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Pros and Cons of Medical Marijuana with Hepatitis C

June 20, 2007

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A 2006 report demonstrated the benefits of marijuana for people undergoing interferon and/or ribavirin treatment for Hepatitis C. On the other hand, recent studies have shown the use of marijuana may increase the acceleration of the disease process and possibly cause decreased immune function. The information presented in this article is not intended to encourage or discourage illegal activity, but rather to provide the reader with proven facts about marijuana's impact on the liver.

by Nicole Cutler, L.Ac.

Despite its illegality in most cases, Cannabis Sativa, commonly known as marijuana, remains a popular recreational drug throughout the world. Now, an increasing amount of proposed legislation is seeking to maintain the legality of medical marijuana, allowing for people with certain medical ailments to legally continue using this illicit drug. As of May 2007, 11 U.S. states host medical marijuana programs that allow for the chronically ill and their caregivers to possess and use marijuana for pain relief or other therapeutic purposes.

Pros
The basis of any argument in favor of medical marijuana claims that it can relieve pain, reduce nausea, and increase appetite in those with chronic disease. While illnesses such as cancer and HIV are approved for some medical marijuana legislation, Hepatitis C has been largely ignored. However, a 2006 report demonstrated a positive use of marijuana for people with HCV.

While therapy for chronic Hepatitis C is most often based on interferon medication, its value is limited due to the uncomfortable side effects it can induce, such as flu-like symptoms, fatigue, insomnia, loss of appetite, nausea, muscle and joint pain, and depression. These symptoms often lead to interferon therapy’s poor adherence, which manifests either in a dose reduction or discontinuation of treatment—both of which hinder interferon’s potential effectiveness against HCV.

Published in the October 2006 European Journal of Gastroenterology and Hepatology, a Northern California study involving 71 participants demonstrated that moderate marijuana use may relieve interferon’s side effects, helping people with Hepatitis C stick with the full treatment regimen.

Without any evidence of killing the virus, researchers assume that marijuana’s influence on Hepatitis C is due to side effect management, rather than an antiviral effect. Lead researcher, Diana Sylvestre, MD, of the University of California at San Francisco emphasized that the benefit of marijuana was primarily due to improved ability to stay on adequate doses of interferon and/or ribavirin. Sylvestre told HIVandHepatitis.com that the researchers could not judge whether marijuana had a direct antiviral effect.

Unfortunately for heavy users, this study did not examine a direct dose-response relationship between the amount of marijuana consumed and the likelihood of successful interferon therapy. In fact, participants who used the largest amounts of marijuana had less success with Hepatitis C interferon therapy. Because the researchers did not perform pre and post-treatment histological assessments using paired liver biopsies, and did not measure immune parameters, the claim of marijuana’s value in Hepatitis C therapy remains limited.

Cons
Ever since the results of the 2006 California study were published, experts have been expressing concern about the health implications of Hepatitis C patients using marijuana. A French study of untreated individuals with Hepatitis C (those not taking interferon therapies) showed that, compared with occasional or non-users of the drug, people who used marijuana daily were:

· more likely to have severe liver fibrosis
· at a higher risk for rapid fibrosis progression.

At the 2007 42nd Annual Meeting of the European Association for the Study of the Liver in Barcelona, Spain, the same French research team reported on a study linking marijuana use and liver steatosis. These researchers noted that marijuana binds to two receptors, CB1 and CB2. Recent experimental data suggests that activation of CB1 receptors increases steatogenesis (liver fat accumulation). Stimulation of the CB1 receptor is assumed to be the reason daily marijuana smoking is associated with the development of significant hepatic fibrosis.

In addition to the discovery that smoking marijuana accelerates liver fibrosis, concerns remain about its impact on the immune system. Experts explain that the use of marijuana may suppress immune function. Cannabinoid receptors are confirmed to be present on the surface of immune cells, and when the cannabinoid molecules from marijuana bind to these receptors, the person’s resistance to disease is compromised. Therefore, various studies have concluded that using marijuana can enhance the disease process.

To Use or Not to Use
While the decision to use marijuana with Hepatitis C is highly personal, taking these facts into consideration can help clarify its proven impact on those living with this disease. In particular, advocates suggest that medical marijuana laws and programs who specify its use for patients with specific conditions such as AIDS and cancer should also include people with Hepatitis C. Additionally, if you have Hepatitis C and are currently struggling with side effects of interferon therapy, it may be worth your while to investigate medical marijuana use in your area. Whether it’s breaking the law or not, any person with Hepatitis C considering smoking this drug should be aware that marijuana has been linked with increased liver fibrosis and possibly with decreased immune function. Whatever you choose to do, make your decisions based on what you believe will enhance your odds at fighting the infectious virus, not on what will hamper them.

References:

Cabral GA, et al., Effects on the Immune System, Handbook of Experimental Pharmacology, 2005.

Klein, TW, et al., Marijuana, immunity and infection, Journal of Neuroimmunology, March 1998.

www.boston.com, Senate votes to allow medical marijuana permanently, Ray Henry, The New York Times Company, May 2007.

www.hivandhepatitis.com, Cannabis Use Predicts Severe Liver Steatosis in Patients with Chronic Hepatitis C, Liz Highleyman, hivandhepatitis.com, 2007.

www.hivandhepatitis.com, Moderate Cannabis Use Associated with Improved Treatment Response in Hepatitis C Patients on Methadone, Liz Highleyman, hivandhepatitis.com, 2007.

www.medscape.com, Hepatitis C -- Current State of the Art and Future Directions, David Bernstein, MD, Medscape, 2007.

www.natap.org, Daily Cannabis Smoking as a Risk Factor for Fibrosis Progression in Chronic Hepatitis C, natap.org, 2007.

www.washingtonpost.com, Marijuana Aids Therapy, Rick Weiss, washingtonpost.com, September 2006.

Posted by Editors at June 20, 2007 12:55 PM