How Cannabis Interacts With Other Drugs

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How Cannabis Interacts With Other Drugs

Practically all chemical compounds, from prescription and over-the-counter to illegal drugs, can interact with other compounds. For instance, scientists identified 82 different drug interactions with caffeine, 25 of which have been classified as moderately severe to severe. Even seemingly harmless substances that aren't normally seen as anything other than food, like grapefruits, are known to interact (increasing drug levels in the blood) with a lot of prescription drugs. Most identified and potential interactions, when it comes to cannabis, are relatively mild, and some drugs even seem to work favorably together with cannabis.

Before diving into some of the drugs that are most commonly combined with cannabis, it is important to understand the two different interaction effects, additive and synergistic.

An additive effect is when the interaction between the two (or more) chemicals result in an effect as if only one drug was given, for example, this is commonly seen when people are given multiple drugs before surgery to relax a patient, 1 + 1 = 2.

Synergistic effects are more like 1 + 1 = 5, where the interaction between the two (or more) chemicals causes an effect greater than the sum of their parts, exaggerating a single effect out of proportion.

Both effects can be found by different CBD/THC ratios and strain profiles because cannabinoid and terpene profiles are variable.

Note: Cannabis can increase effectiveness or potency of other drugs in some cases. Even if the interaction could be beneficial, a medical professional should be closely monitored regularly along with blood work so the patient can adjust their dosing if needed.

Drugs That Affect Blood Sugar Levels

Interestingly, evidence has been found that suggests cannabis may improve blood sugar control and the metabolic process while decreasing insulin resistance. As well as finding lower rates of diabetes and obesity in cannabis users compared to non-users. However, a lot of the evidence comes from large epidemiological studies analyzing general patterns, such as causes and effects of several health conditions in specific populations, and very few studies have zoomed in specifically on how CBD, THC, and other cannabinoids interact with other drugs that are known to affect blood sugar, like insulin.

What happens if you use marijuana with Insulin meds?

Even though there is no conclusive evidence, cannabis may work favorably when mixed with other drugs, but there could also be risks of lowering glucose levels too much when combining with other drugs. Obviously, these effects should be continuously monitored, under medical supervision, to adjust medications appropriately and reduce potential risks.

Drugs That Lower Blood Pressure

What happens if you use marijuana with blood pressure meds?

Cannabis has been found to reduce blood flow in coronary arteries. It is able to do this because THC activates both the CB1 and CB2 cannabinoid receptors simultaneously. In doing this, it causes cardiovascular stress responses that help the heart use more oxygen, reducing coronary artery blood flow. Patients taking blood pressure meds should be mindful that cannabis could compound its effects, although adverse reports are relatively rare.

Drugs That Increase Risk of Bleeding

What happens if you use marijuana with drugs like Warfarin, Heparin, Naproxen, Ibuprofen, etc.?

CBD and THC have both shown they may increase blood thinning drug effects, such as Heparin or Warfarin, as well as other drugs that already have the risk of blood thinning, like Naproxen or Ibuprofen. This could be due to these drugs slowing the metabolism down. To a lesser extent, THC could cause a displacement in protein binding sites of Warfarin.

Opioids

A lot of the studies that have been done suggest a relationship between the body's endocannabinoid system and the natural opioid system known as a bi-directional modulatory. The challenge has come when trying to prove how the specific mechanisms interact, but one property that has been well-established is cannabis' ability to relieve pain. Many medical professionals and now states are coming forward to suggest patients start using cannabis as an alternative to pain meds believing it could curb the overuse or illegal and prescription opioids.

There are no questions that substituting narcotic medications with cannabis could be safer and more beneficial for managing chronic pain from an abuse and toxicity perspective, but what about using it alongside an opioid?

What happens if you use opioids with marijuana?

In 2011, a small study was published by an oncologist from UC, San Francisco, Dr. Donald Abrams, and his team. The study has shown no real change in the concentration of opioid levels in the blood after exposure to cannabis. Furthermore, patients even reported a decrease in pain by 27% following cannabis administration.

It was concluded that using cannabis with an opioid (ONLY when monitored by a physician) can, in fact, safely boost pain-relief. This may also allow patients to be treated with a lesser dose of opioids, in turn, reducing dependency and side effects. Several other studies also support these findings and will be discussed later on.

Alcohol

Using alcohol with basically any drug is usually not a good idea. As alcohol is legal, it is probably the most used drug that people combine with cannabis. What happens if you use alcohol and marijuana?

Using research that is currently available, drawing an overall conclusion is pretty much up to personal biases and interpretation. Depending on your perspective, the same studies could be interpreted both negatively or positively.

One may focus on the studies providing solid evidence that alcohol will increase blood THC levels. There is no evidence to suggests the opposite of THC increasing blood alcohol levels, but on the other side, people focus on the research that shows people consuming less alcohol when using cannabis.

With these two findings, it's not one or the other, they both rely on the other. If THC responds to alcohol by increasing THCs desired effects on mood, then the user wouldn't need as much alcohol.

Definitely more studies need to be done but way back in 1985, there was a small study published, Alcohol and Marijuana: Concordance of Use by Men and Women, by the NIDA (National Institute on Drug Abuse). It focused on the differences in consumption patterns when only cannabis is available, only alcohol is available, and when both cannabis and alcohol are available.

They found that when given the option of using both alcohol and cannabis, 14 out of 16 subjects drank far less alcohol compared to when they only had the option of alcohol. 12 out of the 16 subjects also used a little more cannabis with the option of both as compared to only cannabis being available.

We can't really generalize this to the greater population because it was a small study and more needs to be done, but it does seem to be a consistent pattern. When people have the option of both alcohol and marijuana, their patterns of consumption change: they smoke a bit more while drinking a lot less!

These are both still mind altering drugs and users still need to be cautious. They both cause risks while driving and put together those risks are greater. Cannabis also prevents nausea and vomiting so if your body needs to expel toxins by vomiting because of drinking too much, it will inhibit it and can put you at a very high risk of suffering from alcohol toxicity and can cause death.

Doctors do not suggest using both alcohol and marijuana at the same time.

Sedatives

Many sedatives produce calming effects by interacting with GABA neurotransmitters in the bodies central nervous system. Some examples of these sedatives are alcohol, some antidepressants, barbiturates (phenobarbital), benzodiazepines (Valium, Ativan, etc.), and narcotics (codeine).

Cannabinoids such as THC, CBD, and terpenes, can also produce calming effects. Each cannabinoid produces these effects differently. CBD and certain terpenes can be both wake-inducing and calming, and THC used in too high of a dose can actually do the opposite increasing anxiety and be a stimulant.

What happens if you use marijuana with sedatives?

Cannabis seems to produce an additive effect when combined with a sedative. They both provide a sedative effect that could compliment each other. There's no evidence that shows cannabis to elevate blood levels or increase sedative effects, but the combination should still be avoided as most sedatives are prescribed in a specific dose to produce the best, most desired effects.

In Summary

Cannabis is well-tolerated and relatively safe for most patients as it contains fewer risks of conflicting drug interactions than a lot of other commonly prescribed drugs have. However, cannabis is a complex plant, not a single drug, and is made up of a variety of compounds including cannabinoids and terpenes. Both potentially good and bad interactions are influenced by each plants profiles and can vary from each strain. Given that it is complex and not a single drug, cannabis' versatility therapeutically has become more common among doctors who would rather prescribe one medicine instead of multiple that have a higher risk of clashing and causing other ailments.

5 years ago
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