older adults are more sensitive to the effects of cannabis. Always talk to a doctor or pharmacist before use, and keep all products safely away from children and pets.
Side effects
Common side effects include dizziness, drowsiness, dry mouth, red eyes, increased appetite, changes in mood, anxiety, and trouble with memory or concentration. Higher doses can cause confusion, paranoia, or a faster heartbeat.
Smoking cannabis can irritate the lungs and airways. Eating edibles can be tricky because effects take longer to appear, which sometimes leads people to take too much.
Rare but more serious effects can include severe anxiety or panic, hallucinations or psychosis, fainting, and a condition involving repeated vomiting in long-term heavy users (called cannabinoid hyperemesis syndrome). Seek medical help if you have severe or frightening symptoms.
Cannabis: Reported Adverse Effects
Documented safety reports on Cannabis from the evidence-graded Natural Medicines (TRC Healthcare) database, shown word-for-word from the licensed record.
When inhaled or used orally, cannabis can cause various adverse effects. A specific oromucosal spray containing cannabis extract (Sativex) seems to be well tolerated when used appropriately.
Most Common Adverse Effects:
All ROAs: Dizziness, dry mouth, fatigue, headache, increased appetite, nausea, paranoid and dissociative thinking, and sedation. Intoxicating doses can impair declarative memory, motor coordination, reaction time, and visual perceptions for up to 8 hours.
Inhaled: Upper respiratory tract symptoms, such as cough and wheeze.
Serious Adverse Effects (Rare):
All ROAs: Higher doses of cannabis might cause acute coronary syndrome, arrhythmias, myocarditis, blood pressure changes, cannabinoid hyperemesis syndrome (CHS), hallucinations, pancreatitis, panic, psychosis, and seizures.
Inhaled: Upper respiratory tract symptoms, such as acute eosinophilic pneumonia and drug-induced lung injury. Smoking cannabis daily is associated with increased risk of myocardial infarction and stroke.
Acute bronchitis Pulmonary/Respiratory
Smoking or vaping cannabis can cause cough and bronchodilation. At least 5 cases of pneumomediastinum have been reported. These cases occurred in patients aged 19 to 27 years. In one case, cannabis was smoked the evening before symptoms occurred and in the others, cannabis was smoked daily or chronically; all cases made significant recoveries. There are also cases of hypersensitivity pneumonitis related to the use of cannabis; corticosteroid treatment resulted in resolution.
When smoked long-term, cannabis can cause laryngitis, bronchitis, phlegm, wheezing, and coughing. Using oromucosal spray containing cannabis extract may cause pharyngitis, hoarseness, and throat irritation.
Acute eosinophilic pneumonia has been reported in at least four cases. A 21-year-old male reported using 20 homemade cannabis joints the evening before symptom onset which included respiratory distress and abdominal pain. An 88-year-old male developed cough and dyspnea after using 3 cannabis joints daily for 2 months to control pain. Acute respiratory distress syndrome was reported in a 25-year-old male with a history of smoking both cannabis and methamphetamine. Chronic use of cannabis has also been associated with several cases of an unusual pattern of bullous emphysema. A healthy 17-year-old male with a history of illicit substance use was diagnosed with cannabis-induced thermal epiglottitis after presenting with acute airway obstruction. In one case report, a 51-year-old male presented with drug-induced lung injury following daily cannabis smoking for over 20 years. Heavy, chronic cannabis smoking has also been associated with a case of isolated pulmonary Langerhans cell histiocytosis in a 16-year-old male presenting with recurrent, spontaneous bilateral pneumothoraxes and cystic lesions on pulmonary imaging. In another case, a small apical pneumothorax occurred in a 20-year-old male with a history of disordered cannabis use. Similarly, spontaneous right-sided pneumothorax with bilateral apical blebs was reported in a 23-year-old male with a 5-year history of daily cannabis smoking. Additionally, recurrent spontaneous pneumothorax, tension pneumothorax, and multiple apical blebs were reported in a 26-year-old male with a 10-12-year history of smoking cannabis 7 grams daily.
Meta-analyses of 2 observational studies in adults with recent total hip or knee arthroplasty suggests that a history of cannabis use is associated with a greater risk of postoperative pneumonia and respiratory failure when compared with no history of cannabis use.
Regular smoking of 3-4 cannabis cigarettes per day is reported to produce symptoms and airway histological effects similar to those seen with an average tobacco cigarette use of 20-22 per day. A small clinical trial shows that inhaling a high-grade cannabis (Bedrocan International B.V., Veendam, The Netherlands) 100 mg, containing THC 21.8% and cannabinol 0.1%, does not produce respiratory depression.
Any correlation between cannabis use and lung cancer risk is unclear. Evidence from a case-control study suggests that smoking cannabis increases the risk of lung cancer by 8% for each joint-year of smoking. However, other observational research did not find an association between duration, intensity, or cumulative smoking of cannabis and lung cancer. A meta-analysis of case-control studies could not clarify this association due to the poor methodological quality and reporting of the available research. More data is needed to determine if there is a link between specific types of lung cancer and smoking cannabis.
Orally, in children ages 12 years and younger, accidental ingestion of cannabis-containing edibles has been associated with respiratory depression. In one case, a 5-week-old infant exposed to cannabis in utero and via breastmilk experienced recurrent apneic episodes. After switching to infant formula, the apnea improved.
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- Kaplan EF, Link CN, Schmalzried S, Rosenblatt A, Kellams A, Holland E. Association of Cannabis with Apneic Episodes in a Breastfed Infant: A Case Study. Breastfeed Med 2024;19(6):490-493.
Allergic rhinitis (hay fever) Dermatologic
Rarely, topical exposure to cannabis has resulted rarely in a rash and red, itchy skin. In addition, there are at least 4 reported cases of contact dermatitis and 6 cases of contact urticaria due to cannabis. One of these cases involved airborne allergic contact dermatitis confirmed with patch testing in a 25-year-old male within 30-60 minutes of smoking medical cannabis. Type IV sensitization to cannabis during occupational exposure was also confirmed via patch testing in a 24-year-old female with previously confirmed allergies to rye, grasses, mugwort, and nickel.
There is at least one case of Stevens-Johnson syndrome thought to be associated with use of cannabis in a 32-year-old female. A case of erythema multiforme-like recurrent drug eruption, characterized by the presence of erythematous, scaly, vesiculobullous, and targetoid rash, has been reported in a 19-year-old male who smoked cannabis for about a year prior to developing the condition. Discontinuation of cannabis improved the condition, but symptoms recurred once cannabis use was re-initiated.
- Ocampo TL, Rans TS. Cannabis sativa: the unconventional "weed" allergen. Ann Allergy Asthma Immunol. 2015;114(3):187-92.
- Heyne S, Steininger J, Bauer A. Occupational allergic contact dermatitis to marijuana. Contact Dermatitis 2024.
- Fontane Hoyos CN, Boos J, Goldminz AM. Airborne allergic contact dermatitis to medical marijuana. Contact Dermatitis. 2024;90(1):89-91.
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Antidepressant-induced sexual dysfunction Psychiatric
When used short-term, smoking cannabis or using oromucosal spray containing cannabis extract (Sativex, GW Pharmaceuticals) can cause anxiety or paranoid thinking or dissociation. One small clinical trial shows that inhaling vaporized cannabis containing delta-9- tetrahydrocannabinol (THC) 10 mg, alone or with cannabidiol (CBD) 10-30 mg, modestly induces psychotic symptoms. However, a single dose of inhaled cannabis containing an increased ratio of CBD to THC seems to result in reduced feelings of anxiety when compared to a higher ratio of THC to cannabidiol.
Vaporized cannabis also seems to reduce motivation. In a clinical study in healthy adults, inhaling vaporized cannabis containing 8 mg THC with or without CBD 10 mg and repeating half the dose 1.5 hours later, reduces motivation when compared to placebo.
The chronic use of cannabis can cause apathy, psychic decline, psychosis, and sexual dysfunction. Cannabinoids can increase anxiety, confusion, and hallucinations.
