Advice from the Trenches: Mixed Medicine

Dear C and Dr. B;

I just had an experience with my younger sister, Emma that scared the crap out of me. I don’t ever want it to happen again. First, I have to mention that Emma has been on psychiatric meds for a while. She’s switched doctors a few times and they kept switching her medication. She was on Adderall at one point, but now she’s off that. I think she was on a combination of Tegretol and Wellbutrin when this happened. Anyway, she was feeling really jumpy from her psychiatric meds so we decided to smoke some pot to try and mellow out. The next thing I know she was running around, drooling and talking to herself. Then she became paranoid and started hearing voices. I don’t think pot has ever had that effect on her before. What caused this reaction?

Freaking Francine

C says: you have to ask? There’s only so much crap anyone’s body can handle at the same time. It’s impossible to tell what specific drug or drugs caused the reaction, because your sister is on too many medications. There were no controls here. No one was following doctors orders, and the doctors don’t seem to have been in communication with each other. This is a perfect example of why recreational and pharmaceutical drugs should never be mixed.

Because of the media perception of recreational pot as some kind of banana cake to have with lunch, we forget that it’s a pretty powerful medical plant that is unpredictable as far as individual reactions go. It does tend to exaggerate what is already in one’s head. If your sister was jumpy, you should have known better than to add a drug to the mix that could exaggerate her mood. The pot could have been the last straw to set off a psychic explosion. 

Because marijuana is still classified as a Schedule One drug, we have quite a bit of testimony on its effects, but there is virtually no scientific research to back it up. This doesn’t mean that what we know now is NOT true; it does, however, mean we don’t really know for sure. And here is something else you don’t know for sure – unless you buy pot from a licensed or trusted grower, there’s no telling what’s in it. Street pot can be laced with anything from PCP to embalming fluid. Users aren’t picky if the idea is to get high, because additives greatly boost the effect. Please, people, can we all learn a lesson from the contaminated vaping catastrophe? Don’t put cheap, black market knock-offs in your body! Have some self respect. When I was a teen, we had a name for people who would mix multiple drugs and take anything you handed them – we called them Garbage Heads. 

Dr. B says: It seems to me that your sister’s psychiatric medications may have stopped working, or the effects of the medication could have been exacerbated or made toxic by combining it with marijuana. 

Cannabis is a drug like any other and has to be respected as such. There is a lot unknown about its effect, both benefits and risks, but here’s what we do know: marijuana is metabolized through the cytochrome p450 system in the liver, as are most other substances. As a result, it can affect the body’s metabolic rate, along with affecting the action of other prescriptions, over- the-counter medications, nutritional supplements and recreational drugs that depend on the same enzymes in the liver in order to be broken down and eliminated. 

To put it in technical terms, in the liver, THC functions as a CYP 1A2 inducer and CBD is a 3A4 inhibitor. Concomitant administration of CBD significantly changes serum levels or effects of commonly used psychiatric medications: Topomax  Trileptal, Zonegran, Depakote, opiates (pain meds) and blood thinners. The action of foods such as grapefruit, which can alter the potency of some drugs, can also be affected. In addition, marijuana is a sympathomimetic, which means that it stimulates the release of norepinephrine from the sympathetic nervous system, which can increase agitation. The effect can be accelerated by the addition of medications with similar effect, such as Adderall, Wellbutrin, cocaine and nicotine.  

Marijuana has an initial cognitive sedating effect that can enhance the sedative effect of alcohol, opiates and benzodiazepines (Xanax, Ativan, and Klonopin.) THC, the main psychoactive compound in cannabis, can reduce the effectiveness of Risperidone.

Tell your doctor about ALL the drugs you are using so they can warn you about cross interactions. Most importantly, use common sense. Unfortunately, most of this information is new and still being collected. Many people, including doctors, do not know much about it. 

You can visit Dr. B’s blog at drbrilliantcliche.wordpress.com