Medical Marijuana Safety

There are numerous articles to compare the health effects, both good and bad, with use of medical marijuana.  To summarize all would be difficult on our website, so please see the referenced links.  Below are some good points.

Adverse Effects (*combined list for THC and CBD):

Changes in perception- visual, time

Dry mouth and associated dental issues, Reduced tear flow and blink rate

Sedations, Dizziness, Reduced coordination, Ataxia

Bradycardia, orthostatic hypotenison

Anxiety, Dysphoria (these are dependent on ratios of CBD:THC)

Reduced sperm count (decrease testosterone)

Prospective memory and executive function decline

Bronchitis (resolves after cessastion), Cough (side note: data suggests no long-term change to lung function, ie no increase risk COPD, and little evidence to correlate as cause for lung cancer)

Medical Cannabis is regarded as having a fairly positive safety profile. There is a low to moderate dependence potential. Compared to prescription drugs or illicit drugs, there is low likelihood of overdosing, and the dose needing to obtain medical value is far below lethal doses.  It should not be used at time of acute psychosis.  Relative contraindications include severe cardiovascular (potential risk for arrhythmia), immunological, liver, or kidney disease, or acute illness.  Extraction products should also be avoided if there is risk of hypersensitivity; cannabis extracts are often mixed with oils, ie. safflower oil, and patients need to be mindful and contact the dispensary or their product inserts to avoid allergic reaction.  It is also important to get your product from reputable, regulated companies, as there has been issues of pesticide and fungal/bacterial contamination pending on oversight of other jurisdictions.

Pregnancy / Lactation – given the limitation on studies in pregnancy and lactation, it cannot be recommended through our provider to use medical marijuana.  Mixed studies showed decreased fetal growth but does not appear to cause congenital defect, and may lead to perterm birth.  Heavy use may diminish the neurodevelopment leading to subtle delay in milestones and cognition.  THC does cross through the placenta and can be found in breast milk. Dispensaries have recommended use of contraception for men and women up to three months after the discontinuation of use.

Adolescents

There has been demonstrated decrease in brain volume (medial orbitofrontal and inferior parietal lobe) in adolescent medical marijuana users.  This can associate with poorer complex attention.  When used under the age of 18 years old, the long-term result was lower IQ at subsequent testing 20 years later.  They also may have an increase of psychosis symptoms later in life.  Proclivity to dependency peaks at age 20-24yo.  We require that along with the provider at Southern Comfort medical marijuana clinic, the pediatric patient has their other physician sign consent for trial of therapy, with shared decision making regarding weighing risks:benefits.

People already experience individual benefit of all pharmaceuticals due to psychological makeup; particularly, liver enzymes, ie. some people are sensitive to all medications seemingly and others are very “tolerable” and need higher dosing.  Reliable medical companies like Medscape evaluate the studies on drug-medical marijuana interactions and develop databases to classify the risk of side effects.  You can look up your medications on their website, which then provides explanations of why they would interact here.   Obviously, no database will be completely inclusive, it hasn’t been tested on everything!

There are no endocannabinoid receptors in the brainstem, which is why people can’t die from excessive medical marijuana intake; but can expect an uncomfortable response when taking an excessively high dose regardless.  Some other meds, like opioids and benzodiazepines, there is risk for overdose as the receptors in the brainstem become bonded by the medicine and suppress the heart or lung function.  We will teach you how to use the medication correctly and handle any bad sensations, which might mean changes in titration the next time.

Predictions can be made and dosing should be mindful to use minimum doses and monitoring.  Many chemotherapeutic, antiepileptic, or cardiac arrhythmic medications have a narrow window of dosing, meaning toxicity or subtherapeutic levels that can be risky if not closely monitored.  When looking at the pharmacology of medications that are sympathomimetic, such as nervous system depressants (including alcohol, sleep aids, benzodiazepines, opiates, barbiturates antidepressants), and anticholinergics, we recommend caution when used with medical marijuana, maybe to avoid completely.  It is a relative contradiction for patients with history of cardiac arrhythmias or atherosclerosis, severe immunological, liver, or kidney disease, or in setting of acute illness to be using medical marijuana.

Common sense wisdom – too much of a good thing can be a bad thing.  But if you want to get technical …. some pharmaceuticals will compete with THC and CBD in the liver to break down the chemicals to metabolites. CBD is metabolized by CYP3A and CYP2C19, and as an inhibitor of CYP2D6 will increase concentration of drugs metabolized by this enzyme. THC is metabolized by CYP3A4 and CYP2C9, and can decrease other drugs’ concentration as a metabolized by CYP1A2 inducer.

Other References:

https://doh.dc.gov/sites/default/files/dc/sites/doh/publication/attachments/Medical%20Cannabis%20Adverse%20Effects%20and%20Drug%20Interactions_0.pdf

3 Steps to get a Medical Marijuana ID Card:

3

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and Medication