The following information is presented for educational purposes only.
Medical Marijuana Inc. provides this information to provide an
understanding of the potential applications of cannabidiol. Links to
third party websites do not constitute an endorsement of these
organizations by Medical Marijuana Inc. and none should be inferred.
Damage to the liver can cause a variety of disorders that can lead to
the organ’s failure and potentially threaten one’s life. Studies have
shown cannabis encourages liver health and can protect it from damage.
Overview of Liver Disorders
There are many different types of disorders and diseases that can affect
the liver, which is an organ responsible for digesting food and ridding
the body of toxic substances. The disorders can be inherited or caused
by lifestyle and health factors, like alcohol abuse and viruses, which
damage the liver. In addition, obesity can cause damage to the liver.
The symptoms associated with liver disorders can include swelling and
pain in the abdomen, yellowish skin and eyes, itchy skin, dark urine,
pale stool, chronic fatigue, nausea and vomiting, loss of appetite and a
tendency to bruise easily.
The most common types of liver disorders include:
Hepatitis – A virus
or parasite that causes inflammation of the liver and a reduction in its
function. Hepatitis A causes acute inflammation of the liver and will
commonly get better without treatment. Hepatitis B can be acute and
chronic and it spreads through blood and other body fluids. Hepatitis C
is nearly always chronic and spreads through blood.
Cirrhosis – The
immune system mistakenly attacks healthy cells in the liver, causing the
formation of a fibrous tissue, or scarring, that replaces dead cells.
Non-alcoholic Fatty Liver Disease –
The build-up of extra fat in the cells of the liver and due to causes
other than alcohol consumption.
In haemochromatosis, the liver becomes damaged from the build up of
iron. An abnormal gene inherited by one or both parents causes the
Wilson’s Disease –
Rare and inherited, Wilson’s disease is caused by too much copper
accumulating the liver, brain and other organs.
Cancer of the Liver –
Primary liver cancer, or hepatocellular carcinoma, typically develops in
livers that are damaged by alcohol abuse, hepatitis, hemochromatosis or
Primary Schlerosing Cholangitis –
A disease of the liver’s bile ducts, which are responsible for carrying
bile to the small intestine for digestion. In the disorder, inflammation
causes scars to develop within the bile ducts.
Primary Biliary Cirrhosis –
The immune system mistakenly destroys the bile ducts of the liver.
Budd-Chiari Syndrome –
An uncommon condition characterized by the occlusion of the hepatic
veins, which obstructs the outflow of blood.
The treatment of liver disorders depends on the type of disease.
Typically, the cessation of alcohol use and a reduction in body weight
is necessary. Many cases of liver disorders may require medications or
Findings: Effects of Cannabis on Liver Disorders
Research has shown that cannabidiol (CBD), a major cannabinoid found in
cannabis that activates the CB2 receptors of the body’s endocannabinoid
system, is therapeutically beneficial for treating many liver disorders
(Mallat, et al., 2011).
Studies have shown that CBD can help combat cirrhosis by assisting in
the death of hepatic stellate cells (HSCs), which are responsible for
the accumulation of scarring on the liver. CBD’s activation of the CB2
receptors, however, has been shown to be effective at inducing apoptosis
(death) in these activated HSCs (Lim, Devi & Rozenfeld, 2011). Research
also shows it reduces the force of inflammatory pathways and oxidative
tissue injury, therefore limiting the damage caused by cirrhosis (Mukhopadhyay,
Rajesh & Pacher, 2011).
CBD has also shown to possess liver protective properties and to promote
liver health. CBD was shown to prevent oxidative stress and autophagy
from alcohol consumption (Yang, et al., 2014). One study found that
cannabinoids inhibited CYP1A enzymatic activity, meaning it reduced the
liver’s risk of toxicity and cancer (Ashino, Hakukawa, Itoh & Numazawa,
2014). An animal study found that CBD was effective at restoring liver
function in mice with liver failure (Avraham, et al, 2011).
Research also suggests that cannabis’ anti-inflammatory and protective
properties help in the treatment of hepatitis. One study found that
cannabinoids’ anti-inflammatory properties effectively reduced
inflammation of a damaged liver and researchers therefore suggested that
cannabis could be developed as a potential drug for hepatitis (Lavon, et
al., 2003). Another study found that cannabinoids appeared have
immunosuppressive and profibrogenic effects in patients with chronic
hepatitis C (Patsenker, et al., 2015).
Cannabis can also be helpful in managing symptoms associated with
cirrhosis, hepatitis C and other liver disorders. Cannabis has long been
established as effective for limiting nausea and vomiting, including
patients with hepatitis C who can become sick following antiviral
treatment (Schnelle, Grotenhermen, Reif & Gorter, 1999) (Sharkey,
Darmani & Parker, 2014) (Parker, et al., 2015). In addition, if
cirrhosis patients are suffering from a loss of appetite, medical
marijuana has demonstrated effective at increasing appetite and
stabilizing body weight (Beal, et al., 1995). Cannabis use was found to
significantly affect whether patients with hepatitis C were able to
stick with their treatment prescription (Sylvestre, Clements & Malibu,
Recent animal studies suggest that CBD may inhibit the progression of
cancer (McAllister, Soroceanu & Desprez, 2015) (Orellana-Serradell, et
al., 2015) (Ligresti, et al., 2006). CBD acid (CBDA) was shown to
down-regulate invasive human brain cancer cells and prevent their growth
(Takeda, et al., 2014).
