Can Cannabinoids Help Lupus and Other Diseases?
BY JENNIFER CHEN September 23, 2019
A lupus diagnosis can be devastating. The disease causes the body’s immune system to attack its own tissues and can affect internal organs—including the brain, heart, and lungs—which can start to deteriorate. Lupus flare-ups can leave patients so fatigued and in pain that they’re unable to do the simplest of things, such as walk, cook, or read. Many can’t go outdoors without layers of sunscreen, because the disease can make them extremely susceptible to sunburn.
Lupus affects approximately 240,000 people in the United States, and yet at present doctors neither know the exact cause nor have a cure. Instead, current treatments focus on improving quality of life by controlling symptoms and minimizing flare-ups to reduce risk of organ damage.
“The landscape for treatment of lupus is a bit bleak,” says Fotios Koumpouras, MD, a rheumatologist and director of the Lupus Program at Yale Medicine. “A multitude of drugs have failed in the last 10 to 15 years. Most of the drugs we use are being repurposed from other conditions and are not unique to lupus. Many of them can’t be used during pregnancy, which is a problem because lupus mostly affects young women. All of these issues create the impetus to find new and more effective therapies.”
This is why he’s exploring a candidate for a new lupus treatment option: a molecule with a cannabinoid template structure that binds to cannabinoid receptors, the same receptors involved in the chemicals found in the marijuana plant.
What is CBD?
CBD is a form of cannabinoid called “cannabidiol.” Cannabinoids are a type of chemical that binds to CB1 and CB2 receptors found throughout the body. CB1 receptors are mostly located in the nervous system, connective tissues, gonads, glands, and organs; CB2 receptors are primarily found in the immune system, along with the spleen, liver, heart, kidneys, bones, blood vessels, lymph cells, endocrine glands, and reproductive organs. (Collectively this is called the endocannabinoid system.)
What these cannabinoids do when they bind to the receptors depends on which receptor is activated, and thus can produce effects ranging from the firing of neurotransmitters (the chemical messengers sent from the brain to the rest of the body) that alter mood, to reducing inflammation and promoting digestion.
So, our bodies have their own endocannabinoid system, but cannabinoids can also be found in nature, most abundantly in the marijuana plant. The two most well-known types of cannabinoids in the marijuana plant are THC (tetrahydrocannabinol) and CBD (cannabidiol). THC binds to both the CB1 and CB2 receptors, but the CB1 receptor seems to be responsible for many of the well-known psychoactive effects of marijuana, such as euphoria, increased heart rate, slower reaction times, and red eyes. CB2 receptor binding results in the production of a series of proteins that reduce inflammation. (These proteins are called “resolvins” because they appear to resolve inflammation.) The pharmacology of CBD at cannabinoid receptors is complex and highly variable, but CBD has been shown to activate the endocannabinoid system.
Fotios Koumpouras, MD, is researching a synthetically created cannabinoid molecule that binds preferentially to CB2 receptors (called Lenabasum) to see if it can help ease pain and inflammation in patients with lupus.
Dr. Koumpouras learned from a colleague of ajulemic acid, a side-chain analog of Δ8-THC-11-oic acid, which was designed as a potent therapeutic agent free of the psychotropic adverse effects typical of most cannabinoids. This molecule may help relieve pain and reduce inflammation in systemic lupus erythematosus (SLE), the most common type of lupus. “Reducing inflammation is crucial for patients with lupus because it is what causes the buildup of scar tissue in vital organs that can eventually lead to their deterioration and malfunction,” he says. This cannabinoid molecule was already in study for other diseases, including systemic sclerosis and dermatomyositis.
In 2018, Dr. Koumpouras joined a multi-site randomized clinical trial that aims to recruit 100 participants to examine whether a drug using a synthetically created cannabinoid molecule that binds preferentially to CB2 receptors (called Lenabasum) can help ease pain and inflammation in patients with lupus. Participants will receive Lenabasum or a placebo for almost three months and will continue to be monitored for pain and inflammation levels, as well as lupus disease activity. The study is ongoing, but Dr. Koumpouras anticipates that it will wrap up by early next year.
From “miracle drug” to medicine?
