Accurate Education – Marijuana (Cannabis): Side Effects & Drug Interactions

Marijuana (Cannabis):

Side Effects & Drug Interactions

The medical information on this site is provided as a resource for information only, and is not to be used or relied upon for any diagnostic or treatment purposes and is not intended to create any patient-physician relationship.  Readers are advised to seek professional guidance regarding the diagnosis and treatment of their medical concerns.

 

Marijuana: Medical Use Overview

The use of marijuana for medical purposes remains highly controversial and is fraught with a lack of good quality evidence regarding the specifics of clinical effectiveness and treatment. Side effects with the use of marijuana (cannabis)- based products are not uncommon and are reviewed below. The extent to which the constituents of cannabis interact with other drugs and herbal supplements is not fully understood at this time but is explored below. The following information is provided as an introduction but there will surely be more information to come.

 

See:

Combating Cannabis-Induced Anxiety, Panic and Paranoia

See Also:

Marijuana – Legislative Update for Louisiana

“Medical Marijuana” – Getting Started

Marijuana (Cannabis): Potential for Harm 

Marijuana (Cannabis): Dosing

Cannabidiol (CBD): Clinical Use and Dosing

  

Cannabinoid-Based Medications:

Over-the-Counter Cannabinoid Medications:

 

Palmitoylethanolamide (PEA)

Palmitoylethanolamide (PEA)

 

Cannabidiol (CBD)

Cannabidiol (CBD) – Introduction

Cannabidiol (CBD) – Clinical Use and Dosing

Cannabidiol (CBD) – Drug Actions & Interactions

   

Prescription Cannabis-Based Medications:

FDA-Approved Prescription Cannabis-Based Medications

Louisiana-Rx Cannabis-Based Products – “Medical Marijuana”

 

Clinical Applications of Cannabis:

Cannabis – Anxiety (coming soon)

Cannabis – Chronic Pain Overview

Cannabis – Fibromyalgia

Cannabis – Headaches (coming soon)

Cannabis – Inflammatory Bowel Disease (coming soon)

Cannabis – Neuroinflammation (coming soon)

Cannabis – Sleep (coming soon)

 

The Medical Science of Cannabis:

The Endocannabinoid System

Marijuana (Cannabis) – THC Pharmacokinetics

Marijuana – Cannabinoids and Opioids

 

Understanding Marijuana Products

Marijuana – Botanical

Marijuana – Oral Use coming soon

Marijuana – Inhaled (Smoked and Vaporized)

Marijuana – Topicals coming soon

 

Cannabinoids:

Cannabidiol (CBD)

Cannabigerol (CBG) (coming soon)

Cannabinol (CBN) (coming soon)

Tetrahydrocannabinol (THC) (coming soon)

Tetrahydrocannabivarin (THCV) (coming soon)

 

 Terpenes:

Terpenes – An Overview

   

See also:

Marijuana – Discontinuing Use

Marijuana Addiction – Cannabis Use Disorder (CUD)

  

 

Key to Links:

Grey text – handout

Red text – another page on this website

Blue text – Journal publication

cannabis-caduceus

This section is still being updated for accuracy and completeness.

 

Marijuana – Side Effects & Drug Interactions

 

Marijuana Side Effects

Overall, the adverse side effects of medical cannabis are within the range tolerated for other common medications. Multiple studies have demonstrated that there is no higher incidence of serious adverse events in cannabis subjects following medical cannabis use compared with control subjects, although non-serious adverse events were significantly higher in cannabinoid groups. Dizziness is the most common non-serious adverse effect reported. Other common adverse effects include:

 

  1. Euphoria, altered consciousness
  2. Acute panic or paranoid reaction  (What to do if cannabis causes anxiety, panic or paranoia)
  3. Altered motivation
  4. Sedation
  5. Fatigue
  6. Impaired attention, short and long term memory, and psychomotor performance including 
  7. Tachycardia, orthostatic hypotension (drop in blood pressure associated with sitting to standing)
  8. Dizziness and vertigo
  9. Dry mouth
  10. Increased appetite
  11. Auditory and visual hallucinations
  12. Impaired reaction times
  13. Cognitive impairment, including the ability to learn and remember new information, has been associated with long term illicit cannabis use but has been shown to be reversible after a period of abstinence.
  14. Long-term heavy cannabis smokers have increased risk of pulmonary symptoms such as chronic bronchitis and COPD but have no increased incidence of lung cancer

