IBD expresses itself as either Crohn’s Disease and Ulcerative Colitis, with immunomodulatory and anti-inflammatory drugs the standard prescription
However, these drugs only manage the symptoms in the short term, leaving patients in clear need of an alternative, effective intervention. Could cannabis help?
A group of scientists in Israel has been trying to answer that question in their recent paper, Cannabis in Inflammatory Bowel Diseases: from Anecdotal Use to Medicalization?
There are two manifestations of IBD – Ulcerative Colitis, which only affects the colon, and Crohn’s Disease, which may involve inflammation of any part of the gastrointestinal tract, such as the mouth, esophagus, stomach and anus. Both are serious, often alternating between periods of severe symptoms and relative relief. Symptoms include abdominal pain, diarrhoea, and internal bleeding (especially when the colon is involved). Alarmingly, the condition also leads to an increased risk of cancer of the involved organs.
It is thought that IBD is a result of both genetic and environmental factors, with diet – particularly a high-protein diet – significantly associated with the condition.
While there is no known cure, patients who suffer from IBD have to rely on a wide range of drugs to try and stem the inflammatory process and manage other symptoms such as pain. The standard treatment for IBD consists of various anti-inflammatory agents, such as 5-aminosalicylic acid, along with antibiotics, since bacterial infections are also often at play in the condition.
Patients will generally undergo a variety of immunomodulatory therapies, such as corticosteroids, thiopurines or methotrexate. Monoclonal antibodies are also being employed of late. These biological agents target specific cytokines, which are active in the inflammatory process.
Despite the impressive list of drugs used to manage IBD, patients rarely experience a consistent and sustainable remission. Corticosteroids, the most potent agents, achieve a remission rate of up to 80%, but due to significant side effects cannot be used long-term. Most other therapies only provide a remission rate of 50–60%. Additionally, more than 30% of IBD patients will need surgical intervention at some point, with that figure rising to over 70% of those with Crohn’s disease in particular.
Many are turning to cannabis
Due to the difficulties patients are faced with when it comes to traditional IBD treatments, it comes as no surprise that many are turning to alternative interventions. The study notes that between 16% and 50% of sufferers admit to having tried cannabis for their symptoms. They may have been influenced to do so by the many gastrointestinal symptoms that have been reported to be relieved by cannabis, such as anorexia, nausea, abdominal pain, diarrhoea, and gastroparesis – all of which can be present in IBD.
It is also worth noting that the gastrointestinal tract is rich in cannabinoid receptors, which may help explain cannabis’ efficacy at treating problems arising in this part of the body. In fact, the endocannabinoid system (ECS) is known to participate in maintaining the health of the gastrointestinal tract, whilst the phytocannabinoids THC and CBD have been shown to be effective in treating inflammation both outside and within the gastrointestinal tract. Cannabigerol (CBG) has also been shown to be effective in the treatment of IDB.
New Israeli research
These promising studies prompted Timna Naftali MD and Fred M. Konikoff MD to become interested in the potential role of cannabis and cannabinoids in IBD. They state in their paper that, after finding zero results of cannabis being studied in humans with IDB in a PubMed search in 2009, along with the increasing demand for prescriptions of medical cannabis from patients with IDB, they would undertake an observational study of the use of cannabis in treating IBD in Israel.
They proceeded to gather a list of licensed medical cannabis users within the database of Tikun Olam, a company that grows and supplies medical cannabis by license of the Ministry of Health. They succeeded in finding 30 patients with the diagnosis of Crohn’s disease, who were subsequently interviewed in order to obtain the data needed.
Most of these 30 patients smoked cannabis in the form of ‘joints’ (approx 0.5 g of cannabis per joint) and used between one and three joints per day. They used the Harvey-Bradshaw index in order to judge disease activity and found a reduction from an average of 14 ± 6.7 before cannabis consumption to 7 ± 4.7 (P < 0.001) post consumption. The use of other medications – including 5-ASA and corticosteroids – also appeared to be significantly reduced following the use of cannabis.
Additionally, 15 of the patients had a total of 19 surgeries during an average period of nine years before cannabis use, but only two required surgery during an average period of three years of cannabis use.
The first randomized placebo-controlled trial of cannabis in Crohn’s disease
These results motivated the authors to conduct the first randomized placebo-controlled trial of cannabis in Crohn’s disease. The study saw 21 active Crohn’s disease patients receive either cannabis cigarettes containing 23% of THC or a placebo for eight weeks.
Remarkably, 10 out of 11 patients in the cannabis group experienced a clinical response (Crohn’s Disease Activity Index (CDAI) > 100 ), with five of them achieving complete remission ( CDAI score < 150). A small randomized placebo-controlled study on the efficacy of cannabidiol (CBD) was also conducted. However, no beneficial effect was seen in 19 Crohn’s disease patients. Although it should be noted that this study used a very small dose of 10 mg/day.
Due to the limitations of these human studies – most notably the small number of patients and the fact that inflammatory activity was not measured before and after cannabis use – a further two randomized placebo-controlled studies have been initiated. One of which will look at the use of CBD-rich cannabis oil in Crohn’s disease, with inflammatory markers such as calprotectin and CRP being recorded, as well as an endoscopic evaluation before and after treatment. The second study will assess the effect of smoking cannabis on ulcerative colitis, also measuring inflammatory markers and endoscopic scoring, as well as clinical indices.
It is the authors’ hope that these studies will provide a clearer view of the role cannabis offers in the treatment of IBD. They speculate that the improvements reported by patients could be down to the “euphoria and a sense of general well-being induced by cannabis,” a reduction in stress and anxiety, or a direct result of an anti-inflammatory effect.
Until the results are published, we can take optimism from the fact that the use of cannabis is common in IBD, with many anecdotes complementing the results of the studies outlined above. How cannabis achieves these effects is yet unconfirmed, but thanks to determined scientists like Naftali and Konikoff, huge strides are being taken to find out and the future looks less bleak for sufferers of IBD.[Image credit- Wikimedia.Commons]