Dr. Koumpouras’ excitement over the new drug comes at a time when products containing CBD have flooded supermarkets, labeled with claims that they treat everything from back pain to insomnia. Although CBD is not yet approved by the FDA, the hype around it stems from the popularity of the marijuana plant it is derived from.
But whether CBD actually provides those benefits in a significant way remains to be seen. Only a few studies—small ones—have definitively proven the effectiveness of medicines that involve the endocannabinoid system. To date, the only FDA-approved medication containing CBD is Epidiolex, a medication used to treat two rare forms of severe epilepsy—Lennox-Gastaut syndrome and Dravet syndrome, both which begin mostly in infancy and early childhood. In a group of three clinical trials, Epidiolex seemed to reduce the number of seizures significantly. And yet, Vinita Knight, MD, a Yale Medicine pediatric neurologist, says her patients who take Epidiolex have had mixed results. Some have had reductions in seizures and others haven’t shown much improvement. “We’re not seeing as much success as what’s been reported on Facebook and Twitter,” she says, but adds that so far it has only been prescribed for children with the most debilitating and difficult-to-treat seizures. In addition, some researchers believe that CBD works most effectively in combination with other cannabinoids and compounds found in the marijuana plant, in what is known as the “entourage effect.” Thus, it would be less effective as an isolated chemical in pill form, but that, too, remains unproven.
But these questions are why Dr. Koumpouras is focusing on a compound that, until recently, few have studied.
His research is one of many new studies at Yale and elsewhere looking at the endocannabinoid system and molecules related to CBD action for use in treating everything from Crohn’s disease to psoriatic arthritis, and he hopes that this new data will be used to help paint a more complete picture about the chemical for future treatment options.
“The more data the better,” he says. “The more we’re able to make informed decisions.”
Yale Medicine doctor investigates whether a synthetically created molecule that mimics properties and effects of CBD could treat diseases.
Is CBD Oil for Lupus Safe or Effective?
Richard N. Fogoros, MD, is a retired professor of medicine and board-certified in internal medicine, clinical cardiology, and clinical electrophysiology.
CBD oil, which is derived from marijuana, has become a trend when it comes to treating diseases involving pain and inflammation. But is it effective for lupus?
So far, we don’t have conclusive evidence that CBD oil can safely treat lupus, but research is currently being conducted to help make this possible.
Because medical marijuana is still fairly controversial, and the laws are confusing, there’s a lot of confusion and misinformation out there about CBD. That can make people hesitant to try it. Good news though—a new law is simplifying the matter for many of us.
What Is CBD Oil?
CBD is short for “cannabidiol.” While it comes from cannabis, it doesn’t get you high because it doesn’t have psychoactive properties. The high comes from a different chemical in the plant called THC (tetrahydrocannabinol).
Marijuana growers focus on strains and techniques that increase THC levels. Cannabis that’s grown for hemp tends to have a lot more CBD than THC.
If you look online, you can find a lot of huge claims about using CBD oil for medicinal purposes. Claims are so glowing, in fact, that you might start to wonder if they can possibly be true. Certainly, when they come from websites that promote marijuana legalization and use, you may be wise to question the veracity.
It’s too early in the research process for us to be able to say “yes” about many of the claims. However, we’re learning enough to be able to say “it’s possible,” or even, “we think so.”
CBD oil is used to treat a host of different conditions, although it’s not approved for any of these conditions, as of mid-2018:
- Chronic pain and inflammation
- Glaucoma pain
- Sleep disorders, including insomnia and nightmares
- Bipolar disorder
- Multiple sclerosis
- Parkinson’s disease
- Movement disorders (Huntington’s disease)
- Assistance with smoking cessation
- Stopping the growth of cancerous tumors
When it comes to taking CBD oil, you have a lot of options: smoking, taking capsules, drops or sprays under the tongue, and as a topical ointment. Research in the United States is in the early stages, though, since for decades, legal restrictions made it extremely difficult to study the medical benefits of marijuana.
CBD Oil for Lupus
With a lack of research on CBD oil for lupus, we have to go on what we know about CBD in general and can understand from research into conditions with similar symptoms or pathology. This potential treatment is likely to get attention from lupus researchers eventually, though, for several reasons.
