How Does Cannabis Interact With Other Drugs?

By Canncentral Editor

2019-11-19

Nearly all pharmaceutical, off-the-shelf, and illicit drugs have an interaction in some way or another with other compounds. To date, 82 drug interactions exist with caffeine alone. Even more surprising is that 25 of those 82 are considered to be moderately severe to very severe. As harmless as a grapefruit might seem, it is known to have interactions with many prescription medications. Fortunately for cannabis users, many of the interactions that are said to occur are fairly mild or even may have a beneficial outcome. It is still always good to know what potential interactions may occur and to consider what common drugs people tend to take while possibly under the effects of cannabis.

Looking a little deeper, it’s useful to know what “synergistic” and “additive” mean. Additive means that when there is an interaction between two chemicals, it equals the sum of their parts. An example of this is adding 1 and 1 equals 2. Synergistic on the other hand means when two chemicals interact, the resulting effect is more than the sum of these parts. Whereas in the previous example with additive being 1 and 1 equalling 2, synergistic would be equalling 3. With THC and CBD ratios being different along with their strain profiles, this can create an influence on the effects. There are some instances where marijuana can even increase the effect of some drugs. Dosing then becomes even more important in instances such as this because if there is an interaction and one smoke way more than what they are used to, it can potentially lead to unpleasant effects. When someone has a headache and is also high, their first instinct would probably be to grab the ibuprofen. But then the first question raised in their minds is if ibuprofen and weed interact. 

Sugar Levels Being Affected By Certain Drugs

Some research out there states that marijuana can lower insulin resistance, benefit sugar control, and have a positive effect on metabolic processes. But it appears that most of the research comes from huge studies that look into certain patterns such as the cause and effect of certain medical conditions in certain groups of people. There have been some studies out there indicating that marijuana users have lower rates of diabetes and obesity in comparison to people that don’t use it at all. There have been very few studies done on how specific cannabinoids interact with drugs that have an impact on insulin, though. On a different note, if cannabis is mixed with drugs that lower these insulin levels too much, it could have unfortunate negative consequences. As with all things, it is the best approach to keep a close watch for any effects and correct the dosing accordingly. 

Medication For The Lowering Of Blood Pressure

A certain effect of THC is that it triggers both the CB1 and CB2 cannabinoid receptors at the same time. With both of these receptors being activated, it causes a cardiovascular response that increases oxygen consumption and at the same time, lowering blood flow in the coronary arteries. Even though negative circumstances like this are fairly rare, it is good to keep this in mind if you are taking medication to lower blood pressure. 

Drugs That Cause Elevated Risk Of Bleeding 

CBD and THC can elevate the effect of some drugs that are used for the thinning of the blood. Examples of this are warfarin, heparin, and drugs like ibuprofen and naproxen which have the risk by themselves of thinning out the blood. THC is said to displace warfarin from protein binding sites.

Opioids

There is consistent research that concludes that a bidirectional modulatory relationship exists between one’s natural cannabinoid system and the opioid system, which is also called the endocannabinoid system. But there are still challenges in figuring out just how they interact. Regardless, there are well-documented results of how cannabis can reduce pain and inflammation in the body. Many medical professionals even suggest using marijuana as an alternative pain management as opposed to the abuse of pain medication or further, illicit drugs. Illicit drugs are far easier to abuse and contain a host of far worse consequences than cannabis, so it comes as no surprise as to why it would be preferable. 

The question of how marijuana compares to opioid therapy still exists. As well, the question remains if cannabis can even reduce one’s reliance on opioids or if mixing the two would just be a disaster. 

Dr. Donald Abrams, who is an oncologist from UC, San Francisco, studied the effects of vaporized marijuana in combination with opioids in 2011. There were no significant changes found in blood level concentrations of opioids after exposure to marijuana. Patients actually reported a 27% lowering of their pain after marijuana administration. The conclusion to this research was that cannabis can work in conjunction with the pain-reducing effects of using opioids. It was also found that combining the two can help lower the dosage of opioids and in the end, this would lower dependency and have fewer side effects. This isn’t the only study that found these results either. 

With alcohol, it is usually never a welcome idea to mix with medication. Mixing alcohol with certain drugs like benzodiazepines, sleep medication, and barbiturates can even kill you. It leads many to the question if you can mix alcohol with marijuana safely? You have probably seen it done many times before at parties, but what exactly do the studies reveal? With so many studies out there these days, you will find some that say it’s positive, and some that say it’s negative. Some studies have concluded that alcohol can increase the THC levels in your blood, while other studies say that most people drink less alcohol when under the effects of cannabis. The results do tend to appear sensitive because if THC reacts to alcohol by altering wanted effects on your mood, then you would need to drink less. One study that was published by the National Institute on Drug Abuse tested the consumption differences in three completely different settings where the first one being alcohol only available, second being marijuana available, and third having both available. It found that 14 out of 16 participants drank less alcohol when both marijuana and alcohol were available in comparison to when only alcohol was available. 12 out of 16 participants used more weed when both were available in comparison to when only weed was available. This study revealed that when both substances are at your fingertips, patterns of consumption significantly change. Even though it was a smaller study, it does hold some value. 

Caution is still urged to anyone that uses alcohol and cannabis together. If someone is intoxicated to the point that they are needing to vomit, then this could be an issue because cannabis can inhibit vomiting. This could, in turn, cause alcohol toxicity. 

What To Know About Sedatives And CBD

Most sedatives are known to provide a calming effect. They all have an effect on the central nervous system and this is why they can become addictive or overly used by some people. Both CBD and THC too have a calming effect and can produce a sedative type of state. With THC and CBD, it all depends on the dosing, kind of similar to some medication. If you have a higher dose of THC, this can cause one to have anxiety and be excited. CBD, on the other hand, can be calming and exciting as well. If cannabis is combined with sedatives, it creates a larger effect. Because cannabis produces an additive effect, it can still be daring to mix the two. Though not as risky as mixing alcohol with sedatives, one should still be wary and approach with caution.

Cytochrome P450

Cytochrome P450 is considered to be an enzyme that has an important role in drug interactions. Most of the literature states that CBD is fairly safe and not addictive, but in some people taking some medications, it can cause various issues. The conjunction between CBD and cytochrome P450 appears to come into play in most cases between anti-seizure medications and epilepsy. There was a study compiled in 2015 that revealed that CBD raised the blood concentrations of the medication called clobazam. The overall fix for this would be to lower the dosage of clobazam, and that would lower the side effects. Out of 13 subject participants, all but 4 had a 50% reduction in seizures. The conclusion of the study stated that the combination of CBD and clobazam is a safe and efficacious treatment for epilepsy of the refractory type.

Because CBD breaks down blood thinners, patients need to be cautious and work with their doctor to recognize changes in blood levels. Chemotherapy patients need to be cautious as well because they could face higher blood concentrations. In the end, marijuana is considered to be fairly safe and well-tolerated by most people. It carries lower drug interactions than prescription medications, and it is just a plant that contains many different compounds. Each strain will have its own set of effects, depending on which drug it interacts with. It is difficult to pinpoint exactly what will happen when mixing cannabis and drugs because many of the interactions have not been closely studied. There have been arguments that cannabis can lower the need in having to combine many different medications that could potentially interact because it does so many things. Dr. Donald Abrams has questioned what would be the point in writing so many various medications that could potentially interact with each other when he could just write one?

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