Is cannabis the answer for people with Crohn’s and ulcerative colitis? The evidence is still out on its safety and effectiveness. <span><b>Introduction</b>: Cannabis use among inflammatory bowel disease (IBD) patients is common. There are many studies of various laboratory models demonstrating the anti-inflammatory effect of cannabis, but their translation to human disease is still lacking.<b>Areas covered</b>: The cannabis plant co</span> …
Does cannabis offer new hope for folks with Crohn’s disease and ulcerative colitis?
Stomach pain, cramps, diarrhea, fatigue, rectal bleeding, fever, weight loss—these are just a few symptoms that are all too familiar to people with inflammatory bowel disease (IBD) (1-4). While people with IBD often feel embarrassed about their condition, there is no shame in it. Talking about IBD can lead to finding better ways to cope.
IBD is an umbrella term that describes chronic inflammatory conditions that affect the digestive tract—which includes the mouth, esophagus, stomach, and the small and large intestines (1-5). Crohn’s disease and ulcerative colitis are the most common forms of IBD (6). In North America, over 1.6 million people live with IBD (1;7-8), including around 270,000 Canadians—projected to be 400,000 by 2030 (9). And you guessed it…the fastest growing group of Canadians with IBD is adults aged 65 years old and over (9;10).
The cause of IBD is still a mystery, but it is thought to arise when environmental factors (e.g., infections, antibiotics, etc.) prompt the immune system to mistakenly attack microorganisms and food in the gut, producing inflammation in the digestive tract. Genetics may also play a role in increasing the risk of IBD (1-4;11). Typically, the disease alternates between periods of inactivity (a.k.a. remission) and periods when symptoms flare-up (a.k.a. relapse) (2-4).
Unfortunately, there is no cure for IBD. Instead, go-to medications often aim to reduce inflammation or suppress the immune system to get and keep people in remission (2-5). Many of these medications can come with potentially serious side effects, such as lymphoma, non-melanoma skin cancers, and liver issues (9).
One popular and highly debated alternative treatment option is cannabis (2;4). With cannabis touted as a one stop-shop for many of our medical needs, and its increasing accessibility through legalization, where does the evidence stand on its use for Crohn’s and ulcerative colitis, specifically?
What the research tells us
Two recent systematic reviews —one including patients with active Crohn’s (2) and the other including patients with active ulcerative colitis (4)—looked at the effect of cannabis cigarettes and cannabis oil on outcomes such as disease remission or activity, inflammation, side effects, and quality of life.
When reported on, neither review found that cannabis cigarettes or cannabis oil induced remission in patients with active disease or helped with inflammation (2;4). In both Crohn’s and ulcerative colitis, cannabis cigarettes led to a reduction in disease activity (2;4), but in Crohn’s patients, this was accompanied by an increase in mild side effects such as memory loss, drowsiness, confusion, dizziness, and trouble concentrating (2). Cannabis oil produced potentially meaningful increases in quality of life in both types of IBD (2;4), but in patients with ulcerative colitis, this strategy was associated with mild to moderately severe side effects such as headache, tiredness, dizziness, nausea, and trouble concentrating (4).
So, what should patients and caregivers affected by Crohn’s and ulcerative colitis make of these findings?
Ultimately, the evidence-base around the use of cannabis and cannabis oil for Crohn’s or ulcerative colitis is not of high quality. This means, at this time, no concrete conclusions about the effectiveness or safety of cannabis and cannabis oil can be made. Ideally, future research will include a larger number of participants, account for different disease statuses (e.g., active and inactive), and evaluate different types/doses of cannabis (2;4).
If you’re considering using cannabis or cannabis oil to treat your Crohn’s or ulcerative colitis, reach out to your health care provider to help you navigate the potential harms and benefits and factor in where the current evidence lies.
