Cannabis & The COVID-19 Pandemic: A Physician’s Perspective

By: Joe D. Goldstrich, MD, FACC

This is an opinion-based article from one of our Board members developed from a review of the medical literature. It in no way should be taken as medical advice. There are no published peer-reviewed articles on the effects of cannabinoids for the COVID-19 virus. The views expressed here are based on an interpretation of the existing scientific literature and how it might apply to the current pandemic. No one knows for sure what will work and what won’t. These views must not be construed as established guidelines.

Healthy People with No Evidence of COVID- 19 Infection or Those Who Have Tested Positive and Are Asymptomatic

Smoking/Vaping: According to the Mayo Clinic, “Everyone is at risk of contracting COVID-19. The illness is particularly dangerous for people with underlying conditions, such as heart or lung disease.” Dr. Neil Patel, a Mayo Clinic pulmonologist and critical care medicine specialist, says people who smoke tobacco products, e-cigarettes or cannabis also may be at increased risk of becoming very sick if they contract the virus. “Smoking makes you more susceptible to COVID-19, because it destroys some of your lung’s natural defense mechanisms,” says Dr. Patel. “Vaping may do the same thing.”1 This would apply to smoking or vaping both THC and CBD dominant cannabis. Another member of the SCC Board of Directors, Patricia Frye, MD of Takoma Park Integrative Care, has also emphasized the importance of not smoking or vaping for the prevention and management of COVID-19.

THC: The only available research on THC and influenza has been done in mice. Both research papers suggest that THC will increase the viral load and/or decrease the immune response to the influenza virus. THC does this primarily by binding with the CB1 and CB2 receptors. We don’t know for sure if this would apply to COVID-19. It appears that THC would not be of benefit when you’re trying to prevent a COVID-19 infection. But remember, these were animal studies, and the topic has not been specifically examined in human subjects. 2,3

CBD: Cannabidiol has many beneficial actions within the body. CBD is involved in relieving inflammation from neuropathy, pain, arthritis, schizophrenia, and many other conditions. CBD also provides neuroprotective properties. One of the primary mechanisms by which CBD provides these benefits is through immunomodulation. These inflammatory conditions are aggravated by an overactive immune system that releases an abundance of inflammatory cytokines. CBD can calm down the immune system, reduce the cytokines, and provide relief. This may be beneficial for inflammatory conditions, but it may not be the desired outcome when depending on your immune system to prevent a COVID-19 infection.4

However, blocking cytokine production and release may be very beneficial in dealing with the most malignant aspects of COVID-19 infection. A recent paper titled “Cannabidiol for Viral Diseases: Hype or Hope?” concluded: “Although preclinical studies suggest the potential effectiveness of CBD in viral diseases such as hepatitis C and Kaposi sarcoma, clinical evidence is still lacking”. They specifically looked for evidence that CBD might be helpful in influenza, but no such evidence was found. 5

Based on current research, it appears that CBD may not be helpful when you’re trying to prevent a COVID-19 infection.

Perspective and Summary

It’s clear that cannabinoids have the potential to suppress the immune system. We have no hard evidence to show that this occurs as it relates to COVID-19. Based on my understanding of the current literature, higher doses of CBD (over 25 mg/day) are more likely to be problematic than lower doses (3-10 mg/day). Also, if you have a chronic condition and have been using cannabis medicine successfully and have had no evidence of immune suppression, you probably do not want to disrupt your therapy.

Once COVID-19 Infection Is Established and There Are Symptoms in the Lungs 

If symptoms involving the lungs develop, it is highly recommended that you have expert medical care. This is the most dangerous stage of the infection and is present in about 20% of hospitalized patients. At this stage, a ventilator is almost always required. There aren’t a lot of other medical therapies available to treat the lung involvement in a COVID-19 infection. 

Cytokine Storm: The cytokine storm is an overreaction by the immune system. This is a result of an outpouring of inflammatory cytokines above and beyond what is needed. The overactive cytokines will attack the lungs and other tissues in the body and destroy them. This is what often results in death. 

CBD: As previously mentioned, CBD has been shown to help calm down an overactive immune system. Although there is no published scientific evidence to show that CBD can quiet the cytokine storm, it seems very plausible that it may be a possibility. So, while CBD may not be the best course of action prior to infection with COVID-19, once the infection is established and there is evidence of significant lung involvement, it may be beneficial. In this situation, I would consider using higher doses of CBD (>100 mg/day).

Supplements That May Be Helpful in the Prevention and Treatment of COVID-19

The best review that I’ve seen for supplements that may be beneficial in the prevention and treatment of COVID-19 infection was published by the Integrative Medicine Division of the University Of Arizona Medical School. The article is available as a PDF.

In conclusion, the antiviral action of specific cannabinoids have not been established to the extent that they should be recommended as a treatment option for COVID-19. At the same time, according to a recent statement by the International Association for Cannabinoid Medicines, there is also no evidence that “cannabinoids could increase the risk of viral infection”.6 It is imperative to not spread misinformation or false hope about the benefits of cannabis as a treatment for COVID-19. As always, further research on the topic is needed. 

Joe D. Goldstrich, MD, FACC is a member of the Board of Directors of the Society of Cannabis Clinicians.

Citations

  1. Williams, Vivien. What smokers should know about COVID-19. (2020) Mayo Clinic.
  2. Buchweitz, J.P., et al. “Modulation of airway responses to influenza A/PR/8/34 by Delta9-tetrahydrocannabinol in C57BL/6 mice.J Pharmacol Exp Ther., 2007
  3. Buchweitz, J.P., et al. “Targeted deletion of cannabinoid receptors CB1 and CB2 produced enhanced inflammatory responses to influenza A/PR/8/34 in the absence and presence of Delta9-tetrahydrocannabinol.” J Leukoc Biol., 2008 
  4. Nichols, James & Kaplan, Barbara. “Immune Responses Regulated by Cannabidiol”. Cannabis and Cannabinoid Research, 2020.
  5. Tagne, Alex, et al. “Cannabidiol for Viral Diseases: Hype or Hope?Cannabis and Cannabinoid Research, 2020.
  6. International Association for Cannabinoid Medicine. “Statement of the Board on current corona virus pandemic and the use of cannabinoids”. (2020) IACM-Bulletin.