The Lifevine Foundation
2442 NW Market St. #508
Seattle, WA 98107
State of Washington
Dear Concerned Physician,
The patient presenting this letter to you has been diagnosed with Hepatitis C. The
Lifevine Foundation is a non-profit public education and legal assistance provider for medical
marijuana patients and their physicians. We urge you to consider the following information when
determining whether this patient will potentially benefit from the use of cannabis.
Patients with even mild cases of Hepatitis C often experience nonspecific and
intermittent symptoms such as nausea and vomiting, poor appetite, fatigue, depression, muscle and
joint pains, weight loss, and mild right-upper-quadrant discomfort or tenderness. These symptoms
may become more pronounced and chronic as the disease progresses.
As you are probably aware, drug therapy for Hepatitis C usually consists of the use
of combination therapy with alpha interferon and ribavirin in those patients where such therapy is
indicated. Common side effects of treatment (occurring in more than 10 percent of patients)
include: nausea and vomiting, depression, irritability, weight loss, fatigue, muscle aches,
headaches, and low-grade fever. Substance abuse relapse is often a common result of the therapy due
to the psychological side effects. Flare-ups of pre-existing auto-immune diseases such as
rheumatoid arthritis, ulcerative colitis and Crohn's Disease are common. Marijuana can
mitigate the majority of these side effects as well as offering effective help to those patients
where alpha-interferon treatment is not indicated.
Marijuana (Cannabis) is a powerful antiemetic2, 15, 18
that has been shown to be particularly effective controlling nausea and stimulating the appetites
of immune surpressed patients such as those with HIV or undergoing chemotherapy. Cannabis has
anti-depressant and anti-anxiety properties. It is an anti-inflammatory 3, 4, 6, 9, 10, 14,
18, 19 and immuno-modulating, 7, 8, 11, 12, agent that can help minimize portal
inflammation and slow the progression of both cirrhosis and Hepatocellular carcinoma. The
cannabinoids have been shown to be powerful anti-inflammatories and anti-oxidants. They have also
been shown to have anti-neoplastic activity, at least in gliomas (a form of brain cancer).
Cannabinoids both slow programmed cell death (apoptosis) in normal cells while accelerating
apoptosis in cancer cells. Cannabis has the added advantage of easing, or even completely
eliminating, the muscle pains and cramping 1, 2, 5, 17, 18, 21 that patients often experience.
Marijuana is an effective analgesic.2, 3, 9, 14,15, 16, 20, 21 Cannabis has also been
demonstrated as effective with rheumatoid arthritis, MS, and Crohn's. 4, 7, 8,
20, it can aid in the prevention of inflammation associated with flare-ups of these
conditions should they be present in your patient. Recent studies published this year (2002) have
shown that cannabinoid receptors throughout the digestive tract act to reduce immune-reactivity and
to surpress the vagal drive of the digestive system, slowing the digestive process, allowing more
nutrients to be absorbed at a slower rate, thus putting less stress on the liver 1
The Washington State Medical Quality Assurance Board has included Hepatitis C as a
debilitating medical condition that could potentially benefit from the use of medical marijuana.
Please review the following reference data. The minimal side effects of cannabis will be discussed
following the data.
Published Reference Data (Studies relevant to Hepatitis C, short synopsis - complete
articles are available. Other references are located following the conclusion of this report.)
1. Adami, Frati, Bertini, Kulkarni-Narla, Brown, de Caro, Coruzzi, and Soldani,
"Gastric antisecretory role and immunohistochemical localization of cannabinoid receptors in the
rat stomach" British Journal of Pharmacology Vol. 135, 2002, The study found cannabinoid
receptors throughout the gastrointestinal organs of rats. "Immunoreactivity to the CB1 receptor was
co-localized with that of the cholinergic marker choline acetyltransferase in neural elements
innervating smooth muscle, mucosa and submucosal blood vessels of rat stomach fundus, corpus and
antrum. These results indicate that gastric antisecretory effects of cannabinoids in the rat are
mediated by suppression of vagal drive to the stomach through activation of CB1 receptors, located
on pre- and postganglionic cholinergic pathways."
2. Baron and Folan, "Ulcerative Colitis and Marijuana", Annals of Internal
Medicine, Vol. 112, No.6, p 47, 1990, "The symptoms of ulcerative colitis were repeatedly
relieved by smoked cannabis."
