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Cannabis-induced mania

Mohd Hussain H

JUMMEC, 1999;4:62-63.

Hypomanic episodes have been reported in two patients who were known to have abused cannabis. The nature of its presentation, possible association and treatment modalities are discussed herewith. A greater awareness of such a condition can put clinicians in a better position to give appropriate treatment imediately, and thus prevent any kind of re-occurrence of such a condition especially in vulnerable patients. KEYWORDS: Cannabis, hypomania.

Matched MeSH terms: Cannabis
Medical cannabis for chronic pain: can it make a difference in pain management?

Maharajan MK, Yong YJ, Yip HY, Woon SS, Yeap KM, Yap KY, et al.

J Anesth, 2020 02;34(1):95-103.
PMID: 31535218 DOI: 10.1007/s00540-019-02680-y

Globally, chronic pain is a major therapeutic challenge and affects more than 15% of the population. As patients with painful terminal diseases may face unbearable pain, there is a need for more potent analgesics. Although opioid-based therapeutic agents received attention to manage severe pain, their adverse drug effects and mortality rate associated with opioids overdose are the major concerns. Evidences from clinical trials showed therapeutic benefits of cannabis, especially delta-9-tetrahydrocannabinol and cannabinoids reduced neuropathic pain intensity in various conditions. Also, there are reports on using combination cannabinoid therapies for chronic pain management. The association of cannabis dependence and addiction has been discussed much and the reports mentioned that it can be comparatively lower than other substances such as nicotine and alcohol. More countries have decided to legalise the medicinal use of cannabis and marijuana. Healthcare professionals should keep themselves updated with the changing state of medical cannabis and its applications. The pharmacokinetics and safety of medical cannabis need to be studied by conducting clinical research. The complex and variable chemically active contents of herbal cannabis and methodological limitations in the administration of cannabis to study participants, make the clinical research difficult.

Matched MeSH terms: Cannabis*
The Neuroprotective Properties, Functions, and Roles of Cannabis sativa in Selected Diseases Related to the Nervous System

Mahdi O, Baharuldin MTH, Nor NHM, Chiroma SM, Jagadeesan S, Moklas MAM

Cent Nerv Syst Agents Med Chem, 2021;21(1):20-38.
PMID: 33504317 DOI: 10.2174/1871524921666210127110028

BACKGROUND: Cannabis and its extracts are now being explored due to their huge health benefits. Although, the effect they elicit, whether on humans or rodents, may vary based on the age of the animal/subject and or the time in which the extract is administered. However, several debates exist concerning the various medical applications of these compounds. Nonetheless, their applicability as therapeutics should not be clouded based on their perceived negative biological actions.
METHODS: Articles from reliable databases such as Science Direct, PubMed, Google Scholar, Scopus, and Ovid were searched. Specific search methods were employed using multiple keywords: ''Medicinal Cannabis; endocannabinoid system; cannabinoids receptors; cannabinoids and cognition; brain disorders; neurodegenerative diseases''. For the inclusion/exclusion criteria, only relevant articles related to medicinal Cannabis and its various compounds were considered.
RESULTS: The current review highlights the role, effects, and involvement of Cannabis, cannabinoids, and endocannabinoids in preventing selected neurodegenerative diseases and possible amelioration of cognitive impairments. Furthermore, it also focuses on Cannabis utilization in many disease conditions such as Alzheimer's and Parkinson's disease among others.
CONCLUSION: In conclusion, the usage of Cannabis should be further explored as accumulating evidence suggests that it could be effective and somewhat safe, especially when adhered to the recommended dosage. Furthermore, in-depth studies should be conducted in order to unravel the specific mechanism underpinning the involvement of cannabinoids at the cellular level and their therapeutic applications.

Matched MeSH terms: Cannabis*; Receptors, Cannabinoid; Endocannabinoids
Fulltext Efavirenz does not cause false-positive urine cannabis test in HIV-infected patients on Highly Active Anti-Retroviral Therapy

Koh KC, Lee WY, Eh ZW, Ismail NJ, Tee PS, Othman A, et al.

