does pot hurt your liver?

Does pot hurt your liver in the same way alchohol does?? My 22 year old daughter is schuduled to start tx next month in the telaprivir phase III trial. She also has a beach house for the summer. Since summer beach house and 22 year olds have a lot in common with alchohol consumption, she was reluctant to join the trial, but of course she made the right decision and has joined the trial and sworn off alcholol. I am making an  assumption that in leiu of alchohol, she may in fact partake in some reefer madness while at the beach house and I wasn't all that concerned (that doesn't make me sound like Donna Read, but I am a pragmatic women). Then I read in a post from someone who compiled a list of rescue drug interactions and saw the comment that both pot and alchohol could cause liver damage. I had never heard that. Can someone clarify further for me?  Also, if anyone has any words of wisdom for us regarding teleprivri (if she is lucky enough to get it v. the placebo) I would welcome them. I know the effects of peg/ribo treatment already - I am a relapser after 48 wks of tx, but don't know about the teleprivir. Long post, sorry!

[copyman]

some studies show that weed does damage the liver. anything that enters the lungs gets into the bloodstream which of course is filtered through the liver. if she is not ready to give up these things then maybe she should wait to treat until she is ready.

[roostermom]

No, I know she is ready - I just didn't realize that pot was also an issue. She knows she is incredibly lucky to have gotten a seat in this trial, ( 1 in 10 available) and she will do the right thing. I didn't mean to make her sound like some crazy frat girl - just a normal 22 year old at the beach with friends.

[HectorSF]

Hello. Thanks for your post and concern for your daughter and her treatment.

"Patients with chronic hepatitis C (HCV) infection should not use marijuana (cannabis) daily, according to a study published in Clinical Gastroenterology and Hepatology, the official journal of the American Gastroenterological Association (AGA) Institute. Researchers found that HCV patients who used cannabis daily were at significantly higher risk of moderate to severe liver fibrosis, or tissue scarring. Additionally, patients with moderate to heavy alcohol use combined with regular cannabis use experienced an even greater risk of liver fibrosis.
Researchers found a significant association between daily versus non-daily cannabis use and moderate to severe fibrosis when reviewing this factor alone. Other factors contributing to increased fibrosis included age at enrollment, lifetime duration of alcohol use, lifetime duration of moderate to heavy alcohol use and necroinflammatory score (stage of fibrosis). In reviewing combined factors, there was a strong (nearly 7-fold higher risk) and independent relationship between daily cannabis use and moderate to severe fibrosis.
It is of great importance to disease management that physicians understand the factors influencing HCV disease severity, especially those that are potentially modifiable."

Note that this study pertains to patients with co-infection of HCV-HIV! So while cannabis is not good for the liver, it tends to have a greater impact on more health compromised HCV patients and patients who have a history of abusing alcohol and other drugs.

Luckily your daughter is very young and probably has a healthy liver. What does her biopsy indicate? If she is successful with her treatment she will stop any further damage to her liver caused by HCV. And maybe during the process she as many of us have learned to be more gentle on that amazing, life sustaining organ, the liver.

Best of luck to both of you!!!
Let us know how she does on treatment.
Hector

[roostermom]

her liver biopsy is 0-1 and all of her enzymes are normal, so little is any damage. Will keep you posted. Pretty nervous about the start of her tx having been through it myself - I don't have the luxury of ingnorgance is bliss thing going on. Just hope and pray that she gets the teleprivir and tx is only 24 weeks instead of 48. The Doc just put me on the list for the trial for relapsers, but after reading all of the posts this am re: brain fog, I am not sure this will be the right time for me. I always expected to retreat, but I am a bond trader, about to hit menopause, and brain fog wouldn't help, and as a trader I can't work from home which I did for some of the time last time I was on tx. Last time, i worked for 7 months and dropped to 88 lbs and had to stop working for the balance of tx. Company was very supportive, but this is not the same economy and this would be round two, so not so sure how supportive they would be on the second go. Lots to think about.

[HectorSF]

I understand your career edema. tx can be rough! It was for me. You must find the right time in your life to treat. Only you will know when. Just please don't wait until your liver damage becomes stage 4 as it will affect your chances of SVR.

Best of luck to you both!!!
Hector

[roostermom]

thanks for your support. It means a lot.

