MARIJUANA

MARIJUANA

What is it?

Marijuana is an herb. It contains chemicals called cannabinoids . Cannabinoids affect the central nervous system , which includes the brain and nerves. Cannabinoids are found in the highest levels in the leaves and flowers . These are the parts of the herb that are used to make medicine.

Some people take marijuana extract by mouth or as a spray to be applied under the tongue for pain and symptoms of multiple sclerosis.

Some people breath in marijuana as a medicine. Marijuana is smoked for nausea, vomiting, an eye disease called glaucoma, to increase appetite , to reduce swelling of mucous membranes like the inside the mouth, for leprosy, fever, epilepsy, dandruff, depression, anxiety, sleep, hemorrhoids, HIV/AIDS, obesity, Parkinson’s disease, asthma, bladder infections, cough, nerve pain, cancer pain, fibromyalgia, and multiple sclerosis. It is also inhaled to reduce the chance that the body rejects a kidney if it has been donated from another person. In addition, marijuana is smoked to reduce symptoms of amyotrophic lateral sclerosis (ALS, Lou Gehrig’s disease).

Some people use marijuana to feel good. In this case it is used as a ‘recreational drug’ and is either taken by mouth or smoked (inhaled).

Don’t confuse marijuana with hemp . This is a similar plant but it is grown for the rough parts of the plant, the fiber, as well as for seeds . Hemp contains very low levels of THC, less than 1 %.

In the U.S., marijuana is illegal under federal law. It is classified as a Schedule I controlled substance . But some states including California, Colorado, Washington, Oregon, Arizona, and others have legalized or decriminalized the use of medical marijuana . Some countries such as Canada have legalized recreational marijuana. 

Natural Medicines Comprehensive Database rates effectiveness based on scientific evidence according to the following scale: Effective, Likely Effective, Possibly Effective, Possibly Ineffective, Likely Ineffective, Ineffective, and Insufficient Evidence to Rate.

The effectiveness ratings for MARIJUANA are as follows:

Possibly Effective for…

  • Multiple sclerosis (MS). Spraying a marijuana extract (Sativex, GW Pharmaceuticals) under the tongue seems to improve symptoms of multiple sclerosis such as muscle spasms, the need to urinate, and nerve pain in some people with MS. In the UK, this product is approved as a prescription drug to treat muscle spasms in people with MS. In Canada, this product is approved to treat nerve pain in people with MS. This product is not available as a prescription medicine in the US. Some early research suggests that taking a specific marijuana extract (Cannador, Society for Clinical Research) by mouth helps to reduce muscle stiffness and spasms in people with MS. But other marijuana extracts don’t seem to help to reduce spasms or tremors or help with walking. Some early research shows that smoking marijuana may reduce muscle spasms, pain in the arms and legs, and tremors in people with MS.
  • Nerve pain. Most research shows that smoking marijuana can moderately reduce nerve pain caused by HIV and other conditions. The pain relief lasts for about 2 hours.

Insufficient Evidence to Rate Effectiveness for…

  • Amyotrophic lateral sclerosis (ALS, Lou Gehrig’s disease). Early research shows that people with ALS who use marijuana might have improvements in some symptoms, including depression, appetite, spasms, and drooling.
  • Weight loss in people with advanced cancer (cachexia). Early research shows that taking marijuana extract by mouth does not improve appetite in people with cancer.
  • Nausea and vomiting related to cancer treatment. Early research shows that using a mouth spray containing marijuana helps prevent delayed nausea and vomiting in people treated with cancer drugs. Delayed nausea and vomiting starts at least 24 hours after receiving cancer drugs. Marijuana doesn’t seem to prevent acute nausea and vomiting. This type starts within 24 hours of being treated with cancer drugs.
  • Crohn’s disease. Smoking marijuana might reduce symptoms of Crohn’s disease. But it doesn’t seem to help people become symptom free.
  • An eye disease called glaucoma. Marijuana seems to reduce pressure inside the eye in people with glaucoma. But this effect lasts for only 3-4 hours. And marijuana might decrease blood flow to the nerve that sends information from the eye to the brain. This might make vision worse. It’s unclear if marijuana improves sight in people with glaucoma.
  • Weight loss in people with HIV/AIDS. A survey of people with HIV and loss of appetite found that those who smoke or eat marijuana report having an increased appetite.
  • Parkinson’s disease. Early research suggests that smoking marijuana improves symptoms of Parkinson’s such as pain, stiffness, and shakiness within 30 minutes of smoking.
  • Rheumatoid arthritis (RA). Some research suggests that using a mouth spray containing marijuana extract can decrease morning pain and improve sleep in people with RA. But it doesn’t seem to improve joint stiffness in the morning or overall pain severity.
  • Asthma.
  • Dandruff.
  • Hemorrhoids.
  • Leprosy.
  • Obesity.
  • Preventing organ rejection after kidney transplants.
  • Schizophrenia.
  • Bladder infections.

