Regular readers have probably figured out that my notions are liberal-leaning. I believe in medical coverage for everyone, including hepatitis C treatment for anyone who wants it. I advocate treatment for active drug users, prisoners, and people with no liver damage. I believe that health is a right, not a privilege. I also believe that spending our healthcare dollars is a wise investment in society and helps to increase productivity. 

Given my liberal sentiments, it may surprise you to learn that in the past I had deep concerns about the safety of marijuana for those with liver disease. My opinions were based on the research of the times. New research has convinced me otherwise. I have since done a complete turnaround, and I am now very much in favor of prescribed medical marijuana use. 

In August, Hep published a piece I wrote "Hepatitis C and Pain" (Part 2), I discuss cannabis use. Since the article focused more on pain than on marijuana, I did not go deep in to the issue supporting my endorsement of marijuana use. 

I received this comment:
Hi Lucinda, You usually have good advice to offer, but you need to read this Hepatology journal article about the association between marijuana smoking and liver fibrosis:  If I were a medical professional (and I’m not), I would not endorse or encourage marijuana use for any patient. There just aren’t enough valid, peer-reviewed studies demonstrating the efficacy or safety of long-term marijuana and cannabis use. Perhaps someday there will be. 

My reply:
Thank you for bringing this issue up, and allowing me an opportunity to respond. Believe me, I thought long and hard about this. For many years, I expressed the same concerns that you did, largely based on the research you quoted. I’ve written articles on the subject, encouraging abstinence from marijuana use for anyone wanting a healthy liver. I’ve since revised my opinion. 

That study is severely limited, and there have since been studies that have refuted it, and some even showing some benefit. This particular study shows an association between daily pot smoking and fibrosis, but it does not show casualty. For instance, the study did not look at physical activity level, which we now know is associated with fibrosis. Less activity = more risk of fibrosis, so perhaps it wasn’t the cannabis but low physical activity that was the culprit. 

Personally, I don’t think we know the answer yet to the question of cannabis’s affect on the liver. What I do know is that revered healthcare professionals and organizations endorse medical marijuana, such as Sanjay Gupta, the American Nurses Association, the New England Journal of Medicine, and the American Academy of Family Physicians. In California, marijuana use has been removed as a disqualifier for a liver transplant. 

It is chilling when I see someone in pain who doesn’t want to take an opioid because the drug puts them in a stupor and diminishes quality of life. When they get their life back with medical marijuana, it is amazing. To be denied hep C treatment because of marijuana use is a slippery slope. If we go down that road, then are we going to deny heart surgery to someone who doesn’t exercise or eats meat? All that aside, yes, the gold standard is to strive for a pristine lifestyle. That is definitely something I endorse.

In addition to the fact that we are finding that cannabis does not harm the liver, preliminary evidence suggests it may help it. Don’t take my word for this. To read what scientists say about marijuana use and the liver, here are a few links (there are many more):

Finally, it is worth noting that marijuana is not listed on LiverTox, which provides information about drugs, herbs, and supplements that may harm the liver. Marijuana’s absence may not be an endorsement of its safety, but surely if marijuana was very harmful, we’d have seen it listed by now.