Cannabis use can be habit-forming. Meta-analyses of the available research suggest that as many as 47% of regular cannabis users develop some form of dependence, and up to 9% of all users develop cannabis use disorder. Another meta-analysis of clinical and observational studies suggests that the prevalence of cannabis use disorder is 25% among individuals who use medicinal cannabis. An additional meta-analysis of observational research suggests that the risk of cannabis use disorder is positively associated with frequency of use. In patients with cannabis dependence, cessation of use can precipitate cannabis withdrawal within 1-2 days. The risk for cannabis withdrawal syndrome seems to be greater in males, those with higher cannabis use, and those with concomitant drug or tobacco use. Symptoms of cannabis use withdrawal typically last for 7-14 days and include irritability, nervousness, difficulty sleeping, decreased appetite, and depressed mood. Physical symptoms such as stomach pain, tremors, sweating, fever, or headache might also occur. In one case report, abrupt withdrawal from chronic cannabis use precipitated cannabinoid hyperemesis syndrome. Severity of withdrawal varies, and largely depends on the cumulative amount of cannabis used prior to cessation. Withdrawal symptoms may be particularly problematic in individuals with pre-existing depression or anxiety, resulting in failed cessation attempts. Additionally, psychosis has been reported as a withdrawal symptom. In these cases, psychosis was reported within a few days of abrupt cannabis withdrawal, following a history of daily use over a period of years. In one case series, major symptoms resolved within 2 weeks although some minor symptoms remained in most patients.
Observational and population research suggests that using cannabis is associated with increased risk of developing psychotic symptoms or a psychotic condition, particularly in males and/or patients with preexisting psychosis propensity. One case report also suggested a potential relationship between cannabis use and antepartum psychosis in a patient with pre-eclampsia. This increased risk for psychosis might be attributed to the THC content in cannabis. Observational research suggests that cannabis use is associated with about a 2-fold increased risk of psychosis when compared to never using cannabis. Case-control observational research suggests that cannabis use is associated with a 3-fold increased risk for a first-episode psychosis; daily use of high-potency cannabis was associated with a nearly five-fold increased risk for first-episode psychosis when compared with never using cannabis. Similarly, a meta-analysis of observational research in adolescents suggests that cannabis use is associated with an increased risk of psychosis, with an even greater risk observed in adolescents with a history of childhood trauma, heavier and more frequent use, and those who began using at an earlier age.
Cannabis may also increase the risk of relapse in patients with psychotic disorders, with longer hospital admissions and more severe symptoms compared with nonusers and discontinued users. Furthermore, using cannabis appears to be associated with a 3-fold increased risk of new onset mania. Cannabis use, usually heavy, has also been associated with cases of catatonia in children and adults with or without a previous history of psychiatric illness. In two of these cases, management with electroconvulsive therapy and lorazepam was successful.
Use of cannabis is associated with depression, panic attacks, anxiety, obsessive-compulsive disorder (OCD), and suicide ideation/attempt. In one case, a 32-year-old male chronic cannabis user of about 10 years developed panic attacks. His symptoms had started about 2 years previously. He had recently abstained from cannabis use and had no past history of mental illness. In one case, a 22-year-old male with no previous psychiatric history developed symptoms of OCD after 2-3 months of consistent cannabis use, with worsening of symptoms when cannabis use increased. Symptoms disappeared when the patient abstained from use and recurred when use resumed. Use of cannabis, at least once weekly, has been associated with an increased risk of developing depression. In patients with depression, cannabis use is associated with worsened symptoms and increased suicidal ideation. However, due to the retrospective nature of these studies it is not clear whether depression resulted in increased cannabis use or if the cannabis use worsened or triggered depression. Having depression is associated with an increased odds of cannabis use, especially more frequent daily use, when compared with people without depression. Population research also suggests that using cannabis is associated with 24% increased odds of anxiety when compared to never using cannabis. A meta-analysis of 6 prospective observational studies in adolescents with no pre-existing physical or mental health disorders suggests that cannabis use is associated with 2-fold greater odds of developing an anxiety disorder when compared with adolescents without cannabis exposure. Additionally, clinical research in adults with cancer shows that higher doses of synthetic THC increase the likelihood of anxiety events by about 2-fold when compared with lower doses.
Observational research in young adult chronic cannabis users suggests that smoking high potency cannabis, containing 10% or more of THC, is associated with greater risk of anxiety when compared with smoking lower potency cannabis. The increased anxiety might also contribute to the 2-fold higher odds of youth violence seen with cannabis use when compared with non-use. A meta-analysis of observational research in individuals aged 11-21 years suggests that cannabis smoking is associated with an approximate 2-fold increased risk of both suicidal ideation and attempt when compared with non-cannabis smoking. Similarly, a meta-analysis of 15 observational studies in individuals aged 10-24 years suggests that recurrent cannabis use is associated with a 1.6 greater odds of suicidal ideation when compared with non-use. Similarly, a large observational study of hospitalized adolescents suggests that cannabis use disorder is associated with a 40% increased odds of suicide attempt or self-harm. Between 2009 and 2021, over 18,000 intentional, suspected suicidal cannabis exposures were reported to the National Poison Data System (NPDS) in children and adults aged 5 years and up. Death or another major outcome occurred in approximately 10% of all cases and in 19% of adults aged 65 years and up. Almost all cases occurred in individuals using at least one additional substance; therefore, a direct link cannot be made between cannabis use and attempted suicide.
When consumed in large amounts, edible cannabis products containing at least 50 mg of THC have been associated with anxiety, abnormal behavior, psychosis, and suicidal tendencies. A case of erratic speech and hostile behaviors, followed by suicidal actions resulting in death, has been reported in a 19-year-old male who consumed an edible cannabis cookie. According to the product's label, the serving size should have been one-sixth of the cookie. This serving size would have contained 10 mg of THC. However, the decedent ate the entire cookie after not experiencing effects within 30-60 minutes of the initial dose. Due to this case and other cases of overconsumption of edible cannabis products, in February 2015 the state of Colorado began requiring that edible cannabis products contain no more than 10 mg of THC per serving or that the products have clear demarcation of each 10-mg serving if they contain more than 10 mg of THC. Additionally, a small study in healthy adults shows that oral consumption of brownies containing THC 20 mg plus cannabidiol (CBD) 640 mg increases feelings of anxiety, paranoia, and irritability, when compared to consuming brownies containing only THC 20 mg.
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Arrhythmia Cardiovascular
Orally, edible cannabis products reported to contain 50 mg or more of delta-9-tetrahydrocannabinol (THC) have been associated with myocardial infarction (MI) and ventricular arrhythmia. An epidemiological study in adults 18-74 years old suggests daily cannabis use is associated with a 25% increased odds of MI when compared with non-use, with lower odds for less than daily use, regardless of prior history of cigarette or e-cigarette use. However, cannabis was smoked by 74% of respondents; it is unclear if this association applies to other routes of administration. A case-control study suggests that there is a 4.8-fold increased risk of MI within the first hour after smoking cannabis. Also, there are cases of MI that have occurred soon after smoking cannabis, although this was reported to be triggered by physical activity in some regular cannabis users. In many of these reports, it is unclear if the events were associated with cannabis use or other cardiovascular risk factors such as tobacco use and/or overweight. However, there is at least one case following cannabis use that did not have any other notable cardiovascular risk factors. This 16-year-old healthy male presented with chest pain and an acute MI after smoking cannabis and drinking alcohol. In another case, a 31-year-old male, who was a regular user of cannabis and had a previously undiagnosed myocardial bridge, presented with an MI. In another case, a previously healthy 36-year-old male with a long-term history of cannabis use presented with a suspected spontaneous coronary artery dissection that resulted in cardiac arrest and cardiac catheterization.
Cannabis has also been associated with acute coronary syndrome (ACS). A meta-analysis of epidemiological research suggests that cannabis use is associated with a 29% higher odds of ACS. In some cases, the causality is unclear because patients had other risk factors such as overweight, obesity, and/or tobacco use. In other cases, acute coronary events occurred in young males with no other risk factors for cardiovascular disease besides smoking. In one case report, ACS was linked to severe complications resulting in sudden cardiac death in a younger adult male with no past medical history. Furthermore, in adults with existing coronary artery disease, the regular use of cannabis has been associated with ACS after physical activity.