 

As expected, cannabis-naive patients tend to have more frequent adverse side effects compared with regular users. The effects of THC can change over time, with therapeutic effects more resistant to tolerance development than adverse side effects. Careful attention. to appropriate dosage, delivery method, and ratio of cannabinoids can reduce many of the adverse side effccts.

 

Cannabinoid Hyperemesis Syndrome (CHS)

Cannabinoid Hyperemesis Syndrome (CHS) is a condition characterized by cyclic vomiting and abdominal pain. It is estimated that there are 2.75 million cases in the US each year. Symptoms improve with stopping use of cannabis products and may be reduced with taking a hot shower. Fatal cases have been reported.

 

Cannabis for the Management of Pain – Assessment of Safety Study (COMPASS) – 2015

In this large, 2015 study evaluating 215 patients taking a  standardized herbal cannabis product (12.5% tetrahydrocannabinol) for a 1-year period, adverse affects were evaluated. Among these 215 patients,the frequency of side effects assessed as certainly/very likely related to cannabis were: sleepiness (5 people, .6%), memory loss (4 people, .5%), cough (4 people, .5%), nausea (4 people, .5%), dizziness (3 people, .4%), euphoric mood (3 people,, .4%), hyperhidrosis (2 people,, .2%), and paranoia (2 people, .2%). Moreover, the results indicated that the rate of non-serious side effects among ‘‘current cannabis users’’ was lower than that among ‘‘ex-cannabis users’’ or ‘‘naive users.’’

 

Of note, neurocognitive function did not decline in the cannabis group. This finding differs from that found in studies of long term recreational users of cannabis; a meta-analysis of 15 studies investigating the effects of recreational cannabis use on neurocognitive performance6 suggested that long-term cannabis users performed significantly poorer on tests of memory and attention than short-term users. In that study, both groups consumed similar amounts of cannabis (median = 7 grams/week, range = .3–57 grams/week), but there was no difference in memory and attention between short-term users and non-cannabis users.

 

There are several limitations to this study. There was a significant drop-out rate, which may represent a source of selection bias. Losses to follow-up were estimated at 30% over an average follow-up of 12 months. Factors associated with drop- out included side effects, perceived lack of effectiveness, and/or a dislike of the study product. Also, most study participants in the cannabis group (66%) were experienced cannabis users. Due to the small number of cannabis-naive patients in the study, the safety of medical cannabis use in cannabis-naive individuals could not be addressed.

 

It is important to point out that the adverse effects of medical cannabis cannot be equated with the adverse effect of illicit marijuana use. The amounts and ratios of the different cannabinoid constituents vary dramatically between different marijuana plants, whereas medical marijuana is anticipated to be formulated with specific standardized doses and ratios of the different cannabinoid components. The use of illicit marijuana does not allow for any accurate prediction of dosing.

 

Marijuana – Interactions With Other Drugs and Herbal Preparations

 

Cannabinoids and Opioids

There appears to be a synergistic analgesic (pain-relieving) benefit when cannabinoids are added to opioids for treatment of 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 off opioids.

 

Additionally, animals studies suggest that cannabinoids may reduce the development of tolerance to the analgesic benefits of opioids, resulting in less need for opioid dose escalation.

 

There is no enhancement of cardiorespiratory suppression from opioids with the addition of cannabanoids due to the very low density of cannabinoid (CB) receptors in brainstem cardiorespiratory centers. Cannabinoids are not reported to have any significant effecct on opioid metabolism, however there does appear to be a potential to do so (See below).

