Weed Smoking After A Mini Stroke: Safe Or Not?

Cannabis use has been linked to an increased risk of stroke, with some studies suggesting that it can more than double the likelihood of experiencing a stroke. However, the relationship between cannabis and stroke is complex and not yet fully understood. While some research indicates that cannabis can increase the risk of certain types of strokes, particularly in young people, other studies suggest that cannabinoids like CBD and THC may have neuroprotective effects and could potentially be used to treat strokes. The endocannabinoid system (ECS) in the human body, which includes CB1 and CB2 receptors, is believed to play a role in regulating blood flow to the brain and could be a target for stroke treatment. However, more research is needed, especially in humans, to establish the safety and efficacy of cannabinoids in stroke treatment and recovery.

Cannabis may increase the risk of stroke

There is a growing body of evidence to suggest that cannabis use may increase the risk of stroke, particularly in younger individuals. This is true even for those who are otherwise healthy and fit, with no pre-existing health conditions.

Studies Highlighting the Link

A 2017 report published in the Journal of Thoracic Disease found that recreational marijuana use raises the risk of hospitalization due to ischemic stroke by 17% in the 18–54 age group. This is supported by a 2020 study, which examined whether there was an association between recent cannabis use and acute ischemic stroke. The unadjusted results found a 50% decrease in stroke risk among cannabis users. However, after adjusting for age and other medical demographics, an independent association could not be established.

The Impact of THC

THC, the psychoactive component of marijuana, has been found to activate platelets, leading to increased GPIIb-IIIa expression and activation of factor VII, a potent thrombogenic protein. This can contribute to the pathogenesis of atherosclerosis and trigger acute myocardial infarction.

The Impact on the Cardiovascular System

Cannabis has been found to have several significant effects on the cardiovascular system, including increased heart rate, irregular heartbeat, vasospasms, irregular blood flow to the brain, and acute rises in supine blood pressure. These effects can create an imbalance in myocardial supply and demand, subsequently leading to acute myocardial infarction and increasing the risk of stroke.

The Importance of Consulting a Doctor

While there may be potential benefits to using medical marijuana during stroke recovery, it is crucial to consult a doctor and monitor changing health conditions. With the guidance of an experienced physician and regular consultations, patients can make informed decisions about their health and well-being.

Cannabis may help with post-stroke pain and spasticity

The double-blind, placebo-controlled, crossover study included 37 patients experiencing spasticity caused by a stroke. Each patient received 4 weeks of a 1:1 THC:CBD oro-mucosal nabiximols and a placebo nasal spray, with a 2-week washout period in between. The study found that nabiximols is safe but not effective for use in stroke patients. However, researchers believe that including patients with more severe spasticity levels may have yielded stronger results.

Another case study published in 2021 tested nabiximols in a 61-year-old experiencing central post-stroke pain syndrome. The patient had been taking various medications, including amitriptyline, gabapentin, pregabalin, and opioids, for over 3 years. After 2 days of nabiximols treatment, the patient reported significant improvements in pain intensity, mood, daily activity, quality of life, and sleep.

While these studies show promising results for the use of medical cannabis in treating post-stroke pain and spasticity, more research is needed to determine its safety and efficacy in humans, as many existing studies have been conducted on animals.

Cannabis may impair oxygen metabolization and energy production within cells

THC interacts with two receptors in the body: CB1 and CB2. These receptors are widely distributed in the cardiovascular system, and their activation modulates the cellular activity of the vessel wall, which may contribute to the pathogenesis of atherosclerosis. CB1 receptors are particularly abundant in the frontal cortex, hippocampus, basal ganglia, and cerebellum.

Research has shown that THC can activate platelets via CB1 and CB2 receptors, leading to increased activation of factor VII, a potent thrombogenic protein. This can result in an increased risk of cardio-embolic ischemic stroke.

Additionally, cannabis use has been associated with an increased risk of hemorrhagic stroke, a type of stroke that occurs when an artery ruptures and leaks within the brain, creating excessive pressure and causing damage.

While the exact mechanism by which cannabis may cause ischemic stroke is not fully understood, animal studies have shown that THC has peripheral vasoconstrictor properties, which may contribute to the development of atherosclerosis.

It is important to note that the effects of cannabis on stroke risk are still being studied, and more research is needed to establish a causal relationship. However, the existing evidence suggests that cannabis use may impair oxygen metabolization and energy production within cells, which can have detrimental effects on the brain and increase the risk of stroke.

Cannabis may be a strong treatment option for patients who have suffered from cerebrovascular diseases

Cannabis has been shown to have a positive effect on patients who have suffered from cerebrovascular diseases. The endocannabinoid system (ECS) in our bodies consists of receptors that can be found in a variety of cells. Cannabinoids, including medical cannabis, work by contacting specific receptors such as cannabinoid receptors CB1 & CB2, peroxisome proliferator-activated receptors (PPARs), and transient receptor potential (TRPs).

