CDA Essentials 2017 • Volume 4 • Issue 6

32 | 2017 | Issue 6 I ssues and P eople Drug Interactions The National Standard Research Collaboration, a multidisciplinary group that performs systematic reviews of scientific evidence on alternative and complementary medicine, reports several potential drug interactions associated with cannabis use. 13 • It increases the drowsiness caused by some drugs (e.g., benzodiazepines, barbiturates, narcotics such as codeine and some antidepressants). • It may interact with sedatives, central nervous system depressants, pain relievers, analgesics and corticosteroids. • It increases the risk of bleeding when taken with other drugs that increase the risk of bleeding (e.g., aspirin and other nonsteroidal anti-inflammatory drugs [NSAIDs], blood thinners, antiplatelet drugs). • It may affect sugar levels, and caution is therefore advised with patients who are taking other drugs that affect blood sugar level (e.g., diabetes medication). • It may interact with drugs that affect blood vessel width. Additionally, a review 8 published in the Australian Dental Journal highlights that: • Because of its effects on the parasympathetic system, cannabis use may, in association with a stress response such as a visit to the dentist, be associated with syncopal episodes. • There is a risk of prolonging tachycardia induced by cannabis use when using local anesthetics containing epinephrine. a Want to learn more about the potential impacts of cannabis on dentistry and oral health? Visit Oasis Discussions to watch an interview with Dr. Jose Lança: oasisdiscussions.ca/2017/01/18/marijuana References 1. Pertwee RG, Howlett AC, Abood ME, Alexander SPH, Di Marzo V, Elphick MR et al. International Union of Basic and Clinical Pharmacology. LXXIX. Cannabinoid Receptors and Their Ligands: Beyond CB 1 and CB 2 . Pharmacological Reviews. 2010 December; 62(4):588-631. 2. Grafton SE, Huang PN, Vieira AR. Dental treatment planning considerations for patients using cannabis: a case report. J Am Dent Assoc. 2016 May;147(5):354-61. 3. Health Canada [Internet]. [Ottawa]: Health Canada. Drug Product Database; 2017 [Accessed 2017 June 23]. Available from: health-products.canada.ca/ dpd-bdpp /info.do?lang=en&code=4941 4. Health Canada. [Internet]. [Ottawa]: Health Canada; 2005. SATIVEX – Letter to Health Care Professionals; 2005 [accessed 2017 June 23]. Available from: canada.ca/en/health-canada/services/drugs-health-products/drug-products/notice-compliance/conditions/sativex-letter-health-care-professionals.html 5. Health Canada. [Internet]. [Ottawa]: Health Canada; 2007. SATIVEX (Tetranabinex and Nabidiolex) – Letter to Health Care Professionals; 2008 [accessed 2017 June 23]. Available from: canada.ca/en/health-canada/services/drugs-health-products/drug-products/notice-compliance/conditions/sativex- tetranabinex-nabidiolex-letter-health-professionals.html 6. Health Canada. [Internet]. [Ottawa]: Health Canada; 2016. Consumer Information – Cannabis (Marihuana, marijuana) [accessed 2017 June 23]. Available from: canada.ca/en/health-canada/services/drugs-health-products/medical-use-marijuana/licensed-producers/consumer-information- cannabis-marihuana-marijuana.html 7. Grafton SE, Huang PN, Vieira AR. Dental treatment planning considerations for patients using cannabis: A case report. J Am Dent Assoc. 2016 May; 147(5):354-61. 8. Cho CM, Hirsch R, Johnstone S. General and oral health implications of cannabis use. Aust Dent J. 2005 Jun;50(2):70-4. 9. Joshi S, Ashley M. Cannabis: A joint problem for patients and the dental profession. Br Dent J. 2016 Jun 10;220(11):597-601. 10. Shariff JA, Ahluwalia KP, Papapanou PN. Relationship between frequent recreational cannabis (marijuana and hashish) use and periodontitis in adults in the United States: National Health and Nutrition Examination Survey 2011 to 2012. J Periodontol. 2017 Mar;88(3):273-280. 11. Scully C. Cannabis: adverse effects from an oromucosal spray. Br Dent J. 2007 Sep 22;203(6):E12; discussion 336-7. 12. Joshi S, Ashley M. Cannabis: A joint problem for patients and the dental profession. Br Dent J. 2016 Jun 10;220(11):597-601. 13. National Standard Research Collaboration [Internet]. [Place unknown]: National Standard Research Collaboration. Marijuana (cannabis sativa). Available from: naturalmedicines.therapeuticresearch.com