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Lupus and Cannabis: A New Conversation

At Kaleidoscope Fighting Lupus, we rigorously stay up-to-date on the latest lupus treatments and therapy strategies – the uses of cannabis and its derivatives are no exception.  The following is a brief overview that may begin to answer some questions that you may have.

Note: This article contains some of the latest information about the use of cannabis and its derivatives in the treatment of lupus symptoms. Because of potential health and legal risks associated with cannabis use, we strongly advise speaking with your healthcare practitioner and legal counsel to aid in your decision.

Please also note that some of the language and nomenclature around cannabis may change from resource to resource or even from your own experience with cannabis. It is good to be aware that many cannabis websites, articles and blogs you may find are not always based on research and therefore may be biased and subjective. It is a good rule of thumb to always do your own research and speak with your healthcare practitioner before making any decision or taking advice from non-professional online sources.

Introduction

If you have lupus, your quest for symptom relief may seem endless. You may have never seriously considered cannabis before, but as it becomes less stigmatized and more legal globally, you may be curious if it could work for you. Having more of an understanding of exactly what cannabis is and its potential may be the information you need to start the conversation with your healthcare practitioner.

Cannabis, as a cultivated plant, is believed to have originated in Asia thousands of years ago, making its way around the world as it became valued for its medicinal properties.  There are two main types of cannabis that are usually described, though it is still debated as to whether they are really separate species:  Cannabis sativa and Cannabis indica.  Both types have had a complicated history of being named and misnamed, and both have been so modified and hybridized, that the differences are probably not that as important in terms of medical uses at the consumer end as they were in the past.

  • Cannabis Sativa:  This form of cannabis comes from tall, thin plans with narrow leaves. It was originally cultivated for its fiber and seeds. It contains higher amounts of THC than CBD and therefore offers the psychoactive qualities we typically associate with cannabis, such as euphoria. We’ll learn more about THC and CBD below.  Cannabis sativa is also the crop that is used to produce industrial hemp, though by law, the level of THC in these plants must be less than O.3%, compared to the levels of 3 – 30% that occur in marijuana.
  • Cannabis Indica:  This form of cannabis comes from relatively short, bushy plants with wide leaves. It originated in South Asia and has higher CBD counts and less THC and is therefore less psychoactive. However, it can have dramatically relaxing or sedative effects on the body.

Marijuana actually comes from the dried flowers of either cannabis plant, and there are records that date back to 4000 B.C. that indicate its medical use in everything from treating the pain that comes with childbirth to the common, yet painful, toothache.  Until recently, federal law in the U.S. did not differentiate between hemp and marijuana and therefore both were illegal. The 2018 Farm Bill, however, legalized the regulated production of hemp in the U.S.  Due to this bill, hemp research has been expanding as has the research and use of cannabis in medicine – so, we can predict many new findings in the near future.

When we discuss the research involving the medicinal properties of cannabis, the type of plant is less important than the actual chemicals that can be isolated from the plants.  There are many chemicals that may provide therapeutic effects, but we will focus on the ones called cannabinoids.

Cannabinoids are the most significant active ingredients in cannabis. There are many kinds of cannabinoids, and as it turns out, some are even produced naturally in the human body.  These are called “endogenous” cannabinoids (or endocannabinoids) and are produced in many parts of the body, though they most often circulate in the nervous system as neurotransmitters – sending signals to different parts of the brain.   Endocannabinoids play important, natural, physiological roles that can affect, among other things, mood, memory, pain-sensation and some reproductive processes.  In cannabis plants, over 100 kinds of cannabinoids have been identified.  However, in this article, we will focus on the two most often associated with the plant, and its medicinal uses: THC and CBD.

  • Delta-9-tetrahydrocannabinol (commonly known as THC) is the psychoactive chemical found in cannabis that gives the intoxicating effect of being “high.” When used, THC causes the brain to release dopamine, resulting in feelings of euphoria, and sometimes, even hallucinations. THC also increases the appetite and is often effective for cancer patients who use it to counteract the severe nausea and vomiting experienced after chemotherapy treatments.
  • Cannabidiol (commonly known as CBD) does not contain the mind-altering chemicals found in THC, but clinical research has shown that it can have an effect on anxiety, pain-sensation, cognition and even movement disorders. In 2018, the FDA recognized the therapeutic value of CBD and approved Epidiolex, the first-ever drug containing the compound to treat two pediatric seizure conditions. CBD is gaining more and more attention and is being used to treat everything from acne and colitis to depression and atherosclerosis. There is even hope that it may one day be even used in some cancer treatments.  While CBD looks incredibly promising, research is still in its infancy and much more needs to be done, especially about its long-term effects. 

How can cannabis and its derivatives effectively treat lupus symptoms?

Though, to date, there is nothing conclusive about cannabis being effective in the overall treatment of SLE, several studies indicate that it may be beneficial in treating some of the symptoms found in lupus and many of the overlap diseases. Most experts agree, however, that much more research needs to be done. Once again, it’s important to consult with your own expert – your healthcare practitioner – before starting any new therapies, especially those that can be somewhat controversial.

