Medical marijuana and Hepatitis C
Hepatitis C is a viral liver disease that affects roughly 71 million people across the globe. It can be experienced both as an acute infection that may only last a few weeks or a chronic condition that can affect a patient throughout the rest of their life.
While antiviral hepatitis C treatment can be very effective, it is also known to produce a wide variety of side effects that can have debilitating effects on a patient and their ability to go on with their daily lives. Now, more and more patients are looking to cannabis to provide fast-acting relief from these symptoms. But should they?
UNDERSTANDING HEPATITIS C
Hepatitis C is a blood-borne disease and the most common form of infection is by coming into contact with a small amount of infected blood. This can happen via injection drug use, unsafe injection practices and healthcare, and via blood transfusions of blood that has not been appropriately screened for the disease.
Hepatitis C can also be contracted sexually, or by sharing hygienic products with an infected person, such as razors and toothbrushes. It can also be passed on from a mother to her child during birth.
The initial infection usually does not produce any symptoms. Between 15 and 45% of infected patients may spontaneously clear the virus without any treatment, while roughly 55 to 85% go on to develop chronic hepatitis C infections.
Once the virus has entered the body, it quickly begins replicating, making slightly alternate copies of itself. This leads to the creation of new hepatitis C strains, and ultimately makes it harder for the immune system to fight the virus.
The hepatitis C virus leads to an inflammation of the liver. This is caused by the virus invading liver cells. During the early, or acute, stages of the infection, the body will send immune cells to the liver in order to fight the virus as well as the infected liver cells.
The infected liver cells eventually die and scar tissue forms around the once infected cells. This scar tissue stops the liver from working properly, at which point it struggles to filter toxins from the blood.
The build up of this scar tissue is called cirrhosis. Cirrhosis leads to reduced blood flow to the liver, causing it to shrink and harden, which ultimately leads to vast liver damage and, in many cases, other types of liver diseases.
The incubation period for hepatitis C is between 2 weeks and 6 months. However, up to 80% of infected patients will not experience any symptoms. Those who do may experience fever, fatigue, decreased appetite, nausea, vomiting, abdominal pain, dark urine, grey-coloured faeces, joint pain and jaundice.
The fact that hepatitis C is an asymptomatic condition is problematic, as it means that very few patients are diagnosed with the condition during the acute infection period. Instead, they can be diagnosed up to decades later when the now chronic infection has gone on to cause serious health problems such as severe liver damage.
The risk of cirrhosis and liver cancer for patients suffering from chronic hepatitis C infections are significant. Between 15-30% of all chronic patients will go on to develop cirrhosis within 20 years.
HEPATITIS C TREATMENT
There is no effective vaccine for hepatitis C due to the virus’ ability to create various genotypes and strains of itself.
The screening process for hepatitis C involves 2 steps. First, patients are screened for anti-hepatitis C antibodies. This will identify patients who have been infected by the virus. If a patient tests positive for these antibodies, they must undergo a nucleic acid test for HCV ribonucleic acid to confirm they have a chronic infection.
There are 6 different genotypes of the hepatitis C virus which respond differently to treatment. Hence, infected patients need to undergo laboratory tests to identify which genotype of hepatitis C they have and plan their treatment accordingly. Infected patients should also undergo tests to assess any damage to their liver.
The specific treatment for hepatitis C varies depending on the particular genotype a person is infected with. However, the World Health Organization generally recommends treatments using a variety of medications, such as sofosbuvir, daclatasvir and combination of sofosbuvir and ledipasvir. These treatments can achieve cure rates as high as 95%.
Besides these treatments, patients are also recommended to make certain lifestyle changes, predominantly abstaining from any alcohol consumption in order to minimize any further liver damage. Other liver toxins should also be avoided.
Patients with advanced liver disease should also stay away from non-steroidal anti-inflammatory drugs as they are believed to produce an increased risk of bleeding from the gastrointestinal tract and cause kidney damage.
