Can Cannabinoids Help Lupus and Other Diseases?
BY JENNIFER CHEN September 23, 2019
Lupus is an inflammatory disease that causes the body’s immune system to attack its own tissues, affecting internal organs, which can start to deteriorate. One doctor is looking for a cure using a synthetically created molecule that mimics the properties and effects of CBD.
A lupus diagnosis can be devastating. The disease causes the body’s immune system to attack its own tissues and can affect internal organs—including the brain, heart, and lungs—which can start to deteriorate. Lupus flare-ups can leave patients so fatigued and in pain that they’re unable to do the simplest of things, such as walk, cook, or read. Many can’t go outdoors without layers of sunscreen, because the disease can make them extremely susceptible to sunburn.
Lupus affects approximately 240,000 people in the United States, and yet at present doctors neither know the exact cause nor have a cure. Instead, current treatments focus on improving quality of life by controlling symptoms and minimizing flare-ups to reduce risk of organ damage.
“The landscape for treatment of lupus is a bit bleak,” says Fotios Koumpouras, MD, a rheumatologist and director of the Lupus Program at Yale Medicine. “A multitude of drugs have failed in the last 10 to 15 years. Most of the drugs we use are being repurposed from other conditions and are not unique to lupus. Many of them can’t be used during pregnancy, which is a problem because lupus mostly affects young women. All of these issues create the impetus to find new and more effective therapies.”
This is why he’s exploring a candidate for a new lupus treatment option: a molecule with a cannabinoid template structure that binds to cannabinoid receptors, the same receptors involved in the chemicals found in the marijuana plant.
What is CBD?
CBD is a form of cannabinoid called “cannabidiol.” Cannabinoids are a type of chemical that binds to CB1 and CB2 receptors found throughout the body. CB1 receptors are mostly located in the nervous system, connective tissues, gonads, glands, and organs; CB2 receptors are primarily found in the immune system, along with the spleen, liver, heart, kidneys, bones, blood vessels, lymph cells, endocrine glands, and reproductive organs. (Collectively this is called the endocannabinoid system.)
What these cannabinoids do when they bind to the receptors depends on which receptor is activated, and thus can produce effects ranging from the firing of neurotransmitters (the chemical messengers sent from the brain to the rest of the body) that alter mood, to reducing inflammation and promoting digestion.
So, our bodies have their own endocannabinoid system, but cannabinoids can also be found in nature, most abundantly in the marijuana plant. The two most well-known types of cannabinoids in the marijuana plant are THC (tetrahydrocannabinol) and CBD (cannabidiol). THC binds to both the CB1 and CB2 receptors, but the CB1 receptor seems to be responsible for many of the well-known psychoactive effects of marijuana, such as euphoria, increased heart rate, slower reaction times, and red eyes. CB2 receptor binding results in the production of a series of proteins that reduce inflammation. (These proteins are called “resolvins” because they appear to resolve inflammation.) The pharmacology of CBD at cannabinoid receptors is complex and highly variable, but CBD has been shown to activate the endocannabinoid system.
Fotios Koumpouras, MD, is researching a synthetically created cannabinoid molecule that binds preferentially to CB2 receptors (called Lenabasum) to see if it can help ease pain and inflammation in patients with lupus.
Dr. Koumpouras learned from a colleague of ajulemic acid, a side-chain analog of Δ8-THC-11-oic acid, which was designed as a potent therapeutic agent free of the psychotropic adverse effects typical of most cannabinoids. This molecule may help relieve pain and reduce inflammation in systemic lupus erythematosus (SLE), the most common type of lupus. “Reducing inflammation is crucial for patients with lupus because it is what causes the buildup of scar tissue in vital organs that can eventually lead to their deterioration and malfunction,” he says. This cannabinoid molecule was already in study for other diseases, including systemic sclerosis and dermatomyositis.
