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Although there are over 700 chemicals in cannabis, there are two chemicals that have a big effect on how the body uses enzymes to process other drugs. One of these chemicals is tetrahydrocannabinol, also known as THC. It is the chemical that gets you high. The other of these two main chemicals is cannabidiol, also known as CBD. It is the chemical that gets you stoned.

Different strains of marijuana have different amounts of THC and CBD, so different strains of marijuana will interact with medications in different ways.

For instance, the strains of marijuana that are high in THC, are "recycled" by an enzyme that the body can't make very efficiently when you are taking ketoconazole (Nizoral) for a fungal infection or clarithromycin (Biaxin) for a bacterial infection.

You get higher from pot when you are on certain antifungals or antibiotics. 

The strains that are high in CBD, the chemical that gets you stoned, interact with an enzyme that some people have in abundance and some people don't. There are people who just don't get stoned very easily. When these people take antibiotics and smoke high-CBD pot, their bodies can't process either the medication or the pot very well. They don't get stoned, but they do get all the side effects of their medications.

The kinds of marijuana used for getting high or for controlling nausea like Banana Kush, OG, and Green Skunk will interact with drugs different than the kinds of marijuana used for getting stoned or treating anxiety like Purple Urkle, Grape Ape, Lavender, Grand Daddy Purple, and Purple Kush. 

CBD can also help people come off addicting opiate drugs. It slows down the rate at which the body metabolizes the opioid compounds in the drug, so less of the opiate is needed and coming off the drug is possible. However, this is also something for which it's best to work with a friendly and informed physician rather than on your own.

The effects of CBD on the body's enzyme system are additive to those of nicotine. If smoking cigarettes has an effect on how your body uses a drug or a substance, then smoking cigarettes and getting stoned has an even greater effect. Women's bodies, however, respond differently from men's. Estrogen speeds up the breakdown of both CBD and nicotine. A woman who uses high-estrogen oral contraceptives, or who takes estrogen replacement therapy, or who is in the first half of her menstrual cycle has less of a response to either pot or cigarettes than one whose body has lower amounts of estrogen.

What about adverse effects of THC?

There is a situation in which THC can be deadly. People who receive organ transplants are usually put on a drug called tacrolimus to keep their bodies from rejecting the transplant. Either smoking pot or using marijuana edibles can change the rate at which the liver breaks down tacrolimus and cause a toxic reaction that damages internal organs all over the body.

These interactions are ongoing concerns and require making decisions about whether to use pot or stay on the medication. However, THC and CBD also interact with other medications that are used on a short-term basis:

  • Marijuana increases the time that hydrocodone, oxycodone, and similar pain-relieving drugs stay active. It can help people get by with less of the opiate drug. That isn't to say it prevent addiction or makes opiates totally safe.
  • Any strain of pot that gets you "high" uses up the enzyme that processes NSAIDs for pain and inflammation (a large of group of drugs including aspirin, Tylenol, and Celebrex), most oral medications for diabetes, Dilantin (phenytoin) for epilepsy, and Coumadin (warfarin). These drugs will stay in your system longer and their side effects will be increased if you smoke high-THC pot.
  • Many medications for depression (especially Wellbutrin), acid reflux (all of the proton pump inhibitors), Plavix for blood clots, almost all medications for epilepsy, some medications for high blood pressure (especially propanolol), and high-progesterone birth control pills will stay in the body longer and have greater side effects when people smoke high-CBD, "stoning" cannabis.
  • Any kind of cannabis increases the time that the immunosuppressants tacrolimus, sirolimus, and cyclosporin stay in the bloodstream and increases their side effects. This also happens with most drugs for schizophrenia, marijuana increasing the risk of a condition called tardive dyskinesia, as well as nearly all cancer chemotherapies and nearly all antidepressants.

Sometimes it's just not a good idea to combine marijuana with a prescription medication. If you have side effects from the medication, then you will need either to cut back on the medication with your doctor's guidance or to cut back on marijuana. Cannabis can have a positive effect for many people, but it's never a cure-all. Nor is any other drug.

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