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What did the researchers find?
The effects of cannabis and cannabis oil on Crohn’s disease are uncertain. No firm conclusions regarding the benefits and harms (e.g. side effects) of cannabis and cannabis oil in adults with Crohn’s disease can be drawn. The effects of cannabis and cannabis oil in people with Crohn’s disease in remission have not been investigated. Further studies with larger numbers of participants are required to assess the potential benefits and harms of cannabis in Crohn’s disease. Future studies should assess the effects of cannabis in people with active and inactive Crohn’s disease. Different doses of cannabis and formulations (e.g. cannabis oil or pills) should be investigated.
One small study (N = 22) compared cannabis oil (5% cannabidiol) to placebo oil in people with active CD. This study was rated as high risk of bias for other bias (cannabis participants were more likely than placebo participants to be smokers). There was no difference in clinical remission rates. Forty per cent (4/10) of cannabis oil participants achieved remission at 8 weeks compared to 33% (3/9) of the placebo participants (RR 1.20, 95% CI 0.36 to 3.97; very low certainty evidence). There was no difference in the proportion of participants who had a serious adverse event. Ten per cent (1/10) of participants in the cannabis oil group had a serious adverse event compared to 11% (1/9) of placebo participants (RR 0.90, 95% CI 0.07 to 12.38, very low certainty evidence). Both serious AEs were worsening Crohn’s disease that required rescue intervention. This study did not report on clinical response, CRP, quality of life or withdrawal due to AEs.
What did the researchers investigate?
The researchers extensively searched the literature up to 17 October 2018 and found three studies (93 participants) that met the inclusion criteria. One ongoing study was also identified. All of the studies were small in size and had some quality issues. One small study (21 participants) compared eight weeks of treatment with cannabis cigarettes containing 115 mg of D9-tetrahydrocannabinol (THC) to placebo cigarettes containing cannabis with the THC removed in participants with active Crohn’s disease who had failed at least one medical treatment. Although no difference in clinical remission rates was observed, more participants in the cannabis group had improvement in their Crohn’s disease symptoms than participants in the placebo group. More side effects were observed in the cannabis cigarette group compared to placebo. These side effects were considered to be mild in nature and included sleepiness, nausea, difficulty with concentration, memory loss, confusion and dizziness. Participants in the cannabis cigarette group reported improvements in pain, appetite and satisfaction with treatment.
“If we followed patients longer, we might see some benefit,” Kinnucan says. “Maybe 8 weeks isn’t long enough.”
“We know the effects of cannabis in the gut and brain can have an impact,” says Jami Kinnucan, MD, a gastroenterologist at the University of Michigan. “So, the question raised is: Is there in an improvement objectively? Does inflammatory burden change?”
What the Studies Say
People who use cannabis may be more likely than those who don’t to stop traditional therapy. And there are risks when you stop the treatment you need. “One of the biggest risks of relapse is hospitalization requiring steroids or surgery,” Kinnucan says.
If you’re in treatment and still dealing with symptoms of your Crohn’s disease, it’s reasonable to ask whether any alternative therapies might help. Two related options that have become increasingly popular recently are marijuana and CBD. Both come from different varieties of a plant known as Cannabis sativa, or just cannabis. People also call the plant products that come from hemp CBD.
She says to talk to your doctor about your interest in cannabis and the symptoms that you’re hoping to control. Many doctors may not be comfortable having those conversations, but she encourages it as a way to learn more about symptoms, and people are using cannabis on their own. The bottom line is that given limited evidence on cannabis and uncertainty about its safety, it’s hard for doctors to offer advice.