In April 2018, Joanne shot heroin for the last time after six years of active addiction. During that time, she made numerous attempts at sobriety but each time she faced the same roadblock when she sought outpatient treatment: “They told me I wasn't allowed to smoke weed which made me feel like I was just destined to fail, and I did rather quickly.” Addiction treatment professionals have begun implementing new protocols including harm reduction and medication-assisted treatment, but like Joanne experienced, most treatment programs completely ban cannabis use. This means that if the program discovers that a patient is using cannabis, the patient will most likely get kicked out. The stigma against cannabis use persists, especially when combined with the stigma people with addictions already face. New studies, however, are showing how cannabis can actually support people in their journey to recovery. This might surprise you, but I’ll explain… What is Addiction? The American Psychiatric Association (APA) defines addiction as “compulsive substance use despite harmful consequences.” Medical and mental health professionals refer to drug addiction as substance use disorder. The Diagnostic and Statistical Manual of Mental Disorders (aka “the therapists’ bible” or DSM-5), defines eleven criteria to determine if a person should be diagnosed with substance use disorder. Substance use disorders span a wide variety of problems arising from substance use. The eleven symptoms include: Taking the substance in larger amounts or for longer than you're meant to. Wanting to cut down or stop using the substance but not managing to. Spending a lot of time getting, using, or recovering from use of the substance. Cravings and urges to use the substance. Not managing to do what you should at work, home, or school because of substance use. Continuing to use, even when it causes problems in relationships. Giving up important social, occupational, or recreational activities because of substance use. Using substances again and again, even when it puts you in danger. Continuing to use, even when you know you have a physical or psychological problem that could have been caused or made worse by the substance. Needing more of the substance to get the effect you want (tolerance). Development of withdrawal symptoms, which can be relieved by taking more of the substance. Addiction as a Public Health Epidemic As the opioid epidemic has devastated communities throughout North America, members of the public have pushed for greater awareness and understanding of addiction as a public health issue. Activists and public health experts advocate for expanded access to substance use treatment and more compassionate approaches to people who struggle with addiction. Harm reduction and medication-assisted treatment are two of these approaches. Harm Reduction Treatment Harm Reduction emerged as a public health approach to substance use during the HIV/AIDS epidemic. It was discovered that injection drug users were contracting the virus by sharing needles and other supplies used to inject. Public health and medical professionals as well as members of the activist group ACT UP advocated for and set up needle exchange programs where people could receive sterile syringes, bleach, and other supplies used to inject substances. Advocates for syringe exchanges refer to the practice as “harm reduction” because the programs reduced the likelihood that their participants would share used syringes and contract HIV. The Harm Reduction Coalition defines harm reduction as: A set of practical strategies and ideas aimed at reducing the negative consequences associated with drug use. Harm Reduction is also a movement for social justice built on a belief in, and respect for, the rights of people who use drugs. The concept of harm reduction has been embraced to address other public health crises as well. Other examples of harm reduction include distributing Narcan, the opiate overdose reversal drug, and drug checking kits, which allow people to see if the drugs that they are about to consume have been contaminated with other substances like fentanyl. In essence, harm reduction accepts that people use substances and aims to help them be as safe as possible without pressuring them to stop using altogether. Medication-Assisted Treatment The concept of medication-assisted treatment (MAT) isn’t actually all that new. Professionals and patients living with substance use disorder have been advocating for expanded access to MAT for years. So what is MAT? The Substance Abuse and Mental Health Services Administration (SAMHSA) defines MAT as “the use of FDA-approved medications, in combination with counseling and behavioral therapies, to provide a ‘whole-patient’ approach to the treatment of substance use disorders.” While in the past people have described these medications as “substitutes” for opioids or alcohol, MAT is an evidence-based approach to substance use treatment that encompasses counseling and therapy in addition to medications to help individuals in their recovery. Critics of maintenance medications like methadone and buprenorphine believe that people on MAT are not truly in recovery. They argue that maintenance doesn’t count as sobriety because methadone and buprenorphine are opioids, even though methadone and buprenorphine work differently than opioids like Heroin and Fentanyl and are taken under the supervision of medical professionals. Unfortunately, the stigma towards MAT discourages people from pursuing it as a treatment option. These misconceptions, however, do not change the fact that overwhelming evidence shows that MAT “at least doubles” the rate at which people in treatment for opioid use disorder stay sober (including people who have relapsed in the past). Can cannabis be a form of medication-assisted treatment? As states across the nation have legalized and established medical cannabis programs, more researchers are investigating the potential uses of cannabis for pain management and mental health. Unfortunately, the federal government does not recognize cannabis legalization and the DEA still categorizes marijuana as a Schedule I substance with “no currently accepted medical use and a high potential for abuse.” As a result, scientists who want to research the potential medical uses of cannabis face a number of legal and institutional barriers because the government has historically supported research that demonstrates the health and social risks of cannabis. The government’s view that cannabis has a “high potential for abuse” makes conducting research on the potential role of cannabis in substance use treatment even more difficult. In spite of these obstacles, several preliminary studies conducted in recent years have shown cannabis’s potential to assist in substance use treatment and recovery. Fortunately these restrictions don’t exist in other countries where various studies are ongoing. A 2016 study conducted in Canada surveyed 473 Canadian medical cannabis patients to collect data on patients’ medical conditions, cannabis use patterns, and if they have substituted cannabis for prescription medications, alcohol, and/or illicit substances. As a follow-up, participants were asked to rank six possible reasons why they used cannabis in place of other medications or substances. The study found an association between patients who had received substance use treatment and those substituting cannabis for “illicit substances.” This connection demonstrates that cannabis has assisted some patients in successfully reducing or eliminating their substance use. Another survey of medical cannabis patients in Canada similarly showed participants substituting cannabis use- 44.5% instead of alcohol, 35.5 instead of opioids, and 26.6% instead of other illicit substances. Additionally of the respondents who substituted cannabis for opioid use, 60% of them reported discontinuation of opioid pain medications with cannabis to manage their pain. These studies show that cannabis consumers have found success in using cannabis as a way to address substance abuse. However the use of surveys has a number of limitations. Additional studies specifically focusing on cannabis as a form of medication-assisted treatment are needed to demonstrate the benefits and risks. Beyond research, people in recovery from substance use disorder have shared about how cannabis helped them transition off of other substances and achieve long term recovery. While these stories are no substitute for rigorous scientific research, they could raise awareness among treatment providers and the public as a whole about cannabis’ potential role in recovery. Finding Long Term Recovery through Cannabis Joanne felt discouraged by her experiences in treatment settings: “By the time I was 20 and had been arrested twice for drug-related crimes, I had tried entering an outpatient detox/rehab four times, all with no ‘success’…the only collective time I spent sober during that time was when I would spend a month or so smoking weed and not telling my rehab, until I was told to quit or be kicked out.” For Joanne, abstaining from heroin and cocaine was no easy feat, but the treatment programs discounted her achievements because she was consuming cannabis. Shortly after her fourth attempt at treatment, Joanne spent a year in prison on drug-related charges. She used heroin and suboxone throughout her sentence. When she returned home, Joanne decided to abstain from drugs entirely, including cannabis. After a month of abstinence, Post Traumatic Stress Disorder, and Post Incarceration Stress Disorder, Joanne returned to using cannabis to manage heroin craving and trauma. “This helped me to not go to pick up a rig and dope simply because I was using something far less harmful than any of the drugs I actually wanted,” she said. For Joanne, cannabis was medicinal and a form of harm reduction. On her rocky road to recovery, Joanne was initially able to stay off of heroin and cocaine for 6 months by using cannabis. The next and final time she sought treatment in April 2018, Joanne was prepared to advocate for herself. She knew that her cannabis consumption had helped her stay sober and engaged in treatment in the past. She recognized that compared to injecting heroin or cocaine, her cannabis use was undeniably safer. “I told them I was willing to do Vivitrol shots if I was able to smoke weed during the duration of rehabilitation at their center. Vivitrol has no effect on cocaine use which was my main fear for relapse,” Joanne pointed out. “They told me they would allow it, but I wouldn’t get a certificate of completion and would never fully graduate from the program. I was told to not speak about it in groups even if I found it helpful for me and wanted to discuss it.” Joanne accepted these terms and completed her program, albeit without a graduation certificate or pizza party. She has been sober for over 2 years and continues to use cannabis to manage her cravings and mental health symptoms, which she refers to as her "marijuana maintenance program.” While she did not need a certificate or party to validate her recovery, she expressed frustration and sadness with how the mainstream treatment and recovery world views her approach. Julia and others who use cannabis for harm reduction or MAT treatment continue to hide their use from the rest of the recovery community. Various meetings and recovery events necessitate “total abstinence” as part of their tenet. “Because of my use of weed, I can't necessarily speak openly in recovery groups or 12 step meetings or in IOPs, and it’s devastating that I can't clearly speak out about my success because it's due to the use of a somewhat ‘illegal’ drug.” Julia made a point to say that cannabis use in recovery does not work for everyone. “I always suggest to folks who want to continue smoking weed in active recovery to do so if they see that it doesn't hinder any progress. And once it doesn't work, to switch it up and find other forms of recovery that work for them! It’s an ongoing process even for me, finding the right dose and making sure that I don't allow it to control my life the way heroin and cocaine did.” Cannabis has the potential to become addictive, so people who use it in recovery should be mindful of the signs of substance use disorder described at the beginning of this post and whether their cannabis use is interfering with other aspects of their lives. Additionally, Tetrahydrocannabinol (THC) consumption is not recommended for people who experience or are at risk for psychosis. Policy Change and More Research on Cannabis is Necessary Joanne’s story of attaining sustained recovery through cannabis use demonstrates the life changing potential of cannabis in substance use recovery, but it also shows the barriers that cannabis consumers experience when seeking addiction treatment. Cannabis has the potential to help people struggling with addiction, but cannabis prohibition and the dominance of the abstinence-based model prevent people from accessing the treatment that works for them. The overdose epidemic warrants a new approach to substance use treatment as tens of thousands of people continue to die of fatal overdoses every year. Advocating the US government to reschedule (or de-schedule) cannabis will create more opportunities for experts to research how cannabis can help support substance use treatment. Do you want to reduce the stigma of cannabis use and medication assisted treatment in recovery? Share this post and start the discussion with your friends and family. If you think that cannabis should be de-scheduled, look up your elected officials’ stances on the matter and lobby them for change.
Rebecca Dayan

written by

Rebecca Dayan

LJG 2021

reviewed by

Laura Geftman, LCSW

Rebecca Dayan

written by

Rebecca Dayan

LJG 2021

reviewed by

Laura Geftman, LCSW

In April 2018, Joanne shot heroin for the last time after six years of active addiction. During that time, she made numerous attempts at sobriety but each time she faced the same roadblock when she sought outpatient treatment: “They told me I wasn’t allowed to smoke weed which made me feel like I was just destined to fail, and I did rather quickly.”

Addiction treatment professionals have begun implementing new protocols including harm reduction and medication-assisted treatment, but like Joanne experienced, most treatment programs completely ban cannabis use. This means that if the program discovers that a patient is using cannabis, the patient will most likely get kicked out.

The stigma against cannabis use persists, especially when combined with the stigma people with addictions already face. New studies, however, are showing how cannabis can actually support people in their journey to recovery. This might surprise you, but I’ll explain…

What is Addiction?