For more information, See Cannabinoids and Opioids

  

Alcohol and Benzodiazepines

The combination of cannabinoids with alcohol and benzodiazepines may increase sedation and cognitive impairment. Furthermore, a 2015 study evaluating 32 adult cannabis smokers found that  drinking low- dose alcohol (with approximately 0.065% peak breath- alcohol concentration) 10 min before inhaling low-dose (2.9%) THC, or high-dose (6.7%) THC vaporized cannabis raised blood THC (and 11-hydroxy THC, the primary psychoactive metabolite of THC) levels significantly. The implications of this study suggest that there may be greater cognitive impairment with drinking and using THC products, at least initially after use, and may further impact driving safety.

 

It was noted in this study the alcohol did not affect THC metabolism and therefore its effecct on THC levels may be due to increased absorption of THC from the gut (especially as it was noted that the AUC for THC was unchanged). To offset this effect, it may be worth eating when drinking alcohol and using THC products to slow absorption, but more importantly separate the use of alcohol and a THC product by at least one hour or more.

 

NSAIDS (Non-Steroid Anti-inflammatory Drugs)

NSAIDs such as ibuprofen and naproxen, particularly indomethacin, may suppress the effects of THC.

 

Anticoagulants, anti-platelet drugs, herbs and supplements that reduce blood clotting

Cannabis may change how the body processes these drugs and supplements, possibly increasing the risk of bleeding.

 

Anticholinergic drugs (Tricyclic antidepressants (TCAs) and some muscle relatxers)

Medications with anticholinergic activity such as amitriptyline (Elavil) and doxepin, and muscle relaxers such as cyclobenzaprine (Flexeril) may increase the psychoactive side effccts of cannabinoids.

 

Protease Inhibitors (antiviral drugs)

Cannabis use (especially delta-9 THC) with use of protease inhibitors (antiviral drugs) may reduce their effectiveness.

 

Sedative Drugs

 Cannabis-based drugs may increase the sedation association with sedative drugs

 

Selective Serotonin Reuptake Inhibitors (SSRIs)

Taking cannabis-based products with this SSRIs (Prozac, Paxil etc.) may increase the risk of mania.

 

Herbal Preparations

Sedative agents such as sleep aids (includes supplements containing GABA, melatonin, 5-HTP, skullcap, or valerian) – Use caution when taking these products and cannabis products together because of the potential for increased drowsiness.

 

Drug Metabolic Interactions

The major cannabanoids, THC and CBD are both metabolized in the liver by the CYP450 enzymes 2C9 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. 

 

The bioavailability of medications are generally described in terms of maximum blood level (Cmax) and maximum overall absorption into the blood (AUC).

 

Metabolic Effects of Medications on Cannabinoids

CYP3A4 Inhibitors Effect on Cannabinoids

Treatment with CYP3A4 inhibitors such as ketoconazole can produce an increase in Cmax and AUC of THC (1.2- and 1.8- fold, respectively). The increase in Cmax and AUC of the primary active metabolite of THC, 11-OH-THC,  can be 3 and 3.6-fold, respectively, and of that of CBD (2- and 2-fold, respectively). Therefore, if concomitant drug treatment with CYP3A4 inhibitors (e.g. itraconazole, ritonavir, clarithromycin) is started or stopped during treatment with cannabinoids, a dose adjustment may be required.

 

CYP3A4 Inducers Effect on Cannabinoids

Treatment with CYP3A4 inducers such as rifampicin can reduce the Cmax and AUC of THC (by 40% and 20%, respectively), the primary active metabolite of THC, 11-OH-THC, (by 85% and 87%, respectively) and CBD (by 50% and 60%, respectively). Therefore, concomitant treatment with strong enzyme inducers (e.g. rifampicin, carbamazepine, phenytoin, phenobarbital, St John’s Wort) should be avoided whenever possible. Again, if combined drug treatment with CYP3A4 inducers (e.g. itraconazole, ritonavir, clarithromycin) are started or stopped during treatment with cannabinoids, a dose adjustment may be required within two weeks of starting or stopping the inducer.

