From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Smoking marijuana is not a contraindication for combined oral contraceptive pills (OCPs). Women who use marijuana can generally take combined OCPs safely without increased risks of contraceptive failure or additional health concerns specifically related to the combination. Unlike tobacco smoking, which is considered a relative contraindication for combined OCPs in women over 35 due to increased cardiovascular risks, marijuana smoking has not been established to create the same risk profile. However, it's essential to note that heavy marijuana use might theoretically affect medication adherence, which could indirectly reduce contraceptive effectiveness if pills are forgotten or taken inconsistently. For optimal contraceptive protection, combined OCPs should be taken at approximately the same time each day. Common combined OCPs include formulations with ethinyl estradiol (20-35 mcg) combined with progestins like levonorgestrel, norethindrone, or drospirenone. If adherence is a concern, users might consider longer-acting contraceptive methods like IUDs, implants, or injections that don't require daily administration. The primary reason tobacco is a concern with OCPs is that it increases thrombotic risk, while current evidence doesn't suggest marijuana creates the same blood clotting issues when combined with hormonal contraceptives, as discussed in recent studies 1.
Some key points to consider:
- The risk of thromboembolic disease is related to the estrogen dose and smoking status, but marijuana use has not been directly linked to an increased risk of thrombosis with OCP use 2, 3.
- Progestin-only contraceptives have a different risk profile compared to combined OCPs, and the risk of venous thromboembolism is a concern with certain types of progestins 3, 4.
- Pharmacokinetic interactions between oral contraceptive steroids and other compounds can occur, but there is no firm evidence that smoking or marijuana use alters the pharmacokinetics of oral contraceptive steroids in a clinically significant way 5.
Given the available evidence, the use of combined OCPs in women who smoke marijuana does not appear to pose a significant risk. However, as with any medication, it's crucial to weigh the benefits and risks and consider individual factors, such as adherence and overall health status.