[desrt]

More important to my point of view is the fact that testing + for illegal drugs could knock her out of the trial. Many doctors require a patient to be 6 months clean and sober before starting treatment. Though it's been shown that daily use and use combined with alcohol can accelerate fibrosis, it's nowhere near as harmful as alcohol.

[working dog]

i've been reading posts and talking to friends a lot over the past 2 years...i don't think a little pot would hurt ..in fact it could help with eating ...i really think polution would be much worse...breathing in stuff...from cars...carpet...cleaning stuff...paint...living in a city..using certain types of soap..taking a shower and breathing in poluted water vapor...or make up...smoking ...and if the pot thing bugs you you can use a vaporizer and that can help...theres just so much out there to watch out for....but to get into a trail you'll most likely have to keep away from it....billy

[fretboard]

If you're daughter is going to be on a clinical trial I don't think it would be a good idea to smoke pot.  They take alot of bloods, since the trials are usually done by a teaching hospital they may check for all kinds of drugs including pot.  Also, because the clinical trial sites all have to follow certain guidelines I'm sure they would check for drugs including pot.  It's ultimately up to your daughter whether or not she smokes pot during the trial period, but if I was in the same position and I smoked pot, which I don't, but I did years ago.  I would abstain from all drugs and alcohol.  It would be very unfortunate to be let go from a clinical trial for smoking a little pot.  Do you know if smoking pot increases the enzyme levels in bloods?  I don't know but it really doesn't matter cause I'm sure if she smokes she will get caught.  I didn't read every post above mine so if I've made an error in my response forgive me.  I just answered the question as honestly as I could with my limited knowledge.  Oh I just noticed that desrt says the same thing.  Well that's ok, as you may need to hear it again.  You don't have to defend smoking pot on this forum as everyone on here is fairly open minded.  Clinical trial sites have to go by guidelines and I doubt if they will debate the pros and cons about smoking pot.  God Bless

[copyman]

Please don't take this wrong and I smoked pot for 25 yrs up until 6 yrs ago so by no means am i an angel. You said: "just a normal 22 year old at the beach with friends" , I do not think smoking pot is "normal" for most 22 yr olds. Just my opinion. And like the others said they will check her blood for drugs & alcohol and will be thrown out of the trial immediately upon testing positive. If she wants to "party" for a few more years until the telaprevir or one of the other new drugs come out then maybe that would be better. Much better then getting thrown out of a trial and perhaps having a resistance to telaprevir when it does come out to the public and not working. Best of luck

[Magnum]

As for ommiting you from clinical trials if you smoke pot. The question then is: If you have a Medical Marijuana Card (as I do), can they still ommit you from the clinical trials?
Anyone?

Magnum

[mikesimon]

I have nothing factual to base this on but my experience with this stuff tells me "yes, they can and will omit you if they see pot on a screen". They want to eliminate every possible extraneous factor/variable and I would bet pot fall into that category. I hope I'm wrong though, if that's what you want to do. Mike

[roostermom]

Thanks so much for the info about checking blood levels and taking chances with smoking pot. I never thought of that angle. You are all right, it would be a shame to get bounced out for something like that. This is a VERY uselful forum. She will be having blood work every week for 4 weeks, then every two weeks. While I now they are checking viral loads blood counts and levels of teleprivir, I don't see why they wouldn't also check for additional chemicals in the blood - so glad I asked!!! I know she will do all that is reguired to get through this and to get the full benefits of the trial. She is well aware that she is one of the lucky few to get a place in this trial. As for  the comment that it is out of the norm for 22 year olds to smoke or drink, I would have to disagree - especially coming from someone who smoked pot for 25 years! I am not judging either, just surprized at the naive notion.

[HectorSF]

Does everyone remember this? Please be careful folks!

SEATTLE - Timothy Garon's face and arms are hauntingly skeletal, but the fluid building up in his abdomen makes the 56-year-old musician look eight months pregnant. His liver, ravaged by hepatitis C, is failing. Without a new one, his doctors tell him, he will be dead in days.

But Garon's been refused a spot on the transplant list, largely because he has used marijuana, even though it was legally approved for medical reasons.

"I'm not angry, I'm not mad, I'm just confused," said Garon, lying in his hospital bed a few minutes after a doctor told him the hospital transplant committee's decision Thursday.

With the scarcity of donated organs, transplant committees like the one at the University of Washington Medical Center use tough standards, including whether the candidate has other serious health problems or is likely to drink or do drugs.

