Cannabis and Lupus

Chapter 22 of Treatment of Systemic Lupus Erythematosus describes Systemic Lupus Erythematosus (SLE) as a heterogeneous, multisystem disease that reveals in a unique way per patient, and treatment should be tailored to the type and severity of organ system involvement. As of today, there are still study limitations but there are community standards that help physicians guide treatments and therapies.

Typical symptoms an SLE patient may experience are fatigue, pain, depression, photosensitivity, arthritis, arthralgia, acute pneumonitis, and diffuse alveolar hemorrhage (which is the most uncommon complication).

Current treatments for lupus involve these medications: Glucocorticoids, Hydroxychloroquine, Methotrexate, Azathioprine, Mycophenolate, and Cyclophosphamide. They mostly aid with renal insufficiency and help with major organ functions.

It’s common to have skin issues so skin protection is recommended for photosensitivity, glucocorticoids for lesions, and Hydroxychloroquine for systemic therapy.

Therapeutic Use or the Potential Use of Cannabinoids in this Condition

The article named ‘The Risks and Benefits of Cannabis in the Dermatology Clinic’ mentions preliminary studies show that cannabis can be successful in treating acne, dermatitis, pruritus, wound healing, and skin cancer. Approved medical conditions for cannabis use currently are psoriasis, lupus, nail-patella syndrome, and severe pain.

However, the risks are very concerning and can include oral cancers, oral stomatitis, candidiasis, cannabis arthritis, and angioedema.

Overall, dermatologists need to continue familiarizing themselves with these potential risks as cannabis keeps growing in popularity.

On the other hand, dispensaries have been supportive in providing medical cannabis for dermatologic concerns like treating acne, allergic contact dermatitis, chronic pain, herpes, dermatitis, and lupus.

Research Conducted with Cannabinoids in this Condition

The University of Massachusetts Medical School conducted a study that goes into depth about Ajulemic Acid (AJA). It is an oral, non-psychoactive synthetic cannabinoid-derived drug that binds to the CB2 receptor. It has shown efficacy in inflammation and fibrosis, suppresses tissue scarring, and stimulates endogenous eicosanoids, which also aid in inflammation and fibrosis but without immunosuppression. It is currently developed to be used for Systemic Sclerosis (SSc), Cystic Fibrosis, Dermatomyositis (DM), and Systemic Lupus Erythematosus (SLE).

In clinical trials, AJA has the potential to be a potent inflammation-resolving drug, distinct from NSAIDs, and can aid with various chronic inflammatory diseases. It is also considered disease-modifying, unlike NSAIDs which only relieve symptoms. It also has minimal adverse side effects making it acceptable for chronic administration.

My Thoughts

From the research I've explored in my grad studies, I feel many limitations still don’t allow concrete support. There are several clinical studies out there, but few can validate their statements due to the Schedule 1 status of cannabis.

The existing preliminary research has been very helpful in learning more about cannabis but more controlled trials need to be conducted and evaluated to go into more depth about its safety and effectiveness.

Cannabis and sickle cell

According to the National Heart, Lung, and Blood Institute, Sickle Cell disease is a lifelong illness that consists of a group of inherited blood cell disorders that affect hemoglobin and the shape of blood cells. Rather than having normal disc-shaped cells, a patient with this disease has crescent or ‘sickle-shaped cells. They don’t bend and cause blood flow blockage to the rest of the body. This happens due to tissue dying because of poor blood flow which is very painful.

Common symptoms include chronic pain, inflammation, eye problems, infections, strokes, and pain crises. Conventional treatments for SCD are the following: blood and bone marrow transplant, (which is currently the only cure available), recommended medications, or transfusions for complications. Gene therapy and bone marrow transplants are possible treatments in the near future.

Unfortunately, many states don’t list Sickle Cell Disease as a qualifying condition to attain a medical marijuana card, and patients have to turn to the illicit market for access. Only three states currently have it listed: CT, PA, and OH.

