By Dr. Demetria Bates, DNP, FNP-BC, CCE, and Health Coach

Sickle Cell Disease (SCD) is a genetic disorder characterized by the presence of abnormal hemoglobin in the red blood cells when oxygen levels are low, causing the normally flexible round red blood cells to become rigid and adopt a sickle or crescent shape (Mangla et al., 2023). SCD significantly affects African Americans with research showing that 1 in 13 infants born to African American parents will have the sickle cell trait, but 1 in 365 African Americans have sickle cell disease (Mangla et al., 2023).

Individuals with SCD are at risk for various complications including pain crises, organ damage, and reduced quality of life (Mangla et al., 2023). Managing these symptoms can be challenging, and traditional treatments like pain medications and blood transfusions may not always provide sufficient relief. In this article, we will discuss how Cannabis can be a potential benefit and improve the quality of life in those suffering from SCD. 

Cannabis Medicine's Potential for Enhancing Quality of Life in Sickle Cell Disease

SCD is characterized by the abnormal shape of red blood cells that can become occluded in small blood vessels which leads to blockages and restricts blood flow and oxygen delivery to tissues and organs (Mangla et al., 2023). These blockages lead to vaso-occlusive crises or pain crises that result in severe excruciating pain that can last a few hours up to a few days depending on severity. These crises can occur anywhere in the body but commonly affect the bones, chest, abdomen, and joints (Mangla et al., 2023).

Individuals with SCD have a reduced quality of life due to chronic pain, frequent hospitalizations, and complications such as acute chest syndrome, stroke, pulmonary hypertension, gallstones, leg ulcers, and ophthalmologic problems (Mangla et al., 2023). The unpredictable nature of pain crises and the need for ongoing medical management place a substantial burden on patients and their families which affects their overall physical, emotional, and social well-being.

Addressing Opioid Challenges: Exploring Holistic Approaches to Pain Management in Sickle Cell Disease

Pain is the primary reason SCD individuals are seeking alternative options like Cannabis to mitigate adverse effects. The mainstay of treatment for SCD is opioids for pain management which requires high doses for prolonged periods leading to side effects such as constipation, pruritus, tolerance, dependence, opioid-induced hyperalgesia, dependence, risk of addiction, and respiratory depression (Argueta et al., 2020).

Opioid-associated deaths are increasing which has a detrimental effect on pain management due to the hesitancy of prescribing opioids among healthcare clinicians (Abrams et al., 2020). Individuals with SCD are facing challenges with prescription side effects; in addition to restricted access to opioids and other analgesics, just another factor to considering Cannabis for SCD symptom management.

Exploring the Role of Cannabis in Managing the Complex Pain Mechanism of Sickle Cell Disease

There is a lack of understanding of the pain mechanism in SCD which is complex, but known characteristics are systemic and neurogenic inflammation (Abrams et al., 2020). Understanding how and why Cannabis works in the body will bring further insight as to how the therapeutic benefits of Cannabis can be used for SCD treatment.

Therapeutic Potential of Delta-9-tetrahydrocannabinol (THC)

Cannabis contains a diverse array of chemical compounds known as cannabinoids, with delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) being the most prominent. These cannabinoids interact with the body's endocannabinoid system, which plays a pivotal role in regulating various physiological functions such as mood, appetite, pain, cognition, balance, thermoregulation, and motor function (Argueta et al., 2020).

THC is known to provide analgesic effects by modulating cannabinoid 1 receptors (CB1) in the brain and central nervous system. This modulation alters the transmission of pain signals, potentially reducing pain perception in individuals with SCD (Argueta et al., 2020). THC also exhibits notable anti-inflammatory effects which is crucial for managing the chronic inflammation that is present in SCD.

By modulating the immune response, THC may mitigate inflammation and alleviate associated symptoms in SCD. THC offers neuroprotective effects by safeguarding nerve cells from damage (Argueta et al., 2020). This therapeutic benefit holds particular significance for individuals with SCD, as they are at risk of neurological complications. The neuroprotective effects of THC suggest it could play a vital role in preserving and mitigating the impact of SCD-related neurological complications.

Cannabidiol (CBD) Offers A Range of Therapeutic Effects

CBD possesses anti-inflammatory properties by modulating immune responses and reducing inflammation throughout the body (Curtis & Novelli, 2023). Retrospective studies show that individuals with SCD are more likely to resort to Cannabis for pain relief with a significant decrease in hospitalizations (Curtis & Novelli, 2023).

