Eight weeks of CBD-rich cannabis treatment induced significant clinical and QOL improvement without significant changes in inflammatory parameters or endoscopic scores. The oral CBD-rich cannabis extract was well absorbed. Until further studies are available, cannabis treatment in Crohn's disease sh … There’s a little evidence that cannabis may help with some symptoms of Crohn’s, including improving appetite and sleep, but there’s a lot to consider first before you try it. Learn more. In small studies, smoking cannabis (marijuana — the dried parts of the cannabis plant) has improved IBD symptoms, including pain, nausea, and decreased appetite. However, there is currently no evidence that medical cannabis can reduce IBD inflammation or improve disease activity. Further research is needed, and underway now, regarding the impact of cannabis on IBD.
Oral CBD-rich Cannabis Induces Clinical but Not Endoscopic Response in Patients with Crohn’s Disease, a Randomised Controlled Trial
Aims: Despite reports that medical cannabis improves symptoms in Crohn’s disease [CD], controlled studies evaluating disease response are lacking. This study assessed the effect of cannabidiol [CBD]-rich cannabis oil for induction of remission in CD.
Methods: In a double-blind, randomised, placebo-controlled, single-centre trial, patients received orally either cannabis oil containing160/40 mg/ml cannabidiol/tetrahydrocannabinol [CBD/THC] or placebo for 8 weeks. Disease parameters, including the CD activity index [CDAI], and simple endoscopic score for CD [SES-CD], were assessed before and after treatment. In a subgroup of patients, blood samples were collected for CBD and THC plasma levels.
Conclusions: Eight weeks of CBD-rich cannabis treatment induced significant clinical and QOL improvement without significant changes in inflammatory parameters or endoscopic scores. The oral CBD-rich cannabis extract was well absorbed. Until further studies are available, cannabis treatment in Crohn’s disease should be used only in the context of clinical trials.
Keywords: Crohn’s disease; cannabidiol; cannabis.
© The Author(s) 2021. Published by Oxford University Press on behalf of European Crohn’s and Colitis Organisation. All rights reserved. For permissions, please email: [email protected]
Gianotti RJ, Cheifetz AS. Gianotti RJ, et al. J Crohns Colitis. 2021 Nov 8;15(11):1785-1786. doi: 10.1093/ecco-jcc/jjab091. J Crohns Colitis. 2021. PMID: 34137450 No abstract available.
Kafil TS, Nguyen TM, MacDonald JK, Chande N. Kafil TS, et al. Cochrane Database Syst Rev. 2018 Nov 8;11(11):CD012853. doi: 10.1002/14651858.CD012853.pub2. Cochrane Database Syst Rev. 2018. PMID: 30407616 Free PMC article.
Naftali T, Bar-Lev Schleider L, Dotan I, Lansky EP, Sklerovsky Benjaminov F, Konikoff FM. Naftali T, et al. Clin Gastroenterol Hepatol. 2013 Oct;11(10):1276-1280.e1. doi: 10.1016/j.cgh.2013.04.034. Epub 2013 May 4. Clin Gastroenterol Hepatol. 2013. PMID: 23648372 Clinical Trial.
Naftali T, Mechulam R, Marii A, Gabay G, Stein A, Bronshtain M, Laish I, Benjaminov F, Konikoff FM. Naftali T, et al. Dig Dis Sci. 2017 Jun;62(6):1615-1620. doi: 10.1007/s10620-017-4540-z. Epub 2017 Mar 27. Dig Dis Sci. 2017. PMID: 28349233 Clinical Trial.
Hardy J, Haywood A, Gogna G, Martin J, Yates P, Greer R, Good P. Hardy J, et al. Trials. 2020 Jul 6;21(1):611. doi: 10.1186/s13063-020-04541-6. Trials. 2020. PMID: 32631447 Free PMC article.
