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Hepatitis C is a blood borne virus that makes the liver swell and affects 2.7 million people in the United States. Studies have shown marijuana shows potential as a anti-inflammatory treatment and helps patients manage symptoms associated with the virus.
Overview of Hepatitis C
Hepatitis C is a viral disease caused by the hepatitis virus that leads to inflammation of the liver. The hepatitis C virus (HCV) is a blood borne virus that is most commonly transmitted through unsafe injection practices, but can also be transmitted through unprotected sex with an infection individual.
HCV can cause both acute and chronic infections. The acute HCV virus is typically asymptomatic and only in rare cases is it life threatening. Fifteen to 45% of those with an acute HCV infection will clear themselves of the virus within 6 months and without any treatment. The remaining 55 to 85% of people will have their virus develop into chronic HCV infection, and 15 to 30% of those individuals will develop cirrhosis within 20 years. Chronic HCV can also develop into liver cancer.
According to the World Health Organization, because acute HCV infection is usually asymptomatic, few people are diagnosed during the acute phase. However, some infected individuals may experience fever, fatigue, decreased appetite, nausea, vomiting, abdominal pain, dark urine, gray-colored feces, joint pain and jaundice. Those who continue to be asymptomatic will either unknowingly cure themselves of the virus or have it develop into chronic HCV.
Once a person is diagnosed with HCV, the treatment goal is to cure with direct antiviral agents.
Findings: Effects of Cannabis on Hepatitis C
Research suggests that cannabis has the potential of offering therapeutic benefits to patients with HCV and other liver diseases (Mallat, et al., 2011). The two major cannabinoids found in cannabis, tetrahydrocannabinol (THC) and cannabidiol (CBD) bind with or influence the cannabinoid receptors (CB1 and CB2) of the endocannabinoid system within the body. CB2 receptor activation has demonstrated anti-inflammatory and beneficial effects on alcoholic fatty liver, hepatic inflammation, liver injury, regeneration and fibrosis. A research review determined that the cannabinoids found within cannabis look to tame aspects of chronic liver disease (Zamora-Valdes, et al., 2005). One study found that cannabinoids’ anti-inflammatory properties effectively reduce inflammation of a damaged liver and researchers therefore suggested that cannabis could be developed as a potential drug for hepatitis (Lavon, et al., 2003).
Previous studies had actually implicated cannabis in the progression of cirrhosis, fibrosis, and other liver diseases (Fischer, et al., 2006). However, more recent research has found no link to marijuana smoking and the progression of liver disease (Brunet, et al., 2013). In addition, researchers have expressed that the potential treatment benefits of cannabis on hepatitis C outweigh the risks earlier studies had suggested (Fischer, et al., 2006).
Cannabinoids, including CBD, have proven effective for managing nausea and vomiting produced by therapeutic treatments (Parker, et al., 2015). In what is likely due to this symptom relief offered by cannabis, use of cannabis was found to significantly affect whether patients with hepatitis C were able to stick with their treatment prescription (Sylvestre, Clements & Malibu, 2006).
States That Have Approved Medical Marijuana for Hepatitis C
Currently, 12 states have approved medical marijuana specifically for the treatment of hepatitis C. These states include: Arizona, Arkansas, Illinois, Maine, Massachusetts, Michigan, New Hampshire, New Mexico, North Dakota, Ohio, Rhode Island and Washington.
A number of other states will consider allowing medical marijuana to be used for the treatment of hepatitis C with 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), Nevada (other conditions subject to approval), and Oregon (other conditions subject to approval), (other conditions subject to approval).
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 Hepatitis C
Avraham, Y., Grigoriadis, N., Poutahidis, T., Vorobiev, L., Magen, I., Ilan, Y., Mechoulam, R., and Berry, E. (2011). Cannabidiol improves brain and liver function in a fulminant hepatic failure-induced model of hepatic encephalopathy in mice. British Journal of Pharmacology, 162(7), 1650–1658. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3057300/.