And with cases like Garon's, they also have to consider — as a dozen states now have medical marijuana laws — if using dope with a doctor's blessing should be held against a dying patient in need of a transplant.

Most transplant centers struggle with the how to deal with people who have used marijuana, said Dr. Robert Sade, director of the Institute of Human Values in Health Care at the Medical University of South Carolina.

"Marijuana, unlike alcohol, has no direct effect on the liver. It is however a concern ... in that it's a potential indicator of an addictive personality," Sade said.

The Virginia-based United Network for Organ Sharing, which oversees the nation's transplant system, leaves it to individual hospitals to develop criteria for transplant candidates.

At some, people who use "illicit substances" — including medical marijuana, even in states that allow it — are automatically rejected. At others, such as the UCLA Medical Center, patients are given a chance to reapply if they stay clean for six months. Marijuana is illegal under federal law.

Trusting 'to do the right thing'
Garon believes he got hepatitis by sharing needles with "speed freaks" as a teenager. In recent years, he said, pot has been the only drug he's used. In December, he was arrested for growing marijuana.

Garon, who has been hospitalized or in hospice care for two months straight, said he turned to the university hospital after Seattle's Harborview Medical Center told him he needed six months of abstinence.

The university also denied him, but said it would reconsider if he enrolled in a 60-day drug-treatment program. This week, at the urging of Garon's lawyer, the university's transplant team reconsidered anyway, but it stuck to its decision.

Dr. Brad Roter, the Seattle physician who authorized Garon's pot use for nausea, abdominal pain and to stimulate his appetite, said he did not know it would be such a hurdle if Garon were to need a transplant.

That's typically the case, said Peggy Stewart, a clinical social worker on the liver transplant team at UCLA who has researched the issue. "There needs to be some kind of national eligibility criteria," she said.

The patients "are trusting their physician to do the right thing. The physician prescribes marijuana, they take the marijuana, and they are shocked that this is now the end result," she said.

No one tracks how many patients are denied transplants over medical marijuana use.

Proof of abstinence
Pro-marijuana groups have cited a handful of cases, including at least two patient deaths, in Oregon and California, since the mid-to-late 1990s, when states began adopting medical marijuana laws.

Many doctors agree that using marijuana — smoking it, especially — is out of the question post-transplant.

The drugs patients take to help their bodies accept a new organ increase the risk of aspergillosis, a frequently fatal infection caused by a common mold found in marijuana and tobacco.

But there's little information on whether using marijuana is a problem before the transplant, said Dr. Emily Blumberg, an infectious disease specialist who works with transplant patients at the University of Pennsylvania Hospital.

Further complicating matters, Blumberg said, is that some insurers require proof of abstinence, such as drug tests, before they'll agree to pay for transplants.

Dr. Jorge Reyes, a liver transplant surgeon at the UW Medical Center, said that while medical marijuana use isn't in itself a sign of substance abuse, it must be evaluated in the context of each patient.

"The concern is that patients who have been using it will not be able to stop," Reyes said.

'Least habit-forming'
Dale Gieringer, state coordinator for the California chapter of NORML, the National Organization for the Reform of Marijuana Laws, scoffed at that notion.

"Everyone agrees that marijuana is the least habit-forming of all the recreational drugs, including alcohol," Gieringer said. "And unlike a lot of prescription medications, it's nontoxic to the liver."

Reyes and other UW officials declined to discuss Garon's case.

But Reyes said that in addition to medical concerns, transplant committees — which often include surgeons, social workers, and nutritionists — must evaluate whether patients have the support and psychiatric health to cope with a complex post-operative regimen for the rest of their lives.

Garon, the lead singer for Nearly Dan, a Steely Dan cover-band, remains charged with manufacturing weed. He insists he was following the state law, which limits patients to a "60-day supply" but doesn't define that amount.

"He's just a fantastic musician, and he's a great guy," said his girlfriend, Liesa Bueno. "I wish there was something we could do legally. ... I'm going to miss him terribly if he passes."

-----------------------------------------------------------------------------------------------------------
updated 12:17 p.m. PT, Fri., May. 2, 2008
SEATTLE - A man who was denied a liver transplant largely because he used marijuana with medical approval to ease the symptoms of hepatitis C has died.

Timothy Garon, 56, died Thursday at Bailey-Boushay House, an intensive care nursing center, said his lawyer, Douglas Hiatt, and Alisha Mark, a spokeswoman for Virginia Mason Medical Center, which operates Bailey-Boushay.

