Cannabis and Liver Disease: Can Weed Help Treat Symptoms of Liver Disease?

Liver disease refers to an array of medical conditions that can damage the liver, the body’s second-largest organ. The liver is located on the right side of the abdomen, just below the rib cage. It is essential for over 500 vital processes, including digestion, energy production, and elimination of toxins from the body. Liver disease can cause permanent scarring, called cirrhosis, which can lead to liver failure and liver cancer.

The medical community has studied the effects of liver disease for hundreds of years. Cirrhosis was first described by an English surgeon in 1685, and one of the most common types of liver disease, non-alcoholic fatty liver disease (NAFD), was observed as early as the 1800s.^1,2 

Liver disease is a common ailment; around 1.8% of adults in the United States have been diagnosed with one of its many forms, but experts theorize that millions more are affected and unaware. In 2020, liver disease was America's 12th leading cause of death.

Liver disease has many side effects and complications, and experts continue investigating more effective treatments. The Yale Liver Center, one of only three research centers in the US focused exclusively on the liver, predicts advances in xenotransplantation, gene therapy, cell therapy, and artificial intelligence will be at the forefront of future liver disease diagnosis and treatment.

What Causes Liver Disease?

Lots of things can damage the liver, which means the various types of liver disease have many different causes. Certain risk factors can also increase the chances of developing a liver disease. 

Common causes of liver disease include: 

• Infection: Viruses like Hepatitis A, B, and C can lead to liver damage.
• Autoimmune diseases: Problems with the immune system can cause it to attack the liver, resulting in conditions like primary biliary cholangitis.
• Genetics: Abnormal inherited genes can lead to toxic amounts of certain substances that cause liver damage. With hemochromatosis, a buildup of iron in the body can cause cirrhosis.  
• Cancer: Tumors and other growths can occur in the liver.
• Excess toxins in the body: Consumption of too much alcohol, fat, or medications can lead to other types of liver disease. 

Risk factors that may increase the chance of liver disease include:

• Excess consumption of alcohol
• Obesity
• Type 2 diabetes
• Procedures involving shared needles
• Exposure to blood or bodily fluids
• Family history

Signs & Symptoms of Liver Disease

People who have liver disease may experience one or more of the following symptoms:

• Jaundice, the most common sign of liver disease
• Abdominal pain 
• Bruising easily
• Swollen legs, ankles, or arms
• Dark urine or pale stool 
• Fatigue
• Nausea, vomiting, or loss of appetite

While the above symptoms are somewhat common, it is important to note that not all types of liver disease will result in noticeable symptoms.

Liver disease includes a large number of conditions, including:

• Alcohol-related fatty liver disease
• Alpha-1 antitrypsin deficiency
• Autoimmune hepatitis
• Bile duct cancer
• Cirrhosis
• Hemochromatosis
• Hepatitis A
• Hepatitis B
• Hepatitis C
• Liver adenoma
• Liver cancer
• Non-alcohol-related fatty liver disease (NAFLD)
• Primary biliary cholangitis
• Primary sclerosing cholangitis
• Wilson disease

Certain types of liver disease can be prevented. Healthcare providers recommend lifestyle changes, like eating healthy foods, limiting alcohol, and exercising regularly.

Untreated liver disease can lead to liver failure, which can be fatal. With early diagnosis and treatment, some people with liver disease can avoid its most severe outcomes. 

Can Cannabis Help Alleviate Symptoms of Liver Disease?

