Benefits of Delta-9-THC in Hepatitis C Antiviral Polypharmacy

Author: Mr. Eckhardt is a hepatitis C patient undergoing therapy over the course of numerous years. He is also a healthcare professional, speaker, and writer. He lives in the USA with his wife and is an outspoken medical marijuana advocate.

I am a hepatitis C patient or should I say was; I have recently been cured.

The insidious little bug had been running around my body for years, but I did not look sick, except when I was on antiviral medicine, 48 weeks at a stretch.

There were times when I would feel like I had a cold, a bit achy and under the weather, but generally I felt well. The polypharmacy prescribed for treatment all starts with some form of interferon alpha (IFN). Along with the loathed interferon, various other drugs are thrown in to battle the virus or fight the unrelenting side effects. Yes, ther-apy is like taking poison. The process is an immune system up-regulating. If you have ever had the flu, interfer-on is a large part of what makes you feel sick; try it for 48 weeks.

There are many sources for information on hepatitis C (HCV). Here, I will just outline the disease, symptoms, and side effects. HCV is a viral infection that takes its toll on the liver, causing inflammation and scar-ring. The damage can lead to liver cancer and cirrhosis of the liver. The damage is usually over the course of many years, and about 4 million people in the US have the disease. It is quite possible to live with the dis-ease and not know it for many years. I found out I had the infection from blood work performed prior to an elective surgery. HCV is transmitted via the blood; therefore, it is impor-tant to inform those who may have contact with your blood. People like your sexual partners, dentists, tattoo artists, and, of course, your physi-cians all should be told. HCV does not spread through casual contact, but the amount of virus in the blood is greater than that of an HIV-infect-ed patient, and therefore, more likely to cause an infection with even a small exposure.

During the last course of treatment, I had severe anorexia, some vomiting, considerable nausea, depression (to the point of not wishing to see peo-ple), anemia (difficult to climb stairs because I would get short of breath), myalgia (pain in the muscles), and chills.

OK, the therapy is bad, not some-thing taken on lightly. Why did I do it four times? Simply put, the therapy did not work until the last attempt, and I want to live! The first time, I just used interferon alone, then inter-feron with ribavirin (which is anoth-er antiviral), then pegylated (which means that it is time released) inter-feron with ribavirin, and last and far from least, pegylated interferon with ribavirin and Alinia (which is an anti-protozoal drug that is used on patients with weakened immune sys-tems, e.g. HIV). Each new variation

to the polypharmacy came with no promise it would work, but as the liver damage continues without treatment, it was the only quill in the quiver at the time. The liver takes a hit each day that the virus is circulat-ing though a patient’s body. Even if the virus clears just during therapy (meaning that the detectable amount of virus is minimal or non-detectable, only to return once treat-ment stops), the liver rests, or so goes the thought process.

I follow Murphy’s Law, having geno-type I of the virus, being the most recalcitrant to treatment. When you have your blood tested for hep C, your doctor will also be looking for your genotype, which helps deter-mine the success of the therapy. I did finally win the battle, however, using the most recent therapy protocol instituted by my physician. I also must state that having a hepatologist (liver specialist) who practices in a large teaching hospital and is active-ly involved in clinical trials is ideal.

I would like to now spend some time on how I tolerated the terrible symp-toms of treatment and how I was able to continue on with a somewhat normal life. Marinol (synthetic phar-maceutical THC) and/or cannabis (plant material containing THC and other cannabinoids) enabled me to continue to work my more-than-full-time job and spend some, albeit not much, time with family and friends.

Over the several courses of treatment, I learned that THC (used in this arti-cle as a term for either Marinol or cannabis) was superior to many other drugs in treating some of the refracto-ry (difficult to control) side effects. I learned this at a party, of all places.

I went to the party at a friend’s house; I was doing rather poorly that day, but was still able to attend. A friend noticed that I was “not myself” and asked if I would like to have a smoke. I stated I was not feeling well (I seldom told anyone of my troubles) and thought that I would forgo the fun.

He said it was not going to hurt and might make me feel better: ever hear of medical marijuana? It did make me feel better. My pain waned quick-ly; I even felt sociable. I thought, as my general practitioner has said, that I got high, and that is why I felt bet-ter. The fact that the patient gets high from the medication is not an issue with opiates; I am not sure why the same is not true for cannabis. If a drug makes me feel better and able to tolerate my therapy, is that not a pos-itive clinical outcome (see Sylvestre, below, 2006)? Is a drug that is euphoric taken off the market? Notable to this is that the high is not the same as if you were not sick. The high is somewhat mitigated by the polypharmacy and the side effects being treated.

