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Substance dependence should not be confused with physical dependence.
Physical dependence and tolerance are normal physiological responses to
repeated drug exposure. They do not imply abuse or addiction.

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Seven main criteria can be used to diagnose addiction, including the
development of tolerance and the experience of withdrawal. However, it must
again be remembered that these are normal physiological responses that can
occur with chronic drug treatment.

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Additional criteria include a loss of control over drug use, preoccupation with
the drug and the continued use of the drug despite adverse consequences.
Exhibiting one or two criteria would imply abuse while 3 or more suggest
addiction.

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Several factors, including the drug itself, the drug user and the environment
can impact the likelihood of developing an addiction.

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The more readily available, the lower the cost and the ease of administration
increase the likelihood of a drug being sampled repeatedly. The greater the
purity/potency, the stronger the response to the drug thus increasing the
chances of repeated drug taking. A more rapid onset of action and a short
duration of action increase the use of drug.

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Activation of dopamine pathways, in particular the ventral tergmental area
projection to the nucleus accumbens appears to play an important role in
substance abuse. This pathway, which is important for responding to natural
rewards, such as food, liquids and sex, is usurped by drugs of abuse that more
strongly activate it. The frontal cortex serves as a brake on the reward
pathway, which becomes weakened by repeated exposure to drugs of abuse.

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If you are innately tolerant to, rapidly become tolerant to or rapidly metabolize
a drug, you are more likely to increase your intake to experience the same
euphoria. If you are more likely to experience pleasure this could increase
drug intake. Some psychiatric patients might self-medicate. Prior experiences
and/or expectations can impact the way one responds to drugs. Risk takers are
more likely to experiment with drugs. Adolescents are as a group risk takers,
which is why they are more likely to experiment with drugs.

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Factors in the environment such as peer pressure, role models and general
community attitude towards drug use can impact the choice of experimenting
with drugs. Availability of other reinforcers such as school or athletic
activities, employment, etc, could reduce the likelihood of drug
use.Conditioned stimuli refer to stimuli that become associated with drug
taking behaviors. These could include the people one takes drugs with, the
place where drug taking occurs and the paraphernalia associated with drug
taking. When in the presence of these stimuli, the desire to take drugs may be
increased.

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Behavioral tolerance is the development skills to overcome effects such as
practicing walking a straight line while under the influence of alcohol.
Conditional tolerance is situational. Drugs are paired with specific cues.
Change environment and tolerance is reduced. Acute tolerance may occur
during binge exposure. Sensitization is the opposite of tolerance and is thought
to underlie craving and relapse. Cross tolerance between drugs in the same
class is known to occur.

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Illicit drug use in America has been increasing. In 2012, an estimated 23.9
million Americans aged 12 or older—or 9.2 percent of the population—had
used an illicit drug or abused a psychotherapeutic medication (such as a pain
reliever, stimulant, or tranquilizer) in the past month. This is up from 8.3
percent in 2002. The increase mostly reflects a recent rise in the use of
marijuana, the most commonly used illicit drug.

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Cannabis sativa is part of the hemp family that contains over 400 chemicals,
including greater than 60 that are cannabinoids

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Cannbinol, Cannbidiol, THC are the most abundant cannabinoids. There are
different isoforms of THC including delta 9, the most prevalent, and delta 8.
Both are psychoactive. Varying levels of the cannabinoids can impact the
overall response to marijuana.

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The medical uses of marijuana is controversial, not well studied and it is
generally thought other effective drugs are available.

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These are synthetic forms THC that are missing other cannabinoid ingredients.

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Dronabinol and nabilone are approves for treating emesis and the AIDS
wasting syndrome. Other potential therapeutic uses are listed. There are
reports that marijuana high in cannibidiol is effective for intractable epilepsy.
A child experiencing 300 seizures/week saw a decrease to 2-3/month.

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Potential avenues for future development include drugs that act on cannabinoid
receptors or interfere with endocannabinoid metabolism. Rimonabant is an
example. It was approved (no longer) as anti-obesity drug is some countries
(Not US). Has CNS side effects including depression, anxiety and sleep
problems.

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So what about the use of marijuana for medical conditions? It is a Schedule 1
drug which means that the Federal government believes it has no therapeutic
uses. Thus, NIH does not see value in developing marijuana as a smoked drug.

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It was legalized for medical use in California in 1996. They have not seen an
increase in teenage use. Also adding taxes did not push users to the black
market.

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