Cannabis sativa and marijuana derivatives called cannabinoids are gaining attention as a potential treatment for inflammatory bowel disease like Crohn’s and colitis.
Cannabis and IBD?
Looking for alternative IBD therapies? Due to evolving policies on the medical use of cannabis, physicians, researchers, and patients alike are taking a closer look at the potential therapeutic role of cannabis and cannabis derivatives for a variety of health disorders, including inflammatory bowel disease (IBD).
In the U.S., cannabis is already legalized for the medical treatment of several disorders (depending on the state). These disorders are mostly chronic in nature and include cancer, HIV/AIDS, multiple sclerosis (MS), chronic pain or nausea, hepatitis C, posttraumatic stress disorder (PTSD), amyotrophic lateral sclerosis (ALS), cachexia, glaucoma, and epilepsy.
Could IBD be the next on the list?
Interestingly, anecdotal reports of cannabis treatment for IBD have existed for hundreds of years, and there is even a case study from 1990 in which IBD patients maintained remission through the use of cannabis.
Today, cannabis is gaining attention as a therapeutic agent for IBD. There’s an increasing recognition of the cases of IBD patients who report that they are currently using cannabis to control IBD symptoms like abdominal or joint pain, diarrhea, appetite loss, weight loss, and nausea.
Although not all physicians are fully aware of the latest research on marijuana and IBD, its growing popularity as a potential alternative IBD treatment is prompting healthcare professionals to examine cannabis more closely.
Marijuana for IBD: The Endocannabinoid System
Although somewhat taboo today, Cannabis sativa has been used medicinally for millennia. The plant contains at least 70 pharmacologically active constituents, called cannabinoids. These are divided into several classes of cannabinoids such as phytocannabinoids (which are derived from the plant), synthetic cannabinoids (artificial compounds), and endocannabinoids (endogenous compounds) that together form what is called the endocannabinoid system, or ECS. This system is known to regulate various physiological functions.
The ECS of course includes THC (delta-9-tetra-hydrocannabinol), the most widely recognized of the phytocannabinoids. Currently, THC is considered the most pharmacologically active and the most active psychotropic agent, and it has been the most widely studied cannabinoid.
Studies have shown that modifying the ECS affects various functions in the body, including gastrointestinal physiology. In fact, in mice, cannabinoids have been demonstrated to have a therapeutic effect in mice with colitis.
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Cannabis: Alternative Medicine for Crohn’s Disease?
Currently, Crohn’s patients may use a combination of conventional therapies including aminosalicylates, antibiotics, corticosteroids, immunomodulators, and biologic and biosimilar therapies. Additionally, patients may undergo surgical removal of certain parts of the intestine or bowel.
According to a 2016 systematic overview published in Gastroenterology & Hepatology, a significant number of IBD patients use cannabis for managing Crohn’s symptoms. It appears that cannabis holds the greatest therapeutic potential for patients whose disease is refractory to conventional methods. Patients who use cannabis include reasons such as ineffectiveness of their current therapy, the benefit of fewer side effects, and gaining a sense of control over the disease.
However, those searching hopefully for a natural cure for Crohn’s disease will be disappointed. To date, there is no Crohn’s disease cure. Likewise, while some Crohn’s patients report that cannabis is best natural treatment for Crohn's disease, available research suggests that cannabis does not necessarily modulate the disease itself—it may only ameliorate the symptoms.
Cannabis for Crohn’s Symptom Relief
Cannabis is used in IBD most often for symptomatic relief. Instead of seeing cannabis as a natural treatment for Crohn’s flare ups, more often patients report therapeutic effects of cannabis in managing Crohn’s symptoms such as abdominal pain, nausea, appetite/weight loss, and diarrhea.
Researchers point out that studies on the benefits of cannabis for Crohn’s must take into account the psychoactive effects of the substance. This means that studies must consider that the scores of patients who report improvements in their symptoms may be influenced by the psychoactive properties of cannabis that positively affect their outlook rather than the symptoms themselves.
Cannabis as Crohn’s Treatment
Researchers are still examining the benefits of cannabis for IBD, but anecdotal evidence suggests that cannabis can play a therapeutic role in Crohn’s disease treatment.
Some research does suggest that cannabis also helps to mediate inflammation in the colon. For example, one study on Crohn’s and cannabis use published by Naftali et al found a significant clinical response in Crohn’s patients who inhaled tetrahydrocannabinol-rich (THC-rich) cannabis during the two month trial, as compared to a placebo group. The researchers concluded that cannabis use resulted in a significant steroid-free benefit in patients with active Crohn’s disease.
Side Effects of Cannabis for Crohn’s Disease
Although it may help in managing Crohn’s disease naturally, cannabis and its derivatives are not without adverse effects. Negative side effects include anxiety, psychosis, tachycardia, and dry mouth.
There’s also concern about the development of dependence or tolerance with long-term cannabis use, with an estimated 10% of users developing dependency. Adverse withdrawal symptoms of cannabis include irritability, sleep issues, anorexia, and depression.
Further Studies on Cannabis and Crohn’s
So far, cannabis is still seen as a complementary treatment for conventional therapies. Current research is inconclusive, and cannabis is mostly recommended for symptomatic control only in patients with severe refractory IBD, and only after failure of established medical therapies.
Systematic review of cannabis and Crohn’s disease points to the need for further trials that can clarify whether cannabis modulates inflammation or simply provides IBD symptom relief. Additional long-term studies of high quality with large sample sizes are needed to determine the potential positive and negative effects of cannabis for managing Crohn’s disease.
More Crohn’s Alternative Therapies Research
Cannabis is just one substance that holds promise for IBD patients—there are dozens of new Crohn’s treatments in clinical trials.
One of these is a new IBD treatment from Abbvie called upadacitinib, or ABT-494 . For patients looking for an alternative to Humira for Crohn’s, upadacitinib is being targeted at patients who’ve had an inadequate response to anti–tumor necrosis factor (TNF) therapy, such as Humira, Remicade, or Cimzia.
Looking for alternatives to anti-TNFs? Learn more about participating in the ABT-494 trial here.
Ahmed, W., & Katz, S. (2016). Therapeutic Use of Cannabis in Inflammatory Bowel Disease. Gastroenterology & Hepatology, 12(11), 668–679. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5193087/
Vu, M., P. Melmed, Gil Y. et al. (2013) Weeding Out the Facts: The Reality About Cannabis and Crohn's Disease. Clinical Gastroenterology and Hepatology. 12(5); 898-899. Retrieved from http://www.cghjournal.org/article/S1542-3565(13)01783-7/fulltext