In the recent November elections, we reached a crucial turning point in cannabis decriminalization: over half the states now have cannabis legalized in some form or another. The trend is spreading fast, making legal medical marijuana available for patients in most of the country.
The only problem with this rapid legalization is that the medical world hasn’t quite caught up yet. Because cannabis is still a Schedule I drug, research is limited and training for medical professionals and dispensary workers is all but nonexistent. This means that medical marijuana patients may not be getting the proper care or guidance they deserve.
One of the biggest problems with having a federal Schedule I classification on a drug that half the country now has legal access to is that there are few studies on drug interactions with cannabis. This lack of information trickles down into the two institutions that should be able to provide proper guidance for medical marijuana patients: the medical world and dispensaries. Because of this, many patients are left in the dark when it comes to information on drug interactions.
We believe that cannabis should be treated just like any other medication, meaning that patients should also know about the potential risk for drug interactions with other medications they may be taking. For this reason, we’ve put together a guide of possible drug interactions with cannabis.
Does cannabis increase the potency of pharmaceutical drugs?
First let’s address the somewhat prevalent idea that cannabis increases the potency of pharmaceutical drugs. While cannabis and pharmaceuticals do have interactions, it would be erroneous to say that cannabis amplifies the effects of all pharmaceutical drugs. It would be a more correct statement to say that the effects of cannabis and the effects of some pharmaceuticals are sometimes similar, so when combined, the effect may be amplified.
For example, one of the effects of cannabis is drowsiness. When taking cannabis with other drugs that cause drowsiness such as alcohol, benzodiazepines (drugs that treat anxiety) or muscle relaxants, the subject may experience “central nervous system depression,” resulting in decreased breathing and heart rate, and potential loss of consciousness.
Other pharmaceutical interactions with cannabis
When blood thinners such as aspirin, anticoagulants such as warfarin (Coumadin®) or heparin, antiplatelet drugs such as clopidogrel (Plavix®), and non-steroidal anti-inflammatory drugs such as ibuprofen (Motrin®, Advil®) or naproxen (Naprosyn®, Aleve®) are taken with cannabis, the risk of bleeding may increase.
Since cannabis has the potential to affect blood sugar levels, caution is advised when using medications that also effect blood sugar such as pharmaceuticals for diabetes.
Cannabis may also cause low blood pressure, so it’s important to speak to a health care professional when mixing cannabis with pharmaceuticals that also lower blood pressure.
Pharmaceuticals that are broken down by the liver
Some pharmaceuticals are broken down and transformed in the liver. Cannabis may affect how these pharmaceuticals are processed. In some cases, cannabis may interfere with this process, resulting in an increased level of the pharmaceuticals in the blood which could lead to potentially serious adverse reactions.
On the other hand, some medications may be broken down more quickly by the liver when combined with cannabis, decreasing the effectiveness of the pharmaceutical.
Birth control pills
While more studies need to be done, there is a possibility that cannabis counteracts estrogen. Be cautious, or use an extra form of birth control, such as condoms, when consuming cannabis.
Are pharmaceutical interactions with cannabis dangerous?
As of yet, there is no evidence that pharmaceutical interactions with cannabis are fatal, as there have been no reports of death caused by pharmaceutical interactions with cannabis.
The drug interactions listed above are the most common, but Drug.com lists 587 drugs that are known to interact with cannabis. However, of those 587 interactions, only four (with some minor variations) are listed as major. In the ones listed as major, cannabis is not listed specifically as a dangerous interaction, but rather used as one possible example of a category of drugs that have major interactions with the following pharmaceuticals:
Buprenorphine is an opioid that can be used to treat mild or chronic pain, or as a substance to help opioid addicts recover. Buprenorphine causes nervous central depression, so when combined with cannabis, side effects may cause respiratory distress, coma, or even death
Levomethadyl acetate is a synthetic opioid used to treat dependence on opioids. Using cannabis in tandem with levomethadyl acetate may lead to increased side effects such as drowsiness, dizziness, light-headedness, confusion, depression, low blood pressure, slow or shallow breathing, and impairment in thinking, judgment, and motor coordination. Sever reactions may result in coma or even death on some occasions.
Sodium oxybate is a prescription drug that is used to treat excessive daytime sleepiness (EDS), which is a condition associated with narcolepsy. Side effects related to mixing sodium oxybate with cannabis are similar to those listed for interactions between levomethadyl acetate and cannabis. There is a potential for increased side effects of levomethadyl acetate such as drowsiness, dizziness, light-headedness, confusion, depression, low blood pressure, slow or shallow breathing, and impairment in thinking, judgment, and motor coordination. Occasionally, severe reactions may result in coma and even death.
The interesting thing is that the first three pharmaceuticals in this list can actually be replaced with cannabis instead of using both in tandem and risking increased side effects. Cannabis has been found to alleviate various kinds of pain, from acute to mild and chronic. There are also studies that provide evidence that cannabis can help wean opioid addicts off of their dependencies with little to no side effects and zero recorded deaths. As of right now, conventional wisdom in the pharmaceutical world says to replace a natural opioid with a synthetic one to cure opioid addiction. However, this also means there is potential to replace a natural opioid addiction with a synthetic one, since synthetic opioids are just as addictive as their natural counterparts. All three of these synthetic opioids are listed as having a high risk for dependency, whereas cannabis has none. Furthermore, there are 18,893 overdose deaths in the United States from prescription synthetic opioids that are meant to cure natural opioid addiction, whereas the death toll for marijuana continues at a steady zero.
However, if you are taking any of the above listed pharmaceuticals, it is absolutely imperative that you take note of these potential major interactions. Just like any drug, cannabis can cause increased side effects when mixed with another drug, so it’s important that you speak to your health care professional or do the research before you start combining your pharmaceutical medication with your herbal medication.
If you have further questions about drug to drug interactions, you can speak with one of our medical professionals here.