The ECS and eCBome (a bigger system that the ECS is part of) may serve as a potential treatment option for patients with cerebrovascular disease. When a cerebrovascular event occurs, brain tissues are often damaged and begin to die. Through eCBome receptors and metabolic effects, researchers have found that THC and CBD may help limit the damage to nerve cells in the brain and potentially prevent stroke. This process involves the activation of endocannabinoids and receptors that are able to decrease inflammation and stop brain cells from dying.

Research also suggests that medical cannabis activation of the ECS through the TRPV1 receptor causes the cells of the brain to release a vasodilator called calcitonin gene-related peptide (CGRP). This is important as it can help decrease blood pressure in the brain after a blockage of blood flow.

Among all of the components contained in cannabis, CBD was found to be a good choice for patients suffering from cerebrovascular disease because of its ability to increase endocannabinoids and activate therapeutic eCBome receptors.

However, more research is needed to determine the safety and efficacy of humans as many studies are conducted on animals and not all research is able to apply to humans at this time.

Cannabis may increase the risk of ischemic stroke

There is evidence to suggest that cannabis use may increase the risk of ischemic stroke, particularly in younger individuals. Ischemic strokes occur when blood flow to the brain is blocked by clots or fat buildup in veins and arteries.

Case Studies and Research

A 2013 case-control study of 218 New Zealanders with ischemic stroke or transient ischemic attack (TIA) found that 25 (15.6%) had urine drug screens (UDS) positive for cannabis, compared to 8.1% of control participants. After adjusting for age, sex, and ethnicity, cannabis use was associated with an increased risk of ischemic stroke or TIA. However, no independent association was established after adjusting for tobacco use.

A review by Wolff et al. revealed 59 case reports of cannabis-related stroke, with ischemic stroke being the most prevalent subtype (83%). The mean age of this group was 33 years, and the male-to-female ratio was 4.9:1. Ischemic stroke was more frequent in chronic cannabis users than in occasional users. The findings suggested a temporal association between cannabis consumption and ischemic stroke, with several reports indicating that the stroke occurred while the drug was being smoked or shortly after.

In a case study of 17 ischemic stroke patients exposed to marijuana, a causal relationship was supported by the absence of other vascular risk factors, a temporal link between symptom onset and cannabis exposure, and the recurrence of symptoms upon re-exposure to cannabis. Another literature review by Desbois et al. reported 71 cases of cannabis users with ischemic stroke. All patients were classified as "heavy" marijuana smokers, and acute symptoms occurred during or within 30 minutes of consuming the drug in 76.5% of cases.

Potential Mechanisms

The mechanism by which cannabis may cause ischemic stroke is not fully understood, but several theories have been proposed.

• Atherosclerosis: THC may contribute to the development of atherosclerosis by activating CB1 and CB2 receptors in the cardiovascular system, modulating the cellular activity of the vessel wall.
• Reversible Cerebral Vasoconstriction Syndrome (RCVS): Animal studies have shown that THC has peripheral vasoconstrictor properties, and multifocal intracranial stenosis has been observed in some marijuana users with ischemic stroke.
• Cardio-embolic Ischemic Stroke: Disruption of myocardial supply and demand equilibrium, leading to ischemia.
• Other Mechanisms: There are likely multiple mechanisms for ischemic stroke that are triggered or potentiated by THC. The reason why some chronic users experience ischemic stroke while others do not may be due to individual predispositions, possibly genetic.

Cannabis and the Endocannabinoid System

The endocannabinoid system (ECS) is a network of receptors found throughout the body that regulates various processes, including appetite, pain perception, and the immune system. Cannabinoids, including THC and CBD, interact with these receptors, particularly CB1 and CB2, to exert their effects.

While the ECS has been implicated in the potential treatment of cerebrovascular disease, there is also evidence that its modulation by cannabis may contribute to the risk of ischemic stroke. Activation of CB1 and CB2 receptors in the cardiovascular system can impact cellular activity and contribute to atherosclerosis. Additionally, THC has been shown to activate platelets, leading to increased thrombogenic activity.

Other Cardiovascular Risks of Cannabis Use

Cannabis use has been associated with an increased risk of cardiovascular events, particularly in younger individuals. It can cause tachycardia, increased cardiac output, and cardiac workload, creating an imbalance between myocardial supply and demand, which can lead to acute myocardial infarction.

Additionally, cannabis has been linked to an increased risk of hemorrhagic stroke, a rare but severe form of stroke. In individuals with aneurysmal subarachnoid hemorrhage (aSAH), recent cannabis use was associated with a higher risk of developing delayed cerebral ischemia, a dangerous complication that can result in death or greater disability.

While the link between cannabis use and ischemic stroke requires further research, the existing evidence suggests an association and a potential causal relationship. The modulation of CB1 and CB2 receptors by THC and other cannabinoids may contribute to vascular events, including ischemic stroke. Therefore, it is essential for individuals to disclose any cannabis use to their doctors, especially those with existing cardiovascular risk factors.

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