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Cannabis, Marijuana, Pot, or Weed

No matter what you call it, cannabis can impact your psoriatic disease.

As we stand today, 19 states, Washington D.C., and Guam currently allow adults over the age of 21 to purchase cannabis products recreationally. [1] Only three states do not allow any form of cannabis to be used, whether that be medical, cannabidiol (CBD), low tetrahydrocannabinol (THC), or recreational. [2] We don’t have to go too far back to find the origins of this increase in access either. It was just 29 years ago in 1993 that the U.S. Surgeon General Joycelyn Elders, M.D., proposed studying cannabis legalization – a suggestion for which she may have been forced to resign. [3] In 1996, California was the first state to pass a medical cannabis law. [4]

Of course, we are not here to find out why or how that expanded legalization took place, but instead, to answer this one important question you might have: Will cannabis help me manage my psoriatic disease?

To get some answers, we talked to Jason E. Hawkes, M.D., MS, from the University of California, Davis and Adam Friedman, M.D., FAAD, from the George Washington University School of Medicine and Health Sciences to get answers.

Dr. Friedman starts off by explaining that cannabis is the plant, and cannabinoids are the molecules that affect the body. At the mention of cannabis, your first thought is probably of THC and CBD, which are the main phytocannabinoids derived from the plant. But Dr. Friedman points out that our own bodies produce cannabinoids, called endocannabinoids, such as anandamide (AEA), that regulate several different biologic processes. In addition, synthetic cannabinoids can be made in a laboratory with aspects of both phytocannabinoids and endocannabinoids.

Dr. Friedman explains that some cannabinoids, like THC, interact with the CB1 receptor, which is present in the brain and nervous system and is generally responsible for the “high” that people associate with cannabis use. Whereas other cannabinoids, like CBD, interact with the CB2 receptor, which is present in the immune system, including the skin.

“We are just now beginning to understand the complexity of the human body’s response to specific chemicals and their potential benefit for a broad range of conditions and chronic symptoms,” adds Dr. Hawkes.

While there is still much to be learned, Dr. Friedman says it has been shown that cannabinoids can reduce inflammation and can help resolve the effects of previous inflammation. “So, it's not just about stopping inflammation, but actually resolving it and dampening it down to then allow for proper healing,” says Dr. Friedman. They have even been shown to affect the production of interleukin 17 (IL-17), IL-23, and TNF alpha, all of which are important to the pathogenesis of psoriasis.

“The cannabinoids have the potential to hit multiple different facets of inflammation and induce repair, which will benefit not just psoriasis, but any inflammatory disease, making it a very exciting area for discovery to go after many different disease states, even beyond dermatology,” says Dr. Friedman.

Dr. Hawkes explains that the medical use of cannabis products, or products that contain cannabinoids, is generally considered to be safe, but there are several factors that can affect potential safety of use, including the dose, method of delivery, duration of use, and the specific ingredients.

“The potential benefits of cannabis use for inflammation, itching, anxiety/depression, pain, and insomnia, for example, will be of significant interest to health care providers and patients. Conversely, we are aware of problems with overuse or the abuse of cannabis products such as worsening of anxiety/depression/paranoia, obesity, weight gain/metabolic syndrome, and cardiovascular disease,” says Dr. Hawkes. He adds that because people with psoriatic disease are already at higher risk of these conditions, or comorbidities, this should be taken into account when considering use of cannabis products.

There are additional safety aspects to take note of when utilizing cannabis products, including the non-cannabis ingredients. Dr. Friedman says that there have been reports of allergic reactions to topical cannabis products, likely because of additives in the formulation. This is particularly important for products sold outside of dispensaries, as they are subject to fewer regulations.

The delivery method of cannabis products is also something to keep in mind, as it can significantly affect the amount of cannabinoid absorbed by the body. “For example, as much as 35% of a cannabis-based product may be absorbed when ingested via an edible compared to less than 10% of a product delivered topically,” says Dr. Hawkes. He explains that delivery methods include smoking, vaping (smokeless inhalation), capsules, edibles (food or drink-based products), tinctures (sublingual absorption), and topicals.

Both Drs. Friedman and Hawkes want individuals to discuss potential use of cannabis products with their doctor. Some products may be more appropriate or beneficial for certain symptoms than others. There is also a possibility that cannabis products can interact with other medications you may be taking. “Cannabis products may also amplify the side effects of other concurrent oral medications, such as drowsiness, increased heart rate, or elevated blood pressure,” says Dr. Hawkes.

“As we begin to tease out the specific biologic properties of cannabis strains and their ingredients as well as their potential therapeutic use for specific symptoms,” says Dr. Hawkes, “we are approaching a consumer landscape that could allow for a highly personalized, customizable shopping experience based on an individual’s symptoms or medical conditions.”

Whether you are looking for relief for your psoriatic disease or want to ensure that recreational use won’t cause a flare, your access to cannabis products, as well as research on their safety and efficacy, is only going to increase going forward. Before you try a cannabis product, be sure to review your state laws and discuss any plans with your doctor.

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References

[1] Hansen, C, Alas, H, and Davis Jr, E. Where Is Marijuana Legal? A Guide to Marijuana Legalization. U.S. News and World Report. May 27, 2022. Accessed July 25, 2022. https://www.usnews.com/news/best-states/articles/where-is-marijuana-legal-a-guide-to-marijuana-legalization

[2] State Medical Cannabis Laws. National Conference of State Legislatures. July 18, 2022. Accessed July 25, 2022. https://www.ncsl.org/research/health/state-medical-marijuana-laws.aspx

[3] Blanchard, SK. How the First Black Surgeon General Was Silenced for Considering Drug Legalization. Filter Magazine. December 8, 2020. Accessed July 25, 2022. https://filtermag.org/joycelyn-elders-drug-legalization/

[4] Yu, B., Chen, X., Chen, X.et al. Marijuana legalization and historical trends in marijuana use among US residents aged 12–25: results from the 1979–2016 National Survey on drug use and health. BMC Public Health 20,156 (2020). https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-020-8253-4

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