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Ron Patton | April 19, 2019
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The other day I had an experience with my doctor’s office that really upset me. I have been having knee pain and since I take blood thinners to reduce blood clot risks and stroke I am unable to take Ibuprofen because there is a bleeding risk as side effect.

Ever since I had cancer and became anemic, I have been super vigilant when it comes to keeping my Iron stores healthy and avoiding NSAIDs in order to keep my blood serology levels healthy.

When you have knee pain with inflammation, opiates do not work. So you are pretty much having to suffer. So I called my doctor looking for help and the advice nurse got on the phone and I asked her if she knew of something that I could use to bring down my inflammation.

The conversation wound up becoming an interrogation and an accusation that I was seeking more pain pills which is in violation of my “pill contract.” This was the first time I had ever been accused of abusing my pain medication and was threatened with not having any more resources for pain relief.

I was ambivalent as to whether or not I was to get opiates for my pain and I was very polite about it – but it did not work. I knew that if I lost my cool or my anger about being disrespected I would be reported as a pill seeker. I probably have been reported anyway and I can imagine having my ass handed to me when I see my doctor again.

It appears that the hoax called the opioid crisis is turning nice advice nurses into wardens of the pain prison. But what they don’t realize is that the opioid hysteria is hurting people and it is leading to some peculiar actions that I want to address.

I know that a lot of people do not like me calling the opiod crisis a hoax but I know that the problem is not the opiates themselves – the problem is that we have reached a point in this country where people go through depressive episodes. Some go through worse bouts than others. So they turn to many different drugs to self medicate and opiates are the drugs of choice for a lot of people.

So many people are suffering needlessly because of the hysteria about opioids – we’ve gone too far the other way in making it so difficult for those who need pain relief to get opioid painkillers. They say that opiate abuse has contributed to the suicide rate – but I would think that over time that a lack of effective ways to manage pain will create more suicides in the future.

Is there a benefit of throwing patients into withdrawal just because of hysteria that is counterintuitive?

Opioids and what they do are some of medicine’s greatest discoveries, and they can be used safely with appropriate precautions. And people with a history of opioid dependence have the same right to pain relief as any other patient.

They also deserve respect and to be treated rationally.

However, the treatment that doctors and pharmacists get from the DEA has contributed to the problem and there is no sign of it abating and so there appears to be a secret weapon on the horizon – CBD oil.

I have explored a lot of alternatives to the maintenance drugs I use, I have over time learned the value of herbs and a lot of alternative natural things one can do to relieve inflammation and the pain that goes with it. It is also advantageous to live in a state where marijuana laws have changed which has made it quite easy to explore alternate uses for it – we all know that most people smoke it, and of course we know that when it is smoked, it gives you munchies, jokes are funnier – you are more apt to binge watch Family Guy, or SpongeBob Square Pants and everyone you meet is a trip, or they are more good looking and interesting.

For cancer patients with nausea, pot smoked or eaten gives them an appetite and it balances the over-medicated feeling that comes with the use of synthetic opiates.

Now I do not smoke pot as a rule – I have had edibles while I was recovering from cancer surgery and now I am a full supporter, having often times used cannabinoid oils or CBD ointments to treat pain. I have found that it kills pain on contact and is far more effective than Oxycodone for breakthrough pain and muscle stiffness.

However, depending on your doctor, some CBD use is frowned upon by the medical profession even though it has been proven to be effective in treating patients with epilepsy.

Epidiolex is a CBD pharmaceutical that has been approved for the treatment of seizures.

However, if you read about CBD you will find that there have been a lot of confusing messages being made about it, it’s safety and its effectiveness. One thing is clear that even though CBD has not been studied thoroughly and many are having a hard time comprehending the legality, it is winding up as an ingredient in a lot of things from shampoos to soda and now a hamburger.

Carl’s Jr. is testing out a cannabis burger to stay at the forefront of the CBD trend.

The will sell the Rocky Mountain High: CheeseBurger Delight burger at one location in Denver, Colorado for just one day April 20th, of course. The burger features a sauce infused with CBD.

Though the promotion is limited, it’s not a stunt. The burger chain is using the test to determine whether a CBD burger belongs on its permanent menu.