Before Connecticut approved SCD, a study was conducted to research cannabis use among SCD patients. According to their findings, a majority of the study participants endorsed all the medicinal reasons on the survey: pain, anxiety, mood, sleep, and appetite. A majority also reported cannabis use allowed them to use fewer pain medications. Also, the availability of medical cannabis is associated with fewer deaths related to opioids.

This study examined cannabinoid receptors to mitigate mast cell activation, neurogenic inflammation, and hyperalgesia. They utilized HbSS-BERK sickle and cannabinoid receptor-2-deleted sickle mice. It concluded cannabinoids mitigate mast cell activation, inflammation, and neurogenic inflammation in sickle mice via both cannabinoid receptors 1 and 2. This study supplied ‘proof of principle’ for the potential of cannabinoid and cannabinoid receptor therapy to treat sickle cell anemia. It also demonstrated that cannabinoids reduced mast cell activation in sickle cell anemia.

After reviewing various studies, I did notice some gaps in knowledge and it could be due to a lack of information access, legal constraints due to the states’ individual legalization status, or study participants not fully partaking and didn’t share all the requested information needed. There’s still a lot of work to do in cannabis research and I have faith the government will take this work seriously and will fully acknowledge it.

cannabis and mental health

Is There a Link Between Mental Illness and Cannabis Use?

Anna Rivera

Institute of Emerging Health Profession, Thomas Jefferson University

CSO52: Cannabis & Public Health

Professor Megan K. Reed, Ph.D., MHP

Assignment Due: 11/27/22

Is There a Link Between Mental Illness and Cannabis Use?

‘Tell Your Children: The Truth About Marijuana, Mental Illness, and Violence’ by Alex Berenson is full of opinions with not much accurate research to back them up. He rants about what’s wrong in this society and points fingers at black and brown people, blaming them for increased violence due to mental health issues perpetuated by cannabis consumption.

His points of view are reminiscent of Harry Anslinger’s days with his racist propaganda and promoting ignorance in newspapers, like this excerpt from The Salt Lake Tribune in 1913: “Marihuana is a shortcut to the insane asylum. Smoke marihuana cigarettes for a month and what was once your brain will be nothing but a storehouse for horrid specters''. (Reed Ph.D., MPH, 2022, #1). As mentioned in the Module 3 lecture, newspaper reports on cannabis consumption were aimed at brainwashing to keep people fearful and the information wasn’t backed up by solid data. Unfortunately, the masses believed this disinformation about cannabis being affiliated with crimes/violence, which only strengthened prohibition.

In a way, I understand him agreeing and believing inaccurate data, which is still floating around these days and mostly due to the limited research available. This outcome is due to the FDA not acknowledging/accepting cannabis as having medicinal benefits. Also, the Schedule 1 status doesn’t help either so researchers are restricted because of the DEA. Thankfully, there is private funding available to continue research.

Now, let’s review some work about mental illness associated with cannabis use. The National Institute of Health’s research report named, “Is there a link between marijuana use and psychiatric disorders”, proposed that smoking high-potency cannabis daily has the potential to increase the possibility of developing psychosis

Is There a Link Between Mental Illness and Cannabis Use?

almost five times as opposed to those who never consumed cannabis (Is There a Link Between Marijuana Use and Psychiatric Disorders?; 2020).

It also noted that the substance amount used, the age when consumers first used, and genetics are contributing factors that affect the relationship between teens and cannabis consumption. It concluded that the most compelling evidence associated with cannabis use and psychiatric disorders is in individuals with pre-existing conditions, genetics, or related susceptibility.

The article also mentioned that there has been a correlation between suicidal thoughts/ attempted suicide and teens that consume cannabis. Lastly, it indicated that cannabis has been previously linked to ‘amotivational syndrome’, which they define as ‘diminished or absent drive to engage in typically rewarding activities’. According to verywellmind.com, they define it as ‘a psychiatric condition that is characterized by a change in an individual’s personality, emotions, and cognitive function’. This condition is currently considered a hypothesis due to the endocannabinoid system’s role in helping regulate our mood. It’s been theorized that the brain alters from early cannabis use, but more research needs to be executed to verify this link.