Med J Malaysia, 2013 Jun;68(3):249-52.
PMID: 23749016

Efavirenz is a non-nucleoside reverse transcriptase inhibitor used in combination with other drugs for the treatment of patients with HIV infection. Efavirenz has been reported to cause a positive urine cannabis test reaction which may create problems between HIV-infected patients on Efavirenz and law enforcement agencies. Doctors are at loss whether to issue documents certifying the potential false positive urine cannabis test with Efavirenz to patients. We investigated if the urine of HIV-infected patients on Efavirenz caused a positive urine cannabis test using the AxSYM Cannabinoids Assay®. Urine samples from 51 eligible patients on Efavirenz were tested for cannabis. All tested negative except for one who had used cannabis the day before. Efavirenz does not cause false positive urine cannabis test with the AxSYM Cannabinoids Assay®. Certification documents from doctors are therefore unnecessary.

Matched MeSH terms: Cannabis*
Decriminalization of drug use

Vicknasingam B, Narayanan S, Singh D, Chawarski M

Curr Opin Psychiatry, 2018 07;31(4):300-305.
PMID: 29746420 DOI: 10.1097/YCO.0000000000000429

PURPOSE OF REVIEW: To review the literature on decriminalization of drug use from 2016 to 2017 and suggest the way forward.
RECENT FINDINGS: The systematic review of the literature on decriminalization resulted in seven articles that discuss decriminalization as compared with 57 published articles on legalization. Decriminalization of drug use did not have an effect on the age of onset of drug use and the prices of drugs did not decrease after the implementation of drug decriminalization. Policy-based studies on decriminalization suggest shifting from criminal sanctions to a public health approach, which was endorsed by the United Nations (UN) that viewed drug addiction as a preventable and treatable health disorder. One study preferred decriminalization only for cannabis and cautioned against regulating cannabis like alcohol. Another study indicated that general medical practitioners in Ireland did not favour the decriminalization of cannabis.
SUMMARY: Scientific evidence supporting drug addiction as a health disorder and the endorsement by the UN strengthen the case for decriminalization. However, studies reporting on the positive outcomes of decriminalization remain scarce. The evidence needs to be more widespread in order to support the case for decriminalization. Furthermore, the endorsement by the UN needs to be acted upon by individual member states.

Matched MeSH terms: Cannabis*
Cannabis as antivirals

Sea YL, Gee YJ, Lal SK, Choo WS

J Appl Microbiol, 2023 Jan 23;134(1).
PMID: 36626776 DOI: 10.1093/jambio/lxac036

Cannabis is a plant notorious for its psychoactive effect, but when used correctly, it provides a plethora of medicinal benefits. With more than 400 active compounds that have therapeutic properties, cannabis has been accepted widely as a medical treatment and for recreational purposes in several countries. The compounds exhibit various clinical benefits, which include, but are not limited to, anticancer, antimicrobial, and antioxidant properties. Among the vast range of compounds, multiple research papers have shown that cannabinoids, such as cannabidiol and delta-9-tetrahydrocannabinol, have antiviral effects. Recently, scientists found that both compounds can reduce severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) viral infection by downregulating ACE2 transcript levels and by exerting anti-inflammatory properties. These compounds also act as the SARS-CoV-2 main protease inhibitors that block viral replication. Apart from cannabinoids, terpenes in cannabis plants have also been widely explored for their antiviral properties. With particular emphasis on four different viruses, SARS-CoV-2, human immunodeficiency virus, hepatitis C virus, and herpes simplex virus-1, this review discussed the role of cannabis compounds in combating viral infections and the potential of both cannabinoids and terpenes as novel antiviral therapeutics.

Matched MeSH terms: Cannabis*
Investigation into mechanical, absorption and swelling behaviour of hemp/sisal fibre reinforced bioepoxy hybrid composites: Effects of stacking sequences

Thiagamani SMK, Krishnasamy S, Muthukumar C, Tengsuthiwat J, Nagarajan R, Siengchin S, et al.

