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Regular marijuana use increases risk of Hep C related liver damage

Dec 19, 2012 - 8 comments

hep c


liver damage


regular marijuana use

Thank you to mikesimon for sharing this article.  I am posting it in my journal for reference.

Regular marijuana use increases risk of hepatitis C-related liver damage
Posted on August 30, 2012

Bethesda, MD (Jan. 28, 2008) – 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. 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 7-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.

Hepatitis is an inflammation of the liver. Hepatitis C is the most common form of hepatitis and infects nearly 4 million people in the U.S., with an estimated 150,000 new cases diagnosed each year. While it can be spread through blood transfusions and contaminated needles, for a substantial number of patients, the cause is unknown. This form of viral hepatitis may lead to cirrhosis, or scarring, of the liver. Coinfection of hepatitis C in patients who are HIV positive is common; about one quarter of patients infected with HIV are infected with hepatitis C. The majority of these patients, 50 to 90 percent, were infected through injection drug use. Hepatitis C ranks with alcohol abuse as the most common cause of chronic liver disease and leads to about 1,000 liver transplants yearly in the U.S.

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4043517 tn?1374006573
by mckansas, Dec 20, 2012
I seriously doubt marijuana is on par with alcohol in ANY way. Sounds like propaganda to keep cannabis down since scientist keep discovering new uses for marijuana. I will stand by my thought of smoking as what has kept me so healthy since 1974 when I got it. I do not drink, except my damn bourbon balls at Christmas, I could care less about. Alcohol is bad for you, not weed. PROPAGANDA

Avatar universal
by jules2551, Dec 20, 2012
McKansas - "I will stand by my thought of smoking as what has kept me so healthy since 1974 when I got it."

From reading your journals and status updates you don't sound very healthy to me.  This study was published by the Clinical Gastroenology and Hepatology and they are just reporting their findings.  There is a reason we read all of these studies and gather information so we can make informed and educated choices.

"I seriously doubt marijuana is on par with alcohol in ANY way".  You might want to re-read the article Advocate posted (Mike Simon).  

"PROPAGANDA" Not hardly.  This article evaluates the relationship between alcohol/marijuana use and fibrosis staging.  Plus several other factors are involved so it is not propaganda against marijuana.  

As for myself, I do not smoke marijuana or drink alcohol.  I was able to gather information from this forum and other trusted sights and make an educated choice.  I would like to rid myself of Hep C, hopefully, and not advance to cirrhosis.  And I sure as hell don't want to end up on the transplant list.  

So I hope you can gather more information and make educated decisions.  Life is too short!


Avatar universal
by Advocate1955, Dec 20, 2012
I try to post information on my journals that includes research studies that I find interesting and I hope others will find interesting and help them make informed decisions as well.

I had never heard before that smoking marijuana can actually increase liver damage.  The first that I heard that was specifically from a transplant hepatologist in a liver transplant center in a university based medical center.  
Then mikesimon posted this article, I found it informative, and as I said above, I posted it in my journal for reference.

Personally, if I had any type of hepatitis, I would not choose to do anything that might increase liver damage.  Secondly, if I had advanced Cirrhosis, End Stage Liver Disease, and/or my liver were failing, I would not choose to do anything that would risk causing my liver to fail or that would cause me to be rejected as a candidate for a liver transplant.


163305 tn?1333668571
by orphanedhawk, Dec 20, 2012
I heard of one study that was disputed because all the participants were heavy drinkers, some use pot as well, others did not.
Since this study came out sometime around 2008, I can't  help but wonder if this is not the same study.

Doctors in California have wanted to have mj legal for further research. Good unbiased research is sorely lacking.

One big factor left out of the study was whether there is a difference between smoking it, using a vaporizer, tinctures or edibles.
As whatever we breath, like what we eat is filtered through out liver, it makes sense to me that the smoke itself, from whatever substance, could be damaging to those with an already impaired liver.Just as polluted air is as well.

A better option for people with  liver problems would probably be to either use a good vaporizer, tincture or edible.

163305 tn?1333668571
by orphanedhawk, Dec 20, 2012
Another link to check out:

875426 tn?1325528416
by LivingInHope, Dec 20, 2012
@orphanedhawk:  According to Cannabis Culture Marijuana Magazine, edible marijuana is porcessed through the liver.  The National Cancer Institute says that when marijuana is ingested by mouth, such as with tea or products baked, liver processing occurs.  So, since the chemicals in marijuana are processed by the liver and it is a federally illegal drug, these are two very good reasons for anyone with liver problems to not use marijuana at all.