His death came a week after a doctor told him a University of Washington Medical Center committee had again denied him a spot on the liver transplant list. The team had previously told him it would not consider placing him on the list until he completed a 60-day drug-treatment class.

The case highlights an ethical consideration for those allocating organs for transplant: whether using dope with a doctor's blessing should be held against a dying patient in need of a transplant.

The Virginia-based United Network for Organ Sharing, which oversees the nation's transplant system, leaves it to individual hospitals to develop criteria for transplant candidates.

At some, people who use "illicit substances" — including medical marijuana, even in the dozen states that allow it — are automatically rejected. At others, patients are given a chance to reapply if they stay clean for six months. Marijuana is illegal under federal law.

Dr. Brad Roter, who authorized Garon to smoke pot to alleviate nausea and abdominal pain and to stimulate his appetite, said he did not know it would be such a hurdle if Garon were to need a transplant.

Garon told The Associated Press last week he believed he contracted hepatitis C by sharing needles with "speed freaks" as a teenager. In recent years, he said, pot was been the only drug he used.


Hector

[Trish77]

I'm in a clinical trial and they're pretty sticky about what things you're allowed to take while on the trial.  

Aside from that, treatment, whether 24 or 48 weeks, is a big commitment.  You have to understand what you're potentially giving up and nevermind being at the beach for the summer and missing out on alcohol, she could be nauseated, anemic and super fatigued and she may get tired of not being able to fully participate with her friends, let alone take a few tokes here and there.  I think you're asking for you, not her ... so you know what to do the "parent" thing about .. I would be even more concerned that she's fully totally committed to ANYTHING that could come along.  She's early stage liver damage and she's 22.  She could wait.  If she's truly not ready for this, she should.

With regards to pot .. this is my own opinion.  I'd give it up completely while on a clinical trial and I wouldn't smoke it with Hep C UNLESS it helped me deal with either the issues arising from my Hep C, other health situations I have or if it helped me tolerate the side effects that come with treatment, whether it be the nausea, the depression or what have you, if it made the difference on how successfully I got through treatment or if I got through it at all.

While yes, progression of fibrosis is increased for co-infected (HIV and HCV) persons who smoke pot, and yes, progression of fibrosis is increased the more you smoke pot... smoking pot itself is not harmless to the liver.  Where smoking pot fits in is that the occasional "hit" while on treatment or otherwise is offset by the medicinal benefits of it.  So it's a balance.  

In your daughter's case it's purely recreational and I'd cut it out entirely while on treatment and especially while in a clinical trial.  She wants her very best shot possible.  The odd hit here and there with a friend will not harm her that much if she's not in treatment but I'd still use it very sparingly.  I had the odd drink while not on treatment, but very sparingly there as well.

btw.. I have  22 year old son (and a 23 and 24 year old daughter, none of which live at home). I'm not naive either and while I don't like it much, I know he smokes pot with his friends.  I think it might be happening among that age group a little more than parents would like to think it is.

Best of luck to you and your daughter.

[copyman]

sorry you think most 22 yr olds smoke pot. it is not true.  If i was to guess i would say maybe 10%. Now drinking is a different story, i would say is the norm.

[Trish77]

I don't think most 22 year olds smoke pot. I'm just saying I think it happens more than parents think it does.  I would never have guessed my 22 year old son would EVER have smoked pot...but, there it was one day.  I don't condone it, he knows it..but he lives away from home and I trust him to have good judgment about it based on how he's managing his life. He is excelling in his university studies, his co-op placements every four months which he has received three "Outstanding" ratings out of four placements and his extra-curricular activities as a member of the student engineering executive and other activities on top of a gruelling study load.  I'm not bragging on him,  I'm defending him.  I'm thinking I don't have a pothead on my hands... I have a son who has toked on occasion and probably a "social smoker" even though I wished otherwise.  

