Could cannabidiol be a breakthrough therapy to replace or lessen the use of steroids?

Posted by Mary Biles on Jul 7th 2020

Could cannabidiol be a breakthrough therapy to replace or lessen the use of steroids?

Most of us have been prescribed steroids by a doctor at some point in our lives. They are often the go-to choice to treat sudden bouts of inflammation, allergies or when a physician is simply stuck on what to give a patient. Their immediate effects may seem miraculous. (Oh wow suddenly I have so much energy, my appetite’s back, and my mysterious rash disappeared.) But long-term steroid use comes with a host of side effects.

Enter cannabidiol (CBD), an unexpected contender for a novel steroid sparing treatment of the future.

THE WORLD GOES WILD ABOUT STEROIDS

After their first recorded use for rheumatoid arthritis in 1948 corticosteroids (steroids) quickly became the main immunosuppressive treatment for patients with systemic inflammatory conditions or to prevent rejection after organ transplants. So transformative were their effects that Dr. Philip Hench, Edward Calvin Kendall and Tadeus Reichstein were awarded the 1950 Nobel Prize for Physiology or Medicine for their discovery of the hormone cortisone and its clinical application in rheumatoid arthritis.

A crowd pleaser with patients, steroids were often overprescribed by doctors. Before long a link between steroids and increased morbidity in patients became apparent, and researchers began to find ‘steroid sparing’ immunosuppressant drugs. That said, to this day steroids continue to be prescribed (my dog even had a short dose for a mystery itch in her right ear), although most physicians limit this to short periods of time.

WHAT ARE STEROIDS?

It was Dr. Philip Hench who first posited that steroids – hormones produced in the adrenal glands – alleviate pain associated with rheumatoid arthritis. With the development of corticosteroid drugs like cortisone, hydrocortisone, and prednisone that mimic our endogenous steroids, a new effective way was discovered to reduce inflammation in the body.

But there’s no ‘get out of jail free’ pass with steroids, as their use is often accompanied by unpleasant and sometimes dangerous side effects. These include glaucoma, cataracts, fluid retention, high blood pressure, mood swings, weight gain, diabetes, increased risk of infections, osteoporosis, suppressed adrenal gland function, thin skin, and slower wound healing.

Consequently, doctors only prescribe steroids as a short-term solution, a measure considered relatively safe. Hence, steroids are commonly given to patients with sudden flare ups in autoimmune conditions like Crohn’s disease when short, sharp immunosuppression is required.

However, it’s not just the steroid side effects that can be problematic for patients. Coming off steroids, particularly when a patient has been prescribed short term high doses or lower doses over a longer period of time can result in ‘steroid withdrawal syndrome.’ This happens when the body has become reliant on the ‘pharmaceutical’ steroids, leading its own endogenous production through the hypothalamic-pituitary-adrenal (HPA) axis to weaken and flatline.

As such, patients should not suddenly stop taking steroids. Instead the dose has to be gradually tapered downwards, otherwise symptoms such as weakness, fatigue, decreased appetite, weight loss, nausea, vomiting, diarrhea, abdominal pain and headaches can occur.

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