163305 tn?1333668571
by orphanedhawk, Dec 20, 2012

All our food is processed through the liver.
Everything you eat is made chemicals.

It's illegality ( in most states) has nothing to do with whether it is healthy or not.
( Too much tylenol can kill you yet anyone can buy it including kids.)
Doctors in California have petitioned to have pot legalized for research purposes. There simply is not enough unbiased research to make a blank statement about pot's effects. I can find more claiming it helps than harms.

I ate cannabis  brownies during hep C tx, which my medical team approved of,to relieve my back pain and I am now hep C free.

People have had emergency liver transplants due to taking tylenol..
Nobody has ever died from marijuana or needed a transplant from using too much pot. They might have fallen asleep:)
*                         *                         *

Hepatitis C - The Silent Killer - Can Medical Cannabis Help?

        The short answer is yes.
The primary role of cannabis is to stimulate appetite, reduce nausea and vomiting, and treat joint pain.
This role is applicable to HCV patients undergoing chemotherapy, those with cancer or cirrhosis, and those with joint pain and headache. Cannabis is far less toxic than other medications that might be prescribed for these conditions and where liver impairment is concerned, it is vital to avoid toxicity. Cannabis may help alleviate the depression often produced by chronic illness and by combination drug therapy. Additionally, cannabis based food products may provide needed extra nutrition without taxing the liver. Using cannabis in place of alcohol is an established harm reduction technique particularly important when liver disease is present.

        Perhaps more important but still unknown is the possibility that some of the chemical components of cannabis (the Cannabinoids) may actually reduce liver inflammation and slow the progression of both cirrhosis and Hepatocellular carcinoma. The cannabinoids have been shown to be powerful anti-inflammatories and anti-oxidants. They have also been shown to have anti-neoplastic activity, at least in gliomas (a form of brain cancer). Cannabinoids both slow programmed cell death (apoptosis) in normal cells while accelerating apoptosis in cancer cells.

        Since cannabis is nontoxic it might as well be tried, particularly in patients who have chronic progressive disease that is likely to result in death. Dosing is up to the physician and patient. Usually patients "self-titrate" or use only what they feel they need for symptomatic relief. This may be a mistake as the protective effects of cannabis are best achieved with a steady state minimal blood level of Cannabinoids. It is recommended that a base line level of Cannabinoids be maintained with regular doses of oral cannabis products and the smoked or vaporized form of cannabis used for acute symptomatic relief.

excerpts from Jay R. Cavanaugh, PhD

        Cannabis is not hepatotoxic. You can use cannabis to treat the symptoms of hepatitis C without affecting its course. Many people who have this problem use cannabis to get symptomatic relief. - Lester Grinspoon MD

        ... Patients with even mild cases of Hepatitis C often experience nonspecific and intermittent symptoms such as nausea and vomiting, poor appetite, fatigue, depression, muscle and joint pains, weight loss, and mild right-upper-quadrant discomfort or tenderness. These symptoms may become more pronounced and chronic as the disease progresses....

Avatar universal
by Haileyscomet42, Dec 16, 2013
Cannabis – Improved Treatment Response In Hepatitis C Patients
March 25, 2013 By Truth Seeker Leave a Comment
Moderate Cannabis Use Associated with Improved Treatment Response in Hepatitis C Patients on Methadone

By Liz Highleyman

Interferon-based therapy for chronic hepatitis C virus (HCV) infection is often limited by side effects including flu-like symptoms, fatigue, insomnia, loss of appetite, nausea, muscle and joint pain, and depression, which can lead to poor adherence, dose reduction, or treatment discontinuation.

Medicinal cannabis may relieve such side effects and help patients stay on treatment, according to a study published in the October 2006 European Journal of Gastroenterology and Hepatology.

Several studies – as well as ample anecdotal evidence – have demonstrated that medical marijuana can reduce nausea, increase appetite, and improve wasting in people with HIV.

Diana Sylvestre, MD, of the University of California at San Francisco and colleagues conducted a study to define the impact of cannabis use during HCV treatment. The prospective observational study included 71 patients at OASIS (Organization to Achieve Solutions in Substance Abuse), a community-based clinic providing medical and psychiatric treatment to substance users in Oakland, California.