Over 30 case reports suggest a causal relationship between cannabis use and ischemic stroke occurrence and/or recurrence. A meta-analysis of epidemiological research suggests that cannabis use is associated with a 20% higher odds of stroke. However, despite this association, evidence from prospective studies is needed to support the link. In many of the reported cases, the patients also regularly consumed alcohol and tobacco, which could have been additional contributing factors. Other drugs of abuse may have also contributed. One epidemiological study in adults 18-44 years of age who were abusing multiple substances, mainly amphetamines and cocaine, suggests that the addition of cannabis use is associated with 76% higher odds of ischemic stroke. Some studies also suggest that cannabis independently increases stroke risk. An epidemiologic study in young adults suggests that cannabis use within the last 30 days is associated with an 82% increased odds of stroke. The odds were increased further with frequent cannabis use, or with concomitant tobacco smoking or e-cigarette use. Similarly, a larger epidemiological study in adults 18-74 years of age suggests daily cannabis use is associated with a 42% increased odds of stroke when compared with non-use, with lower odds for less than daily use, regardless of prior history of cigarette or e-cigarette use. However, cannabis was smoked by 74% of respondents; it is unclear if this association applies to other routes of administration. Population research has also found that hospitalization related to ischemic stroke is increased by 17% in recreational users of cannabis; this increase is independent of other potential causes. However, not all research has found a link between cannabis use and stroke. A case-control study in stroke patients suggests that cannabis use is not associated with an increased risk of ischemic stroke or transient ischemic attack when adjusted for tobacco use. Another retrospective study in adults undergoing urine toxicology screening did not find an association between cannabis use and incidence of acute ischemic stroke over a 2-year period.
Meta-analyses of up to 3 observational studies in adults with recent total hip or knee arthroplasty suggest that a history of cannabis use is associated with a greater risk of postoperative cardiovascular complications, including thromboembolic events and cerebrovascular accidents, when compared with no history of cannabis use.
Smoking cannabis can cause a dose-dependent 20% to 100% increase in heart rate that begins within 10 minutes of smoking and lasts for 2-3 hours. A retrospective study suggests that cannabis use, abuse, and dependence in teenagers is associated with cases of palpitations and arrhythmias such as ventricular fibrillation, atrial flutter, and atrial fibrillation. Smoking cannabis might cause tachycardia by inhibiting vagal tone or by stimulating beta-adrenergic receptors. Also, smoking cannabis appears to cause orthostatic hypotension or, conversely, modestly increase blood pressure in patients who are supine. Smoking cannabis has also been associated with 1 case of recurrent vasovagal syncope that required a dual chamber pacemaker implant and 6 cases of atrial fibrillation. Many of these acute effects of smoking cannabis decrease after continued use for several days to a few weeks. However, abrupt cessation of cannabis might also increase blood pressure.
Cannabis use has also been associated with bradycardia. In one case, an elderly male accidentally ate 3 cannabis cookies with a recommended serving of one eighth of a cookie. The bradycardia resulted in dizziness and faintness and was nearly fatal. Cannabis use has also been associated with sinus arrest and heart block. In a review highlighting 11 case reports of severe bradyarrhythmia associated with cannabis consumption, 3 were due to third-degree heart block, 2 were due to second-degree heart block, and 6 were due to sinus arrest. In an additional case report, a 2-year-old boy developed bradycardia with first-degree atrioventricular (AV) block which lasted 12 hours after accidentally consuming an unknown number of cannabis gummies containing THC.
Regular use of cannabis has also been associated with cases of cannabis arteritis, a type of peripheral vascular disease, with some cases requiring amputation. There is some disagreement over whether cannabis use contributes to the development of arteritis. A review of over 50 cases of arteritis associated with cannabis use suggests that tobacco use was prevalent in most cases. Since the clinical and pathological features of arteritis are the same as those of thromboangiitis obliterans, which is associated with tobacco use, there is limited evidence from these cases to suggest that cannabis is a causative factor for arteritis. Still, symptoms worsened with use of cannabis in many cases, and disease progression was halted when cannabis was discontinued. Additionally, there are reported cases of cannabis arteritis without concurrent tobacco use. In one case, cannabis arteritis was reported in a 31-year-old male with a 12-year history of cannabis use, in the absence of concurrent tobacco use. The patient reported a 3-year history of claudication symptoms, which coincided with a transition from smoking cannabis to vaping high-potency cannabis oil several times a day. Symptoms improved 4 weeks after cannabis cessation. There is another case of cannabis arteritis in a middle-aged male who was not currently using tobacco; however, he smoked cannabis in blunt wraps, which contained nicotine. Symptoms resolved and did not recur following treatment with aspirin and nifedipine and avoidance of cannabis. Cannabis discontinuation is recommended to prevent disease progression and avoid amputation.
Cannabis use may be associated with myocarditis and myopericarditis. There have been at least 12 probable cases of myocarditis reported in the literature, usually based on temporal association and exclusion of other potential causes. In case reports, cannabis was used twice weekly for 3 months in one case and almost daily in others. Most individuals were males under 30 and recovered with treatment. There is at least one case of acute myocarditis with pericarditis in a 26-year-old male who smoked cigarettes and vaped cannabis daily.
A case of ventricular bigeminy and a case of circulatory collapse have been considered to be related to treatment with a specific oromucosal spray containing THC and cannabidiol (CBD) (Sativex, GW Pharmaceuticals).
There have also been several cases of rarer cardiovascular complications. A case of renal and spleen infarction following use of large amounts of cannabis and cocaine has been reported in a 24-year-old male with healthy arteries. The event may have been due to cannabis and cocaine-induced thrombosis. A case of renal artery spontaneous dissection has also been reported. Additionally, a case of spontaneous coronary artery dissection has been reported in a 61-year-old male with recent cannabis use and a history of hypertension. There are at least 2 cases of diffuse alveolar hemorrhage associated with cannabis use, although, in both cases, contaminants and/or other drugs may have contributed. Anecdotal reports of central retinal vein occlusion, limb ischemia, and acute thrombosis of aorta have also been associated with cannabis use. The development of stress cardiomyopathy has been temporally related to the consumption of cannabis. In one patient, there was evidence of recurrence. The development of non-ischemic dilated cardiomyopathy and cardioembolism has also been temporally related to the consumption of cannabis, as seen in a single case report describing a young male with no previous medical history. There is also a single case report of pericardial effusion suspected to be related to vaping cannabis 1.5 mg daily, providing 95% THC, for 2 months. However, the presence of contaminants in the product could not be ruled out.
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- Arshad H, Mousa A, Oudah B, Kakhktsyan T, Abu-Abaa M, Kass R. Cannabis-Induced ST-Segment Elevation Myocardial Infarction With Possible Coronary Artery Dissection: A Case Report. Cureus. 2023;15(5):e39594.
- Jouanjus E, Lapeyre-Mestre M, Micallef J; French Association of the Regional Abuse and Dependence Monitoring Centres (CEIP-A) Working Group on Cannabis Complications. Cannabis use: signal of increasing risk of serious cardiovascular disorders. J Am Heart
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- Storck W, Elbaz M, Vindis C, et al. Cardiovascular risk associated with the use of cannabis and cannabinoids: a systematic review and meta-analysis. Heart. 2025:heartjnl-2024-325429.
- Hackam DG. Cannabis and stroke: systematic appraisal of case reports. Stroke. 2015;46(3):852-6.
- Ince B, Benbir G, Yuksel O, et al. Both hemorrhagic and ischemic stroke following high doses of cannabis consumption. Presse Med. 2015;44(1):106-7.
- Farouji I, Chan KH, Battah A, et al. A rare case of marijuana associated with ascending aorta thrombosis complicated with stroke and bilateral renal infarcts. Radiol Case Rep 2021;17(1):119-123.
- Westover AN, McBride S, Haley RW. Stroke in young adults who abuse amphetamines or cocaine: a population-based study of hospitalized patients. Arch Gen Psychiatry. 2007 Apr;64(4):495-502.
- Parekh T, Pemmasani S, Desai R. Marijuana Use Among Young Adults (18-44 Years of Age) and Risk of Stroke: A Behavioral Risk Factor Surveillance System Survey Analysis. Stroke. 2020;51(1):308-310.
- Barber PA, Pridmore HM, Krishnamurthy V, et al. Cannabis, ischemic stroke, and transient ischemic attack: a case-control study. Stroke. 2013 Aug;44(8):2327-9.
- San Luis CV, Nobleza COS, Shekhar S, et al. Association between recent cannabinoid use and acute ischemic stroke. Neurol Clin Pract. 2020;10(4):333-339.
- Yang G, Li F, Wang Q, Liu Y, Guo J, Yue C. Association between history of cannabis use and outcomes after total hip or knee arthroplasty: a systematic review and meta-analysis. Front Public Health 2024;12:1377688.
- Beaconsfield P, Ginsburg J, Rainsbury R. Marihuana smoking. Cardiovascular effects in man and possible mechanisms. N Engl J Med. 1972 Aug 3;287(5):209-12.
