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Inflammatory bowel disease, which caused 51,000 deaths in 2013, is the chronic inflammation of the digestive track. Studies have shown marijuana reduces the pain, nausea and diarrhea associated with the disease and even shows promise as a treatment that encourages remission.
Overview of Inflammatory Bowel Disease
Inflammatory bowel disease (IBD) is chronic inflammation of lining of the digestive track. The two major types of IBD are ulcerative colitis, which affects the innermost lining of the large intestine and rectum, and Crohn’s disease, which can affect different areas of the digestive track and often sees the inflammation spread deep into affected areas. More rare types of IBD’s include collagenous colitis and lymphocytic colitis.
The symptoms associated with IBD vary depending on inflammation severity. The disease causes abdominal pain, rectal bleeding, severe diarrhea, fever, weight loss, fatigue, blood in one’s stool, and malnutrition. The pain caused by IBD can be debilitating.
Heredity and abnormal behavior by the immune system are likely what cause Crohn’s disease. Those who have family members with the disease are more common to acquire it themselves. When the immune system responds to fight off a virus, bacteria, fungi and other microorganisms, at times it can respond abnormally and also attack the harmless cells in the digestive track, which in turn leads to inflammation.
There is no confirmed cure for inflammatory bowel disease. However, treatments significantly reduce the disease’s associated symptoms and in some cases, even bring about remission. Treatment efforts commonly include anti-inflammatory, antibiotic, anti-diarrhea, and pain relief medications. In some cases, a feeding tube may be necessary to allow the digestive track to rest and lower inflammation. Surgery may be employed remove the damaged portion of the digestive track.
Findings: Effects of Cannabis on Inflammatory Bowel Disease
Cannabis has been determined to effectively address the symptoms associated with inflammatory bowel disease disease. Two cannabinoids found in cannabis, tetrahydrocannabinol (THC) and cannabidiol (CBD), possess anti-inflammatory effects, offer pain relief, reduce nausea and stimulate appetite. As a result, cannabis use is common among those with inflammatory bowel disease. One study found that 17.6% of inflammatory bowel disease patients use marijuana to treat their symptoms, and although use was also found to be associated with a higher risk of surgery, patients reported an improvement in abdominal pain (83.9%), abdominal cramping (76.8%), joint pain (48.2%), and diarrhea (28.6%) (Storr, et al., 2014).
The benefits of cannabis help those with inflammatory bowel disease to manage their discomfort and experience a better quality of life. In one study, after three months of being treated with cannabis, inflammatory bowel disease patients reported improvements in their general health perception, social functioning, ability to work, physical pain and depression. These same patients also saw an increase in body weight and body mass index (Lahat, Lang & Ben-Horin, 2012). In another study, individuals with inflammatory bowel disease reported that marijuana was “very helpful” in relieving their abdominal pain, nausea and diarrhea (Ravikoff, et al., 2013). In individuals with Crohn’s disease, cannabis caused a significant improvement in appetite and sleep (Naftali, et al., 2013). Nausea relief as well as reductions in both pain sensation and feelings of unpleasantness was reported after cannabis use in another study (Schicho & Storr, 2014). In addition, using cannabis has also been shown to reduce the need of other medications in patients with Crohn’s disease (Naftali, et al., 2013).
Research also suggests that cannabis may be effective at helping those with inflammatory bowel disease to reach long-term remission. Medical cannabis use has been determined to be associated with an improvement in disease activity (Naftali, Mechulam, Lev & Konikoff, 2014). In one study, cannabis rich in tetrahydrocannabinol (THC) produced significant benefits to 10 or 11 patients with active Crohn’s disease, without side effects, and 5 of those 11 subjects achieved complete remission (Naftali, et al., 2013).
