The question of whether it is advisable to consume cannabis edibles while infected with a systemic illness like COVID-19 is complex, largely due to the oral delivery method. Edibles are absorbed slowly through the digestive tract, leading to a delayed onset and prolonged effect compared to inhalation. While many individuals consider using edibles to manage feelings of discomfort or anxiety during an illness, there is limited clinical data specific to COVID-19 and cannabis consumption. Assessing the safety and predictability of the effects requires understanding how the body processes these compounds when fighting an infection.
How Illness Affects Edible Metabolism
The primary active compounds in edibles, delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD), are metabolized extensively by the liver through first-pass metabolism. This process relies heavily on Cytochrome P450 (CYP450) enzymes, specifically the CYP3A4, CYP2C9, and CYP2C19 isoforms. When THC is metabolized, it is converted into 11-hydroxy-THC, a secondary compound that is significantly more psychoactive and contributes to the potent, long-lasting effects of edibles.
A systemic viral infection like COVID-19 triggers a strong inflammatory response involving the release of pro-inflammatory cytokines. These cytokines have been shown to downregulate the activity and expression of several CYP450 enzymes in the liver.
When these metabolizing enzymes are suppressed, the body’s ability to clear THC and CBD compounds from the bloodstream slows down. This reduced clearance means that the concentration of THC and its potent metabolite, 11-hydroxy-THC, may increase and remain elevated for a longer duration than expected. Consequently, the effects of a standard edible dose can become unpredictable, potentially feeling much stronger and lasting significantly longer than when the individual is healthy. The variability in blood flow to the liver, which can also be altered during a febrile illness, further contributes to this unpredictable metabolism.
Potential Interactions with COVID Medications
A major concern when using edibles during illness involves potential drug-drug interactions (DDIs) with other medications taken for symptom relief or viral treatment. Cannabidiol (CBD) is a known inhibitor of several CYP450 enzymes, particularly CYP3A4 and CYP2C19, which metabolize a wide range of common pharmaceuticals. Taking a CBD-containing edible could inhibit the metabolism of a co-administered drug, leading to higher-than-intended concentrations of that drug in the body.
This interaction is particularly relevant for certain medications used to treat COVID-19. Antiviral drugs like Paxlovid are metabolized by CYP3A4, and CBD inhibition could cause the antiviral agent to accumulate to potentially toxic levels. Even common over-the-counter pain relievers, such as high doses of acetaminophen, rely on CYP450 enzymes, and their metabolism could be altered, increasing the risk of adverse effects. It is important to discuss all cannabis use with a medical professional, especially when starting a prescription antiviral or an oral steroid like dexamethasone.
Effect on Specific COVID Symptoms
The effects of edibles on COVID-19 symptoms can be a balancing act between potential comfort and possible complication. On the positive side, the compounds may offer relief from several common complaints associated with the infection. Edibles are frequently used to promote sleep, reduce anxiety, and stimulate appetite, which can be beneficial for individuals struggling with insomnia, stress, or the loss of taste and smell.
Conversely, the systemic effects of COVID-19 can amplify the negative side effects of cannabis. THC can sometimes cause dizziness or lightheadedness, which may be exacerbated if an individual is already dehydrated or experiencing a high fever. The unpredictable potency resulting from altered metabolism can also increase the likelihood of experiencing undesirable psychological effects, such as heightened anxiety or paranoia. Furthermore, edibles require a functioning gastrointestinal (GI) tract for absorption, and if the infection is causing severe nausea, vomiting, or diarrhea, the absorption rate will be compromised and inconsistent.
Safety Protocols for Use During Illness
If a person chooses to use edibles while ill with COVID-19, implementing strict safety protocols is advised to mitigate the risks of unpredictable effects and drug interactions. Due to the uncertainty in metabolism, the most important guideline is to significantly reduce the standard dose, often referred to as “start low and go slow.” Beginning with a quarter or half of the typical dose allows the user to gauge the body’s altered response before committing to a larger amount.
Maintaining adequate hydration is also crucial, as dehydration from fever or illness can intensify side effects like dizziness and dry mouth. Avoid consuming edibles if experiencing severe respiratory distress, extreme nausea, or a very high fever, as these symptoms indicate a greater systemic strain. It is imperative to disclose all cannabis use, including edibles, to any healthcare provider, particularly if new prescription medications are being considered or if symptoms worsen, requiring urgent medical attention.