- Wilsey B, Marcotte TD, Deutsch R, Zhao H, Prasad H, Phan A. An exploratory human laboratory experiment evaluating vaporized cannabis in the treatment of neuropathic pain from spinal cord injury and disease. J Pain. 2016;17(9):982-1000.
- Ramphul K, Joynauth J. Cardiac Arrhythmias Among Teenagers Using Cannabis in the United States. Am J Cardiol. 2019;124(12):1966.
- Clark SC, Greene C, Karr GW, MacCannell KL, Milstein SL. Cardiovascular effects of marihuana in man. Can J Physiol Pharmacol. 1974 Jun;52(3):706-19.
- Clark SC. Marihuana and the cardiovascular system. Pharmacol Biochem Behavior. 1975;3(2):299-306.
- Licciardi M, Utzeri E, Marchetti MF, Nissardi V, Cecchetto G, Montisci M, Montisci R. Syncope and Cannabis: hypervagotonia from chronic abuse? A case report and literature review. BMC Cardiovasc Disord. 2023;23(1):518.
- Sidney S. Cardiovascular Consequences of Marijuana Use. J Clin Pharmacol. 2002;42(11 Suppl):64S-70S.
- Ploucher S, Koilpillai S, Iyyani M, Carlan S. A case of near-fatal bradycardia caused by accidental cannabis intoxication. Cureus 2023;15(4):e37430.
- Malviya A, Khan SA, Gupta A, Mishra A. Chronic Marijuana Consumption Leading to High-Grade Atrioventricular Block in a Young Male. Cureus 2021;13(7):e16202.
- Idris I, Diez JR, Assoku BA, Beker S. Accidental ingestion of tetrahydrocannabinol-laced gummies causing bradycardia and first-degree atrioventricular block in a pediatric patient: A case report. Cureus 2022;14(7):e26826.
- Noel, B., Ruf, I., and Panizzon, R. G. Cannabis arteritis. J Am.Acad.Dermatol. 2008;58(5 Suppl 1):S65-S67.
- Combemale P, Consort T, Denis-Thelis L, et al. Cannabis arteritis. Br J Dermatol. 2005;152(1):166-9.
- Banana Y, Bashir H, Boukabous S, Rezziki A, Benzirar A, El Mahi O. Cannabis arteritis: A case report and brief review of the literature. Ann Med Surg (Lond) 2022;76:103523.
- Pilitsi E, Kennamer B, Trepanowski N, et al. Cannabis arteritis presenting with Raynaud's and digital ulcerations: a case-based review of a controversial thromboangiitis obliterans-like condition. Clin Rheumatol 2023;42(7):1981-1985.
- Colling M, Souri Y, Reifsnyder T. Tetrahydrocannabinol vape-associated cannabis arteritis in a patient with minimal tobacco exposure. J Vasc Surg Cases Innov Tech 2024;11(1):101673.
- Grotenhermen, F. Cannabis-associated arteritis. Vasa 2010;39(1):43-53.
- Alirezaei T, Mohammadi MKA, Irilouzadian R, Zarinparsa H. Marijuana-induced myocarditis in a 24-year-old man. Arch Clin Cases 2022;9(2):69-74.
- Prota C, Ravera A, Caleo O, Campanile A. Marijuana-induced toxic myocarditis: a case report and a review of the literature. J Cardiovasc Med (Hagerstown) 2022;23(12):814-818.
- Rahman A, Alqaisi S. Myopericarditis associated with marijuana intake: A case report and literature review. Cureus 2023;15(5):e39413.
- Oudah B, Al-Ameri N, Mousa A, Arshad H, Abu-Abaa M, Park S. Variant Angina and Cannabis-Induced Myocarditis: A Rare Presentation of Myocardial Inflammation. Cureus. 2023;15(6):e41196.
- Rog, D. J., Nurmikko, T. J., Friede, T., and Young, C. A. Randomized, controlled trial of cannabis-based medicine in central pain in multiple sclerosis. Neurology 9-27-2005;65(6):812-819.
- Rog, D. J., Nurmikko, T. J., and Young, C. A. Oromucosal delta9-tetrahydrocannabinol/cannabidiol for neuropathic pain associated with multiple sclerosis: an uncontrolled, open-label, 2-year extension trial. Clin Ther. 2007;29(9):2068-2079.
- Le Guen, P. Y., Gestin, S., Plat, E., Quehe, P., and Bressollette, L. [Renal and spleen infarction after massive consumption of cannabis and cocaine in a young man]. J.Mal Vasc. 2011;36(1):41-44.
- Zafrullah F, Raheela F, Ali F, et al. Spontaneous Coronary Artery Dissection in the Setting of Marijuana: A Case Report. Cureus 2024;16(4):e59284.
- Bucchino L, Monzani A, Fracon S, Genoni G, Cena T, Bellone S. Cannabis-Related Diffuse Alveolar Hemorrhage in a 16-Year-Old Patient: A Case Report. Front Pediatr. 2019;7:468.
- Le Q, Dangol G, Bhandari A. A rare case of diffuse alveolar hemorrhage caused by fentanyl-laced marijuana. Cureus 2023;15(5):e38523.
- Singh BO, Panda PK, Walia R. Recreational cannabis use causing non-ischaemic cardiomyopathy and cardioembolism in a young adult. BMJ Case Rep 2021;14(6):e243193.
- Maharaj N, Swarath S, Seecheran R, Seecheran V, Seecheran NA. Suspected cannabis vaping-induced pericardial effusion. J Investig Med High Impact Case Rep 2022;10:23247096221140251.
Asthma Immunologic
Oral, topical, and occupational exposure to cannabis has been associated with reports of sensitization and allergic reactions. More than one allergen in cannabis may be responsible. Exposure to cannabis smoke can also cause nasal congestion, runny nose, sneezing, coughing, and wheezing, possibly related to an allergic response in some individuals.
Cases of topical and airborne contact dermatitis have been reported after cannabis exposure. There has also been at least one case of Stevens-Johnson syndrome and a case of erythema multiforme-like eruption thought to be associated with cannabis use. Additionally, an asthma attack has been reported in a 51-year-old male who inhaled cannabis seeds.
- Ocampo TL, Rans TS. Cannabis sativa: the unconventional "weed" allergen. Ann Allergy Asthma Immunol. 2015;114(3):187-92.
- Wasik J, Likonska A, Kurowski M. IgE-Mediated Allergy and Asymptomatic Sensitization to Cannabis Allergens-Review of Current Knowledge and Presentation of Six Cases. Medicina (Kaunas) 2024;60(6):954.
- Fontane Hoyos CN, Boos J, Goldminz AM. Airborne allergic contact dermatitis to medical marijuana. Contact Dermatitis. 2024;90(1):89-91.
- Heyne S, Steininger J, Bauer A. Occupational allergic contact dermatitis to marijuana. Contact Dermatitis 2024.
- Li J, Miller M, Abu Khalaf S, Nelson TB. Weeding out the culprit: Cannabinoid-associated Stevens-Johnson Syndrome. Cureus 2023;15(5):e39454.
- Ozyurt S, Muderrisoglu F, Ermete M, Afsar F. Cannabis-induced erythema multiforme-like recurrent drug eruption. Int J Dermatol. 2014;53(1):e22-3.
- Vidal, C., Fuente, R., Iglesias, A., and Saez, A. Bronchial asthma due to Cannabis sativa seed. Allergy 1991;46(8):647-649.
Bone loss Musculoskeletal
Meta-analyses of up to 3 observational studies in adults with recent total hip or knee arthroplasty suggests that a history of cannabis use is associated with a greater risk of postoperative surgical revision, dislocation, mechanical loosening of prosthesis, periprosthetic fracture, and infection when compared with no history of cannabis use.
Chronic use of large amounts of cannabis has been associated with alterations in bone metabolism. In one case report, a 56-year-old male patient who had smoked up to 7 grams of cannabis daily for 25 years presented with osteoporosis and multiple vertebral crush fractures.
A 26-year-old male developed hypokalemia-induced progressing paralysis, followed by rhabdomyolysis, thought to be related to recreational cannabis use.
Orally, in children ages 12 years and younger, accidental ingestion of cannabis-containing edibles has been associated with ataxia, tremors, hypotonia, hypothermia, nystagmus, respiratory depression, and seizures. Legalization of recreational cannabis has been associated with an increased rate of poisoning from cannabis edibles.
