Lack of standardized labels for marijuana products can lead to poor kidney outcomes
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Key takeaways:
- Marijuana can have negative interactions with drugs used by kidney transplant recipients.
- The standardization of marijuana product labels could improve treatment.
SCOTTSDALE, Ariz. — Lack of standardized labels for marijuana products in the United States can lead to poor kidney outcomes, according to a presenter at the Southwest Nephrology Conference.
Laura Wicks, PharmD, BCPS, an acute care clinical pharmacy specialist from Banner University Medical Center in Phoenix, detailed the current legality of marijuana, the impact the drug can have on patients and what can be done about the lack of standardized labels on marijuana products.
In the United States, the federal government uses the Controlled Substances Act to place substances on a regulation schedule, Wicks said. Marijuana is labeled as a Schedule I drug, a category that includes heroin, LSD and ecstasy. Currently, the legalization of marijuana varies by state and without federal standards to uphold, so does the labeling.
In Arizona, medical and recreational marijuana is legal. According to Wicks, more than 130,969 patients held an Arizona medical marijuana card in November 2022, with the largest demographic being individuals aged between 18 and 30 years. Of these, most use the card for chronic pain, Wicks said.
Tetrahydrocannabinol (THC) and cannabidiol (CBD) are the therapeutic compounds involved in marijuana. THC causes most of the psychotropic effect and can have euphorigenic and sedative benefits, whereas CBD can have sedative and pain-relieving effects, Wicks said. Currently, the FDA has approved a synthetic THC called dronabinol and an oral solution of CBD called cannabidiol, neither of which are specifically prescribed for patients with kidney disease.
Wicks said marijuana can be administered through inhalation, oral edibles, sublingual items or topical salves. Utilization type can impact the length of the effect of the drug.
How marijuana effects patients
In addition to the varying effect marijuana can have depending on how it is consumed, some drugs, such as warfarin, buprenorphine and tacrolimus, can have poor interactions with marijuana.
According to Wicks, the lack of accurate standardization and labeling of THC and CBD products makes it difficult to manage inhibition of the drugs on enzymes.
Wicks referenced a kidney transplant recipient she treated who occasionally used marijuana. The use of marijuana led to an onset and offset of fluctuating tacrolimus levels in the patient. The target tacrolimus range is 4 ng/mL to 6 ng/mL, but when marijuana was utilized, the patient showed tacrolimus levels far outside the desired range. Another patient experienced poor tacrolimus rates when applying THC creams to a family member without gloves.
She added, “The lack of standardization makes managing these drug interactions quite challenging.”
Unrelated to drug interactions, marijuana use can lead to neuropsychiatric effects, medical nonadherence and organ complications.
For example, fungal spores in marijuana products can be infectious, and Wicks noted concern for transplant recipients. To fight infection, transplant recipients have to reduce their anti-rejection medications. Therefore, Wicks said, infections caused by marijuana can potentially lead to transplant rejection.
Alternatives to marijuana
Often, patients utilize marijuana when they are experiencing symptoms, such as insomnia, anxiety or lack of appetite, Wicks said. Because marijuana can have negative interactions with other treatments, Wicks suggested nonaddictive marijuana alternatives that can be consistently dosed.
For insomnia, Wicks said that patients could be prescribed trazodone, hydroxyzine (which can also treat anxiety) or melatonin. For lack of appetite, mirtazapine or dronabinol can be helpful for patients. For anxiety, Wicks suggested prescribing selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, cognitive-behavioral therapy or hydroxyzine.
However, if a patient does utilize marijuana, Wicks said, it should be on the patient’s medication list and treated as a pharmaceutical substance.
“The main thing I would focus on with patients who are utilizing marijuana who are not in the transplant realm is ensuring that they are navigating the drug interactions with their other substances and ensuring that we're not seeing side-effects or doing something ineffective because of the drug interaction that's occurring,” Wicks told Healio. “It's definitely something that I would do a comprehensive medication review on.”
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Wicks L. Marijuana’s effect on pharmacologic therapies: Awareness for the medical team. Presented at: Annual Southwest Nephrology Conference. March 23-24, 2023; Scottsdale, Ariz.
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