Cannabis like the corona virus is a disrupter and therefore proper education is imperative. Similar to most infections, the elderly, disabled and immunocompromised are most at risk however there are a higher percentage of healthy individuals who are suffering from covid-19. We know not to congregate in Emergency rooms if it is just a common cold or pass a prerolled joint or vape during this pandemic. Frequent hand washing with soap and social distancing to prevent overwhelming our health care system is the only solution. Similarly, it is essential to advise our patients about the medical benefits of cannabis, the safest delivery methods and how to dose appropriately. So, we need to be mindful about the importance that this is a public health emergency for a society and use good judgement.
Patients are stocking up on their medical marijuana because they know they are not able to easily leave their houses; they do not know for how long and cannabis is their medicine. They are also more anxious about the unknown and are using cannabis to calm themselves while they homeschool their kids or learn how to cope with potential decreases in wages from hours lost at work and get restful sleep.
As a Pain Management Physician specializing in Cannabis Medicine, I have chosen to practice telemedicine through the 1135 waiver from CMS as it is a medical emergency. Under 381.986 Florida statute we can certify existing qualified patients through telemedicine. I am seeing new patients as a face to face visit as needed.
What I have seen is people fear that if one becomes infected with covid 19 they know this virus affects their pulmonary system and they want to do their part to have the healthiest lungs. This is similar to how we all suggest taking supplements such as vit d, c and zinc and probiotics or even glutathione to support our immune system. More people are turning to tinctures and capsules or vaping flower. Smoking cannabis can increase the risk of acute bronchitis, however, does not increase the risk of head, neck, lung cancer published in 2017 sciences medicine and engineering.
Cannabinoids and terpenes have been studied in relation to our immune function. “However,” according to the IACM, “there is no evidence that individual cannabinoids – such as CBD, CBG or THC – or cannabis preparations protect against infection … or could be used to treat COVID-19, the disease produced by this virus.” But the IACM also emphasizes “there is no evidence that the use of cannabinoids could increase the risk of viral infection.” For example, we know the cannabinoid THC is a bronchodilator. CBD and THCA, pinene, beta caryophyllene all play a role in decreasing inflammation. CBD has Antifungal properties and CBD and CBDA can help with anxiety in times of crisis and panic. THC, CBN and Myrcene may help get a restful sleep. However, antiviral properties of CBD are not well established.
There is a large body of evidence from in vivo and in vitro models showing that cannabinoids and their receptors influence the immune system, viral pathogenesis, and viral replication.
“A new wave of research and mounting anecdotal evidence points towards cannabinoids having an adaptive, immunomodulating effect, rather than just suppressing immune activity.” The ability of cannabinoids to both suppress and enhance immune function lends credence to the notion that the endocannabinoid system is involved in bidirectional immunomodulation, keeping inflammation in check under healthy conditions but enabling an inflammatory response when needed to fight infection.
The interaction between cytokines (a group of proteins that regulate inflammatory responses), immune cells, and the endogenous cannabinoid system plays an important role in neuroinflammation and neurodegeneration. It is documented that stimulation of the CB2 cannabinoid receptor by THC and its endogenous counterparts can suppress inflammation. Cannabinoid receptor signaling confers therapeutic effects by downregulating inflammatory cytokine expression.
CBD also acts as a potent anti-inflammatory, reducing cytokine production and inhibiting immune cell function. A 2014 study by Louisiana State University scientists demonstrated that regular cannabis use can increase white blood cell counts in immune deficiency disorders such as HIV, suggesting a proinfammatory, immune-boosting effect. That is the exact opposite of what is needed to mitigate a viral-induced cytokine storm.
Evidence suggests that cannabinoids may systematically influence viral infection through regulation of host immunity and inflammatory response [Reiss, 2010; Rom and Persidsky, 2013], cell metabolism [Molina et al., 2011b], and the ability to enter host cells [Benamar et al., 2009], integrate into the host genome [Valk, 1997,1999], replicate [Roth et al., 2005; Rock et al., 2007; Molina et al., 2014], be released [Cabral et al., 1986], and by novel epigenomic and miRNA activation. Contradictions exist in the literature about the effects of cannabinoids on viral infections. For example, in HIV, viral replication is enhanced in an inflammatory state and chronic inflammatory conditions are related to an increased level of viremia [Kfutwah et al., 2006; Groot et al., 2006]; thus, CB activation could suppress viral replication by antiinflammatory action. Identification of the mechanisms responsible for these functions is complicated because of the multiplicity of cannabinoid-related signaling and effects [Smith et al., 2010; Rom and Persidsky, 2013], tissue-specific responses to the viral infection [Lee et al., 2007; Zaritsky et al., 2013], multiple cellular mechanisms involved in inflammatory responses [Klein and Cabral, 2006], and kinetics of viral replication [Molina et al., 2011b].
While we wait for more data about the Corona virus and Cannabis modulating the immune system, we need to be informed and not fearful and help our community. Personal acts of goodness during a public health crisis is essential. Economic losses will cause deep despair. CMS guidelines help us properly adapt to smart strategies like telehealth. We need to appreciate our ecosystem and use this time to slow down not to overconsume. We cannot always be prepared for a crisis, but we can follow guidelines and appreciate that there is a bigger world out there and start to work together.
Dr. Michelle Weiner, is an Interventional Pain Management Physician board certified in Physical Medicine and Rehabilitation. She completed her residency and fellowship training at the University of Miami. Her specialty is focused on prevention, treatment, reversal of health deterioration, increasing function and managing pain. Dr. Weiner focuses on diagnosing and treating spine and musculoskeletal pain as well as chronic migraines at the Spine and Wellness Centers of America