Medical Marijuana/Cannabidiol (CBD) for Sjogren’s Syndrome

It’s been a little while since my last post, but I hope my readers in the United States had an enjoyable Thanksgiving holiday. It can be challenging to find the positives when fighting a serious chronic disease, but I hope everyone has at least something to be thankful for.

The recent elections in the United States legalized marijuana (medical or recreational) in a number of states. There are now 28 states where marijuana is legal for medical use, and 8 states (plus Washington DC) where it is legal for recreational use. With the attention being focused on the medical applications of marijuana, one may ask if there is any evidence that medical marijuana could be used to treat Sjogren’s Syndrome.

The short answer is that there is very little direct evidence that marijuana can be used to treat SS. Restrictions on cannabis research in many countries including the United States has meant that research on cannabis has moved quite slowly. In addition, most of the research has focused on cancer treatments and pain management. However, there is also little evidence that helminths or low-dose Naltrexone are effective SS treatments due to the general lack of well-funded research for SS. As a result, it makes sense to take a step back and look at what research is available for general inflammation and other autoimmune diseases.

Here, the evidence is still fairly light. A recent journal article in American Society for Clinical Pharmacology and Therapeutics highlights the current state of autoimmunity research:

Currently evidence supports cannabis and its active ingredients as an immune-modulating agents, affecting T-cells, B-cells, Monocytes and Microglia-cells, causing an overall reduction in pro-inflammatory cytokine expression and an increase in anti-inflammatory cytokines. Due to the supporting evidence of cannabinoids as an immune-modulating agent, research focusing on cannabinoids and autoimmunity has emerged. Several clinical trials in multiple sclerosis, inflammatory bowel disease and fibromyalgia suggest cannabis‘ effectiveness as an immune-modulator. However, contradicting results and lack of large scale clinical trials obscure these results. Though lacking clinical research, in-vitro and in-vivo experiments in rheumatoid arthritis, diabetes type 1 and systemic sclerosis, demonstrate a correlation between disease activity and cannabinoids.

The full article provides more details, and while there are positive signs, particularly in a lab, there is not enough real-world evidence with human patients to reach a verdict. The article does explain the history of medical cannabis (going back to 4000 BC) and the progression of current medical work. While marijuana contains over 500 different components, it is the cannabinoids that have been of greatest interest. The two main cannabinoids for purposes of medical research are tetrahydrocannabinol (THC) and cannabidiol (CBD). THC is the cause of most effects that marijuana is known for, including a feeling of relaxation and sometimes anxiety. THC also has some medical uses today, including Dronabinol, a prescription drug used to treat nausea caused by cancer.

CBD, unlike THC, has few psychological side effects, and is believed to moderate the effects of THC. In lab studies, it has also been found to have anti-inflammatory effects, as well as modulating effects on certain immune cells. As a result, CBD is a major focus for the limited medical research being carried out with cannabis.

So where does that leave us SS patients? While there is limited research, the increasing availability of marijuana has lead to anecdotal success stories from the online community. In addition, there has been an increase in CBD products being made from industrial hemp, which has very low THC content and can be legally imported into the United States from other countries. Unfortunately, there are very few regulations on these products outside of states where they are legal, so there is a danger in purchasing unknown and untested products online. As a result, for those who live in states or countries where medical marijuana is legal, I would recommend going through government-approved dispensaries instead of ordering CBD derived from hemp oil online. Many marijuana dispensaries now sell oils and other products with high CBD and low THC content. Do note that one common side effect of marijuana is dry mouth, which is unfortunate for us SS patients. Hopefully this side effect will be less problematic when using CBD oil.

Personally, I have decided to add high-CBD oil to my treatment regimen. Unfortunately, finding recommended doses is difficult due to the lack of available research. I’ve decided to start at around 30mg and go from there. CBD seems to stay in one’s system for around 8 hours, meaning that 2-3 doses would probably be necessary. Unfortunately, CBD oil is not cheap, and a weeks supply can run from $20 to $50 or more, depending on where or how it is purchased and how large a dose is used. I will start small and report back on my findings as time progresses.

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