 

Metabolic Effects of Cannabinoids on other Medications

CBD Inhibits CYP2D6

CBD has been identified as a potent inhibitor of CYP2D6 which may have significant impact on the metabolism of medications that are broken down by CYP2D6, including hydrocodone (Norco, Vicodin, Zohydro, Hysingla). As such, use of CBD with tramadol or codeine may significantly reduce the analgesic effectiveness of these two opioids. Hydrocodone is metabolized to a small extent (15-20%) to hydromorphone by CYP2D6. Since hydromorphone is four times more potent as an analgesic compared to hydrocodone, inhibition of CYP2D6 by cannabinoids may result in less analgesic contribution by hydromorphone when cannabinoids are added to a hydrocodone regimen. This effect has not yet been definitively established.

 

CBD Inhibits CYP3A4 and CYP 3A5

CBD is also a potent inhibitor of CYP3A enzymes, especially CYP3A5. While CYP34 is the dominant CYP3A isoform in the metabolism of most drugs, some drugs such as diltiazem, are more efficiently metabolized by CYP3A5 than by CYP3A4. Also, CYP3A5 is a major isoform of CYP3A found in extrahepatic tissues and plays an important role in the metabolism of endogenous and exogenous compounds in these tissues. Thus, the inhibition of CYP3A5 by CBD may cause interactions with other medications but may also disturb normal metabolism of endogenous compounds.

   

Since cannabinoids are readily distributed in various tissues due to a high lipophilicity, tissue concentrations of CBD may be even higher than the blood concentration, suggesting that the inhibition of human CYP3A by CBD might be caused during and/or even after marijuana smoking.

 

CBD Inhibits CYP2C9

CBD has also been reported to inhibit CYP2C9. Warfarin (coumadin), an important blood thinner prescribed to reduce the risk of blood clots in the prevention of heart attacks, strokes and peripheral artery clots, may have blood levels reduced when CBD is added. This could result in an increased risk of the conditions Warfarin is being taken to prevent. Caution should be used when combining CBD with Warfarin and the prescribing physicians should be notified and consulted prior to combining.

    

THC Induces CYP1A2

THC has been reported to induce, or increase, levels of CYP 1A2, the enzyme that metabolizes tizanidine (Zanaflex) a commonly prescribed muscle relaxer used for neck pain and spasm. Tizanidine is a medication with a narrow therapeutic margin, meaning there may be a small range of optimal levels in which a little too low is ineffective but a little more may be too strong and associated with side effects. Thus adding, or discontinuing THC may result in significant changes in the clinicl effects of tizanidine and caution should be applied to avoid loss of benefit or possible side effects respectively.
 

 

Botanical Cannabis

Botanical cannabis is highly inconsistent and variable in its chemical composition, leading to wide variability with respect to both side effects and drug interactions. Cannabis species have been found to fall into three general chemotypes (chemical compositions) based on genetically-determined THC:CBD ratios:

 

Category I: Relatively high total THC and low total CBD

Category II: THC:CBD ratios near equal (1:1)

Category III: Relatively low total THC and high total CBD

 

For more information about botanical marijuana:

Marijuana: Botanical

 

 

Resources:

National Academy of Sciences

The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research

 

International Cannabinoid Research Society

International Cannabinoid Research Society – Home page

 

You Tube video marijuana education links:

Cannabis The Evil Weed (2009) part 1 of 16

 

 

  1. Introduction to Medical Cannabis (Module 1) – The Endocannabinoid System by Dr. Towpik
  2. Introduction to Medical Cannabis (Module 2) – Pharmacology & Phytocannabinoids by Dr. Towpik
  3. Introduction to Medical Cannabis (Module 3) – Chronic Pain, Palliation & Case Studies by Dr. Towpik
  4. Introduction to Medical Cannabis (Module 4) – CINV & Epilepsy by Dr. Teh
  5. Introduction to Medical Cannabis (Module 5) – Adverse Effects & Potential Drug Interactions
  6. Introduction to Medical Cannabis (Module 6) – Patient Care, Dosing & Titration by Dr. Teh

 

 

Lay-person Websites

These lay-person websites appear to be good resources for exploring medical marijuana. However, as is the case generally regarding medical applications of marijuana and its constitnuents, there is a huge amount of information that is not based in good science and relies on anecdotal (word-of-mouth) evidences. Reader, beware:

