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Cannabis (Cannabis sativa) is an herbal drug. It contains chemicals called cannabinoids, including delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD).

The cannabinoids in cannabis work by binding to specific sites in the brain and on the nerves. There are over 100 cannabinoids in cannabis, but THC and CBD are the most well-studied. Cannabinoids are found in the highest levels in the leaves and flowers of the plant.

Cannabis is commonly used as a recreational drug. People also commonly use cannabis for multiple sclerosis (MS) and nerve pain. It is also used for nausea, vomiting, migraine, and many other conditions, but there is no good scientific evidence to support these uses. There is also no good evidence to support using cannabis for COVID-19.

Don't confuse cannabis with hemp. Hemp contains very low levels of THC, less than 0.3% according to legal standards. Both hemp and cannabis also contain cannabinoids such as CBD, cannabidivarin (CBDV), cannabigerol (CBG), and others. Unlike hemp, cannabis is illegal under federal law in the US. It is classified as a Schedule I controlled substance. But some states have legalized or decriminalized recreational use.

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  • Multiple sclerosis (MS).  A foreign prescription drug spray (Sativex) and oral cannabis extract seem to reduce spasticity and pain in patients with MS. It is unknown if inhaled cannabis is beneficial.
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  • Neuropathic pain.  Inhaled cannabis seems to temporarily reduce neuropathic pain in some patients, although the optimal dose remains unclear.
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When taken by mouth: Cannabis is possibly unsafe when used in large amounts or long-term. Edible cannabis containing 50 mg or more of THC has been linked with serious side effects. Regularly taking large amounts of cannabis might cause cannabinoid hyperemesis syndrome (CHS). CHS leads to severe nausea and vomiting that doesn't respond to typical anti-nausea drugs. Also, using cannabis for at least 1-2 weeks can cause dependence.

When sprayed into the mouth: A specific cannabis extract (Sativex) is possibly safe. This is a prescription-only product in the UK and Canada. It is not approved in the US.

When inhaled: Cannabis is possibly unsafe when used in large amounts or long-term. Smoking or vaping cannabis can cause breathing problems. Vaping products containing THC have been linked to serious lung injury. Regularly smoking cannabis may cause CHS and/or dependence.

Special Precautions & Warnings:

Pregnancy: Using cannabis is unsafe during pregnancy. Cannabis passes through the placenta and can slow the growth of the fetus and increase the risk for premature birth, stillbirth, childhood leukemia, abnormalities, or the need for intensive care after birth. It can also lead to lower intelligence and emotional problems in the child when they grow up. It also increases the risk for anemia and high blood pressure while pregnant.

Breast-feeding: Using cannabis is likely unsafe while breast-feeding. The chemicals in cannabis pass into breastmilk and stay in breastmilk for longer than 6 weeks, even after cannabis use has been stopped. These chemicals might slow down the development of the baby. Avoid all cannabis use if planning to breastfeed.

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

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

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

Depression: Using cannabis might increase the risk for depression. It can also worsen symptoms of depression and increase thoughts about suicide in those who already have depression.

Diabetes: Cannabis use might make it harder to control blood sugar levels. It might also increase the risk for long-term complications from diabetes. Until more is known, be cautious using cannabis.

Epilepsy: High doses of cannabis might cause seizures in people with epilepsy. There have been several reports where high doses of cannabis have caused seizures.

Liver disease: It is unclear if cannabis worsens chronic liver disease. Until more is known, be cautious using cannabis.

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

Schizophrenia: Using cannabis might make symptoms of schizophrenia worse.

Quitting smoking: Using cannabis might make it harder to quit smoking.

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

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

Disulfiram (Antabuse)

Interaction Rating=Moderate Be cautious with this combination.

Disulfiram (Antabuse) might interact with marijuana. Taking marijuana along with Disulfiram can cause agitation, trouble sleeping, and irritability.

Fluoxetine (Prozac)

Interaction Rating=Moderate Be cautious with this combination.

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

Sedative medications (Barbiturates)

Interaction Rating=Major Do not take this combination.

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=Major Do not take this combination.

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=Major Do not take this combination.

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 watchful with this combination.

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: Cannabis might cause sleepiness and slowed breathing. Taking it along with other supplements with similar effects might cause too much sleepiness and/or slowed breathing in some people. Examples of supplements with this effect include hops, kava, L-tryptophan, melatonin, and valerian.
Herbs and supplements that might slow blood clotting: Cannabis might slow blood clotting and increase the risk of bleeding. Taking it with other supplements with similar effects might increase the risk of bleeding in some people. Examples of supplements with this effect include garlic, ginger, ginkgo, nattokinase, and Panax ginseng.

There are no known interactions with foods.

Cannabis is commonly used in capsules, edible products, sprays, vape products, and cigarettes. Products can vary significantly depending on how much delta-9-tetrahydrocannabinol (THC), cannabidiol (CBD), and other cannabinoids they contain. Speak with a healthcare provider to find out what type of product and dose might be best for a specific condition.

Cannabis is illegal under federal law in the US. It is classified as a Schedule I controlled substance. Some states have legalized or decriminalized use.

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