Brad asked
I started recently taking CW HEMP OIL 28mg per dose. I take 5mg/325mg oxycodone twice a day and lorazepam 0.5 mg for anxiety if needed. Are any of these interactions with the CBD Oil?
Answer
Cannabidiol, also known as CBD, is one of the major constituents of the cannabis plant. Depending on the cannabis species and chemovar (i.e. chemical variation), CBD can make up nearly 40% of the active constituents in extracts.
What Is CBD?
CBD, unlike THC, is considered to be non-euphoric and therapeutically beneficial for the treatment of pain, inflammation anxiety etc...
The mechanism of action of CBD is complex, but is thought to bind to receptors that can cause desensitization of pain and can inhibit the inactivation of the endogenous cannabinoids (naturally occurring the the body) such as anandamide, and therefore increase its concentration.
CBD Drug Interactions
Most of what we know in regard to drug interactions come from clinical trials of commercially available prescription products that contain CBD or synthetic versions of it. One such drug is Sativex. The trials for these drugs don't list any specific drugs that may interact but do mention how cannabinoids, such as CBD, can affect metabolizing enzymes.
Both THC and CBD have been shown in studies to metabolized by the cytochrome P450 system of metabolizing enzymes and could potentially inhibit them. In fact, studies have shown CBD inhibition of the following metabolizing enzymes:
- CYP2C9
- CYP2C19
- CYP3A4
- CYP2D6
If any of these metabolizing enzymes are inhibited, drugs that are substrates for them may potentially have their concentrations increased (due to a decrease in metabolism).
CBD Interactions With Oxycodone And Ativan
CBD With Oxycodone
Oxycodone is known to be metabolized by a variety of enzymes, including:
- CYP3A4
- CYP2D6
There is therefore a risk of increased oxycodone concentrations in the body when taken with CBD, due to inhibition of metabolism. This could potentially increase sedation with the drug and as well as increase the risk of respiratory depression. However, this risk appears to be low.
Most studies which show that CBD can affect metabolizing enzymes use extremely large doses, much more than most individuals would be taking. One such study used over 250mg CBD per dose! Most individuals would be using closer to 3 to 30 mg per dose and lower doses aren't associated with significant metabolizing enzyme inhibition.
CBD With Ativan
Ativan (lorazepam) is not thought to be metabolized by any CYP enzymes, but is instead metabolized by liver glucuronidation. Therefore, there doesn't appear to be any potential interactions between Ativan and CBD. However, as CBD can cause mild sedation, caution is advised when combining with other sedating drugs, such as Ativan.
Conclusion
There is a theoretical interaction between CBD and oxycodone, where oxycodone concentrations could be increased, but the risk appears to be low and has never been documented. Nevertheless, you should be sure to speak with your doctor before adding CBD to your medication list if you take oxycodone.
CBD is not thought to interact with Ativan as Ativan is not metabolized by CYP enzymes. It is a sedating drug however and use with CBD might lead to additive sedation.