It’s important to note that earlier studies implicated cannabis in the
progression of cirrhosis, fibrosis, and other liver diseases (Fischer,
et al., 2006). However, more recent research has determined that
marijuana smoking is not linked to the development or progression of
liver disease (Brunet, et al., 2013). In addition, the earlier studies
had actually found liver disease to be associated with activation of the
CB1 receptor. Activation of the CB2 receptor, however, has shown to have
beneficial effects on alcoholic fatty liver, hepatic inflammation, liver
injury, regeneration and fibrosis. This suggests that using cannabis to
selectively activate the CB2 receptor offers therapeutic potential for
cirrhosis and other liver diseases (Mallat, et al., 2011). Further,
researchers have expressed that cannabis’ potential treatment benefits
outweigh the risks suggested in earlier studies (Fischer, et al., 2006).
States That Have Approved Medical Marijuana for Liver Disorders
Currently, 12 states have approved medical marijuana specifically for
the treatment of hepatitis C. These states include: Arizona, Arkansas, Illinois, Maine, Massachusetts, Michigan, New
Dakota, Ohio, Rhode
Island and Washington.
In addition, nearly all states that have passed medical marijuana
legislation have approved medical marijuana specifically for the
treatment of cancer. These states include: Alaska, Arkansas, Arizona, California, Colorado, Connecticut, Delaware,Florida, Georgia, Hawaii, Illinois, Louisiana, Maine, Massachusetts, Michigan, Minnesota, Montana, Nevada, New
Dakota, Ohio, Oregon, Pennsylvania, Rhode
Island, Vermont andWashington.
No states have approved medical marijuana specifically for the treatment
of cirrhosis, non-alcoholic fatty liver disease, haemochromatosis,
Wilson’s disease, primary schlerosing cholangitis, or primary biliary
However, in Washington
D.C., any condition can be approved for medical marijuana as long as
a DC-licensed physician recommends the treatment. In addition, a number
of other states will consider allowing medical marijuana to be used for
the treatment of liver disorders with the recommendation from a
physician. These states include: California (any
debilitating illness where the medical use of marijuana has been
recommended by a physician), Connecticut (other
medical conditions may be approved by the Department of Consumer
Protection), Massachusetts (other
conditions as determined in writing by a qualifying patient’s
physician), Nevada (other
conditions subject to approval), Oregon (other
conditions subject to approval), Rhode
Island (other conditions
subject to approval), and Washington (any
“terminal or debilitating condition”).
Also, various states have approved medical marijuana for the treatment
of symptoms commonly associated with liver disorders. For example, 19
states have approved medical marijuana specifically for the treatment of
nausea. These states include: Alaska, Arizona, Arkansas, California, Colorado, Delaware, Hawaii, Maine, Maryland, Michigan, Montana, Nevada, New
Dakota, Oregon, Rhode
For patients also experiencing extreme weight loss or cachexia, 23
states have approved medical marijuana for treatment. These states
include: Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Hawaii, Illinois, Louisiana, Maine, Maryland, Michigan, Minnesota, Montana, Nevada, New
Dakota, Oregon, Rhode
Island, Vermont and Washington. Several
states have approved medical marijuana specifically to treat “chronic
pain.” These states include: Alaska, Arizona, California, Colorado, Delaware, Hawaii, Maine, Maryland, Michigan, Montana, New
Mexico, Ohio, Oregon, Pennsylvania, Rhode
Island and Vermont.
The states of Nevada, New
Dakota, Montana, Ohio and Vermont allow
medical marijuana to treat “severe pain.” The states of Arkansas, Minnesota, Ohio, Pennsylvania and Washington have
approved cannabis for the treatment of “intractable pain.”
Recent Studies on Cannabis’ Effect on Liver Disorders
CBD killed the hepatic stellate cells responsible for
scarring accumulation on the liver.Cannabidiol
causes activated hepatic stellate cell death through a
mechanism of endoplasmic reticulum stress-induced apoptosis. (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3168994/)
Cannabidiol restored normal liver function in mice
experiencing liver failure.Cannabidiol
improves brain and liver function in a fulminant hepatic
failure-induced model of hepatic encephalopathy in mice.(http://www.ncbi.nlm.nih.gov/pubmed/21182490)
Cannabis use significantly affected whether hepatitis
patients were able to adhere to their virus treatment
use improves retention and virological outcomes in patients
treated for hepatitis C. (http://www.ncbi.nlm.nih.gov/pubmed/16957511)
Cannabinoids found to significantly reduce liver injury in
novel synthetic cannabinoid derivative inhibits inflammatory
liver damage via negative cytokine regulation.(http://www.ncbi.nlm.nih.gov/pubmed/14645663)
Ashino, T., Hakukawa, K., Itoh, Y., and Numazawa, S. (2014). Inhibitory
effect of synthetic cannabinoids on CYP1A activity in mouse liver
microsomes. The Journal of Toxicological Sciences, 39(6), 815-20.
