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Chronic inflammation is caused by abnormal behavior in the immune system and can lead to tissue, joint and organ damage. Studies have shown marijuana is effective at reducing chronic inflammation associated with a variety of diseases and can help patients manage the pain associated with their inflammation-related condition.
Overview of Inflammation
While inflammation is an essential response by the body’s immune system to injury, bacteria and viruses, at times the inflammatory response is called upon unnecessarily. When called upon appropriately, the inflammatory response effectively removes the infectious or damaging stimuli so that the body can initiate the healing process. However, when called upon unnecessarily, in the case of autoimmune diseases, the immune system reacts as if tissues are infected or abnormal when in actuality they are normal. As a result, the body causes damage to its own tissues.
Acute inflammation that comes and goes as necessary to deal with injuries and diseases represents a well-balanced and effective immune system. With chronic inflammation, however, the immune system is essentially “out-of-wack” as it won’t shut off the inflammatory response.
Examples of diseases that are associated with inflammation include rheumatoid arthritis, a chronic inflammatory disease that causes joint destruction, deformity and loss of function, psoriatic arthritis, which causes joint pain, stiffness and swelling, as well as red patches on the skin, Crohn’s and other inflammatory bowel diseases where the digestive tract becomes inflamed, atherosclerosis, the inflammation of arterial walls that can limit or block blood flow and cause heart attacks and stroke, and some cancers.
Treatment of inflammatory diseases typically involves anti-inflammatory and pain medications and the modifying or avoidance of particular activities that stress the inflamed area. In certain cases, surgery is required.
Findings: Effects of Cannabis on Inflammation
Medical marijuana has been found to be effective at both reducing chronic inflammation and at curtailing the pain associated with inflammatory-related diseases, thanks to its two major cannabinoids, tetrahydrocannabidiol (THC) and cannabidiol (CBD).
Both THC and CBD have demonstrated success at reducing inflammation related to a variety of conditions. Studies have shown that THC is able to reduce the development of atherosclerosis, the chronic inflammatory disease and a major risk factor of heart attacks and strokes, and at reducing airway inflammation related to the flu virus (Fimiani, et al., 1999) (Buchweitz, et al., 2008). CBD has been found to have the capability of reducing joint inflammation and has demonstrated effective at inhibiting the disease’s progression (Sumariwalla, et al., 2004) (Nagarkatti, et al., 2009). CBD has also shown to effectively reduced edema (Costa, et al., 2004). In terms of Crohn’s disease, cannabis is able to lower the digestive track inflammation and has even demonstrated it can improve the chances of reaching complete remission (Naftali, Mechulam, Lev & Konikoff, 2014) (Nagarkatti, et al., 2009). Studies also suggest that the cannabinoids in marijuana may be beneficial in certain types of cancers that are triggered by chronic inflammation (Nagarkatti, et al., 2009).
While both THC and CBD have demonstrated anti-inflammatory effectiveness, the way each goes about it varies. Both cannabinoids decrease the production and release of pro-inflammatory cytokines and decrease the activation of the LPS-induced STAT1 transcription factor, a key factor in some of the pro-inflammatory process. CBD, however, also reduces the activity of the NF-kappaB pathway, a primary pathway regulating pro-inflammatory genes, and upregulates the activation of the STAT3 transcription factor, which induces anti-inflammatory events (Kozela, et al., 2010). CBD also assists in anti-inflammation efforts by suppressing fatty acid amidohydrolase activity, which results in an increased concentration of the anti-inflammatory endocannabinoid, anandamide (Burstein & Zurier, 2009).
Inflammatory pain is a common symptom of a number of chronic inflammation diseases, such as sickle cell disease and cancer, but cannabis has proven helpful in pain management. The cannabinoids in cannabis act upon the cannabinoid receptors 1 and 2 (CB1, CB2), which are involved in the mediation of pain associated with inflammation (Clayton, Marshall, Bountra & O’Shaughnessy, 2002) (Elikottil, Gupta & Gupta, 2009) (Kehl, et al., 2003). Studies have also found that CBD is effective in reducing neuropathic pain by reducing the inflammation causing sciatic nerve construction (Costa, et al., 2007).
States That Have Approved Medical Marijuana for Inflammation
Inflammation is not specifically included on the list of approved conditions for medical marijuana in any state. However, many states do include specific inflammation-related conditions. Medical marijuana is approved for patients with arthritis in Connecticut (psoriatic arthritis), California, Illinois and New Mexico.
