In times as uncertain as these, it is no surprise that people are anxious; and when people are uncertain & anxious, they start looking for answers. Answers can give a person faith and hope. Unfortunately, sometimes these answers are not only wrong, but also potentially dangerous. The idea that cannabis, cannabidiol (CBD) or any other cannabinoid or terpene is a potential cure for a viral infection like the novel coronavirus (COVID-19) outbreak is perhaps one of the more dangerous ones. Here’s some questions answered. From https://commons.wikimedia.org/wiki/File:3D_medical_animation_corona_virus.jpg; source: https://www.scientificanimations.com/wiki-images/ (CC BY-SA 4.0) “What about the effects of cannabinoids like CBD on the immune system?” Yes, cannabinoids have immunomodulatory effects. This means that they can restore balance to the immune system. If there is too much or too little of an inflammatory response, cannabinoids can help keep this to a happy medium. This does not mean that cannabinoids can beat viral infections. “What about cannabigerol (CBG)?” CBG has been found to have antibacterial properties, which can make it useful for antibiotic-resistant infections like MRSA (as can terpenes like pinene). However, antibacterials are not antivirals. Thus, an antibacterial like CBG will have no effect on a virus like COVID-19. It is possible that cannabinoids’ antibacterial properties have a use for secondary infections. “What about cannabinoids’ anti-inflammatory effects?” Cannabinoids’ anti-inflammatory effects can prove to be immensely useful for many different conditions, but inflammatory responses to acute viral infections are generally very useful. To quote the study ‘Cannabinoids and Viral Infections’: “The anti-inflammatory activity of cannabinoids may compromise host inflammatory responses to acute viral infections, but may be beneficial in persistent infections. In neurons, where innate antiviral/pro-resolution responses include the activation of NOS-1, inhibition of Ca2+ activity by cannabinoids, increased viral replication and disease.” This applies to viral infections where inflammatory responses are associated with clearance and recovery (e.g. influenza), not inflammatory responses that are pathological (e.g. multiple sclerosis), where cannabinoids can prove useful. That cannabinoids like CBD are useful for viral infections like hepatitis C does not mean it will have similar effects on other types of viral infection. Cytokine function, relationship to disease, and location in the human body. Credit: NIAID (CC BY 2.0), https://www.nih.gov/ “Could cannabinoids therefore increase the chances of getting coronavirus?” We do not know much about coronavirus at the moment, let alone how it would interact with cannabinoids, which are already understudied. Different diseases have different pathologies, and it is impossible to say how precisely cannabinoids interact with a virus like COVID-19. As THC can suppress immune response, it could be possible that cannabinoid use may not be ideal for treating something like COVID-19, but there is no science saying whether or not this is true. Whether or not cannabis use increases the chances of a person contracting COVID-19 is difficult to say. It could even be argued that the anxiolytic effects of cannabis can lead to less anxiety and proper sleep, which improves immune function! There is no link between the likelihood of catching COVID-19 and cannabis use. With all this being said, it must be reiterated that cannabinoids are immunomodulators. This means that they can potentially be used to raise or lower immune response. Which sets of cannabinoids and terpenes do so, and for which types of physiologies (remember that everyone has a unique endocannabinoid system), remains the subject of study. Therefore, cannabinoids’ immunomodulatory effects may be a sort of “double-edged sword”. They can potentially dampen inflammatory response, which can be useful in instances of an out-of-control inflammatory response such as cytokine storms. However, immunosuppression may be a problem when inflammatory responses are needed. It is interesting to note that in subgroups of patients with severe COVID-19, cytokine storm syndrome and hyperinflammation is a major concern. Also, whilst cannabinoids may not necessarily be ideal for some viral infections, they may be useful for others with different pathologies, as well as for the sequelae (a chronic condition arising from an acute one) of some types of influenza virus like H1N1. Whether this applies to COVID-19 as well, we cannot say for sure. In fact, we cannot say for sure whether or not cannabis works for H1N1, either, as it’s a theory that hasn’t been tested! Author: Derrick Coetzee, source: https://www.flickr.com/photos/dcoetzee/8488782713/ (CC0 1.0) “The above sounds like some of the reasons why people say to keep ibuprofen away from coronavirus patients. Is this true?” There is a lot of debate surrounding whether or not ibuprofen may worsen COVID-19 due to its anti-inflammatory effects. There are some anecdotal reports and an interesting supposition in The Lancet, which looks at patients with cardiac diseases, hypertension, or diabetes who are treated with ACE2-increasing drugs who may be more susceptible to the virus, but nothing definite saying that ibuprofen can make COVID-19 worse. The World Health Organization (WHO) has recommended avoiding ibuprofen for COVID-19 symptoms. The BMJ also suggests that some types of anti-inflammatory drugs like ibuprofen could be an aggravating factor for the infection. The BMJ article also suggests that blocking the key inflammatory molecule interleukin-6 may help prevent the cytokine storms of seriously ill patients. So the key here seems to be in blocking the right kind of hyperinflammation. Whether or not CBD blocks this inflammatory response is subject to more research. Those who are taking ibuprofen for another condition ought to speak to their physician if they have any concerns. However, all the above information is speculation, and there is no definitive evidence as of yet that ibuprofen may not be ideal for the treatment of COVID-19. Just like many conditions, there are a variety of potential causes and factors that can make an infection worse. Yes, there are some issues with NSAIDs like ibuprofen, but this does not mean that such medications can’t be used properly where appropriate. Also, just like many medications, there may be some parts of the populace that are more sensitive to it, whether