Meanwhile, it was reported last year that Coca Cola was researching a CBD infused cola to be released on the market this year. The burger and the cola shows how much excitement there is over the potential health benefits of CBD.

I know that the soda will be popular because a market next store to my house sells a CBD cherry cola and CBD lemonade soda that I tried and it was really good.

Coke and Aurora Cannabis, a Canadian cannabis producer, were in “serious talks” to develop such beverages, a development attributed to unidentified sources.

Now, while CBD seems to be popping up as a magic ingredient in everything I am beginning to get a little paranoid about how this is showing up in everything without a warning that it may interact badly with medications that have been prescribed by doctors.

While the majority of the vast majority of the science indicates CBD oil is safe for use and consumption, it does pose a few risks that, if not properly understood, could be dangerous.

I found out the hard way that large doses of CBD can make one of the medications that I take underperform. But things like Kale and Grapefruit juice may also cause one of the pills I take to underperform. The scary thing is that if this drug underperforms it has the potential to become fatal.

One of the reasons this happens is because of the inhibition of the cytochrome P450 enzyme system.

Found within the liver, the cytochrome P450 enzyme system is responsible for metabolizing potentially toxic compounds, including over 60% percent of any drugs you have consumed.

According to Davis’s Drug Guide, this system contains more than 50 enzymes that process and eliminate toxins.

In order to determine the appropriate dosages of medications, doctors make calculations using the average amount of time it takes for various drugs and medications to be processed through the cytochrome P450 system.

If only one drug is being processed, and the system is generally healthy, these averages provide accurate dosage information.

However, certain substances have the ability to affect processing times within this system, making drugs metabolize faster or slower than they would on their own.

Similarly, if the cytochrome P450 system is unhealthy due to problems with the liver or other pre-existing conditions, drugs may not metabolize as they should.

CBD can inhibit the cytochrome P450 system’s ability to metabolize certain drugs, leading to an overall increase in processing times.

Interestingly, CBD oil is not alone in its effect on drug metabolism. Grapefruit, watercress, St. John’s Wort, and goldenseal all have a similar impact in terms of CYP450 inhibition.

When the CYP450 system is impacted in this way, it leads to higher levels of certain drugs in your system at one time. This can cause unwanted side effects, and sometimes, an overdose.

If you are taking a medication affected by CBD, you should consult your doctor to make sure that it is safe for you to supplement your personal care routine with CBD oil. From there, the two of you may consider adjusting the dosage on your medications so that you can use both products safely.

Any drug metabolized by CYP450 enzymes could potentially interact with cannabidiol. According to the Indiana University Department of Medicine, drugs known to use the CYP450 system include:

• Steroids
• HMG CoA reductase inhibitors
• Calcium channel blockers
• Antihistamines
• Prokinetics
• HIV antivirals
• Immune modulators
• Benzodiazepines
• Antiarrythmics
• Antibiotics
• Anesthetics
• Antipsychotics
• Antidepressants
• Anti-epileptics
• Beta-blockers
• PPIs
• Angiotension II blockers
• Oral hypoglycemic agents
• Sulfonylureas

This list does not include all of the potential medications impacted by cannabidiol. Nor will every medication in the categories contained on this list will cause an interaction. For these reasons, you should consult with a medical professional before supplementing with CBD oil.

There are certain medications, known as “prodrugs,” that need to be metabolized to produce the therapeutic compound. In other words, you ingest an inactive compound and once in the body, it is processed into the active drug. If this processing is dependent on CYP3A4 (part of the larger CYP450 system), then inhibitors can result in too little active drug in the body for the desired therapeutic effect.
Codeine, for example, is a prodrug that is metabolized into morphine which provides the effect.

Vyvanse and Concerta are two other popular pharmaceutical medications for ADHD that fall into this category.

If you are worried that your CYP450 pathway may not be functioning properly, physicians can test the system to ensure that the medications you take are metabolizing as expected.

Alcohol and cannabis are both widely consumed in our society and the effects of combining the two are well known.

What is less understood by the general public, are the effects of combining alcohol and the cannabinoid compound CBD.

