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Thank you for your interesting question. Cesamet (nabilone) is considered a cannabinoid because it binds to the cannabinoid receptors in the body. Usually, Cesamet is prescribed to treat nausea and vomiting ( especially during chemotherapy treatment). I do not prescribe it for pain and I have not seen it prescribed for pain. Although, it may be a useful pain reliever because of its effects on the central nervous system.   Yes, Cesamet is similar to Marijuana because they are both in the cannabinoid family of chemicals. In fact, Marijuana has up to 60 different cannabinoids in it, with delt-9-tetrahydrocannabinol (THC) being the primary cannabinoid. The adverse side effects are similiar for all cannabinoids: drowsiness, vertigo (dizzy), depression, dysphoria (feel bad). So watch out.   Yes, the urine toxicology test for Marijuana can be positive with Cesamet. Usually, this test tries to be specific to THC, but it also can react to other cannabinoids like Cesamet. A positive test can be confirmed specifically for Marajuana using gas chromatography/mass spectrometry (GS/MS), just fancier test.   I hope this information allows you to be a more informed consumer and better able to decided whether or not to use this medication. Remember, the choice is always yours when deciding to try a new medication. The more information the better. If you need more information, check with your doctor or pharmacist. Dr. Christina Lasich, MD