Jamie asked
I take hydrocodone and have been for the past few years. I am wondering if it is safe to take CBD (cannabidiol) oil with it for additional pain relief.
Answer
Cannabidiol (CBD) is a major constituent of the cannabis plant and is considered "non-psychoactive", unlike delta-9-tetrahydrocannabinol (THC). In fact, depending on the variety of cannabis, CBD can make up close to 40% of cannabis extracts according to studies.
In regard to drug interactions with CBD, there is a distinct lack of studies to make definitive statements. This is true with hydrocodone and CBD interactions as well.
Nevertheless, based on the data available, the combination of CBD and hydrocodone appears relatively safe. There does not appear to be a risk of additive respiratory depression when using hydrocodone and CBD, a major consideration when combining hydrocodone with other drugs.
However, there is a theoretical interaction between CBD and hydrocodone where the effectiveness of hydrocodone in relieving pain could be decreased.
Below, we discuss the current evidence available regarding CBD and potential interactions with hydrocodone, including a potential decrease in efficacy of the pain relieving drug.
Taking Hydrocodone With CBD (Cannabidiol)
While studies looking at specific drug interactions with CBD are uncommon, it is known that CBD affects the cytochrome P450 system, which is extremely important for the metabolism of countless drugs.
Studies have shown that CBD can inhibit:
- CYP 2C9
- CYP 2C19
- CYP 3A4
- CYP 2D6
- CYP 3A4
When a metabolizing enzyme is inhibited, this often leads to increased concentrations for most drugs, due to decreased metabolism.
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).
This interaction is more theoretical than evidence based as there are a lack of studies that have reported this interaction. In addition, there is some controversy in regard to just how much, if at all, CBD can inhibit metabolizing enzymes.
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.
The doses of CBD used in studies that have shown potential interactions ranges widely. While most over the counter CBD products range from 1mg to 10mg per serving, studies have used anywhere from 100mg to 600mg! There is a good chance the more commonly used lower doses of CBD don't have significant interactions at all, but more studies are needed.
Safety Of CBD And Opioids Like Hydrocodone
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 fact, toxicity studies in animals show extremely large amounts of CBD are needed to produce dangerous effects.
Lastly, in studies where a combination of an opioid and CBD are given, most report no increase in adverse events.
One study evaluated the use of CBD and fentanyl, one of the most potent opioids available. Per the study:
"CBD does not exacerbate adverse effects associated with intravenous fentanyl administration. Co-administration of CBD and opioids was safe and well tolerated."
Cannabinoids, such as CBD and THC, have even been investigated to aid in opioid withdrawal symptoms.
Conclusion
Based on available evidence, there does not appear to be any significant interaction between CBD (cannabidiol) and hydrocodone. If anything, CBD may decrease the analgesic effects of hydrocodone, by limiting the conversion of the drug to the more potent hydromorphone in the body.
Nevertheless, if you are currently taking hydrocodone, it would be prudent to discuss adding on CBD for pain relief with your doctor so you can be evaluated and monitored appropriately.
