Is cannabis the answer for people with Crohn’s and ulcerative colitis? The evidence is still out on its safety and effectiveness. 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.
Does cannabis offer new hope for folks with Crohn’s disease and ulcerative colitis?
Stomach pain, cramps, diarrhea, fatigue, rectal bleeding, fever, weight loss—these are just a few symptoms that are all too familiar to people with inflammatory bowel disease (IBD) (1-4). While people with IBD often feel embarrassed about their condition, there is no shame in it. Talking about IBD can lead to finding better ways to cope.
IBD is an umbrella term that describes chronic inflammatory conditions that affect the digestive tract—which includes the mouth, esophagus, stomach, and the small and large intestines (1-5). Crohn’s disease and ulcerative colitis are the most common forms of IBD (6). In North America, over 1.6 million people live with IBD (1;7-8), including around 270,000 Canadians—projected to be 400,000 by 2030 (9). And you guessed it…the fastest growing group of Canadians with IBD is adults aged 65 years old and over (9;10).
The cause of IBD is still a mystery, but it is thought to arise when environmental factors (e.g., infections, antibiotics, etc.) prompt the immune system to mistakenly attack microorganisms and food in the gut, producing inflammation in the digestive tract. Genetics may also play a role in increasing the risk of IBD (1-4;11). Typically, the disease alternates between periods of inactivity (a.k.a. remission) and periods when symptoms flare-up (a.k.a. relapse) (2-4).
Unfortunately, there is no cure for IBD. Instead, go-to medications often aim to reduce inflammation or suppress the immune system to get and keep people in remission (2-5). Many of these medications can come with potentially serious side effects, such as lymphoma, non-melanoma skin cancers, and liver issues (9).
One popular and highly debated alternative treatment option is cannabis (2;4). With cannabis touted as a one stop-shop for many of our medical needs, and its increasing accessibility through legalization, where does the evidence stand on its use for Crohn’s and ulcerative colitis, specifically?
What the research tells us
Two recent systematic reviews —one including patients with active Crohn’s (2) and the other including patients with active ulcerative colitis (4)—looked at the effect of cannabis cigarettes and cannabis oil on outcomes such as disease remission or activity, inflammation, side effects, and quality of life.
When reported on, neither review found that cannabis cigarettes or cannabis oil induced remission in patients with active disease or helped with inflammation (2;4). In both Crohn’s and ulcerative colitis, cannabis cigarettes led to a reduction in disease activity (2;4), but in Crohn’s patients, this was accompanied by an increase in mild side effects such as memory loss, drowsiness, confusion, dizziness, and trouble concentrating (2). Cannabis oil produced potentially meaningful increases in quality of life in both types of IBD (2;4), but in patients with ulcerative colitis, this strategy was associated with mild to moderately severe side effects such as headache, tiredness, dizziness, nausea, and trouble concentrating (4).
So, what should patients and caregivers affected by Crohn’s and ulcerative colitis make of these findings?
Ultimately, the evidence-base around the use of cannabis and cannabis oil for Crohn’s or ulcerative colitis is not of high quality. This means, at this time, no concrete conclusions about the effectiveness or safety of cannabis and cannabis oil can be made. Ideally, future research will include a larger number of participants, account for different disease statuses (e.g., active and inactive), and evaluate different types/doses of cannabis (2;4).
If you’re considering using cannabis or cannabis oil to treat your Crohn’s or ulcerative colitis, reach out to your health care provider to help you navigate the potential harms and benefits and factor in where the current evidence lies.
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.