Cannabis for IBD: Can it help?

For those living with inflammatory bowel disease or IBD, digestion can be a minefield. Inadvertent snacking on a trigger food can provoke excruciating pain or even numbness. A stressful day at work may lead to a flare in inflammation and hospitalization.

The chorus often sounded by those living with IBD is the way the disease can detrimentally impact one’s quality of life, and the ability to eat, sleep, work, exercise, socialize, and even travel. Cannabis has captured significant attention as an alternative treatment for gastrointestinal disorders. Can it offer therapeutic benefits for those living with IBD?

What is IBD?

IBD is an umbrella term that encompasses disorders characterized by chronic inflammation of the digestive tract, leading to symptoms such as abdominal cramps, diarrhea, fatigue, and weight loss. The two most common expressions of IBD are Crohn’s disease and ulcerative colitis. Individuals living with IBD are more likely to develop autoimmune diseases, especially rheumatoid, connective tissue, and dermatological disorders, than those who do not live with the disease.

Globally, IBD is becoming more prevalent in the West and is also on the rise in developing countries. According to expert Dr. Gilaad Kaplan, IBD appears to be a modern disease that has accompanied industrialization and is correlated with factors such as food additives and smoking. Treatment for IBD varies based on the severity and extent of the condition, and may include specific medications or surgery in severe cases.

What cannabis can and can’t do for IBD

Experimentation with alternative treatments is common among IBD patients. Conventional IBD therapies can be accompanied by serious side effects, especially with long-term use. The use of corticosteroids, for example, has been linked to higher incidences of autoimmune disease and greater susceptibility to infections.

Between 15-40% of adult patients with IBD turn to cannabis, claiming it relieves pain and nausea, stimulates appetite, assists sleep, and reduces the need for other medications. Cannabis use is extremely common among adolescent IBD patients, with one 2017 study claiming that 30-40% of young adults living with IBD had tried it and experienced some benefits.

Cannabis use has additionally been linked to reduced complications among IBD patients. A 2019 study compared the prevalence of Crohn’s disease complications among patients who used cannabis and those who didn’t. The authors found that cannabis users were significantly less likely to develop fistulas, abdominal abscesses, require blood transfusions or colectomies, or need parenteral nutrition.

For Dr. Jami Kinnucan, a gastroenterologist with clinical expertise in IBD and assistant professor at the University of Michigan, cannabis heralds promise alongside significant limitations. Kinnucan acknowledges that currently, conventional medical therapy does not meet all the needs of IBD patients, with many individuals experiencing persistent symptoms that can profoundly affect their quality of life.

One of the limitations of cannabis is that there is a scarcity of robust research from which to draw firm conclusions. “There have only been a handful of randomized controlled trials looking at cannabis in IBD,” said Kinnucan. “These studies have used various cannabis formulations, including THC only, THC and CBD, and CBD only. The studies looking at combination CBD:THC have found the greatest benefit over placebo in the reduction in symptoms that are associated with IBD including abdominal pain, diarrhea, nausea, and quality of life.”

Does cannabis mask symptoms or treat the disease?

Among the IBD studies where cannabis has been shown to alleviate symptoms, the effect seems to be more pronounced in patients with Crohn’s disease than ulcerative colitis. “The likely reason for this is improved abdominal pain, which is more common in patients with Crohn’s disease,” said Kinnucan. “The improvement in pain is the most cited benefit among IBD patients who use cannabis.”

While symptoms associated with IBD may improve under the influence of cannabis, there appears to be little effect on the root of the disease—the inflammation. “The studies have failed to show that cannabis, in any formulation, reduces the inflammation associated with IBD. While patients feel better, their disease doesn’t seem to improve,” said Kinnucan.

The question remains whether the beneficial effects occur because certain symptoms are being masked, or whether a true anti-inflammatory effect is taking place.

Integrating cannabis into IBD treatment: Risks and recommendations

According to Kinnucan, there is presently insufficient data to support the use of cannabis as a primary treatment for IBD. “I would not recommend that patients who have ongoing inflammation use cannabis as the primary mechanism for disease control,” said Kinnucan. “The main risk that has been associated with cannabis in IBD is that patients who use cannabis are more likely to discontinue their effective primary medical therapy.”

Kinnucan additionally points out while short-term risks appear minimal, the risks associated with long-term use of cannabis in IBD patients are less understood. A 2014 study found that patients with Crohn’s disease who used cannabis for six months or more showed a worse disease prognosis, due to an increased likelihood of needing surgery. Other research has identified a higher prevalence of psychiatric illness among IBD patients who use cannabis.

These findings serve to underline that, at present, cannabis is best considered a supplementary treatment. “In my experience, those patients that have adequate inflammation control—the disease is in remission—but experience ongoing symptoms, such as decreased appetite, abdominal pain, nausea or sleep disturbances, might benefit from adjuvant cannabis therapy to improve these symptoms,” said Kinnucan.

For patients looking to use cannabis as a supplement to their medical regimen, Kinnucan recommends oral formulations to minimize the risk associated with inhalation. She also advises patients to discuss cannabis use with their treating physician or healthcare provider.

Future directions

“Overall, we need larger randomized control trials evaluating cannabis in IBD, looking at multiple formulations and dosages to understand the true benefit and true risk of cannabis use in patients with IBD,” emphasized Kinnucan.

There are currently three clinical trials in the pipeline investigating cannabis as a treatment for IBD. Other researchers in the field are starting to stray beyond the familiar territory of THC and CBD, turning their attention to lesser-known cannabinoids such as CBC (cannabichromene) and CBG (cannabigerol), which may also have specific benefits to offer.

As these new findings come to light, we’ll likely gain a more nuanced and insightful grasp of how to harness the therapeutic potential of cannabis for IBD.