 

  1. www.CannabisBusinessTimes.com
  2. www.CBDschool.com
  3. www.gfarma.news
  4. www.GreenCamp.com
  5. www.Healer.com
  6. www.Marijuana.com
  7. www.MedicalJane.com
  8. www.profofpot.com
  9. www.ProjectCBD.org
  10. www.Weedmaps.com

 

References:

Politics of Medical Marijuana – Consequences

  1. Use-of-Prescription-Pain-Medications-Among-Medical-Cannabis-Patients
  2. Effects of Legal Access to Cannabis on Scheduled II-V Drug Prescriptions. – PubMed – NCBI
  3. It is premature to expand access to medicinal cannabis in hopes of solving the US opioid crisis – 2018
  4. Association of Medical and Adult-Use Marijuana Laws With Opioid Prescribing for Medicaid Enrollees. – PubMed – NCBI
  5. Patterns of medicinal cannabis use, strain analysis, and substitution effect among patients with migraine, headache, arthritis, and chronic pain in a medicinal cannabis cohort – 2018
  6. Patterns and correlates of medical cannabis use for pain among patients prescribed long-term opioid therapy. – PubMed – NCBI
  7. Associations between medical cannabis and prescription opioid use in chronic pain patients – A preliminary cohort study – 2017
  8. The prevalence and significance of cannabis use in patients prescribed chronic opioid therapy: a review of the extant literature. – PubMed – NCBI
  9. The use of cannabis in response to the opioid crisis: A review of the literature. – PubMed – NCBI
  10. Medical Cannabis Laws and Opioid Analgesic Overdose Mortality in the United States, 1999–2010 – 2014
  11. Rationale for cannabis-based interventions in the opioid overdose crisis – 2017
  12. Cannabis and the Opioid Crisis – 2018
  13. Impact of co-administration of oxycodone and smoked cannabis on analgesia and abuse liability. – PubMed – NCBI
  14. Building smart cannabis policy from the science up – 2017

 

Politics of Medical Marijuana – Louisiana

  1. louisiana-medical-marijuana-expansion-bill-signed-into-law-may-20-2016
  2. louisiana-2016-sb180-chaptered
  3. medical-marijuana-in-louisiana-who-will-get-access-june-2015
  4. now-in-effect-louisiana-medical-marijuana-law-shields-patients-and-caregivers-from-prosecution-aug-5-2016
  5. La house committee passes bill to allow medical marijuana prescription 4-5 2018

    

Politics of Medical Marijuana – Colorado

  1. The Clinical Conundrum of Medical Marijuana – 2017

 

Medical Marijuana – Prescribing Guidelines

  1. Simplified guideline for prescribing medical cannabinoids in primary care – Canadian Family Physician – 2018
  2. Physician Recommendation of Medical Cannabis Guidelines Calif Medical Assoc – 2011
  3. Prescribing smoked cannabis for chronic noncancer pain. Preliminary recommendationsCanadian Family Physician – 2014

 

Medical Marijuana – Potential Harms Associated with Cannabis Use

  1. Brief Review of Human Studies Regarding Increased Risk of Harm with Cannabis Use – State of Minnesota – 2016

 

Medical Marijuana – Driving

  1. Establishing legal limits for driving under the influence of marijuana – 2014
  2. Medical Marijuana and Driving – a Review – 2014
  3. Impact of Prolonged Cannabinoid Excretion in Chronic Daily Cannabis Smokers’ Blood on Per Se Drugged Driving Laws – 2013

 