3. Beltramo and Piomelli, "Functional role of high-affinity anandamide transport as
revealed by selective inhibition." Science, Vol.277, No. 5329, pp1094, 1997, "Cannabinoid
and non-cannabinoid compounds in marijuana reduce pain and inflammation."
4. BW Healthwire, January 1998, "Pre-clinical studies show CT-3 reduces
chronic and acute inflammation and reduces destruction of joints." Atlantic Pharmaceuticals was
evaluating CT-3, a cannabinoid derivative. The company reported "In recent studies, the agent was
found to reduce inflammation and prevent the destruction of joint tissue."
5. Egli, Elsohly, Henn and Spiess. International Journal of Clinical
Pharmacology, Vol. 34, No. 10, pp46-452, 1988, "The effect of orally and rectally administered
delta-9-tetrahydrocannabinol on spasticity" "THC was shown to relieve muscle spasms in human
6. Formukong, Evans, and Evans "Analgesic and anti-inflammatory activity of
constituents of cannabis sativa l" Inflammation, Vol. 12 No. 4, pp361-371, 1988, "Cannabidol
is more effective than aspirin in reducing inflammation" (Cannabidol or CBD, is one of the scores
of cannibinoids found in marijuana other than THC)
7. Friedman, H.; Klein, T.W.; Newton, C.; and Daaka, Y., "Marijuana receptors and
immunomodulation." Advances in Experimental Medicine and Biology 373: pp103-113, 1995, "The
study suggested that the immunosuppressive effects of cannabinoids might be useful clinically; for
example, in treating multiple sclerosis.
8. Grotenhermen Dr. Franjo, IACM-Bulletin of 25 June 2000, (IACM): "We know
from animal studies that THC inhibits the production of Th-1 cytokines such as IL-1, IL-2, and
IFN-gamma and stimulates the production of Th-2 cytokines such as IL-4, IL-10, and TGF-beta. This
would give reason for a causal therapeutic use of THC in certain autoimmune diseases that appear to
be Th-1 mediated such as Crohn's disease, a form of chronic intestinal inflammation, and rheumatoid
9. Holdcroft, et al., "Pain relief with oral cannabinoids in familial Mediterranean
fever" Anesthesia, Vol. 52, No. 5, May 1997. This research paper done at Hammersmith
Hospital in London confirmed cannabis' analgesic effects in the first UK clinical trial. The
paper states "Cannabinoids have analgesic and possibly anti-inflammatory properties but their
clinical use has been restricted by legislation"
10. Hollister L.E, "Health Aspects of Marijuana" Pharmacological Review, Vol.
38, No. 1, 1986, "Constituents of marijuana; CBC, olivitol, and cannoflavin all have marked
11. Hollister L.E, "Marijuana and immunity" Journal of Psychoactive Drugs
Vol.20 (1:): 3-8, January-March, 1988, Cannabinoids found in marijuana are effective
12. Kaminsky N. E., "Evidence for a cannabinoid receptor in immunomodulation by
cannabinoid compounds" Advances in Experimental Medicine and Biology, Vol. 335, 115-120,
1993, Identifies the receptors and process that allows marijuana to be an effective
13. Kaminsky N. E. Journal of Neuroimmunology, 1998, "These [cannabinoids]
might be useful as immune modulators, perhaps to be used as anti-inflammatory agents"
14. Maurer, Henn, Dietrich and Hoffmann "Delta-9-tetrahydrocannibinol shows
anti-spastic and analgesic effects in a single case double-blind trial" European Archive of
Psychiatry and Neurological Science, Vol. 240 No. 1 pp1-4 1990, The trial compared Codeine,
THC, and a placebo. The study found codeine and THC had comparable analgesic effects but only THC
had a significant beneficial effect on spasticity and inflammation."