While hepatitis C treatment can be relatively effective, it can cause a wide variety of side effects. These include:
- A loss of appetite
- Nausea and vomiting
- Muscle pain
- Coughing and fever
- Dry skin and rashes
- Low mood or depressive symptoms
- Irritability or short-temper
CANNABIS AND HEPATITIS C: A WAY TO LOOK FORWARD
Research shows that many chronic hepatitis patients are turning to cannabis for relief. It’s important to note that cannabis isn’t believed to cure the body of hepatitis or help fight hep C infections. Instead, it is believed to offer fast-acting relief from some of the side effects of treatment.
As we mentioned above, the side effects of hepatitis C treatment can be serious. For some patients, the adverse effects of treatment can be so strong as to have a serious impact on their ability to go on with their regular lives and commitments.
The research into the effectiveness of marijuana use in managing the symptoms associated with hepatitis C treatment is limited. However, it isn’t uncommon for patients to use both inhaled cannabis or oral cannabis-derived medicines and products in an attempt to dull symptoms like nausea, vomiting, appetite loss, and insomnia.
The literature reviewing this trend, unfortunately, is conflicting. A 2008 study conducted by the Department of Internal Medicine at the University of Ottawa, for example, found that the use of cannabinoid-based oral medications helped with managing HCV treatment-related symptoms that contribute to weight loss and may stabilize weight decline.
Furthermore, a 2006 study conducted by researchers at the Department of Medicine at the University of California also found that modest cannabis use produced a decrease in treatment discontinuation and increased sustained virological response (SVR) rates in patients undergoing chronic hepatitis C treatment.
However, studies have also found that cannabis can have a negative effect on hep C patients. A 2008 study conducted by researchers from the Department of Hepatology and Gastroenterology at the Groupe Hospitalier Henri Mondor-Albert Chenevier in France, examined how cannabis use may interfere with regular hepatitis treatment.
The study found that some cannabinoids (active compounds found in cannabis like THC and CBD) may promote steatosis (an abnormal retention of fat in cells). The results from the study showed that cannabis may promote steatosis by activating hepatic CB1 receptors. This also suggests that the endocannabinoid system (the body’s system that mediates the effects of cannabis and also manages mood, appetite, memory, etc) may play a big steatogenic role.
In an attempt to help clear up some of this debate surrounding the use of cannabis in chronic hepatitis C patients, researchers from Canada followed up with a new study in 2014.
Researchers from The University of Ottawa, the Ottawa Hospital Research Institute, Carleton University, and Public Health Ontario examined the prevalence of cannabis use among chronic hepatitis C patients.
The authors of the study evaluated chronic hepatitis C patients at The Ottawa Hospital Viral Hepatitis Clinic from 2000 to 2009. Using the hospital’s database, the authors were able to extract information about individual patients regarding self-reported marijuana use and other information like demographics, HIV coinfection, alcohol use, liver biopsy results, treatment outcomes, and more.
Information regarding cannabis use was available for 550 patients, 159 (28.9%) of whom were using marijuana at the time of their first assessment. Sustained virological response and marijuana use data were available for 359 of the 550 cohort of participants.
By reviewing the data from these patients, the study authors found that cannabis use did not promote fibrosis, inflammation or steatosis, nor did it influence biopsy histology or alter key outcomes of hepatitis C antiviral therapy. Marijuana use also didn’t improve treatment completion rates.
The evidence from this latest study seem highly controversial, seeing that they contrast the findings from previous research on cannabis and how it affects hep C patients and the efficiency of their treatment.
CANNABIS AND HEP C: A CALL FOR MORE RESEARCH
The differences in the results of all of these studies may boil down to a number of factors, including different research methods, varying definitions, and much more.
Either way, the stark contrast between findings suggests that there is a need for a bigger body of research into this field so that chronic hepatitis C patients, whether they use cannabis or not, can make informed decisions about how their choices may be affecting their treatment.
Note: We have taken the utmost care and precaution whilst writing this article. That being said, please take note of the fact that we are not medical professionals of any kind. Cannabis.info is strictly a news and information website. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment.