By Joshua Troncosa
People regard CBD as the go-to pain relief aid when you need something that won’t affect your thinking, will calm inflammation, and will help ease pain and anxiety. There are a number of patients who regularly mix various types of prescription medicines with CBD extracts, tinctures, etc., and do not know that CBD and some medications can have a very tricky relationship. What’s worse, many patients are afraid to visit to their doctor for fear of reprisal or the doctor turning them away. The general public and the medical community’s attitude towards cannabis are changing and a new wave research is finally starting to come out. In keeping with trying to bring you the latest cannabis news here are a couple of examples of interactions being investigated right now. I present these to you in the hopes it gives you a place to open up a conversation with your doctor to learn more about CBD as this research progresses.
Many universities from around the world including; The Hebrew University of Jerusalem, University of California – San Diego, and even our very own University of New Mexico are all in the process of studying how the myriad of different compounds found in cannabis are used by the body to heal itself. This research is also showing that these phyto, or plant-based, cannabinoids work exceptionally well with our own endocannabinoid system. CBD can also work to interrupt the processing and digestion of certain medicines. This is proving positive in terms of helping people with stopping opioid use, but also troublesome with regard to other drugs that break down in the liver and kidneys as well.
Researchers are finding that CBD works extremely well with human liver enzymes and it is metabolized quickly and efficiently, lending CBD the potent abilities it expresses to us. Researchers are also finding out that some liver enzymes prefer CBD over most commercial synthesized medicines such as barbiturates, opioids, and some anti-seizure and anticonvulsant medications. CBD in some cases inhibits some liver enzyme production that has to do with breaking down and digesting certain drugs. It is being shown in some research that cannabis works so well at binding with sites that it prevents our bodies from breaking down and using other pharmaceuticals; this cause those drugs to stay in the body longer until the CBD can be digested first and then the other drugs.
Adrian Devitt-Lee has an excellent article on Project CBD which details how CBD can affect a liver enzyme family called Cytochrome P450. This is one interaction that can lead to drugs staying in our systems longer and putting a heavier strain on the kidneys and livers which digest those drugs. This means those of us who rely upon pharmaceutical assistance need to keep a vigilant eye on our systems and need to openly communicate with our healthcare professionals about our cannabis use. We also need to encourage and help our healthcare workers gain access to new tools and research that conventional medicine or journals may discourage or limit access too.
The people at the cutting edge of getting this information to patients are the cannabis nurses and doctors. Many dispensaries are now keeping RN’s, nurse practitioners, knowledgeable assistants, and more on staff to help answer the variety of questions patients may have. They do their best to keep reading the scientific and medical journals being produced by large universities and institutions to be able to present this information in an easy to understand language.
A great deal of people share the concern that if they bring this up to their doctors, then they will have their treatment interfered with. This has been true in special cases, with the DEA putting a tighter grip on physicians who prescribe both opioids and cannabis to the same patients, also to the patients who take large doses to maintain function- in the hope that it curbs illegal prescription sales. The stigma against opening dialogue with your doctor must be broken, be willing to sit there and talk it out with your doctor so you all can get on the same page, to properly monitor your blood work, and get the best healthcare possible. With the newer understanding that high doses of CBD can affect liver enzyme production, combined with new evidence that the liver gives priority to CBD over most prescribed medicines it is important to make sure your doctor keeps a good eye on your medicine levels in your blood to keep you in the best of health.
I’m going to specify here that what I’m talking about is a very small issue that a small amount of us face. A number of people do not need and do not use a great deal of medicines outside of cannabis as a patient out of personal preference or necessity. There is a large minority though that are disabled and prescribed a wide variety of medications by the doctors to help them get through the day with better functionality. It is to those people I wish to express my concern. I am not a doctor or a certified health professional in any way. I am a nerd who loves to read and tell the tale of what I’ve found. In this case I’ve found some information that leads me to tell you to consult your physician, who is versed in medical language and syntax, about this possible issue and present them some reading material to consult. I write this in the hopes that each of you can find a place to talk about the way CBD interacts with other drugs.
The cannabis industry as an institution is undergoing great growth and is still being battled every step of the way by the federal government. There has been an uncharacteristic rise in marijuana related arrests on the rise the last few years. It is important that we as patients continue to emphasize the importance of cannabis to our productivity and continued success to our physicians. For those of us who require more hands-on care with doctors, remember to have your doctor keep an eye on your blood work with regards to “liver enzyme function” and “latent medication levels.” If your using large doses of CBDs in tincture of other forms make sure to talk to your doctors and regularly get your bloodwork done so they can make sure your liver and kidney function keeps working well and are not becoming overworked by your other meds.
Your doctor will know the best courses of action available to take with regard to your prescription medicines. Make sure to keep them informed of your cannabis intake and the information that you find in your research. Keep getting your regularly scheduled blood work so you and your doctor both can keep an eye on your progress. I hope this article has given you some encouragement to talk to your physician about cannabis and this possible issue – and I hope this helps you get better use out of your medicine.
The weblinks below will start to show you some of this new information.
Useful Web Resources:
Project CBD – “CBD-Drug Interactions: Role of Cytochrome P450” by Adrian Devitt-Lee “https://www.projectcbd.org/science/cannabis-pharmacology/cbd-drug-interactions-role-cytochrome-p450”
US National Library of Medicine – National Institutes of Health “An Update on Safety and Side Effects of Cannabidiol: A Review of Clinical Data and Relevant Animal Studies” by Kerstin Iffland* and Franjo Grotenhermen “https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5569602/”
Center for Medicinal Cannabis Research at UCSD “https://www.cmcr.ucsd.edu/”
Cannabinoids Research Multidisciplinary Center – The Hebrew University of Jerusalem “https://cannabinoids.huji.ac.il”