15. National Academy of Science, Institute of Medicine, "Marijuana and
Medicine; Assessing the Science Base " Executive Summary, 1999, "Conclusion: Scientific data
indicate the potential therapeutic value of cannabinoid drugs, primarily THC, for pain relief,
control of nausea and vomiting, and appetite stimulation;"
16. Noyes and Barnes, Comprehensive Psychiatry, Vol. 15, No. 6, pp 413s-416s,
1974, "There are indications that the active ingredients in marijuana may be an effective analgesic
that is efficacious in functional pain"
17. Petro and Ellenberger, "Treatment of human spasticity with
delta-9-tetrahrdrocannibinol" Journal of Clinical Pharmacology, Vol. 21, 1981, "THC can
relieve a broad range of muscle spasms in humans and animals"
18. Pharmos Corporation Press Release, May 21 1998, Researchers reported that
experimental treatment of rats suffering from ulcerative colitis with Dexanabinol (synthetic
cannabidiol-CBD) "significantly reduced the anorexia and the colonic inflammation associated with
this condition compared with untreated rats."
19. Richardson, Kilo, & Hargreaves, "Cannabinoids Reduce Hyperalgesia and
Inflammation via Interaction with Peripheral CB1 Receptors". Pain Vol. 75, 1 pp. 111-119,
1998, Conclusion is in title.
20. Society for Neuroscience Conference, symposium syllabus, Functional Role of
Cannabinoid Receptors, Aug. '98, "Cannabinoids were shown to have a direct effect on the
biochemical pain signals in the central nervous system, and to exhibit superior pain control to
addictive opiate based narcotics. Cannabinoids prevented hyperalgia and were shown to be
particularly effective in the treatment of arthritis and other inflammation induced pain.
21. Zeltser, R.; Seltzer, Z.; Eisen, A.; Feigenbaum, J.J.; and Mechoulam, R
"Suppression of neuropathic pain behavior in rats by a non-psychotropic synthetic cannabinoid with
NMDA receptor-blocking properties" Pain Vol. 47(1): 95-103, October. 1991, The study found
cannabis surpressed neuropathic pain which complicates many CNS diseases. Cannabis was effective
when few available therapies provided even partial relief.
*The oldest medical text known to man was written over 5,000 years ago. The Chinese
Pen Ts'ao, prescribed cannabis for rheumatism and digestive disorders among other
*The New English Dispensary of 1764 recommended hemp to reduce
*In 1814, Nicholas Culpepper published his Complete Herbal, which included
"allaying humors of the bowels" and "reducing inflammation" among the applications of cannabis.
*Surgeon William O'Shoughnessy in his 1839 paper titled On the preparation
of the Indian Hemp found that cannabis relieved rheumatism, convulsions and muscle spasms.
*The 1854 United States Dispensatory listed many uses for cannabis including
"reduction of inflammation", "relax muscle contractions", "treatment of digestive disorders" and as
"an analgesic and sedative"
*Between 1840 and 1890 over 100 papers were published on the medical uses of
*Sir William Osler, known as the "father of modern medicine", proclaimed cannabis the
best treatment for migraine pain in his authoritative 1915 textbook.
*In 1937, when the Marijuana Tax Act was before Congress The American Medical
Association protested vehemently, Dr William C. Woodward, the AMA's counsel, testified that
the bill would deprive Americans of one of the most useful drugs known to medicine. He also
complained that the only reason there hadn't been a larger public outcry was because the Act
referred to the Mexican slang "marijuana" and not to cannabis, which everyone understood was a
There has never been a reported death from overdose of marijuana 10, 15, 22, 23,
26 27. There has never been a death or permanent health effect reported from long-term heavy
use of marijuana 10, 22, 23, 27. Side effects include; a slight increase in heart
rate24, 25, slight hypotension24, 25, increased appetite 15, 24,
and of course, a mild euphoric effect. There are "no deleterious effects on the normal
cardiovascular system" as a result of these side effects according to a 1997 WHO
report27,. An Australian National Drug Strategy report states "Tolerance to the
cardiovascular effects develop within 7-10 days in persons receiving daily doses of THC"
The euphoria also is subject to the effects of tolerance. Any effects on coordination
and cognition dissipate within 7-10 days of daily use15, 24. However marijuana's
effects continue to aid with the patient's stress reduction and to alleviate the depression
and other emotional problems that Hepatitis C patients often suffer from 10, 15, 28, 29,
30. Many patients find cannabis far superior to Valium, Serax, Elavil, or Sinequan; all are
commonly prescribed to Hepatitis C sufferers. Please contact the Lifevine Foundation for published
data regarding the anti-anxiety and anti-depressant properties of cannabis. Hepatitis C patients
find the appetite stimulation10, 15, 31, an added benefit. It is likely that your
patient has already tried marijuana for their symptoms and feels the perceived benefits outweigh
any side effects they have experienced.
