Lighting it up in the Transplantation Region, Team Marijuana is OK faces off against Team Marijuana is Not OK in a fiery battle to hash out a winner. There are several arguments supporting both teams, so let’s hit it.
However, cannabis dependence or abuse (CDOA) after kidney transplantation appears to have consequences for allograft and patient outcomes . Although post-transplant CDOA is associated with increased graft loss, plenty of people use cannabis responsibly and do not abuse it. There is no denying that substance dependence or abuse of any drug is detrimental to health. We should keep an open mind and allow our patients to be honest and open with their cannabis usage to ensure that dependence or abuse does not develop.
Official Blog of the American Journal of Kidney Diseases
We should be mindful that the legal cannabinoid market is still fairly young and early in development but expanding rapidly, possibly even too fast, before regulatory agencies are able to develop appropriate guidance, safety evaluation, quality standards, and consumer protections . It is reasonable to be hesitant regarding cannabis use in transplant recipients until we know more about its effects on transplant recipients. However, this will not be possible as long as cannabis remains a Schedule I controlled substance. As health care providers, we want to do what is best for our patients while keeping them safe.
– Guest Post written by Joshua Rein @ThepHunClub
Michael Jordan may have won March Madness in 1982 but in 2020, a different MJ flies high and takes to the court. Marijuana (cannabis) for recreational and medicinal uses has exploded in popularity and social acceptance across the world. This is particularly true for older adults and the elderly , whose usage has increased by 200% over the last 3 years.
Case in point: tacrolimus , an immunosuppressive medication used to prevent organ rejection in patients who have had heart, liver, or kidney transplants. CBD interferes with the metabolism of tacrolimus, according to research conducted by Dr. Alloway , who specializes in post-transplant immunosuppression. And because tacrolimus is a narrow therapeutic index drug (meaning the window between efficacy and toxicity is very small), this interference can lead to clinically significant negative outcomes (such as kidney problems or organ rejection), she says.
Are the concentrations in commercially available CBD high enough to cause this interaction? The evidence doesn’t really say one way or another. Dr. Alloway’s research involved a high dosage of CBD that wouldn’t be found in a retail product. However, it “highlights that a drug interaction is there,” she says. Plus, tacrolimus is metabolized in the body by a group of enzymes called cytochrome P450 and CBD is a known inhibitor of this process. What does that mean? If CBD inhibits the metabolism of tacrolimus, the patient can end up with too-high levels of tacrolimus in the body. In light of this, she urges anyone taking tacrolimus to speak with their transplant team before using CBD. Don’t get your hopes up, though—using herbal remedies, particularly those with potential interactions, is generally frowned upon by doctors looking after transplant recipients (including Dr. Alloway).
Is CBD marijuana?
Dr. McIntrye, who co-authored a 2018 study that concluded that healthcare providers need more information about drug-drug interactions with CBD and psychotropic medication, says much of the information out there is confusing and contradictory. Therefore, he echoes Dr. Alloway’s statement that it is absolutely prudent that patients clear the use of CBD with their doctor before giving it a go.
But claims that CBD aids in the treatment of certain mental health and psychiatric conditions, don’t pass muster, says Roger McIntyre, MD , professor of psychiatry and pharmacology at the University of Toronto.
CBD is thought to act on certain receptors in your brain and other parts of the body, in ways that could relieve pain, or help certain health conditions, like childhood seizure disorders. However, as with any “natural” product, the fact that it comes from plants doesn’t automatically render it innocuous. For some people, particularly those taking certain prescription medications, using CBD is risky. It has anticoagulant effects that can thin blood; it can also modestly lower blood pressure. These effects could be dangerous for people with certain medical conditions.