While many don’t even consider cannabis a “drug” itself, we believe that we need to know not only its effects, but also what are the risks of using it in combination with other substances. Shall we talk about it?

How many times have you heard, from friends, that cannabis is a natural medicine and therefore there are no risks related to its consumption? Or even that it’s not a drug? (Everyone, let’s work to disassociate the word drug from a negative stigma, after all, sugar, coffee and tea are drugs too). As much as our relationship with cannabis is a love bubble, we believe that we cannot romanticize this plant! Like all substances, there are risks and benefits associated with its use, and also its interactions to other substances. and today we are going to talk about it here!

Many are surprised when they realize that there are risks with the combination of cannabis with other drugs, especially psychedelic substances. This belief that the plant is not a drug, or is a “weaker drug”, leads many people to have a false sense of security in its consumption, especially when there is a poli use of substances.

In our new series “Cannabis and other drugs”, we want to bring a healthier dialogue and remove the cloudiness with which the subject is often dealt with. We are, first of all, an anti-prohibitionist and Harm Reduction platform, and that extends way beyond cannabis legalization. We believe that the war on drugs and its purely punitive actions have already shown that this does not work, and that the use of substances has always existed and will always exist in humanity. What we need is to talk, bring information and educate, users and non-users. Only in this way can we reduce the harms associated with consumption, and also the current policy.

In this first post, we want to bring a little more about the interaction between cannabis and other drugs, in addition to raising a reflection on Harm Reduction: how are we taking care of ourselves and those around us in relation to substance use? Are we paying attention to what it is, how it is and what it is consumed with? This is extremely important, and we’ll show you why here! Come with us.

Only with love and without prejudice can we do what is most important to us: caring!

What to consider as a drug?

Usually, when thinking about drugs, it is common, especially for a non-user, that a pejorative image comes to mind. After all, what is understood as a drug? Cannabis, alcohol, cocaine, heroin, tobacco; or are coffee, sugar and drugs also part of this “chain” of substances?

The media has a great role in building beliefs and opinions, and the demonization of drugs and stigmatization of the user contribute to the way the population will understand the complex phenomenon of drugs. As strange as that sounds, in the early 20th century it was possible to buy cocaine at the pharmacy in Brazil, showing that, at that time, there was a recognition of the therapeutic potential of the substance.

For a deeper dive into the subject, is every legal drug safe to use? What about an illicit drug? Common sense believes that their ban is based on safety and public health, but is that true? As we have already seen here on the blog, it is not quite the situation – prohibitionism can have a thousand and one reasons, political, economic and social, but health is not exactly one of them.

But let’s give a name to things: the current definition of a drug by the World Health Organization is “any natural or synthetic substance that administered by any route in the body affects its structure or function”. That is, it is a term that ranges from your cannabis to aspirin!

How to classify these substances?

Cannabis is a psychoactive drug, so it has the power to change the state of perception of its users. Other psychoactive substances, like it, are classified, and can be separated as:

• Stimulants: increase the speed at which neurotransmitters transmit information (such as, for example, cocaine);
• Depressors: decrease the speed of transmission of neurotransmitters (such as cannabis);
• Disturbing: they confuse and hinder the transmission of information from neurotransmitters (such as LSD).

In literature on the subject, there are also three other classifications:

• Empathogenic: a class of psychoactive substances that produce experiences of emotional communion, feeling of being one with the world, identification with another and emotional openness (as, for example, MDMA);
• Entheogenic Substances: substances, usually plants, with psychoactive properties and are used mostly in rituals focusing on spirituality, “to come into being”. The term  Entheogen emerged as a replacement for the terms hallucinogen and psychedelic.
• Dissociative: type of substances that distort visual and auditory perceptions, producing feelings of dissociation (such as, for example, PCP and ketamine).

Cannabis interactions with other substances

There is a myth that cannabis is a “mild drug”, as many people say. This is what causes many users to mix substances and not even treat cannabis as a risk factor – but the truth is, the interaction with other substances lead to states of discomfort! It’s important to understand the risks of poliuse of substances, what are the most dangerous interactions. Only education and information can reduce the risks and harms of its consumption – especially in the case of medications for continuous use!

Some common thoughts regarding drug use in the context of parties, as reported by PreParty, are:

– I just dropped one and I’m going to smoke a bit to activate it;

– The effect is fading, I’m going to smoke one to strech it out;

– When the “high” is ending I smoke one and it looks like it comes back.

Many still believe that in challenging psychedelic experiences, smoking one to “relax” is a good option. There are some myths that we need to break, like this one. As a matter of fact, it can intensify the experience. And that is the purpose of this post and series! Inform about substances, in an open and prejudice-free debate.

