Psychiatric Pharmacy Essentials: Medication Interactions with Drugs of Abuse

Due to the potential for concomitant psychiatric illness and substance use, understanding the potential interactions between prescription medications and illicit substances is important.

  • What are some potential drug-drug interactions between illicit drugs and prescription medications?1-3
  • How does cigarette smoking (polycyclic aromatic hydrocarbons) affect medications?4-5
  • What are possible drug interactions in patients that consume alcohol?6-7
  • How do opioids and benzodiazepines interact? What is the clinical significance of the combination?8-10
  • How do illicit drugs interact with anti-retroviral therapies?11-12
  • How do natural or synthetic cannabis products interact with prescription medications?13-18

Reviewer 1: Claire Herbst, PharmD, BCPS, BCPP
Reviewer 2: Roisin Sabol, PharmD
2025-2026 AAPP Resident and New Practitioner Committee

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  2. Abbott KL, Flannery PC, Gill KS et al. Adverse pharmacokinetic interactions between illicit substances and clinical drugs. Drug Metab Rev. 2020; 52(1): 44-65. [PubMed]     
  3. Lindsey WT, Stewart D, Childress D. Drug interactions between common illicit drugs and prescription therapies. Am J Drug Alcohol Abuse. 2012;38(4):334-43. [PubMed]
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  5. Kohut SJ. Interactions between nicotine and drugs of abuse: a review of preclinical findings. Am J Drug Alcohol Abuse. 2017;43(2):155-170. [PubMed]
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  10. U.S. Food and Drug Administration. FDA Drug Safety Communication: FDA urges caution about withholding opioid addiction medications from patients taking benzodiazepines or CNS depressants: careful medication management can reduce risks. 2017. [Weblink]
  11. Desai N, Burns L, Gong Y, et al. An update on drug-drug interactions between antiretroviral therapies and drugs of abuse in HIV systems. Expert Opin Drug Metab Toxicol. 2020;16(11):1005-1018. [PubMed]
  12. Cernasev A, Veve MP, Cory TJ, et al. Opioid use disorders in people living with HIV/AIDS: a review of implications for patient outcomes, drug interactions, and neurocognitive disorders. Pharmacy (Basel). 2020;8(3):168. [PubMed]
  13. Arellano AL, Papaseit E, Romaguera A, Torrens M, Farre M. Neuropsychiatric and General Interactions of Natural and Synthetic Cannabinoids with Drugs of Abuse and Medicines. CNS Neurol Disord Drug Targets. 2017;16(5):554-566. [PubMed]
  14. Kong TY, Kim JH, Kim DK, Lee HS. Synthetic cannabinoids are substrates and inhibitors of multiple drug-metabolizing enzymes. Arch Pharm Res. 2018;41(7):691-710. [PubMed]
  15. Brown JD, Winterstein AG. Potential adverse drug events and drug-drug interactions with medical and consumer cannabidiol (CBD) use. J Clin Med. 2019;8(7):989. [PubMed]
  16. Qian Y, Gurley BJ, Markowitz JS. The potential for pharmacokinetic interactions between cannabis products and conventional medications. J Clin Psychopharmacol. 2019;39(5):462-471. [PubMed]
  17. Brown JD. Potential adverse drug events with tetrahydrocannabinol (THC) due to drug-drug interactions. J Clin Med. 2020;9(4):919. [PubMed]
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