The American Psychiatric Association (APA) defines addiction as “compulsive substance use despite harmful consequences.” Medical and mental health professionals refer to drug addiction as substance use disorder. The Diagnostic and Statistical Manual of Mental Disorders (aka “the therapists’ bible” or DSM-5), defines eleven criteria to determine if a person should be diagnosed with substance use disorder. Substance use disorders span a wide variety of problems arising from substance use. The eleven symptoms include:

  1. Taking the substance in larger amounts or for longer than you’re meant to.
  2. Wanting to cut down or stop using the substance but not managing to.
  3. Spending a lot of time getting, using, or recovering from use of the substance.
  4. Cravings and urges to use the substance.
  5. Not managing to do what you should at work, home, or school because of substance use.
  6. Continuing to use, even when it causes problems in relationships.
  7. Giving up important social, occupational, or recreational activities because of substance use.
  8. Using substances again and again, even when it puts you in danger.
  9. Continuing to use, even when you know you have a physical or psychological problem that could have been caused or made worse by the substance.
  10. Needing more of the substance to get the effect you want (tolerance).
  11. Development of withdrawal symptoms, which can be relieved by taking more of the substance.

Addiction as a Public Health Epidemic

As the opioid epidemic has devastated communities throughout North America, members of the public have pushed for greater awareness and understanding of addiction as a public health issue. Activists and public health experts advocate for expanded access to substance use treatment and more compassionate approaches to people who struggle with addiction. Harm reduction and medication-assisted treatment are two of these approaches.

Harm Reduction Treatment

Harm Reduction emerged as a public health approach to substance use during the HIV/AIDS epidemic. It was discovered that injection drug users were contracting the virus by sharing needles and other supplies used to inject. Public health and medical professionals as well as members of the activist group ACT UP advocated for and set up needle exchange programs where people could receive sterile syringes, bleach, and other supplies used to inject substances. Advocates for syringe exchanges refer to the practice as “harm reduction” because the programs reduced the likelihood that their participants would share used syringes and contract HIV. The Harm Reduction Coalition defines harm reduction as:

A set of practical strategies and ideas aimed at reducing the negative consequences associated with drug use. Harm Reduction is also a movement for social justice built on a belief in, and respect for, the rights of people who use drugs.

The concept of harm reduction has been embraced to address other public health crises as well. Other examples of harm reduction include distributing Narcan, the opiate overdose reversal drug, and drug checking kits, which allow people to see if the drugs that they are about to consume have been contaminated with other substances like fentanyl. 

In essence, harm reduction accepts that people use substances and aims to help them be as safe as possible without pressuring them to stop using altogether. 

Medication-Assisted Treatment

The concept of medication-assisted treatment (MAT) isn’t actually all that new. Professionals and patients living with substance use disorder have been advocating for expanded access to MAT for years. 

So what is MAT? The Substance Abuse and Mental Health Services Administration (SAMHSA) defines MAT as

“the use of FDA-approved medications, in combination with counseling and behavioral therapies, to provide a ‘whole-patient’ approach to the treatment of substance use disorders.”

While in the past people have described these medications as “substitutes” for opioids or alcohol, MAT is an evidence-based approach to substance use treatment that encompasses counseling and therapy in addition to medications to help individuals in their recovery. 

Critics of maintenance medications like methadone and buprenorphine believe that people on MAT are not truly in recovery. They argue that maintenance doesn’t count as sobriety because methadone and buprenorphine are opioids, even though methadone and buprenorphine work differently than opioids like Heroin and Fentanyl and are taken under the supervision of medical professionals. Unfortunately, the stigma towards MAT discourages people from pursuing it as a treatment option. These misconceptions, however, do not change the fact that overwhelming evidence shows that MAT “at least doubles” the rate at which people in treatment for opioid use disorder stay sober (including people who have relapsed in the past).

Can cannabis be a form of medication-assisted treatment?

As states across the nation have legalized and established medical cannabis programs, more researchers are investigating the potential uses of cannabis for pain management and mental health. Unfortunately, the federal government does not recognize cannabis legalization and the DEA still categorizes marijuana as a Schedule I substance with “no currently accepted medical use and a high potential for abuse.” 

As a result, scientists who want to research the potential medical uses of cannabis face a number of legal and institutional barriers because the government has historically supported research that demonstrates the health and social risks of cannabis. The government’s view that cannabis has a “high potential for abuse” makes conducting research on the potential role of cannabis in substance use treatment even more difficult. In spite of these obstacles, several preliminary studies conducted in recent years have shown cannabis’s potential to assist in substance use treatment and recovery.

Fortunately these restrictions don’t exist in other countries where various studies are ongoing. A 2016 study conducted in Canada surveyed 473 Canadian medical cannabis patients to collect data on patients’ medical conditions, cannabis use patterns, and if they have substituted cannabis for prescription medications, alcohol, and/or illicit substances. As a follow-up, participants were asked to rank six possible reasons why they used cannabis in place of other medications or substances. The study found an association between patients who had received substance use treatment and those substituting cannabis for “illicit substances.” This connection demonstrates that cannabis has assisted some patients in successfully reducing or eliminating their substance use. 

Another survey of medical cannabis patients in Canada similarly showed participants substituting cannabis use- 44.5% instead of alcohol, 35.5 instead of opioids, and 26.6% instead of other illicit substances. Additionally of the respondents who substituted cannabis for opioid use, 60% of them reported discontinuation of opioid pain medications with cannabis to manage their pain.

These studies show that cannabis consumers have found success in using cannabis as a way to address substance abuse. However the use of surveys has a number of limitations. Additional studies specifically focusing on cannabis as a form of medication-assisted treatment are needed to demonstrate the benefits and risks. 

Beyond research, people in recovery from substance use disorder have shared about how cannabis helped them transition off of other substances and achieve long term recovery. While these stories are no substitute for rigorous scientific research, they could raise awareness among treatment providers and the public as a whole about cannabis’ potential role in recovery.

Finding Long Term Recovery through Cannabis

 Joanne felt discouraged by her experiences in treatment settings: “By the time I was 20 and had been arrested twice for drug-related crimes, I had tried entering an outpatient detox/rehab four times, all with no ‘success’…the only collective time I spent sober during that time was when I would spend a month or so smoking weed and not telling my rehab, until I was told to quit or be kicked out.” For Joanne, abstaining from heroin and cocaine was no easy feat, but the treatment programs discounted her achievements because she was consuming cannabis.

Shortly after her fourth attempt at treatment, Joanne spent a year in prison on drug-related charges. She used heroin and suboxone throughout her sentence. When she returned home, Joanne decided to abstain from drugs entirely, including cannabis. After a month of abstinence, Post Traumatic Stress Disorder, and Post Incarceration Stress Disorder, Joanne returned to using cannabis to manage heroin craving and trauma. 

“This helped me to not go to pick up a rig and dope simply because I was using something far less harmful than any of the drugs I actually wanted,” she said. 

 For Joanne, cannabis was medicinal and a form of harm reduction. On her rocky road to recovery, Joanne was initially able to stay off of heroin and cocaine for 6 months by using cannabis. 

The next and final time she sought treatment in April 2018, Joanne was prepared to advocate for herself. She knew that her cannabis consumption had helped her stay sober and engaged in treatment in the past. She recognized that compared to injecting heroin or cocaine, her cannabis use was undeniably safer. 

“I told them I was willing to do Vivitrol shots if I was able to smoke weed during the duration of rehabilitation at their center. Vivitrol has no effect on cocaine use which was my main fear for relapse,” Joanne pointed out. “They told me they would allow it, but I wouldn’t get a certificate of completion and would never fully graduate from the program. I was told to not speak about it in groups even if I found it helpful for me and wanted to discuss it.”

Joanne accepted these terms and completed her program, albeit without a graduation certificate or pizza party. She has been sober for over 2 years and continues to use cannabis to manage her cravings and mental health symptoms, which she refers to as her “marijuana maintenance program.”

While she did not need a certificate or party to validate her recovery,  she expressed frustration and sadness with how the mainstream treatment and recovery world views her approach. Julia and others who use cannabis for harm reduction or MAT treatment continue to hide their use from the rest of the recovery community. Various meetings and recovery events necessitate “total abstinence” as part of their tenet.

“Because of my use of weed, I can’t necessarily speak openly in recovery groups or 12 step meetings or in IOPs, and it’s devastating that I can’t clearly speak out about my success because it’s due to the use of a somewhat ‘illegal’ drug.”

Julia made a point to say that cannabis use in recovery does not work for everyone.

“I always suggest to folks who want to continue smoking weed in active recovery to do so if they see that it doesn’t hinder any progress. And once it doesn’t work, to switch it up and find other forms of recovery that work for them! It’s an ongoing process even for me, finding the right dose and making sure that I don’t allow it to control my life the way heroin and cocaine did.”

Cannabis has the potential to become addictive, so people who use it in recovery should be mindful of the signs of substance use disorder described at the beginning of this post and whether their cannabis use is interfering with other aspects of their lives. Additionally, Tetrahydrocannabinol (THC) consumption is not recommended for people who experience or are at risk for psychosis. 

 Policy Change and More Research on Cannabis is Necessary

Joanne’s story of attaining sustained recovery through cannabis use demonstrates the life changing potential of cannabis in substance use recovery, but it also shows the barriers that cannabis consumers experience when seeking addiction treatment.

Cannabis has the potential to help people struggling with addiction, but cannabis prohibition and the dominance of the abstinence-based model prevent people from accessing the treatment that works for them. The overdose epidemic warrants a new approach to substance use treatment as tens of thousands of people continue to die of fatal overdoses every year. Advocating the US government to reschedule (or de-schedule) cannabis will create more opportunities for experts to research how cannabis can help support substance use treatment.

Do you want to reduce the stigma of cannabis use and medication assisted treatment in recovery? Share this post and start the discussion with your friends and family.

If you think that cannabis should be de-scheduled, look up your elected officials’ stances on the matter and lobby them for change.

American Psychiatric Association. (2013). Substance-Related and Addictive Disorders. 

In Diagnostic and statistical manual of mental disorders (5th ed.).

https://doi.org/10.1176/appi.books.9780890425596.dsm16

 

Connery, H. S., MD, PhD. (2015). Medication-Assisted Treatment of Opioid Use Disorder.

Harvard Review of Psychiatry, 23(2), 63-75. doi:10.1097/hrp.0000000000000075

 

Harm Reduction Principles: National Harm Reduction Coalition. (2020, August 31). Retrieved

September 28, 2020, from https://harmreduction.org/about-us/principles-of-harm-reduction/

 

Lucas, P. (2017). Rationale for cannabis-based interventions in the opioid overdose crisis. Harm

reduction journal, 14(1), 1-6.

 

Lucas, P., Baron, E. P., & Jikomes, N. (2019). Medical cannabis patterns of use and substitution

for opioids & other pharmaceutical drugs, alcohol, tobacco, and illicit substances; results from a cross-sectional survey of authorized patients. Harm reduction journal, 16(1), 9.

 

Lucas, P., Walsh, Z., Crosby, K., Callaway, R., Belle‐Isle, L., Kay, R., … & Holtzman, S. (2016).

Substituting cannabis for prescription drugs, alcohol and other substances among medical cannabis patients: The impact of contextual factors. Drug and Alcohol Review, 35(3), 326-333.

