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By David R. Shorey, East County Program Manager, Institute for Public Strategies

Photo courtesy Marijuana Prevention Initiative

March 14, 2022 (San Diego) -- When Proposition 215 was passed in 1996 legalizing “Medical Use of Marijuana” and Proposition 64 was passed in 2016 legalizing recreational use, medical professionals provided arguments in support. The California Medical Association endorsed Proposition 215 “…because it incorporates best practices.” Such endorsements presented the image that the positive medical impacts of cannabis outweighed any negative ones. Unfortunately, seven years after full legalization, we are seeing an impact that wasn’t discussed either in the ballot arguments in favor of legalization nor in the anecdotal stories used to advance each measure.

Every day in San Diego County, about three dozen people show up at a local hospital emergency room for several reasons related to cannabis use, a common one being drug interactions. Chances are that when the medication was prescribed and when the prescription was filled, neither the doctor nor pharmacist issued any warnings about using cannabis alongside their regimen. Now that cannabis is legal for recreational consumption in California, this has become a growing problem.

Pilot Program

Photo right via Creative Commons 

In what is believed to be the first of its kind in the U.S., the San Diego County Marijuana Prevention Initiative (MPI) established a program in partnership with pharmacies throughout the East County and beyond, aimed at raising awareness and providing consumers with information on how cannabis interacts with medication. Since the program was launched in September at the Sharp Rees-Stealy pharmacy in Santee, more than 10,000 information cards in English and 2,000 in Spanish have been distributed as an attachment to prescription medications at 17 pharmacies countywide.

Photo left via Creative Commons

“The project was created in response to increasing local hospital emergency room visits related to marijuana, about 37 visits a day in the county,” said Joe Eberstein, program manager at MPI. “A common reason being drug interactions. The cards directed patients to an online resource called, which lists common drug interactions between THC (tetrahydrocannabinol), CBD (cannabidiol) and over the counter medications.”

The project was developed by local pharmacists, doctors and prevention providers. It also included a survey piece that was designed to collect consumer feedback on whether this information was even popular among consumers.

Public Support

“We are happy to report that the preliminary survey results/data show support for this type of public health information with about 90% of patients supporting the project and similar consumer protections,” Eberstein said. “We have info cards available on our website for download at”

Photo right via Creative Commons 

Dr. Roneet Lev is an emergency and addiction physician and chief medical officer for the Center for Community Research in San Diego.

“Every day I treat patients in the emergency department, with marijuana poisoning. Every day,” Lev said. “Lack of consumer protection and proper labeling have left consumers at risk for potential harmful consequences.”

Lev says that another common drug interaction is an additive effect of pain medication, anxiety medicine, depression medicine and sleeping pills. They can interact and cause over sedation.

Increasing Awareness

“Before this project, there were very few pharmacies in San Diego County that provided drug interaction information with cannabis products,” said Dr. Seung Oh, pharmacy supervisor at Sharp Rees-Stealy in Santee. ‘We are not here to say anything about using cannabis one way or another. We’re simply here to increase awareness that just like drinking grapefruit juice could interact with important medication, cannabis could potentially do the same thing.”

Dr. Nirma Patel, director of Pharmacy Services at Scripps Health, issued a warning to would-be cannabis users. “Marijuana is legal in California. But what a lot of people don’t know is, that it’s not safe for everyone,” he said.

The Downtown San Diego area has its own unique challenges, according to Dr. Aram Penaranda, pharmacy director at Allen Pharmacy.

“Our pharmacy clients are vulnerable and have complex medical and mental health conditions. They are often not aware of the drug interactions that exist between their medications and marijuana,” Dr. Penaranda said. “It is quite common to see on prescription labels ‘do not take with alcohol or other drugs.’ Unfortunately, marijuana use is often overlooked.”

Ongoing Conversation

Dr. Penaranda says his pharmacists have been trained in answering questions related to this project in the hope that this project will “spark an ongoing conversation about patient safety and cannabis use.”

Cannabis is legal for recreational use in California as long as you are over 21. The age cutoff is 18 for consumers using medical cannabis with a doctor’s recommendation. No one is arguing to put the leaf back in the bag. However, if you consume cannabis, you need to tell your doctor to ensure that any potential side effects from use with other medications are avoided.

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