Cannabis for Crohn's and Colitis?

When you live with Inflammatory Bowel Disease (IBD), such as Crohn’s disease (CD) or ulcerative colitis (UC), you may find yourself searching for new ways to manage your symptoms and improve your quality of life. Many people with Crohn’s or Colitis use cannabis as a way to manage their symptoms, but what exactly are the benefits and risks of using cannabis with IBD? Let’s break it down.

What Is Cannabis?

Cannabis, also known as marijuana, is a plant that contains over 100 different cannabinoids, but the two most well-known are tetrahydrocannabinol (THC) and cannabidiol (CBD).

• THC: This is the component responsible for the "high" associated with marijuana use. THC affects cells in the brain and peripheral nervous system, which is why it has psychoactive effects.
• CBD: Unlike THC, CBD doesn’t produce a high, which means it may not have the same risk for addiction. It has been studied for its potential therapeutic benefits, especially for conditions where a psychoactive effect is not desirable.

FDA-Approved Cannabis Products

Some cannabis-based products have been approved by the FDA for specific medical conditions: ^

• Epidiolex: A purified form of CBD that is used to treat seizures associated with epilepsy.
• Dronabinol (Marinol or Syndros): Dronabinol is a synthetic form of THC that helps treat nausea in cancer patients undergoing chemotherapy and stimulates appetite in individuals with AIDS.
• Nabilone (Cesamet): Nabilone is another synthetic THC product that is used similarly to Dronabinol for treating nausea and appetite loss.

Why individuals with IBD may be interested in using cannabis

If you have Inflammatory Bowel Disease (IBD), you might consider using cannabis for several reasons including: ^{ }

• Pain Management: Many IBD patients deal with chronic abdominal pain and use cannabis for pain relief.
• Reduced Nausea: Some patients experience nausea and vomiting, especially during flare-ups and use cannabis to alleviate these symptoms. 
• Appetite Stimulation: IBD can lead to a decreased appetite, which may result in weight loss and malnutrition. Individuals with IBD may use cannabis to improve their appetite. 
• Improved Sleep: Many individuals with IBD struggle with sleep disturbances due to pain, trips to the bathroom, discomfort, or anxiety and they may want to try using cannabis to help improve their sleep quality.
• Perceived Anti-Inflammatory Properties: Some patients believe that cannabis helps reduce inflammation. 

• Anxiety and Stress Relief: Living with a chronic condition like IBD can lead to significant stress and anxiety and some patients use cannabis to help manage it.
• Peer Recommendations: Recommendations from friends, family, or online IBD communities often encourage patients to try cannabis. 

How Cannabis Affects Inflammation in IBD

Cannabis has been explored for its potential anti-inflammatory effects in individuals with IBD. A systematic review and meta-analysis, a type of study that includes combined results from many studies on the topic, found that cannabinoids are not effective at inducing remission in IBD patients. ^

Cannabis for Managing IBD Symptoms

Despite its limited effectiveness in inducing remission, cannabis might still offer symptom relief, though several studies to date have shown mixed results. 

A systematic review and meta-analysis found that cannabinoids significantly improved patient-reported symptoms including abdominal pain, general well-being, nausea, diarrhea, and poor appetite.^ Interestingly, even though cannabis use in individuals with IBD increases appetite levels, one study in individuals with IBD found that it may not actually increase body weight.^ 

Another study found that recent cannabis users with IBD actually reported more abdominal pain, poor appetite, and gas.^ One theory for this could be that cannabis users with IBD are experiencing more severe symptoms because their disease is not well managed with medications, which may, in turn, encourage them to seek alternative options for symptom relief. 

Based on the research available to date, it’s clear that we need more studies before we know for sure whether cannabis use is helpful for managing IBD symptoms. 

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Impact of Cannabis on Disease Outcomes

Research on the impact of cannabis use on disease outcomes in individuals with IBD has been somewhat conflicting:

• Positive Outcomes: One study found that cannabinoid use was associated with shorter hospital stays and a lower risk of needing parenteral nutrition (intravenous feeding).^
• Poor Clinical Outcomes: However, in a study with over 1,000 IBD patients, individuals with ulcerative colitis (but not Crohn’s disease) who used cannabis before a hospital admission were nearly 2.5 times more likely to be readmitted within 30 days.^ In another study, researchers found that Crohn’s disease patients using cannabis were more likely to need steroids & opioids and all cannabis using IBD patients were more likely to need to go to the emergency department and be hospitalized.^ 

Other Potential Uses of Cannabis

Cannabis and its derivatives are not only being explored for IBD but also for other conditions:^

• Epilepsy and Parkinson’s Disease: CBD may have a moderate effect in managing epilepsy and Parkinson’s disease.
• Chronic Pain and Appetite Stimulation: Dronabinol has been found to moderately impact chronic pain and appetite, and has shown benefits for those with Tourette’s syndrome.
• Spasticity and Substance Use Disorders: Nabiximols, another cannabis-based product, may help with chronic pain, spasticity (muscle stiffness), sleep disorders, and even substance use disorders.

Risks and Drawbacks of Using Cannabis

While cannabis may offer some benefits, it also comes with potential risks, including the following:

• Lung Health: Smoking cannabis can damage lung tissues, leading to conditions like bronchitis and scarring of small blood vessels.^
• Heart Health: Cannabis use has been linked to an increased risk of strokes and heart diseas.^
• Mental Health: cannabis use can lead to increased anxiety, psychological distress, suicidal thoughts, and psychotic symptoms.^ These risks are particularly concerning for individuals with mood disorders and its use is therefore contraindicated in this population.^ 

• Long-Term Use Problems: Cannabis-use disorder is a condition where an individual is unable to stop using cannabis despite experiencing adverse effects, such as vomitin.^ Long-term cannabis use can increase dependance on it and withdrawal symptoms, such as increased irritability, sleep disturbance, reduced appetite, and depression, make it challenging to discontinue its use.^ 
• Delayed Mental Functioning: Cannabis can also lead to mental slowness, impaired reaction times, and memory declin.^{ }

• GI Symptoms: Cannabis can also cause nausea, vomiting, diarrhea, and abdominal pain. In some cases, it can lead to more serious conditions like cannabinoid hyperemesis syndrome, a condition characterized by severe vomiting. Cannabis use can also lead to intussusception, a condition where part of your intestine goes into another part of your intestine. 

Conclusion

Cannabis and its associated cannabinoids present a complex array of potential benefits and risks for individuals with IBD. While they may help manage certain symptoms and improve quality of life, they come with significant health risks that should also be considered. Before considering cannabis as a treatment option, it’s essential to consult with your IBD care team including your gastroenterologist to carefully weigh the pros and cons and to explore all available treatment options that will help you feel your best.