 

Parekh, R., MD, MPH (Ed.). (2017, January). What Is Addiction? Retrieved September 28, 2020,

from https://www.psychiatry.org/patients-families/addiction/what-is-addiction

 

Swartz, R. (2010). Medical marijuana users in substance abuse treatment. Harm Reduction

Journal, 7(1), 3.

 

United States, Drug Enforcement Administration. (n.d.). Drug Scheduling. Retrieved September

28, 2020, from https://www.dea.gov/drug-scheduling

 

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Can Cannabis Play a Role in Recovery? Preliminary Research Says Yes
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HEY NEWBIES- START HERE!

KEEP IN MIND

Stay calm. Canna-curious is cool! But collect some info first.
If you are:

  • under 25 years old
  • taking any medication
  • at risk for heart disease
  • family history of psychosis
  • family history of mood disorders
  • family history of addiction

…please be sure to consult a medical or mental health professional.

NAVIAGTE

EXPLORE

Medical Cannabis Users Beware! Drug Interactions You Need to Know About

LJG 2021

written by

Laura Geftman, LCSW

Hannah Sadock, MS

reviewed by

Hannah Sadock, MS

Brain

written by

Namen Namestein

Brain

reviewed by

Namen Namestein

If using cannabis while taking other medications has you questioning their interaction- I applaud your good thinking. Just like adding a new prescription to your daily medication regimen there is concern for possible drug interactions, which holds true of cannabis as well. Afterall, cannabis is medicine, though to avoid negative side effects and medication counteracting from prescription drugs, cannabis needs to be considered as a potential factor in causing those effects through its process of metabolization resulting in possible effects.

Now, let us break down medication interactions and what you may need to be more aware of when medicating with cannabis. We will review the different kinds of side effects, what to avoid to prevent them, certain kinds of medication you shouldn’t take with cannabis, and other other things to manage adverse drug interactions.

Types of Drug Interactions

As all drugs can cause an array of reactions- some benign and others serious- it is important to know about possible drug interactions. The effectiveness of drugs can be increased or decreased when combined with another drug or substance. These are the threes types of drug interactions take may be cause for concern:

💊 drug-drug interactions occur when two or more drugs react with each other, which includes prescription, over-the-counter, and illicit drugs. This is of utmost concern with drugs that have a narrow range between therapeutic and lethal doses.

💊 drug-food interactions occur when drugs react with foods, dietary supplements and/ or beverages. Some drugs may also interfere with the body’s ability to absorb nutrients. 

💊 drug-disease interactions occur when a drug exacerbates or worsen an existing medical condition. High risk conditions for drug interactions include:

✱ kidney disease 
✱ liver disease 
✱ diabetes 
✱ asthma
✱ cardiac problems
✱ epilepsy
✱ high blood pressure
✱ low blood pressure 

Types of Drug Interaction Effects

Drug interaction predictors enable risk assessment of drugs. The dreaded side effects of medication are actually broken down into three types and it is important to understand the difference between each to know how best to manage them. Here are the definitions and  differentiating factors of additive, synergistic, and antagonistic effects:

✳️ additive effects of drugs produce a reaction created by causative factors acting together as the sum of their individual effects. Simply put- that means the two chemicals work together to equal the sum of their parts. The impact of the two or more drugs together adds scientific value to the predicted outcome. Elements essentially added to each other’s intended outcome chemically and biologically.

✳️ synergistic effects refers to the effect of two chemicals interacting creating a greater reaction than using one individually. The interaction adds to the strength to the effect of the medicine. When chemicals are synergistic, the potential hazards of the chemicals should be considered and re-evaluated.

✳️ antagonistic effects speaks to the instance when two or more drugs are combined to produce a weaker, decreased, or opposite effect on the body. Drug antagonism may block or reduce the effectiveness of one or more drugs.

Cannabis Drug Interactions

If you plan to use cannabis medicinally, chances are you are already on a course of other medication. Common uses of cannabis often include diagnoses of cancer, chronic pain, epilepsy/seizures, nausea and vomiting, muscle spasms, inflammatory conditions, Alzheimer’s, and Parkinson’s diseases. The wide range of uses increases the likelihood of potential drug interactions as most of these diagnoses affect individuals who require numerous medications combinations due to age or illness. All the more reason to review the drug interaction considerations when medicating with cannabis.

The following drug-drug interactions are cause for concern when using cannabis

🚩 opioids may allow for lower opioid doses while reducing risk of dependency and fewer side effects. 

🚩 sedatives (benzodiazepines, antidepressants, barbiturates, narcotics) produces an additive effect with cannabis increasing sedative effects.

🚩 blood sugar medication could be a risk when cannabis is combined as glucose levels could significantly drop causing a medical emergency.

🚩 blood pressure medication may compound effects by activating receptors to induces a cardiovascular stress response that can elevate cardiac oxygen consumption while reducing blood flow in coronary arteries.

🚩 blood thinning medication effectiveness’ may be augmented possibly slowing down the metabolism of these drugs. 

🚩 heart rhythm medication with cannabis may amplify its affect and change the heart rhythm.

🚩 thyroid medication may compete with cannabis in the cytochrome P450 pathways to be metabolized.

🚩 seizure medication may induce seizure if not properly used with cannabis.

🚩 alcohol …uh, yeah. Alcohol is a drug. When combined with cannabis these substances may result in very different reactions depending on many variables including which one you use first and how you consume them. 

There are some drugs that are of utmost concern as their interaction with cannabis could be fatal. Potentially serious drug interactions include:

⚠️ warfarin

⚠️ amiodarone

⚠️ levothyroxine

⚠️ clobazam

⚠️ lamotrigine

⚠️ valproate

Tips to avoid adverse effects from drug interactions

There is clearly lots to know to mitigate the risks involved with drug interactions. To best prepare yourself for medical cannabis use and to decrease the risk of interactions, consider these tips: 

🔹 Know your own medicines. Be sure to read about the medication prescribed and any interactions to consider.

🔹 When you see your doctor, be sure to inform them about all the drugs you are taking. These should include over-the-counter medications, vitamins, dietary supplements, herbal remedies, cannabis, CBD, and any medicinal substance.

🔹 Keep your list of medications up to date, which is particularly important if you visit more than one doctor or pharmacy.

🔹 Ask your doctor or pharmacist what to avoid- medications / food/ beverages…

🔹 Take medication as instructed and learn about possible side effects. Be sure to make your medical providers aware of any side effects you experience.

🔹 Review your medications regularly to eliminate unnecessary ones as interactions increase when medication variety increases.

🔹 Do your own research! Not every doctor and/or pharmacist is up on the latest cannabis info. You, too, can take some responsibility for your treatment. Consider looking up your medicine interactions with MedScape, Drugbank, and any other online resources offering updated info on pharmaceuticals + cannabis.

In Conclusion

Cannabis has the potential to interact with many medications, including over-the-counter medications, herbal products, and prescription medications. Some medications should never be administered in combination with cannabis while others may need modification or reduction to prevent serious issues. Cannabis may increase or decrease the effectiveness or potency of other drugs. Though always consult your doctor before tampering with your regimen. 

All interactions considered, everyone should inform healthcare professionals should be informed of any condition(s) and/ or medications / dietary supplements being administered during a doctor’s visit or when purchasing medicines at the pharmacy. Yup, that means cannabis, CBD, and any form of chemical compound derived from it. Cannabis, like every other medication, must be considered when ANY medical professional is treating you. Stay safe potential cannabis users!

https://news.gallup.com/businessjournal/170696/win-natural-talent-additive-effects.aspx

https://www.fda.gov/drugs/information-consumers-and-patients-drugs/you-age-you-and-your-medicines

Alsherbiny, M. A., & Li, C. G. (2018). Medicinal Cannabis-Potential Drug Interactions. Medicines (Basel, Switzerland), 6(1), 3. https://doi.org/10.3390/medicines6010003

Aronson J. K. (2004). Classifying drug interactions. British journal of clinical pharmacology, 58(4), 343–344. https://doi.org/10.1111/j.1365-2125.2004.02244.x

Cascorbi I. (2012). Drug interactions–principles, examples and clinical consequences. Deutsches Arzteblatt international, 109(33-34), 546–556. https://doi.org/10.3238/arztebl.2012.0546

Jiang R, Yamaori S, Takeda S, et al. Identification of cytochrome P4540 enzymes responsible for metabolism of cannabidiol by human liver microsomes. Life Sci. 2011;89:165-170.

Rebecca L Hartman, Timothy L Brown, Gary Milavetz, Andrew Spurgin, David A Gorelick, Gary Gaffney, Marilyn A Huestis, Controlled Cannabis Vaporizer Administration: Blood and Plasma Cannabinoids with and without Alcohol, Clinical Chemistry, Volume 61, Issue 6, 1 June 2015, Pages 850–869, https://doi.org/10.1373/clinchem.2015.238287

Toennes SW, Schneider K, Kauert GF, Wunder C, Moeller MR, Theunissen EL, Ramaekers JG. Influence of ethanol on cannabinoid pharmacokinetic parameters in chronic users. Anal Bioanal Chem. 2011 Apr;400(1):145-52. doi: 10.1007/s00216-010-4449-2. Epub 2010 Nov 30. PMID: 21116612.

Lukas SE, Benedikt R, Mendelson JH, Kouri E, Sholar M, Amass L. Marihuana attenuates the rise in plasma ethanol levels in human subjects. Neuropsychopharmacology. 1992 Aug;7(1):77-81. PMID: 1326277.

Yurasek, A.M., Aston, E.R. & Metrik, J. Co-use of Alcohol and Cannabis: A Review. Curr Addict Rep 4, 184–193 (2017). https://doi.org/10.1007/s40429-017-0149-8

Ramaekers, J. G., Theunissen, E. L., de Brouwer, M., Toennes, S. W., Moeller, M. R., & Kauert, G. (2011). Tolerance and cross-tolerance to neurocognitive effects of THC and alcohol in heavy cannabis users. Psychopharmacology, 214(2), 391–401. https://doi.org/10.1007/s00213-010-2042-1

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HEY NEWBIES- START HERE!

KEEP IN MIND

Stay calm. Canna-curious is cool! But collect some info first.
If you are:

  • under 25 years old
  • taking any medication
  • at risk for heart disease
  • family history of psychosis
  • family history of mood disorders
  • family history of addiction

…please be sure to consult a medical or mental health professional.

NAVIAGTE

EXPLORE

Cannabis and Mental Health: Harm Reduction Strategies

There is a well-documented link between cannabis and the onset of psychosis in vulnerable individuals. Typically, guidelines recommend that people with a history of mental illness, either individually or in their family, should avoid cannabis at all costs. Approximately 1 in 5 Canadians and Americans experience a mental health condition each year, and approximately 1 in 33 Canadians will experience psychosis in their lifetime, with similar numbers in the States.But is abstinence the only option? Or might there be some middle ground, where people can consume cannabis while taking measures to protect themselves?

There is little consensus on the specifics of the complicated relationship between cannabis and mental health, although the association between cannabis use and mental illness is well-documented. Some experts staunchly insist that cannabis causes mental illness, while others believe the data reflects the fact that people with a predisposition to mental illness are more likely to be attracted to cannabis.

But what almost everyone can agree on is that people with a personal or familial history of mental illness, in particular, psychosis, should take action to reduce harm if they do choose to consume cannabis.

There are many choices that can reduce potential mental health risks of cannabis consumption.

What are the mental health risks of cannabis?

The main mental health risk of cannabis consumption is developing psychosis, the experience of losing contact with reality. The symptoms vary among individuals, but may include unusual thoughts, seeing or hearing things that are not there, and paranoid or delusional beliefs.

