As the main blog contributor for Molly’s Fund Fighting Lupus, I generally write about issues and/or experiences that I have encountered throughout my 26 year lupus journey. I also write about things that I believe are relevant in the areas of treatment and symptom management. It is rare that I come across a subject that I know so little about, but is a recurring topic of discussion at many support groups, and on our social media. The subject I am referring to is cannabis. Now, regardless on how you feel about the subject of cannabis, know that I am writing purely on the basis of informing our community of readers what the world is saying about the use of cannabis and the use for lupus symptoms. Clearly, I am not a medical doctor or a naturopath. I am not advising, nor am I coming from a place of personal experience (believe me, this is a whole new “bowl” of wax for me). However, I do feel a responsibility to stay informed and to present the latest news and treatments that are out there, to you, my beloved lupus warriors. Lastly, I want you to know that I heard your questions, and that they are valid ones. So, can we talk about cannabis?
WHAT IT IS:
Cannabis is a central Asian and Indian subcontinent indigenous flowering plant that includes three main species: sativa, indica and ruderalis. It is believed to be used by over 182.5 million people worldwide, in the form of hemp fibers and oils (derived from cannabis sativa), for medical purposes, and as a recreational drug. Cannabis has many different names, but is mainly identified as marijuana (the dried leaves and flowers of the plant). There are two main ingredients in the
cannabis/marijuana plant: cannabidiol (CBD) and tetrahydrocannabinol (THC). Both CBD and THC belong to a unique class of compounds known as cannabinoids. While many strains of marijuana are known for having high levels of THC, high CBD strains are less common. What is the difference between the two you ask? Well, THC is the principal psychoactive component responsible for alterations in mood, perception and consciousness. THC is what gives a person the sensation of being “high.” On the flip side, CBD is becoming more and more popular for its analgesic, anti-inflammatory, and anti-anxiety benefits without the psychoactive effect or “high” feeling.
HOW IT CAN BE USED:
One of the most surprising facts I learned while doing research for this blog was the myriad of ways cannabis may be consumed. You can eat it, wear it, smoke it and vape it, grind it up and put it in a pill and juice it!
Eat it:
Ingesting cannabis or cannabis edibles (cannabis infused food) is considered safer than other forms because it does protect the lungs. And with lupus, the last thing you need is to exacerbate lung issues. However, the effects of edibles can be delayed (up to two hours) so people need to be careful to not overdue and take too much before it takes effect. Baked goods, candies, liqueurs, teas, honey sticks, butter, and juices are all options of different types of edibles. For more information on cannabis edibles click here.
Wear it:
Cannabis topicals can be applied directly to the skin in the form of lotions, balms and oils and are considered one of the safest ways to consume the medication. Another plus, rubbing it on your skin will not result in any sort of psychoactive effect. These topicals are absorbed through the skin for localized relief of pain, soreness and inflammation in a more fast acting relief than ingesting cannabis.
Smoke It:
Smoking marijuana is one of the oldest and still most popular ways of feeling the effects of it quickly. Although cannabis is not as bad as nicotine, it still can cause bronchial and lung irritation, airflow obstruction, and hyperinflation. The British Lung Foundation, in their 2012 survey, found that because there is so little awareness about the danger of smoking marijuana (compared to cigarettes) that 40% of individuals under the age of 35 were not aware that smoking cannabis causes 
any harmful effects. People generally smoke cannabis longer and take bigger inhalations, which can lead to more carbon monoxide and toxin exposure.
Vape it:
Vaporizing cannabis has been proven to be safer than smoking marijuana in a pipe, bong or joint. Vaporizing cannabis heats the air around it, releasing the cannabinoid and it’s effects. Vaporizers limit the odor and drastically reduce the amount of chemical irritants that one would inhale in a cigarette.
Inhale via Bong/Water Pipe/Steam Roller:
Bongs, pipes and steam rollers are handmade tubes (typically of glass) devices used to produce strong hits of smoke. These methods are typically not recommended because the hits (quick inhalations of sloke) can be very intense.
THE PRO’S:
Cannabis has been used as an alternative medicine in many cultures for thousands of years and its beneficial effects have been shown in the treatment of nausea and vomiting associated with cancer chemotherapy; cachexia in HIV/AIDS patients; and in neuropathic pain and spasticity in multiple sclerosis. And has even helped with epileptic seizures.
There have been many personal testimonies of how CBD has helped with sleep, anxiety, PTSD, depression, and many other conditions.
There have been personal testimonies of how CBD has helped with appetite stimulation for those who are undergoing chemotherapy.
The rate of addiction is lower compared to rate of addiction to tobacco and nicotine.
Some feel there are little to no side effects compared to the side effects of traditional western medicine.
THE CON’S:
By federal law, the possession of cannabis is illegal in the United States, except within approved settings, and a growing number of states, territories, and the District of Columbia have enacted laws to legalize its medical use.
The U.S. Food and Drug Administration and the Center for Disease Control have not approved Cannabis as a treatment for lupus, cancer or any other medical condition. However, the FDA has approved Marinol and Syndros and Cesamet (which include the a synthetic form of THC) for therapeutic uses in the United States.
Cannabis may increase the effects of other drugs that cause drowsiness, including antidepressants, alcohol, antihistamines, sedatives (used to treat insomnia), pain relievers, anxiety medicines, seizure medicines, and muscle relaxants.
You cannot drive or use heavy machinery after use. It is not safe and you could be charged with a chemical DUI.
The drug doesn’t so much reduce pain as make the same level of pain more bearable. Read more about that here.
