Respiratory depression is one of the most dangerous adverse effects of high doses of opioids and drug interactions with opioids, like hydrocodone. Fortunately, CBD, and other constituents of marijuana, do not appear to depress respiration to any significant degree, if at all.
In our latest question and answer, the pharmacist discusses whether or not CBD (cannabidiol) products interact with hydrocodone.
There are a variable of published studies that suggest that while CBD does inhibit metabolizing enzymes, it is not significant and the amount of CBD needed to affect these metabolizing enzymes in humans far exceeds what is possible with common dosing and consumption.
Taking Hydrocodone With CBD (Cannabidiol)
Cannabinoids, such as CBD and THC, have even been investigated to aid in opioid withdrawal symptoms.
In fact, toxicity studies in animals show extremely large amounts of CBD are needed to produce dangerous effects.
However, hydrocodone is metabolized in the body by CYP 2D6 to hydromorphone, which is significantly more potent than hydrocodone and mainly responsible for the analgesic effects of the drug. Therefore, potential metabolism inhibition by CBD could theoretically decrease the effectiveness of hydrocodone (due to less conversion to hydromorphone).
Studies have shown that CBD can inhibit:
The reduction of intestinal inflammation through the control of neuroimmune axis exerted by CBD suggests this CBD may be a promising drug for the therapy of inflammatory bowel disease, especially Crohn’s disease. CBD modulates inflammatory agents IL-12 and IL-10 and reduces activity of TNF-α, another inflammatory agent. CBD inhibits recruitment of inflammation-inducing mast cells and macrophages in the intestine, reducing intestinal damage principally mediated by peroxisome proliferator activated receptor-γ (PPAR-γ) receptor pathway. These findings may explain the significant reduction in disease activity for Crohn’s disease noted in a retrospective observational study of 30 patients treated with Δ9-THC and CBD. Lymphocytes are another key target of the immunomodulatory action of CBD. Specifically, CBD exhibits a generalized suppressive effect on T- cell functional activities in the gut.
While the CYP 1A2 enzyme is not a major enzyme in the metabolism of methadone, it has been reported that methadone levels can dangerously increase with smoking cessation. As a rule of thumb, it has been recommended that a stepwise daily methadone dose reduction of approximately 10% be engaged until the fourth day after smoking cessation.
Cannabis – Anxiety (coming soon)
CBD: Drug Interactions
The major cannabanoids, THC and CBD are both metabolized in the liver by the CYP450 enzymes 2C9, 2C19 and 3A4. Drugs that inhibit these enzymes may enhance or prolong the effects of THC and CBD. Whether people with genetic variants of these enzymes may experience altered effects from cannabinoids is not known. In one study, potential drug–drug interactions of THC/CBD oro-mucosal spray (Sativex, nabiximols) in combination with CYP450 inducers and inhibitors were assessed using various dose regimens. The antibiotic rifampicin, an inducer of CYP3A4, significantly reduced the peak plasma concentration of CBD, while the antifungal ketoconazole, a CYP3A4 inhibitor, nearly doubled the peak plasma concentration of CBD. However, the moderate CYP2C19 inhibitor omeprazole (Prilosec), a proton-pump inhibitor used to treat gastroesophageal reflux disease (GERD), did not significantly alter the pharmacokinetics of CBD.
Nicotine Addiction – Preliminary findings indicate that CBD reduces cigarette smoking in smokers trying to quit. Although the mechanism for this effect has not been definitely identified, CBD may modulate nicotine reward through its ability to increase endocannabinoid levels by inhibiting FAAH, the enzyme that breaks down the endogenous endoccannabinoids (see belpw). It has been demonstrated that inhibiting FAAH blocks nicotine seeking and nicotine-induced dopamine release in the NAc reward center. It also reduces anxiety during nicotine withdrawal in animals.
There appears to be a synergistic analgesic (pain-relieving) benefit when cannabinoids are added to opioid treatment for pain in which there is a greater-than-additive benefical effect with the addition of cannabinoids. Studies indicate a trend towards reduced use of opioids when patients taking opioids add cannabinoids to their regimen. It is not uncommon for patients started on cannabinoids to be able to taper down or off opioids.
Clinical studies have revealed definitive anxiolytic effects of CBD. CBD reverses anxiety brought on by THC and by a public-speaking simulation in patients with social phobia. Neuroimaging studies also show that CBD decreases activation of brain regions associated with anxiety, fear, and emotional processing, including the amygdala and the anterior and posterior cingulate cortex.