Marijuana - medication interactions - thoughts?

Trauma Columnist · Aug 10, 2017

You bring up a very good point.

JustKeepDriving · Aug 10, 2017

Probably the best presentation I've seen on it is: https://doh.dc.gov/sites/default/files/dc/sites/doh/publication/attachments/Medical%20Cannabis%20Adverse%20Effects%20and%20Drug%20Interactions_0.pdf - District of Columbia Department of health on medical cannabis averse effects and drug interactions

Cytochrome P45 enzymes involved in the metabolism of tetrahydrocannabinols and cannabinol by human hepatic microsomes. - PubMed - NCBI - Article citation on THC and CBN CYP450 Interactions that's also helpful

I'd also check out Scientific Publications as they have a whole center for medicinal cannabis research.

WestCoastSunRN, MSN, CNS · Aug 10, 2017

Good for you -- for being a provider who wants to know about this. Sadly many many users are under the age of 26 -- with still-developing brains. And there is not very much public education, if any, about the great many down-sides to marijuana use. It's the new ETOH, but we know less about it -- and yet we know enough that users should be proceeding with caution. But many kids aren't thinking about how their IQ and executive functioning may be affected, or how they may not be employable in a job of their choosing or one they are trained for if they use marijuana. It is being touted as a harmless herb -- completely natural with little to no adverse side effects -- or "no different than alcohol", or "better for you than alcohol". But regardless of how it compares to alcohol as a recreational drug, it certainly need to be closely examined --- and yes, especially in the way it may alter or potentiate other herbs, meds and supplements, not to mention the effect on developing brains (which make up a large part of the population fascinated with it)

Zyprexa · Aug 11, 2017

A majority of my psych patients use marijuana, some end up admitted for psychosis when it turns out they've just been using spice (synthetic marijuana). Super dangerous...I've had patients so delusional they've jumped off bridges/run into traffic and had serious, life threatening injuries. Some become so violent their families call the police. One patient on spice beat up his little brother so badly the kid ended up in PICU with severe head trauma. Even regular marijuana clouds judgement, we don't even know yet what the long term effects are. It's scary and stupid how people think this drug is safe. Heroin was thought to be a "safer, less addictive" form of morphine over 100 years ago.

MunoRN, RN · Aug 12, 2017

A majority of my psych patients use marijuana, some end up admitted for psychosis when it turns out they've just been using spice (synthetic marijuana). Super dangerous...I've had patients so delusional they've jumped off bridges/run into traffic and had serious, life threatening injuries. Some become so violent their families call the police. One patient on spice beat up his little brother so badly the kid ended up in PICU with severe head trauma. Even regular marijuana clouds judgement, we don't even know yet what the long term effects are. It's scary and stupid how people think this drug is safe. Heroin was thought to be a "safer, less addictive" form of morphine over 100 years ago.

CBD, a major component of marijuana, has shown an ability in early studies to treat schizophrenia including acute episodes as effectively as modern atypical antipsychotics, but without the nasty side effects. What's more important for those with psych histories is the characteristics of the marijuana they are using in terms of the THC to CBD ratio.

Marijuana Compound May Beat Antipsychotics at Treating Schizophrenia | Psych Central News

Cannabidiol, a Cannabis sativa constituent, as an antipsychotic drug. - PubMed - NCBI

Cannabidiol enhances anandamide signaling and alleviates psychotic symptoms of schizophrenia. - PubMed - NCBI

Cannabidiol as a potential treatment for psychosis. - PubMed - NCBI

As to the long term effects, marijuana has actually been in usage longer and in a larger portion of the population than most drugs/medications currently in use, so it's long term effects are relatively well understood.

MunoRN, RN · Aug 12, 2017

As an NP in California, where recreational marijuana use is now legal, I am concerned about possible marijuana-medication interactions. There is a lot of information on ETOH - medication interactions, but I haven't seen specific information pertaining to marijuana. Today, I came across an article suggesting marijuana can increase blood pressure, sometimes fatally (see below), so that suggests HTN patients should not smoke pot. Would greatly appreciate information and/or experiences around this.
Marijuana use holds three-fold blood pressure death risk: study | Reuters

This was a retrospective study that suggested a connection between hypertension and marijuana use with extremely indirect measurements. Oddly, it found no correlation between marijuana use and hypertension endpoints such as stroke and heart attack. When directly measured, marijuana use commonly decreases blood pressure, making the inferred correlation questionable at best.

Not being an RCT, we also don't know what the baseline risk of these folks are. We know there are physiological characteristics that make someone more likely to try and continue using marijuana, some of those characteristics also correlate to an increased risk of high blood pressure.

So we don't know if the marijuana-using-subgroup started out with an increased risk of hypertension of 5% which marijuana use was able to reduce to 3%.