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Pathophysiology · Chapter 18. Drug Addiction. Substance Abuse. Poisoning

Cannabism

*Cannabis sativa*

Cannabism is a pathological condition that develops as a result of using narcotic drugs derived from dried female flowers of Indian hemp. The main active substances of such agents are plant cannabinoids, which possess pronounced psychoactive effects.

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Main formsMarijuana, bhang, and concentrated resin — hashish.
Active substancesTHC, cannabidiol, cannabinol, and anandamide.
MetabolismIn the liver, THC is converted into 11-hydroxy-tetrahydrocannabinol.
Psychoactive effectsEuphoria, thought disorders, and impaired attention.
2 min readFor medical studentsUpdated 09/24/2026
Material prepared by WhiteCoat Pro editorial team based on platform study guidesReviewed by medical editor: Aulov A. A., general practitioner · 09/24/2026

Etiology and types of substances

The term originates from the Latin name for Indian hemp — Cannabis sativa. The pathogenesis is based on the use of various forms of plant material. These include:

  • Marijuana
  • Bhang
  • Hashish, which is a concentrated resin containing approximately 12% tetrahydrocannabinol.

The primary pharmacological activity is provided by cannabinoids. Among them, anandamide, tetrahydrocannabinol, cannabidiol, and cannabinol stand out. A special group consists of synthetic analogues (e.g., CP-55940 and WIN-55212-2). Unlike natural compounds, which are practically insoluble in water, synthetic cannabinoids have high solubility and induce a more potent psychoactive effect.

Pharmacokinetics and metabolic transformations

Upon entering the body, tetrahydrocannabinol exhibits a specific pathway of distribution and elimination:

  1. Absorption: THC rapidly penetrates the bloodstream, after which it is actively adsorbed by internal organs and tissues.
  2. Metabolism: The main transformations occur in hepatocytes. In the liver, the parent substance is transformed into 11-hydroxytetrahydrocannabinol, which also retains psychoactive properties. Additionally, over two dozen secondary metabolites with minimal psychoactive activity are formed.
  3. Elimination: The elimination of THC and its breakdown products from the body occurs slowly, primarily through the gastrointestinal tract with feces.
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Clinical manifestations of intoxication

The effect of tetrahydrocannabinol on the central nervous system is accompanied by a characteristic spectrum of symptoms. Pathophysiological effects include:

  • A sensation of general muscular and psychological relaxation.
  • A state of euphoria resembling the effects of consuming small doses of alcohol.
  • Pronounced thought disorders.
  • Difficulty concentrating.
  • Behavioral disturbances similar to signs of alcohol intoxication.

Briefly: answers to topical questions

What are the manifestations of withdrawal syndrome upon discontinuing cannabinoids?

The withdrawal syndrome upon discontinuing cannabinoids clinically resembles tobacco cessation. It manifests as sleep and appetite disorders, irritability, fatigue, chills, tremor, as well as somatic discomfort: chest tightness, shortness of breath, cardialgia, headache, and throbbing in the temples.

The duration of the withdrawal syndrome is described as about a week; another source indicates that it resolves without treatment in 4–6 days.

How to memorize

THC is converted in the liver to 11-hydroxy-THC and excreted in the feces, causing euphoria and relaxation.

Class and exam questions

Which compounds are included in the group of main active substances of cannabis?

The main cannabinoids include anandamide, tetrahydrocannabinol, cannabidiol, and cannabinol.

What is THC converted into during hepatic metabolism?

In the liver, THC is metabolized into 11-hydroxytetrahydrocannabinol, which also possesses psychoactive properties, as well as into more than 20 other metabolites.

How do synthetic cannabinoids differ from natural ones?

Synthetic compounds (e.g., CP-55940 and WIN-55212-2) have high water solubility—unlike natural ones, which are practically insoluble—and also induce a more potent psychoactive effect.

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What else to study on this topic

  • Comparison of pharmacokinetics of natural and synthetic cannabinoids
  • The role of 11-hydroxytetrahydrocannabinol in the development of psychoactive effects
  • Mechanisms of THC adsorption by tissues and organs
  • Features of the elimination of cannabis metabolites from the body
  • Pathophysiology of behavioral disorders during intoxication

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Other topics in «Chapter 18. Drug Addiction. Substance Abuse. Poisoning»

Psychotropic substancesTypes of drug addictionCocaine dependenceOpioid addictionHallucinogensChronic alcoholismPathogenesis of drug addiction and substance abuseInitial stage of drug addictionIntermediate stage of drug addictionFinal stage of drug addictionEtiology and classification of poisoningTypes of PoisonsPrinciples of poisoning treatment
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