While this can enhance the desired effects of those medications, it can also enhance the side effects and increase the risk of overdosing. In the first scenario, competition between two or more substances that are metabolized by the same enzymes reduces the rate at which one or all of those substances are broken down. Among these enzymes, there are six that metabolize 90 percent of all drugs. The table below—adapted from the Flockhart Table of drug interactions—lists some of the most common medications metabolized by these six key CYP450 enzymes. If you are currently taking any medications, it is important to check with your doctor or pharmacist before adding CBD to your treatment regimen.

Examining the subjective effects of vaporized cannabis in conjunction with opioids, Dr. Donald Abrams, an oncologist from UC, San Francisco, and his team published a small study in 2011. They found no significant change in opioid blood level concentrations after exposure to cannabis.

There are, for example, 82 identified drug interactions with caffeine (of which 25 are classified as moderately severe to severe). Even seemingly benign what is hemp oil substances, like grapefruit, are known to interact with many prescription drugs. When it comes to cannabis, most potential interactions that have been identified are relatively mild. And, in fact, some drugs seem to work together with cannabis favorably. The majority of the addiction treatment effects of CBD have been investigated in the context of opiate drugs.

The marijuana plant contains over 100 compounds known as cannabinoids. Most famous among them is tetrahydrocannabinol (THC), the main psychoactive cannabinoid. Cannabidiol (CBD) continues to rise in popularity as more research suggests a variety of health benefits, including relief for ailments such as chronic pain and inflammation, anxiety, depression, epilepsy, and high blood pressure.

However, characterizing the specific mechanisms by which they interact proves challenging. Nonetheless, the pain-relieving properties of cannabis are well-established. And, many medical professionals have come forward to suggest cannabis (as an alternative pain medication) could play a role in stemming the overuse of prescription (and illicit) opioids. Both THC and CBD may increase the effect of drugs used for blood thinning (e.g. warfarin or heparin), or drugs known to carry their own risk of blood thinning (e.g. ibuprofen, naproxen, etc.). Virtually all chemical compounds, from over-the-counter drugs and prescription pharmaceuticals to illicit substances, interact with other compounds.

Moreover, patients reported a 27% decrease in pain following cannabis administration. Most studies suggest there is a bidirectional modulatory relationship between the body’s natural opioid system and the body’s natural cannabinoid system (the endocannabinoid system).

CBD normalizes opioid-induced impairments in the reward center (the nucleus accumbens – NAc), including AMPA and CB1 receptor levels. In a human clinical study it was demonstrated that CBD does not alter the subjective effects of fentanyl but reduces heroin cue-induced drug craving and anxiety.