Here’s a list of some of the ways cannabis may provide symptom relief:

  • Anxiety and Stress:  A study from 2015 suggests that CBD oil may be a viable treatment for several anxiety disorders including panic disorder, generalized anxiety disorder, social anxiety and the stress that comes from constant worry. Aaron Cadena in his blog for Medium writes that CBD can stimulate serotonin receptors, which can aid in moderating anxiety levels. Cadena also writes that CBD can work by “dampening the neural activity in stress circuits throughout the brain.”
  • Fibromyalgia:  Cannabis use by individuals with fibromyalgia in a 2010 study resulted in a “statistically significant…reduction of pain and stiffness, enhancement of relaxation, and an increase in somnolence and feeling of well-being.” In other words, cannabis may also be a helpful sleep aid.
  • Arthritis and Inflammation:  Though conducted on rats, a 2016 study showed promise by concluding that “transdermal CBD gel significantly reduced joint swelling” and that “topical CBD application has therapeutic potential for relief of arthritis pain-related behaviours and inflammation without evident side-effects.” In 2009 researchers concluded that both THC and CBD may “suppress inflammatory response and subsequently attenuate disease symptoms.” Anti-inflammatory drugs, like corticosteroids, are some of the most used medications in the lupus patient’s toolkit, and anything that can be added to that toolkit in a targeted way, with fewer side effects, could be very helpful.
  • Nausea/Vomiting Prevention and Appetite Stimulation:  FDA-approved Dronabinol is a drug that contains a synthetic version of THC in its formula. It treats and prevents the severe nausea and vomiting that occurs with certain cancer medicines.  It is has also shown to be effective as an appetite stimulant in patients with AIDS. If you are on a methotrexate regimen and experience nausea and/or weight loss, this may be an option to discuss with your healthcare practitioner.
  • Pain:  The effect of cannabis on pain alone is a bit more ambiguous. In 2011, researchers determined that while THC has “sedative effects,” it has no effect on “perceived pain intensity” and in fact THC “relieved specifically the perceived unpleasantness of pain,” but not the pain itself. In 2005, however, Canadian officials approved Sativex­, a “cannabis-derived oromucosal spray containing equal proportion of THC…and cannabidiol (CBD)…for treatment of central neuropathic pain in multiple sclerosis, and in 2007 for intractable cancer pain.”

To Include Cannabis in Your Treatment Plan or Not to Include it in Your Treatment Plan?

Making the decision to use cannabis in your lupus treatment plan should not be taken lightly. At this point, you may be wondering what your healthcare practitioner’s stance on cannabis is. You may have already guessed that there isn’t one simple, conclusive answer. While cannabis may look promising to you, and its therapeutic qualities may be highly recommended by some online sources, your healthcare practitioner may be more skeptical.

According to WebMD, a lot more research needs to be done on the medical use of cannabis before most healthcare practitioners like your rheumatologist feel comfortable prescribing it. Very little is known about the effects of medical cannabis on rheumatoid disease specifically. In his 2018 article for The Rheumatologist, medical journalist Larry Beresford writes “very little research has addressed concerns specific to rheumatologists, such as the chronic pain associated with rheumatologic conditions.” Beresford notes that “one recent study concluded there is insufficient evidence to recommend any cannabinoid for symptom management in patients with chronic pain associated with rheumatic disease.”

Knowing that your rheumatologist or any of your healthcare team may be a bit reticent to prescribe cannabis for you, it is best to arm yourself with as much information as possible if you decide you want to make the argument and advocate for including it in your treatment plan. You may be feeling optimistic at the thought of this unconventional therapy as being the answer to some of your symptoms, but conversely, you need to know the potential downsides of cannabis use as well.

The potential side-effects of using CBD include:

  • Dry mouth.
  • Drowsiness.
  • Diarrhea
  • Drop in appetite.
  • Interactions with blood thinners. According to Harvard Health, CBD can interact with the blood thinner Coumadin (warfarin), and can in turn affect any blood thinning medication you may be taking.
  • Changes to liver enzymes, which are used to process drugs.
  • Low blood pressure.
  • Lightheadedness
  • Increased tremor in individuals with Parkinson’s disease.
  • Altered hormone levels.
  • A potentially compromised immune system.

The potential side effects of THC include:

  • Headache.
  • Coughing.
  • Nausea.
  • Lightheadedness
  • Increased appetite.
  • Dissociation (feeling disconnected).
  • Dry eyes.
  • Paranoia.
  • Increased anxiety
  • Tachycardia – arrhythmia in which your heart beats faster than normal at rest – which can severely impact you if you suffer from any cardiovascular issues.
  • Short-term memory issues.
  • Impairment of motor skills, which can severely impair the ability to drive or operate heavy machinery safely.
  • Decreased IQ though it’s not clear if this is short-term or long-term.

Aside from being a potential health-risk to you, the next issue with using cannabis is legality. In the U.S. for example, laws can change from state to state and regardless, cannabis is still federally illegal. In the workplace, that only complicates matters. You may be legally able to buy and use cannabis where you live, but your employer may not be so forgiving if they discover you have done so. All of this makes it imperative that you consult not only your healthcare practitioner, but also legal counsel before deciding to use cannabis.