[hepcjim]

I have cirrhosis and have smoked pot for years My blood counts seem to be getting better in the last couple of years. Because of that I have to think the pot is not doing any damage at least right now. I think the spikes I stuck my self with back in the late 60 ies were far worse.  Thanks Hepcjim

[fretboard]

"As for ommiting you from clinical trials if you smoke pot. The question then is: If you have a Medical Marijuana Card (as I do), can they still ommit you from the clinical trials"?  Anyone?  
Yes they can, I'm sure that they would ask you to stop a month or two prior to getting on, if they knew you smoked pot ahead of time.  My guess is your medical marijuana card is only as good as the State it's written on.  All clinical trials are federal in nature as there is a ton of oversight done by the fda.  Both directly and afterwards to gain approval of the trial drug.  Until the feds agree with California or other States' laws those cards are only half good, sure if I needed medical marijuana I would have one, but the truth is that those little clinics that the feds keep closing down charge way too much for their pot.  The federal government and State government would be doing everyone a big favor to legalize and tax marijuana.  Until the feds grow up and smell the pot we're all losing.  People who smoke and people like me who don't.  Feel it would save a ton of money to legalize not only pot, but other drugs as well.  The prison system is killing us financially and it doesn't even begin to help the sentenced prisoners with their drug or alcohol addictions.  Locking someone up for drugs (as a posession charge only) is plain ignorant and a waste of, this taxpayers money.  God Bless

[meki]

"More important to my point of view is the fact that testing + for illegal drugs could knock her out of the trial. Many doctors require a patient to be 6 months clean and sober before starting treatment."


That's exactly my thoughts --- why chance being kicked out of the one chance she might have to clear???

Meki
Ps. Much luck!

[Dot.Calm]

I would be more concerned about mold and the damaging effects it has on ones liver & health than cannabis itself. Pot plants are notorious breeders of mold.

[merryBe]

recent studies show absent all other factors that cannibinol increases fibrosis to an average of 7x the normal rate in HCV patients.

that means, in one year the average patient will lose to fibrosis 7 times less liver tissue than the pot smoker.

the pot smoker will in one year have a liver with 7 years damage,and 7 yrs. closer to failing..
2 years smoking pot = 14 years damage
3 years smoking pot= 21 years fibrotic damage and closer to liver failure..

in other words what is normally a 40 year process, from contracting HCV to end stage...is shortened for pot smokers, and drinkers, to as little as 5-10 years.
not good odds.

I guess the question is.....how long do you want to have a functioning liver??

mb

[Mr Liver]

36 yrs smoking pot with hcv = 252 yrs damage
Question: Would this be in people years ?
Mr Liver

[Marcia2202]

Was just wondering, if that corresponds to every day pot smoking or to a joint once in a while? Haven't smoked pot since the 80ies, and am definitely not intending to do so again. Just curious.

Marcia

[desrt]

Please quote the reference for your 7x figure. Almost 30 years living with the virus, aprox half that time as a smoker and my liver showed minimal fibrosis in 2001. I guess this means I have the liver of a 142 year old. Please don't post something like this without giving a reference.

[merryBe]

your man sir is noted, it must depend on the strength of the pot, the amount used, and the degree to which the virus has advanced has undoubtedly got a part to play..

in other words the further in stage, or higher the VL, then also, my guess, is the greater the fibrotic effect...of course some of this may be reversed in those still making enough HGH to heal right, so 7x the acceleration is an average only.

the reason I put some stock in the study is because they ruled out the common mitigating factors, such as NASH ETC.

[merryBe]

until you get to a certain stage of this disease, your body may be able to keep up with reversals of damage.  Example: say you are very athletic, you may produce more HGH than average, in this case your liver may turn over every cell in one years time...

the average time for entire organ turnover is 1 1/2 years...meaning the liver is an amazing healer as long as the pituitary and bone marrow do their jobs.

However at some point the rate of damage is going to far exceed the rate of repair an aging body can perform at...and at that point the downhill curve can be quite steep.
Example: even in non HCV female drinkers the curve from stage one to stage 3 looks snail paced compared to the time it takes to go from stage 3 to 4, assuming alcohol consumption continues. .

the pot study has been posted in here 15 times..as you well know...
I'll post it again, but I serious doubt the pot smokers will really lend it any credence.
the fact that some folks want to ignore the research, doesn't mean the research isn't valid,
remember that.
mb.

[merryBe]

Marijuana Increases Risk of Hepatitis C-Related Liver Damage
02/03/2008
BETHESDA, Md. – Patients with chronic hepatitis C virus (HCV) infection should not use marijuana (cannabis) daily, according to a study published in Clinical Gastroenterology and Hepatology, the official journal of the American Gastroenterological Association (AGA) Institute. Researchers found that HCV patients who used cannabis daily were at significantly higher risk of moderate to severe liver fibrosis, or tissue scarring. Additionally, patients with moderate to heavy alcohol use combined with regular cannabis use experienced an even greater risk of liver fibrosis. The recommendation to avoid cannabis is especially important in patients who are coinfected with HCV/HIV, since the progression of fibrosis is already greater in these patients.

