An evidence-based look at Crohns Disease and Ulcerative Colitis. This blog explores various aspects of inflammatory bowel disease, including nutrition, treatment, and lifestyle based on clinical evidence.
Sunday, July 21, 2013
Inflammatory Bowel Disease and Pot
Medical Marijuana and IBD
The great pot debate has been
raging for several years. While
possessing marijuana is still a federal offense, many state governments have
chosen to create medical marijuana exceptions to laws at a state level. At a federal level, resource limitations and
other priorities have limited any federal enforcement of medical marijuana
providers at a state level.
Medical marijuana has been
proposed as a treatment for many conditions, ranging from glaucoma relief to
its use as an anti-emetic by cancer patients.
This post focuses on the use of marijuana and cannabinoids on
inflammatory bowel disease from a medical perspective, and does not address
other uses of the drug or its legal status.
Marijuana has been shown to have a
modulation effect on the cannabinoid receptors CB1 and CB2 in rat studies. Because CB1 and CB2 are related to enteric
and immune modulation, marijuana has the potential for impacting Crohn’s and
Ulcerative Colitis patients (though positively or negatively is not known).(1) There has been some human genetic research
showing that CNR1, a human cannabinoid receptor, has a modulation effect on the
susceptibility of an individual to Crohn’s and UC.(2) There is even some evidence in mouse models
of colitis that cannabidiol (not the psychotropic THC), an ingredient of
marijuana, has a positive impact on intestinal protection.(3)
Marijuana has been postulated to
have a positive effect on both Crohn’s disease and Ulcerative Colitis, however
the evidence for it doing so is sparse.
The most cited study looking at the effects showed a positive increase
in the health of individuals who used marijuana and had Crohn’s disease. Unfortunately, the study only included 30
patients and was a retrospective (and uncontrolled) study.(4) A smaller study, consisting of 21 patients,
showed a positive change in CDAI scores vs. placebo in a prospective look. This study used cigarettes with THC for the
active and with the THC removed for the control, so the study was likely not
blind to the users.(5) To date, there
have been no large-scale, well-controlled studies showing the efficacy of
marijuana for IBD.
Marijuana consumption through
smoking has many of the same associated negatives as nicotine-based smoking,
though some to a lesser degree, including the impact on the lungs and the
psychotropic effects (which can also be a positive in some circumstances). Additionally, smoking marijuana has an impact
on gastric motility, slowing down digestive function, which may be dangerous
for individuals with structuring disease.(6)
If a particular cannabinoid can be
isolated and taken orally to interact positively with the CB1 and CB2
receptors, it may open up a new treatment path for IBD. Right now, smoking marijuana has known
negative side effects (and the cannabinoid ratios are not well controlled), and
has not shown efficacy in quality evidence-based studies for the treatment of
Crohn’s and Ulcerative Colitis. That
said, preliminary studies show areas of promise, and cannabinoid extracts may
prove an effective treatment with substantial testing and research (though more
likely through oral administration than inhalation).
·Smoking marijuana to treat Crohn’s and
Ulcerative Colitis has no solid proof of efficacy.
·There are known negative side effects to smoking
marijuana, and unless better evidence is uncovered, its use by those with IBD
is not warranted.
1.Tsou, K., S. Brown, M. C. Sanudo-Pena, K.
Mackie, and J. M. Walker. "Immunohistochemical distribution of cannabinoid
CB1 receptors in the rat central nervous system."Neuroscience 83,
no. 2 (1997): 393-411.
2.Storr, Martin, Dominik Emmerdinger, Julia
Diegelmann, Simone Pfennig, Thomas Ochsenkühn, Burkhard Göke, Peter Lohse, and
Stephan Brand. "The cannabinoid 1 receptor (CNR1) 1359 G/A polymorphism
modulates susceptibility to ulcerative colitis and the phenotype in Crohn's disease."PLoS
no. 2 (2010): e9453.
3.Borrelli, Francesca, Gabriella Aviello, Barbara
Romano, Pierangelo Orlando, Raffaele Capasso, Francesco Maiello, Federico
Guadagno et al. "Cannabidiol, a safe and non-psychotropic ingredient of
the marijuana plant Cannabis sativa, is protective in a murine model of
colitis."Journal of molecular medicine 87,
no. 11 (2009): 1111-1121.
4.Naftali, T., L. Bar Lev, D. Yablecovitch, E.
Half, and F. M. Konikoff. "Treatment of Crohn's disease with cannabis: an
observational study."The Israel Medical Association journal: IMAJ 13,
no. 8 (2011): 455.
5.Naftali, Timna, Lihi Bar Lev, Iris Dotan,
Ephraim Philip Lansky, Benjaminov Fabiana Sklerovsky, and Fred Meir Konikoff.
"Cannabis Induces a Clinical Response in Patients with Crohn’s Disease: a
Prospective Placebo-Controlled Study."Clinical Gastroenterology and Hepatology (2013).
6.Aviello, G., B. Romano, and A. A. Izzo.
"Cannabinoids and gastrointestinal motility: animal and human
studies."Eur Rev Med Pharmacol Sci 12,
no. Suppl 1 (2008): 81-93.