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Official websites use. Share sensitive information only on official, secure websites. Cannabis also known as marijuana is the most frequently used illicit psychoactive substance in the world. However, their composition and pharmacological properties make them dangerous substances. Cannabis does have therapeutic properties for certain indications. These therapeutic applications pertain only to certain cannabinoids and their synthetic derivatives. The objective of this article is to summarize current developments concerning cannabis and the spread of SCs. Future studies must further explore the benefit-risk profile of medical cannabis use. Keywords: cannabis , cannabidiol , medical cannabis , psychosis , synthetic cannabinoid , tetrahydrocannabinol. Cannabis also known as marijuana is a psychoactive plant that contains more than components, of which cannabinoids have presently been identified. Cannabis potency is primarily evaluated according to a sample's THC concentration. This is the primary psychoactive cannabinoid in cannabis. The adverse effects after acute or regular cannabis use are in direct relation to THC concentrations in the product. Over the last few years, many studies have shown that CBD levels may also have an important impact. It may also be capable of antagonizing at least some of the adverse effects related to THC. Various cannabis preparations are available on the illicit drug market: hashish, herbal cannabis leaves and flowers , and oils. Real-time monitoring of confiscated cannabis preparations has enabled scientists to measure the potency of currently used products. Changes can then be compared with the prevalence of negative health consequences in users. Furthermore, the last few years have seen a substantial rise in the use of synthetic cannabinoids SCs , especially in frequent cannabis users. The attraction of SCs may be that whereas they provide psychoactive effects that are similar to cannabis and are also easily obtained, they are undetected through usual screenings. However, their composition and pharmacological properties make them potentially dangerous substances. Here, we summarize current developments concerning cannabis and the spread of SCs. Despite increasing detrimental issues arising from cannabis use, studies have shown that this drug and some SCs may have a number of therapeutic effects, depending on the specific posology. Recent reports indicate that cannabis production is increasing and that cannabinoid formulations have been changing over the last two decades, especially with regard to their THC and CBD concentrations. This trend has been observed not only in the United States, but also in several European countries, such as the Netherlands and Italy. In a study by ElSohly et al, 4 38 samples seized in the United States between January 1, and December 31, were analyzed. In parallel, CBD concentration decreased from 0. Median THC content showed a significant increasing trend from about 6. Another study performed in the Netherlands in confirmed these results with a different trend. In the years to , they found a small but statistically significant decline in THC concentration: a 0. Thus, in the Netherlands, the THC content has remained stable during the last 10 years. This study emphasized the fact that global increases in THC levels and decreases in CBD levels are largely linked to the spread of indoor cultivation practices. On average, cultivars from the Netherlands are twice as potent as imported products. The high THC concentrations obtained from the various cannabis varieties result from technical advances in production, such as genetic manipulations, cross-breeding, and improvements in indoor hydroponic cultivation. As advanced techniques and more potent seeds have become more widely available, this has contributed to the steadily increasing THC concentrations in cannabis. These changes may have significant real-world clinical consequences because the chances of detrimental psychological effects seem to increase when cannabis with high concentrations of THC is consumed. Synthetic cannabinoids SCs emerged in the s when researchers were first exploring the endocannabinoid system and attempting to develop new treatments for cancer pain. Around the year , SC appeared on the illicit drug market, where their prevalence had long been underestimated. Since then, their place in the market has steadily increased. More than synthetic psychoactive substances have been identified on the illicit market. There has been a steep rise over the last 5 years with the appearance of new synthetic drugs. Since , more than SCs have been identified in various products, 24 of which appeared in Today, intra-European production is closely monitored. Indeed, each SC is replaced by newer analogs within a year or two. SC use varies a great deal between different countries and populations. Compared with other new drugs on the market, the increase in consumption of SCs was particularly remarkable. They may also be sold as tablets, capsules, or powders. SCs have different pharmacological properties than cannabis. They also do not contain any CBD whatsoever, contrary to cannabis, where it is present in varying concentrations. Products of the same brand and sold under the same name have highly variable product compositions and concentrations. Similarly, the pharmacokinetics depends on the administration route. In some cases, the onset of psychoactive effects and physical symptoms begins a few minutes after smoking. Some users have described feeling limited in their movements, whereas no motor deficits are objectively observed. On average, the effects last for about 6 hours, steadily decreasing until the next day. Almost 30 years ago, Andreasson et al showed an association between cannabis use and the later emergence of schizophrenia. Despite confounding factors, sufficient proof currently exists showing that cannabis use increases the risk of psychotic disorders. Over the last 5 decades, increasing THC concentrations have been observed in products available in many countries. Some studies have indicated that CBD may have antipsychotic properties. One study has suggested an association between dose and response, showing that daily users of high-dose cannabis begin their first psychotic episode an average of 6 months earlier than those who had never used cannabis. Psychotic patients who continue to use cannabis had a significantly greater number of relapses than patients who had stopped using cannabis or had never used. Based on studies examining the evolution of THC levels in cannabis over the last few decades, one hypothesis is that previous studies may have underestimated the impact of cannabis on existing psychosis. In fact, ecological proof seems to argue in favor of greater psychosis risk among youths who have recently been exposed to high-dose cannabis than in former generations exposed to lower THC doses. Such an analysis, however, has yet to be performed. It is too soon to confirm this hypothesis. Current clinical data are insufficient to justify prevention measures concerning cannabis use or restriction of highly concentrated varieties. Numerous complications have been observed in SC users. Anxious symptoms, such as ruminations, anxiety, and panic attacks, are often seen following SC use. Sleep disorders, hyperactivity, agitation, and irritability have also been reported. Acute intoxication may be associated with cognitive disorders such as short-term memory loss. There have also been cases of paranoia, flashbacks, and suicidal ideation. Although SCs have a similar mechanism of action to THC, the different pharmacological properties, such as higher affinity for CB1 and CB2 receptors, higher efficacy, as well as the absence of CBD, result in different physiological and toxicological effects, especially concerning its pro-psychotic effects. The psychotogenic effects of SC are increasingly alarming, with numerous reports of individuals who become psychotic after SC use. Delirious symptoms, acoustico-verbal hallucinations, and dissociative elements have all been described in individuals without a history of psychosis. SCs are potentially addictogenic because these substances can increase dopamine secretion within the nucleus accumbens and the ventral tegmental area. Intense and severe cravings have also been reported. An increasing number of nonfatal intoxications, as well as deaths, after presentation to the emergency room or in consultation have been reported, especially in young people. THC is the psychoactive principle of cannabis, inducing the cannabis inebriation sought by many users. Its addictive potential and negative consequences are now well known. CBD seems not to induce euphoria and seems to have antipsychotic, anxiolytic, antiepileptic, and anti-inflammatory properties. According to an evaluation in by the Institute of Medicine in the United States on cannabis as a medication, the future of medical cannabis resides in isolating its cannabinoid components and their synthetic derivatives. Various forms of cannabis have been studied to ascertain the therapeutic properties of cannabis. It has been approved in several countries Canada, Europe , but not in the United States, as an adjunctive therapy in the treatment of spastic pain in patients with neurological disorders. A meta-analysis reviewed randomized clinical trials worldwide of medical cannabis and cannabinoids from through The most frequently studied cannabinoid forms were medications produced by pharmaceutical companies: nabilone, nabiximols, and dronabinol. This study included only two trials using plant-based cannabis smoked and vaped. The same level of proof was shown for nabiximols or smoked THC in the treatment of chronic cancer pain and neuropathic pain. This meta-analysis showed that CBD was not significantly more efficient in treating psychosis than a usual antipsychotic, such as amisulpiride, or depression compared with nabiximols. Finally, one very small crossover trial with six patients was not able to detect an effect of cannabinoids on intraocular pressure. A systematic review by the American Academy of Neurology examined publications from through November concerning the use of cannabinoids in the treatment of multiple sclerosis, movement disorders, and epilepsy. The other formulations seemed to be effective in these indications, but with lower levels of proof. Proof was insufficient to conclude as to the efficacy of smoked cannabis. In other neurological indications, such as Huntington disease and Tourette syndrome, proofs were judged insufficient. Cannabinoids would seem to have some therapeutic interest in the following indications: epilepsy, addictions, psychotic disorders, anxiety, and sleep disorders. However, there are currently insufficient levels of proof. Indeed, a Cochrane review from , for example, concluded that there were insufficient levels of proof for cannabinoids in the treatment of epilepsy. They remain the subject of preclinical and human research. In animal studies, CBD has shown significant antiepileptic activity, reducing seizure