Medical Marijuana – Opioids

  1. Use-of-Prescription-Pain-Medications-Among-Medical-Cannabis-Patients
  2. It is premature to expand access to medicinal cannabis in hopes of solving the US opioid crisis – 2018
  3. Patterns of medicinal cannabis use, strain analysis, and substitution effect among patients with migraine, headache, arthritis, and chronic pain in a medicinal cannabis cohort – 2018
  4. Patterns and correlates of medical cannabis use for pain among patients prescribed long-term opioid therapy. – PubMed – NCBI
  5. Associations between medical cannabis and prescription opioid use in chronic pain patients – A preliminary cohort study – 2017
  6. The prevalence and significance of cannabis use in patients prescribed chronic opioid therapy: a review of the extant literature. – PubMed – NCBI
  7. The use of cannabis in response to the opioid crisis: A review of the literature. – PubMed – NCBI
  8. Medical Cannabis Laws and Opioid Analgesic Overdose Mortality in the United States, 1999–2010 – 2014
  9. Rationale for cannabis-based interventions in the opioid overdose crisis – 2017
  10. Cannabis and the Opioid Crisis – 2018
  11. Impact of co-administration of oxycodone and smoked cannabis on analgesia and abuse liability. – PubMed – NCBI
  12. Cannabinoid–Opioid Interaction in Chronic Pain
  13. Synergistic interactions between cannabinoid and opioid analgesics. – PubMed – NCBI
  14. FDA approves CBD drug – Epidiolex – The Washington Post

 

Medical Marijuana – Drug Interactions

  1. Medicinal Cannabis—Potential Drug Interactions – 2019
  2. Drug-drug interactions as a result of co-administering Δ9-THC and CBD with other psychotropic agents. – PubMed – NCBI – 2018
  3. Controlled Cannabis Vaporizer Administration – Blood and Plasma Cannabinoids with and without Alcohol – 2015

 

 

Medical Marijuana – Opioid Drug Interactions

  1. The Effect of CYP2D6 Drug-Drug Interactions on Hydrocodone Effectiveness – 2014
  2. Cannabidiol, a Major Phytocannabinoid, As a Potent Atypical Inhibitor for CYP2D6 – 2011
  3. Potent inhibition of human cytochrome P450 3A isoforms by cannabidiol. – Role of phenolic hydroxyl groups in the resorcinol moiety – 2011

 

Medical Marijuana – Pain

  1. Use-of-Prescription-Pain-Medications-Among-Medical-Cannabis-Patients
  2. It is premature to expand access to medicinal cannabis in hopes of solving the US opioid crisis – 2018
  3. Patterns of medicinal cannabis use, strain analysis, and substitution effect among patients with migraine, headache, arthritis, and chronic pain in a medicinal cannabis cohort – 2018
  4. Patterns and correlates of medical cannabis use for pain among patients prescribed long-term opioid therapy. – PubMed – NCBI
  5. Associations between medical cannabis and prescription opioid use in chronic pain patients – A preliminary cohort study – 2017
  6. Medical Marijuana for Treatment of Chronic Pain and Other Medical and Psychiatric Problems – A Clinical Review – 2015

 

Medical Marijuana – Pharmacokinetics

  1. Human Cannabinoid Pharmacokinetics – 2007

 

Medical Marijuana – Tolerance Reversal

www.Healer.com

  1. Cannabis Sensitization 6 Day protocol – Healer.WorkBook – Inhalation
  2. Cannabis Sensitization 6 Day protocol – Healer.WorkBook – Tincture

  

    

Medical Marijuana – Product Evaluation

  1. The Cannabinoid Content of Legal Cannabis in Washington State Varies Systematically Across Testing Facilities and Popular Consumer Products – 2018
  2. Recommended methods for the identification and analysis of cannabis and cannabis products – 2009
  3. Quality Control of Traditional Cannabis Tinctures – Pattern, Markers, and Stability – 2016

 

Medical Marijuana – Sleep & Sleep Apnea

  1. Medical Cannabis and the Treatment of Obstructive Sleep Apnea – An American Academy of Sleep Medicine Position Statement – 2018
  2. Cannabis, Cannabinoids, and Sleep: a Review of the Literature. – PubMed – NCBI
  3. Misc Abstracts @ Obstructive Sleep Apnea – 2017
  4. Cannabinoid May Be First Drug for Sleep Apnea – 2018
  5. Pharmacotherapy of Apnea by Cannabimimetic Enhancement, the PACE Clinical Trial – Effects of Dronabinol in Obstructive Sleep Apnea – 2018

