With World Hepatitis Day upcoming on July 28, 2019, we thought it would be an opportune time to review select documentation associated with patients afflicted with hepatitis C, and links to cannabis use. While cannabis is ineffective at treating the disease or complications that can lead to liver disease and cirrhosis, it may assist with the management of symptoms such as nausea.
Hepatitis C is a viral infection that causes liver inflammation and sometimes leads to serious liver damage. Complications are primarily related to the development of advanced fibrosis or the formation of excess fibrous connective tissue in an organ. It is most commonly caused by a viral infection, although autoimmune and non-viral causation can arise in other hepatitis subtypes. The latter includes hepatitis that forms as a result of liver damage caused by medications, drugs, toxins, and alcohol.
As the human liver plays an integral role in metabolic and toxic-filtering activities in the body, loss of function can lead to serious long-term health consequences. The list of commonly associated symptoms resulting from hepatitis C infection include:
• Sore muscles
• Joint paint
• Stomach pain
• Nausea and poor appetite
• Dark urine
• Itchy skin
Unlike certain subtypes of the disease, hepatitis C can be both acute and chronic. Unfortunately, approximately 75-85% of afflicted individuals develop the chronic form, which can last indefinitely if left untreated. Administration of antiviral drugs is generally a frontline treatment option in those with chronic hepatitis C. The virus is considered “cured” if it is not detected in blood samples for 3 months after treatment is completed.
According to Government of Canada statistics, the overall reported rate of hepatitis C infection in Canada was 29.55 cases per 100,000 people in 2013. In 2011, it was estimated that over 461,000 Canadians carried a history of hepatitis C infection. Of these, an estimated 220,000 to 246,000 people were chronically infected. About 44% of those chronically infected were not aware of their infection or went undiagnosed.
Several research studies have been conducted on the topic, with mixed results.
A 2006 study sought to define the impact of cannabis use during treatment. This prospective, observational study examined standard interferon and ribavirin treatment in 71 recovering substance users, of whom 22 (31%) used cannabis and 49 (69%) did not. The results suggest that modest cannabis use may offer symptomatic and virological benefits to some patients by helping them maintain adherence to dosing regimens.
However, subsequent research conducted by scientists from the same academic institution found that moderate to heavy cannabis use could be harmful to hepatitis C patients. A 2008 University of California at San Francisco study observed 204 persons with chronic hepatitis C virus (HCV) infection. The outcome was determined by fibrosis score on biopsy, and the primary factor evaluated was daily cannabis use. It found that fibrosis stage - as assessed by the Ishak method - was much more prevalent in daily cannabis users than occasional or non-cannabis users. Their conclusion was that daily cannabis use is strongly associated with moderate-to-severe fibrosis (liver scarring) and that HCV-infected individuals should reduce or abstain from cannabis use.
More recent studies have generally supported cannabis’ role in mitigating HCV-related symptoms. One study went a step beyond, by implying cannabis use helps reduce the incidence of liver cirrhosis (late-stage scarring). This is in direct contradiction to the study referenced above.
The 2018 report aimed to investigate the impact of cannabis use on the relevance of chronic liver disease (CLD) among HCV-infected individuals. The researchers analyzed 188,333 records, matching cannabis user and non-cannabis user at a 1:1 ratio - excluding those with co-morbid CLD symptoms stemming from other sources. Their findings suggest that cannabis use is associated with a decreased incidence of liver cirrhosis, although no change in mortality or hospital in-patient stays was observed. The researchers noted that observational endpoints warrant further molecular mechanistic studies.
Given the robust data demonstrating cannabidiol’s (CBD) effectiveness in reducing pain, inflammation and nausea, it wouldn’t be surprising that cannabis could alleviate like symptoms in those suffering from hepatitis C. Many HCV symptoms are similar to those cannabis is purported to help. It might also explain why many HCV sufferers reportedly use cannabis in moderate-to-heavy doses.
Please note, we’ve taken only a select view in this field of study. A more comprehensive archive can be readily sourced from online medical databases. Please seek your doctor’s advice before considering cannabis as an adjunct treatment for HCV-related symptoms.
With any cannabis-infused products, the general rule is to start with a low amount, and only increase slowly. Here at JWC, we would like to remind you that determining your dosage should be based on the information provided to you on your medical document. Do not change your dosage without first consulting with your healthcare provider. As always, make sure that your edibles are properly labelled and are stored out of reach of children and pets. When working with edible cannabis-infused products, try to understand and maintain the ratios between the amount of cannabis and the ingredient (such as butter or oil) which is being infused. If your cannabis-infused ingredient is potent, consider reducing the amount used in your recipe by adding a mixture of non-infused ingredient. The same caution should be applied by you for cannabis obtained on the recreational market without medical consultation, such that you should carefully monitor your use in order to determine a dosage which is predictable and appropriate for you.
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