In 2018, Dr. Koumpouras joined a multi-site randomized clinical trial that aims to recruit 100 participants to examine whether a drug using a synthetically created cannabinoid molecule that binds preferentially to CB2 receptors (called Lenabasum) can help ease pain and inflammation in patients with lupus. Participants will receive Lenabasum or a placebo for almost three months and will continue to be monitored for pain and inflammation levels, as well as lupus disease activity. The study is ongoing, but Dr. Koumpouras anticipates that it will wrap up by early next year.
From “miracle drug” to medicine?
Dr. Koumpouras’ excitement over the new drug comes at a time when products containing CBD have flooded supermarkets, labeled with claims that they treat everything from back pain to insomnia. Although CBD is not yet approved by the FDA, the hype around it stems from the popularity of the marijuana plant it is derived from.
But whether CBD actually provides those benefits in a significant way remains to be seen. Only a few studies—small ones—have definitively proven the effectiveness of medicines that involve the endocannabinoid system. To date, the only FDA-approved medication containing CBD is Epidiolex, a medication used to treat two rare forms of severe epilepsy—Lennox-Gastaut syndrome and Dravet syndrome, both which begin mostly in infancy and early childhood. In a group of three clinical trials, Epidiolex seemed to reduce the number of seizures significantly. And yet, Vinita Knight, MD, a Yale Medicine pediatric neurologist, says her patients who take Epidiolex have had mixed results. Some have had reductions in seizures and others haven’t shown much improvement. “We’re not seeing as much success as what’s been reported on Facebook and Twitter,” she says, but adds that so far it has only been prescribed for children with the most debilitating and difficult-to-treat seizures. In addition, some researchers believe that CBD works most effectively in combination with other cannabinoids and compounds found in the marijuana plant, in what is known as the “entourage effect.” Thus, it would be less effective as an isolated chemical in pill form, but that, too, remains unproven.
But these questions are why Dr. Koumpouras is focusing on a compound that, until recently, few have studied.
His research is one of many new studies at Yale and elsewhere looking at the endocannabinoid system and molecules related to CBD action for use in treating everything from Crohn’s disease to psoriatic arthritis, and he hopes that this new data will be used to help paint a more complete picture about the chemical for future treatment options.
“The more data the better,” he says. “The more we’re able to make informed decisions.”
Yale Medicine doctor investigates whether a synthetically created molecule that mimics properties and effects of CBD could treat diseases.
Updated on May 15, 2020. Medical content reviewed by Dr. Joseph Rosado, MD, M.B.A, Chief Medical Officer
An estimated 1.5 million Americans have lupus, with at least 16,000 new cases reported each year. The effects of the disease can range from mild to life threatening. Patients often seek medical marijuana for lupus to control the symptoms since there is no cure for the disease. Understanding the relationship between marijuana and lupus helps you decide if it’s a suitable alternative treatment for you or a loved one.
Why Cannabis Is Effective in Treating Lupus
As an alternative medicine, medicinal cannabis is considered an ideal medication to help lupus patients cope with the many symptoms of the disorder, such as immense nausea and debilitating pain. While medical marijuana is primarily known to be an anti-inflammatory, this alternative remedy can successfully suppress certain parts of the immune system. Let’s take a closer look at how weed causes these beneficial effects in the body.
Lupus is characterized by pain and inflammation. When you use medical cannabis for lupus, you can effectively treat both of those symptoms. By successfully lowering the levels of the body’s inflammation-promoting protein interleukin-2, and raising levels of the anti-inflammatory protein interleukin-10, cannabis shows that it may be beneficial for treating autoimmune disorders such as lupus where inflammation is the main complication. That inflammation is often responsible for pain in the body. Marijuana helps relieve that pain.
Since lupus is caused by an overactive immune system that attacks healthy tissue, suppressing the immune system may help relieve the symptoms you feel. Marijuana helps achieve this through the activation of myeloid-derived suppressor cells (MDSCs). Once activated, the MDSCs may help combat the hyperactivity of your immune system.