Int J Biol Macromol, 2019 Nov 01;140:637-646.
PMID: 31437507 DOI: 10.1016/j.ijbiomac.2019.08.166

This work focuses on the fabrication of hybrid bio-composites using green epoxy as the matrix material, hemp (H) and sisal (S) fibre mats as the reinforcements. The hybrid composite with sisal/hemp fibres were fabricated by cost effective hand lay-up technique, followed by hot press with different stacking sequences. Static properties of the composites such as tensile, compressive, inter-laminar shear strengths (ILSS) and hardness were examined. The physical properties such as density, void content, water absorption and thickness swelling were also analyzed. The experimental results indicate that hybrid composites exhibited minor variation in tensile strength when the stacking sequence was altered. The hybrid composite with the intercalated arrangement (HSHS) exhibited the highest tensile modulus when compared with the other hybrid counterparts. Hybrid composites (SHHS and HSSH) offered 40% higher values of compressive strength than the other layering arrangements. HHHH sample exhibited the highest ILSS value of 4.08 MPa. Typical failure characteristics of the short beam test such as inter-laminar shear cracks in the transverse direction, micro-buckling and fibre rupture were also observed.

Matched MeSH terms: Cannabis/chemistry*
Fulltext Marijuana "bong" pseudomonas lung infection: a detrimental recreational experience

Kumar AN, Soo CI, Ng BH, Hassan T, Ban AY, Manap RA

Respirol Case Rep, 2018 02;6(2):e00293.
PMID: 29321937 DOI: 10.1002/rcr2.293

The use of Cannabis sativa, also known as marijuana, is believed to have dated back to thousands of years B.C. More than 200 decades later, it remains a popular recreational psychoactive substance that can be smoked through a water pipe. We report a case of marijuana smoking via a "bong" device, which has resulted in severe Pseudomonas aeruginosa necrotizing pneumonia treated with conservative medical therapy. This case highlights the importance of recognizing that life-threatening pneumonia can potentially be linked to marijuana and "bong" usage. Complicated cases should be considered for early surgical intervention.

Matched MeSH terms: Cannabis
Immunomodulation by morphine and marijuana

Yahya MD, Watson RR

Life Sci, 1987 Dec 07;41(23):2503-10.
PMID: 2824957

The immunomodulatory effects of morphine and the active components of marijuana, particularly tetrahydrocannabinol, on various aspects of the host immune parameters include alterations in humoral, cell-mediated and innate immunity. Most studies have shown immunosuppressive effects due to use of these abused substances, although there are reports that they may not produce any deleterious effect and may even enhance some aspects of host immunity. They reduce resistance to cancer growth and microbial pathogens in animals.

Matched MeSH terms: Cannabis*
Fulltext Valorization of Byproducts of Hemp Multipurpose Crop: Short Non-Aligned Bast Fibers as a Source of Nanocellulose

Dalle Vacche S, Karunakaran V, Patrucco A, Zoccola M, Douard L, Ronchetti S, et al.

Molecules, 2021 Aug 04;26(16).
PMID: 34443315 DOI: 10.3390/molecules26164723

Nanocellulose was extracted from short bast fibers, from hemp (Cannabis sativa L.) plants harvested at seed maturity, non-retted, and mechanically decorticated in a defibering apparatus, giving non-aligned fibers. A chemical pretreatment with NaOH and HCl allowed the removal of most of the non-cellulosic components of the fibers. No bleaching was performed. The chemically pretreated fibers were then refined in a beater and treated with a cellulase enzyme, followed by mechanical defibrillation in an ultrafine friction grinder. The fibers were characterized by microscopy, infrared spectroscopy, thermogravimetric analysis and X-ray diffraction after each step of the process to understand the evolution of their morphology and composition. The obtained nanocellulose suspension was composed of short nanofibrils with widths of 5-12 nm, stacks of nanofibrils with widths of 20-200 nm, and some larger fibers. The crystallinity index was found to increase from 74% for the raw fibers to 80% for the nanocellulose. The nanocellulose retained a yellowish color, indicating the presence of some residual lignin. The properties of the nanopaper prepared with the hemp nanocellulose were similar to those of nanopapers prepared with wood pulp-derived rod-like nanofibrils.

Matched MeSH terms: Cannabis/chemistry*
Fulltext Cannabis as a risk factor for persistent and severe depression: a case report

Khadijah Hasanah, A.A., Aia Harlina, A.R., Nik Ruzyanei, N.J.

Malaysian Journal of Psychiatry, 2014;23(2):73-76.
MyJurnal

Evidence linking cannabis use and depression remains inconsistent. Variations of clinical features were observed in those with history of cannabis use presented with affective symptoms. We report a case of a 19-year-old male college student with a history of heavy cannabis use for at least seven months. A month after stopping cannabis, he presented with severe persistent depressive symptoms. He had no withdrawal symptoms prior to this. He had severe depressive symptoms with melancholic features and progressed to multiple and serious suicidal attempts. While the use of cannabis is implicated in neither the patient’s diagnosis nor management, its use has a significant role in influencing the clinical features and course of the illness. This case suggests that depression can start long after cessation of cannabis use with the history of cannabis remained as a significant risk factor.