While THC can cause paranoia in people without mental illnesses, the evidence suggests that those who develop full-blown psychotic illness in response to cannabis use were likely predisposed to it in the first place.

There is also some evidence suggesting that people who have mental health vulnerabilities may be more likely to try cannabis, rather than cannabis causing their mental illness.

Depression and heavy use of cannabis are also associated, but similarly, it is unclear if the association is causal, or if shared factors may increase the likelihood of both cannabis consumption and depression.

Strategies for lower risk cannabis consumption

Most physicians recommend a person abstain from cannabis if they have a personal or family history of mental illness. If someone chooses to consume cannabis anyway, there are a few ways to reduce harm.

The Centre for Addictions and Mental Health (CAMH), along with Health Canada, has produced a set of lower risk cannabis use guidelines.

The guidelines explain that abstinence is the most effective way to avoid the psychiatric risks of cannabis. In addition, they suggest delaying the use of cannabis as long as possible, and ideally until after adolescence.

Dr. Romina Mizrahi, MD, professor of psychiatry at the University of Toronto, and director of the Focus on Youth Psychosis Prevention program at CAMH explains:

“The key issue, I think, here really has to do with brain development,” she says. “One would want to minimize use before the brain is developed. And I would usually say ideally until 24 or 25. But I mean, it has to be after the age of 21, for sure.”

The guidelines also recommend people opt for cannabis with lower THC content overall, and a higher CBD to THC ratio.

Dr. Mizrahi emphatically agrees.

“We know that THC is associated with psychotic experiences, and we also know it’s associated with abuse and dependence. So certainly I want to make that recommendation that when people have to choose, they attempt as much as possible to use a minimal THC content.”

Finally, the guidelines suggest that people with a family history of psychosis should not consume cannabis at all.

If you have a first-degree relative—a mother, father, brother, sister, or child—who has experienced a psychotic disorder, it is worth being extra cautious.

Your risk is higher the more closely you are related to the affected individual. For example, the risk of schizophrenia is 6.3x higher in those with an affected first-degree relative, and 2.4x higher in those with an affected second-degree relative. Second-degree relatives include aunts, uncles, nieces, nephews, half siblings, grandparents, and grandchildren.

Dr. Kim Lam, MD, a patient educator at Apollo Cannabis Clinics in Toronto, has some additional advice to offer.

Lam suggests patients with any history of mental illness use the “start low and go slow” rule. This means starting with a low dose of cannabis, and increasing it slowly to reduce the risk of side effects.

When asked about how cannabinoid content can impact a person’s experience, Lam’s clinical experience lines up with the CAMH guidelines.

“Cannabis with a higher CBD content and lower THC content can reduce harm in a mental health context,” Lam said.

“Because THC is psychoactive, and CBD has been shown to help diminish the side effects of THC, we often like to start patients on just CBD, and add THC only if needed.”

Importantly, people with mental health vulnerabilities who choose not to abstain from cannabis can still make choices to reduce the risk to their mental health.

Here are some harm reduction strategies for cannabis consumption:

      • Consider abstinence. Abstinence is the best way to avoid the mental health risks of cannabis consumption. Consider this more strongly if you have a close relative who is affected by psychosis.
      • Delay use until after adolescence (age 21). Cannabis is thought to affect teens’ brain development, which may account for some of the mental health risks.
      • If you choose to consume, select cannabis with lower THC content overall, and cannabis with a higher CBD to THC ratio. Avoid illicit cannabis, which is not tested.
      • Start low and go slow to reduce the risk of side effects. If you have a distressing mental experience while using cannabis, stop consuming it temporarily and seek help.
Leafly logo

This article written by Laura Tennant was originally posted on Leafly.com.

Chou, I. J., Kuo, C. F., Huang, Y. S., Grainge, M. J., Valdes, A. M., See, L. C., Yu, K. H., Luo, S. F., Huang, L. S., Tseng, W. Y., Zhang, W., & Doherty, M. (2017). Familial Aggregation and Heritability of Schizophrenia and Co-aggregation of Psychiatric Illnesses in Affected Families. Schizophrenia bulletin, 43(5), 1070–1078. https://doi.org/10.1093/schbul/sbw159

https://www.schizophrenia.ca/docs/SSC%20and%20SSCF%20Annual%20Report%20for%202017-2018.pdf

Louisa Degenhardt, Wayne Hall, Michael Lynskey. Exploring the association between cannabis use and depression. Addiction: 98 (11), 1471-1640, (November 2003).

Morrison, P., Zois, V., McKeown, D., Lee, T., Holt, D., Powell, J., . . . Murray, R. (2009). The acute effects of synthetic intravenous Δ9-tetrahydrocannabinol on psychosis, mood and cognitive functioning. Psychological Medicine, 39(10), 1607-1616. doi:10.1017/S0033291709005522

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HEY NEWBIES- START HERE!

KEEP IN MIND

Stay calm. Canna-curious is cool! But collect some info first.
If you are:

  • under 25 years old
  • taking any medication
  • at risk for heart disease
  • family history of psychosis
  • family history of mood disorders
  • family history of addiction

…please be sure to consult a medical or mental health professional.

NAVIAGTE

EXPLORE

Everything You Need to Know About THC (But Might be Afraid or Too High to Ask)
Jessica Christion

written by

Jessica Christion

Hannah Sadock, MS

reviewed by

Hannah Sadock, MS

Jessica Christion

written by

Jessica Christion

Hannah Sadock, MS

reviewed by

Hannah Sadock, MS

Tetrahydrocannabinol (THC), is the most known and talked about compound in the cannabis plant. Of course following right behind is CBD, though THC tends to be the main star of the cannabis community and for good reason. THC is known for making you feel “high,” which plays a large influence on its popularity.  Its popularity has grown in more recent years as the chemical compound holds many beneficial effects, specifically in medicinal properties supported by evidence-based practices. While THC can be helpful for some, we must address that its effectiveness may lead to adverse side effects, if not careful. THC affects everyone differently, so we should take our time and learn about how THC can produce a euphoric effect that may be a positive and/or negative experience. 

What are Cannabinoids?

Aside from cannabinoids being the most mispronounced word in cannabis science- kuh–nab–uh-noid- they actually comprise approximately 100 of the 500 chemical compounds, responsible for psychological and physiological effects. Cannabinoids are a group of chemical compounds made up of 21 carbon atoms in a 3-ring structure. They bind to receptors throughout the brain and body. 

Cannabinoids are neurotransmitters exerting their effects by interacting with specific cannabinoid receptors present on the cell’s surface. The effects of cannabinoids depend on the part of the body or brain being targeted for symptom relief. When deficiencies or problems arise in the endocannabinoid system, unpleasant symptoms and physical complications may occur. Neurotransmitters mediate communication between cells to stabilize these symptoms or deficiencies within our endocannabinoid system as the cannabinoids activate receptors to maintain internal stability and health. 

Most cannabinoids are not intoxicating by themselves and are needed in combination with other cannabinoids to influence different effects. There is a diverse range of cannabinoids influencing targeted receptors by bonding with them to produce effects for achieving homeostasis or balance. In our case, THC is considered a phytocannabinoid or exogenous cannabinoid. 

What is a Phytocannabinoid?

Phytocannabinoids or exogenous cannabinoids are compounds naturally existing in the cannabis Sativa plant. If you know any Latin- “Phyto” means “of a plant or relating to plants,” so in our case, phytocannabinoids are derived from or a product of the cannabis plants. Phytocannabinoids are made in the plant’s glandular trichomes, which are small hairs found on the surface of its leaves and secrete resin to protect phytocannabinoids. Since production takes place on the external surface, phytocannabinoids are also referred to as “exogenous cannabinoids” as they develop on the outside of an organism. Like addressed before, the cannabis plant has over 500 compounds and 100 of those compounds belong to this class of cannabinoids. Below is a common list of cannabinoids, you may be familiar with found in this class:

🍃 tetrahydrocannabinol (THC)
🍃 cannabidiol (CBD)
🍃 cannabidiolic acid (CBDA) 
🍃 tetrahydrocannabinolic acid (THCA)
🍃 cannabinol (CBN)
🍃 cannabigerol (CBG)
🍃 cannabichromene (CBC)
🍃 tetrahydrocannabivarin (THCV)

One of the essential qualities of cannabinoids that make them critical to the treatment of physical and mental health complications is its homeostatic tendencies. When consumed, cannabinoids quickly enact the endocannabinoid system by attaching or influencing the receptors. They interact with the properties within these chemical compounds to produce effects such as mood enhancement, pain relief, anxiety decrease, and stimulation of appetite. 

What is THC?

THC stands for Tetrahydrocannabinol. THC is the main and most well-known compound in the cannabis plant. THC is known for its psychoactive properties of feeling “high,” though how does it make you feel high? THC shares nearly the same structure as a natural chemical called anandamide. Anandamide acts as a neurotransmitter that serves the purpose of increasing dopamine. THC and Anandamide bind to the same receptors in our brain creating the psychoactive effect that we all feel… aka feeling high as a kite. 

What are the potential effects of THC? 

THC can make everyone feel different, the most common psychoactive effects reported include but are not limited to: 

🌿 euphoria
🌿 relaxation
🌿 introspection
🌿 creativity
🌿 sedation
🌿 sensory alteration
🌿 appetite stimulation
🌿 focus 
🌿 energy-boosting

THC can also produce some common undesired effects which may include but are not limited to:

😵‍ red eyes
😵‍ disorientation
😵‍ dizziness
😵‍ anxiety 
😵‍ paranoia 

THC can also assist with common medicinal needs including but not limited to:

🌿 pain relief
🌿 inflammation
🌿 anti-inflammatory 
🌿 autoimmune disorders
🌿 insomnia
🌿 nausea
🌿 depression
🌿 anxiety 
🌿 PTSD
🌿 sleep apnea 
🌿 migraines 
🌿 Alzheimer’s disease

Let’s put it all together 

THC binds with our receptors in our brain producing increased dopamine levels, and as a result, creating a euphoric feeling. Effects can make everyone feel different, for some symptoms may improve, and for others, it can make symptoms worse. You know your body more than anyone, so trust your process and body sensations. It is always important to start small when trying cannabis for the first time. It may also be a good idea to keep track of what strains work best for you, including their effects, positive or negative. Whether you are a recreational user or a medical patient no one likes being too “high”, so be patient with yourself when exploring THC. 

