Last week a 50 year old woman came to see my practice partner, Dr. Becker. She came for insomnia and had recently started herself on a cannabis product from a local recreational cannabis store. She was quite concerned because not only had this product not helped, but her PCP had noticed that recently the patient’s liver tests had become abnormal. The PCP was rightfully quite concerned and was at a loss to explain these tests.
The PCP told the patient to stop everything and, over a period of several weeks, the patient’s tests drifted toward normal. When we saw her, the patient’s tests were mostly normal, headed in the right direction, and only really needed to be monitored to be sure they returned to fully normal. However, the question remained what had caused this event and could the patient use cannabis for her insomnia.
As Dr. Becker and I discussed this case, as we often do, we realized that the patient had been using a particular product from a specific manufacturer. On further investigation of this product that was billed as “Sleep” we discovered that it is a combination product. This is a product that contains other things besides cannabis. In general, in Medicine, we try to avoid these combinations for just the reasons that we’ll see shortly.
The cannabis industry is a very competitive environment for companies. They are all striving to differentiate themselves from their competitors. After all, it’s hard to sell cannabis products when all companies have the same weed. Many are therefore turning to making these combination products to develop a loyal customer base.
Problems arise when manufacturers use ingredients that seem like a good idea, but aren’t. A great example of this is the lung illness that we saw surface in 2018 in people using vape pens. This was called EVALI (E-cigarette or Vaping Use-Associated Lung Injury). The problem, it turned out, was that manufacturers need a liquid to thin the cannabis material so that it works in the vape devices. They got the idea that vitamin E would be a great health benefit, so they’d put it in the vapes. Unbeknownst to them, but well known to physicians, I might add, vitamin E is highly allergenic in about 20% of people. Putting vitamin E on your skins might cause a rash that is annoying, but inhaling it causes essentially a huge rash in your lungs that turned out to be fatal for many.
What they don’t know can hurt you!
On further investigation of the product that had been used by this patient, we discovered that the manufacturer had put Corydalis in it. Corydalis is a flowering plant that has been used in Eastern medicine and contains several potentially toxic chemicals. It has been shown to provoke potentially fatal liver failure, as well as be a potent neurotoxin. While it is available in the US as a supplement, current medical recommendation is to avoid Corydalis entirely. https://www.cancercarewny.com/content.aspx?chunkiid=104681
The number of these combi products are growing for the reasons I mentioned above. Even simple products like those that combine cannabis with melatonin are not recommended. For about 20% of people melatonin will produce vivid and sometimes disturbing dreams. That’s in addition to those for whom it simply does nothing. When taking a combination medication it can be difficult to discern which ingredient is the culprit when something goes sideways. It’s easy enough to take two medications separately. That way we can easily stop the most likely problem and see what happens.
To the extent that cannabis, and in particular medical cannabis is poorly regulated at both the state and federal levels, we are hard pressed to be sure that a product is safe. We know that the cannabis elements are backed by research and are properly tested for contamination but we can’t know much about the other ingredients. Worse, the regulations don’t adequately address these other ingredients. For example, the offending product in the above patient’s case did not list Corydalis on the package. It was only by digging around on their website that we were able to ferret out the presence of this dangerous additive.
Until the government steps up to regulate these medicines properly, we just have to be extra vigilant and wary of products that are combinations. Further, as is clear from this patient’s experience, “natural” ingredients can be just as dangerous as any human-made chemicals. I often say, “cobra venom is all natural, but that doesn’t mean it’s any good for you.” They’re all chemicals after all.
Bottom line:
Avoid combinations meds, avoid products with vague names that imply a benefit without actually backing it up, and as always avoid products recommended by the industry that’s selling it. Get your advice from a knowledgeable and caring Cannabis Specialist.
Consult with a Qualified Boston Medical Marijuana Expert Today
Those considering using THC, CBD, or any type of medicine found in cannabis to help manage their condition should consider speaking to a trained medical expert who is knowledgeable about using cannabis therapeutically. Massachusetts medical marijuana doctor Jordan Tishler, M.D. sits on the faculty of Harvard Medical School and has years of experience helping patients treat pain and other ailments using cannabis. He and the team at InhaleMD stand ready to assist patients in determining whether medical marijuana is right for them. For more information, or to set up a virtual consultation with the team at InhaleMD, call us at (617) 477-8886 today.