TABLE 3.
Interaction between opioids and cannabis, based on clinical trials.
| Drugs | Probability | Severity | Observed effects | Patient outcomes | Recommendation | References |
|---|---|---|---|---|---|---|
| Opioids | ||||||
| Fentanyl (n = 17) (Perpetrator—Unknown) | Defined | Not applicable |
Plasma CBD concentration was not significantly affected by fentanyl dosing (AUC Wilcoxon p > 0.05). Higher fentanyl dosing was associated with reduced CBD clearance (p = 0.02) In subjects on 400 mg of CBD, the mean peak urinary concentration of CBD conjugates (U max) for higher fentanyl dosing was 2 μg/L, as compared with 4.6 μg/L for lower fentanyl dosing In subjects on 800 mg of CBD, U max was 2.8 μg/L for the higher fentanyl dosing group and 3.7 μg/L for lower fentanyl dosing |
Adverse events reported were dizziness/drowsiness (n = 5), itching/rash (n = 3), abdominal discomfort (n = 2), diarrhea (n = 2), headache (n = 2), and nausea/vomiting (n = 2), but none were associated with peak concentration (C max) of CBD | Fentanyl is well tolerated and safe to be co‐administered | 9 |
| Morphine (n = 13) [Possible decreased gastrointestinal (GI) motility] | Defined | Not applicable |
Significant percentage changes in pain rating were reported (a decrease of 33.7%). C max values demonstrated a statistically significant decrease from 43.68 to 29.66 mg/mL (p = 0.003) No significant statistical change in 12‐h AUC (AUC12) was reported. THC plasma concentrations were not affected by morphine |
The analgesic effect was enhanced significantly. A subjective “high” was reported with the concomitant cannabis and morphine. All participants in the morphine/cannabis cohort (n = 10) experienced heightened stimulation and decreased hunger on Day 5 of the study | No recommendation provided | 10 |
| Oxycodone (n = 11) (Possible decreased GI motility) | Defined | Not applicable | The pain rating decreased by 21.3%. No significant changes in oxycodone kinetics were observed. THC plasma concentration was not affected by oxycodone | The analgesic effect was enhanced. A subjective “high” was reported with concomitant cannabis and oxycodone. All participants (n = 11) reported reduced anxiety on Day 5 | No recommendation provided | 10 |