Campo, P. (n.d.). Cannabinoids 101: THC – The Apothecarium. Https://Apothecarium.com/. Retrieved June 26, 2021, from https://apothecarium.com/blog/2018-7-9-cannabinoids-101-thc/?s=thc

Cao, C., Li, Y., Liu, H., Bai, G., Mayl, J., Lin, X., Sutherland, K., Nabar, N., & Cai, J. (2014). The Potential Therapeutic Effects of THC on Alzheimer’s Disease. Journal of Alzheimer’s Disease, 42(3), 973–984. https://doi.org/10.3233/jad-140093

Elsevier Enhanced Reader. (n.d.). Reader.elsevier.com. Retrieved August 14, 2021, from https://reader.elsevier.com/reader/sd/pii/S2352250X16302342?token=DDE675D1B41A7C5354437B97C3BC847DB8C70DBCDD7A2FEB4AC258D0CEC01831BE0FB200416D78D2440344F07AE77A92&originRegion=us-east-1&originCreation=20210814234227

Johnson, J. R., Burnell-Nugent, M., Lossignol, D., Ganae-Motan, E. D., Potts, R., & Fallon, M. T. (2010). Multicenter, Double-Blind, Randomized, Placebo-Controlled, Parallel-Group Study of the Efficacy, Safety, and Tolerability of THC:CBD Extract and THC Extract in Patients with Intractable Cancer-Related Pain. Journal of Pain and Symptom Management, 39(2), 167–179. https://doi.org/10.1016/j.jpainsymman.2009.06.008

Lland, R. (2018, July 9). What Is THC (Tetrahydrocannabinol)? Leafly. https://www.leafly.com/news/cannabis-101/what-is-tetrahydrocannabinol

Maroon, J., & Bost, J. (2018). Review of the neurological benefits of phytocannabinoids. Surgical Neurology International, 9(1), 91. https://doi.org/10.4103/sni.sni_45_18

Triangale, MD, R., & Jensen, MD, C. (2011). Cannabis and Insomnia. http://files7.webydo.com/92/9209805/UploadedFiles/5E9EC245-448E-17B2-C7CA-21C6BDC6852D.pdf

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HEY NEWBIES- START HERE!

KEEP IN MIND

Stay calm. Canna-curious is cool! But collect some info first.
If you are:

  • under 25 years old
  • taking any medication
  • at risk for heart disease
  • family history of psychosis
  • family history of mood disorders
  • family history of addiction

…please be sure to consult a medical or mental health professional.

NAVIAGTE

EXPLORE

LJG 2021

written by

Laura Geftman, LCSW

Hannah Sadock, MS

reviewed by

Hannah Sadock, MS

LJG 2021

written by

Laura Geftman, LCSW

Hannah Sadock, MS

reviewed by

Hannah Sadock, MS

A proclame to fame is the common phrase; “I have such a type..” which can link to a magnitude of preferences in someone’s life. Though for some, when it comes to “a type” of strain found in cannabis, the pressure is on to pursue the relief again. Though here is the problem, solely searching for this strain without considering the brand can lead to a completely different experience than before. You may notice differences in the flower with the smell, taste and/or burn, so to avoid this for the future, we must consider the key three factors to successful types of strains:

🧬 phenotypes

🧬 genotypes

🧬 chemotypes 

When we consider the lineage of cannabis, which just like any plant, has been adapting over time to accommodate its habitat, we are left to dive deeper into education on cannabis genetics. Thousands of years of adaptation has created strains to express their best traits for survival in all geographical locations. Diverse habitats have required the plant to make accommodations to maintain survival, creating a conditioned array of cannabis varieties. All the more reason to further investigate the variability of strains by understanding phenotypes, genotypes and chemotypes. 

What are Genotypes?

There is no debate that cannabis is a plant making its function and form closely related to other flowering plants in our atmosphere. The plant is a living organism with a genetic code that stimulates adaptations to survive its environment. Genetic codes are inherited from past cannabis crossings or ancestors determining growth, appearance, and other characteristics. As new strains are birthed through cross-breeding, genotypes develop, which essentially means the “ingredients” for a strain’s individual internal sequences of DNA and RNA creating its unique characteristics. 

The genetic composition of the cannabis plant- called the genotype- acts as a blueprint or map for its genetics. It provides a range of growth possibilities to the plant. It also determines how the genetics evolve and change as they are passed down. Each cannabis strain carries a different genetic code and therefore different genotypes. Just like every living organism; plants, humans, animals, all comprise of genetic sequences that make us one of a kind.

What are Phenotypes?

Two things influence the structural formation of any given cannabis plant: genetics and environment. The physical expression of a genotype is referred to as a phenotype. The traits, such as, color, shape, smell, and resin production are influenced by the environment causing adaptations from the plant’s genetic code. Therefore the environment cannabis is grown in can greatly affect and/or evolve the plant’s genetic code.

Cannabis has progressed its predigre from generations of being grown wildly, stimulating evolutionary adaptations for maintaining survival in specific climate and environmental conditions. Today, cannabis plants, dependent on strain show different characteristics in appearance with: 

🌿 Indica adapted to cooler conditions and thrived in mountainous regions. Plants were commonly short and stocky with broad leaves.

🌿 Sativa plants grew tall with slender leaves in tropical jungle conditions.

Cannabis breeders have crossed these varieties even further resulting in the production of new hybrids widing the margin for phenotypes and genotypes. The diversity provides a choice of flavours, aromas, and effects. For top dollar, patients can purchase clone/ replications of plants harvested by growers with specific phenotype expressions to achieve consistent relief. However, we must consider, thanks to evolutionary needs and DNA, not all plants will produce the same chemical compounds with exact concentration at each harvest. Much like humans have siblings from identical origins, plants essentially have siblings too with their own unique genetic sequence! 

What are Chemotypes?

Cannabis breeders are now providing us a virtually endless selection of strains to choose. While most dispensaries sell products as indica, sativa, or hybrid products, it would be more appropriate to identify cannabis by its chemotypes. 

Cannabis strains will produce different effects depending on the mixtures and concentrations of cannabinoids present in a given plant. Chemotypes are the classification of different cannabis varieties based on their chemical constituents. Five different chemotypes have been identified as follows:

🪴 Type I: the “drug type” because of its high THC content and low CBD:THC ratio

🪴 Type II: the “intermediate,” consisting of near equal parts THC and CBD

🪴 Type III: the “fiber” or “non-drug type” is mainly CBD

🪴 Type IV: which is predominantly CBG, with some CBD present

🪴 Type V: material with undetectable amounts of any cannabinoids

Genotypes, Phenotypes, Chemotypes for Your Type

Modern day cannabis has evolved in many ways. While many talk about the potency of today’s cannabis, it is important to recognize how the plant genetics and cultivation environments affect the medicine. Hopefully this will increase your understanding of defining characteristics for each strain, the various subtle differences in its phenotypes, and therefore easier to try diverse strains and potencies to find what works best for you. Be sure to keep track!

Aizpurua-Olaizola O, Soydaner U, Öztürk E, Schibano D, Simsir Y, Navarro P, Etxebarria N, Usobiaga A. 2016. Evolution of the cannabinoid and terpene content during the growth of Cannabis sativa plants from different chemotypes. Journal of Natural Products 79: 324–331.

Basas-Jaumandreu J, De las Heras FXC. 2020. GC-MS metabolite profile and identification of unusual homologous cannabinoids in high potency Cannabis sativa. Planta Medica 86: 338–347.

Bayer PE, Golicz AA, Scheben A, Batley J, Edwards D. 2020. Plant pan-genomes are the new reference. Nature Plants 6: 914–920.

Sawler, J., Stout, J. M., Gardner, K. M., Hudson, D., Vidmar, J., Butler, L., Page, J. E., & Myles, S. (2015). The Genetic Structure of Marijuana and Hemp. PloS one, 10(8), e0133292. https://doi.org/10.1371/journal.pone.0133292

Schwabe, A.L., McGlaughlin, M.E. Genetic tools weed out misconceptions of strain reliability in Cannabis sativa: implications for a budding industry. J Cannabis Res 1, 3 (2019). https://doi.org/10.1186/s42238-019-0001-1

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HEY NEWBIES- START HERE!

KEEP IN MIND

Stay calm. Canna-curious is cool! But collect some info first.
If you are:

  • under 25 years old
  • taking any medication
  • at risk for heart disease
  • family history of psychosis
  • family history of mood disorders
  • family history of addiction

…please be sure to consult a medical or mental health professional.

NAVIAGTE

EXPLORE

CBD for anxiety

A pounding heart, sweaty palms, racing thoughts: For those living with an anxiety disorder, these unwelcome symptoms can make everyday life feel debilitating.

One in 13 people around the world live with an anxiety disorder, making them the most common mental health disorder worldwide, according to the World Health Organization (WHO). For those living with anxiety, finding a safe method for managing symptoms is a critical concern.

Quick-acting anti-anxiety medication, such as Xanax and Valium, may offer instant relief but can become addictive. Long-range anxiety medications, such as Prozac, may help reduce symptoms over time, but don’t work for everyone.

Enter cannabidiol, better known as CBD. CBD has recently captured the spotlight as an alternative or complementary treatment for anxiety.

CBD: Snake oil or powerful anxiety treatment?

Clinical research on CBD as a treatment for anxiety disorders has proliferated in recent years with accumulating evidence pointing to its therapeutic potential.

Although most studies on CBD are preclinical and use animal models, clinical studies using human participants are now emerging.

In a double-blind study from 2019, 37 Japanese teenagers with social anxiety disorder (SAD) received 300 mg of CBD oil or a placebo every day for four weeks. The teens were assessed with surveys used to diagnose and measure SAD symptoms. The anti-anxiety properties of CBD reduced symptoms aligned with the disorder, providing relief comparable to Paroxetine, a drug commonly used to treat the condition.

Interestingly, in the follow-up, nine of the seventeen teenagers who received the CBD intervention also declared that they had decided to seek some form of treatment. Teenagers with SAD rarely seek help due to the stigma surrounding the condition and for fear of interacting with therapists.

A 2019 retrospective case study reviewed outpatients at a mental health clinic in Fort Collins, Colorado. Forty-seven of the patients sampled had expressed concerns about anxiety. Over three months, the majority of patients were given 25 mg of CBD daily in addition to treatment.

After the first monthly assessment, 79.2% of patients experienced an improvement in anxiety. After two months, 78.1% of patients reported a further improvement compared with the previous month.

However, there were also patients who reported that the symptoms of their anxiety worsened after taking CBD—15.3% felt their anxiety had become exacerbated after the first month and 19.5% felt their anxiety had worsened further after the second month.

Another study, done in 2018, also suggests that CBD may heighten anxiety. It included a small sample of individuals with paranoid traits and found that CBD exacerbated anxiety among some of the participants. Anxiety was measured through symptoms such as cortisol concentration, heart rate, and systolic blood pressure.

These contradictory findings may be due to factors such as small sample sizes and variations in dosing. CBD is a bidirectional medicine, which means it can cause opposing responses at different doses. We’ll delve deeper into this below.

How should I consume CBD for anxiety?

If you’re curious about using CBD oil as a tool to help manage your anxiety, education is critical. Understanding the pros and cons of the various ingestion methods can help you determine which form of consumption best suits your needs.

tinctures and oils represent a quick, easy, and accurate way to consume CBD. Most tinctures contain CBD in an alcohol base. CBD oils contain CBD extracts infused into a carrier oil, such as coconut or hemp seed oil.

Tinctures and oils are taken using a dropper, which allows you to easily measure intake. The cannabinoid rapidly enters the bloodstream when taken sublingually—results can kick in as quickly as ten minutes and last up to three to four hours.

CBD vape oils can be vaped using a special pen that vaporizes the oil. At present, the safety of vaping has come under intense scrutiny. A serious lung condition known as VAPI, or EVALI, has hospitalized more than 2,000 people and led to the deaths of 42. The federal Centers for Disease Control has found that most cases have been linked to the use of illicit-market THC vape cartridges tainted with vitamin E oil (tocopheryl-acetate).

CBD vape cartridges purchased in legal state-licensed cannabis stores are highly regulated, while CBD cartridges purchased from other sources are completely unregulated. Proceed with caution when considering any vaping product in an unregulated environment.

edibles CBD can be added to almost every food under the sun. While super easy to consume in this form—and often delicious, particularly as gummies—it may take an hour or more before results are felt.