due to their own natural physiology, an underlying health condition or because of interactions with other medications. “Do cannabinoids have any use at all in influenza-type infections?” There is some evidence that cannabinoids can help reduce fever and mitigate headaches and a runny nose, which are all caused by excessive inflammation. This inflammatory response is very useful in the short-term, but in the long-term overwhelming inflammation can start to damage cells in the body. Cannabinoids may also be useful for fighting the secondary bacterial infections that follow a viral infection, but not necessarily the virus itself. Therefore, no matter how much cannabis you use, it will not likely be any sort of “cure” for Coronavirus. What about chloroquine or hydroxychloroquine? Chloroquine and hydroxychloroquine are used to treat malaria, as well as lupus and arthritis. Whilst there is no definitive evidence that chloroquine works for the treatment for COVID-19, there are some clinical studies showing that the anti-malarial may be useful for treating COVID-19 (please note: this is a treatment, not a “cure” or vaccine). Chloroquine works for malaria by essentially starving the parasite and preventing the degradation of hemoglobin and red blood cells. As an antiviral, chloroquine increases the pH in the cells, which results in an impaired release of the virus. Chloroquine also inhibits the production of inflammatory cytokine IL-1, which could perhaps prevent the over-inflammation that leads to more serious problems. Alongside Remdesivir, chloroquine has been shown to have some efficacy in inhibiting COVID-19 in vitro. Another trial shows that chloroquine/hydroxychloroquine and azithromycin could help reduce viral load, but the sample size is small. However, use of chloroquine is still in its experimental stage. Chloroquine is also contraindicated for those with diabetes or heart problems. The antibiotic azithromycin may potentially be useful for secondary, bacterial infections that can cause pneumonia. However, once again, much of the above is theoretical. There are also some studies that show the opposite. Another study wisely suggests that we should not jump the gun and await the results from trials. We should also be aware that clinical-grade hydroxychloroquine/chloroquine should be used, and in appropriate doses as directed by health professionals. We should also not drain the availability of azithromycin and chloroquine/hydroxychloroquine so as not to cause shortages for those with lupus or arthritis, especially when there is so much conflicting information regarding their efficacy. “I need medical marijuana for a medical condition – should I keep using it?” Those who are in need of cannabis for medical purposes can carry on using it. All medications need to be balanced out in terms of risks, harms and benefits, and cannabinoids are no different in this regard. However, if you are smoking cannabis and you do not need to ingest it in this manner, it may be wise to use this time to stop doing so and perhaps find an alternative method. Smoking anything is not good for the lungs, and COVID-19 can cause severe damage to the lungs. “Should healthy people avoid using cannabis during the Coronavirus pandemic?” This may be a great time to stop smoking cannabis and use alternative methods in order to protect your lungs. Other than this, not necessarily. In fact, it is also arguable that using some cannabis can help prevent anxiety and insomnia. Of course, anxiety and insomnia can wreak havoc on the immune system, which increases your chances of infection. The key is balance. Should you be unfortunate enough to catch COVID-19, it would perhaps be best to stop using cannabis for several weeks, as it may interfere with other medications that may be used to treat you. For most young, healthy people (though not necessarily all – COVID19 can still be serious), COVID19 is so far quite mild to moderate. In such instances, the body’s natural inflammatory responses seem to respond to the virus quite well. Letting your body fight off the infection and preventing yourself from infecting others who may be more vulnerable seems to work for many. COVID19 seems to generally be quite the “sneaky” virus. It is asymptomatic in many people. It can masquerade as any number of other coronavirus infections, making it difficult to know for definite if one has had it or not. Moreover, the symptoms range from mild and barely any symptoms at all, to serious and deadly. Taking the virus seriously, social distancing and developing an appropriate vaccine will likely be the best form of treatment. Image by Gerd Altman from Pixabay. Cannabis and COVID-19 – Key Points Here’s where cannabis may be a positive for a COVID-19: Those suffering from anxiety, insomnia, depression etc. may find some use in CBD, THC and other cannabinoids & terpenes. Relief from anxiety, insomnia, PTSD and so on can help boost immune function. This is a particularly distressing time, and the anxiolytic effects of cannabis can prove very useful. Those suffering from conditions like cancer, nausea, seizure disorders, MS and many other inflammatory conditions may still find use in cannabinoid-based medications. Whilst not necessarily useful immediately, cannabinoids may be useful for controlling long-term, excessive inflammation and its side-effects. More research is needed to understand post-viral recovery and CBD’s ability to control a cytokine storm. CBD may reduce ACE2 receptor expression, blocking entry points in the lungs for COVID-19. Cannabinoids may be useful for secondary bacterial infections. Those who suffer from diabetes, obesity, immune system diseases and many other underlying health problems are at greater risk of contracting COVID-19 and suffering from further complications. CBD and THC may be useful in treating such conditions. Here’s where cannabinoids may not be useful for COVID-19: The initial stages of battling the infection, where inflammatory responses are useful. Smoking cannabis is not ideal for the lungs, especially when there is a virus that affects the lungs in particular. Alternative ingestion methods (e.g. tinctures, capsules, edibles, inhalers) may be a better choice. Interference with other medications. If you have any more questions or want to get your medical marijuana card online, please do not hesitate to contact us here at Leafwell. See a doctor today and get a physician’s recommendation for a medical marijuana card. Online appointments available in some states.