The most obvious risk of smoking marijuana, is, of course, the risk incurred smoking
any vegetable material. There are several factors to consider when determining this risk. If your
patient is not suffering from malabsorbtion due to their Hepatitis C and they are able to keep food
digesting for two hours, the patient may choose to eat their cannabis and avoid all smoking risks.
Other smoking methods such as vaporizers (which heat the cannabis to a temperature high enough to
"vaporize" the cannabinoids on the surface of the marijuana without igniting the vegetable matter)
may minimize the smoking risks.
The carcinogenic ingredients in both tobacco and cannabis are primarily the tars that
reside in both plants - not the THC or other cannabinoids of cannabis. The main difference in the
incidence of development of lung cancer is a matter of exposure to these tars, which is
overwhelmingly greater with tobacco than with cannabis.
It takes 20 - 25 pack/years or more (1 pack/year = smoking 1 pack of cigarettes/day
for 1 year.) for most tobacco-induced lung cancers to develop. 20 - 25 pack/years worth of
cigarettes = 150,000 to 200,000 cigarettes. Of all those people who smoke 1 pack/day or more of
tobacco cigarettes for all of their adult lives, only 1 in 5 (20%) will actually develop
tobacco-induced lung cancer.
Most patients who use marijuana medicinally develop their illness in mid to late
life, and start smoking marijuana medicinally only when their projected remaining life span is
already relatively short. Light medical marijuana users - (1-2 joints/day) in one year would smoke
365 - 730 joints; In ten years - 3650 - 7300 joints. In order to reach the equivalent of 200,000
cigarettes it would take them 270 years, at which time 1/5 of them might develop a cancer.
Very heavy use of medicinal marijuana may amount to 10 joints/day. In one year they
would smoke roughly 3,650 joints; in ten years- 36,500 joints It would take them 54 years to smoke
the equivalent of 200,000 tobacco cigarettes, at which time 1/5 of them might develop a cancer.
These figures assume large (1 gm) joints are being smoked - similar in size to a tobacco
Tobacco smoke is a bronchial constrictor known to penetrate the lung's smaller
peripheral air passages and causes inflammation of the lung's absorbent microphages. Tobacco
causes blockages which leads to emphysema. Dr. Donald Tashkin, a federally sponsored pulmonologist
and professor of medicine at UCLA Medical School has determined that marijuana smoke acts as a
bronchial dilator and surpresses inflammation of the lung's macrophages. In a 1997 UCLA
study involving 394 participants32 Tashkin noted "Neither habitual long-term marijuana
smokers nor intermittent marijuana smokers exhibited any significantly different rates of decline
in lung function. No differences were noted between even quite heavy smoking and non-smoking of
marijuana." In contrast, the tobacco-only smokers in the study experienced a rapid decline in lung
function during the eight years this study ran. The study also found no connection between
marijuana and tobacco smoking in those s ubjects who smoked both. The evidence from this exhaustive
real-world study indicates that the pulmonary health of marijuana smokers is no different from that
of the general population.
In an article in American Journal of Respiratory Cellular and Molecular Biology 2001
Mar; 24(3): 339-44 titled "Induction and regulation of the carcinogen-metabolizing enzyme CYP1A1 by
marijuana smoke and delta (9) tetrahydrocannabinol" by the Roth et al, Division of Pulmonary and
Critical Care Medicine, Department of Pathology and Laboratory Medicine, UCLA School of Medicine,
"Induction of the carcinogen-metabolizing enzyme cytochrome P4501A1 (CYP1A1) is a key step in the
development of tobacco-related cancers." They determined THC had a significant inhibitory effect on
the cancer-causing enzyme's induction into the body.