What’s more, the oral bioavailability of CBD can hinder CBD absorption—when you consume CBD orally, it has to pass through your gastrointestinal tract before it is metabolized by the liver. As a result, a limited quantity of CBD makes it into the circulatory system.

It’s important to also note that the FDA has recently deemed food containing CBD illegal. You’ll have to get CBD edibles in state-licensed adult-use markets.

smoking provides an almost instantaneous method for enjoying the effects of CBD. Smoking sends the cannabinoid directly to the alveoli of the lungs, and from there, CBD molecules enter the bloodstream for rapid absorption. However, measuring your CBD intake can be tricky when you smoke, and the act of smoking itself can cause lung inflammation.

Dosing CBD for anxiety

If you read the studies cited above, you’ll notice that the dosing varied significantly between them. The teens in the Japanese study were provided with 300 mg of CBD daily, while the outpatients in the Colorado study received 25 mg. Why such a large discrepancy in dose?

As most scientists and clinicians will readily admit, there is no universally recommended dosage for CBD, and, to date, there haven’t been any large-scale clinical trials to inform dosage guidelines. In addition, the FDA is still learning about CBD—such as its cumulative effects on the body—before it decides on how to regulate it.

This doesn’t necessarily mean CBD is unsafe. Existing research already suggests that it appears to be a safe, well-tolerated treatment. If you’re interested in experimenting with CBD to manage your anxiety symptoms, aim for an informed, cautious approach to dosing (which is always a good idea). Below are some dosing considerations.

General dosing tips

Some basic factors that you should consider when devising a CBD dose include:

👉 body weight

👉 metabolism

👉 concentration of CBD

👉 severity of your anxiety

The concentration of CBD varies between products, and is generally expressed as milligrams (mg) per container.

Once you know the potency of the CBD product you hold, you can use a dosage calculator or an app such as Accugentix to help settle on your perfect dose. Dosage calculations can provide a recommended dose in milligrams based on your body weight and the severity of your symptoms.

Your unique body chemistry also affects how you respond to CBD. Some individuals metabolize medicine faster than others, which can be attributed to genes or lifestyle. If you know that you metabolize medication quickly, it’s possible that you may benefit from a higher dose.

Bidirectional effects

CBD may do different things at different doses, a phenomenon known as bidirectional effects. Overstimulation of the body’s endocannabinoid system may exacerbate symptoms instead of alleviating them.

Additionally, high levels of CBD, such as 300 mg, have been known to promote sleepiness and relaxation. Conversely, low levels of CBD may create an elevating response, inciting wakefulness and alertness. The best way to avoid unwanted bidirectional effects is to follow the adage: start low, go slow.

Start low, go slow

Titration refers to the process of adjusting the dosage of a medication to get its maximum benefits without adverse effects. CBD has been shown to be safe even when taken in high doses (300-600 mg), nonetheless, it’s advisable and more cost-effective to start with a low dose and increase it incrementally, observing how you feel as you go.

This method forces you to pay attention to subtle changes in your body as it responds to the medication. Everyone’s optimal dosage and tolerance is unique, and this process allows you to get acquainted with yours.

Dr. Dustin Sulak, a cannabis medicine expert at Healer, offers educational resources for novice and seasoned cannabis users alike to find their optimal dosage.

Talk to an expert on medical cannabis

If you’re still feeling unsure and you live in a state where you can safely converse with a health professional about CBD, consider scheduling a consultation. Some cannabis dispensaries also have medical experts on hand who can provide you with sound advice and dosage recommendations.

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This article written by Emma Stone was originally posted on Leafly.com.

Blessing, E.M., Steenkamp, M.M., Manzanares, J. et al. Cannabidiol as a Potential Treatment for Anxiety Disorders. Neurotherapeutics 12, 825–836 (2015). https://doi.org/10.1007/s13311-015-0387-1

https://adaa.org/understanding-anxiety/facts-statistics

Hundal H, Lister R, Evans N, Antley A, Englund A, Murray RM, Freeman D, Morrison PD. The effects of cannabidiol on persecutory ideation and anxiety in a high trait paranoid group. J Psychopharmacol. 2018 Mar;32(3):276-282. doi: 10.1177/0269881117737400. Epub 2017 Oct 31. PMID: 29086614.

Nobuo, Masataka. Anxiolytic Effects of Repeated Cannabidiol Treatment in Teenagers With Social Anxiety Disorders. Frontiers in Psychology 10, 2466 (2019). DOI=10.3389/fpsyg.2019.02466    

Shannon, S., Lewis, N., Lee, H., & Hughes, S. (2019). Cannabidiol in Anxiety and Sleep: A Large Case Series. The Permanente journal, 23, 18–041. https://doi.org/10.7812/TPP/18-041

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HEY NEWBIES- START HERE!

KEEP IN MIND

Stay calm. Canna-curious is cool! But collect some info first.
If you are:

  • under 25 years old
  • taking any medication
  • at risk for heart disease
  • family history of psychosis
  • family history of mood disorders
  • family history of addiction

…please be sure to consult a medical or mental health professional.

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Cannabis and Mental Health: Harm Reduction Strategies

There is a well-documented link between cannabis and the onset of psychosis in vulnerable individuals. Typically, guidelines recommend that people with a history of mental illness, either individually or in their family, should avoid cannabis at all costs. Approximately 1 in 5 Canadians and Americans experience a mental health condition each year, and approximately 1 in 33 Canadians will experience psychosis in their lifetime, with similar numbers in the States.But is abstinence the only option? Or might there be some middle ground, where people can consume cannabis while taking measures to protect themselves?

There is little consensus on the specifics of the complicated relationship between cannabis and mental health, although the association between cannabis use and mental illness is well-documented. Some experts staunchly insist that cannabis causes mental illness, while others believe the data reflects the fact that people with a predisposition to mental illness are more likely to be attracted to cannabis.

But what almost everyone can agree on is that people with a personal or familial history of mental illness, in particular, psychosis, should take action to reduce harm if they do choose to consume cannabis.

There are many choices that can reduce potential mental health risks of cannabis consumption.

What are the mental health risks of cannabis?

The main mental health risk of cannabis consumption is developing psychosis, the experience of losing contact with reality. The symptoms vary among individuals, but may include unusual thoughts, seeing or hearing things that are not there, and paranoid or delusional beliefs.

While THC can cause paranoia in people without mental illnesses, the evidence suggests that those who develop full-blown psychotic illness in response to cannabis use were likely predisposed to it in the first place.

There is also some evidence suggesting that people who have mental health vulnerabilities may be more likely to try cannabis, rather than cannabis causing their mental illness.

Depression and heavy use of cannabis are also associated, but similarly, it is unclear if the association is causal, or if shared factors may increase the likelihood of both cannabis consumption and depression.

Strategies for lower risk cannabis consumption

Most physicians recommend a person abstain from cannabis if they have a personal or family history of mental illness. If someone chooses to consume cannabis anyway, there are a few ways to reduce harm.

The Centre for Addictions and Mental Health (CAMH), along with Health Canada, has produced a set of lower risk cannabis use guidelines.

The guidelines explain that abstinence is the most effective way to avoid the psychiatric risks of cannabis. In addition, they suggest delaying the use of cannabis as long as possible, and ideally until after adolescence.

Dr. Romina Mizrahi, MD, professor of psychiatry at the University of Toronto, and director of the Focus on Youth Psychosis Prevention program at CAMH explains:

“The key issue, I think, here really has to do with brain development,” she says. “One would want to minimize use before the brain is developed. And I would usually say ideally until 24 or 25. But I mean, it has to be after the age of 21, for sure.”

The guidelines also recommend people opt for cannabis with lower THC content overall, and a higher CBD to THC ratio.

Dr. Mizrahi emphatically agrees.

“We know that THC is associated with psychotic experiences, and we also know it’s associated with abuse and dependence. So certainly I want to make that recommendation that when people have to choose, they attempt as much as possible to use a minimal THC content.”

Finally, the guidelines suggest that people with a family history of psychosis should not consume cannabis at all.

If you have a first-degree relative—a mother, father, brother, sister, or child—who has experienced a psychotic disorder, it is worth being extra cautious.

Your risk is higher the more closely you are related to the affected individual. For example, the risk of schizophrenia is 6.3x higher in those with an affected first-degree relative, and 2.4x higher in those with an affected second-degree relative. Second-degree relatives include aunts, uncles, nieces, nephews, half siblings, grandparents, and grandchildren.

Dr. Kim Lam, MD, a patient educator at Apollo Cannabis Clinics in Toronto, has some additional advice to offer.

Lam suggests patients with any history of mental illness use the “start low and go slow” rule. This means starting with a low dose of cannabis, and increasing it slowly to reduce the risk of side effects.

When asked about how cannabinoid content can impact a person’s experience, Lam’s clinical experience lines up with the CAMH guidelines.

“Cannabis with a higher CBD content and lower THC content can reduce harm in a mental health context,” Lam said.

“Because THC is psychoactive, and CBD has been shown to help diminish the side effects of THC, we often like to start patients on just CBD, and add THC only if needed.”

Importantly, people with mental health vulnerabilities who choose not to abstain from cannabis can still make choices to reduce the risk to their mental health.

Here are some harm reduction strategies for cannabis consumption:

      • Consider abstinence. Abstinence is the best way to avoid the mental health risks of cannabis consumption. Consider this more strongly if you have a close relative who is affected by psychosis.
      • Delay use until after adolescence (age 21). Cannabis is thought to affect teens’ brain development, which may account for some of the mental health risks.
      • If you choose to consume, select cannabis with lower THC content overall, and cannabis with a higher CBD to THC ratio. Avoid illicit cannabis, which is not tested.
      • Start low and go slow to reduce the risk of side effects. If you have a distressing mental experience while using cannabis, stop consuming it temporarily and seek help.
Leafly logo

This article written by Laura Tennant was originally posted on Leafly.com.

Chou, I. J., Kuo, C. F., Huang, Y. S., Grainge, M. J., Valdes, A. M., See, L. C., Yu, K. H., Luo, S. F., Huang, L. S., Tseng, W. Y., Zhang, W., & Doherty, M. (2017). Familial Aggregation and Heritability of Schizophrenia and Co-aggregation of Psychiatric Illnesses in Affected Families. Schizophrenia bulletin, 43(5), 1070–1078. https://doi.org/10.1093/schbul/sbw159

https://www.schizophrenia.ca/docs/SSC%20and%20SSCF%20Annual%20Report%20for%202017-2018.pdf

Louisa Degenhardt, Wayne Hall, Michael Lynskey. Exploring the association between cannabis use and depression. Addiction: 98 (11), 1471-1640, (November 2003).

Morrison, P., Zois, V., McKeown, D., Lee, T., Holt, D., Powell, J., . . . Murray, R. (2009). The acute effects of synthetic intravenous Δ9-tetrahydrocannabinol on psychosis, mood and cognitive functioning. Psychological Medicine, 39(10), 1607-1616. doi:10.1017/S0033291709005522

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HEY NEWBIES- START HERE!

KEEP IN MIND

Stay calm. Canna-curious is cool! But collect some info first.
If you are:

  • under 25 years old
  • taking any medication
  • at risk for heart disease
  • family history of psychosis
  • family history of mood disorders
  • family history of addiction

…please be sure to consult a medical or mental health professional.