- Yang G, Li F, Wang Q, Liu Y, Guo J, Yue C. Association between history of cannabis use and outcomes after total hip or knee arthroplasty: a systematic review and meta-analysis. Front Public Health 2024;12:1377688.
- Reece AS. Severe multisystem dysfunction in a case of high level exposure to smoked cannabis. BMJ Case Rep. 2009;2009. pii: bcr08.2008.0798.
- Simonsen SK, Rittig NF, Poulsen PL, Svart MV. Hypokalemic paresis in a 26-year-old man after recreational cannabis use. Am J Case Rep 2022;23:e936008.
- Ammerman SD, Ryan SA, Adelman WP, et al. The impact of marijuana policies on youth: clinical, research, and legal update. Pediatrics. 2015;135(3):584-7.
- Lewis B, Fleeger T, Judge B, Riley B, Jones JS. Acute toxicity associated with cannabis edibles following decriminalization of marijuana in Michigan. Am J Emerg Med. 2020:S0735-6757(20)30872-X.
Burns Gastrointestinal
Smoking and ingesting cannabis can cause xerostomia, nausea, and vomiting. Vaping cannabis has been reported to cause sore throat and bad taste in up to 35% of patients. Cannabis has also been reported to cause oral candidiasis. There have been 2 case reports of tongue candidiasis attributed to dry mouth after heavy cannabis use. A specific cannabis oromucosal spray (Sativex, GW Pharmaceuticals) can cause dry mouth, nausea, and bad taste. Less commonly, this cannabis product may cause red and white buccal mucosal patches to develop inside the mouth. Clinical research in patients with chronic, cancer-related pain receiving prescription opioids has found that using this product for 2-5 weeks increases nausea by 43% and vomiting by 50% when compared with opioid treatment alone.
Excessive and prolonged cannabis use (2-3 times daily over 2 years) can lead to cannabinoid hyperemesis syndrome (CHS). This condition is characterized by cyclic attacks of nausea and vomiting, often accompanied by abdominal pain. CHS does not seem to be alleviated by conventional antiemetic medicine. Some patients experiencing CHS report using extremely hot baths to temporarily reduce symptoms. In one case, the extreme water temperature caused repeated burns, resulting in sepsis and hospitalization. Symptoms of CHS resolve only after a sustained period of abstaining from cannabis use. CHS can also sometimes precipitate hypophosphatemia, which has been attributed to hyperventilation during CHS. CHS has been linked to severe complications such as electrolyte imbalances. There is at least one case of nephrolithiasis in a young adult with a history of daily cannabis use and nephrolithiasis. The nephrolithiasis was thought to be related to CHS-associated dehydration and electrolyte imbalance. CHS was also reported to precipitate diabetic ketoacidosis (DKA) in a 21-year-old female with type 1 diabetes who regularly used cannabis. Additionally, CHS was reported to cause thiamine deficiency resulting in Wernicke encephalopathy in a 16-year-old male with chronic cannabis use. Symptoms improved following thiamine supplementation. There is also a case report of superior mesenteric artery syndrome in an adolescent female thought to be precipitated by rapid weight loss due to recurrent CHS. There are 3 case reports of young adults chronically using cannabis that died from complications of cannabis use and CHS.
Chronic cannabis use has also been associated with several cases of intussusception; however a causal mechanism and link has not been determined. There are at least 22 reported cases of adult intussusception, with associated abdominal pain, vomiting, and diarrhea, possibly associated with the chronic use of cannabis. Most cases resolved spontaneously; however, some required laparoscopic/manual reductions. Intussusception has been also reported in an infant with chronic passive exposure to cannabis via breastfeeding.
Although laboratory research has suggested that cannabis use can decrease gastrointestinal motility, observational research suggests that cannabis use is associated with 30% reduced odds of constipation and no change in the likelihood for diarrhea.
In one case report, a 26-year-old male with a 6-month history of daily cannabis use required cholecystectomy for gangrenous acalculous cholecystitis, presenting as persistent abdominal pain and intractable vomiting.
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- Lotan I, Treves TA, Roditi Y, Djaldetti R. Cannabis (medical marijuana) treatment for motor and non-motor symptoms of Parkinson disease: an open-label observational study. Clin Neuropharmacol. 2014;37(2):41-4.
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Cancer Neurologic/CNS
Smoking, vaping, or ingesting cannabis can cause headache, dizziness, numbness, disorientation, somnolence, and fatigue. Recurrent, strong headaches associated with cannabis use might be related to reversible cerebral vasoconstriction syndrome (RCVS). In one cohort, 32% of individuals with RCVS were cannabis users. Meta-analyses of 2 observational studies in adults with recent total hip or knee arthroplasty suggests that a history of cannabis use is associated with a greater risk of postoperative cerebrovascular accidents when compared with no history of cannabis use.
Intoxicating doses of cannabis impair reaction time, motor coordination, declarative memory, and visual perceptions, and can also produce panic reactions and other emotional disturbances. An individual's driving ability can be impaired for up to 8 hours. One small clinical trial shows that inhaling vaporized cannabis containing delta-9- tetrahydrocannabinol (THC) 10 mg, alone or with cannabidiol (CBD) 10-30 mg, modestly impairs verbal recall. A small prospective study has found that inhaling vaporized cannabis containing THC 13.75 mg or THC/cannabidiol 13.75 mg increases lane weaving for the first 100 minutes when compared with placebo. This impairment was comparable to that of a blood alcohol concentration of 0.05%, which is considered to indicate clinically relevant impairment. The validity of this finding is limited because the study only tested a single dose of cannabis, which does not mimic typical real-world use. Acute use of cannabis has also been associated with increased motor collision risk, especially if the driver is using alcohol or other drugs concomitantly. Two retrospective studies suggest that state-based legalization and commercialization of cannabis is associated with increased traffic fatalities. Based on this data, experts predict that nationwide cannabis legalization could result in 6,800 more traffic fatalities per year. The increase in traffic fatalities may vary state to state. For example, one study found an increase in fatalities in Colorado but not in Washington state. These studies are limited due to their retrospective nature and a lack of control over other confounding factors such as out-of-state cannabis tourism that could have affected driving fatalities.
Inhalation of highly potent cannabis might sometimes cause intoxication similar to serotonin syndrome. In 2 case reports, patients presented to the emergency room with dilated pupils, lower extremity rigidity, and clonus after smoking a highly potent form of cannabis. Another case reports a 20-year-old male taking cannabis and fluoxetine who presented with 2 episodes of serotonin syndrome that were not correlated to changes in fluoxetine administration.
Two cases of paralysis secondary to hypokalemia are reported, likely due to coupling of cannabinoid receptors to potassium channels; both patients had complete resolution of symptoms after potassium replacement.
When smoked chronically and in large amounts, cannabis might cause seizures. Two cases report adult males smoking cannabis, one in the form of "moon rock," who presented with secondary generalized tonic-clonic seizures that were managed with medications. Additionally, there have been 2 cases of new-onset seizures in pediatric patients reported after accidental ingestion of cannabis-containing edibles.
Cannabis-induced acute encephalopathy has been found in a 94-year-old female given cannabis by a family member. The cannabis had been marketed as being pure cannabidiol (CBD); however, a urinary analysis tested positive for delta-9-tetrahydrocannabinol (THC). Symptoms included confusion and disorientation, hallucinations, and diarrhea. A case of acute hippocampal encephalopathy has been reported in a 24-year-old male with a history of heavy cannabis use (8 to 10 joints daily for 6 years) who presented to the emergency department with a nonfebrile status epilepticus and diminished consciousness, requiring intubation and admission to the intensive care unit. Cases of posterior reversible encephalopathy syndrome (PRES) have also been reported. Additionally, Wernicke encephalopathy has been reported in a 16-year-old male, with cannabis hyperemesis syndrome identified as the underlying cause of his thiamine deficiency. Symptoms improved following thiamine supplementation.
In one case report, early-onset frontotemporal dementia resulting in extreme behaviors (e.g., eating inedible objects, incontinence, mutism) was visualized with magnetic resonance imaging (MRI) in a 34-year-old male after 2 years of cannabis use; psychiatric and other neurodegenerative diagnoses were ruled out.
Long-term use of cannabis can cause cognitive impairment, affecting executive function, learning and memory, and global cognition, that lasts longer than the period of acute intoxication. These cognitive impairments develop slowly and worsen as the years of cannabis use increase, with some research suggesting they become clinically significant after about 2 decades of use.