Kafil TS, Nguyen TM, MacDonald JK, Chande N. Kafil TS, et al. Inflamm Bowel Dis. 2020 Mar 4;26(4):502-509. doi: 10.1093/ibd/izz233. Inflamm Bowel Dis. 2020. PMID: 31613959 Review.
Bilbao A, Spanagel R. Bilbao A, et al. BMC Med. 2022 Aug 19;20(1):259. doi: 10.1186/s12916-022-02459-1. BMC Med. 2022. PMID: 35982439 Free PMC article. Review.
Baratta F, Pignata I, Ravetto Enri L, Brusa P. Baratta F, et al. Front Pharmacol. 2022 May 25;13:888903. doi: 10.3389/fphar.2022.888903. eCollection 2022. Front Pharmacol. 2022. PMID: 35694246 Free PMC article.
De Conno B, Pesce M, Chiurazzi M, Andreozzi M, Rurgo S, Corpetti C, Seguella L, Del Re A, Palenca I, Esposito G, Sarnelli G. De Conno B, et al. Foods. 2022 Apr 4;11(7):1044. doi: 10.3390/foods11071044. Foods. 2022. PMID: 35407131 Free PMC article. Review.
Tartakover Matalon S, Azar S, Meiri D, Hadar R, Nemirovski A, Abu Jabal N, Konikoff FM, Drucker L, Tam J, Naftali T. Tartakover Matalon S, et al. Front Endocrinol (Lausanne). 2021 Aug 31;12:685289. doi: 10.3389/fendo.2021.685289. eCollection 2021. Front Endocrinol (Lausanne). 2021. PMID: 34531823 Free PMC article. Clinical Trial.
Buckley MC, Kumar A, Swaminath A. Buckley MC, et al. Adv Ther. 2021 Jul;38(7):4152-4161. doi: 10.1007/s12325-021-01805-8. Epub 2021 Jun 10. Adv Ther. 2021. PMID: 34110607 Free PMC article. Review.
Can Marijuana or CBD Help With My Crohn’s Disease?
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.
Some people with inflammatory bowel diseases (IBD), including Crohn’s, are using cannabis of one type or another for symptom relief. There’s also a little bit of evidence that cannabis may help with some symptoms of Crohn’s, including improving appetite and sleep. But there’s a lot to consider first before you run out to try it. For one, while some people do seem to feel better when using cannabis, it’s isn’t clear it helps with their disease.
“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?”
The answer is no, she says. There’s no objective improvement in inflammation.
That’s important because Crohn’s disease is an inflammatory condition. Many of the treatments your doctor prescribes help you feel better by controlling the inflammation. So far, it looks like cannabis might make you feel better too, but without controlling your IBD. One reason that’s a concern, Kinnucan says, is that cannabis could mask or hide symptoms.
“If you are having regular abdominal pain, you need to look at the disease,” she says. “Often it’s untreated or undertreated. You don’t want to use cannabis as a Band-Aid.”
What the Studies Say
Experts generally agree that the data on cannabis for Crohn’s is uncertain for now. The only data in people with Crohn’s disease come from three small clinical studies. Altogether, those studies include fewer than 100 people with active Crohn’s.
Only one of the three suggests that cannabis in the form of marijuana cigarettes might help people who hadn’t done well with other treatments control their disease. Five out of 11 people who smoked cannabis cigarettes for 8 weeks in the study had a remission, compared to one person in the group that smoked placebo cigarettes. The other two studies looked at CBD oil. Neither found CBD helped people control their Crohn’s disease. One of them did show some evidence that the treatment helped improve quality of life.
More research is needed in more people with Crohn’s disease, and there are studies ongoing. One reason it’s complicated is that cannabis comes in many varieties. The plant has two main active ingredients: THC (short for delta-9 tetrahydrocannabinol) and CBD (short for cannabidiol). It’s the THC in marijuana that gives you a high. The CBD products you can buy usually come from hemp and shouldn’t have much if any THC. We need more time to study the various compounds found in cannabis.