Patients diagnosed with Crohn’s disease are allowed to legally use marijuana for treatment in Arizona, Arkansas, Connecticut, Florida, Georgia, Hawaii, Illinois (and other irritable bowel syndromes), Louisiana, Maine (and other irritable bowel syndromes), Massachusetts, Michigan, Minnesota, Montana, New Hampshire, New Jersey (and other irritable bowel syndromes), New Mexico, New York (and other irritable bowel syndromes), North Dakota, Ohio, Pennsylvania, Rhode Island and Washington. Connecticut has also approved medical marijuana to treat ulcerative colitis, another type of irritable bowel syndrome.
If an inflammation-related condition is causing chronic pain, medical marijuana has been approved for treatment in Alaska, Arizona, California, Colorado, Delaware, Hawaii, Maine, Maryland, Michigan, Montana, New Mexico, Ohio, Oregon, Pennsylvania, Rhode Island and Vermont. The states of Nevada, New Hampshire, North Dakota, Montana, Ohio and Vermont allow medical marijuana to treat “severe pain.” The states of Arkansas, Minnesota, Ohio, Pennsylvania and Washington have approved cannabis for the treatment of “intractable pain.”
A number of other states will consider approving medical marijuana for the treatment of other conditions, but require an approval or a recommendation by a physician. These states include: California (any debilitating illness where the medical use of marijuana has been recommended by a physician), Connecticut (other medical conditions may be approved by the Department of Consumer Protection), Massachusetts (other conditions as determined in writing by a qualifying patient’s physician), Nevada (other conditions subject to approval), Oregon (other conditions subject to approval), Rhode Island (other conditions subject to approval), and Washington (any “terminal or debilitating condition”).
In Washington D.C., any condition can be approved for medical marijuana as long as a DC-licensed physician recommends the treatment.
Recent Studies on Cannabis’ effect on Inflammation
- Buchweitz, JP., Karmaus, PW., Williams, KJ., Harkema, JR. and Kaminski, NE. (2008, March). Targeted deletion of cannabinoid receptors CB1 and CB2 produced enhanced inflammatory responses to influenza A/PR/8/34 in the absence of presence of Delta9-tetrahydrocannabinol. Journal of Leukocyte Biology, 83(3), 785-96.
- Burstein, S. (2015, April). Cannabidiol (CBD) and its analogs: a review of their effects on inflammation. Bioorgaic & Medicinal Chemistry, 23(7), 1377-85.
- Burstein, SH. and Zurier, RB. (2009, March). Cannabinoids, endocannabinoids, and related analogs in inflammation. The AAPS Journal, 11(1), 109-19.
- Clayton, N., Marshall, FH., Bountra, C., and O’Shaughnessy, CT. (2002, April). CB1 and CB2 cannabinoid receptors are implicated in inflammatory pain. Pain, 96(3), 253-60.
- Costa, B., Colleoni, M., Conti, S., Parolaro, D., Franke, C., Trovato, AE., and Giagnoni, G. (2004, March). Oral anti-inflammatory activity of cannabidiol, a non-psychoactive constituent of cannabis, in acute carrageenan-induced inflammation in the rat paw. Naunyn-Schmiedeberg’s Archives of Pharmacology, 369(3), 294-9.
- Costa, B., Trovato, AE., Comelli, F., Giagnoni, G., and Colleoni, M. (2007, February). The non-psychoactive cannabis constituent cannabidiol is an orally effective therapeutic agent in rat chronic inflammatory and neuropathic pain. European Journal of Pharmacology, 556(1-3), 75-83.
- Elikkottil, J., Gupta, P. and Gupta, K. (2009, November-December). The analgesic potential of cannabinoids. Journal of Opioid Management, 5(6), 341-57.
- Fimiani, C., Liberty, T., Aquirre, AJ., Amin, I., Ali, N. and Stefano, GB. (1999, January). Opiate, cannabinoid, and eicosanoid signaling converges on common intracellular pathways nitric oxide coupling. Prostaglandins & Other Lipid Mediators, 57(1), 23-34.
- Kozela, E., Pietr, M., Juknat, A., Rimmerman, N., Levy, R., and Vogel, Z. (2010). Cannabinoids Δ9-Tetrahydrocannabinol and Cannabidiol Differentially Inhibit the Lipopolysaccharide-activated NF-κB and Interferon-β/STAT Proinflammatory Pathways in BV-2 Microglial Cells. The Journal of Biological Chemistry, 285(3), 1616–1626.
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