Using oromucosal spray containing cannabis extract (Sativex, GW Pharmaceuticals) can cause dizziness, lightheadedness, sleepiness, and fatigue. Two clinical studies in adults with cancer show that non-inhaled medical cannabis has a negative effect on mental concentration when compared with control.
Limited research shows that consuming large amounts of CBD might increase the adverse effects of THC. A small study in healthy adults shows that consumption of brownies containing THC 20 mg plus cannabidiol (CBD) 640 mg increases feelings of sedation and memory impairment when compared to consuming brownies containing only THC 20 mg.
Prospective, observational research in children who were 12 years old at the time of enrollment suggests that cannabis use is associated with poorer sleep quality at 18 years of age. Additionally, more recent use at age 18 years was associated with a greater reduction in sleep quality. In children ages 12 years and younger, accidental ingestion of cannabis-containing edibles has been associated with lethargy, seizures, and coma. Legalization of recreational cannabis has been associated with an increased rate of poisoning from cannabis edibles.
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- Nadeem Z, Wu C, Burke S, Parker S. Serotonin syndrome and cannabis: A case report. Australas Psychiatry. 2024;32(1):100-101.
- Simonsen SK, Rittig NF, Poulsen PL, Svart MV. Hypokalemic paresis in a 26-year-old man after recreational cannabis use. Am J Case Rep 2022;23:e936008.
- Singh A, Apostolatos A, Iyer A, Bescobedo B, Middlemas M. Cannabis Use: An Uncommon Cause of Hypokalemia-Induced Acute Paralysis. Cureus. 2023;15(8):e44393.
- Fogang YF, Camara M, Mbonda PC, Toffa D, Touré K. Late onset epilepsy associated with marijuana abuse: a case report with MRI findings. Pan Afr Med J. 2014;17:158.
- Leczycki M, Zaki P, Espiridion ED. Moon Rock Cannabis-Induced Psychosis and New-Onset Seizures in a 20-Year-Old Male. Cureus. 2023;15(7):e42752.
- Emoto J, Weeks K, Kallail KJ. Accidental Acute Cannabis Intoxication Presenting as Seizure in Pediatrics Patients. Kans J Med. 2020;13: 129-130.
- Moussa MK, Hall MAK, Akwe J. Cannabis-induced acute encephalopathy in a 94-year-old woman due to family administration of cannabidiol (CBD) products: A case report. Cureus 2023;15(4):e37927.
- Zebbakh H, Imrani K, Benbrahim F, Moatassim Billah N, Nassar I. Acute toxic hippocampal encephalopathy in heavy cannabis users: A case report. Radiol Case Rep 2024;19(5):1913-1916.
- Bennasser A, Oudrhiri Safiani M, El Mostarchid A, Zhim M, Jiddane M, Touarsa F. Posterior reversible encephalopathy syndrome (PRES) following cannabis consumption: A rare association. Radiol Case Rep 2024;20(1):59-63.
- Munroe M, Shah Z, Setya A. Wernicke encephalopathy in a pediatric patient with cannabinoid hyperemesis: A novel case report. JPGN Rep 2024;5(3):411-413.
- Moshfeghinia R, Oji B, Hosseinzadeh M, Pourfridoni M, Ahmadi J. Early onset frontotemporal dementia following cannabis abuse: a case report. BMC Psychiatry. 2023;23(1):484.
- Solowij N, Stephens RS, Roffman RA, et al. Cognitive functioning of long-term heavy cannabis users seeking treatment. JAMA 2002;287:1123-31..
- Indlekofer, F., Piechatzek, M., Daamen, M., Glasmacher, C., Lieb, R., Pfister, H., Tucha, O., Lange, K. W., Wittchen, H. U., and Schutz, C. G. Reduced memory and attention performance in a population-based sample of young adults with a moderate lifetime
- Lovell ME, Akhurst J, Padgett C, Garry MI, Matthews A. Cognitive outcomes associated with long-term, regular, recreational cannabis use in adults: A meta-analysis. Exp Clin Psychopharmacol. 2019 Oct 31.
- Rog, D. J., Nurmikko, T. J., Friede, T., and Young, C. A. Randomized, controlled trial of cannabis-based medicine in central pain in multiple sclerosis. Neurology 9-27-2005;65(6):812-819.
- Perras, C. Sativex for the management of multiple sclerosis symptoms. Issues Emerg.Health Technol. 2005;(72):1-4.
- Rog, D. J., Nurmikko, T. J., and Young, C. A. Oromucosal delta9-tetrahydrocannabinol/cannabidiol for neuropathic pain associated with multiple sclerosis: an uncontrolled, open-label, 2-year extension trial. Clin Ther. 2007;29(9):2068-2079.
- Richards, B. L., Whittle, S. L., and Buchbinder, R. Neuromodulators for pain management in rheumatoid arthritis. Cochrane.Database.Syst.Rev. 2012;1:CD008921.
- Duran M, Pérez E, Abanades S, et al. Preliminary efficacy and safety of an oromucosal standardized cannabis extract in chemotherapy-induced nausea and vomiting. Br J Clin Pharmacol. 2010;70(5):656-63.
- Crichton M, Dissanayaka T, Marx W, et al. Does medicinal cannabis affect depression, anxiety, and stress in people with cancer? A systematic review and meta-analysis of intervention studies. Maturitas 2024;184:107941.
- Zamarripa CA, Spindle TR, Surujunarain R, et al. Assessment of orally administered ?9-tetrahydrocannabinol when coadministered with cannabidiol on ?9-tetrahydrocannabinol pharmacokinetics and pharmacodynamics in healthy adults: A randomized clinical trial
- Ogeil RP, Cheetham A, Mooney A, et al. Early adolescent drinking and cannabis use predicts later sleep-quality problems. Psychol Addict Behav. 2019 May;33(3):266-273.
- Ammerman SD, Ryan SA, Adelman WP, et al. The impact of marijuana policies on youth: clinical, research, and legal update. Pediatrics. 2015;135(3):584-7.
- Lewis B, Fleeger T, Judge B, Riley B, Jones JS. Acute toxicity associated with cannabis edibles following decriminalization of marijuana in Michigan. Am J Emerg Med. 2020:S0735-6757(20)30872-X.
Cancer Oncologic
There is some concern that cannabis use increases the risk for cancer. A meta-analysis of observational case-control studies suggests that cannabis is not associated with an increased risk for head and neck squamous cell carcinoma or oral cancer. However, more than 10 years of cannabis use is associated with an increased risk for testicular germ cell tumor.
Any correlation between cannabis use and lung cancer risk is unclear. Evidence from a case-control study suggests that smoking cannabis increases the risk of lung cancer by 8% for each joint-year of smoking. However, other observational research did not find an association between duration, intensity, or cumulative smoking of cannabis and lung cancer. A meta-analysis of case-control studies could not clarify this association due to the poor methodological quality and reporting of the available research. More data is needed to determine if there is a link between specific types of lung cancer and smoking cannabis.
Two observational studies in adults with cancer who were receiving immunotherapy suggest that using cannabis and/or cannabinoids may worsen outcomes. In one observational study, adults with advanced cancer who used cannabis had a shorter time to cancer progression and shorter average overall survival. In a retrospective review, adults with advanced cancer who used cannabis had similar progression and survival rates, but a reduced response to immunotherapy treatment.
- Ghasemiesfe M, Barrow B, Leonard S, Keyhani S, Korenstein D. Association between marijuana use and risk of cancer: a systematic review and meta-analysis. JAMA Netw Open. 2019 Nov 1;2(11):e1916318.
- Aldington, S., Harwood, M., Cox, B., Weatherall, M., Beckert, L., Hansell, A., Pritchard, A., Robinson, G., and Beasley, R. Cannabis use and risk of lung cancer: a case-control study. Eur.Respir.J 2008;31(2):280-286.
- Zhang LR, Morgenstern H, Greenland S, et al. Cannabis smoking and lung cancer risk: Pooled analysis in the International Lung Cancer Consortium. Int J Cancer. 2015;136(4):894-903.
- Braun IM, Bohlke K, Abrams DI, et al. Cannabis and Cannabinoids in Adults With Cancer: ASCO Guideline. J Clin Oncol 2024;42(13):1575-1593.