NAVIAGTE

EXPLORE

Medical Cannabis Users Beware! Drug Interactions You Need to Know About

LJG 2021

written by

Laura Geftman, LCSW

Hannah Sadock, MS

reviewed by

Hannah Sadock, MS

Brain

written by

Namen Namestein

Brain

reviewed by

Namen Namestein

If using cannabis while taking other medications has you questioning their interaction- I applaud your good thinking. Just like adding a new prescription to your daily medication regimen there is concern for possible drug interactions, which holds true of cannabis as well. Afterall, cannabis is medicine, though to avoid negative side effects and medication counteracting from prescription drugs, cannabis needs to be considered as a potential factor in causing those effects through its process of metabolization resulting in possible effects.

Now, let us break down medication interactions and what you may need to be more aware of when medicating with cannabis. We will review the different kinds of side effects, what to avoid to prevent them, certain kinds of medication you shouldn’t take with cannabis, and other other things to manage adverse drug interactions.

Types of Drug Interactions

As all drugs can cause an array of reactions- some benign and others serious- it is important to know about possible drug interactions. The effectiveness of drugs can be increased or decreased when combined with another drug or substance. These are the threes types of drug interactions take may be cause for concern:

💊 drug-drug interactions occur when two or more drugs react with each other, which includes prescription, over-the-counter, and illicit drugs. This is of utmost concern with drugs that have a narrow range between therapeutic and lethal doses.

💊 drug-food interactions occur when drugs react with foods, dietary supplements and/ or beverages. Some drugs may also interfere with the body’s ability to absorb nutrients. 

💊 drug-disease interactions occur when a drug exacerbates or worsen an existing medical condition. High risk conditions for drug interactions include:

✱ kidney disease 
✱ liver disease 
✱ diabetes 
✱ asthma
✱ cardiac problems
✱ epilepsy
✱ high blood pressure
✱ low blood pressure 

Types of Drug Interaction Effects

Drug interaction predictors enable risk assessment of drugs. The dreaded side effects of medication are actually broken down into three types and it is important to understand the difference between each to know how best to manage them. Here are the definitions and  differentiating factors of additive, synergistic, and antagonistic effects:

✳️ additive effects of drugs produce a reaction created by causative factors acting together as the sum of their individual effects. Simply put- that means the two chemicals work together to equal the sum of their parts. The impact of the two or more drugs together adds scientific value to the predicted outcome. Elements essentially added to each other’s intended outcome chemically and biologically.

✳️ synergistic effects refers to the effect of two chemicals interacting creating a greater reaction than using one individually. The interaction adds to the strength to the effect of the medicine. When chemicals are synergistic, the potential hazards of the chemicals should be considered and re-evaluated.

✳️ antagonistic effects speaks to the instance when two or more drugs are combined to produce a weaker, decreased, or opposite effect on the body. Drug antagonism may block or reduce the effectiveness of one or more drugs.

Cannabis Drug Interactions

If you plan to use cannabis medicinally, chances are you are already on a course of other medication. Common uses of cannabis often include diagnoses of cancer, chronic pain, epilepsy/seizures, nausea and vomiting, muscle spasms, inflammatory conditions, Alzheimer’s, and Parkinson’s diseases. The wide range of uses increases the likelihood of potential drug interactions as most of these diagnoses affect individuals who require numerous medications combinations due to age or illness. All the more reason to review the drug interaction considerations when medicating with cannabis.

The following drug-drug interactions are cause for concern when using cannabis

🚩 opioids may allow for lower opioid doses while reducing risk of dependency and fewer side effects. 

🚩 sedatives (benzodiazepines, antidepressants, barbiturates, narcotics) produces an additive effect with cannabis increasing sedative effects.

🚩 blood sugar medication could be a risk when cannabis is combined as glucose levels could significantly drop causing a medical emergency.

🚩 blood pressure medication may compound effects by activating receptors to induces a cardiovascular stress response that can elevate cardiac oxygen consumption while reducing blood flow in coronary arteries.

🚩 blood thinning medication effectiveness’ may be augmented possibly slowing down the metabolism of these drugs. 

🚩 heart rhythm medication with cannabis may amplify its affect and change the heart rhythm.

🚩 thyroid medication may compete with cannabis in the cytochrome P450 pathways to be metabolized.

🚩 seizure medication may induce seizure if not properly used with cannabis.

🚩 alcohol …uh, yeah. Alcohol is a drug. When combined with cannabis these substances may result in very different reactions depending on many variables including which one you use first and how you consume them. 

There are some drugs that are of utmost concern as their interaction with cannabis could be fatal. Potentially serious drug interactions include:

⚠️ warfarin

⚠️ amiodarone

⚠️ levothyroxine

⚠️ clobazam

⚠️ lamotrigine

⚠️ valproate

Tips to avoid adverse effects from drug interactions

There is clearly lots to know to mitigate the risks involved with drug interactions. To best prepare yourself for medical cannabis use and to decrease the risk of interactions, consider these tips: 

🔹 Know your own medicines. Be sure to read about the medication prescribed and any interactions to consider.

🔹 When you see your doctor, be sure to inform them about all the drugs you are taking. These should include over-the-counter medications, vitamins, dietary supplements, herbal remedies, cannabis, CBD, and any medicinal substance.

🔹 Keep your list of medications up to date, which is particularly important if you visit more than one doctor or pharmacy.

🔹 Ask your doctor or pharmacist what to avoid- medications / food/ beverages…

🔹 Take medication as instructed and learn about possible side effects. Be sure to make your medical providers aware of any side effects you experience.

🔹 Review your medications regularly to eliminate unnecessary ones as interactions increase when medication variety increases.

🔹 Do your own research! Not every doctor and/or pharmacist is up on the latest cannabis info. You, too, can take some responsibility for your treatment. Consider looking up your medicine interactions with MedScape, Drugbank, and any other online resources offering updated info on pharmaceuticals + cannabis.

In Conclusion

Cannabis has the potential to interact with many medications, including over-the-counter medications, herbal products, and prescription medications. Some medications should never be administered in combination with cannabis while others may need modification or reduction to prevent serious issues. Cannabis may increase or decrease the effectiveness or potency of other drugs. Though always consult your doctor before tampering with your regimen. 

All interactions considered, everyone should inform healthcare professionals should be informed of any condition(s) and/ or medications / dietary supplements being administered during a doctor’s visit or when purchasing medicines at the pharmacy. Yup, that means cannabis, CBD, and any form of chemical compound derived from it. Cannabis, like every other medication, must be considered when ANY medical professional is treating you. Stay safe potential cannabis users!

https://news.gallup.com/businessjournal/170696/win-natural-talent-additive-effects.aspx

https://www.fda.gov/drugs/information-consumers-and-patients-drugs/you-age-you-and-your-medicines

Alsherbiny, M. A., & Li, C. G. (2018). Medicinal Cannabis-Potential Drug Interactions. Medicines (Basel, Switzerland), 6(1), 3. https://doi.org/10.3390/medicines6010003

Aronson J. K. (2004). Classifying drug interactions. British journal of clinical pharmacology, 58(4), 343–344. https://doi.org/10.1111/j.1365-2125.2004.02244.x

Cascorbi I. (2012). Drug interactions–principles, examples and clinical consequences. Deutsches Arzteblatt international, 109(33-34), 546–556. https://doi.org/10.3238/arztebl.2012.0546

Jiang R, Yamaori S, Takeda S, et al. Identification of cytochrome P4540 enzymes responsible for metabolism of cannabidiol by human liver microsomes. Life Sci. 2011;89:165-170.

Rebecca L Hartman, Timothy L Brown, Gary Milavetz, Andrew Spurgin, David A Gorelick, Gary Gaffney, Marilyn A Huestis, Controlled Cannabis Vaporizer Administration: Blood and Plasma Cannabinoids with and without Alcohol, Clinical Chemistry, Volume 61, Issue 6, 1 June 2015, Pages 850–869, https://doi.org/10.1373/clinchem.2015.238287

Toennes SW, Schneider K, Kauert GF, Wunder C, Moeller MR, Theunissen EL, Ramaekers JG. Influence of ethanol on cannabinoid pharmacokinetic parameters in chronic users. Anal Bioanal Chem. 2011 Apr;400(1):145-52. doi: 10.1007/s00216-010-4449-2. Epub 2010 Nov 30. PMID: 21116612.

Lukas SE, Benedikt R, Mendelson JH, Kouri E, Sholar M, Amass L. Marihuana attenuates the rise in plasma ethanol levels in human subjects. Neuropsychopharmacology. 1992 Aug;7(1):77-81. PMID: 1326277.

Yurasek, A.M., Aston, E.R. & Metrik, J. Co-use of Alcohol and Cannabis: A Review. Curr Addict Rep 4, 184–193 (2017). https://doi.org/10.1007/s40429-017-0149-8

Ramaekers, J. G., Theunissen, E. L., de Brouwer, M., Toennes, S. W., Moeller, M. R., & Kauert, G. (2011). Tolerance and cross-tolerance to neurocognitive effects of THC and alcohol in heavy cannabis users. Psychopharmacology, 214(2), 391–401. https://doi.org/10.1007/s00213-010-2042-1

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HEY NEWBIES- START HERE!

KEEP IN MIND

Stay calm. Canna-curious is cool! But collect some info first.
If you are:

  • under 25 years old
  • taking any medication
  • at risk for heart disease
  • family history of psychosis
  • family history of mood disorders
  • family history of addiction

…please be sure to consult a medical or mental health professional.

NAVIAGTE

EXPLORE

Everything You Need to Know About THC (But Might be Afraid or Too High to Ask)
Jessica Christion

written by

Jessica Christion

Hannah Sadock, MS

reviewed by

Hannah Sadock, MS

Jessica Christion

written by

Jessica Christion

Hannah Sadock, MS

reviewed by

Hannah Sadock, MS

Tetrahydrocannabinol (THC), is the most known and talked about compound in the cannabis plant. Of course following right behind is CBD, though THC tends to be the main star of the cannabis community and for good reason. THC is known for making you feel “high,” which plays a large influence on its popularity.  Its popularity has grown in more recent years as the chemical compound holds many beneficial effects, specifically in medicinal properties supported by evidence-based practices. While THC can be helpful for some, we must address that its effectiveness may lead to adverse side effects, if not careful. THC affects everyone differently, so we should take our time and learn about how THC can produce a euphoric effect that may be a positive and/or negative experience. 

What are Cannabinoids?

Aside from cannabinoids being the most mispronounced word in cannabis science- kuh–nab–uh-noid- they actually comprise approximately 100 of the 500 chemical compounds, responsible for psychological and physiological effects. Cannabinoids are a group of chemical compounds made up of 21 carbon atoms in a 3-ring structure. They bind to receptors throughout the brain and body. 

Cannabinoids are neurotransmitters exerting their effects by interacting with specific cannabinoid receptors present on the cell’s surface. The effects of cannabinoids depend on the part of the body or brain being targeted for symptom relief. When deficiencies or problems arise in the endocannabinoid system, unpleasant symptoms and physical complications may occur. Neurotransmitters mediate communication between cells to stabilize these symptoms or deficiencies within our endocannabinoid system as the cannabinoids activate receptors to maintain internal stability and health. 

Most cannabinoids are not intoxicating by themselves and are needed in combination with other cannabinoids to influence different effects. There is a diverse range of cannabinoids influencing targeted receptors by bonding with them to produce effects for achieving homeostasis or balance. In our case, THC is considered a phytocannabinoid or exogenous cannabinoid. 