Research on Cannabis and Lupus
Research related to the use of medical cannabis is often limited due to federal regulations and the limited availability of cannabinoids to researchers. While there isn’t a lot of lupus-specific research available, many studies have shown effects of marijuana that can be beneficial for people with lupus.
One study looked at the effects of marijuana on the immune system. Researchers took blood samples from cannabis smokers and nonsmokers. The study found that the cannabis smokers had higher levels of interleukin-10, which may suppress the immune system, and lower levels of natural killer cells and lymphocytes, which enhance immunity. For the average person, decreased immunity is a negative, but in autoimmune diseases such as lupus, it could be beneficial.
While official studies and research are limited, many patients have their own anecdotal evidence that is enough to convince them of marijuana’s effectiveness. Many people suffering from lupus have found weed to be much more effective in treating their lupus symptoms than their prescribed medications.
Treating Lupus With Marijuana
Determining the correct medication is often a matter of trial and error with adjustments as you go, and, similarly, finding the right strain and ingestion method of marijuana for lupus takes some experimentation. Every patient’s symptoms are different and people’s bodies respond differently, so the cannabis treatment that works for one lupus patient may not be as effective for another.
Some patients use cannabis in conjunction with their current lupus treatments. The cannabis may provide additional relief beyond what the patient experiences from the traditional treatments. Marijuana may also help alleviate some of the side effects of traditional medicine. For example, if a medication makes you feel nauseous, weed may help ease that feeling. Other patients rely primarily on marijuana for treatment, or they gradually transition from traditional medication to marijuana. It is important to work closely with your care provider or a quality marijuana doctor to ensure your condition is treated properly. A lack of proper treatment for lupus could lead to more serious episodes with severe symptoms and potentially risky health effects.
Sativa strains are particularly helpful for people who feel fatigued from lupus, as they tend to have an energizing effect. Some Sativa strains to try include Super Silver Haze, Sour Diesel and Strawberry Cough. If you have trouble sleeping due to the pain and other symptoms of lupus, use an Indica strain, especially at night when you want to sleep. Indica strains create a feeling of sleepiness. Some options include Afghan Kush, Granddaddy Purple and Bubba Kush.
When you look at different marijuana strains, you see that they vary in the amounts of THC and CBD. Both cannabinoids can be beneficial for lupus. THC has a psychoactive effect, which gives you the feeling of being high. If you want to avoid that feeling, look for strains with low THC levels. Strains with higher levels of CBD often help patients in managing lupus symptoms. Some examples of those strains include Cannatonic, Charlotte’s Web, Harlequin, One-to-One and Sour Tsunami.
How you consume the cannabis for lupus also affects how well it works and how much relief you feel. Consider the following common methods and their pros and cons:
- Smoking: Often associated with recreational use of weed, smoking is an option for using cannabis to treat lupus. A key benefit is the almost immediate effects you feel when you smoke marijuana. The drawback is the high heat point, which can produce unwanted byproducts and potentially cause lung issues similar to smoking cigarettes.
- Vaporizing: When you vaporize cannabis, you use a lower heat point than smoking, which minimizes the byproducts that could be potentially harmful. You still feel the benefits almost instantaneously just like smoking.
- Edibles: If you’re looking for lasting relief, edibles infused with cannabis are a good option. They take longer to kick in, about 30 minutes to a few hours, but you’ll feel the effects much longer than you do with smoking or vaporizing. Plus, some people prefer eating a treat rather than inhaling cannabis.
- Topical applications: For lupus, a topical application can be an effective option. This lets you target the relief where you feel the immediate pain or swelling, such as joints or a particularly achy area. It may also be effective in treating skin conditions associated with the disease. You can get lotions, balms, salves and oils made with marijuana for the topical application option.
Some appropriate methods of using this alternative medication would be vaporizing an Indica strain at night to help with sleep and using a topical cream during the day to treat joint pain. You might also choose an edible at night to benefit from the longer effects of this type of ingestion.