Matched MeSH terms: Cannabis
Drug abuse and counter-measures in Japan

Kumagai H

Med J Malaysia, 1974 Dec;29(2):136-44.
PMID: 4282402
Matched MeSH terms: Cannabis
Fulltext Suppression of Cisplatin-Induced Vomiting byCannabis sativain Pigeons: Neurochemical Evidences

Ullah I, Subhan F, Alam J, Shahid M, Ayaz M

Front Pharmacol, 2018;9:231.
PMID: 29615907 DOI: 10.3389/fphar.2018.00231

Cannabis sativa
(CS, familyCannabinaceae) has been reported for its anti-emetic activity against cancer chemotherapy-induced emesis in animal models and in clinics. The current study was designed to investigateCSfor potential effectiveness to attenuate cisplatin-induced vomiting in healthy pigeons and to study the impact on neurotransmitters involved centrally and peripherally in the act of vomiting. High-performance liquid chromatography system coupled with electrochemical detector was used for the quantification of neurotransmitters 5-hydroxytryptamine (5HT), dopamine (DA) and their metabolites; Di-hydroxy Phenyl Acetic acid (Dopac), Homovanillic acid (HVA), and 5-hydroxy indole acetic acid (5HIAA) centrally in specific brain areas (area postrema and brain stem) while, peripherally in small intestine. Cisplatin (7 mg/kg i.v.) induce emesis without lethality across the 24 h observation period.CShexane fraction (CS-HexFr; 10 mg/kg) attenuated cisplatin-induced emesis ∼ 65.85% (P< 0.05); the reference anti-emetic drug, metoclopramide (MCP; 30 mg/kg), produced ∼43.90% reduction (P< 0.05). At acute time point (3rdh), CS-HexFr decreased (P< 0.001) the concentration of 5HT and 5HIAA in the area postrema, brain stem and intestine, while at 18thh (delayed time point) CS-HexFr attenuated (P< 0.001) the upsurge of 5HT caused by cisplatin in the brain stem and intestine and dopamine in the area postrema.CS-HexFr treatment alone did not alter the basal neurotransmitters and their metabolites in the brain areas and intestine except 5HIAA and HVA, which were decreased significantly. In conclusion the anti-emetic effect ofCS-HexFr is mediated by anti-serotonergic and anti-dopaminergic components in a blended manner at the two different time points, i.e., 3rdand 18thh in pigeons.

Matched MeSH terms: Cannabis
Fulltext The Autonomic Progress Bar Motivates Treatment Completion for Patients of Stimulant Use Disorder and Cannabis Use Disorder

Chen IC, Teng G, Chen CJ, Lan TH, Liu HJ

Front Psychiatry, 2019;10:944.
PMID: 31998160 DOI: 10.3389/fpsyt.2019.00944

Background: The intrinsic motivation behind the "need to complete" is more influential than external incentives. We introduced a novel progress-bar tool to motivate the completion of programs designed to treat stimulant and cannabis use disorders. We further examined the effectiveness of the progress bar's scoring approach in forecasting consistently negative urine tests. Methods: This study's participants included 568 patients with stimulant, amphetamine-type, and cannabis use disorders who were undergoing 12-month mandatory treatment programs at Taichung Veterans General Hospital in Taiwan. Patients were given scores of 1, -1, or 0 depending on whether they received negative, positive, or missing urinalysis reports, respectively. The autonomic progress bar generated weekly score totals. At the group level, scorei donated scores from all patients for a given week (i denoted the week). Scorei was standardized to adjusted scorei. We then conducted Autoregressive Integrated Moving Average (ARIMA) Model of time-series analyses for the adjusted scorei. Results: A total of 312 patients maintained treatment progress over the 12-month program. The autonomic score calculator totaled the shared achievements of these patients. The coefficients of the lag variables for mean (p), lag variables for residual error term (q), and number of orders for ensuring stationary (d) were estimated at p = 3, d = 4, and q = 7 for the first half of the treatment program, and were estimated at p = 2, d = 2, and q = 3 for the second half. Both models were stationary and tested as fit for prediction (p < 0.05). Sharply raised adjusted scores were predicted during the high-demand treatment phase. Discussion: This study's novel progress-bar tool effectively motivated treatment completion. It was also effective in forecasting continually negative urine tests. The tool's free open-source code makes it easy to implement among many substance-treatment services.

