Contributor: Asia Mayfield
There’s fresh hope for patients suffering from inflammatory bowel disease (IBD). Cannabis is being looked at as a serious, viable option for treatment. Research efforts are being aided by the legalization movements sweeping the country.
Patients interested in trying cannabis for themselves can legally purchase flower, edibles, and concentrated products in more than half of the United States. The medical community is deeply interested.
A flurry of recent studies focusing on cannabis and IBD show promise. Navigating the research on your own, however, takes effort. In this article, we’ll break down the current state of medical research.
What is IBD?
Nearly 2 million Americans suffer from IBD. The term actually describes two separate conditions: ulcerative colitis and Crohn’s disease.
IBD is an autoimmune disease, which means the body attacks itself. Ulcerative colitis affects the rectum and large intestine while Crohn’s disease can inflame any part of the body’s digestive tract.
- Bloody stool
- Stomach pain
- Weight loss
- Loss of appetite
Treatment can involve drugs, lifestyle changes, and surgery.
IBD is often debilitating.
Jami Kinnucan, assistant professor of medicine at Michigan Medicine, University of Michigan, writes in Gastroenterology & Hepatology:
“There is currently a large unmet need in the treatment of inflammatory bowel disease (IBD) with conventional medical therapy. Despite improvement in disease activity, many patients have persistent clinical symptoms that have significant impact on their quality of life.”
Patients are turning toward cannabis because they’re eager for relief. The majority of Crohn’s patients require surgery in their lifetime. The exact procedure performed depends on the severity of the disease.
IBD is a chronic condition. Patients need a solution that’s gentle enough on the body for daily use. Pharmaceutical medications aren’t guaranteed to work, and they come with serious risks.
Researchers believe that about 20 percent of IBD patients regularly use cannabis to treat their symptoms. Closer to 40 percent have tried cannabis at least once. The symptoms patients are trying to relieve include: diarrhea, pain, and lack of appetite.
The Endocannabinoid System
The endocannabinoid system (ECS) is designed to help the body regulate its emotions, hunger, pain, immune response, and more. Endocannabinoids, compounds naturally produced by the body, bond to cannabinoid receptors. These are scattered throughout the body, concentrated in areas like the brain and fat tissue.
Cannabinoids are nearly identical in shape to endocannabinoids. However, they’re only found in cannabis plants. When someone ingests cannabis, cannabinoid molecules bind to the body’s endocannabinoid receptors.
“There are very good grounds to believe that the endocannabinoid system is a potential therapeutic target in Crohn’s disease and other gastrointestinal diseases,” said Dr. Timna Naftali, lead researcher on an Israeli IBD study presented in 2018. “For now, however, we can only consider medicinal cannabis as an alternative or additional intervention that provides temporary symptom relief for some people with Crohn’s disease.”
There are two main types of cannabinoid receptors: CB1 and CB2. THC, the cannabinoid responsible for cannabis’ intoxicating effects, interacts with CB1 receptors.
Dr. Naftali’s team looked at 46 people with Crohn’s disease. Some of the patients ingested a placebo for eight weeks. The other participants consumed cannabis oil comprised of 4 percent THC and 15 percent CBD. The participants’ symptoms, quality of life, and overall health were closely monitored.
“Cannabis has been used for centuries to treat a wide range of medical conditions, and studies have shown that many people with Crohn’s disease use cannabis regularly to relieve their symptoms,” Dr. Naftali explained.
“It has always been thought that this improvement was related to a reduction in inflammation in the gut and the aim of this study was to investigate this.”
After reviewing the results, the team determined that 65 percent of the group ingesting cannabis entered clinical remission. Only 35 percent of the placebo achieved the same status. The participants who consumed cannabis also reported an improved quality of life.
However, the participants’ inflammation levels weren’t affected. “We have previously demonstrated that cannabis can produce measurable improvements in Crohn’s disease symptoms but, to our surprise, we saw no statistically significant improvements in… the inflammatory markers we measured in the cannabis oil group compared with the placebo group,” said Dr. Naftali.
Separate studies have demonstrated that cannabis has an anti-inflammatory effect. It’s possible that while this is true, most of the benefits IBD patients derive from cannabis arise from another source.
Research into IBD and cannabis has been blocked by federal restriction. The U.S. government classifies cannabis as a Schedule 1 Drug. It’s difficult for researchers to fund large studies.
A lot of past research has focused on Crohn’s disease. A study that looked at ulcerative colitis found that participants struggled to adhere to the study guidelines. The study authors suggest participants were too affected by THC to stick to their therapy plan.
For years, patients were hesitant to speak to their doctors about medical cannabis. The attached stigma was too great. Cannabis was not only illegal, the reefer madness era painted weed smokers as social deviants, liable to break out into violence.
The climate is completely different now. Doctors openly tout the benefits of smoking cannabis. “Gastroenterologists should incorporate this discussion into their routine clinical evaluation of IBD patients,” writes Dr. Kinnucan of the University of Michigan.
“Most importantly, health care providers should know that under the federal law, they are protected from prosecution for recommending or suggesting that a patient use medical cannabis. Many providers are not aware of this and might avoid discussing medical cannabis because they think there may be legal or licensing implications.”
Patients who live in states with a legal recreational cannabis market can easily access quality products. Patients who are dealing with a medical cannabis market need to apply for a medical license first.
The type of product that a patient should get depends entirely on personal need and preference. Someone troubled by lung problems might want to avoid smoking flower. A patient with a sensitive palette might be wary about trying edibles.
Cannabis is prized as a potential IBD treatment because it has almost no side effects. The long-term effects of cannabis use, particularly among the IBD population, haven’t been thoroughly studied.
In the short-term, patients risk anxiety. High amounts of THC are loosely correlated with increased rates of anxiety. This is especially true if the person has little experience with cannabis.
Most researchers agree that “the small studies performed in both Crohn’s disease and ulcerative colitis have failed to show serious adverse events.” Many doctors are willing to prescribe cannabis to their IBD patients because there are almost no drawbacks. Cannabis users are less likely to develop an addiction than patients who use pharmaceutical drugs.
The science surrounding cannabis and IBD is still being formed. Many doctors and researchers believe cannabis has its use in treatment. However, there haven’t been enough studies for anyone to have a definitive opinion.
Patients who decide to incorporate cannabis into their treatment regimen should proceed carefully. It’s a good idea to have a discussion with a doctor prior to medicating.
Already using THC or CBD in your health plan regimen? Give our weekly cannabis recommendations a glance before your next dispensary visit.