Medical Marijuana –Misc

  1. A tale of two cannabinoids: the therapeutic rationale for combining tetrahydrocannabinol and cannabidiol. – PubMed – NCBI
  2. Cannabis and cannabis extracts – greater than the sum of their parts? – 2001
  3. Medical cannabis and mental health: A guided systematic review. 2016 – PubMed – NCBI
  4. Epidemiological characteristics, safety and efficacy of medical cannabis in the elderly. – PubMed – NCBI
  5. Cannabis-conclusions – 2017 National Academy of Sciences
  6. Cannabis-chapter-highlights – 2017 National Academy of Sciences
  7. Cannabis-report-highlights – 2017 National Academy of Sciences
  8. Clinical Endocannabinoid Deficiency (CECD): Can this Concept Explain Therapeutic Bene ts of Cannabis in Migraine, Fibromyalgia, Irritable Bowel Syndrome and other Treatment-Resistant Conditions?-2004
  9. Cannabimimetic phytochemicals in the diet – an evolutionary link to food selection and metabolic stress adaptation? – 2016
  10. Marijuana use and the risk of lung and upper aerodigestive tract cancers: results of a population-based case-control study. – PubMed – NCBI
  11. Cannabis use and cognitive function: 8-year trajectory in a young adult cohort. – PubMed – NCBI
  12. Cannabinoids for Medical Use: A Systematic Review and Meta-analysis. – PubMed – NCBI
  13. Cannabinoids and Cytochrome P450 Interactions. – PubMed – NCBI Pharmacogenetics of Cannabinoids – 2018
  14. Systematic review of systematic reviews for medical cannabinoids – 2018
  15. Adverse effects of medical cannabinoids – a systematic review – 2008
  16. Cannabimimetic effects modulated by cholinergic compounds. – PubMed – NCBI
  17. Antagonism of marihuana effects by indomethacin in humans. – PubMed – NCBI
  18. Pharmacokinetics and pharmacodynamics of cannabinoids. – PubMed – NCBI
  19. Clinical Pharmacodynamics of Cannabinoids – 2004
  20. Affinity and Efficacy Studies of Tetrahydrocannabinolic Acid A at Cannabinoid Receptor Types One and Two. – 2017
  21. Quality Control of Traditional Cannabis Tinctures – Pattern, Markers, and Stability – 2016
  22. Exogenous cannabinoids as substrates, inhibitors, and inducers of human drug metabolizing enzymes: a systematic review. – PubMed – NCBI
  23. Pharmacology of Cannabinoids
  24. Current-status-and-future-of-cannabis-research-Clin-Researcher-2015
  25. Taming THC – potential cannabis synergy and phytocannabinoid-terpenoid entourage effects – 2011
  26. The Cannabis sativa Versus Cannabis indica Debate – An Interview with Ethan Russo, MD – 2016
  27. Review of the neurological benefits of phytocannabinoids – 2018
  28. Alternatives to Opioids in the Pharmacologic Management of Chronic Pain Syndromes: A Narrative Review of Randomized, Controlled, and Blinded Clinic… 2017 – PubMed – NCBI

Emphasis on Education

 

Accurate Clinic promotes patient education as the foundation of it’s medical care. In Dr. Ehlenberger’s integrative approach to patient care, including conventional and complementary and alternative medical (CAM) treatments, he may encourage or provide advice about the use of supplements. However, the specifics of choice of supplement, dosing and duration of treatment should be individualized through discussion with Dr. Ehlenberger. The following information and reference articles are presented to provide the reader with some of the latest research to facilitate evidence-based, informed decisions regarding the use of conventional as well as CAM treatments.

 

For medical-legal reasons, access to these links is limited to patients enrolled in an Accurate Clinic medical program.

 

Should you wish more information regarding any of the subjects listed – or not listed –  here, please contact Dr. Ehlenberger. He has literally thousands of published articles to share on hundreds of topics associated with pain management, weight loss, nutrition, addiction recovery and emergency medicine. It would take years for you to read them, as it did him.

 

For more information, please contact Accurate Clinic.

 

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