An overview of cannabis based treatment in Crohn’s disease
Introduction: Cannabis use among inflammatory bowel disease (IBD) patients is common. There are many studies of various laboratory models demonstrating the anti-inflammatory effect of cannabis, but their translation to human disease is still lacking.Areas covered: The cannabis plant contains many cannabinoids, that activate the endocannabinoid system. The two most abundant phytocannabinoids are the psychoactive Tetrahydrocannabinol (THC), and the (mostly) anti-inflammatory cannabidiol (CBD). Approximately 15% of IBD patients use cannabis to ameliorate disease symptoms. Unfortunately, so far there are only three small placebo controlled study regarding the use of cannabis in active Crohns disease, combining altogether 93 subjects. Two of the studies showed significant clinical improvement but no improvement in markers of inflammation.Expert opinion: Cannabis seems to have a therapeutic potential in IBD. This potential must not be neglected; however, cannabis research is still at a very early stage. The complexity of the plant and the diversity of different cannabis chemovars create an inherent difficulty in cannabis research. We need more studies investigating the effect of the various cannabis compounds. These effects can then be investigated in randomized placebo controlled clinical trials to fully explore the potential of cannabis treatment in IBD.
Keywords: Cannabis; Crohn’s disease; inflammatory bowel disease; marihuana; ulcerative colitis.
Kafil TS, Nguyen TM, MacDonald JK, Chande N. Kafil TS, et al. Cochrane Database Syst Rev. 2018 Nov 8;11(11):CD012853. doi: 10.1002/14651858.CD012853.pub2. Cochrane Database Syst Rev. 2018. PMID: 30407616 Free PMC article.
Hasenoehrl C, Storr M, Schicho R. Hasenoehrl C, et al. Expert Rev Gastroenterol Hepatol. 2017 Apr;11(4):329-337. doi: 10.1080/17474124.2017.1292851. Epub 2017 Feb 16. Expert Rev Gastroenterol Hepatol. 2017. PMID: 28276820 Free PMC article. Review.
Carvalho ACA, Souza GA, Marqui SV, Guiguer ÉL, Araújo AC, Rubira CJ, Goulart RA, Flato UAP, Bueno PCDS, Buchaim RL, Barbalho SM. Carvalho ACA, et al. Int J Mol Sci. 2020 Apr 22;21(8):2940. doi: 10.3390/ijms21082940. Int J Mol Sci. 2020. PMID: 32331305 Free PMC article. Review.
Naftali T, Bar-Lev Schleider L, Dotan I, Lansky EP, Sklerovsky Benjaminov F, Konikoff FM. Naftali T, et al. Clin Gastroenterol Hepatol. 2013 Oct;11(10):1276-1280.e1. doi: 10.1016/j.cgh.2013.04.034. Epub 2013 May 4. Clin Gastroenterol Hepatol. 2013. PMID: 23648372 Clinical Trial.
Kafil TS, Nguyen TM, MacDonald JK, Chande N. Kafil TS, et al. Inflamm Bowel Dis. 2020 Mar 4;26(4):502-509. doi: 10.1093/ibd/izz233. Inflamm Bowel Dis. 2020. PMID: 31613959 Review.
De Conno B, Pesce M, Chiurazzi M, Andreozzi M, Rurgo S, Corpetti C, Seguella L, Del Re A, Palenca I, Esposito G, Sarnelli G. De Conno B, et al. Foods. 2022 Apr 4;11(7):1044. doi: 10.3390/foods11071044. Foods. 2022. PMID: 35407131 Free PMC article. Review.
McDew-White M, Lee E, Alvarez X, Sestak K, Ling BJ, Byrareddy SN, Okeoma CM, Mohan M. McDew-White M, et al. EBioMedicine. 2022 Jan;75:103769. doi: 10.1016/j.ebiom.2021.103769. Epub 2021 Dec 23. EBioMedicine. 2022. PMID: 34954656 Free PMC article.
Abyadeh M, Gupta V, Paulo JA, Gupta V, Chitranshi N, Godinez A, Saks D, Hasan M, Amirkhani A, McKay M, Salekdeh GH, Haynes PA, Graham SL, Mirzaei M. Abyadeh M, et al. Biomolecules. 2021 Sep 27;11(10):1411. doi: 10.3390/biom11101411. Biomolecules. 2021. PMID: 34680044 Free PMC article. Review.
Silvestri C, Pagano E, Lacroix S, Venneri T, Cristiano C, Calignano A, Parisi OA, Izzo AA, Di Marzo V, Borrelli F. Silvestri C, et al. Front Pharmacol. 2020 Oct 8;11:585096. doi: 10.3389/fphar.2020.585096. eCollection 2020. Front Pharmacol. 2020. PMID: 33162890 Free PMC article.