When one hears the term “medical cannabis,” a variety of core diseases and conditions come to mind. Cancer, HIV/AIDS, arthritis, multiple sclerosis, and Crohn’s disease all gain significant benefit from the cannabinoids and terpenes contained in cannabis. A set of diseases not typically conjured are those of the liver. Recent research indicates that a lack of homeostasis (balance) in the body’s endocannabinoid system (what a medical professional would call “dysregulation”) can result in hepatitis, fibrosis, and cirrhosis.
Liver fibrosis, one of the most common forms of liver disease, afflicts more than 400,000 patients in the United States and is the tenth leading cause of death in the country. It occurs when the liver, the largest organ in the human body, experiences “excessive accumulation of scar tissue” that results from chronic inflammation and the death of liver cells. Dying cells are replaced by those that are regenerating, a process that produces abnormal areas of tough, fibrous tissue called nodules. As more nodules form, the liver begins to literally harden.
Cirrhosis is a situation in which the liver does not function properly, typically because of long-term damage. This damage is often inflicted during repeated alcohol binging and suffered by alcoholics. Like Alzheimer’s, cirrhosis reveals itself very slowly, typically over months or even years. It may result in patients being weak and tired and experiencing swelling of the calves and feet. They may also exhibit yellow skin and bruise easily. One of the most dangerous symptoms of cirrhosis is the accumulation of abdominal fluid, which may become very rapidly infected. Other possible outcomes include liver cancer and bleeding from the esophagus.
Much media attention is paid to the issue of alcohol versus cannabis for recreational use. It is fitting that cannabis offers not only a healthier euphoriant than whiskey or vodka, but also one that can help repair the damage imposed on the body, especially the liver, by an overabundance of the alcohol molecule — especially over the long term. A variety of cannabinoids battle inflammation, which is the root cause of many diseases, including cancer, arthritis, fibromyalgia, and liver disease.
Endocannabinoid System and Cirrhosis
Many theorize that conditions like cirrhosis and other diseases, especially those related to inflammation, are the result of an endocannabinoid deficiency, or basically being malnourished in terms of cannabinoids and terpenes. Why? It turns out that patients with active cirrhosis feature CB2 receptors in their liver cells, whereas those not suffering from the disease lack these receptors. CB1 and CB2 receptors are those targeted by cannabinoids like THC and CBD. It is only through the binding of these special molecules with the appropriate receptors that medical benefit is experienced by patients.
Is this expression of cannabinoid receptors, which is intended to reduce the fibrosis process, the diseased liver’s way — via the endocannabinoid system and its governance of the immune system — to be prepared to accept phytocannabinoids (those derived from plants like cannabis) with the goal of restoring health and homeostasis? Researchers have learned just enough to understand that this mechanism is very similar to how cannabinoids take control of cancer cells, basically reprogramming them to cease spreading or even self-destruct.
It is interesting to observe how these CB2 receptors are located in the liver cells of patients with active cirrhosis, but not in those people not suffering it. This observation appears to indicate that the endocannabinoid system plays a protective role in a variety of liver diseases and overall immune system function.
Fibrosis and Consumption Volumes
Some studies have shown that the volume of cannabis consumed by a patient or lifestyle user determines the efficacy gained. For example, a 2004 analysis study in France regarding the development of fibrosis in hepatitis C patients found a “high progression rate” for fibrosis in those who daily consumed both cannabis and 30 grams of alcohol. For those who consumed cannabis moderately, however, no effect was found on the development of fibrosis (it neither increased or decreased).
A 2005 study conducted at Hebrew University Medical School concluded that endocannabinoids — the body’s own internally-produced cannabinoids that are intimately involved in regulation of the immune system and nervous system — help control things like vascular changes and the modulation of inflammation. In addition, it found these endocannabinoids to be critical to proper neurological function and helpful for those suffering from liver diseases like fibrosis and cirrhosis.
“Endocannabinoids appear to be involved in several aspects of acute and chronic liver disease.”
Like many similar efforts, these researchers called for further studies to better understand the role of both phytocannabinoids and endocannabinoids.
A 2011 study published in the journal Cell Death and Disease revealed that CBD causes malignant cells in liver fibrosis to commit suicide, a process called “induced apoptosis.” The study concluded: “Collectively, these results, coupled with the excellent safety and tolerability profile of cannabidiol in humans, strongly suggest that it may have great therapeutic potential…” The researchers suggested that CBD may be an effective treatment for:
“…diabetic complications, and perhaps other cardiovascular disorders, by attenuating oxidative/nitrosative stress, inflammation, cell death, and fibrosis.”
A study released in 2013 in the journal Clinical Infectious Disease revealed that, counter to other studies, like the 2004 French research cited above, regular cannabis consumption does not accelerate the progression of liver disease, specifically fibrosis. This comprehensive human study involved nearly 700 participants and almost 2,000 person years of follow-up. Researchers concluded:
“In this prospective analysis, we found no evidence for an association between marijuana smoking and significant liver fibrosis progression in HIV/HCV coinfection.”
Congress Blocking Research
Currently, cannabis is classified as Schedule I under the Controlled Substances Act in the United States, meaning it has a legal status of being highly addictive, dangerous, and providing zero medical value. It shares this classification with heroin and bath salts. Even methamphetamines and cocaine reside in less-restrictive Schedule II, meaning they can be prescribed by a licensed physician.
During the summer of 2015, Congress voted down a bill to study the medical efficacy of cannabis and CBD oil for conditions like epilepsy and cancer. The research would have been conducted by the National Institutes of Health under the direction of the Drug Enforcement Administration. If Congress is not willing to allow even this highly restricted and arguably biased level of cannabis research to occur, the independent human trials necessary to adequately understand how the cannabinoids and terpenes in the plant help patients suffering from conditions like liver disease will not occur.
With the federal government (and many individual states) very much against cannabis as medicine — let alone lifestyle enhancement — it is ironic that an increasing number of states like California and Washington are enjoying the social and economic benefits of legal cannabis, but the research results needed by medical professionals, caretakers, and budtenders in even these progressive states continues to lag because of conservative opposition in Washington, D.C.
This post was originally published on December 21, 2015, it was updated on October 5, 2017.