WHAT YOUR RHEUMATOLOGIST MIGHT SAY:
The interesting thing here is that acceptance of this type of therapy varies from speciality to speciality. In a recent study by medscape, Rheumatologists ranked the lowest in support for medical marijuana use, with only 54% saying it delivers benefits and 44% supporting legalization. Whereas, other specialists like, Oncologists, showed the highest support for patient use and legalization of the drug due to the appetite stimulating effects that are helpful for chemotherapy patients.
One of the reasons some rheumatologists are hesitant to endorse the use of cannabis is due to other drug interactions. The FDA has reported drug interactions with cannabis among people who took Neurontin (Gabapentin), a pretty common lupus and fibromyalgia drug. Other common lupus medications that might interact are: barbiturates, sedative medications (ambien, klonopin, ativan), antidepressants (prozac), muscle relaxants (flexeril), opioids and even warfarin (coumadin) which is used for the common lupus overlap disease Antiphospholipid syndrome.
Another reason why your rheumatologist may not be on board with you trying medical marijuana is due to the fact that the American College of Rheumatology published a five year study at the University of New Mexico in 2014, that indicated marijuana use in SLE was not associated with 
reduced pain, use of steroids, use of narcotics or disease activity. In fact, the study showed that narcotic use went up, as well as, an increase in end stage renal disease and neuropsychiatric SLE. Sadly, the data they collected was not medically supportive of cannabis being used as a treatment method for SLE. Aslo, Oxford neuroscientist and author Michael Lee, states (in reference to pain control) that “Cannabis does not seem to act like a conventional pain medicine. Brain imaging shows little reduction in the brain regions that code for the sensation of pain, which is what we tend to see with drugs like opiates. Instead, cannabis appears to mainly affect the emotional reaction to pain in a highly variable way.” Many doctors feel that cannabis acts like more of a pain distractor than a painkiller.
These reasons, along with the lack of scientific evidence of it’s benefits, may be why your rheumatologist might give you a strange stare when you ask if cannabis is a good option to treat your lupus symptoms. You may have better luck bringing it up with your primary care doctor or with your naturopath.
CANNABIS AND LUPUS
We all know that pain associated with lupus inflammation can be incredibly debilitating. Although I have not personally tried cannabis, I have read many articles (some anecdotal, some scientifically based) that state cannabis use does help relieve the pain and inflammation of lupus. There is a particular anti-inflammatory protein called interleukin-10 that cannabis has been shown to increase while it decreases the levels of pro-inflammatory protein interleukin-2. There has also been cases made that it decreases over-active immune systems by activating MDSCs (myeloid-derived suppressor cells).
Here are some ways cannabis may aid in discomfort of lupus symptoms:
Edibles can be ingested in small quantities at night to aid in relaxation, pain relief and sleep.
Cannabis creams, balms and salves can be rubbed on inflamed or achy muscles and joints.
Vape (don’t smoke) cannabis if you are experiencing bouts of severe pain.
Drink raw cannabis juice or take capsules.
The fact of the matter is that there is still a lot of research to be done regarding how precisely cannabis is helpful in treating lupus symptoms. Sure, there is some documentation regarding marijuana’s anti-inflammatory properties, but when it comes to a systemic illness like lupus, there is just not enough scientific data from medical sources to support long-term benefits. That being said, there are some exciting studies that have been recently published and are still presently in the works. Newsweek’s 2014 article reports that in states where medical marijuana is legal, painkiller deaths have dropped by 25%. Now, it is difficult to know if the study included those with pre-existing conditions (like lupus) or not. And sure, it may feel as if it is taking the pain of lupus or rheumatoid arthritis away, but is it really? Well, Dr. Jason McDougall, a professor in the department of pharmacology and anesthesia at Halifax University in Nova Scotia is using a three-year grant from the Arthritis Society to study how cannabis compounds can manage arthritis pain. Dr. McDougall is hopeful that by administering the cannabis like molecules to the painful arthritic areas, they will see improvement not only with dampening the pain levels in the brain but with the actual reduction of inflammation in the joint as well. Though the study has not been concluded, it is encouraging to see doctors pushing for scientific facts to support alternative therapies, like cannabis, as options for those who desperately need them.
We at Molly’s Fund, highly support more research being implemented to further evaluate the use of medical marijuana for safely and effectively treating the symptoms of lupus. And if cannabis is something that you are considering, the best thing you can do is have an open conversation about medical marijuana with your doctor. We understand that in many states, it has been legalized. However, just because it is permissible doesn’t make it beneficial to you. You need to consider your medications and your symptoms. And before you vape, smoke, juice or pick up a joint, pick up the phone and call…your doctor.
Sources:
http://herb.co/2016/05/15/cannabis-vs-lupus/
https://www.drugs.com/illicit/cannabis.html
http://www.truthonpot.com/2014/09/24/5-differences-between-cbd-vs-thc/
http://www.medscape.com/features/slideshow/medical-marijuana#6
http://www.safeaccessnow.org/using_medical_cannabis
http://www.webmd.com/vitamins-supplements/ingredientmono-947-MARIJUANA.aspx?activeIngredientId=947&activeIngredientName=MARIJUANA
https://unitedpatientsgroup.com/blog/2015/10/20/how-cannabis-helps-lupus
http://acrabstracts.org/abstract/medical-marijuana-related-outcomes-in-patients-with-systemic-lupus-erythematosis/
http://www.newsweek.com/states-medical-marijuana-painkiller-deaths-drop-25-266577
https://en.wikipedia.org/wiki/Cannabis_smoking
http://metro.co.uk/2012/06/05/one-cannabis-joint-a-day-is-as-bad-as-20-cigarettes-455838/
http://www.cbc.ca/news/canada/nova-scotia/dalhousie-researcher-investigates-use-of-marijuana-for-arthritis-pain-1.3142592
http://www.smithsonianmag.com/science-nature/marijuana-isnt-a-pain-killerits-a-pain-distracter-169786068/
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