severity. Recent studies in young patients suffering from severe, treatment-resistant epilepsy have shown that CBD may have a specific indication in these forms. Due to its implications in the reward system, endocannabinoid signaling represents a potential therapeutic target in treating addictions. The results from randomized, controlled trials suggest that CB1 receptor agonists such as dronabinol and nabiximols may be effective in treating cannabis withdrawal. Dronabinol may also decrease opioid withdrawal symptoms. Rimonabant, an inverse agonist of CB1 receptors, has shown promising effects in tobacco cessation; it also causes adverse psychiatric effects. Few clinical trials have examined the effect of cannabinoids in treating alcohol-use disorder; those examining rimonabant have shown negative results. Fourteen studies were found, nine in animals and five in humans. Some preclinical studies suggest that CBD may have some therapeutic properties in treating opioid-, cocaine-, and psychostimulant-use disorders. Some preliminary data suggest that it could be advantageous in treating cannabis and tobacco-use disorder in humans. One randomized, double -blind clinical trial compared the use of CBD versus amisulpride for 4 weeks in, respectively, 20 and 19 patients with psychosis. A potential advantage for CBD is its milder side effects: fewer extrapyramidal symptoms, less weight gain, and no hyperprolactinemia. The understanding of the relationship between sleep and cannabinoids has been obscured by significant methodological differences resulting in mitigated results. The results from the literature seem to favor a beneficial effect of acute cannabis intoxication on sleep. On the other hand, regular cannabis use seems to have a negative impact on sleep quality. Different cannabinoids seem to have a differential impact on sleep. One study has suggested a therapeutic potential for dronabinol and nabilone on sleep disorders and nightmares. Thus, there is preclinical evidence and some clinical evidence for therapeutic properties regarding a number of diseases. However, larger controlled clinical trials are needed to show efficacy and safety for each disorder. Cannabis use and its negative consequences have increased over the last several years in parallel with increasing cannabis potencies. SCs seem to be particularly popular among cannabis users. This emerging market represents a specific public health problem in light of the severe complications in relation to their use. What the risks are of developing a psychotic disorder after SC administration remains a fundamental question. This is an emerging area of research in which more robust epidemiological studies must be developed. These must provide detailed information concerning not only the quantity and the frequency of cannabis use, but also, and more importantly, the type of cannabis used. The use of SCs must also be more largely examined in light of the severe consequences associated with their use. The legislative policies that have been established to reduce the risks in relation to cannabis have long represented an obstacle to research concerning medical cannabis use. Improved knowledge of the endocannabinoid system and of exocannabinoids has proven that cannabis may have significant therapeutic effects. Despite sparse research, certain countries, such as the United States, have authorized the use of plant-based medical cannabis. As a library, NLM provides access to scientific literature. Dialogues Clin Neurosci. Show available content in en es fr. Find articles by Genevieve Lafaye. Find articles by Laurent Karila. Find articles by Lisa Blecha. Find articles by Amine Benyamina. Issue date Sep. 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View Alerts and Messages Archive. Required: Honduras currently requires travelers arriving from or traveling to Panama and every nation in South America to present proof of yellow fever vaccine. Airlines may still require additional documentation prior to boarding. Suggested: measles, rubella, rabies, hepatitis A, hepatitis B, typhoid. Friday, a. Closed Fridays. Visit the Embassy of Honduras website or any of the Honduran consulate websites for the most current visa information. Special Requirements for Minors : Under Honduran law, children under age 21 who are traveling unaccompanied or with only one parent must have written, notarized permission to travel from the non-traveling parent s. The U. Find information on dual nationality , prevention of international child abduction , and customs information on our websites. In particular, Gracias a Dios is a remote location where narcotics trafficking is commonplace, infrastructure is weak, government services are limited, and police or military presence is scarce. As a result, the U. Embassy has restricted U. The Honduran government conducts police and military patrols in major cities in an effort to reduce crime. However, the ability of Honduran law enforcement authorities to prevent, respond to, and investigate criminal incidents, and to prosecute criminals is limited. Areas frequented by tourists, such as the Bay Islands including Roatan, Utila and Guanaja and Copan Ruins, have notably lower rates of violent crime and increased law enforcement services. Travelers should still exercise reasonable precautions. Of note, foreign residents of the Bay Islands who purchase properties have reported increased incidents of harassment, including being the victims of violent attacks, after becoming involved in disputes. Review your personal security plans; remain aware of your