What is a Phytocannabinoid?

Phytocannabinoids or exogenous cannabinoids are compounds naturally existing in the cannabis Sativa plant. If you know any Latin- “Phyto” means “of a plant or relating to plants,” so in our case, phytocannabinoids are derived from or a product of the cannabis plants. Phytocannabinoids are made in the plant’s glandular trichomes, which are small hairs found on the surface of its leaves and secrete resin to protect phytocannabinoids. Since production takes place on the external surface, phytocannabinoids are also referred to as “exogenous cannabinoids” as they develop on the outside of an organism. Like addressed before, the cannabis plant has over 500 compounds and 100 of those compounds belong to this class of cannabinoids. Below is a common list of cannabinoids, you may be familiar with found in this class:

🍃 tetrahydrocannabinol (THC)
🍃 cannabidiol (CBD)
🍃 cannabidiolic acid (CBDA) 
🍃 tetrahydrocannabinolic acid (THCA)
🍃 cannabinol (CBN)
🍃 cannabigerol (CBG)
🍃 cannabichromene (CBC)
🍃 tetrahydrocannabivarin (THCV)

One of the essential qualities of cannabinoids that make them critical to the treatment of physical and mental health complications is its homeostatic tendencies. When consumed, cannabinoids quickly enact the endocannabinoid system by attaching or influencing the receptors. They interact with the properties within these chemical compounds to produce effects such as mood enhancement, pain relief, anxiety decrease, and stimulation of appetite. 

What is THC?

THC stands for Tetrahydrocannabinol. THC is the main and most well-known compound in the cannabis plant. THC is known for its psychoactive properties of feeling “high,” though how does it make you feel high? THC shares nearly the same structure as a natural chemical called anandamide. Anandamide acts as a neurotransmitter that serves the purpose of increasing dopamine. THC and Anandamide bind to the same receptors in our brain creating the psychoactive effect that we all feel… aka feeling high as a kite. 

What are the potential effects of THC? 

THC can make everyone feel different, the most common psychoactive effects reported include but are not limited to: 

🌿 euphoria
🌿 relaxation
🌿 introspection
🌿 creativity
🌿 sedation
🌿 sensory alteration
🌿 appetite stimulation
🌿 focus 
🌿 energy-boosting

THC can also produce some common undesired effects which may include but are not limited to:

😵‍ red eyes
😵‍ disorientation
😵‍ dizziness
😵‍ anxiety 
😵‍ paranoia 

THC can also assist with common medicinal needs including but not limited to:

🌿 pain relief
🌿 inflammation
🌿 anti-inflammatory 
🌿 autoimmune disorders
🌿 insomnia
🌿 nausea
🌿 depression
🌿 anxiety 
🌿 PTSD
🌿 sleep apnea 
🌿 migraines 
🌿 Alzheimer’s disease

Let’s put it all together 

THC binds with our receptors in our brain producing increased dopamine levels, and as a result, creating a euphoric feeling. Effects can make everyone feel different, for some symptoms may improve, and for others, it can make symptoms worse. You know your body more than anyone, so trust your process and body sensations. It is always important to start small when trying cannabis for the first time. It may also be a good idea to keep track of what strains work best for you, including their effects, positive or negative. Whether you are a recreational user or a medical patient no one likes being too “high”, so be patient with yourself when exploring THC. 

Campo, P. (n.d.). Cannabinoids 101: THC – The Apothecarium. Https://Apothecarium.com/. Retrieved June 26, 2021, from https://apothecarium.com/blog/2018-7-9-cannabinoids-101-thc/?s=thc

Cao, C., Li, Y., Liu, H., Bai, G., Mayl, J., Lin, X., Sutherland, K., Nabar, N., & Cai, J. (2014). The Potential Therapeutic Effects of THC on Alzheimer’s Disease. Journal of Alzheimer’s Disease, 42(3), 973–984. https://doi.org/10.3233/jad-140093

Elsevier Enhanced Reader. (n.d.). Reader.elsevier.com. Retrieved August 14, 2021, from https://reader.elsevier.com/reader/sd/pii/S2352250X16302342?token=DDE675D1B41A7C5354437B97C3BC847DB8C70DBCDD7A2FEB4AC258D0CEC01831BE0FB200416D78D2440344F07AE77A92&originRegion=us-east-1&originCreation=20210814234227

Johnson, J. R., Burnell-Nugent, M., Lossignol, D., Ganae-Motan, E. D., Potts, R., & Fallon, M. T. (2010). Multicenter, Double-Blind, Randomized, Placebo-Controlled, Parallel-Group Study of the Efficacy, Safety, and Tolerability of THC:CBD Extract and THC Extract in Patients with Intractable Cancer-Related Pain. Journal of Pain and Symptom Management, 39(2), 167–179. https://doi.org/10.1016/j.jpainsymman.2009.06.008

Lland, R. (2018, July 9). What Is THC (Tetrahydrocannabinol)? Leafly. https://www.leafly.com/news/cannabis-101/what-is-tetrahydrocannabinol

Maroon, J., & Bost, J. (2018). Review of the neurological benefits of phytocannabinoids. Surgical Neurology International, 9(1), 91. https://doi.org/10.4103/sni.sni_45_18

Triangale, MD, R., & Jensen, MD, C. (2011). Cannabis and Insomnia. http://files7.webydo.com/92/9209805/UploadedFiles/5E9EC245-448E-17B2-C7CA-21C6BDC6852D.pdf

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HEY NEWBIES- START HERE!

KEEP IN MIND

Stay calm. Canna-curious is cool! But collect some info first.
If you are:

  • under 25 years old
  • taking any medication
  • at risk for heart disease
  • family history of psychosis
  • family history of mood disorders
  • family history of addiction

…please be sure to consult a medical or mental health professional.

NAVIAGTE

EXPLORE

LJG 2021

written by

Laura Geftman, LCSW

Hannah Sadock, MS

reviewed by

Hannah Sadock, MS

LJG 2021

written by

Laura Geftman, LCSW

Hannah Sadock, MS

reviewed by

Hannah Sadock, MS

A proclame to fame is the common phrase; “I have such a type..” which can link to a magnitude of preferences in someone’s life. Though for some, when it comes to “a type” of strain found in cannabis, the pressure is on to pursue the relief again. Though here is the problem, solely searching for this strain without considering the brand can lead to a completely different experience than before. You may notice differences in the flower with the smell, taste and/or burn, so to avoid this for the future, we must consider the key three factors to successful types of strains:

🧬 phenotypes

🧬 genotypes

🧬 chemotypes 

When we consider the lineage of cannabis, which just like any plant, has been adapting over time to accommodate its habitat, we are left to dive deeper into education on cannabis genetics. Thousands of years of adaptation has created strains to express their best traits for survival in all geographical locations. Diverse habitats have required the plant to make accommodations to maintain survival, creating a conditioned array of cannabis varieties. All the more reason to further investigate the variability of strains by understanding phenotypes, genotypes and chemotypes. 

What are Genotypes?

There is no debate that cannabis is a plant making its function and form closely related to other flowering plants in our atmosphere. The plant is a living organism with a genetic code that stimulates adaptations to survive its environment. Genetic codes are inherited from past cannabis crossings or ancestors determining growth, appearance, and other characteristics. As new strains are birthed through cross-breeding, genotypes develop, which essentially means the “ingredients” for a strain’s individual internal sequences of DNA and RNA creating its unique characteristics. 

The genetic composition of the cannabis plant- called the genotype- acts as a blueprint or map for its genetics. It provides a range of growth possibilities to the plant. It also determines how the genetics evolve and change as they are passed down. Each cannabis strain carries a different genetic code and therefore different genotypes. Just like every living organism; plants, humans, animals, all comprise of genetic sequences that make us one of a kind.

What are Phenotypes?

Two things influence the structural formation of any given cannabis plant: genetics and environment. The physical expression of a genotype is referred to as a phenotype. The traits, such as, color, shape, smell, and resin production are influenced by the environment causing adaptations from the plant’s genetic code. Therefore the environment cannabis is grown in can greatly affect and/or evolve the plant’s genetic code.

Cannabis has progressed its predigre from generations of being grown wildly, stimulating evolutionary adaptations for maintaining survival in specific climate and environmental conditions. Today, cannabis plants, dependent on strain show different characteristics in appearance with: 

🌿 Indica adapted to cooler conditions and thrived in mountainous regions. Plants were commonly short and stocky with broad leaves.

🌿 Sativa plants grew tall with slender leaves in tropical jungle conditions.

Cannabis breeders have crossed these varieties even further resulting in the production of new hybrids widing the margin for phenotypes and genotypes. The diversity provides a choice of flavours, aromas, and effects. For top dollar, patients can purchase clone/ replications of plants harvested by growers with specific phenotype expressions to achieve consistent relief. However, we must consider, thanks to evolutionary needs and DNA, not all plants will produce the same chemical compounds with exact concentration at each harvest. Much like humans have siblings from identical origins, plants essentially have siblings too with their own unique genetic sequence! 

What are Chemotypes?

Cannabis breeders are now providing us a virtually endless selection of strains to choose. While most dispensaries sell products as indica, sativa, or hybrid products, it would be more appropriate to identify cannabis by its chemotypes. 

Cannabis strains will produce different effects depending on the mixtures and concentrations of cannabinoids present in a given plant. Chemotypes are the classification of different cannabis varieties based on their chemical constituents. Five different chemotypes have been identified as follows:

🪴 Type I: the “drug type” because of its high THC content and low CBD:THC ratio

🪴 Type II: the “intermediate,” consisting of near equal parts THC and CBD

🪴 Type III: the “fiber” or “non-drug type” is mainly CBD

🪴 Type IV: which is predominantly CBG, with some CBD present

🪴 Type V: material with undetectable amounts of any cannabinoids

Genotypes, Phenotypes, Chemotypes for Your Type

Modern day cannabis has evolved in many ways. While many talk about the potency of today’s cannabis, it is important to recognize how the plant genetics and cultivation environments affect the medicine. Hopefully this will increase your understanding of defining characteristics for each strain, the various subtle differences in its phenotypes, and therefore easier to try diverse strains and potencies to find what works best for you. Be sure to keep track!

Aizpurua-Olaizola O, Soydaner U, Öztürk E, Schibano D, Simsir Y, Navarro P, Etxebarria N, Usobiaga A. 2016. Evolution of the cannabinoid and terpene content during the growth of Cannabis sativa plants from different chemotypes. Journal of Natural Products 79: 324–331.

Basas-Jaumandreu J, De las Heras FXC. 2020. GC-MS metabolite profile and identification of unusual homologous cannabinoids in high potency Cannabis sativa. Planta Medica 86: 338–347.

Bayer PE, Golicz AA, Scheben A, Batley J, Edwards D. 2020. Plant pan-genomes are the new reference. Nature Plants 6: 914–920.

Sawler, J., Stout, J. M., Gardner, K. M., Hudson, D., Vidmar, J., Butler, L., Page, J. E., & Myles, S. (2015). The Genetic Structure of Marijuana and Hemp. PloS one, 10(8), e0133292. https://doi.org/10.1371/journal.pone.0133292

Schwabe, A.L., McGlaughlin, M.E. Genetic tools weed out misconceptions of strain reliability in Cannabis sativa: implications for a budding industry. J Cannabis Res 1, 3 (2019). https://doi.org/10.1186/s42238-019-0001-1

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