Hepatitis C is a viral disease of the liver that afflicts an estimated four million Americans. Chronic hepatitis C is typically associated with fatigue, depression, joint pain and liver impairment, including cirrhosis and liver cancer.
Patients diagnosed with hepatitis C frequently report using cannabis to treat both symptoms of the disease as well as the nausea associated with antiviral therapy.[1-2] An observational study by investigators at the University of California at San Francisco (UCSF) found that hepatitis C patients who used cannabis were significantly more likely to adhere to their treatment regimen than patients who didn't use it. Nevertheless, no clinical trials assessing the use of cannabinoids for this indication are available in the scientific literature.
Preclinical data indicates that the endocannabinoid system may moderate aspects of chronic liver disease[4-5] and that cannabinoids may reduce inflammation in experimental models of hepatitis. Some other clinical reviews have reported a positive association between daily cannabis use and the progression of liver fibrosis (excessive tissue build up) and steatosis (excessive fat build up) in select hepatitis C patients.[7-9] However, more recent trial data reports that cannabis smoking is not associated with the promotion of liver disease in Hep C subjects.
Experts possess divergent opinions regarding the therapeutic use of cannabinoids for hepatitis C treatment. Writing in the October 2006 issue of the European Journal of Gastroenterology, investigators from Canada and Germany concluded that cannabis' "potential benefits of a higher likelihood of treatment success [for hepatitis c patients] appear to outweigh [its] risks." By contrast, other experts discourage the use of cannabis in patients with chronic hepatitis until further studies are performed.[12-16]
 Schnelle et al. 1999. Results of a standardized survey on the medical use of cannabis products in the German-speaking area. Forschende Komplementarmedizin (Germany) 3: 28-36.
 David Berstein. 2004. “Hepatitis C – Current state of the art and future directions.” MedScape Today.
 Sylvestre et al. 2006. Cannabis use improves retention and virological outcomes in patients treated for hepatitis C. European Journal of Gastroenterology & Hepatology. 18: 1057-1063.
 Zamora-Valdes et al. 2005. The endocannabinoid system in chronic liver disease (PDF). Annals of Hepatology 4: 248-254.
 Lavon et al. 2003. A novel synthetic cannabinoid derivative inhibits inflammatory liver damage via negative cytokine regulation. Molecular Pharmacology 64: 1334-1344.
 Hezode et al. 2005. Daily cannabis smoking as a risk factor for progression of fibrosis in chronic hepatitis C. Hepatology 42: 63-71.
 Ishida et al. 2008. Influence of cannabis use on severity of hepatitis C disease. Clinical Gastroenterology and Hepatology 6: 69-75.
 Brunet et al. 2013. Marijuana smoking does not accelerate progression of liver disease in HIV-hepatitis C coinfection: a longitudinal cohort analysis. Clinical Infectious Diseases 57: 663-670.
 Fischer et al. 2006. Treatment for hepatitis C virus and cannabis use in illicit drug user patients: implications and questions. European Journal of Gastroenterology & Hepatology. 18: 1039-1042.
 Schwabe and Siegmund. 2005. op. cit.
 Hezode et al. 2005. op. cit.
 David Berstein. 2004. op. cit.
 Hezode et al. 2008. Daily cannabis use: a novel risk factor of steatosis severity in patients with chronic hepatitis C. Gastroenterology 134: 432-439.
 Purohit et al. 2010. Role of cannabinoids in the development of fatty liver (steatosis). The AAPS Journal 12: 233-237.