Exploring Cannabis Use for HS
When you think of medications to help with Hidradenitis Suppurativa (HS), marijuana may not be the first to come to mind, but it has become a popular option in the HS community. THC (more broadly blanketed under cannabis) is legal medically in 29 states, while recreational marijuana is legal in 9 states and Washington D.C. As a result, more HS patients are seeking their medical marijuana card or incorporating marijuana as part of their treatment for HS. Please note that each country, city, state and counties have different laws in regards to purchase, possession, cultivation, and/or consumption of marijuana. Check out https://norml.org/ for more information on your state. Please consult your medical team when adding any medication or supplement to your treatment plan.
Hidradenitis Suppurativa is a debilitating, chronic, complex inflammatory illness and reducing the amount of inflammation in our body can help alleviate some of the pain and related symptoms. Flares can cause people to experience nausea, vomiting, pain, fatigue, and many other debilitating symptoms. Marijuana can help with several of these issues. Although marijuana is mostly known as an old street drug that you smoke, as times have changed, so has the progression of medical marijuana, which is now a viable option as a medication.
THE ENDOCANNABINOID SYSTEM
The endogenous cannabinoid system, named after the plant that led to its discovery, is perhaps the most important physiologic system involved in establishing and maintaining human health. Endocannabinoids and their receptors are found throughout the body: in the brain, organs, connective tissues, glands, and immune cells. In each tissue, the cannabinoid system performs different tasks, but the goal is always the same: homeostasis, the maintenance of a stable internal environment despite fluctuations in the external environment. The endocannabinoid system, with its complex actions in our immune system, nervous system, and all of the body’s organs, is literally a bridge between body and mind.
The word “cannabis” refers to all products derived from the plant Cannabis sativa, which contains about 540 chemical substances. Besides THC and CBD, more than 100 other cannabinoids have been identified.
The word “marijuana” refers to parts of or products from the plant Cannabis sativa that contain substantial amounts of tetrahydrocannabinol (THC). THC is the substance that’s primarily responsible for the effects of marijuana on a person’s mental state. Some cannabis plants contain very little THC; under U.S. law, these plants are considered “industrial hemp” rather than marijuana.
CBD vs THC
"When we use cannabis, we are capitalizing on our own endocannabinoid system," says Dr. Aung-Din. "We make endocannabinoids, and we have CB1 and CB2 receptors, so when you use cannabinoids, you're actually using those receptors, whereas traditional pharmaceuticals either block or stimulate processes. But modulation is what cannabinoids use, which is a much better process."
Cannabidiol or CBD can come from either hemp or marijuana, it is often derived from hemp in order to avoid added amounts of THC. CBD does not typically have the characteristics a marijuana high produces and dilutes the effects of THC. Ingesting CBD derived from hemp will not test positive for THC on a drug test. CBD has also had positive reviews when used for medical conditions.
THC is the psychoactive component in marijuana that gives you the feeling of being high - however, CBD acts as a counterbalance to the effects of THC. While THC induces drowsiness and gives you that body-high, CBD can actually increase energy.
According to the National Institute on Drug Abuse (NIDA), THC affects things like thinking, memory, pleasure, movements, concentration, coordination, and sensory and time perception. For these reasons, doing things like operating heavy machinery or driving while under the influence of the drug may be dangerous.
There are 3 typical strains: Indica, Hybrid, and Sativa.
Indica cannabis is a plant derived from India, Pakistan, Turkey, and Afghanistan and known to make you more tired, which is good for night time and sleep. It can have a relaxing effect and increase your appetite.
Sativa cannabis is a plant from certain regions of Africa, Asia, Southeast Asia, and Central America. When consuming this plant you might feel more energized and creative. It is more appropriate for daytime use.
Hybrids can be a mix of strains for a more personal preference.
METHODS FOR USE
Flower: Traditional marijuana that people are known to smoke from a bowl, pipe, bong, or joint.
Vape Pens: These pens have become incredibly popular over the last decade.. Dispensaries sell cartridges that attach to a battery “pen”. There are multiple flavors, strains and strengths. It is in an oil base and does not give off much of an odor in most cases.. It is not considered a natural item as well since the cartridge has other chemicals added. You will also see Hybrid pens that contain CBD and THC or labeled as a 1:1 ratio (1 part CBD 1 part THC). When consuming vape pens it is possible to control settings on some devices and give the ability to maintain or monitor your effects from the THC.
