Cannabis-based medicines: On the topic of intoxication

This study aimed to clarify the pharmacological meaning of intoxication as it applies to cannabis-based medicines; distinguish intoxication from related terms such as psychoactive, psychotropic and euphorigenic; and evaluate how these distinctions inform clinical practice, prescribing frameworks and regulatory classification of THC- and CBD-containing products.

A narrative review of pharmacological, clinical and regulatory literature was conducted, drawing on cannabinoid receptor pharmacology, pharmacokinetic studies of THC and CBD, ICD-11 diagnostic criteria for substance intoxication, WHO scheduling assessments and international regulatory frameworks. Evidence was synthesised to develop a coherent clinical taxonomy and to examine the implications of dose, route of administration, patient-level modifiers and statutory definitions for classifying cannabinoids as intoxicants.

THC is a partial CB1 receptor agonist and a dose- and route-dependent intoxicant. Oral administration produces substantially higher exposure to the active metabolite 11-hydroxy-THC, increasing intoxication likelihood and severity. Patient-specific factors further modify intoxication risk. CBD acts as a negative allosteric modulator at CB1, does not produce euphoria or functional impairment at clinically relevant doses and does not meet ICD-11 criteria for an intoxicant. A taxonomy distinguishing psychoactive, psychotropic, euphorigenic and intoxicant is proposed.

THC and CBD differ fundamentally in receptor pharmacology, clinical effects and intoxication potential. Intoxication should be defined by functional impairment, not by psychoactivity alone. Adoption of precise, pharmacologically grounded terminology is essential for rational prescribing, informed consent, patient safety and coherent regulatory policy.