States That Have Approved Medical Marijuana for Inflammatory Bowel Disease
Other states have approved medical marijuana to treat only specific types of inflammatory bowel diseases, including Arizona (Crohn’s disease), Arkansas (Crohn’s disease, Ulcerative Colitis) Connecticut (Crohn’s disease, Ulcerative Dolitis), Florida (Crohn’s disease), Georgia (Crohn’s disease), Hawaii (Crohn’s disease), Illinois (Crohn’s disease), Louisiana (Crohn’s disease), Maine (Crohn’s disease), Massachusetts (Crohn’s disease), Michigan (Crohn’s disease), Minnesota (Crohn’s disease), Montana (Crohn’s disease), New Hampshire (Crohn’s disease), New Jersey (Crohn’s disease), New Mexico (Crohn’s disease), Ohio (Crohn’s disease, Ulcerative Colitis), Pennsylvania (Crohn’s disease), Rhode Island (Crohn’s disease), Washington (Crohn’s disease), and West Virginia (Crohn’s disease).
A number of other states will consider allowing medical marijuana to be used for the treatment of inflammatory bowel disease with the recommendation from a physician. These states include: California (any debilitating illness where the medical use of marijuana has been recommended by a physician), Connecticut (other medical conditions may be approved by the Department of Consumer Protection), Massachusetts (other conditions as determined in writing by a qualifying patient’s physician), Nevada (other conditions subject to approval), Oregon (other conditions subject to approval), Rhode Island (other conditions subject to approval), and Washington (any “terminal or debilitating condition”).
In Washington D.C., any condition can be approved for medical marijuana as long as a DC-licensed physician recommends the treatment.
Several states have approved medical marijuana specifically to treat “chronic pain,” a symptom commonly associated with inflammatory bowel disease. These states include: Alaska, Arizona, California, Colorado, Delaware, Hawaii, Maine, Maryland, Michigan, Montana, New Mexico, Ohio, Oregon, Pennsylvania, Rhode Island and Vermont. The states of Nevada, New Hampshire, North Dakota, Montana, Ohio, Vermont, and West Virginia allow medical marijuana to treat “severe pain.” The states of Arkansas, Minnesota, Ohio, Pennsylvania, Washington, and West Virginia have approved cannabis for the treatment of “intractable pain.”
Recent Studies on Cannabis’ Effect on Inflammatory Bowel Disease
Borrelli, F., Fasolino, I., Romano, B., Capasso, R., Maiello, F., Coppola, D., Orlando, P., and Battista, G. (2013, May). Beneficial effect of the non-psychotropic plant cannabinoid cannabigerol on experimental inflammatory bowel disease. Biochemical Pharmacology, 85(9), 1306-1316. Retrieved from http://www.sciencedirect.com/science/article/pii/S0006295213000543.
De Filippis, D., Esposito, G., Cirillo, C., Cipriano, M., De Winter, B.Y., Scuderi, C., Sarnelli, G., Cuomo, R., Steardo, L., De Man, J.G., and Iuvone, T. (2011). Cannabidiol Reduces Intestinal Inflammation through the Control of Neuroimmune Axis. PLoS ONE, 6(12), e28159. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3232190/.
Di Carlo, G., and Izzo, A.A. (2003, January). Cannabinoids for gastrointestinal diseases: potential therapeutic applications. Expert Opinion on Investigative Drugs, 12(1), 39-49. Retrieved from http://www.tandfonline.com/doi/pdf/10.1517/135437220.127.116.11?needAccess=true.
Esposito, G., Filippis, D.D., Cirillo, c., Iuvone, t., Capoccia, E., Scuderi, C., Steardo, A., Cuomo, R., and Steardo, L. (2013, May). Cannabidiol in inflammatory bowel diseases: a brief overview. Phytotherapy Research, 27(5), 633-6. Retrieved from http://onlinelibrary.wiley.com/wol1/doi/10.1002/ptr.4781/full.
GBD 2013 Mortality and Causes of Death Collaborators. (2015, January 10). Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet, 385(9963), 117-71. Retrieved from http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)61682-2/fulltext.