Because liver diseases have many causes, it makes sense that cannabis might interact differently with the various types. Cannabinoids like CBD and THC are metabolized in the liver, which may work abnormally in people with liver disease. Furthermore, certain medications have been found to increase the presence of CBD or THC in someone with liver disease.³

• In a 2007 study, researchers investigated how the endocannabinoid system might affect liver cirrhosis by activating cannabinoid receptors in human tissue samples. They found that cannabis may cause or restrict fibrosis depending on which cannabinoid receptor was involved.⁴ Further research in 2011 confirmed these results, stating the CB1 receptor was profibrogenic and the CB2 receptor was antifibrogenic.⁵

• Researchers studied 315 people with hepatitis C in 2008. They found that daily cannabis users had increased fat build-up in the liver or steatosis. They concluded that cannabis should not be used by people with hepatitis C.⁶ Conversely, in a 2018 study of people with hepatitis C, experts found a decreased risk of steatosis and a lower occurrence of liver cirrhosis in cannabis users compared to non-users. However, there was no overall difference in mortality.⁷

• In a 2018 study involving people who overuse alcohol, experts observed significantly lower rates of alcohol-related liver disease in cannabis users versus nonusers.⁸ In another 2018 study, researchers measured liver function in healthy, long-term cannabis users, focusing on THC. They found no significant differences in liver function and concluded that cannabis may have some long-term safety in relatively healthy adults. Although this study had no control group, these results emphasize the need for more extensive studies.⁹

• In a 2020 study of more than 10,000 adults with NAFLD, researchers compared cannabis use (or non-use) and liver function. Cannabis users had a higher rate of ascites, a sign of liver damage, which could be due to the CB1 receptor. However, there were no other adverse events or higher rates of cirrhosis. CBD may be beneficial in some cases of liver disease, but more studies are needed.¹⁰

Whether or not cannabis is bad for your liver or has a therapeutic potential does not come down to a solid yes or no; rather, it may depend on which type of liver disease you have. More studies are needed before clinical guidance can be issued for any condition. The research shows that cannabis can affect the liver both positively and negatively. Cannabis may even metabolize differently in the body of someone with liver disease. 

In the case of liver disease from hepatitis C, using medical cannabis is not recommended. In people with alcohol-related liver disease and NAFLD, cannabis use may not be harmful, but the research is not definitive. Studies on specific cannabinoids and their effect on liver function in healthy people and those with liver disease are needed.

Based on current research, CBD may be valuable in some instances of liver disease, but experts must figure out how it may be used safely and effectively. CBD appears to reduce and protect against fibrosis, but risks may still be attached to its use for someone with liver damage.¹¹

Consult with your healthcare provider if you have, or are at risk for, liver disease. Because cannabinoids metabolize in the liver and can interact differently with certain medications, it is essential to make sure you are not introducing more risk.

Until researchers know more about the effects of cannabis on the liver, it is hard to recommend cannabis products for someone with liver disease. If you are taking medication for liver disease, you should avoid cannabis. Cannabis use is sometimes associated with behaviors that can increase your risk of liver disease, like overeating, so it is important to remain self-aware. If you will use cannabis, stick to trustworthy, lab-tested CBD-only products or products with CBD and low amounts of THC. Until more is known about the effects of smoking cannabis, it is advisable to avoid this method of consumption.

Legality and Doctor’s Recommendation

To determine if your state considers liver disease a qualifying condition for medical cannabis, check out our Laws & Regulations section for the medical cannabis rules for your state.

If you find that your state recognizes liver disease or its symptoms as a qualifying medical condition, you can seek a doctor’s recommendation to get your medical cannabis card in your state.

How NuggMD Can Help

NuggMD is the nation's leading medical cannabis technology platform, serving patients in over half the United States. We’ve connected over 1,300,000 patients with their new medical cannabis doctors face-to-face via our state-of-the-art telemedicine platform. 

We believe that every human being has the right to explore the benefits of medical cannabis and are fully committed to helping each patient explore all their options in their journey to wellness. For further information on whether you qualify for medical cannabis, select your state.

Frequently Asked Questions About Cannabis & Liver Disease

Does cannabis help with cirrhosis?

Studies show that using cannabis does affect the liver. Both THC and CBD are metabolized in the liver, and depending on which cannabinoid receptors are activated, they may increase or decrease the scarring that leads to liver cirrhosis. A 2020 study found no increase in cirrhosis in cannabis users with NAFLD. The research is conflicting and emphasizes the need for further studies.

Are cannabinoids bad for your liver?