Potential Side Effects of Marijuana
Unlike traditional treatments used for lupus that can cause very unpleasant and sometimes severe side effects, patients who have used medical marijuana to treat lupus have significantly improved with no noticeable negative side effects. Some patients report feeling some minor side effects that generally go away once the marijuana wears off. Some of those potential effects include:
- Euphoria or a feeling of being high, particularly when using strains high in THC
- Sleepiness, particularly with Indica strains
- Increased appetite
Some patients actually want some of the side effects. For example, if you are having trouble sleeping because pain caused by lupus keeps you up at night, the sleepiness as a side effect may actually help you get better rest. When compared to the potential side effects of traditional medicines, the side effects of marijuana are much easier to handle.
Many marijuana states allow the use of marijuana to treat lupus when certain qualifying conditions occur. The qualifying condition usually occurs when lupus causes chronic pain or severe nausea. Medical marijuana is a natural alternative to traditional lupus treatments without the side effects. If you or a loved one is dealing with lupus and you’re wondering if medical marijuana is a suitable treatment option, we can help. Let us connect you to hundreds of quality marijuana doctors across the country in all legal marijuana states. Cannabis could provide you with the relief you need from the pain and inflammation of lupus.
Additional Lupus & Cannabis Resources
For more information about how cannabis can be used to treat Lupus, check out our resources:
What Is Lupus?
Lupus is an autoimmune disease that causes your immune system to attack its own tissues and organs. Under normal conditions, your body produces antibodies to attack foreign invaders in the body. With an autoimmune condition such as lupus, the body creates autoantibodies that attack healthy tissue. Lupus is a chronic condition, meaning it usually lasts at least six weeks but often for years. The condition causes inflammation, which affects many different body systems, resulting in pain and damage in those systems. Lupus often affects the joints, skin, kidneys, blood cells, brain, heart and lungs.
Lupus is often difficult to diagnose because its signs and symptoms are similar to many other conditions, including thyroid problems, Lyme disease, rheumatoid arthritis and fibromyalgia. The most distinctive sign of lupus is a facial rash in the shape of butterfly wings unfolding across the nose and both cheeks. This rash occurs in many but not all patients.
The symptoms of lupus vary significantly in different patients. You may notice symptoms come on suddenly, or they might gradually develop. Some symptoms are temporary, while others are permanent. Symptoms range from mild to severe, with many patients experiencing episodes or flares of more intense symptoms, followed by a significant improvement. Because the disease affects different systems in each patient, the symptoms also vary depending on how the disease affects your body.
Some potential symptoms of lupus include:
- Rash shaped like a butterfly across the face
- Skin lesions that may worsen with sun exposure
- Stiffness, pain and swelling in joints
- Swelling of the feet, legs, hands and around eyes
- Raynaud’s phenomenon, which causes fingers and toes to turn blue or white in cold or due to stress
- Dry eyes
- Confusion or memory loss
- Chest pain, especially when breathing
- Shortness of breath
- Photosensitivity, which is sensitivity to the sun or light
- Hair loss
- Ulcers in the mouth or nose
- Swollen glands
In some cases, lupus causes complications that can be severe. These complications often affect specific body systems. Some possible complications include:
- Kidney damage
- Kidney failure
- Increased risk of blood clotting or bleeding
- Vasculitis, which is an inflammation in blood vessels
- Pleurisy, which is inflammation of the chest cavity lining
- Pericarditis, which causes inflammation in the heart muscle, arteries and heart membrane
- Increased risk of heart disease and heart attacks
- Infection due to a weakened immune system
- Increased risk of cancer
- Bone tissue death due to diminished blood supply, resulting in breaks and bone collapse
- Increased risk of miscarriage, preeclampsia and preterm birth in pregnant women with lupus
Lupus most often starts between the ages of 15 and 44, with women of childbearing age being the most common group to develop the disease. Lupus affects people of all ethnicities and races, but women of color have two to three times the likelihood to develop the condition than Caucasian people.
