Marijuana as a Crohn’s disease treatment may sound psychedelic — but it’s gaining traction.
While possession and use of marijuana is still prohibited by federal law which supersedes state law, 44 states have medical marijuana laws that allow for the use of the drug. Fourteen states explicitly permit the use of medical marijuana to treat Crohn’s disease (but not ulcerative colitis). And, as you’ve surely heard on the news, recreational marijuana is legal in 8 states and Washington D.C.
Despite these changes, the long prohibition on marijuana has had an impact on research. There have been few studies evaluating the efficacy and safety of marijuana – though the existing research and anecdotal evidence suggest there may be value for people living with Crohn’s disease or inflammatory bowel disease (IBD). Let’s check out those studies.
NOTE: Always be aware of federal and state laws before using any substance. NORML, a group working to reform marijuana laws, provides information on state medical marijuana laws.
Are people with IBD currently using marijuana?
A survey of 292 patients at Brigham and Women’s Hospital Crohn’s and Colitis Center attempted to understand current use of people with IBD, over 60% of whom had Crohn’s disease. The study was published in Inflammatory bowel diseases in 2013 and found that 51.3% of people were either active users, or past users, or marijuana. And, the majority of people felt that the drug was helpful for relief of the following symptoms:
- abdominal pain
- poor appetite
Interestingly, responses indicated that marijuana may not have been useful in helping with diarrhea — which may help future researchers determine the biological mechanisms at play. All in all, there was interest in use of marijuana by people with IBD and half of people that had never used the drug before expressed interest in using it for symptom control. The researchers suspected that legal barriers and drug screening by employers could have held the usage statistics down.
There were some things to be aware of with this study. 90% of the patients surveyed were white. This may have been a reflection on the location of the study: Brigham and Women’s Hospital in Boston. Also, as symptom improvement was based on participant recall, it is possible that people experienced recall bias, over-exaggerating the actual benefits.
Marijuana and Crohn’s disease clinical studies
The first report of marijuana, often known by the name cannabis in research, being used to treat Crohn’s disease in humans was published by Naftali, T., et. al, in 2011. This was a retrospective, observational study on 30 patients with Crohn’s disease. Using the Harvey Bradshaw index to measure disease severity, the researchers found that cannabis significantly decreased Crohn’s presence. Additionally, participants needed other medications less and required fewer surgeries when using cannabis.
Dr. Naftali continued researching the value of marijuana on Crohn’s disease and in 2013 published a prospective placebo-controlled study. This study attempted to induce remission in Crohn’s disease patients with high disease activity that did not respond to steroids, immunomodulators, or biologics. Participants either smoked cannabis with THC (Δ9-tetrahydrocannabinol, a cannabinoid) or a placebo where the THC was extracted.
While remission was not achieved, the 8 week course of THC-rich cannabis “produced significant clinical, steroid-free benefits [for] 10 of 11 patients with active Crohn’s disease.” This study, while promising, was conducted on a small number of individuals. Larger trial size is necessary to better understand the impact of the drug.
With a focus on IBD more generically, Lahat, Lang, and Ben-Horin, 2012, studied 13 patients treated for 3 months with cannabis. These patients reported significant “improvement in general health perception, social functioning, ability to work, physical pain, and depression.” Additionally, the participants experienced weight gain and a rise in body mass index (BMI). Again, the results are promising despite a small sample size.
Future marijuana research
Beyond legal barriers to funding and completing research on marijuana, there are problems with ensuring that the plants being used are consistent. This problem is examined by FiveThirtyEight who notes that the genetic diversity in different strands of cannabis are as different as between, “humans and chimpanzees.” This is a problem for using marijuana as a drug as the consistency of the product can be hard to ensure. And, differences in cannabis could lead to different effects.
For example, THC, the most commonly known cannabinoid (a chemical compound that can impact the brain or body) in cannabis is known to cause the psychoactive elements of the drug. However, cannabidiol or CBD is a different cannabinoid that may be useful for medical applications because it does not have the psychoactive properties. There are at least 113 active cannabinoids in cannabis and those cannabinoids occur in different amounts due to the history of the plant strand and cultivation. This can make it hard, if not impossible, to ensure that products are consistent over time. Obviously, a problem when trying to do accurate research and when trying to understand the medical value of a drug.
An increased understanding of the endocannabinoid system in the body and cannabinoids is necessary. This research is just beginning to pick up speed. If the small studies available up until now and the anecdotal stories are true, marijuana may help people with Crohn’s live happier and healthier lives.