Other tests conducted by Dr. Tashkin at UCLA have found a slightly higher risk of
bronchitis and other upper respiratory infections in marijuana smokers33. This risk may
be mitigated by the use of vaporizers or by the use of ice or water-cooled pipes
Other risks include physical or psychological dependence. These risks are far lower
than with any other psychotropic drug15. The addictive properties of marijuana are less
than caffeine, ephedrine, or benzodiazepines (like Valium).15 Marijuana is similar to
chocolate in it's potential for dependency34. Unlike alcohol, nicotine, opiates,
barbiturates, amphetamines, cocaine or chocolate, marijuana does not effect the dopamine receptors
of the brain35, 36. There is no physical withdrawal10, 15, 26, 27,36. Unlike
steroids and other pharmaceuticals, one can cease use immediately; there is no need to "taper down"
There is compelling evidence that cannabis is an effective antiemetic,
anti-inflammatory, immune modulating, analgesic and anti spasmodic agent. These properties are
indicated for patients suffering from Hepatitis C. Five thousand years of recorded medical of use,
has shown no long-term consequences. Side effects from the use of medical marijuana are much milder
than the side effects of the traditional drugs used to treat Hepatitis C. Many patients who use
cannabis report they are able to continue the use of their prescription medications only when the
side effect can be mitigated with cannabis. Marijuana also has recognized anti-anxiety,
anti-depressant and stress reducing qualities which ease psychological symptoms and side effects as
well as helping to prevent substance abuse relapse. Cannabis has the ability to stimulate appetite,
which many Hepatitis C patients find beneficial. Patients without prescription insurance find the
ability to grow their own medicine at li ttle or no cost to be an additional benefit.s
RCW 69.51A states that for a patient to qualify for use of medical marijuana, their
physician must find that "It is their medical opinion that the potential benefits of the
medical use of marijuana would likely outweigh the health risks for this patient." We urge
you to sign the enclosed "Documentation of Medical Authorization to Possess Marijuana for Medical
Purposes in Washington State." The Washington State Medical Association has prepared this document
for use by our state's physicians. The link between stress and Hepatitis C is well
established. Eliminating the stress induced by the fear of arrest by patients who currently use
marijuana for their symptoms is yet one more benefit of the medical marijuana act.
Other Published reference data
22. Mechoulam R. 1986. The pharmacology of cannabis sativa. In Cannabinoids as
Therapeutic Agents, ed. R Mechoulam, pp. 1Ð19. Boca Raton, FL: CRC
23. Zias J, Stark H, Sellgman J, Levy R, Werker E, et al. 1993. Early medical use of
cannabis. Nature 363:215
24. Nelson, A critical review of the research literature concerning some biological
and psychological effects of cannabis Advisory Committee on Illicit Drugs, Cannabis and the Law
in Queensland: Criminal Justice Commision of Queenslans Australia 1993
25. Avakian, Hovath, Michael and Jacobs, Effects of marijuana on cardio-respiratory
responses to submaximal exercise Clinical Pharmacological Therapeutics Vol. 6, pp771-781,
26. National Commision on Marijuana and Drug Abuse Report, 1972
27. World Health Organization Project on Health Implications of Cannabis Use,
28 Guimares, Anxioltic effect of cannabidol derivatives in the elevated plus-maze,
General Pharmacology Vol. 25, pp 161-164 1994
29. Zuardi, et al, Action of cannabidol on the anxiety and other effects produced by
delta-9 THC in normal subjects, Pschopharmacology Vol. 76 pp 245-250
30. Zuardi, et al, Effects of isapirone and cannabidol on human experimental anxiety,
Journal of Pschopharmacology Vol. 7, pp 82-88
31. Nelson K, Walsh D, Deeter P, Sheehan F. 1994. A phase II study of delta-9-tetrahydrocannabinol for appetite stimulation in cancer-associated anorexia.
J.Palliative Care 10:14Ð18
32. Tashkin et al, Effects of habitual use of marijuana and/or cocaine on the lung,
Research findings on smoking abused substances, NIDA Monograph 99, 1990
33. Tashkin, Is frequent marijuana smoking hazardous to health?, Western Journal
of Medicine Vol 158, No. 6, pp596-601 1993
34. Piomelli D. 1997. Functional role of high-affinity anandamide transport, as
revealed by selective-inhibition. Science 277:1094Ð
35.Casteneda et al, 1991, THC does not effect striatal dopamine release:micro
dialasis in freely moving rats.
36. Gifford, Gardner and Ashby The effects of intravenous administration of delta-9
tetrahydracannabinol on the activity of A-10 dopamine neurons recorded in vivo in anesthetized
rats, Neuropsychopharmacology Vol. 36 No.2, pp.96-99 1997
Report by Bruce Buckner