CBD is known to have analgesic properties by interacting with pain signaling pathways. Research shows that CBD has no direct activity on cannabinoid 1 receptor (CB1), but rather acts as an agonist on cannabinoid 2 receptor (CB2) and other receptors such as neurotransmitters to alter pain perception and inflammation (Britch, Babalonis & Walsh, 2021).

CBD demonstrates neuroprotective potential by shielding nerve cells from oxidative stress, inflammation, and modulation of cytokine release (Fernández-Ruiz et al., 2013). This anti-inflammatory and neuroprotective action of CBD is pivotal for managing the underlying mechanisms associated with SCD, thereby offering a holistic approach to managing and alleviating symptoms.

Cannabis Shows Promising Potential In Improving The Quality of Life for Individuals Suffering From Sickle Cell Disease (SCD).

The analgesic, anti-inflammatory, and neuroprotective properties of THC and CBD offer alternative options for managing chronic pain, inflammation, and associated complications without the detrimental side effects often seen with traditional opioid treatments.

Individuals seeking a natural approach to managing SCD-related pain may benefit from utilizing Cannabis to provide relief and enhance their overall well-being.

References

1. Abrams DI, Couey P, Dixit N, et al. Effect of Inhaled Cannabis for Pain in Adults With Sickle Cell Disease: A Randomized Clinical Trial. JAMA Netw Open. 2020;3(7):e2010874. doi:10.1001/jamanetworkopen.2020.10874

2. Argueta DA, Aich A, Muqolli F, Cherukury H, Sagi V, DiPatrizio NV, Gupta K. Considerations for Cannabis Use to Treat Pain in Sickle Cell Disease. J Clin Med. 2020 Dec 1;9(12):3902. doi: 10.3390/jcm9123902. PMID: 33271850; PMCID: PMC7761429.

3. Britch, S. C., Babalonis, S., & Walsh, S. L. (2021). Cannabidiol: Pharmacology and therapeutic targets. Psychopharmacology, 238(1), 9–28. 

4. Curtis, S. A., & Novelli, E. M. (2023). Is CBD ready for prime time in sickle cell disease?. Blood, 141(2), 132–133. https://doi.org/10.1182/blood.2022018393

5. Fernández-Ruiz, J., Sagredo, O., Pazos, M. R., García, C., Pertwee, R., Mechoulam, R., & Martínez-Orgado, J. (2013). Cannabidiol for neurodegenerative disorders: Important new clinical applications for this phytocannabinoid?. British Journal of Clinical Pharmacology, 75(2), 323–333. 

6. Mangla A, Ehsan M, Agarwal N, et al. Sickle Cell Anemia. [Updated 2023 Sep 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482164/

7. Osunkwo I, Andemariam B, Minniti CP, Inusa BPD, El Rassi F, Francis-Gibson B, Nero A, Trimnell C, Abboud MR, Arlet JB, Colombatti R, de Montalembert M, Jain S, Jastaniah W, Nur E, Pita M, DeBonnett L, Ramscar N, Bailey T, Rajkovic-Hooley O, James J. Impact of sickle cell disease on patients' daily lives, symptoms reported, and disease management strategies: Results from the international Sickle Cell World Assessment Survey (SWAY). Am J Hematol. 2021 Apr 1;96(4):404-417. doi: 10.1002/ajh.26063. Epub 2021 Feb 25. PMID: 33264445; PMCID: PMC8248107.

Additional Resources

1. Editorial Team. “Sickle Cell Disease Statistics and Facts.” Sickle-Cell, 16 Nov. 2020, https://sickle-cell.com/statistics.

About Dr. Demetria Bates, DNP, FNP-BC, CCE

Dr. Demetria Bates, DNP, FNP-BC, CCE, is a distinguished healthcare professional with a passion for bridging the gap between Cannabis medicine and Western medicine. She is the founder and CEO of Bates Virtual Health & Consultants, LLC which provides medical card services exclusively for Virginia residents. She works with individuals seeking to understand the integration of Cannabis medicine for health and wellness.  

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Effective Cannabis Newsletter is a platform to educate on the vital role of the Endocannabinoid System (ECS) in one's health. The information is not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment. All content, including text, graphics, images, and information, contained in or available through this newsletter is for general information purposes only. It is not medical advice; it is health awareness.