A meta-analysis of 46 studies found regular cannabinoid use associated with elevated levels of both pro- and anti-inflammatory biomarkers, suggesting immunomodulation rather than simple anti-inflammatory effects.
Immunology researchers, medical cannabis patients, inflammation-focused clinicians
54,382 participants; both pro- and anti-inflammatory markers elevated with cannabis use
What the researchers found
Cannabis use was associated with higher anti-inflammatory biomarkers (SMD = 0.298, PD = 99%) and pro-inflammatory biomarkers (SMD = 0.166, PD = 100%). CBD RCTs suggested small pro-inflammatory marker increases (SMD = 0.15, PD = 90.9%). No consistent effects in prospective studies. Results varied by demographics, study design, and recency of use.
Why it matters
Cannabis is widely described as "anti-inflammatory," but this meta-analysis shows regular use modulates the immune system in both directions simultaneously, with implications for people using cannabis to manage inflammatory conditions.
The numbers in context
46 studies, 54,382 participants, 190 effect sizes. Anti-inflammatory SMD = 0.298 (CrI 0.052-0.536). Pro-inflammatory SMD = 0.166 (CrI 0.122-0.209). CBD RCTs: pro-inflammatory SMD = 0.15. No major publication bias.
How the study worked
Systematic review and Bayesian multilevel meta-analysis of 46 studies (54,382 participants). 190 effect sizes pooled in three analyses. Bayesian hierarchical models accounted for clustering within studies and biomarkers.
What this study cannot tell us
Most evidence from cross-sectional studies. Only 2 prospective and 10 RCTs. Heterogeneity in cannabinoid type, dose, and duration across studies.
How to read the evidence
Large meta-analysis with advanced Bayesian methods, but predominantly cross-sectional evidence limits causal interpretation.
When this study was published
2026 publication with search through October 2025
The bigger picture
The "cannabis is anti-inflammatory" narrative oversimplifies a complex immunological picture. Cannabis acts as an immunomodulator, and the long-term consequences of dual modulation remain unknown.
Questions still open
- Does dual pro/anti-inflammatory modulation benefit or harm people with autoimmune conditions? What are the long-term cardiovascular consequences?
Common questions
Is cannabis anti-inflammatory?
Does CBD reduce inflammation?
Read the original research
Regular cannabinoid use and inflammatory biomarkers: Systematic review and hierarchical meta-analysis.
Brain, behavior, and immunity, 106517
Citation
Murri, Martino Belvederi; Guglielmo, Riccardo; Zizzi, Alessio; Muscettola, Angela; Nanni, Maria Giulia; Dall'Oro, Manuela; Serafini, Gianluca; Inuggi, Alberto; Escelsior, Andrea; Amore, Mario; Grassi, Luigi. (2026). Regular cannabinoid use and inflammatory biomarkers: Systematic review and hierarchical meta-analysis.. Brain, behavior, and immunity, 106517. https://doi.org/10.1016/j.bbi.2026.106517
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