Alcohol depends on a few different metabolic pathways in the human body, with the primary enzymes involved being:
• Alcohol dehydrogenase (ADH)
• Aldehyde dehydrogenase (ALDH)
• CYP450 (specifically CYP2E1)

In people who only drink socially or occasionally, ADH and ALDH handle the entire workload of metabolizing ethanol. However, when binge drinking (or during chronic consumption of alcohol) CYP450 gets involved to assist the overloaded ADH and ALDH pathways.

• The CB1 receptor is a significant player in the reinforcing and motivating attributes of alcohol.
• Combining alcohol and CBD results in significantly lower blood levels of alcohol.
• CBD reduces the reinforcement, motivation and relapse for alcohol.
• CBD protects the liver from damage done by binge-drinking alcohol. CBD prevents against alcohol-induced neurodegeneration. CBD attenuates alcohol-
induced liver steatosis, metabolic dysregulation, inflammation and neutrophil-mediated injury.
• Cannabinoids have an effect on nearly all enzymes responsible for metabolizing alcohol.
• CB1 receptor agonists (THC) encourage alcohol consumption, while CB1 receptor antagonists (CBD) decrease it.

Although the pharmacokinetics of alcohol and CBD are not yet well-understood, what we do know is CBD inhibits the CYP450 enzyme system, and this system plays a significant role in alcohol metabolism.

Additionally, as found in mice, CBD alters levels of ADH and ALDH to varying degrees. It is important to be mindful and cautious when mixing CBD and alcohol.

Caffeine is the world’s most famous and commonly consumed psychoactive drug. Who doesn’t ingest even a little from time to time?

CBD oil is rapidly gaining ground on coffee in terms of popularity and so it only makes sense that people would start combining the two.

As it turns out, the two substances go very well together!

Caffeine is molecularly very similar to adenosine, a compound produced in our bodies that activates the A2a receptor. Caffeine binds to the A2a receptors, inhibiting the reuptake of adenosine.

When adenosine binds to the A2a receptor, the result is what is commonly known as the ‘rest and digest’ effect. Consequently, blocking adenosine from binding results in vasodilation, which increases clarity and alertness.

CBD oil is also a partial agonist of the A2a receptor; so the theory goes that by combining caffeine and CBD, adenosine is blocked across the board, resulting in not only more stimulation, but reduced anxiety (due to CBD’s effects on other neurotransmitters systems).

It is worth noting that these effects depend on the serving size of the CBD. High amounts of CBD are more likely to cause drowsiness and sedation.

Additionally, caffeine is metabolized by a CYP450 enzyme, specifically CYP1A2. As CBD inhibits the CYP450 enzyme system, a slowed excretion rate of caffeine will occur. This can mean the effects of the caffeine will be more prolonged and drawn out. The can be both good and bad!

On the bright side, CBD oil and caffeine together will cause the boost from your morning cup of coffee to last all day instead of just a few hours. On the downside, it’s easy to overdo it and end up wide-eyed in bed when you are trying to go to sleep.

Considering this information, again, it is best to be mindful and cautious when mixing caffeine and CBD.

This is why I have my apprehensions about all of the CBD added as that special ingredient in everything.

St. John’s Wort is also a very effective antidepressant and for a while, it was certainly as appealing as CBD. But no one wanted to put it in a Burger sauce or infuse it with Coca-cola or suspend it in Gummy Bears.

Even if there were more evidence that CBD works wonders, we would still have the question of what CBD-based products actually contain.

Not all states require CBD manufacturers to accurately label their products. With scant regulation, consumers should be skeptical. The source matters, too, since heavy metals or other contaminants have been found in some hemp grown in China or Eastern Europe.

There is also the possibility that some CBD products may contain THC in amounts that could make you intoxicated or impaired.

The responsible approach to all of this is to admit that there may be health consequences, for some people that use it and that the greed and the hype should be curtailed for the effort of research and hope.

Right now it seems that it is all about hype, hope, and big bucks. This really raises my cynicism over something that can be helpful for some people.

The truth is that there are plenty of opportunists out there capitalizing on what can be seen as a fad tincture.

Putting it in cheeseburgers and soda, in my opinion, is a bit like jumping the shark.

Written by Ron Patton

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