“If you have HCV, it can be cured, but not without an attempt by you to persevere. THC is an excellent addition to the polypharmacy required to win the battle. I found both Marinol and cannabis to be beneficial in mitigating side effects, although plant-based medicine is often better, as it can be titrated to the proper dose for the symptoms and is effective immediately.”

If I stopped here with the benefits of using THC during antiviral therapy for HCV, I would say that there is subjective evidence that the high gained through smoking cannabis is beneficial to the patient. But there is more, much more, to this wonderful plant and its most noted cannabi-noid, delta-9-tetrahydrocannabinol (THC).

Dronabinol (Marinol) and plant material were used during the last attempt to eradicate the virus. Previously, I was naive about Marinol. Marinol has benefits and drawbacks, as does smoking plant material. I asked my liver doctor if he would prescribe Marinol during this last course of treatment, as I was aware that it worked well against the muscle pain. He was willing, unless I ended up in a drug study that did not allow its use. I ended up not in a drug study, so he prescribed the Marinol. I was quite lucky, as I could not have completed therapy without THC.

THC, synthetic or plant based, at this time has no known effect on the battle to eradicate HCV. There are studies showing that THC and other cannabinoids do affect the immune system. The extent of action on the immune system and what that action may be is still to be determined. Did the THC molecule help me in my battle? The answer is yes, but we will not speculate on any putative effect on the immune system. I write this article to impart a patient’s perspec-tive on its benefit during antiviral therapy for HCV infection, and to describe my experience with Marinol and plant material in helping me tol-erate the side effects of the therapy.

First, I would like to discuss driving. Driving is problematic with THC/cannabis therapy. If one needs to hold a job during treatment, driv-ing may be imperative. Such was the case with me. I had a job, and it required countless hours of driving. When using these therapies, in par-ticular cannabis from the plant, most of us know it is illegal to drive. In many states, it may also be illegal to drive days after ingestion, as the test to establish intoxication measures metabolites of THC in your blood. In other words, you use, derive ben-efit, and then the THC is metabo-lized, stored in fat, and sitting in your system. You could be tested some time after use and be positive. This, of course, is well after any effect on driving ability is gone. There is debate about how much cannabis it takes to affect driving ability. Marinol, on the other hand, leaves the door somewhat open. The pack-age insert warns that you should not use it while driving (and performing other potentially dangerous activities) until it is established that you are able to toler-ate the drug and to per-form such tasks safely. The insert does not state that driving is out, just that you need to be sure that you can perform this task safely. My take on this is, you can drive, but if you cause an accident, the authorities will say, obviously you were not OK to drive.

Another note of caution: My eyes blow out just as if I were smoking weed. I become Rudolph with eyes so bright! You may be using Marinol, but you may as well have just smoked. During therapy (during the last effort with antiviral meds), for the most part, I kept the THC use to the evening and night so as not to drive while using THC from either source. As therapy went on, I found that when using Marinol, the high, although erratic, did not seem to impair my driving. Marinol one day may make you high; the next dose you may not notice much at all. Oral THC is kind of a crapshoot.

In my case, the side effects were dif-ferent on a daily basis. I called this “the side effect of the day.” One day, the anorexia would be the prevalent problem, and the next day it might be nausea or vomiting or both. Onset of side effects can be remark-ably rapid, having no warning. I could not plan on how I would feel. Toward the end of therapy, I could not go very long without dosing; you need to consider how this will affect your ability to hold a job and whether you feel you can drive.

During previous periods of antiviral therapy, I had used plant material, primarily due to the myalgia. Before going on the Alinia with interferon, my main problematic side effect was myalgia, with occasional nausea and/or vomiting. Cannabis was won-derful. I would look forward to com-ing home from work for that first puff and the substantial relief it brought to me. The myalgia would just slowly melt away, leaving me more relaxed and comfortable.

The myalgia usually got worse as the day progressed, but a few inhalations, and the pain would subside. Interferon therapy also had sleep effects, relieving associated insomnia; I had either sleep onset insomnia or sleep maintenance insomnia or both. Cannabis was useful in this regard, as benzodiazepine effectiveness quickly wanes over a short peri-od of time, whereas the cannabis effects are relatively stable over the therapy period (48 weeks). During the most recent period of therapy, the use of THC throughout the 24-hour day, myalgia was not a problem. Marinol was effective because the effect lasted longer than smoking plant material, so I seldom had pain or insomnia from interferon.