Patient Demographics

Eligible participants were recovering substance users with HCV who had been on methadone maintenance therapy for at least 3 months. Patients with non-HCV-related liver disease or decompensated cirrhosis were excluded. Among the 30 patients with liver biopsy results, the mean Metavir inflammation grade was 2.4 and the mean fibrosis stage was 2.6. Subjects with untreated depression were first stabilized on antidepressants.

Use of cannabis during the study was “neither endorsed nor prohibited.” About one-third of participants used marijuana during hepatitis C treatment. “Regular” marijuana use was defined as every day or every other day for at least 4 weeks. Drug and alcohol use were assessed by self-report and random monthly urine testing.

22 patients (31%) reported cannabis use during ant-HCV treatment, while 49 (69%) did not.

Baseline characteristics were generally similar between marijuana users and non-users.

The median age was about 50 years in both groups.

Compared with non-users, cannabis users were somewhat more likely to be male (68% vs 57%) and Caucasian (86% vs 69%), but less likely to have genotype 1 HCV (48% vs 61%).

About 60% of participants reported a previous psychiatric diagnosis (usually depression); cannabis users and non-users had similar rates of psychiatric diagnosis and antidepressant use.

32% of cannabis users and 37% of non-users reported use of other illicit substances during HCV treatment (including heroin, cocaine, and methamphetamine), while 14% and 24%, respectively, reported alcohol consumption; these differences were not statistically significant.

Participants were treated with conventional interferon alfa-2b (3 million units 3 times weekly) plus 1000-1200 mg daily ribavirin. Patients were initially treated for 48 weeks regardless of genotype, but the protocol was later amended to allow 24-week therapy for those with genotypes 2 or 3.

Adherence to therapy was assessed by self-report, ribavirin pill counts, and returned empty interferon vials. Participants were considered adherent if they took 80% or more of prescribed interferon and ribavirin for at least 80% of the projected treatment course.


In an intent-to-treat analysis, 37 patients (52%) achieved an end-of-treatment response (undetectable HCV RNA at the end of 24 or 48 weeks of therapy):

- 14 cannabis users (64%);
- 23 non-users (47%) (P = 0.21).

Overall, 21 out of 71 participants (30%) achieved sustained virological response (SVR), or continued undetectable HCV RNA 6 months after the end of therapy:

- 12 of 22 cannabis users (54%);
- 9 of 49 non-users (18%) (P = 0.009).

Post-treatment virological relapse rates were 14% for cannabis users and 61% for non-users (P = 0.009).

End-of-treatment response rates were similar among occasional cannabis users (10 of 16; 62%) and regular users (4 of 6; 67%).

10 of 16 occasional users (62%) went on to achieve SVR, compared with 2 of 6 regular users (33%), but the difference was not statistically significant.

Most patients (93%) reported at least one treatment-related side-effect, with similar rates among cannabis users and non-users.

Overall, 17 of 71 patients (24%) discontinued therapy early:

- 1 cannabis user (5%);
- 16 cannabis non-users (33%) (P = 0.01).

Overall, 48 patients were adherent (68%):

- 19 cannabis users (86%);
- 29 non-users (59%) (P = 0.03).

There was no significant difference in adherence between occasional and regular cannabis users (87% vs 83%)

91% of cannabis users took at least 80% of prescribed interferon, compared with 76% of non-users. For ribavirin, the corresponding rates were 91% and 84%; these differences were not statistically significant.

However, cannabis users were significantly more likely than non-users to remain on therapy for at least 80% of the projected treatment duration (95% vs 67%; P = 0.01).

The average duration of HCV treatment was 38 weeks for cannabis users, compared with 33 weeks for non-users.


In conclusion, the authors wrote, “Our results suggest that modest cannabis use may offer symptomatic and virological benefit to some patients undergoing HCV treatment by helping them maintain adherence to the challenging medication regimen.”


In their discussion, the authors wrote that their results “suggest that the use of cannabis during HCV treatment can improve adherence by increasing the duration of time that patients remain on therapy; this translates to reduced rates of post-treatment virological relapse and improved SVR.”

“Although other potential mechanisms may contribute to its enhancement of treatment outcomes, such as altered immunological function and improved nutritional status,” they added, “it appears that the moderate use of cannabis during HCV treatment does not lead to deleterious consequences.”