surroundings and local events; and monitor local news stations for updates. Maintain a high level of vigilance, take appropriate steps to enhance your personal security, and follow instructions of local authorities. Read the Travel Advisory for Honduras for additional information. Demonstrations: Demonstrations regularly occur in Honduras, particularly near the Presidential Palace, Congress, and the universities in Tegucigalpa. Protests and work stoppages have become common at Ministerio Publico offices throughout the country, leading to interruptions in services. Additionally, some protests directed toward the U. Palmerola is currently the main international airport for Tegucigalpa. Protests often result in the extended closure of major roads and highways in and between major cities, blocking the flow of goods, services and reducing access to daily household supplies. Victims of Crime: If you are a victim of crime, call the national police by dialing Remember that local authorities are responsible for investigating and prosecuting the crime. Also contact the U. Embassy at or and after-hours at We can:. Domestic Violence: U. Embassy for assistance. Severe Weather: Honduras is vulnerable to hurricanes, heavy rains, and flooding, especially between June and November. Scams: See the Department of State page for information on scams. Tourism: The tourism industry is unevenly regulated, and safety inspections for equipment and facilities do not commonly occur. First responders are generally unable to access areas outside of major cities and to provide urgent medical treatment. See our webpage for more information on insurance providers for overseas coverage. There may be restrictions on freedom of movement and other rights under this State of Exception. Monitor local media for updates and information on restrictions in specific neighborhoods. Criminal Penalties: You are subject to local laws. If you violate local laws, even unknowingly, you may be expelled, arrested, or imprisoned. It is important for all U. Judicial procedures are not always clear or easily understood by foreigners, and significant delays during the investigation and trial dates are common. Furthermore, some crimes are also prosecutable in the United States, regardless of local law. For examples, see our website on crimes against minors abroad and the Department of Justice website. Arrest Notification: If you are arrested or detained, ask police or prison officials to notify the U. Embassy immediately. See our webpage for further information. Customs Regulations: Strict regulations apply to the import and export of items such as vehicles, medications, and business equipment. Honduran law prohibits the export of artifacts from pre-colonial civilizations, as well as certain birds and other flora and fauna. Medication and Medical Equipment: Medical brigades traveling to Honduras are advised that they need to complete customs forms, as well as medical clearance forms, at least three business days prior to brining medications or medical equipment into the country. Firearms: No one may bring firearms into Honduras, except for diplomats and other official travelers, or individuals participating in sporting events who have obtained a firearm permit from the Honduran Ministry of Security or Ministry of Defense prior to travel. Individuals who attempt to bring firearms into Honduras without an appropriate permit, will face prosecution for criminal possession and possibly trafficking of firearms. Marine Safety and Oversight: Honduran military personnel commonly board private vessels in Honduran territorial waters to verify crew and passenger documentation. Criminals have been known to pose as fisherman and commit armed assaults. If your vessel is hailed by a suspicious vessel, contact the U. Investment: Many U. Due to poor regulation, financial investments pose high risks and have led to substantial losses. Exercise extreme caution before investing in real estate. Fraudulent deeds are common and have led to numerous disputes. In addition, threats and violence have been used against U. Numerous U. Adventure Sports: There is little to no oversight of safety standards in Honduras. You should research service providers to ensure they are using internationally acceptable or certified equipment, guides, safety measures, and instruction. Travelers Who Require Accessibility Assistance: Honduran law requires access to buildings for persons with disabilities; however, few buildings are accessible. Women Travelers: See our travel tips for Women Travelers. Staff, facilities, and supplies in Honduras often do not meet U. There are adequate facilities in Tegucigalpa and San Pedro Sula for advanced surgical procedures in case of non-elective emergencies. Honduras lacks the infrastructure to maintain water purity and food safety. Diarrheal illness is very common even in large cities and luxury accommodations. Only sealed commercial water containers bottles are considered safe to drink. Air pollution can aggravate or lead to respiratory problems during the dry season due to widespread forest fires and agricultural burning. The State Department and the U. Embassy will not pay your medical bills: Be aware that U. Medicare does not apply overseas. Medical insurance: Make sure your health insurance plan provides coverage overseas. Most care providers overseas only accept cash payments. We strongly recommend supplemental insurance to cover medical evacuation. Prescription medication: If traveling with prescription medication, check with the Embassy of Honduras in