Tetrahydrocannabinol (THC) is a cannabinoid found in cannabis. It is the principal psychoactive constituent of Cannabis and one of at least 113 total cannabinoids identified on the plant. Although the chemical formula for THC (C21H30O2) describes multiple isomers, the term THC usually refers to the delta-9-THC isomer with chemical name (−)-trans-Δ9-tetrahydrocannabinol. THC, also known pharmaceutically as dronabinol, is used medically to relieve chemotherapy-induced nausea and HIV/AIDS-related anorexia. Nabiximols, a botanical drug which contains THC, is used medically to treat symptoms of multiple sclerosis, including spasticity and neuropathic pain. THC acts as a partial agonist at CB1 and CB2 cannabinoid receptors. THC can be administered orally, inhaled, or transdermally, with bioavailability and onset varying by route, and is extensively metabolized in the liver to active and inactive metabolites before being excreted in feces and urine. Side effects include red eyes, dry mouth, drowsiness, memory impairment, anxiety, and, with chronic use, cannabinoid hyperemesis syndrome. While human overdose is rare, THC can interact with other drugs and has a complex pharmacokinetic profile. THC is classified variably under international and US law, with medical use approved in multiple countries. Research supports its effectiveness for spasticity and central pain in multiple sclerosis, though evidence for other neurological disorders is limited, and long-term high-dose exposure may carry uncertain toxicity risks.
Uses
Recreational
THC is widely used as a recreational drug, both by itself or with other cannabinoids like cannabidiol (CBD) or in the form of cannabis. It is the main psychoactive constituent in cannabis. The effects of THC include euphoria, appetite stimulation, sedation, cognitive and memory impairment, pain relief, anxiety, and reduced body temperature. THC can produce strong hallucinogenic effects, mystical experiences, and psychosis-like reactions at high doses in a subset of individuals. These hallucinogenic effects are distinct from but potentially just as strong as or even stronger than those of other hallucinogens like serotonergic psychedelics, dissociatives, and salvia. Besides the hallucinogenic effects, high doses of THC can also produce effects including anxiety, panic, paranoia, delusions, heavy sedation, and catalepsy. Strong THC exposures and associated hallucinogenic and aversive effects have been especially associated with cannabis edibles.
Medical
THC, referred to as dronabinol in the pharmaceutical context, is approved in the United States as a capsule or solution to relieve chemotherapy-induced nausea and vomiting and HIV/AIDS-induced anorexia. THC is an active ingredient in nabiximols (Sativex), a specific extract of Cannabis that was approved as a botanical drug in the United Kingdom in 2010 as a mouth spray for people with multiple sclerosis to alleviate neuropathic pain, spasticity, overactive bladder, and other symptoms. Nabiximols (as Sativex) is available as a prescription drug in Canada. In 2021, nabiximols was approved for medical use in Ukraine. THC is sometimes prescribed off-label to treat glaucoma, Crohn's disease, and post-traumatic stress disorder (PTSD).
Side effects Side effects of THC can include red eyes, dry mouth, drowsiness, short-term memory impairment, difficulty concentrating, ataxia, increased appetite, anxiety, paranoia, psychosis (i.e., hallucinations, delusions), decreased motivation, and time dilation, among others. Chronic usage of THC may result in cannabinoid hyperemesis syndrome (CHS), a condition characterized by cyclic nausea, vomiting, and abdominal pain that may persist for months to years after discontinuation.
Overdose The median lethal dose of THC in humans is not fully known as there is conflicting evidence. A 1972 study gave up to 90 mg/kg of THC to dogs and monkeys without any lethal effects. Some rats died within 72 hours after a dose of up to 36 mg/kg. A 2014 case study based on the toxicology reports and relative testimony in two separate cases gave the median lethal dose in humans at 30 mg/kg (2.1 grams THC for a person who weighs 70 kg; 154 lb; 11 stone), observing cardiovascular death in the one otherwise healthy subject of the two cases studied. A different 1972 study gave the median lethal dose for intravenous THC in mice and rats at 30–40 mg/kg. A 2020 fact sheet published by the US Drug Enforcement Administration stated that "no deaths from overdose of marijuana have been reported."
Interactions Formal drug–drug interaction studies with THC have not been conducted and are limited. The elimination half-life of the barbiturate pentobarbital has been found to increase by four hours when concomitantly administered with oral THC.
Pharmacology
Mechanism of action
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