How can you use cannabis safely?

There are many ways to use cannabis for its medicinal benefits – it will depend on your personal preference. Like any plant or herb, it can be prepared in a variety of ways, some of which may appeal to you or work better for you and some that won’t. It is also important to be aware of any drug interactions with any of the medications you may be taking. While no significant interactions are known of at this time, it is still important to consider how cannabis may react in your body. It is known, however, that using cannabis while taking opiates for pain can intensify the effect of the opiates and that drinking alcohol while using cannabis can intensify the effects of both.

  • Ingest Cannabis as an Edible – Cannabis can be added to cakes, cookies, brownies or even brewed into tea. It can be added to salad dressing or even made into a butter. Cannabis can also be made into an oil or even a pill for easy ingestion.

When cannabis is an ingredient in an edible, the cannabinoids are introduced first to your digestive tract and then absorbed to your blood.  After this, they will pass through your liver before moving on to the rest of the body. This means that there are many steps between the cannabinoid in its original form, and where it might actually act on your symptoms.  If you have digestive symptoms due to your lupus, this may complicate matters even more.  When THC enters your liver, enzymes convert it into a more potent form of THC called 11-hydrozytetrahydrocannabinol (11-OH-THC) making it more potent than it was before.  Each person will digest and metabolize cannabinoids a bit differently, so predicting the dosage of edibles can be difficult.  That said, you can also easily ingest too much cannabis depending on the particular recipe that was followed – or how much other food you may be eating. It is best to speak to someone knowledgeable about ingesting edibles before you add it to a favorite recipe.

  • Smoke or Vape Cannabis – Smoking cannabis may be irritating to the lungs because you are not only inhaling smoke, you are inhaling all of the parts of the plant and fibers as well. It is best to inhale slowly and shallowly. Taking cannabis into the lungs gets it to your blood more quickly than through edibles, so it is always a good idea to start with as little as possible at first in order to find the smallest amount that brings you relief.

Note:  Vaping was once thought to be a relatively safe way to inhale cannabis because you would be inhaling relatively reliable doses of cannabinoids as opposed to all the other parts of the cannabis plant that may cause irritation. However, in September of 2019, the Centers for Disease Control (CDC) and the Food and Drug Administration (FDA) announced that they were investigating an outbreak of lung injuries and deaths associated with e-cigarette use.  The cause of these injuries is unknown, but the CDC recommends refraining from the use of e-cigarettes or vaping products, especially if they are not from reputable manufacturers.  As always, check with your trusted healthcare provider.

  • Apply Cannabis Topically – If you suffer from pain or stiffness, applying cannabis topically may be effective and won’t cause any psychoactive effect. It can be made into salves, lotions, oils, body butters or creams and can be used to treat everything from chapped lips to migraine headaches.

Topical cannabis may provide anti-inflammatory effects or pain relief. If you suffer from cutaneous lupus or have any open sores or wounds, you will want to consult with your healthcare practitioner before applying.

In Conclusion

As you may now realize, cannabis use is not a straightforward decision. Hopefully, however, this article has removed some of the mystery so that you can confidently speak to your healthcare practitioner and make a more informed decision about including it in the management of your symptoms if it’s something you’ve been considering.

 

References

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Barrus, D., Capogrossi, K., Cates, S., Gourdet, C., Lefever, T., Novak, S., Peiper, N., & Wiley, J. (2016). Tasty THC: Promises and challenges of cannabis edibles. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5260817/
Beresford, L. (2018). Marijuana for rheumatology patients? Retrieved from https://www.the-rheumatologist.org/article/marijuana-rheumatology-patients/?singlepage=1
Berke, J., & Gould, S. (2016). New Jersey lawmakers postponed a critical vote to legalize marijuana – here are all the states where pot is legal. Retrieved from https://www.businessinsider.com/legal-marijuana-states-2018-1
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Cadena, A. (n.d.). The benefits of CBD for anxiety. Retrieved from https://medium.com/cbd-origin/benefits-of-cbd-for-anxiety-9d913300ed5d
Capella, D., Carbonell, J., Duran, M., Farre, M., & Fiz, J. (2011). Cannabis use in patients with fibromyalgia: Effect on symptoms relief and health-related quality of life. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3080871/pdf/pone.0018440.pdf
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Author: Liz Heintz

Liz Heintz is a technical and creative writer who received her BA in Communications, Advocacy, and Relational Communications from Marylhurst University in Lake Oswego, Oregon. She most recently worked for several years in the healthcare industry. A native of San Francisco, California, Liz now calls the beautiful Pacific Northwest home.

All images unless otherwise noted are property of and were created by Kaleidoscope Fighting Lupus. To use one of these images, please contact us at [email protected] for written permission; image credit and link-back must be given to Kaleidoscope Fighting Lupus. 

All resources provided by us are for informational purposes only and should be used as a guide or for supplemental information, not to replace the advice of a medical professional. The personal views expressed here do not necessarily encompass the views of the organization, but the information has been vetted as a relevant resource. We encourage you to be your strongest advocate and always contact your healthcare practitioner with any specific questions or concerns.