Dried leaves and flowers from the hemp plant Cannabis sativa are called marijuana, and dried resin from the flower tops of this plant is known as hashish. The psychoactive ingredient of marijuana is d9-tetrahydrocannabinol (d9-THC). d9-THC binds to a specific brain receptor for which an endogenous ligand has been discovered.20

Marijuana is usually smoked, but it can be ingested. Symptoms persist for 2 to 4 hours, or longer if ingested. Drowsiness, euphoria, heightened sensory awareness, paranoia, distortions of time and space, and feelings of unreality are described. Hallucinations do not normally occur at usual doses. Common physiological effects of marijuana are mild tachycardia, injected conjunctiva, bronchodilation, orthostatic hypotension, and impaired motor coordination. Although significant medical complications occur rarely, if at all, users may experience panic reactions, or even brief toxic psychoses due to d 9-THC.

Acute psychiatric symptoms due to marijuana use can usually be managed with reassurance alone, but benzodiazepines can be used if medication is warranted. Urine tests are unreliable indicators of acute marijuana intoxication because it is detectable for days after use in novice users, and for weeks after the last use in chronic users.21

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