Psychiatric Pharmacy Essentials: Medication Interactions with Drugs of Abuse

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

  • What are the potential drug-drug interactions between illicit drugs and 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 drugs of abuse interact with anti-retroviral therapies?11-12
  • How do natural or synthetic cannabis interact with medications? 13-18

Reviewer 1: Carly Rainey, PharmD, BCPS
Reviewer 3: Austin Smith, PharmD, BCPP
2024-2025 AAPP Resident and New Practitioner Committee

References

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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 Abus. 7th ed. 2012;38(4):334-43. DOI: 10.3109/00952990.2011.643997. PubMed PMID: 22221229.
  4. Kroon LA. Drug interactions with smoking. Am J Health Syst Pharm. 2007;64(18):1917-21. DOI: 10.2146/ajhp060414. PubMed PMID: 17823102.
  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]
  6. Cousins G, Galvin R, Flood M, et al. Potential for alcohol and drug interactions in older adults: evidence from the Irish longitudinal study on ageing. BMC Geriatr. 2014;14:57. [PubMed]
  7. Qato DM, Manzoor BS, Lee TA. Drug-alcohol interactions in older U.S. adults. J Am Geriatr Soc. 2015;63(11):2324-2331. [PubMed]
  8. Jones JD, Mogali S, Comer SD. Polydrug abuse: a review of opioid and benzodiazepine combination use. Drug Alcohol Dependence. 2012;125(1-2):8-18. DOI: 10.1016/j.drugalcdep.2012.07.004. PubMed PMID: 22857878.
  9. McCance-Katz EF, Sullivan LE, Nallani S. Drug interactions of clinical importance among the opioids, methadone and buprenorphine, and other frequently prescribed medications: a review. Am J Addict. 2010;19(1):4-16. DOI: 10.1111/j.1521-0391.2009.00005.x. PubMed PMID: 20132117; PubMed Central PMCID: PMC3334287.
  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, Farré M. Neuropsychiatric and General Interactions of Natural and Synthetic Cannabinoids with Drugs of Abuse and Medicines. CNSNDDT. 2017;16(5):554-566. DOI: 10.2174/1871527316666170413104516. PubMed PMID: 28412920.
  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]
  18. Doohan. PT, Oldfield LD, Arnold JC, Anderson, LL. Cannabinoid Interactions with Cytochrome P450 Drug Metabolism: a Full-Spectrum Characterization. AAPS J. 2021 Jun 28;23(4):91. [Pubmed]