Genetic predisposition accounts for 40-60% of the vulnerability to addiction, highlighting its nature as a medical condition.
Factors like early exposure, trauma, and socioeconomic conditions play critical roles in the development of SUD.
Cannabis is the most widely used illicit drug globally, while hallucinogens are experiencing renewed scientific interest for therapeutic applications. This module explores the endocannabinoid system, the complex pharmacology of cannabis, and the emerging "psychedelic renaissance" in mental health treatment. Understanding these substances is increasingly important as policies evolve and therapeutic applications expand.
By the end of this module, you will be able to:
The endocannabinoid system was discovered in the 1990s while researchers studied how cannabis affects the brain. It is now recognized as a fundamental regulatory system.
Receptors: | Receptor | Location | Function | |----------|----------|----------| | CB1 | Brain, CNS | Psychoactive effects, memory, appetite, pain | | CB2 | Immune system, periphery | Inflammation, immune response |
Endogenous Cannabinoids (Endocannabinoids):
Enzymes:
The endocannabinoid system regulates:
Unlike most neurotransmitters, endocannabinoids work "backwards":
THC (Delta-9-Tetrahydrocannabinol):
CBD (Cannabidiol):
Other Cannabinoids:
| Property | THC | CBD | |----------|-----|-----| | Psychoactive | Yes | No | | CB1 binding | Direct agonist | Indirect/modulatory | | Euphoria | Yes | No | | Anxiety | Can increase | Generally decreases | | Legal status | Restricted | More widely legal | | Drug test | Detected | Not typically detected |
| Route | Onset | Duration | Bioavailability | |-------|-------|----------|-----------------| | Smoked | Seconds-minutes | 2-3 hours | 10-35% | | Vaporized | Seconds-minutes | 2-3 hours | Higher than smoking | | Edibles | 30-90 minutes | 4-8 hours | 4-12% | | Sublingual | 15-45 minutes | 2-4 hours | Variable | | Topical | Local effect | Variable | Minimal systemic |
Clinical Pearl: Edibles have delayed onset, leading users to consume more while waiting for effects. This is a common cause of cannabis-related ED visits.
Desired:
Adverse:
DSM-5 Criteria: Same 11 criteria as other SUDs
Prevalence: ~9% of users develop CUD; higher with early onset
Risk Factors:
Withdrawal Syndrome (onset 1-2 days, peak 2-6 days):
Cognitive:
Respiratory (smoked):
Psychiatric:
Cannabis Hyperemesis Syndrome:
Modern cannabis has dramatically higher THC concentrations:
Concerns:
Classic (Serotonergic) Hallucinogens:
Dissociatives:
Atypical:
Primary action: Agonism at 5-HT2A serotonin receptors
Effects:
Psilocybin (Magic Mushrooms):
LSD:
MDMA:
1950s-60s: Early research showed promise for:
1970s: Controlled Substances Act ended most research
2000s-Present: Renewed scientific interest with rigorous methodology
Psilocybin:
MDMA:
Ketamine:
Proposed Mechanisms:
Critical Elements:
Psychological:
Contraindications:
Safety Note: Therapeutic use involves careful screening, controlled settings, and professional support—not recreational use.
Dr. Sharma is asked by a patient with treatment-resistant depression about psilocybin therapy. The patient has tried multiple SSRIs and SNRIs without adequate response and read about clinical trials. She asks, "Should I try magic mushrooms?"
Discussion Questions:
Part 2 Complete! Next: Part 3: Behavioral Addictions, beginning with Module 11: Technology, Gambling & Gaming →
External links
Use one of the external tools below to explore "Cannabis & Hallucinogens: The Psychedelic Renaissance". Check clinical claims against approved sources.
External links
Use one of the external tools below to explore "Cannabis & Hallucinogens: The Psychedelic Renaissance". Check clinical claims against approved sources.