Things look very grim right now in American healthcare. The cost of healthcare in the States has been rising each year and I have been saying for years that the US healthcare system will implode on itself. Now, with the coronavirus spreading it is becoming evident that this will be the straw that breaks the camel’s back. Hospitals will be overwhelmed with sick patients that are dying from coronavirus.
It is a good time to discuss how cannabis may prove useful in these patients, who are not going to be able to get ICU beds. Some of them will be dying at home because of this and cannabis may be a life-saver.
But first, let’s discuss the risks of using cannabis at this time. Obviously, patients who are inhaling cannabis products are prone to sharing their vape pens and their joints. This is a terrible idea. Cannabis is a social drug and at this time it is not wise to socialize. We must maintain social distancing and use our own products, not those of others. Inhaling cannabis makes us prone to coughing and spreading germs in the air. Make sure to cover your mouth with your elbow or a tissue to prevent aerosolizing the coronavirus all around you to infect others.
Having said that, cannabis may prove useful at the time when coronavirus is ready to kill us. We do not have any medications to treat coronavirus, only those that provide symptom relief. The way the virus kills us is through a complex series of immune reactions that lead to a condition called sepsis. When a patient goes through sepsis, their immune system releases chemicals that spread throughout the body and have serious consequences. Small amounts of inflammation in the body are helpful for healing and preventing spread of infection, but massive systemic inflammation kills us. Our vessels dialate, our organs fail, and we die from inflammatory overload. That is what happens in victims of coronavirus.
Cannabis contains THC, its active ingredient. THC binds CB1 receptors in the brain, which cause us to get high. THC also binds CB2 receptors on the cells of the immune system, like white blood cells. When CB2 receptors are activated by cannabis, it modulates the response of the immune system and lowers the amount of inflammatory chemicals released. It is an anti-inflammatory medication like no other. Cannabis has been very minimally studied due to the prohibition of government-funded research and we have few studies to base treatment on. However, in such situations, we can use the theoretical mechanisms of drugs to hypothesize how they will provide benefit or harm. We know that cannabis has never killed anyone and we know that it has effects on the immune system that may benefit at times of sepsis. This article from January explains some of these mechanisms.
When I was a hospitalist and a resident of internal medicine I began treating patients using synthetic THC on hospital ICU patients. The medication that is legal and the exact equivalent of THC is called dronabinol and it has been FDA approved since the 90’s. I would give this medication to patients that I couldn’t improve in the intensive care unit. Suddenly, they would start eating more and responding to their families. It would help them enough to get them out of the ICU, to the medical floors for discharge to nursing homes and back to regular life. At those times, I felt that it was the psychological properties of THC that would improve their psychological wellbeing and a mind-over-matter response would occur to improve their condition. But as I consider it more, I wonder if these patients, who were septic, were actually responding to the CB2 receptor mechanism, which would improve their sepsis and allow their body to recover. If this is true, then cannabis may be extremely useful for patients at times when they are trying to recover from a coronavirus infection causing severe sepsis with organ failure.
I encourage patients to report cannabis use during severe coronavirus infections. If there appears to be no hope in surviving an infection in an elderly patient or one with comorbidies that make it difficult to combat the virus, a last resort can be to ingest or inhale THC in an attempt to lower the inflammatory response of severe sepsis and provide the body a chance to recover. These recommendations are based only on theory and no studies, so if you try them then do so at your own risk. However, if the treatment does improve a patient’s condition it should be documented or discussed with healthcare practitioners and made evident to the federal government. That way, if it turns out that cannabinoid receptor agonists like THC are helpful for this condition, the government must change its stance on marijuana prohibition immediately to make up for the lost time it has caused in its research and the lives we have lost from not knowing about THC’s usefulness.
If you are a healthcare practitioner or a patient interested in information about medical cannabis, you can pre-order the Clinician’s Guide to Cannabis that will be available in June. Right now it is only available for pre-order in digital (Kindle) version but a paperback version will be available for sale this summer.