Washington, D. Always ensure you have enough medicine to cover your travel time, and research its availability in Honduras, or whether there is a viable replacement. Medical Marijuana: Marijuana, even for medicinal use and with a prescription, is illegal in Honduras. A traveler who is found to have any amount of marijuana in their possession including vape cartridges, edibles, organic cannabis, etc. Please review the U. Vaccinations: Honduras requires proof of Yellow Fever immunization if traveling to or coming from another country endemic with Yellow Fever. Check with your airline for vaccine requirements and be up-to-date on all vaccinations recommended by the U. Centers for Disease Control and Prevention. Road Conditions and Safety: Because of crime, poor road conditions, and heavy commercial truck traffic, driving in Honduras can be dangerous. Embassy discourages car and bus travel after dark. While Honduras and the United States have signed and ratified a Stolen Vehicle Treaty, existing Honduran laws protect good faith buyers even of stolen vehicles , so the recovery and return of these vehicles to their original owners is not guaranteed. Vehicle insurance may mitigate loss; please check with the National Insurance Crime Bureau or with private insurance carriers about coverage details. See our Road Safety page for more information. Aviation Safety Oversight: As there is no direct commercial air service to the United States by carriers registered in Honduras, the U. Maritime Travel: Mariners planning travel to Guatemala should also check for U. Information may also be posted to the U. Coast Guard homeport website , and the NGA broadcast warnings. Subscribe to get up-to-date safety and security information and help us reach you in an emergency abroad. Make two copies of all of your travel documents in case of emergency, and leave one with a trusted friend or relative. Antigua and Barbuda. Bonaire, Sint Eustatius, and Saba. Bosnia and Herzegovina. British Virgin Islands. Burkina Faso. Burma Myanmar. Cabo Verde. Cayman Islands. Central African Republic. Costa Rica. Cote d Ivoire. Czech Republic. 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Cancel GO. Embassy Messages Alerts. Quick Facts. Passport must have three months validity. One page required for entry stamp. No for stays of up to 90 days. Embassies and Consulates. Destination Description. Entry, Exit and Visa Requirements. To enter Honduras, you need: A U. Evidence of onward travel. For stays of up to 90 days, you do not need a visa for tourism. Please note, individuals who do not obtain the appropriate visa, or overstay their time in Honduras, may face significant exit fines. If notarizing a permission letter in Honduras, the letter should be notarized by a Honduran notary public. If notarizing a permission letter in the United States, the letter should be apostilled by the U. Honduran immigration authorities may also accept permission letters notarized at a Honduran embassy or consulate in the United States. If there is no second parent with legal custody of the child e. Safety and Security. Gracias a Dios In particular, Gracias a Dios is a remote location where narcotics trafficking is commonplace, infrastructure is weak, government services are limited, and police or military presence is scarce. Bay Islands and Copan Ruins Areas frequented by tourists, such as the Bay Islands including Roatan, Utila and Guanaja and Copan Ruins, have notably lower rates of violent crime and increased law enforcement services. Special circumstances: Customs Regulations: Strict regulations apply to the import and export of items such as vehicles, medications, and business equipment. Further health information: World Health Organization U. Travel and Transportation. Honduran roads are poorly lit and poorly marked. Traffic signs are often inadequate or non-existent. People and animals wander onto the roads. Rockslides are common, especially in the rainy season May through December and can cause closure of major highways. Dangerous stretches of road include: The road between Tegucigalpa to Choluteca: Be aware of mountain curves. The road from Juticalpa to Telica, and from the turn off to Gualaco on Route 39 to San Esteban and Bonito Oriental: Rival criminal elements engage in violent acts against one another. Avoid this road and stay on the main Tegucigalpa-Juticalpa-Catacamas road while traveling in Olancho. Honduran law requires all vehicles involved in an accident to remain in place until Transit Authority agents arrive. Notify your car insurance company as soon as possible, preferably right after the accident. Public Transportation: Avoid public transportation in Honduras. If you must travel by bus, always travel during daylight hours and on first-class conveyances, not economy buses. Choose taxis or rideshares carefully. Hotels and resorts may be able to recommend trusted taxi or shuttle services. Instruct the driver not to pick up other passengers, agree on the fare before you enter the vehicle, and have small bills available for payment, as taxi drivers often do not make change. When possible, travel in groups. Call us in Washington, D. Follow us on X formerly known as 'Twitter' and Facebook. See traveling safely abroad for useful travel tips. Last Updated: August 1, Travel Advisory Levels. Assistance for U. Embassy Tegucigalpa. USAHonduras state. Honduras Map. View Larger Map. Learn about your destination. Enroll in STEP. Travel Tip. You are about to visit:. Popular Links. Stay Connected. Law Enforcement.

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