Anorexia, which is something I had a significant problem with during my last stint of therapy, is a truly odd phenomenon. You can be hungry and still not care to eat. I am not talking of anorexia nervosa, where the patients see themselves as over-weight and they wish to control their perceived fat. Anorexia is the absence of desire to eat. It may or may not be associated with nausea or vomiting. I could literally not eat all day, and this, of course, just added to the misery, making me weak, tired, with an overall ill feel-ing. Marinol and plant material helped with the problem. I did lose weight, but with the aid of THC, I was able to plateau. However, even with an improved ability to eat, my tastes did change. I found that many foods I had previously enjoyed, such as salads and vegetables, were not welcomed by me. I could eat meat; beef for the most part tasted better. Sweets were the other food source I found palatable. THC seems to point the taste toward sweets and fats. I lost not only fat but mus-cle. I initially tried to exer-cise, but I could not due to the anemia causing shortness of breath. I lost some weight but retained a middle-age gut due to the types of foods that I could tolerate. That being said, I honestly could not have completed therapy this round without the THC, as the anorexia would have done me in.

Nausea and vomiting were also in my body’s bag of tricks during thera-py. These symptoms often did pres-ent together. Nausea can be treated with antiemetics other than cannabis, but they produce their own side effects, and the doctors were reluctant to add more to the polypharmacy. With using the cannabis for myalgia, it was easy to use cannabis for the nausea. There is a difference with Marinol and plant-based medicine in mitigating this side effect. Smoking is almost instantly effective. Marinol, being quite errat-ic in its onset of action and dose effectiveness, is not something you want to use unless you use enough to keep the symptoms at bay 24/seven. My doctor kept the Marinol to no more than 20 mg each day. At 20 mg per day, I could not fully get rid of my nausea and vomiting throughout the day and night. Nausea comes on very quickly, for no apparent reason. If you wait too long to treat the symptoms, you likely will proceed to vomiting, even if you have not eaten. Plant-based medicine, in my opinion, was much better at treating this.

Vomiting, like nausea, had a quick onset, with no warning, making plant-based medicine the obvious choice. Vomiting also is hard to treat with pharmaceuticals, as you can take them but you may just vomit the medication up. When you vomit up your medicine, it is hard to know how much to take next and when; you may have lost the entire last dose taken or assimilated some of the dose, making the next dosing a guessing game.

Depression was another serious problem for me. I was treated with an antidepressant, which helped a great deal. THC did play a part in mitigating the problem. THC tends to elevate mood and can even get you to laugh in the face of all this fucked-up shit.

What does the science say? Well, there is a study1 that showed: “Conclusions: 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.” There is also a negative study2: “In conclusion, daily cannabis smoking is significantly associated with fibrosis progression during chronic hepatitis C (CHC). Patients with ongoing CHC should be advised to refrain from regular cannabis use.”

I can say that the first study listed does confirm my opinion on cannabis use for the HCV patient. I cannot speak to the later study in reference to myself, as I do have scar-ring, but I have not undergone a biopsy since embarking on a year of chronic cannabis use. I can say that without THC or cannabis mitigating the side effects of the polypharmacy prescribed for me, being virus free would have been impossible.

If you have HCV, it can be cured, but not without an attempt by you to persevere. THC is an excellent addi-tion to the polypharmacy required to win the battle. I found both Marinol and cannabis to be beneficial in mit-igating side effects, although plant-based medicine is often better, as it can be titrated to the proper dose for the symptoms and is effective imme-diately.

References

Sylvestre, D. L., B. J. Clements, et al. (2006). “Cannabis use improves retention and virological outcomes in patients treated for hepatitis C.” Eur J Gastroenterol Hepatol 18(10): 1057-1063.

Hezode, C., F. Roudot-Thoraval, et al. (2005). “Daily cannabis smoking as a risk factor for pro-gression of fibrosis in chronic hepatitis C.” Hepatology 42(1): 63-71.

Driving with cannabis information – Marijuana and Actual Driving Performance U.S. Department of Transportation, National Highway Traffic Safety Administration

(DOT HS 808 078), Final Report, November 1993 http://norml.org/index.cfm?Group_ID=5450

Some more common ways HCV is transmitted:

Blood transfusion

Intravenous drug use (when shar-ing needles)

Needle-stick injuries

Sharing straws during cocaine inhalation

Tattooing and body piercing

Sexual transmission

Tooth brushing (sharing a brush)

Side effects vary among patients. Some patients only have side effects during the first couple of weeks, when starting therapy; others are not as lucky. The most common side effects are flu-like symptoms, because your body fights flu viruses using interferon, which causes the achy, tired, and feverish symptoms.

Common side effects of therapies are: