Coronavirus and Cannabis by David Bearman, MD

   The question that is being asked today is this: is cannabis helpful or harmful in this coronavirus pandemic circumstance? The answer is, no one knows. We are at a disadvantage because of both the lack of research on the coronavirus and the long, sad history of the federal government systematically blocking research on cannabis. We must mainly rely on common knowledge, conventional wisdom, common sense, as well as any lessons that may come from looking at previous epidemics and pandemics in the twentieth century.

  We are navigating uncharted waters when it comes to cannabis and COVID-19, but this is not the first time we have had a viral pandemic with the ready availability of cannabis. Cannabis was also widely available at the time of the 1918 Spanish Flu Pandemic. At that time doctors wrote two to three million cannabis-containing prescriptions per year, and there were over 25 cannabis-containing patented medicines which were available over the counter. Evidence that this did not cause alarm amongst organized medicine is demonstrated by the American Medical Association (AMA) testimony to the House Ways and Means Committee by the AMA Chief Legal Counsel, William C. Woodward, a doctor, attorney, and past president of the American Public Health Association, against the 1937 Marijuana Tax Act. He testified that “the AMA knows of no dangers from the medicinal use of cannabis”.

Respiratory vs Oral Route.

 The coronavirus has airborne transmission and specifically affects the respiratory system, therefore we need to keep our respiratory systems as healthy as possible. In this regard, cannabis provides some pluses and minuses. 

1. When smoked, cannabis can cause increased bronchial irritation and an increase in sputum production. Cannabis is also anti-inflammatory, and if taken orally it may decrease pulmonary  secretions associated with inflammation. 
2.  Furthermore, some cannabinoids are anti-viral, so it's arguable, but unproven, that this antiviral property may be beneficial in fighting Covid 19.

 Bottom line:

 If you're going to use cannabis during this pandemic COVID-19 , don’t smoke it. If you prefer or rely on the respiratory route of administration, opt for a vaporizing device, such as the Volcano. Avoid the use of vaporizer pens and cartridges. Better yet, replace the respiratory route with the oral route. The oral route circumvents sputum production and bronchial irritation, yet retains the anti-microbial and anti-inflammatory effects of cannabis.

Cannabinoids

 Cannabis is an effective anti-inflammatory agent, and it may down-regulate the immune system. It is most likely CBD - not THC - which affects the CB2 receptors and down-regulates the immune system. The immune system is very complicated and the Endocannabinoid System (ECS) plays a role along with prostaglandins and various cellular components. As recent warnings have come out cautioning against using steroids, NSAIDs, and other anti-inflammatory agents, one has to ask if cannabis use, with its CBD and other anti inflammatory terpenes is helpful, harmful, or maybe both depending on the dose & composition.

 Dr. Donald Abrams of University of California San Francisco (UCSF) School of Medicine performed a National Institute of Drug Abuse (NIDA)-funded Safety study on HIV/AIDS patients using both cannabis and THC. His findings were that cannabis was safe to use in the care and treatment of patients with the immune depressing disease, HIV/AIDS. So while this finding is reassuring, there is little that be definitively said about cannabis and the coronavirus.

Dr. Barry Mennen adds a cautioning note he says “Although no clinical trials exist showing poorer outcomes in patients infected with COVID-19 who use therapeutic or recreational cannabis, the data from pre-human studies” suggests caution. He was commenting on studies where THC was administered to mice with influenza. He saw an increase in viral loads and a decrease in the immune system to fight off the virus. This worry may be overblown, as Dr. Abrams’ research with cannabinoids and HIV/AIDS showed no increase in infection risk with cannabis despite the immune system being compromised by that HIV virus. In dealing with COVID-19 we are dealing with something new, a novel entity with very little data and therein lies the issue.

Terpenes

 Terpenes, the molecules that create the scent of cannabis, also play a role in helping strengthen the immune system. Some immune-boosting terpenes that are found in cannabis & our food are: beta-caryophyllene (black pepper, holy basil), linalool (lavender), limonene (citrus), myrcene (mango, lemongrass) and alpha-pinene (rosemary, basil).  

 Conclusion

 These are challenging times, made ever more challenging due to the White House disbanding the Pandemic Response Unit in 2018, and downplaying the seriousness of this pandemic. We are left to our own devices to discern the best way to protect our community, our families, and ourselves. To use or not to use cannabis is one of the lesser matters to be concerned about. Stay home, wash your hands, keep social distances; this is a time for unity and civility, not hysteria. If you decide that your medical use of cannabis is necessary, the oral route (ie: edibles, tinctures, juice, and oils) avoids the sputum production and bronchial irritation of smoking, yet retains the anti-microbial and anti-inflammatory effects. Stay well.

Best Practices for Cannabis Use During COVID-19

• Avoid ingestion by Inhalation if possible. Smoking & Vape pens are discouraged. Vaporized cannabis is the best method, if required.
• Oral ingestion (edibles, tinctures, oils) is suggested.