Matched MeSH terms: Cannabis
Patterns of drug use amongst Malaysian secondary schoolchildren

Spencer C, Navaratnam V

Drug Alcohol Depend, 1980 May;5(5):379-91.
PMID: 7371500

A representative sampling of the secondary school population of two states of Malaysia (sample size 16166) indicated that 11% of students had had experience of drug use. Use of a single drug was the common pattern, with cannabis reported most often by older students, and sedatives most often by younger students. A quarter of those who had used drugs reported experience with four or more substances and were likely to have progressed rapidly to heroin. This progression may be facilitated by the ready availability of heroin and the local tradition of smoking or inhaling rather than injecting opiates. Descriptions of drug migration patterns based on Western samples are not fully appropriate worldwide, because the youthful abuser is much influenced both by local market forces and by cultural traditions, even though the epidemic of youthful drug abuse is itself worldwide.

Matched MeSH terms: Cannabis
Fulltext Extent and patterns of drug abuse among children in Malaysia

Navaratnam V, Aun LB, Spencer CP

Bull Narc, 1979 Jul-Dec;31(3-4):59-68.
PMID: 44684

A field survey, based on a representative sample of children aged 12 to 16 years was carried out in three different areas of Malaysia. The data derived from the study have revealed that 10.5 per cent of them used drugs for non-medical reasons. Drug use was more common among boys (11.9 per cent) than girls (8.6 per cent). The highest frequency of drug was found in the youngest group--12-year-old children (13.5 per cent). The use of barbiturate and/or non-barbiturate sedatives (5.5 per cent) ranked first. This was followed in descending order by tranquillizers (4.5 per cent), simultants/amphetamines (3.9 per cent), heroin (3.6 per cent), morphine and/or opium (3.9 per cent), the hallucinogens (3.1 per cent) and cannabis (2.7 per cent).

Matched MeSH terms: Cannabis
Neuropsychiatric implications of transient receptor potential vanilloid (TRPV) channels in the reward system

Singh R, Bansal Y, Parhar I, Kuhad A, Soga T

Neurochem Int, 2019 12;131:104545.
PMID: 31494132 DOI: 10.1016/j.neuint.2019.104545

Neuropsychiatric disorders (NPDs) exert a devastating impact on an individual's personal and social well-being, encompassing various conditions and brain anomalies that influence affect, cognition, and behavior. Because the pathophysiology of NPDs is multifactorial, the precise mechanisms underlying the development of such disorders remain unclear, representing a unique challenge in current neuropsychopharmacotherapy. Transient receptor potential vanilloid (TRPV) type channels are a family of ligand-gated ion channels that mainly include sensory receptors that respond to thermal, mechanical and chemical stimuli. TRPV channels are abundantly present in dopaminergic neurons, thus playing a pivotal role in the modulation of the reward system and in pathophysiology of diseases such as stress, anxiety, depression, schizophrenia, neurodegenerative disorders and substance abuse/addiction. Recent evidence has highlighted TRPV channels as potential targets for understanding modulation of the reward system and various forms of addiction (opioids, cocaine, amphetamines, alcohol, nicotine, cannabis). In this review, we discuss the distribution, physiological roles, ligands and therapeutic importance of TRPV channels with regard to NPDs and addiction biology.

Matched MeSH terms: Cannabis
Public Health Threat of Tobacco and Substance Use in Asia: An Introduction to the Theme Issue

Chun J

J Psychoactive Drugs, 2020 01 22;52(1):1-4.
PMID: 31967534 DOI: 10.1080/02791072.2020.1717686

Tobacco and substance use is a great public health concern in Asia. The prevalence of tobacco smoking, while steadily declined in Western countries over past few decades, has increased in many regions of Asia, especially in low- and middle-income countries. And high-income countries in the region have reported rapid growth rates in e-cigarette use in recent years. Furthermore, illicit drugs, specially cannabis, amphetamines, and opioids, have begun to threaten the health of the people in the region like never before. To better understand the landscape of the two primary public health concerns in Asia, tobacco and substance use, this special issue examines cigarette/e-cigarette use and tobacco control policies for five selected countries (Singapore, China, South Korea, Japan, and Laos People's Democratic Republic); and explores substance use related issues focused on prevention, influencing factors, and policies of three countries (Hon Kong, Malaysia, and India). The research, policy, and clinical implications from this issue will contribute to mitigating the global burden of tobacco and substance use-related public health issues in Asia.