More evidence is needed to rate marijuana for these uses.

Marijuana contains chemicals that work by binding to specific sites in the brain and on the nerves.

Marijuana extract is POSSIBLY SAFE when used as a specific spray (Sativex, GW Pharmaceuticals) that is applied under the tongue.

Marijuana is POSSIBLY UNSAFE when smoked. Smoking marijuana is associated with an increased the risk of developing lung cancer. Also, some reports suggest that smoking marijuana might cause air-filled cavities to form within lung tissue. These air-filled cavities can cause symptoms such as chest pressure, soreness, and difficulty breathing.

Smoking marijuana or using mouth sprays containing marijuana extract can cause headache, dizziness, drowsiness, dry mouth, nausea, and paranoid thinking. Smoking marijuana might also increase appetite, cause coughs, increase heart rate, increase or decrease blood pressure, and impair mental functioning. Some reports suggest that smoking marijuana may also increase the risk of acute coronary syndrome, heart attack, and/or swelling of walls of the arteries (arteritis). However, in many cases, people who experienced these events after smoking marijuana had other risk factors for heart-related events such as smoking cigarettes or being overweight.

Special Precautions and Warnings:

Pregnancy: Marijuana is UNSAFE when taken by mouth or smoked during pregnancy. Marijuana passes through the placenta and can slow the growth of the fetus. Marijuana use during pregnancy is also associated with childhood leukemia and abnormalities in the fetus.

Breast-feeding: Using marijuana, either by mouth or by inhalation is LIKELY UNSAFE during breast-feeding. The chemicals in marijuana pass into breast milk . Too much of these chemicals might slow down the development of the baby.

Bipolar disorder: Using marijuana might make manic symptoms worse in people with bipolar disorder.

Heart disease: Marijuana might cause fast heartbeat and high blood pressure. It might also increase the risk of a having heart attack.

A weakened immune system: Certain chemicals in marijuana can weaken the immune system . This might make it more difficult for the body to fight infections.

Allergies to fruits and vegetables: Marijuana might increase the risk of an allergic reaction in people with allergies to foods like tomatoes, bananas, and citrus fruit. 

Depression: Marijuana use, especially frequent use, might make symptoms of depression worse.

Multiple sclerosis: Taking marijuana by mouth might make symptoms of multiple sclerosis worse. 

Lung diseases: Marijuana can make lung problems worse. Regular  use over a period of years might increase the risk of lung cancer . Some people develop a type of lung disease called emphysema.

Schizophrenia: Using marijuana might make symptoms of schizophrenia worse.

Stroke: Using marijuana after having a stroke might increase the risk of having a second stroke.

Surgery: Marijuana affects the central nervous system or the brain and nerves. It might slow the central nervous system too much when combined with anesthesia and other medications during and after surgery. Stop using marijuana at least 2 weeks before a scheduled surgery.

Anesthesia

Interaction Rating = Moderate Be cautious with this combination.
Talk with your health provider.

Using marijuana might increase how much anesthesia your doctor needs to give to you for surgery. Tell your doctor if you regularly use marijuana. If possible, stop using marijuana at least 2 weeks before surgery.

Antipyrine

Interaction Rating = Moderate Be cautious with this combination.
Talk with your health provider.

The body breaks down antipyrine to get rid of it. Some chemicals in marijuana might decrease how quickly the body breaks down antipyrine. This might increase antipyrine levels in the body and increase its effects and side effects.

Disulfiram (Antabuse)

Interaction Rating = Moderate Be cautious with this combination.
Talk with your health provider.

Taking marijuana with disulfiram (Antabuse) might cause you to feel irritated, nervous, jittery, and excited. Doctors call this hypomania.

Fluoxetine (Prozac)

Interaction Rating = Moderate Be cautious with this combination.
Talk with your health provider.

Taking marijuana with fluoxetine (Prozac) might cause you to feel irritated, nervous, jittery, and excited. Doctors call this hypomania.

Medications changed by the liver (Cytochrome P450 2E1 (CYP2E1) substrates)

Interaction Rating = Moderate Be cautious with this combination.
Talk with your health provider.

Some medications are changed and broken down by the liver. Marijuana might increase how quickly the liver breaks down some medications. Using marijuana along with some medications that are broken down by the liver might decrease the effects of some medications. Before using marijuana talk to your healthcare provider if you take any medications that are changed by the liver.

Some medications changed by the liver include acetaminophen, chlorzoxazone (Parafon Forte), ethanol, theophylline, and anesthetics such as enflurane (Ethrane), halothane (Fluothane), isoflurane (Forane), methoxyflurane (Penthrane).