"Hepatitis C is a major public health concern and the number of patients developing complications of chronic disease is on the rise," according to Norah Terrault, MD, MPH, from the University of California, San Francisco, and lead investigator of the study. "It is essential that we identify risk factors that can be modified to prevent and/or lessen the progression of HCV to fibrosis, cirrhosis and even liver cancer. These complications of chronic HCV infection will significantly contribute to the overall burden of liver disease in the U.S. and will continue to increase in the next decade."

This is the first study that evaluates the relationship between alcohol and cannabis use in patients with HCV and those coinfected with HCV/HIV. It is of great importance to disease management that physicians understand the factors influencing HCV disease severity, especially those that are potentially modifiable. The use and abuse of both alcohol and marijuana together is not an uncommon behavior. Also, individuals who are moderate and heavy users of alcohol may use cannabis as a substitute to reduce their alcohol intake, especially after receiving a diagnosis like HCV, which affects their liver.

Researchers found a significant association between daily versus non-daily cannabis use and moderate to severe fibrosis when reviewing this factor alone. Other factors contributing to increased fibrosis included age at enrollment, lifetime duration of alcohol use, lifetime duration of moderate to heavy alcohol use and necroinflammatory score (stage of fibrosis). In reviewing combined factors, there was a strong (nearly seven-fold higher risk) and independent relationship between daily cannabis use and moderate to severe fibrosis. Gender, race, body mass index, HCV viral load and genotype, HIV coinfection, source of HCV infection, and biopsy length were not significantly associated with moderate to severe fibrosis.

Of the 328 patients screened for the study, 204 patients were included in the analysis. The baseline characteristics of those included in the study were similar to those excluded with the exception of daily cannabis use (13.7 percent of those studied used cannabis daily versus 6.45 percent of those not included). Patients who used cannabis daily had a significantly lower body mass index than non-daily users (25.2 versus 26.4), were more likely to be using medically prescribed cannabis (57.1 percent versus 8.79 percent), and more likely to have HIV coinfection (39.3 percent versus 18.2 percent).

The prevalence of cannabis use amongst adults in the U.S. is estimated to be almost 4 percent. Regular use has increased in certain population subgroups, including those aged 18 to 29.

Source: American Gastroenterological Association

[merryBe]

Influence of cannabis use on severity of hepatitis C disease.Ishida JH, Peters MG, Jin C, Louie K, Tan V, Bacchetti P, Terrault NA.
Department of Medicine, University of California at San Francisco, San Francisco, California, USA.

BACKGROUND & AIMS: Complications of HCV infection are primarily related to the development of advanced fibrosis and whether cannabis use is a risk factor for more severe fibrosis is controversial. METHODS: Baseline data from a prospective cohort study of 204 persons with chronic HCV infection were used for analysis. The outcome was fibrosis score on biopsy, and the primary predictor evaluated was daily cannabis use. RESULTS: The median age of the cohort was 46.8 years, 69.1% were male, 49.0% were white, and the presumed route of infection was injection drug use in 70.1%. The median lifetime duration and average daily use of alcohol were 29.1 years and 1.94 drink equivalents per day, respectively. Cannabis use frequency (within prior 12 months) was daily in 13.7%, occasional in 45.1%, and never in 41.2%. Fibrosis stage, assessed by the Ishak method, was F0, F1-2, and F3-6 in 27.5%, 55.4%, and 17.2% of subjects, respectively. Daily compared with non-daily cannabis use was significantly associated with moderate to severe fibrosis (F3-6 vs F1-2) in univariate (odds ratio [OR], 3.21; 95% confidence interval [CI], 1.20-8.56, P = .020) and multivariate analyses (OR, 6.78; 95% CI, 1.89-24.31, P = .003). Other independent predictors of F3-6 were >or=11 portal tracts (compared with <5, OR, 6.92; 95% CI, 1.34-35.7, P = .021) and lifetime duration of moderate to heavy alcohol use (OR per decade, 1.72; 95% CI, 1.02-2.90, P = .044). CONCLUSIONS: Daily cannabis use is strongly associated with moderate to severe fibrosis, and HCV-infected individuals should be counseled to reduce or abstain from cannabis use.