The specific cause of lupus is not known, but many researchers feel the disease stems from a combination of factors. Some possible triggers could include hormones, genetics and environmental factors, such as chemicals or viruses. Even things like emotional stress, exhaustion and certain types of drugs could trigger lupus. Some people may naturally have a higher tendency to develop lupus, which is then triggered by those potential factors. There is currently no cure for lupus, but treatment options can help control symptoms.
Types of Lupus
There are four main types of lupus, each with slightly different effects on the body. The type of lupus you have affects the treatment options.
The primary type of the disease is systemic lupus, which is the most common type and is the type that most people think of at the mention of lupus. Systemic lupus can affect the major organ systems throughout the body, with inflammation affecting the functioning of the kidneys, nervous system, circulatory system and other parts of the body. Symptoms in any of those body systems can range from mild to severe.
A second type of the disease is cutaneous lupus. This type of lupus only affects the skin, not the other systems of the body. Rashes and lesions appear on the skin. The most common type is a discoid rash, which appears in circular areas as raised, scaly and red without itching. Rashes and lesions can appear anywhere, but they often affect skin exposed to the sun. Cutaneous lupus can also cause skin pigment changes and hair loss. Roughly 10 percent of people initially diagnosed with cutaneous lupus eventually develop systemic lupus. It is possible that those people actually had systemic lupus from the beginning, but it initially only presented in the form of skin symptoms.
Certain legal prescription drugs cause drug-induced lupus. While many medications can cause the condition, the drugs most often associated with it include Hydralazine for high blood pressure, Procainamide for irregular heart rhythm and Isoniazid for tuberculosis. Symptoms are similar to systemic lupus but usually without affecting major organs. The symptoms usually go away within six months of stopping the medication.
While not a true type of lupus, neonatal lupus presents similar symptoms in infants. It happens when antibodies from a pregnant woman with lupus affect her baby in the womb. The symptoms upon birth often include a rash, liver problems or lower than normal blood cell counts. These symptoms normally clear up within months of birth, but the condition can cause serious heart defects in affected babies. Treatment options for babies of at-risk mothers are available.
Current Treatments for Lupus
Lupus has no cure, so the primary focus of the currently available treatments is addressing the specific symptoms. Since those symptoms vary from patient to patient, the medications and treatments used also vary. Patients typically work closely with their physicians to determine how to treat specific symptoms. The medications used may change frequently as you experience flares or have symptoms diminish.
Some common treatment options for lupus include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs are available over the counter and aim to relieve pain, swelling and fever. When over-the-counter NSAIDs aren’t strong enough, patients may receive prescription-strength versions of the pain reliever. Risks associated with NSAIDs include bleeding in the stomach, kidney issues and a higher risk of heart problems.
- Corticosteroids: These drugs are used to reduce inflammation associated with the disease. Reducing inflammation can help relieve other issues caused by the inflammation, including pain, swelling and tenderness. Prednisone is a commonly prescribed drug. Potential side effects include weight gain, fluid retention, bruising, osteoporosis, diabetes, higher infection risk, acne, irritability, insomnia, depression and high blood pressure.
- Antimalarial drugs: The same medications used to treat malaria are sometimes used to control lupus symptoms in combination with other drugs. They may help with rashes, mouth ulcers, pain, inflammation and blood clotting. These drugs help suppress production of the autoantibodies that cause damage to healthy tissue. Upset stomach is a common side effect. In very rare cases, the drugs could potentially cause retina damage.
- Immunosuppressants: Another option for treating lupus is medication that suppresses the immune system. While that suppression could help minimize the damage done to the body by its own immune system, it also comes with some risks, which may vary depending on the specific medication used. Those potential side effects include a higher risk of infection, liver damage, higher risk of cancer, fertility issues, nausea, diarrhea and fever.
- Anticoagulants: Lupus can cause blood-clotting issues. If a patient is at risk of life-threatening blood clots, anticoagulants to thin the blood may be used.
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