Cannabis is renowned for its broad therapeutic benefits & safety profile due to its low acute toxicity. However, several factors must be considered when evaluating cannabis as an appropriate treatment option.
The legal status of cannabis in the United States is complicated & varies depending on which state you are in, your age, & even the chemical composition of a product.
Cannabis remains illegal at the federal level. However, 48 states & most US territories have passed laws allowing the legal use of medical cannabis in some form for qualifying patients. Most of these states require patients to register to receive legal protections & purchase cannabis from licensed retail outlets. 23 states & DC allow patients or their caregivers to cultivate cannabis for themselves. These programs have limited federal protections, excluding patients who work for or have contracts with the federal government, patients who live in Section 8 housing, veterans receiving care from the VA, & individuals in hospitals or hospice programs that depend on federal funding.
In 2018, Congress redefined hemp as cannabis with less than .3% THC. This has created a market of unregulated “hemp-derived” products such as CBD & THC delta 8. However, while legal under federal law, many states consider these products illegal under state law unless produced & sold through a licensed producer because the FDA has not approved their use in food & beverages or as a dietary supplement.
Cannabis therapeutics can help with a variety of medical conditions and their symptoms. However, several factors could create serious health issues for individuals using cannabis, such as intensifying symptoms of other underlying conditions and disorders and drug interactions. Your medical professional may not be aware of these issues, so be prepared to educate not only yourself but also your medical professional when considering if cannabis therapeutics is the best treatment for you!
SURGERY: Cannabis affects the central nervous system & acts as a blood thinner, which can impact surgical procedures & recovery. Patients should inform their healthcare providers & potentially refrain from using cannabis before surgery.
MENTAL HEALTH: Individuals with schizophrenia can experience exacerbated symptoms due to cannabis use, necessitating careful evaluation before consumption.
CARDIOVASCULAR: Cannabis can cause rapid heartbeat & fluctuations in blood pressure, making it essential for individuals with heart disease to exercise caution.
ORGAN TRANSPLANT RECIPIENTS: Individuals who have received organ transplants should be cautious due to the presence of Aspergillus, a contaminant frequently found in cannabis, which can lead to complications with transplant rejections. Additionally, drug interactions with tacrolimus may occur, especially in individuals with certain allelic variability in CYP3A. As a CYP3A inhibitor, cannabis may heighten tacrolimus toxicity.
Some employers have strict drug policies that may prohibit cannabis use, even for medical purposes. Unless prohibited by state law, employers can still drug test & discipline their employees for cannabis use. Many products from the “hemp-derived” market have low levels of THC even though their labels claim otherwise.
Cannabis use and home cultivation have been used as ammunition for child custody during divorce proceedings and by child protection services as evidence of an unfit home. Cannabis possession may be a violation of probation or parole and can complicate immigration proceedings.
Cannabis remains illegal at the federal level, which means that state protections are not extended to patients who work for or have contracts with the federal government, patients who live in federally subsidized housing, veterans receiving care from the VA, or patients in hospitals and hospice programs.
Cannabis therapeutics are not covered by insurance. Patients must be prepared to pay "out of pocket" for not only their medicine but often for doctor appointments with cannabis specialists.
Cannabis can be added to treatment plans to enhance efficacy or alleviate side effects associated with other therapies (adjunct treatment). Sometimes, patients may want to replace prescribed medications (substitution treatment). However, transitioning off prescription drugs should be approached with caution & under the supervision of a medical professional.
* To avoid any disruption or complications during a transition period, patients should secure an adequate supply of the specific cannabis product they plan to use in their new treatment regimen to avoid major medical issues.
When multiple drugs are present in the liver, they may compete for enzymes, influencing how they are metabolized. Cannabis can influence how certain drugs are metabolized, which can lead to changes in their effectiveness & side effects. Similarly, some medications can affect how cannabis works in your body.
AVOID CANNABIS: Warfarin, Buprenorphine, & Tacrolimus.
USE CAUTION: Amiodarone Amlodipine (Norvasc) Antimycotics Azole antifungals Calcium Antagonists Diltiazem Hydrochloride (Cartia, Tiazac) Doxycycline Enalapril Maleate (Vasotec) Erythromycin Escitalopram Oxalate (Lexapro) Fenofibrate like (Fibricor, Trilipix), Fluconazole (Diflucan) Fluoxetine Hydrochloride (Prozac) Grapefruit HIV Protease Inhibitors Isoniazid Ketoconazole Lamotrigine (Lamictal) Macrolides (Clarithromycin) Mifepristone Proton Pump Inhibitors (Cimetidine) Verapamil
INCREASES CANNABIS EFFECTS: Clozapine (Cannabis increases effects), Methadone (Cannabis increases effects), Clobazam (Cannabis increases effects), Chlorpromazine (Cannabis decreases effects), Hexobarbital (Cannabis increases effects), Rifampicin (Decreases cannabis effects), Stiripentol (Cannabis increases effects), Theophylline (Cannabis decreases effects), Valproate (Assess liver function).
SYNERGISTIC DRUG INTERACTIONS: When cannabis is used with opioid pain medications, there may be increased opioid analgesic effects. Cannabinoids may also work synergistically with gabapentin to improve the therapeutic window and effects.
ANTACIDS, ANTIBIOTICS, & IRRITABLE BOWEL SYNDROME (IBS)—The use of antacids and antibiotics, as well as individuals with gastrointestinal disorders such as IBS, may increase a person's susceptibility to developing Salmonellosis. This unpleasant and potentially fatal illness is caused by exposure to a contaminant frequently found in cannabis, the salmonella bacteria.
PRESCRIPTION DRUGS, PESTICIDES, & HEAVY METALS: Pesticides & heavy metals are often found in cannabis products. The liver & kidneys can typically break down & remove trace amounts of these contaminants from the body. However, several types of prescription drugs impact the body’s ability to properly eliminate these toxins, creating intensified exposure.
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