The Use of Cannabis in Patients with Hepatitis C

By Cheryl Smith

In her presentation at the 8th National Conference on Cannabinoid Medicine, Diane Sylvestre, MD, urged caution those with hepatitis C virus (HCV) in their use of marijuana.

In the US alone, four million people have the virus, and some don’t even know it. Until 1992, blood donors were not routinely tested, so while the epidemic was silently incubating in the bloodstreams of Americans, one out of ten people who received a transfusion became infected. This is no longer the route of transmission; instead, HCV has become spread mainly through IV drug use. Nevertheless, those with this virus can have a variety of symptoms that they have to cope with unless and until they receive the cure.

Of those infected with the virus, 25% will be lucky enough to have a spontaneous remission and eliminate it from their blood. In the other three-quarters, it often lies dormant until the immune system goes into attack mode, leading to scar tissue in the liver, cirrhosis, a higher incidence of liver cancer, and even death. Fortunately, there is now a 90% cure rate with new drugs, so people are encouraged to get tested and get treated.

Common symptoms of chronic HCV include weight loss, nausea and digestive problems—all problems that are well-known to be helped by cannabis. It has also been found to help people deal with the side effects of treatment. However, while cannabis may help with these immediate symptoms, it has also been shown in studies to be correlated with increased fibrosis (scarring) of the liver. With too much scarring comes cirrhosis of the liver and, in some cases, cancer and other medical problems.

Dr. Sylvestre reviewed three studies that looked at the use of medical marijuana by people with HCV. One of them, which was retrospective (looking back at patient records) show four times as much fibrosis in patients who used cannabis daily. She noted that it was unclear what amount of cannabis that led to the result.

The second study looked at current patients and also showed increased fibrosis with cannabis use. Fibrosis was determined by looking at a liver biopsy.

The third study looked at the level of liver enzymes (which is only an indirect method to determine whether the fibrosis is occurring) and found no correlation between cannabis use and fibrosis.

According to Dr. Sylvestre, the takeway from these studies is that:

  • Cannabis use in HCV may increase fibrosis
  • It is unclear how much cannabis is linked to worsening scarring in the liver; it may be related to the dose.
  • Non-daily use of cannabis appears to be safe.

Individuals who have HCV need to consider how much cannabis they need to treat their symptoms and try to minimize their use. Because all of these studies dealt with smoked cannabis, more research needs to be done on other methods of ingestion.

Cheryl K. Smith is a freelance writer and medical marijuana advocate and activist living in the coast range outside of Eugene. Cheryl is a member of the Advisory Committee on Medical Marijuana and a director for Compassionate Oregon.