In 1942, the American Journal of Psychiatry released an article named, “The Psychiatric Aspects of Marihuana Intoxication”. It included observations about research achieved at Welfare Hospital in NYC, under the mayor’s Commission of Marihuana. The leading doctors were Dr. Allentuck and Dr. Bowman, which studied 77 subjects released from prison. They concluded that cannabis is a contributory cause of crime and permits anti-social tendencies. (The Psychiatric Aspects of Marihuana Intoxication, 2019)

Is There a Link Between Mental Illness and Cannabis Use?

They indicated their conclusions were confirmed about cannabis relaxing inhibitions and possibly contributing to concerning behavior. However, the editor of the paper kept stating that further investigation was needed and I’m glad that was mentioned.

Just like Alex Berenson, Dr. Bowman and Dr. Allentuck expressed opinions without much evidence, which can be harmful, especially when it comes to public health. Misconceptions and misinformation do have a negative impact on one’s mindset and unfortunately, that’s how fear-mongering starts in the media.

Another research was covered by National Academies on mental health, and according to them, the evidence alluded to cannabis consumption possibly increasing the risk of developing disorders such as schizophrenia, depression, social anxiety, and other psychoses. They also found the following:

Alternatively, in individuals with schizophrenia and other psychoses, a history of cannabis use may be linked to better performance on learning and memory tasks. Heavy cannabis users are more likely to report thoughts of suicide than non-users, and in individuals with bipolar disorder, near-daily cannabis users show increased symptoms of the disorder than non-users. (Health Effects of Marijuana and Cannabis-Derived Products Presented in New Report, 2017)

Lastly, the National Drug & Alcohol Research Centre in Sidney also supported similar findings. (Gates, 2016). According to them, there are two main factors associated with cannabis consumption:

1. The age you start consuming, especially before 18 years old

Is There a Link Between Mental Illness and Cannabis Use?

The study mentioned it is a key stage for brain development and can negatively impact synaptic pruning, which they define as ‘when old neural connections are deleted and the white matter development is affected, which is responsible for transmitting signals in the brain.’

1. Consumption pattern

This is about the dosage, duration, and frequency, especially if the user consumes weekly at a minimum. The higher the dose, the more THC (tetrahydrocannabinol, the main psychoactive chemical component in cannabis) is being ingested. They claim it has an impact on certain parts of our brains involving regulating emotions.

Based on the findings compiled from all these articles, not much is concrete evidence and I understand due to the limitations of research. However, they all have a similar consensus and that helps get a basic understanding of the potential issues that can stem from extensive or elongated cannabis use.

My takeaway is to not start until you’re an adult and consume in moderation. If there are underlying mental issues, the user should take precautions and cautiously monitor their intake to avoid making their condition(s) worse.

Is There a Link Between Mental Illness and Cannabis Use?

References

Gates, P. (2016). Does cannabis cause mental illness? | NDARC - National Drug and Alcohol Research Centre. National Drug & Alcohol Research Centre. Retrieved November 13, 2022, from https://ndarc.med.unsw.edu.au/blog/does-cannabis-cause-mental-illness

Health Effects of Marijuana and Cannabis-Derived Products Presented in New Report. (2017, January 12). National Academies. Retrieved November 12, 2022, from https://www.nationalacademies.org/news/2017/01/health-effects-of-marijuana-and-cannabis-derived-products-presented-in-new-report

Is there a link between marijuana use and psychiatric disorders? (2020, July 2). National Institute on Drug Abuse. Retrieved November 12, 2022, from https://nida.nih.gov/publications/research-reports/marijuana/there-link-between-marijuana-use-psychiatric-disorders

The Psychiatric Aspects of Marihuana Intoxication. (2019, January 17). Jama Network Journal. Retrieved November 12, 2022, from https://jamanetwork.com/journals/jama/fullarticle/259597

Reed Ph.D., MPH, M. K. (2022). Professor [Module 3 Lecture]. In The Past.