An example of this is the table below, made by the Escola livre de Redução de Danos, and widely shared on social networks at the time of Carnival in Brazil:

It shows exactly how one drug can interact with the other, whether the mixture is dangerous and whether it can be potentially fatal. We can see that:

• The use of cannabis together with substances such as cocaine, NBOME and LSD, mushrooms or DMT can be dangerous (!!!)
• The use of cannabis together with substances such as alcohol, ketamine, ecstasy (MDA or MDMA) and GHB, according to this information, presents a low health risk – but one substance can increase the effects of the other. Therefore, if you want to cut the effect of one of them, concomitant use should be avoided. 
• The use of cannabis together with benzodiazepines presents a low health risk, but it can cause one or both to have diminished effects.

With other types of drugs, such as antidepressants, sedatives, opiates and various medications, it is also necessary to analyze the risks before concomitant use!

With drugs that lower blood glucose

There is evidence to suggest that cannabis can decrease insulin resistance, improve the metabolic process and help control blood sugar levels. However, there are still few studies that examine specifically how THC, CBD or other cannabinoids interact with other drugs that have known effects on blood sugar (such as insulin). It is possible that cannabis works favorably with them – even so, the best thing to do is to continuously monitor the effects to mitigate potential risks and adjust the medication accordingly.

With drugs that lower the pressure

One of the main characteristics of THC is that it simultaneously activates the CB1 and CB2 receptors of our endocannabinoid system. Activation of both receptors induces a response to cardiovascular stress that can reduce blood flow in the coronary arteries. Although reports of adverse reactions are relatively rare, patients taking blood pressure medications should be aware that cannabis can exacerbate its effects!

With blood thinning drugs

Both THC and CBD can increase the effect of drugs used to thin the blood (for example, warfarin or heparin), or drugs known to present their own risk of thinning the blood (for example, ibuprofen, naproxen, etc.), possibly decreasing the metabolism of these drugs.

With opiates

Examining the subjective effects of cannabis vaporized in conjunction with opioids, Dr. Donald Abrams, a UC oncologist, San Francisco, and his team published a small study in 2011. They found no significant change in blood concentrations of opioids after exposure to cannabis. In addition, patients reported a 27% reduction in pain after administering cannabis. There are no reports of adverse reactions to concomitant substance use, although it should be noted.

With sedatives

Many sedatives – such as alcohol, benzodiazepines (Ativan, Valium, etc.), some antidepressants, barbiturates such as phenobarbital and narcotics such as codeine – influence GABA neurotransmitters in the central nervous system, producing a calming effect. Likewise, certain strains of cannabis can produce sedative effects. When combined, cannabis has an additive effect, while it does not appear to raise blood levels or enhance the actions of other sedatives. So while it is not as risky as mixing alcohol with sedatives (which can be deadly), the combination is still risky. Users must exercise extreme care or avoid combining altogether.

What is the conclusion of all this?

Our biggest advice is: if you have any doubts about whether or not you can use cannabis with another drug, talk to someone and find out about the substances you usually consume. Another tip is to make any concomitant use carefully, in small doses, to understand how the substances react in your body and to have an idea of what works or not for you.

Look for Harm Reduction organizations and platforms, where the objective is to dialogue without judgments and prejudices. Unlike punitive policies, the HR believes that “good or bad, legal and illegal drugs are part of this world and choose to work to minimize their harmful effects rather than simply ignoring or condemning them” (Harm Reduction Coalition, 2002- 2003).

• Here in Brazil, one of our greatest references is ResPire, a project that was born in 2010 from the É de Lei Community Center, taking the Harm Reduction approach to the context of parties. With this project, actions are carried out with the objective of reducing unwanted effects after drug use – such as “bad trips”, developing bonds with these users, self-care strategies, and also carrying out prevention and health promotion within the environment to decrease vulnerabilities and STD transmission.

It is also important to remember!

The effect of any psychoactive does not depend only on the substance, but also on the “set”, which is how the subject is psychologically at the moment of the experience (including his personality and expectation) and the “setting”, which is the place where the subject is found: not only the geographical environment, but also the sociocultural environment in which the individual and the substance are inserted. These elements make it possible, for example, that tobacco, which is a stimulant of the central nervous system, is often used “to calm down”.

According to the author Escohotado, “the use of drugs depends on what they offer chemically and biologically, and also on what they represent as pretexts for minorities and majorities. They are determined substances, but the models of administration depend a lot on what is thought about them in each time and place. Concretely, the conditions of access to consumption are as decisive as what is consumed”.

Talking about other drugs is essential for us to understand, as a whole, the human relationships with these perception-altering substances! In addition, breaking the stigma is what brings us closer to people who are users, not just of cannabis, and even identifying symptoms of problematic use and knowing how to take care of them.

That way we can expand our minds and learn that, in order to do Harm Reduction, we need to end prejudices against realities that are different from ours – especially those planted in our minds by a prohibitionist and punitive society. 

Shall we talk more about this? In the next text of the series, we will tell you what power plants are and how they act. Keep an eye out on it!