Therapeutic Use of Cannabis in Inflammatory Bowel Disease

Waseem Ahmed | Seymour Katz

Ninety-one percent of patients indicated improvement of IBD symptoms with cannabis use; 83.9% reported improved abdominal pain, 76.8% indicated improved abdominal cramping, 48.2% had improved joint pain, and 28.6% reported improved diarrhea.12 Patients also believed that cannabis improved their general well-being, stress level, and sense of control over IBD. Patients report substantial therapeutic effects of cannabis in the management of abdominal pain, nausea, and diarrhea, and a significant number of patients are interested in using cannabis for management of their IBD. Symptomatic Improvement With Cannabis Use in Patients With Inflammatory Bowel Disease Following the promising results of cannabinoids in murine models of colitis ( ),29-32 Naftali and colleagues in 2011 presented the first study examining the response of patients with CD to cannabis use ( ).33 The authors conducted a retrospective, observational study of 30 CD patients in Israel who were legally using cannabis due to a lack of response to conventional treatments and chronic intractable pain. Lahat and colleagues were able to provide CRP levels for only 6 patients before and during treatment, and this trended toward a decrease in CRP levels during treatment with cannabis.34The authors concluded that cannabis use improves quality of life in patients with IBD, results in a statistically significant increase in patient weight and body mass index, and improves clinical disease activity index in patients with CD, and postulated that such effects were related to the analgesic, anti-inflammatory, antimotility, and additional effects of cannabinoids.34 After performing retrospective research,33 Naftali and colleagues completed the first prospective, randomized, double-blind, placebo-controlled trial by evaluating 21 patients with CD refractory to aminosalicylates, corticosteroids, immunomodulators, or biologic agents.35 The primary objective of the study was induction of remission of CD as defined by a Crohn’s Disease Activity Index (CDAI) score of less than 150 after 8 weeks of treatment. Although each of these studies reports improved levels of abdominal pain, nausea, and appetite, significant prior data have shown that cannabis use via central effects can be responsible for such benefits; the fact that fewer patients reported relief of diarrhea argues that cannabis may not have a role in mediating inflammation and instead masks active disease with symptomatic improvement and overexaggerates treatment effect, as suggested by Storr and colleagues.12 The majority of these trials occurred in specialized IBD centers with a largely white, homogeneous population that does not match the typical demographic seen in IBD patients today.

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