Long Covid: Experts explore the role of cannabinoids in treatment

Experts explored the idea of cannabinoid therapy in the treatment of long Covid, in a one-off webinar hosted by the Medical Cannabis Clinicians Society.

Professor Mike Barnes, neurologist and director of the Medical Cannabis Clinicians Society (MCCS), was joined by Dr Anjali Didi, a general practitioner based in Australia and Dr Hosseini, chief scientific officer at BOD pharmaceuticals, to explore the role that cannabinoids could play in treating long Covid.

The webinar, which took place on Tuesday 30 November, was aimed at clinicians who may be treating patients experiencing long Covid patients and are keen to learn about alternative therapies or treatments.

It could not have been more timely, following the emergence of a new concerning variant in the UK, Omicron.

Dr Anjali Didi explained the importance that the endocannabinoid system (ECS) has in the body and how this interacts with different cannabinoids, focusing on CBD, THC, CBG, CBC and CBDV. She highlighted the important role of the CB1 and CB2 receptors throughout the body.

Different cannabinoids may have different benefits associated with them. Studies have shown that CBG may produce a response in skin tumours, while CBC and CBDVA may potentially reduce seizures by up to 40 per cent.

Dr Didi said that although doctors can often feel nervous about prescribing cannabinoids such as THC, they needn’t be worried.

Dr Didi: “THC interacts with the CB1 receptor as an agonist. It’s responsible for intoxicating effects in high doses and that’s important to know when you prescribe. CBD is known to counteract that intoxicating effect, so even though that is something people worry about when they first start to prescribe in low or 50:50 doses, it’s unlikely. The rule is always start low, go slow.”

Dr Didi, who was originally based in the UK before relocating to Australia, has treated both British and Australian patients.

When she began to see long Covid patients at her clinic, she noted a particular set of symptoms occurring in patients around two months post-infection.

“Long Covid was something I was labelling a set of symptoms as, that I had seen in people typically around two months post the acute infection,” she explained.

“The World Health Organisation is now calling it post Covid-19 syndrome or post-acute sequelae Covid (PASC). Some of the symptoms that have appeared in reports and my practice include insomnia, depression, anxiety, fatigue both mental and physical, shortness of breath and cough.”

Her patients also report pain in different places, including the joints, headaches, chest pain, myalgia, neurocognitive dysfunction, involuntary movement and anosmia that persists. Case reports also show repeated pyrexia, fever and dizziness.

It was original research on CBD and sleep that convinced Dr Didi to try prescribing cannabinoids for the treatment of long Covid. She explained her experience with prescribing cannabis for one of her patients.

Long Covid case study

The patient that Dr Didi chose to present was a 42-year-old British male patient who contacted Covid in March. He was diagnosed after losing his sense of smell.

“His initial infection was in another country in March, with an acute loss of smell when he couldn’t smell his coffee. He was quite well for three or four days with just that. He [then] started to present with a lot of diarrhoea and his acute infection with myalgia changed from day 10 to headaches, night sweats and breathlessness with a cough,” she said.

“The biggest thing was that it got worse when he was lying down, so he was sleeping on two or three pillows. He worked quite hard in the finance industry but he has never been well since the infection.”

Dr Didi explained that her patient experienced a lot of disturbance with muscle fasciculations [twitching] in the body which caused a lot of anxiety, resulting in an insomnia pattern that stopped him from being able to sleep.

While her patient was healthy with no chronic conditions, he had mentioned he had asthma and allergies as a child. He came to see the doctor after struggling for nine months after his initial infection. He had also been off work for some months as a result of the illness.

“He had some pill rolling tremors that were worrying him and he had learned to sit holding his right hand to prevent the fasciculations taking over from his thought process. He felt he couldn’t think as well as he used to be able to, but I had no way to measure that and neither did he. He was fatigued enough to not be able to walk his daughter to school which was around a 10 – 15-minute walk.”

As well as brain fog and tiredness, Dr Didi’s patient also reported feeling pain in his muscles and stabbing chest pains which were quite debilitating. However, his biggest issue was lack of sleep and he had tried using prescription medication or alcohol to help.

Dr Didi said: “Since the PASC had started, he hadn’t been able to sleep, sometimes all night. He felt, looking back, that it was the fasciculations but also the speed of thoughts in his head, whether that was caused by lockdown or his worry about his symptoms. It could have been an amalgamation of things.”

Long COVID crash

In April, her patient experienced what he described as a ‘Covid crash.’

Dr Didi outlined the different medications that he had tried but it was after this that she suggested they discuss medical cannabis.

She explained: “He was able to walk a little bit but was very fatigued. In September, he had a two week period where he was unable to get out of bed, enough that his wife was bringing him makeshift bedpans. When he wakes up, he finds that his joints ache and he doesn’t have any balance.”

The doctor started him on a small dose of Seroquel to help improve his sleep, before starting him on a tiny dose of a BOD medical cannabis product with a ratio of 20mg of CBD and less than two per cent THC.

He began to feel less anxious but felt he wanted to reduce the SSRI due to experiencing issues with his libido. Dr Didi increased the medical cannabis but he began to feel increasingly sleepy. He found success with 20mg of Medcabilis [the BOD product] but felt the 40mg was too strong for him.

“I wanted to try to support him in his decision to go back to work,” she added.

“I asked him to try a new SSRI but continue with the CBD which is something he never stopped. He felt that the one or two days he stopped it, he didn’t feel well in terms of fatigue. He was also able to complete 10-minute walks where he could take his daughter to school.”

Dr Didi also presented another case study of a woman with long Covid who struggled to sleep. She was prescribed a 50:50 ratio of THC and CBD. She reported that it helped her daytime anxiety so has been kept on her dose.

Dr Hosseini from BOD Medical Cannabis explained more about the two products used in both case studies.

“The two case studies mentioned included the Medicabilis five per cent, which is a pharmaceutical-grade product available in the UK by prescription,” she said.

“It has 50mg per ml of CBD but in addition, it does have other minor cannabinoids as well. It has less than 2mg per ml of THC which makes it relatively safe for prescribing to manage symptoms related to neurological or psychological effects such as anxiety.”

So can cannabinoids treat Covid-19?

Prof Barnes concluded the panel by touching on the recent research which suggests cannabinoids may help with lung inflammation experienced by Covid patients.

A study from early 2021 revealed that some cannabis strains could potentially help to reduce a type of inflammatory distress referred to as a ‘cytokine storm’.

He suggested that as long Covid is sometimes caused by the cytokine storm, an overreaction of the immune system, through cannabinoids we may be able to reduce the numbers of patients suffering from symptoms.

“Cannabinoids – generally CBD – being anti-inflammatory may reduce the incidence of long Covid,” commented Prof Barnes.

“There are some early indicators from Israel and Canada, so people are looking around that more definitively.”

He added: “It’s a really important question for global health but we still can’t answer it yet.”