Brunet, L., Moodie, E.E., Rollet, K., Cooper, C., Walmsley, S., Potter, M., Klein, M.B. (2013, September). Marijuana Smoking Does Not Accelerate Progression of Liver Disease in HIV-Hepatitis C Coinfection: A Longitudinal Cohort Analysis. Clinical Infectious Diseases, 57(5), 663-670. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3739469/.
Caraceni, P., Domenicali, M., and Bernardi, M. (2008, May). The endocannabinoid system and liver diseases. Journal of Neuroendocrinology, 20 Suppl 1, 47-52. Retrieved from http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2826.2008.01679.x/full.
Fisher, B., Reimer, J., Firestone, M., Kalousek, K., Rehm, J., and Heathcote, J. (2006, October). Treatment for hepatitis C virus and cannabis use in illicit drug user patients: implications and questions. European Journal of Gastroenterology & Hepatology, 18(10), 1039-42. Retrieved from http://journals.lww.com/eurojgh/Fulltext/2006/10000/Treatment_for_hepatitis_C_virus_and_cannabis_use.1.aspx.
Fouad, A.A., and Jresat, I. (2011, November 16). Therapeutic potential of cannabidiol against ischemia/reperfusion liver injury in rats. European Journal of Pharmacology, 670(1), 216-23. Retrieved from http://www.sciencedirect.com/science/article/pii/S0014299911009599.
Fouad, A.A., Al-Mulhim, A.S., and Gomaa, W. (2013, October). Protective effect of cannabidiol against cadmium hepatoxicity in rats. Journal of Trace Elements in Medicine and Biology, 27(4), 355-363. Retrieved from http://www.sciencedirect.com/science/article/pii/S0946672X13000953.
Hegde, V.L., Nagarkatti, P.S., and Nagarkatti, M. (2011). Role of Myeloid-Derived Suppressor Cells in Amelioration of Experimental Autoimmune Hepatitis Following Activation of TRPV1 Receptors by Cannabidiol. PLoS ONE, 6(4), e18281. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3069975/.
Hepatitis C. (2015, July). World Health Organization. Retrieved from http://www.who.int/mediacentre/factsheets/fs164/en/.
Lavon, I., Sheinin, T., Meilin, S., Biton, E., Weksler, A., Efroni, G., Bar-Joseph, A., Fink, G., and Avraham, A. (2003, December). A novel synthetic cannabinoid derivative inhibits inflammatory liver damage via negative cytokine regulation. Molecular Pharmacology, 64(6), 1334-41. Retrieved from http://molpharm.aspetjournals.org/content/64/6/1334.long.
Mallat, A., Teixeira-Clerc, F., Deveaux, V., Manin, S., and Lotersztajn, S. (2011, August). The endocannabinoid system as a key mediator during liver diseases: new insights and therapeutic openings. British Journal of Pharmacology, 163(7), 1432-40. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3165953/.
Parker, L.A., Rock, E.M., and Limbeer, C.L. (2011, August). Regulation of nausea and vomiting by cannabinoids. British Journal of Pharmacology, 163(7), 1411-22. Retrieved from http://onlinelibrary.wiley.com/wol1/doi/10.1002/cpt.98/full.
Sylvestre, D.L., Clements, B.J., and Malibu, Y. (2006, October). Cannabis use improves retention and virological outcomes in patients treated for hepatitis C. European Journal of Gastroenterology & Hepatology, 18(10), 1057-63. Retrieved from http://journals.lww.com/eurojgh/pages/articleviewer.aspx?year=2006&issue=10000&article=00005&type=abstract.
Viral Hepatitis – Hepatitis C Information. (2015, May 31). Centers for Disease Control and Prevention. Retrieved from http://www.cdc.gov/hepatitis/hcv/hcvfaq.htm.
Zamora-Valdes, D., Ponciano-Rodriguez, G., Chavez-Tapia, N.C., Mendez-Sanchez, N. (2005). The endocannabinoid system in chronic liver disease. Annals of Hepatology, 4(4), 248-254. Retrieved from http://www.medigraphic.com/pdfs/hepato/ah-2005/ah054c.pdf.