In this study, it appears that the treatment response benefit was primarily due to improved ability to stay on adequate doses of interferon and/or ribavirin. Sylvestre told HIV and that the researchers could not judge whether there was a direct antiviral effect. “It was probably more of a side-effect management effect than an antiviral effect, but we can’t rule out the latter,” she said.

There remain concerns about the safety of marijuana use by individuals with chronic hepatitis C. Cannabinoid receptors are present on immune cells, and use of the drug may suppress immune function. In addition, there is some evidence that frequent marijuana use may contribute to liver fibrosis. As reported in the July 2005 issue of Hepatology, French researchers found that HCV positive individuals who smoked cannabis daily were more likely to have severe fibrosis and were at higher risk for rapid fibrosis progression than those who used marijuana only occasionally or not at all. However, the participants in that study were not receiving treatment for hepatitis C.

Notably, in the current study, there was no direct dose-response relationship between the amount of cannabis consumed and the likelihood of sustained virological response. In fact, the patients who used the largest amounts of cannabis did not show as much benefit from hepatitis C therapy. The researchers did not perform pre- and post-treatment histological assessments using paired liver biopsies, and did not measure immune parameters.

“The lack of dose response in our study argues against specific receptor or metabolism-related effects, and suggests instead that cannabis exerted its benefit by non-specific improvements in symptom management,” the authors stated. “Interestingly, because the benefits of heavy cannabis use were less apparent, we cannot rule out the possibility that detrimental biological or immunological mechanisms may be relevant at higher levels of consumption. Obviously, further study is needed.”

Unfortunately, because cannabis is strictly controlled in the U.S. and the federal government considers the drug illegal even in states with medical marijuana laws, it is difficult to conduct randomized, controlled trials.


In an accompanying editorial, a group of hepatitis C experts from Canada and Germany noted that people who use illicit drugs are the main risk group for new hepatitis C infections, and “will form the largest HCV treatment population for years to come.”

While past treatment guidelines advised against hepatitis C treatment for active substance users and those with a recent history of active use, this categorical recommendation is no longer in effect in the U.S. and Europe, since recent studies have shown that such patients can achieve good treatment outcomes as long as they are able to maintain adequate adherence. Treatment remains a challenge for this population, however, in part because substance users have a higher prevalence of depression and other psychiatric conditions, which are associated with an increased likelihood of neuropsychological side effects during interferon therapy.

Sylvestre’s study, the editorial authors wrote, “suggests that cannabis use may benefit treatment retention and outcomes in illicit drug users undergoing HCV treatment” and that “there is substantial evidence that cannabis use may help address key challenges faced by drug users in HCV treatment.” Several recent studies have demonstrated the benefits of combining anti-HCV therapy with methadone maintenance, in effect offering “one-stop shopping.”

The authors suggested that the therapeutic effects of cannabis “may be of principal importance and benefit for the distinct needs of illicit drug users” on methadone maintenance, because methadone itself is associated with some of the same side effects as interferon (bone aches, loss of energy, depression).

“Overall, cannabis use may thus even offer dual benefits, in facilitating adherence to both methadone maintenance therapy and HCV treatment in the HCV-infected drug user, and thus contribute to public health benefits related to both these interventions,” they noted.

“While further research is required on the biological and clinical aspects of the benefits of cannabis use for HCV treatment, and the effectiveness of cannabis use for HCV treatment needs to be explored in larger study populations,” they concluded, “we advocate that in the interim existing barriers to cannabis use are removed for drug users undergoing HCV treatment until the conclusive empirical basis for evidence-based guidance is available.”

In particular, they suggested that medical marijuana laws and programs that specify its use for patients with specific conditions such as AIDS and cancer should also include people with hepatitis C.



D L Sylvestre, B J Clements, Y Malibu. Cannabis use improves retention and virological outcomes in patients treated for hepatitis C. European Journal of Gastroenterology and Hepatology 18(10): 1057-1063. October 2006.

B Fischer, J Reimer, M Firestone, and others. Treatment for hepatitis C virus and cannabis use in illicit drug user patients: implications and questions. European Journal of Gastroenterology and Hepatology 18(10): 1039-1042. October 2006.

C Hezode, F Roudot-Thoraval, S Nguyen, and others. Daily cannabis smoking as a risk factor for progression of fibrosis in chronic hepatitis C. Hepatology 42(1): 63-71. July 2005.

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