Using Cannabis in the Treatment of Inflammatory Bowel Disease

Submitted by Rachel Walsh, PA Student, Case Western Reserve University and Corie Kovach, MD, FACOG, MBA at Ohio Holistic Healthcare in Amherst, Ohio

 

The use of cannabis, most commonly referred to as marijuana, is increasing in popularity

in North America, roughly 47.5% of people from age 26 and older used in 2017. In the United

States, cannabis remains a schedule I substance and its use for recreational or medical means is

illegal according to federal law. However, individual state laws have allowed for medical use of

marijuana in 33 states and recreational use in 11 states.

The marijuana plant Cannabis sativa has been used in medical practice for thousands of

years. Cannabis has also grown increasingly popular in the treatment of inflammatory bowel

disease, among other chronic ailments. The pharmacologically active constituents of the

plant are termed cannabinoids, which act on the endocannabinoid system. This system

regulates various functions in the body, including gastrointestinal and immunity function.

Among the phytocannabinoids, delta-9-tetra-hydrocannabinol (THC) is thought to be the most

pharmacologically active. Studies reveal THC also plays roles as a relaxant, appetite stimulant, and analgesic. Another commonly studied phytocannabinoid within the cannabis plant is

cannabidiol, which is known to be an anti-inflammatory, anti-convulsant, antioxidant, anti-

psychotic, and anti-neoplastic. Studies suggest the combination of CBD and THC have a strong

anti-inflammatory and analgesic effect.

Inflammatory bowel disease (IBD) is a chronic inflammatory condition comprised of

Ulcerative colitis and Crohn’s disease. IBD is characterized by relapsing and remitting episodes

of inflammation primarily involving the gastrointestinal tract, although the pathophysiology of

IBD is not yet fully understood. Conventional therapies aimed at induction and remission of IBD

mainly work through immune suppression which consists of aminosalicylates, antibiotics,

corticosteroids, and immunomodulators (immune suppressors). The use of medical marijuana

for IBD has gained great attention in the press and the medical field; and there is growing

recognition of a fraction of IBD patients who are using cannabis for symptomatic control of

their IBD. These patients are reporting successful management of abdominal pain, joint pain,

cramping, diarrhea, poor appetite, weight loss, and nausea. How can this be? Research has

shown endocannabinoid CB1 and CB2 receptors are found in all layers of intestinal sections and

immune cells that regulate inflammation. Endocannabinoids, found in cannabis, thereby act on

CB1 and CB2 receptors in the gut and immune cells, which then quiets inflammation and

allows normal digestion to occur.

Taking a closer look into human studies, a 2014 Canadian population study of 319 IBD

patients, 91% of patients reported an improvement of symptoms with cannabis use. 83.9%

reported improved abdominal pain, 76.8% reported improved abdominal cramping, and 26%

reported resolved diarrhea. 37.5% reported that cannabis worked better than corticosteroids

and 87.9% would recommend cannabis use to other IBD patients. In short, cannabis has the

ability to entirely change a severely afflicted IBD patient’s well-being.  Patients and clinicians are starving for additional research and information; however, research has been made somewhat difficult and  limited secondary to the changing political status of the drug and amid threats of federal prosecution.