Cannabis…for years we called it the gateway drug. Today, I think of it as an exit drug. An exit from too many medications. In my 20 years working in a traditional retail pharmacy, I have seen a healthcare system where many patients are left disappointed, suffering and underwhelmed by too many medications. The most current statistics from the CDC report that half of Americans are on at least one prescription medication. The United States consumes the majority of all prescription medications, spends the most on healthcare, and sadly our health outcomes and life expectancy are not the best (we are ranked 46th globally) and have been declining since 2014. Americans are engulfed in prescription medications and it’s not working. Every day I see Utah patients seeking medical cannabis as an alternative to Big Pharma. We see an exciting pattern in other markets where as access to cannabis increases, there is a decrease in the number of traditional medications prescribed.
While I see an overuse, I am also grateful for medications. I do not think it’s wise to vilify any single medication or substance. When used with respect and sparingly, all medications are important tools for health. There are a number of medications that I see patients replace quite often with cannabis. You should check with your provider whenever you make changes to your medication routine. Many patients come into the pharmacist office and tell me they want to stop all their medications. This can be dangerous and I recommend you consult with your cannabis pharmacist or your provider to help manage your medications safely. As a general rule the easiest medications to stop taking first before checking with your provider are those that are used only as needed.
Pain Medications/Opiods
Medical cannabis is most commonly recommended to treat chronic pain. THC is the primary cannabinoid to help with pain. CBD and CBG are also used for their anti-inflammatory effects and can replace medications like ibuprophen and naproxen that can cause kidney damage and GI issues. CBD is also useful for neuropathic pain. All of these cannabinoids work best when used together along with the terpenes and flavinoids in the cannabis plant. Sometimes pain medications like opiods lose efficacy over time and have harsh side effects and overdose liability. The CDC just released preliminary data reporting 87,000 deaths in the US from Sept 2019 to October 2020 which is a 29% increase in substance overdose deaths over last year. The majority of these deaths are from opiods. We are still in the midst of an opiod crisis in this country. Cannabis is helpful for pain and as an added bonus I have seen patients use cannabis as a tool to help taper off opiods since it seems useful for many of the symptoms you may experience with opiod withdrawal such as nausea, anxiety, trouble sleeping, tremors and flu-like symptoms. There is also a synergistic effect of cannabis with opiods that can be a great tool in reducing or discontinuing opiods. CBD and THC bind to the opiod mu receptor as a positive allosteric modulator making the opiod more effective at a lower dose. Talk to your cannabis pharmacist or your QMP about how to use cannabis to ease the process of opiod medication tapering.
Sleeping Medications
While sleep is not an official qualifying condition, it is common that patients with chronic pain have trouble sleeping. I do see a number of patients use cannabis to replace sleeping medications like zolpidem(Ambien), quetiapine(Seroquel), and trazodone. PTSD patients are often prescribed sleep medications to prevent nightmares. Cannabis can be an alternative to these medications.
Anxiety Medications
Anxiety is not an official qualifying condition, but I do see patients using cannabis to treat the anxiety associated with chronic pain, cancer and other qualifying conditions. THC and CBD in small amounts seem to help ease anxiety. Be careful with dosing since too much THC can actually cause anxiety. You should feel comfortable replacing any anxiety medications that are used occasionally and as needed but anything your provider prescribed daily to treat anxiety you should discuss before discontinuing.
Stimulants
Adderall, Concerta and Ritalin are examples of stimulants often prescribed for ADHD and to improve focus. Stimulants are the most common medication prescribed for Americans ages 12-19. It is not important that you be consistent on these medications and dosing guidelines suggest these medications should not be used every day. It’s recommended to take days off often and use them as needed. Side effects of these medications can be troublesome and include trouble sleeping, loss of appetite and mood changes. Stimulants are usually not recommended to be a long-term medication because of their side effects. I have noticed a number of my patients who start using cannabis tend to use their stimulants less often and I encourage using them as little as possible especially if they have side effects like trouble sleeping.
Stomach Medications
Cannabis is used for Crohn’s disease, ulcerative colitis, nausea, appetite, and gut mobility issues. I notice medications like ondansetron(Zofran), metoclopermide(Reglan), and omeprazole(Prilosec) are often discontinued after patients are on a cannabis regimen.
Anti-depressants
Anti-depressants are estimated to be only 20-30% effective for depression and often they come with side effects such as a headache, nausea, insomnia and a decrease in sexual libido. We are finding that traditional anti-depressants like citalopram(Celexa) and fluoxetine(Prozac) are not as effective as we originally thought for minor depression. I have seen many patients stop taking anti-depressants after they start using cannabis. Depression is not a qualifying condition but again we see it associated with chronic pain, cancer, hospice care and other qualifying conditions. Consistency is important with anti-depressants so do not stop these without talking to your provider.
Migraine Medications
Some medications used to treat acute migraine attacks like sumitriptan(Imitrex) or Fioricet can lead to something called medication overuse disorder or rebound headaches. Where taking a medication too often can increase the number of migraine attacks. Treating the pain from a migraine with THC may be a better option for some patients. Migraines are thought to be the result of an electrical misfire that triggers a complex inflammatory cascade and blood pressure changes. Some patients are prescribed anticonvulsants to prevent migraines. CBD/CBG has the potential to replace these preventative migraine medications such as topiramate(Topamax) which has unpleasant side effects. Talk to your provider about cannabis for treating migraine pain if you are not getting relief from your migraine medications.
Epilepsy Medications
Some patients have better seizure control using combinations of CBD and THC compared to traditional anticonvulsants. I have seen a number of patients reduce their seizure medications under a health care provider’s direction.
Alcohol and Nicotine
While these are not a traditional medication, I have talked to a number of cannabis patients who report a reduction in alcohol use and smoking. I have heard from many patients how cannabis is a tool that has helped them avoid alcohol and smoking. Addiction is a complex issue and replacing one substance with another does not address the root cause. I would strongly recommend seeing a trained addiction healthcare provider if you struggle with substance use issues.
Remember in the state of Utah you may only be prescribed cannabis for the Utah approved qualifying conditions. Talk to your primary care provider or cannabis pharmacist today so they can review your medication profile and suggest areas where discontinuing medications may be warranted. Some medications are easier to discontinue compared to others and all medication changes should be done under the advice of a healthcare provider. Your cannabis pharmacist can advise you on which medications are safe to discontinue and which ones require a taper.
Mindy Madeo is a medical cannabis patient and Utah pharmacist pursuing a Medical Cannabis Science and Therapeutics Masters degree from the University of Maryland College of Pharmacy. She currently carries the role as Lead Pharmacist for Beehive Farmacy in Brigham City, Utah.