Medications changed by the liver (Cytochrome P450 3A4 (CYP3A4) substrates)

Interaction Rating = Moderate Be cautious with this combination.
Talk with your health provider.

Some medications are changed and broken down by the liver. Marijuana might decrease how quickly the liver breaks down some medications. Using marijuana along with some medications that are broken down by the liver might increase the effects and side effects of some medications. Before using marijuana talk to your healthcare provider if you take any medications that are changed by the liver.

Some medications changed by liver include lovastatin (Mevacor), clarithromycin (Biaxin), cyclosporine (Neoral, Sandimmune), diltiazem (Cardizem), estrogens, indinavir (Crixivan), triazolam (Halcion), and others.

Medications for dissolving blood clots (Thrombolytic drugs)

Interaction Rating = Moderate Be cautious with this combination.
Talk with your health provider.

Marijuana might slow blood clotting. Taking marijuana with medications used for dissolving blood clots might increase the chance of bleeding and bruising.

Some medications used for dissolving blood clots include alteplase (Activase), anistreplase (Eminase), reteplase (Retevase), streptokinase (Streptase), and urokinase (Abbokinase).

Medications moved by pumps in cells (P-glycoprotein Substrates)

Interaction Rating = Moderate Be cautious with this combination.
Talk with your health provider.

Some medications are moved by pumps into cells. Marijuana might make these pumps less active and increase how much of some medications get absorbed by the body. This might increase the side effects of some medications.

Some medications that are moved by these pumps include etoposide, paclitaxel, vinblastine, vincristine, vindesine, ketoconazole, itraconazole, amprenavir, indinavir, nelfinavir, saquinavir, cimetidine, ranitidine, diltiazem, verapamil, corticosteroids, erythromycin, cisapride (Propulsid), fexofenadine (Allegra), cyclosporine, loperamide (Imodium), quinidine, and others.

Medications that slow blood clotting (Anticoagulant / Antiplatelet drugs)

Interaction Rating = Moderate Be cautious with this combination.
Talk with your health provider.

Marijuana might slow blood clotting. Taking marijuana extracts along with medications that also slow clotting might increase the chances of bruising and bleeding.

Some medications that slow blood clotting include aspirin, clopidogrel (Plavix), diclofenac (Voltaren, Cataflam, others), ibuprofen (Advil, Motrin, others), naproxen (Anaprox, Naprosyn, others), dalteparin (Fragmin), enoxaparin (Lovenox), heparin, warfarin (Coumadin), and others.

Sedative medications (Barbiturates)

Interaction Rating = Moderate Be cautious with this combination.
Talk with your health provider.

Marijuana might cause sleepiness and drowsiness. Medications that cause sleepiness are called sedatives. Taking marijuana along with sedative medications might cause too much sleepiness.

Sedative medications (CNS depressants)

Interaction Rating = Moderate Be cautious with this combination.
Talk with your health provider.

Marijuana might cause sleepiness and drowsiness. Medications that cause sleepiness are called sedatives. Taking marijuana along with sedative medications might cause too much sleepiness.

Some sedative medications include clonazepam (Klonopin), lorazepam (Ativan), phenobarbital (Donnatal), zolpidem (Ambien), and others.

Theophylline

Interaction Rating = Moderate Be cautious with this combination.
Talk with your health provider.

Taking marijuana might decrease the effects of theophylline. But there isn’t enough information to know if this is a big concern.

Warfarin (Coumadin)

Interaction Rating = Minor Be cautious with this combination.
Talk with your health provider.

Using marijuana might increase the effects of warfarin (Coumadin). Smoking marijuana while taking warfarin (Coumadin) might increase the chance of bruising and bleeding.

Herbs and supplements that cause sleepiness

Marijuana might cause sleepiness. Using it along with other herbs and supplements that have the same effect might cause too much sleepiness. Some of these supplements include 5-HTP, calamus, California poppy, catnip, hops, Jamaican dogwood, kava, St. John’s wort, skullcap, valerian, yerba mansa, and others.

Herbs and supplements that might slow blood clotting

Using marijuana with other herbs that can slow blood clotting might increase the risk of bleeding in some people. These other herbs include angelica, clove, danshen, ginger, ginkgo, red clover, turmeric, vitamin E, willow, and others.

Alcohol

Using dronabinol with alcohol might increase the effects of alcohol on the central nervous system.

The following doses have been studied in scientific research:

BY MOUTH:

  • The prescription product dronabinol (Marinol), which is one chemical in marijuana, is used in doses of 5 to 15 mg/m2 every 2 for 4 hours for nausea and vomiting due to cancer chemotherapy, and 2.5 to 10 mg twice daily for improving appetite in people with AIDS. However, current scientific information indicates that smoking or inhaling marijuna might not be safe. Talk with your healthcare provider before using this product.

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