Matched MeSH terms: Cannabis
Fulltext Cannabis sativa subsp. sativa's pharmacological properties and health effects: A scoping review of current evidence

Lim XY, Tan TYC, Muhd Rosli SH, Sa'at MNF, Sirdar Ali S, Syed Mohamed AF

PLoS One, 2021;16(1):e0245471.
PMID: 33465140 DOI: 10.1371/journal.pone.0245471

INTRODUCTION: Hemp (Cannabis sativa subsp. sativa), commonly used for industrial purposes, is now being consumed by the public for various health promoting effects. As popularity of hemp research and claims of beneficial effects rises, a systematic collection of current scientific evidence on hemp's health effects and pharmacological properties is needed to guide future research, clinical, and policy decision making.
OBJECTIVE: To provide an overview and identify the present landscape of hemp research topics, trends, and gaps.
METHODS: A systematic search and analysis strategy according to the preferred reporting items for systematic review and meta-analysis-ScR (PRISMA-ScR) checklist on electronic databases including MEDLINE, OVID (OVFT, APC Journal Club, EBM Reviews), Cochrane Library Central and Clinicaltrials.gov was conducted to include and analyse hemp research articles from 2009 to 2019.
RESULTS: 65 primary articles (18 clinical, 47 pre-clinical) were reviewed. Several randomised controlled trials showed hempseed pills (in Traditional Chinese Medicine formulation MaZiRenWan) improving spontaneous bowel movement in functional constipation. There was also evidence suggesting benefits in cannabis dependence, epilepsy, and anxiety disorders. Pre-clinically, hemp derivatives showed potential anti-oxidative, anti-hypertensive, anti-inflammatory, anti-diabetic, anti-neuroinflammatory, anti-arthritic, anti-acne, and anti-microbial activities. Renal protective effects and estrogenic properties were also exhibited in vitro.
CONCLUSION: Current evidence on hemp-specific interventions are still preliminary, with limited high quality clinical evidence for any specific therapeutic indication. This is mainly due to the wide variation in test item formulation, as the multiple variants of this plant differ in their phytochemical and bioactive compounds. Future empirical research should focus on standardising the hemp plant for pharmaceutical use, and uniformity in experimental designs to strengthen the premise of using hemp in medicine.

Matched MeSH terms: Cannabis
Warfarin and food, herbal or dietary supplement interactions: A systematic review

Tan CSS, Lee SWH

Br J Clin Pharmacol, 2021 02;87(2):352-374.
PMID: 32478963 DOI: 10.1111/bcp.14404

AIMS: To present an updated overview on the safety of concurrent use of food, herbal or dietary supplement and warfarin.
METHODS: A systematic literature review was performed on 5 databases from inception up to 31 December 2019. These interactions were classified depending on the likelihood of interaction and supporting evidences.
RESULTS: A total of 149 articles describing 78 herbs, food or dietary supplements were reported to interact with warfarin. These reports described potentiation with 45 (57.7%) herbs, food or dietary supplements while 23 (29.5%) reported inhibition and 10 (12.8%) reported limited impact on warfarin pharmacokinetics and pharmacodynamics. Twenty unique herb and dietary supplements also reported to result in minor bleeding events, such as purpura and gum bleeding as well as major events such as intracranial bleeding that led to death.
CONCLUSION: While most food, herbs and supplements can be safely taken in moderation, healthcare professionals should be aware of the increased risk of bleeding when taking several food and herbs. These include Chinese wolfberry, chamomile tea, cannabis, cranberry, chitosan, green tea, Ginkgo biloba, ginger, spinach, St. John's Wort, sushi and smoking tobacco. Patients should be counselled to continue to seek advice from their healthcare professionals when starting any new herbs, food or supplement.

Matched MeSH terms: Cannabis

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