Edibles: Most people have heard about “special brownies” or pot brownies. Patients can now purchase THC infused chocolate dipped blueberries, candy bars, gummies, honey, and almost anything you can imagine. Cannabis infused butter enables you to turn any recipe into an edible. Consuming cannabis in this form takes the most time in order to feel the effects as your body has to digest and break down the food. It has been noted when people try edibles it is recommended to eat a small amount and wait sixty to ninety minutes before consuming another THC infused edible. This form is the most difficult option to attempt to control your effects, please go slow with this option.
Topicals: These are a favorite for many HS patients and are used on the skin in the form of salves, lotions, bath bombs, and Rick Simpson Oil (RSO).
RSO and FECO: Rick Simpson Oil (RSO) is a high-THC oil that can be used in several different ways and for multiple purposes. RSO is made from the flowers of the cannabis plant and isopropyl alcohol and is cooked down into a tar like substance. You can place a small grain of rice size on a piece of food and eat it or apply it directly to a lesion to help it heal. FECO is very similar, but instead of isopropyl alcohol, an alcohol you would drink, like moonshine or Everclear, is used. Both RSO and FECO have been credited for reducing flares as well as pain.
As someone with Hidradenitis Suppurativa you may be eligible to qualify for your medical marijuana card (varies based on state). Many of us with HS also have other comorbidities that may enable you to qualify for a medical marijuana card. Research on comorbidities linked to HS can be found HERE.
Some common conditions treated with medical marijuana:
IBD (Irritable Bowel Disease)
PTSD (Post Traumatic Stress Disorder)
TBI (Traumatic Brain Injury)
Patients using medical marijuana have reported a decreased amount of:
Reduction in inflammation
Controls nausea and vomiting caused by cancer chemotherapy and other medications
Can stimulate appetite
Drugs containing cannabinoids may be helpful in treating certain rare forms of epilepsy, nausea and vomiting associated with cancer chemotherapy, and loss of appetite and weight loss associated with HIV/AIDS. In addition, some evidence suggests modest benefits of cannabis or cannabinoids for chronic pain and multiple sclerosis symptoms. Cannabis isn’t helpful for glaucoma. Research on cannabis or cannabinoids for other conditions is in its early stages.
The following sections summarize the research on cannabis or cannabinoids for specific health conditions.
Research has been done on the effects of cannabis or cannabinoids on chronic pain, particularly neuropathic pain (pain associated with nerve injury or damage).
A 2018 review looked at 47 studies (4,743 participants) of cannabis or cannabinoids for various types of chronic pain other than cancer pain and found evidence of a small benefit. Twenty-nine percent of people taking cannabis/cannabinoids had a 30 percent reduction in their pain whereas 26 percent of those taking a placebo (an inactive substance) did. The difference may be too small to be meaningful to patients. Adverse events (side effects) were more common among people taking cannabis/cannabinoids than those taking placebos.
A 2018 review of 16 studies of cannabis-based medicines for neuropathic pain, most of which tested a cannabinoid preparation called nabiximols (brand name Sativex; a mouth spray containing both THC and CBD that is approved in some countries but not in the United States), found low- to moderate-quality evidence that these medicines produced better pain relief than placebos did. However, the data could not be considered reliable because the studies included small numbers of people and may have been biased. People taking cannabis-based medicines were more likely than those taking placebos to drop out of studies because of side effects.
A 2015 review of 28 studies (2,454 participants) of cannabinoids in which chronic pain was assessed found the studies generally showed improvements in pain measures in people taking cannabinoids, but these did not reach statistical significance in most of the studies. However, the average number of patients who reported at least a 30 percent reduction in pain was greater with cannabinoids than with placebo.
Many studies of cannabis or cannabinoids in people with health problems (such as multiple sclerosis, PTSD, or chronic pain) have looked at effects on sleep. Often, there’s been evidence of better sleep quality, fewer sleep disturbances, or decreased time to fall asleep in people taking cannabis/cannabinoids. However, it’s uncertain whether the cannabis products affected sleep directly or whether people slept better because the symptoms of their illnesses had improved. The effects of cannabis/cannabinoids on sleep problems in people who don’t have other illnesses are uncertain.
Published research on Cannabinoid Delivery Systems for Pain and Inflammation Treatment can be found here.
Marijuana is not for everyone and is not a cure, however, many in the community attest to its effectiveness. Chronic pain is something those with HS become accustomed to living with and marijuana may offer another option besides opioids to help control the pain and other symptoms associated with HS.
Content in this article is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay seeking treatment because of something you have read on this website.
Written by Roni Swihart
Edited by Brindley Kons Brooks