Inflammatory bowel disease (IBD). (2015, February 18). Mayo Clinic. Retrieved from http://www.mayoclinic.org/diseases-conditions/inflammatory-bowel-disease/basics/definition/con-20034908.
Jamontt, J., Molleman, A., Pertwee, R., and Parsons, M. (2010). The effects of Δ9-tetrahydrocannabinol and cannabidiol alone and in combination on damage, inflammation and in vitro motility disturbances in rat colitis. British Journal of Pharmacology, 160(3), 712–723. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2931570/.
Lahat, A., Lang, A. and Ben-Horin, S. (2012). Impact of cannabis treatment on the quality of life, weight and clinical disease activity in inflammatory bowel disease patients: a pilot prospective study. Digestion, 85(1), 1-8. Retrieved from https://www.karger.com/Article/Purchase/332079.
Lal, S., Prasad, N., Ryan, M., Tangri, S., Silverberg, M.S., Gordon, A., and Steinhart, H. (2011, October). Cannabis use amongst patients with inflammatory bowel disease. European Journal of Gastroenterology & Hepatology, 23(10), 891-6. Retrieved from Cannabis use amongst patients with inflammatory bowel disease. Retrieved from http://journals.lww.com/eurojgh/pages/articleviewer.aspx?year=2011&issue=10000&article=00011&type=abstract.
Lim, C.T., Kola, B., Feltrin, D., Perez-Tilve, D., Tschöp, M.H., Grossman, A.B., and Korbonits, M. (2013). Ghrelin and cannabinoids require the ghrelin receptor to affect cellular energy metabolism. Molecular and Cellular Endocrinology, 365(2), 303–308. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3566541/.
Naftali, T., Bar-Lev Schleider, L., Dotan, I., Lansky, EP., Sklerovsky Benjaminov, F. and Konikoff, FM. (2013, October). Cannabis induces a clinical response in patients with Crohn’s disease: a prospective placebo-controlled study. Clinical Gastroenterology and Hepatology, 11(10), 1276-1280. Retrieved from http://www.cghjournal.org/article/S1542-3565(13)00604-6/fulltext.
Naftali, T., Mechulam, R., Lev, LB, and Konikoff, FM. (2014). Cannabis for inflammatory bowel disease. Digestive Diseases, 32(4), 468-74. Retrieved from https://www.karger.com/Article/Purchase/358155.
Pertwell, R. (2001, June). Cannabinoids and the gastrointestinal tract. Gut, 48(6), 859-867. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1728337/.
Ravikoff Allegretti, J., Courtwright, A., Lucci, M., Korzenik, J.R., and Levine, J. (2013, December). Marijuana use patterns among patients with inflammatory bowel disease. Inflammatory Bowel Diseases,19(13), 2809-14. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4126607/.
Schicho, R. and Storr, M. (2014). Cannabis finds its way into treatment of Crohn’s disease. Pharmacology, 93(1-2), 1-3. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4076530/.
Storr, M., Devlin, S., Kaplan, G.G., Panaccione, R., and Andrews, C.N. (2014, March). Cannabis use provides symptom relief in patients with inflammatory bowel disease but is associated with worse disease prognosis in patients with Crohn’s disease. Inflammatory Bowel Diseases, 20(3), 472-80. Retrieved from http://journals.lww.com/ibdjournal/Abstract/2014/03000/Cannabis_Use_Provides_Symptom_Relief_in_Patients.6.aspx.
Wallace, J.L., Flannigan, K.L., McKnight, W., Wang, L., Ferraz, J.G., and Tuitt, D. (2013, April). Pro-resolution, protective and anti-nociceptive effects of a cannabis extract in the rat gastrointestinal tract. Journal of Physiology & Pharmacology, 64(2), 167-75. Retrieved from http://www.jpp.krakow.pl/journal/archive/04_13/pdf/167_04_13_article.pdf.