- Lupus contributes to an epidemic of pain, including untreated and undertreated pain. Current treatments are far from perfect, so drug companies have a sizable financial incentive to find more effective medications.
- The opioid addiction/overdose epidemic is a huge problem for society and puts a lot of strain on the resources of the medical community as well as law enforcement. Meanwhile, several studies have shown that when marijuana becomes legal in a state, the number of opioid prescriptions—and overdose deaths—drops. That’s bound to get the attention of doctors who want to protect their patients, law enforcement agencies battling the problem, and lawmakers seeking solutions.
- A wealth of research suggests that CBD oil is effective against pain and inflammation. In its pure form, it’s generally regarded as safe. Lupus involves considerable inflammation.
- We have abundant anecdotal evidence from people with lupus who say it’s effective. That can’t substitute for scientific proof, but it’s one more thing that gets doctors interested.
Additionally, a 2018 study published in Cellular Immunology found that CBD may alter T-cell activity after spinal cord injury. Abnormal activity of T-cells (which are part of the immune system) are believed to be involved in lupus.
Lupus can include pain from neuropathy (nerve damage), and multiple studies suggest that CBD can alleviate that type of pain from diabetes, HIV, and other sources.
CBD Side Effects
We probably don’t yet know all of the possible side effects of CBD. Some side effects that have been reported are:
- Changes to liver enzymes used to process drugs
- Dry mouth
- Low blood pressure
- Increased tremor in Parkinson’s disease (at high doses)
The World Health Organization says CBD oil may also:
- Alter hormonal levels
- Stimulate the immune system at low levels, and suppress it at higher levels
CBD doesn’t appear to lead to addiction or abuse. It’s also believed to have a low toxicity level, which means it takes a lot to cause an overdose.
Is CBD Legal?
You’d think the question of whether CBD is legal would get a straightforward, yes or no answer, but the legality issue can be confusing.
A lot of pro-marijuana websites have long claimed that it’s legal in all 50 states as long as it doesn’t have more than 0.3 percent THC. They based that argument on the provisions of a specific farm bill. But in 2018, the 9th Circuit Court of Appeals ruled that the old bill didn’t apply to hemp or products derived from it.
Then came the 2018 Farm Bill. This piece of legislation was wildly popular in both the Senate, where it was passed in June of 2018, and the House, where it was passed in December of 2018 and then quickly signed into law. It re-classifies hemp as a legal agricultural product, which makes CBD products legal at the federal level.
In states where marijuana and/or CBD is legal, there’s no longer a clash between state and federal law, so the products are legally safe to use. Still, some states have specific laws on the books banning hemp products. So what does the new Farm Bill mean for those states?
Technically, federal law overrules state law. However, that doesn’t mean those states will stop arresting and trying people for CBD use, especially if they want to challenge the new federal law. If you’re in one of those states, talk to an expert about any possible trouble you could get into for using CBD products. The website ProCon.org has information about which states have laws specific to CBD oil. A site called Governing maintains a map of where marijuana is legal in some form.
The only form of CBD that is FDA-approved is Epidiolex, a purified formulation of CBD used for rare forms of epilepsy. All the other CBD sources being enthusiastically marketed today are unregulated. They often contain amounts of CBD that are substantially different (too much or too little) than the labels indicate, and frequently contain higher levels of THC (the intoxicating chemical found in marijuana) than is permitted in a legitimate CBD product. Anyone electing to use CBD today will need to be cautious and ideally should consult with their physician before doing so.
A Word From Verywell
Treatment decisions should never be taken lightly, and that applies to “natural” treatments like CBD as well—especially when you take the law into account. Consider the pros and con carefully, and be sure to discuss this option with your doctor. Even if you’re taking it illegally, your doctor needs to know—your health could depend on it. As with any treatment, it’s important to watch for side effects.
With legal changes in store and lots of research coming out, we can probably expect a lot of change, and quickly, when it comes to CBD oil.
See what we know about CBD oil as a potential treatment for lupus, what the side effects are, and what you need to know about the legal status.