Diabetes Endocrine
Small clinical studies suggest that smoking cannabis daily for 21 days increases caloric intake and causes weight gain in otherwise healthy adults who are heavy or casual cannabis smokers. It is thought that cannabinoids in cannabis increase appetite by influencing the endogenous endocannabinoid system. However, there is conflicting evidence regarding the effects of chronic cannabis smoking on caloric intake and body weight. Also, epidemiological research in the US has found that people with a history of cannabis use tend to have a lower body mass index when compared with never users.
Other epidemiological research suggests that cannabis use is associated with worsened glycemic control and an increased risk for serious complications in patients with diabetes. Observational research has found that people with type 1 diabetes that report recreational cannabis use have worsened glycemic control and a 2-fold increased risk for diabetic ketoacidosis (DKA) than those who do not report recreational cannabis use. A case of recurrent DKA precipitated by cannabinoid hyperemesis syndrome has also been reported in a 21-year-old female with type 1 diabetes who used cannabis regularly. A cohort study in adults with type 2 diabetes suggests that cannabis use is associated with a higher risk for diabetic nephropathy, myocardial infarction, and peripheral arterial occlusion when compared with no cannabis use. It is not clear if these associations are due to cannabis use or to a difference in lifestyle and self-care behaviors. Risk-taking behaviors in general have been associated with worsened glycemic control and increased HbA1c. More research is needed to clarify if a causal relationship exists between cannabis use and glycemic control.
Cannabis use has also been associated with at least 27 cases of acute pancreatitis. In one case report, a 30-year-old female developed acute pancreatitis at two different time periods after increasing the frequency of smoking cannabis.
- Greenberg I, Kuehnle J, Mendelson JH, Bernstein JG. Effects of Marihuana use on body weight and caloric intake in humans. Psychopharmacol. 1976;49:79-84.
- Mushtaq, F., Mondelli, V., and Pariante, C. M. The metabolic implications of long term cannabis use in patients with psychosis. Epidemiol.Psichiatr.Soc. 2008;17(3):221-226.
- Reis MG, Ferreira AJF, Sohouli MH, Taimeirão DR, Vieira RAL, Guimarães NS. Effect of cannabis and subproducts on anthropometric measures: a systematic review and meta-analysis. Int J Obes (Lond). 2024;48(1):44-54.
- Sansone RA, Sansone LA. Marijuana and body weight. Innov Clin Neurosci. 2014;11(7-8):50-4.
- Alshaarawy O, Anthony JC. Are cannabis users less likely to gain weight? Results from a national 3-year prospective study. Int J Epidemiol. 2019 Oct 1;48(5):1695-1700.
- Akturk HK, Taylor DD, Camsari UM, Rewers A, Kinney GL, Shah VN. Association Between Cannabis Use and Risk for Diabetic Ketoacidosis in Adults With Type 1 Diabetes. JAMA Intern Med. 2018.
- Hogendorf AM, Fendler W, Sieroslawski J, et al. Breaking the Taboo: Illicit Drug Use among Adolescents with Type 1 Diabetes Mellitus. J Diabetes Res. 2016;2016:4153278. Epub 2015 Dec 29.
- Thurheimer-Cacciotti JL, Sereika SM, Schmitt P, et al. The effect of risk-taking behaviors on hemoglobin A1c in women with type 1 diabetes. Diabetes. 2017;66:A226. Abstract Only.
- Alduraibi RK, Altowayan YF, AlMharwal BT. Unexpected cause of recurrent diabetic ketoacidosis in type 1 diabetes: a case report. BMC Endocr Disord. 2023;23(1):137.
- Winhusen T, Theobald J, Kaelber D, Tlimat A, Lewis D. Using big data to evaluate the association between substance use disorders (SUDS) and T2DM-complications. Journal of General Internal Medicine. 2018;33(2):S382. Abstract Only.
- Lee P, Greenfield JR, Gilbert K, Campbell LV. Recreational drug use in type 1 diabetes: an invisible accomplice to poor glycaemic control? Intern Med J. 2012 Feb;42(2):198-202.
- Howaizi M, Chahine M, Haydar F, Jemaa Y, Lapoile E. Cannabis-induced recurrent acute pancreatitis. Acta Gastroenterol Belg. 2012;75(4):446-7.
- Sly M, Clark K, Karaghossian G, Narang VK, Gill M, Ragland AS. Cannabis-Induced Pancreatitis in a Young Adult Male. J Investig Med High Impact Case Rep 2021;9:23247096211035238.
Diarrhea Renal
Acute kidney injury has been reported after oral cannabis use. In one case, it was likely caused by pre-existing mild dehydration related to a lack of fluid intake, followed by cannabis-induced diarrhea. Meta-analyses of 2 observational studies in adults with recent total hip or knee arthroplasty suggests that a history of cannabis use is associated with a greater risk of postoperative acute kidney injury when compared with no cannabis use.
Acute eosinophilic pneumonia with acute renal failure has been reported in a 21-year-old male who reported using 20 homemade cannabis joints the evening before symptom onset.
Cannabinoid hyperemesis syndrome (CHS) is characterized by cyclic attacks of nausea and vomiting, often accompanied by abdominal pain. CHS has been linked to dehydration and electrolyte imbalances. There is at least one case of nephrolithiasis in a young adult with a history of daily cannabis use and nephrolithiasis. The nephrolithiasis was thought to be related to CHS-associated dehydration and electrolyte imbalance.
- Moussa MK, Hall MAK, Akwe J. Cannabis-induced acute encephalopathy in a 94-year-old woman due to family administration of cannabidiol (CBD) products: A case report. Cureus 2023;15(4):e37927.
- Yang G, Li F, Wang Q, Liu Y, Guo J, Yue C. Association between history of cannabis use and outcomes after total hip or knee arthroplasty: a systematic review and meta-analysis. Front Public Health 2024;12:1377688.
- Chabot C, Gouat F. Rare finding of acute eosinophilic pneumonia associated with heavy cannabis use: A case-report. Radiol Case Rep 2022;17(9):3040-3042.
- Nourbakhsh M, Miller A, Gofton J, Jones G, Adeagbo B. Cannabinoid Hyperemesis Syndrome: Reports of Fatal Cases. J Forensic Sci. 2019;64(1):270-274.
- Chocron Y, Zuber JP, Vaucher J. Cannabinoid hyperemesis syndrome. BMJ. 2019 Jul 19;366:l4336.
- Kheifets M, Karniel E, Landa D, Vons SA, Meridor K, Charach G. Resolution of Cannabinoid Hyperemesis Syndrome with Benzodiazepines: A Case Series. Isr Med Assoc J. 2019 Jun;21(6):404-407.
- Patel M, Sathiya Narayanan R, Peela AS. A case of a patient with cannabis hyperemesis syndrome along with recurrent nephrolithiasis. Cureus 2023;15(4):e37182.
Dry eye Ocular/Otic
The use of inhaled cannabis can cause a characteristic reddening of the eyes. Smoking cannabis can also cause dry eyes. Acute poisoning from cannabis can cause lacrimation. Orally, in children ages 12 years and younger, accidental ingestion of cannabis-containing edibles has been associated with nystagmus. A case of bilateral optic neuropathy was reported in a 28-year-old male, 8 hours after smoking cannabis and cigarettes. Treatment involved high-dose corticosteroids, aspirin, and complete abstinence from cannabis use. There is also a case of retinal arterial macroaneurysm rupture causing vision loss and requiring surgery in a 17-year-old male thought to be associated with cannabis consumption the previous day.
Observational research suggests that cannabis use at least once per month increases the risk for tinnitus. The severity of tinnitus does not appear to be correlated to the quantity or frequency of cannabis use.
- Hebel SK, ed. Drug Facts and Comparisons. 52nd ed. St. Louis: Facts and Comparisons, 1998.
- Ocampo TL, Rans TS. Cannabis sativa: the unconventional "weed" allergen. Ann Allergy Asthma Immunol. 2015;114(3):187-92.
- Ware MA, Wang T, Shapiro S, et al. Smoked cannabis for chronic neuropathic pain: a randomized controlled trial. CMAJ 2010;182:e694-e701.
- Gruenwald J, Brendler T, Jaenicke C. PDR for Herbal Medicines. 1st ed. Montvale, NJ: Medical Economics Company, Inc., 1998.
- Ammerman SD, Ryan SA, Adelman WP, et al. The impact of marijuana policies on youth: clinical, research, and legal update. Pediatrics. 2015;135(3):584-7.
- Emoto J, Weeks K, Kallail KJ. Accidental Acute Cannabis Intoxication Presenting as Seizure in Pediatrics Patients. Kans J Med. 2020;13: 129-130.
- Khalili MR, Hosseini S, Shirvani M. Bilateral Optic Neuropathy Associated with Acute Inhaled Marijuana Use: Case Report and Review of the Literature. Neuroophthalmology 2024;48(3):186-192.
- Daoudi I, Mabchour A, Rasquin F, Van Bol L, Demols P. Retinal arterial macroaneurysm rupture in a 17-year-old: Could cannabis consumption be a risk factor? J Fr Ophtalmol. 2025:S0181-5512(25)00141-X.
- Qian ZJ, Alyono JC. An association between marijuana use and tinnitus. Am J Otolaryngol. 2020 Jan - Feb;41(1):102314.
Hepatitis Hepatic
There is at least one case of acute hepatitis likely related to the chronic use of cannabis.
Intravenously, cannabis may cause toxic hepatitis.
Sickle cell disease Genitourinary
The chronic use of cannabis can cause abnormal menstruation. Cannabis use has been associated with priapism in a few case reports. There is also some speculation that cannabis use might precipitate a priapism attack in patients with sickle cell trait. However, it is too early to know if a causal relationship exists.
Meta-analyses of 3 observational studies in adults with recent total hip or knee arthroplasty suggests that a history of cannabis use is associated with a greater risk of postoperative urinary tract infections when compared with no history of cannabis use.
- Gruenwald J, Brendler T, Jaenicke C. PDR for Herbal Medicines. 1st ed. Montvale, NJ: Medical Economics Company, Inc., 1998.
- Matta A, Tandra PK, Berim L. Priapism in a patient with sickle cell trait using marijuana. BMJ Case Rep. 2014;2014.
- Yang G, Li F, Wang Q, Liu Y, Guo J, Yue C. Association between history of cannabis use and outcomes after total hip or knee arthroplasty: a systematic review and meta-analysis. Front Public Health 2024;12:1377688.
Subarachnoid hemorrhage Hematologic
A few cases of intracerebral hemorrhage have been associated with cannabis use. In some but not all cases, reversible vasoconstriction syndrome was associated with intracerebral hemorrhage. Some population research suggests that cannabis use is associated with an 18% increased risk of developing an aneurysmal subarachnoid hemorrhage, independent of other risk factors. However, other population research does not support these findings.
Meta-analyses of up to 4 observational studies in adults with recent total hip or knee arthroplasty suggests that a history of cannabis use is associated with a greater risk of postoperative thromboembolic events, as well as a greater need for postoperative transfusions, when compared with no history of cannabis use. Additionally, a retrospective chart review in adults undergoing chest masculinization surgery suggests that a history of cannabis use is associated with 3.5-fold greater odds of postoperative hematoma when compared with no cannabis use.
- Atchaneeyasakul K, Torres LF, Malik AM. Large amount of cannabis ingestion resulting in spontaneous intracerebral hemorrhage: A case report. J Stroke Cerebrovasc Dis. 2017;26(7):e138-e139.
- Goyal H, Awad HH, Ghali JK. Role of cannabis in cardiovascular disorders. J Thorac Dis. 2017;9(7):2079-2092.
- Yang G, Li F, Wang Q, Liu Y, Guo J, Yue C. Association between history of cannabis use and outcomes after total hip or knee arthroplasty: a systematic review and meta-analysis. Front Public Health 2024;12:1377688.
- Park JB, Lee D, Adebagbo OD, et al. Impact of marijuana on masculinization top surgery postoperative complications: Single-surgeon single-institutional experience. J Plast Reconstr Aesthet Surg 2024;93:302-304.
Adverse-effects data: Natural Medicines, Therapeutic Research Center
Dosing
There is no single standard dose for cannabis. The right amount depends on the product, its strength, the THC and CBD content, how it is taken, and the person using it. Products can vary a lot in potency, which makes consistent dosing difficult.
A common harm-reduction approach is to 'start low and go slow,' meaning begin with a small amount and wait to see how it affects you before taking more. This is especially important with edibles, which can take an hour or more to work.
For prescription cannabis-based medicines, follow your doctor's instructions exactly. For other products, follow the product label and check with a pharmacist or doctor before starting.
Cannabis & Pregnancy
Cannabis & Breastfeeding
© 2026 Therapeutic Research Center
Pregnancy & lactation ratings: Natural Medicines, Therapeutic Research Center
References & further reading
The 261 references that drive our Cannabis monograph and interaction data, from the evidence-graded Natural Medicines (TRC Healthcare) database. Citations with a link open the study on PubMed or the publisher’s site.
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- Hebel SK, ed. Drug Facts and Comparisons. 52nd ed. St. Louis: Facts and Comparisons, 1998.
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- Perras, C. Sativex for the management of multiple sclerosis symptoms. Issues Emerg.Health Technol. 2005;(72):1-4.
- Zhu, H. J., Wang, J. S., Markowitz, J. S., Donovan, J. L., Gibson, B. B., Gefroh, H. A., and Devane, C. L. Characterization of P-glycoprotein inhibition by major cannabinoids from marijuana. J Pharmacol Exp.Ther. 2006;317(2):850-857. PubMed
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- Vidal, C., Fuente, R., Iglesias, A., and Saez, A. Bronchial asthma due to Cannabis sativa seed. Allergy 1991;46(8):647-649.
- Beshay, M., Kaiser, H., Niedhart, D., Reymond, M. A., and Schmid, R. A. Emphysema and secondary pneumothorax in young adults smoking cannabis. Eur.J Cardiothorac.Surg. 2007;32(6):834-838. PubMed
- Rog, D. J., Nurmikko, T. J., and Young, C. A. Oromucosal delta9-tetrahydrocannabinol/cannabidiol for neuropathic pain associated with multiple sclerosis: an uncontrolled, open-label, 2-year extension trial. Clin Ther. 2007;29(9):2068-2079.
- Aldington, S., Harwood, M., Cox, B., Weatherall, M., Beckert, L., Hansell, A., Pritchard, A., Robinson, G., and Beasley, R. Cannabis use and risk of lung cancer: a case-control study. Eur.Respir.J 2008;31(2):280-286. PubMed
- Noel, B., Ruf, I., and Panizzon, R. G. Cannabis arteritis. J Am.Acad.Dermatol. 2008;58(5 Suppl 1):S65-S67.
- Cappelli, F., Lazzeri, C., Gensini, G. F., and Valente, S. Cannabis: a trigger for acute myocardial infarction? A case report. J Cardiovasc.Med.(Hagerstown.) 2008;9(7):725-728. PubMed
- Indlekofer, F., Piechatzek, M., Daamen, M., Glasmacher, C., Lieb, R., Pfister, H., Tucha, O., Lange, K. W., Wittchen, H. U., and Schutz, C. G. Reduced memory and attention performance in a population-based sample of young adults with a moderate lifetime
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- Zammit, S., Moore, T. H., Lingford-Hughes, A., Barnes, T. R., Jones, P. B., Burke, M., and Lewis, G. Effects of cannabis use on outcomes of psychotic disorders: systematic review. Br.J Psychiatry 2008;193(5):357-363. PubMed
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This information is for education only and is not a substitute for professional medical advice. Always check with your pharmacist or doctor before starting, stopping, or combining supplements and medications.
Parts of this content are provided by the Therapeutic Research Center, LLC.
DISCLAIMER: Currently this does not check for drug-drug interactions. This is not an all-inclusive comprehensive list of potential interactions and is for informational purposes only. Not all interactions are known or well-reported in the scientific literature, and new interactions are continually being reported. Input is needed from a qualified healthcare provider including a pharmacist before starting any therapy. Application of clinical judgment is necessary.
© 2021 Therapeutic Research Center, LLC
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Products that contain Cannabis
A rotating sample of real supplements in our database that list Cannabis — open any to see its full ingredients and every drug interaction we check.
- Gentle Pathway by Energetix
- Amla Plus by R-U-Ved
- Hemp Derived CBD Tincture Spray 1000 mg Creamsicle Flavor by OXZGEN
- Detox by Prince Of Peace
- Pure 1500 Mint by Natures Plus HempCeutix
- Pure 3000 by Natures Plus HempCeutix
- Pure 6000 by Natures Plus HempCeutix
- Relief by Natures Plus HempCeutix
- Pure 1500 by NaturesPlus HempCeutix
- Pure 750 by NaturesPlus HempCeutix
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