The evidence available — while not convincing — doesn’t rule out the possibility that cannabis might help some people with Crohn’s. Kinnucan says one reason studies so far may not show a benefit is that they might not use the best cannabis formulations. There’s some experimental evidence that cannabinoids can help with inflammation. But, she says, it might take a more targeted approach to see those benefits in people with IBD. The existing studies also have been small and short-term.
“If we followed patients longer, we might see some benefit,” Kinnucan says. “Maybe 8 weeks isn’t long enough.”
What to Consider
For someone with Crohn’s disease interested in using cannabis, Kinnucan says there’s no reason to think it will help if you already feel well and your disease is in remission. For a person who has Crohn’s but doesn’t have obvious symptoms, it’s possible that adding cannabis to other medications might have some benefits, although those aren’t proven. If you want to replace their prescribed medicines with cannabis, she says, “we certainly don’t have any evidence to support that.”
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.
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.
“Providers have no idea what to tell patients who say, ‘OK, I want to start cannabis. What should I do?’” Kinnucan says. “There’s limited guidance about how to advise patients.”
Your doctor may have other ideas about ways to help you feel better. For now, if you’re set on trying it, Kinnucan suggests starting with the lowest THC concentration and going from there to limit potential side effects. Work with a medicinal pharmacy that may have some more advice about what’s available.
The Crohn’s and Colitis Foundation’s official position statement on medical cannabis notes that while there’s some evidence the cannabinoids found in our bodies naturally might help with inflammation, it’s less clear that similar compounds from cannabis do. There’s some evidence that cannabis may help with symptoms, but its use is limited by other concerns about side effects and safety.
There are also legal issues to consider when it comes to cannabis. CBD is federally legal, and it’s becoming easier to get it. Marijuana isn’t legal at the federal level. More states are allowing it, but rules and restrictions vary. If you’re thinking about using or recommending medical cannabis, CBD, or marijuana, you need to check your state laws carefully. Employers may also have drug use policies to consider.
Mayo Clinic: “Medical Marijuana.”
Expert Review of Gastroenterology and Hepatology: “An overview of cannabis based treatment in Crohn’s disease.”
Clinical Gastroenterology and Hepatology: “Cannabis induces a clinical response in patients with Crohn’s disease: a prospective placebo-controlled study.”
Jami Kinnucan, MD, gastroenterologist, University of Michigan.
Cochrane Database of Systematic Reviews: “Cannabis for the treatment of Crohn’s disease.”
Crohn’s and Colitis Foundation: “Foundation Position Statement: Medical cannabis,” “Medical Cannabis.”
In small studies, smoking cannabis (marijuana — the dried parts of the cannabis plant) has improved IBD symptoms, including pain, nausea, and decreased appetite.
However, there is currently no evidence that medical cannabis can reduce IBD inflammation or improve disease activity. Further research is needed, and underway now, regarding the impact of cannabis on IBD.
Video Length 00:01:20
What is the role of medical cannabis in the management of IBD? You may be hearing more and more about medical cannabis. How can it help patients with IBD? Watch this video to learn more about cannabis as well as its potential benefits and risks.
Cannabis is composed of over 70 active compounds called phytocannabinoids or cannabinoids.
The first is delta-9-tetrahydrocannabinol, or THC. THC is most known for its effects on one’s mental state. It has been known to alleviate nausea and chronic pain and improve one’s appetite.
The second is cannabidiol, or CBD, which has more anti-inflammatory or immune properties. Therapeutic uses may include reducing inflammation and treating insomnia, sleep apnea, spasticity, and pain.
Potential side effects
It is important to remember that cannabis can cause side effects including severe nausea and vomiting (a condition called cannabis hyperemesis syndrome), impaired short-term memory, difficulty concentrating, altered judgment, impaired coordination, anxiety, worsening mood, and long-term problems with behavior and reasoning, particularly in adolescents. There are also increased risks for fetuses and newborns if used during pregnancy or breastfeeding.