The current research shows that cannabinoids, like THC and CBD, are metabolized in the liver and thus may interact differently in someone with liver disease. In some cases, these cannabinoids may increase liver scarring, but in others, they may decrease this fibrosis. Certain medications can also increase the presence of these cannabinoids in your body. Until more is known, science cannot definitively say cannabinoids are bad or good for your liver. 

Does smoking cannabis affect your liver?

There is limited data on the impact of smoking cannabis or tobacco on the liver. One 2020 study found that smoking tobacco may be harmful. While researchers do not know exactly how smoking cannabis differs from tobacco, it is advisable to avoid it if you have, or are at risk for, liver disease.¹²

References

1. Braillon A. Laennec's cirrhosis. Lancet. 2019;393(10167):131-132. doi:10.1016/S0140-6736(18)32523-6
2. Ayonrinde OT. Historical narrative from fatty liver in the nineteenth century to contemporary NAFLD - Reconciling the present with the past. JHEP Rep. 2021;3(3):100261. Published 2021 Feb 26. doi:10.1016/j.jhepr.2021.100261
3. Zhu J, Peltekian KM. Cannabis and the liver: Things you wanted to know but were afraid to ask. Can Liver J. 2019;2(3):51-57. Published 2019 Aug 27. doi:10.3138/canlivj.2018-0023
4. Teixeira-Clerc F, Julien B, Grenard P, et al. CB1 cannabinoid receptor antagonism: a new strategy for the treatment of liver fibrosis. Nat Med. 2006;12(6):671-676. doi:10.1038/nm1421
5. Patsenker E, Stoll M, Millonig G, et al. Cannabinoid Receptor Type I Modulates Alcohol-Induced Liver Fibrosis. Molecular Medicine. 2011;17(11-12):1285-1294. doi:https://doi.org/10.2119/molmed.2011.00149
6. Hézode C, Zafrani ES, Roudot-Thoraval F, et al. Daily cannabis use: a novel risk factor of steatosis severity in patients with chronic hepatitis C. Gastroenterology. 2008;134(2):432-439. doi:10.1053/j.gastro.2007.11.039
7. Adejumo AC, Adegbala OM, Adejumo KL, Bukong TN. Reduced Incidence and Better Liver Disease Outcomes among Chronic HCV Infected Patients Who Consume Cannabis. Can J Gastroenterol Hepatol. 2018;2018:9430953. Published 2018 Sep 23. doi:10.1155/2018/9430953
8. Adejumo AC, Ajayi TO, Adegbala OM, et al. Cannabis use is associated with reduced prevalence of progressive stages of alcoholic liver disease. Liver Int. 2018;38(8):1475-1486. doi:10.1111/liv.13696
9. Bonnet U, Canbay A, Specka M, Scherbaum N. Long-Term Heavy Recreational Cannabis Use and Serum Delta-9-Tetrahydrocannabinol Levels are not Associated with an Impaired Liver Function in Cannabis Dependents. Journal of Psychoactive Drugs. 2018;50(4):355-360. doi:https://doi.org/10.1080/02791072.2018.1482031
10. Choi CJ, Weiss SH, Nasir UM, Pyrsopoulos NT. Cannabis use history is associated with increased prevalence of ascites among patients with nonalcoholic fatty liver disease: A nationwide analysis. World J Hepatol. 2020;12(11):993-1003. doi:10.4254/wjh.v12.i11.993
11. De Ternay J, Naassila M, Nourredine M, et al. Therapeutic Prospects of Cannabidiol for Alcohol Use Disorder and Alcohol-Related Damages on the Liver and the Brain. Frontiers in Pharmacology. 2019;10. doi:https://doi.org/10.3389/fphar.2019.00627
12. Rutledge SM, Asgharpour A. Smoking and Liver Disease. Gastroenterol Hepatol (N Y). 2020;16(12):617-625.

The information in this article and any included images or charts are for educational purposes only. This information is neither a substitute for, nor does it replace, professional legal advice or medical advice, diagnosis, or treatment. If you have any concerns or questions about laws, regulations, or your health, you should always consult with an attorney, physician or other licensed professional.