Avraham, Y., Grigoriadis, N., Poutahidis, T., Vorobiev, L., Magen, I.,
Ilan, Y., Mechoulam, R., and Berry, E. (2011). Cannabidiol improves
brain and liver function in a fulminant hepatic failure-induced model of
hepatic encephalopathy in mice. British
Journal of Pharmacology, 162(7),
Beal, J.E., Olson, R., Laubenstein, L., Morales, J.O., Bellman, P.,
Yangco, B., Lefkowitz, L, Plasse, T.F. and Shephard, K.V. (1995,
February). Dronabinol as a treatment for anorexia associated with weight
loss in patients with AIDS. Journal
of Pain and System Management, 10(2),
Fisher, B., Reimer, J., Firestone, M., Kalousek, K., Rehm, J., and
Heathcote, J. (2006, October). Treatment for hepatitis C virus and
cannabis use in illicit drug user patients: implications and questions. European
Journal of Gastroenterology & Hepatology, 18(10), 1039-42.
Lavon, I., Sheinin, T., Meilin, S., Biton, E., Weksler, A., Efroni, G.,
Bar-Joseph, A., Fink, G., and Avraham, A. (2003, December). A novel
synthetic cannabinoid derivative inhibits inflammatory liver damage via
negative cytokine regulation. Molecular
Pharmacology, 64(6), 1334-41.
Ligresti, A., Moriello, A.S., Starowicz, K., Matias, I., Pisanti, S., De
Petrocellis, L., Laezza, C., Portella, G., Bifulco, M., and Di Marzo, V.
(2006, September). Antitumor activity of plant cannabinoids with
emphasis on the effect of cannabidiol on human breast carcinoma. Journal
of Pharacologogy and Experimental Therapeutics, 318(3), 1375-87.
Lim, M.P., Devi, L.A., and Rozenfeld, R. (2011). Cannabidiol causes
activated hepatic stellate cell death through a mechanism of endoplasmic
reticulum stress-induced apoptosis. Cell
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Mallat, A., Teixeira-Clerc, F., Deveaux, V., Manin, S., and Lotersztajn,
S. (2011, August). The endocannabinoid system as a key mediator during
liver diseases: new insights and therapeutic openings. British
Journal of Pharmacology, 163(7), 1432-40.
McAllister, S.D., Soroceanu, L., and Desprez, P.Y. (2015, June). The
Antitumor Activity of Plant-Derived Non-Psychoactive Cannabinoids. Journal
of Neuroimmune Pharmacology, 10(2), 255-67.
Mukhopadhyay, P., Monanraj, R., and Pacher, P. (2011, May 15).
Cannabidiol protects against hepatic ischemia/reperfusion injury by
attenuating inflammatory signaling and response, oxidative/nitrative
stress, and cell death. Free
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Orellana-Serradell, O., Poblete, C.E., Sanchez, C., Castellon, E.A.,
Gallegos, I., Huidobro, C., Llanos, M.N., and Contreras, H.R. (2015,
April). Proapoptotic effect of endocannabinoids in prostate cancer
Reports, 33(4), 1599-608.
Parker, L.A., Rock, E.M., Sticht, M.A., Wills, K.L., and Limebeer, C.L.
(2015). Cannabinoids suppress acute and anticipatory nausea in
preclinical rat models of conditioned gaping. Clinical
Pharmacology and Therapeutics, 97(6), 559-61.
Patsenker, E., Sachse, P., Chicca, A., Gachet, M. S., Schneider, V.,
Mattsson, J., Lanz, C., Worni, M., de Gottardi, A., Semmo, M., Hampe,
J., Schafmayer, C., Brenneisen, R., Gertsch, J., Stickel, F., and Semmo,
N. (2015). Elevated Levels of Endocannabinoids in Chronic Hepatitis C
May Modulate Cellular Immune Response and Hepatic Stellate Cell
Journal of Molecular Sciences, 16(4),
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October). Results of a standardized survey on the medical use of
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Sharkey, K.A., Darmani, N.A., and Parker, L.A. (2014). Regulation of
nausea and vomiting by cannabinoids and the endocannabinoid system. European
Journal of Pharmacology, 722, 134-46.
Sylvestre, D.L., Clements, B.J., and Malibu, Y. (2006, October).
Cannabis use improves retention and virological outcomes in patients
treated for hepatitis C. European
Journal of Gastroenterology & Hepatology, 18(10), 1057-63.
Takeda, S., Okazaki, H., Ikeda, E., Abe, S., Yoshioka, Y, Watanabe, K.,
and Aramaki, H. (2014). Down-regulation of cyclooxygenase-2 (COX-2) by
cannabidiolic acid in human breast cancer cells. The
Journal of Toxicological Sciences, 39(5), 711-6.
Yang, L., Rozenfeld, R., Wu, D., Devi, L.A., Zhang, Z., and Cederbaum,
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