You are meeting for the first time, and have a lot of anticipation and ground to cover. Never having met before, you are not sure how the first encounter will go. Or, maybe this is a quick focused interaction, and you are wondering if there will be enough time to really get fully acquainted. On the other hand, you may feel reticent to share too much at this stage. These are all perfectly understandable scenarios if you were meeting someone on a blind date, but did you ever feel this way about an appointment with your doctor?
The doctor-patient relationship is most certainly an intimate one. But for cannabis users, you may feel uneasy disclosing that detail to your physician. It’s true…doctors are people too with their own beliefs and biases. And even though medical cannabis is currently legal in 23 states and D.C. – you really have no idea if your doctor is a proponent or an opponent of its use – which may lead to not feeling comfortable enough to be fully transparent with them.
However, as with other information that may have an effect on your health, discussing your interest in, or use of, medical cannabis with your doctor is important, particularly if you are also being treated for other conditions where drug interactions could be an issue.
Here are some basics about medical cannabis and potential side effects that could occur if taken with other medications. It may come as a surprise that many of our current prescription medications are plant-based. Given that, one can imagine that combining chemically active substances might create the potential for those substances to interact. This mingling can be favorable, unfavorable, or inconsequential. Patients and physicians would do well to consider the potential reactions that both prescribed and over-the-counter medications and herbs could have because sometimes they are not insignificant.
Here are five major categories of medications that are fairly widely prescribed, and their possible interactions you should be informed about, if combined with medical cannabis use:
- Medications that are hormones:
Cannabis may counteract estrogen used as either hormone replacement or as birth control. It might have the effect of making this hormone less effective than its intended dosing amount.
- Medications where the liver is a site of metabolism:
A wide variety of medications that are broken down by the liver may be appreciably impacted by the presence of medical cannabis. The liver uses a number of specific mechanisms to break down medication. In some cases, cannabis can slow this process down, and in other cases, speed this process up. The net result is that for some medications like diltiazem (a heart medication), lovastatin (a cholesterol medication), and others, the medication may be at a higher blood concentration level or last longer than anticipated. The contrary might be true for medications such as acetaminophen (Tylenol), and some inhaled anesthesia medications used during surgery whereby these are broken down more quickly, and lead to the need for higher concentrations or rendering time of benefit of shorter duration.
- Medications that are sedatives or central nervous system depressants:
Cannabis can cause sleepiness and drowsiness. This, in combination with other medications that do this, could increase their effects. Examples in this category include: medications prescribed for insomnia like ambien/zolpidem, medications prescribed for anxiety such as ativan/lorazepam, some pain medications like narcotics, some antidepressants, and of course, alcohol.
- Medications that slow blood clotting:
Cannabis may slow blood clotting. Some prescriptions medications are prescribed to slow clotting like diclofenac, enoxaparin, and warfarin. And, some over the counter medications slow clotting as well such as aspirin and ibuprofen (advil, motrin). Combining cannabis with any of these medications has the potential to increase the risk of bruising or bleeding.
- Medications for cancer, diabetes, HIV and others:
Medication that may be used to treat cancer (certain chemo-therapies), treat diabetes, treat HIV (like indinavir), and medications used to treat patients who have had an organ transplant (like cyclosporine) may also have the potential to interact with cannabis. These categories are particularly important to know about because these patients may be using medical cannabis to manage symptoms of nausea or to increase their appetite.
Special consideration should be noted for pregnant or breast-feeding women. Cannabis is known to cross the placenta and to be excreted into breast milk. Well-established information regarding the efficacy and safety of cannabis in this population is lacking, so be sure to discuss your potential or existing cannabis use with your physician.
A Final Note
This list is not exhaustive by any means. The goal is to prompt consideration of drug/cannabis interactions of some major categories, and to open up a dialogue with your doctor. Unlike a blind date, your doctor is someone that you need to be transparent with from the very beginning. Being open and upfront with your healthcare team is the basis for a long-lasting and mutually beneficial ‘relationship’.
If you would like to learn more about cannabis and how it fits in to your existing health program, schedule a consultation with us to have your medical cannabis questions answered.
Join us on May 21st and 22nd for two full days of medical cannabis education by the best minds in the industry.