[merryBe]

Gastroenterology. 2008 Feb;134(2):622-5.
Daily cannabis use: a novel risk factor of steatosis severity in patients with chronic hepatitis C.Hézode C, Zafrani ES, Roudot-Thoraval F, Costentin C, Hessami A, Bouvier-Alias M, Medkour F, Pawlostky JM, Lotersztajn S, Mallat A.
Department of Hepatology and Gastroenterology, Groupe Hospitalier Henri Mondor-Albert Chenevier, Créteil, France.

BACKGROUND & AIMS: Steatosis is highly prevalent in patients with chronic hepatitis C (CHC) and has been reported to increase fibrosis and reduce the rate of viral eradication. Two recent studies indicate that endocannabinoids promote experimental steatosis via activation of hepatic CB1 receptors. We therefore investigated the impact of cannabis smoking on steatosis severity during CHC. METHODS: A total of 315 consecutive patients with untreated CHC undergoing liver biopsy were included. Detailed histories of recent cannabis, alcohol, and tobacco use were recorded. Steatosis, activity, and fibrosis stage were assessed by 2 pathologists according to METAVIR. Marked steatosis was defined as >/=30%. Patients were categorized as cannabis nonusers (63.5%), occasional cannabis smokers (12.4%), or daily cannabis smokers (24.1%). RESULTS: Multivariate analysis identified 6 predictors of marked steatosis: daily cannabis use (odds ratio [OR], 2.1; 95% confidence interval [CI], 1.01-4.5]), activity grade >/=A2 (OR, 2.1; 95% CI, 1.0-4.3), genotype 3 (OR, 5.4; 95% CI, 2.6-11.3), hyperglycemia or diabetes (OR, 5.1; 95% CI, 1.8-15.0), body mass index >27 kg/m(2) (OR, 2.1; 95% CI, 1.0-4.3), and serum HCV RNA load (OR, 1.7; 95% CI, 1.0-2.9). Upon adjustment of HCV genotype (3 vs non-3) or alcohol intake (/=30 g/day), marked steatosis was more frequent in daily cannabis users compared with occasional users and nonusers (P = .03 and P = .008, respectively). CONCLUSIONS: Our results identify daily cannabis smoking as a novel independent predictor of steatosis severity during CHC and strongly argue for a steatogenic role of the cannabinoid system. Cannabis use should be discouraged in patients with CHC.

[Trish77]

merryBe:  You keep saying that pot use increases fibrosis 7x but you don't qualify that.  That's for daily use.  The poster who asked this question was asking what's the damage to a young woman who might take the occasional hit with friends.  Your answer is misleading to answer the poster's question by saying her daughter's fibrosis would increase by 7X.

Indeed, unless every person who's asking that question is a daily pot smoker, and we haven't qualified yet if that's one joint (don't know the current vernacular for that) a day or more, then your stock answer of 7X increase to fibrosis for ANYONE who smokes pot continues to be misleading.

Based on the study you posted, which I also posted the last time you gave this 7X answer without qualifying it, you should be answering that question from now on by saying that studies show that fibrosis increases by 7X for daily pot smokers.

Despite this study, doctors continue to condone the use of medical marijuana for persons on treatment for HCV to help them deal with the side effects when that is the most effective means of dealing with the side effects. Even the study you're quoting here stops short of recommending that pot be avoided .. it only goes as far as saying persons with HCV should reduce pot usage or abstain.  

[desrt]

Thank you for posting these so that those with an interest can see where you misquoted/misinterpreted results. Especially interesting is the study with 7x figure - daily use and use with alcohol - things already covered in this thread.
And almost 40% of the study subjects coinfected with HIV - that never skewed the results of any study.

[meNtoby]

I would counsel any pot smoker that if they are involved in an injury accident, in some states, parties can be drug tested now and charged as driving under the influence.  In Kansas I believe this to be true, although, for arguments sake you could say, injury accident regarding a fatallity.  Either way, a tragedy for the victim's family who pushed for this law. And not good for the conscience of a 20 something, let alone their resume. Laws don't discriminate between a 21 year old having a first experience, an innocent puff so to speak, and an experienced pot smoker who believes he can handle driving to the mini-mart.  Perhaps if it were legal like alcohol, they would be concerned about levels of intoxication, but since pot is illegal, they didn't have to.  I imagine the defendant's lawyer in a civil law suit afterward would push that issue, but the money, and disaster to families only mounts.

[meNtoby]

Only got away from the subject a little, as your daughter would probably be dropped from a clinical trial were she to be in jail.  But I'm doubting her beach house is in Kansas...just wanted to give you something to possibly help dissuade her use.  :-)

[merryBe]

the point of telling someone they are misquoting a study is to read it first..

the whole point trish was that daily use was factored in, etc.....but HIV and other factors had no similar effect.

read the paragraph again

both pot smokers alone and in combo with alcohol were studied...

the two following studies strongly discourage use, and if I pull up ten more...someone will still say it's all wrong, regardless.

I made my points.

Researchers found a significant association between DAILY versus non-daily cannabis use and moderate to severe fibrosis when reviewing this factor alone. Other factors contributing to increased fibrosis included age at enrollment, lifetime duration of alcohol use, lifetime duration of moderate to heavy alcohol use and necroinflammatory score (stage of fibrosis). In reviewing combined factors, there was a strong (nearly seven-fold higher risk) and independent relationship between daily cannabis use and moderate to severe fibrosis.
Gender, race, body mass index, HCV viral load and genotype, HIV coinfection, source of HCV infection, and biopsy length were NOT significantly associated with moderate to severe fibrosis

in other words, daily use, not other factors was causing the fibrosis to increase 7 fold.

I'd suggest you read the piece through and then write the researchers and ask them what they mean by this...seems clear enough  to me...

[Trish77]

merryBe...your original post was as follows:

"recent studies show absent all other factors that cannibinol increases fibrosis to an average of 7x the normal rate in HCV patients.

that means, in one year the average patient will lose to fibrosis 7 times less liver tissue than the pot smoker.

the pot smoker will in one year have a liver with 7 years damage,and 7 yrs. closer to failing..
2 years smoking pot = 14 years damage
3 years smoking pot= 21 years fibrotic damage and closer to liver failure.. "

Not once in the comment above do you mention daily usage as being the criteria that 7X figure is based upon.   Obviously that was unclear to others as you were subsequently asked if that meant daily or occasional use.

I have not said a WORD about HIV or alcohol being an influence.  I'm actually well aware of the impact of co-infection and/or alcohol along with DAILY pot use leading to increased fibrosis MORE than the 7X figure which is attributed SOLELY to DAILY pot use.

MY comment was directed at the fact that you leave out the criteria that 7X figure is based upon and skew it by simply saying that pot use increases fibrosis 7X.  Well pot use in and of itself does NOT increase fibrosis by 7X.  DAILY pot use does.  Neither in this thread nor in the last one do you clarify your 7X figure with the qualifier of "daily pot use".

I stand by my comment to you that your original post is misleading without including the criteria of "daily use" that goes with the 7X figure...which you did not include in this thread nor in the other thread.  The study you subsequently posted only further reinforces that your original post was misleading.

Trish

[Fl_Gator]

I am also enrolled in the Phase 3 trials here in Florida. I would love to be able to compare notes on my way through...although I am twice your daughters age and probably twice her weight. I have only met one other study patient here. I will start taking the meds in mid June. Please let me know if you would be willing to stay in touch.

Please urge your daughter to quit...the study is so much more important. I also have children close in age to your daughter. I can safely say that neither of them smokes pot. My youngest quit after a drug test threatened to exclude her from an internship that she dearly wanted. The oldest is a computer geek and has tried it but doesn't really care for the buzz. They both drink but they do it responsibly. I feel fortunate that they are as mature as they are. I wish I had been as responsible when I was there age.


Fl Gator

[lile1223]

24 yr old female here.  finished treatment in march...successful so far.  daily pot smoker-multiple joints a day sometimes-never had fibrosis.  smoking definitely helped with appetite but sure didn't help with depression.  never told my doctors but i think they knew anyway because of certain liver enzymes.  i don't know about trials, but they can't legally test for drugs without permisson.  when i became anemic smoking pot only made me feel worse.  if your daughter is going to smoke more than a joint once in a while i highly suggest investing in a vaporizer because it does a lot less damage to the lungs and mouth.  i was dehydrated enough as it was but i believe smoking caused extreme dryness in and around my mouth to the point that it was painful to eat.  i wish her much luck in her summer beach house plans.  i took me a long time to feel comfortable around my drunk college friends especially while on tx.