Inflammatory Bowel Disease and Cannabis as a Therapeutic Agent

Cannabis, more popularly known as marijuana, is gaining in popularity. In 2009, over 10.7% of North Americans between the ages of 15 and 64 reported using cannabis. 1 According to federal law, cannabis usage in the United States is prohibited for either recreational or therapeutic purposes. However, contrary to federal policy, 24 states have legalized medicinal marijuana usage and 4 have legalized recreational use; use of marijuana has also been decriminalized in 21 states. 2 There are a growing number of patients who are curious in cannabis’ therapeutic potential for a wide range of conditions as government laws shift to accommodate medical cannabis.

Cancer, HIV/AIDS, MS, chronic pain, nausea, hepatitis C virus, PTSD, amyotrophic lateral sclerosis (ALS), cachexia (extreme weight loss), glaucoma, and epilepsy are just some of the chronic, debilitating conditions for which medical cannabis use has been legalized at the state level in the United States.

Although evidence supporting cannabis’s use as a medical therapy for these ailments is few and contradictory at best, its popularity as an alternative treatment option is growing as people increasingly choose CAM over traditional medicine.

Cannabis sativa, or the marijuana plant, has been utilized for therapeutic purposes for centuries.

Cannabinoids are the name given to the pharmacologically active components of the plant, of which we now know there are at least 70. The endocannabinoid system (ECS) coordinates the actions of phytocannabinoids (cannabinoids derived from plants), synthetic cannabinoids (artificial compounds with cannabinomimetic effects), and endocannabinoids (endogenous compounds with cannabinomimetic effects) to control a wide range of physiological processes.

The phytocannabinoid delta-9-tetra-hydrocannabinol (THC) is often considered to be the most pharmacologically active of all the cannabinoids. Among the phytocannabinoids, THC has been the subject of the most research and is widely regarded as the most potent psychoactive component. Cannabidiol, cannabigerol, and cannabichromene are other types of phytocannabinoids, however they don’t have any noticeable mental effects. 8 Nabilone (Cesamet; Meda Pharmaceuticals), dronabinol (Syndros); and nabiximols are all similar formulations of the same chemicals. The US Food and Drug Administration (FDA) has authorized the use of nabilone for chemotherapy-induced nausea and vomiting that has not responded to standard antiemetics, and dronabinol for both chemotherapy-induced nausea and vomiting and AIDS-related anorexia. The use of nabiximols to treat cancer pain, neuropathic pain, and MS-related spasticity has been authorized in countries other than the USA.

Ulcerative colitis (UC) and Crohn’s disease (CD) are two forms of inflammatory bowel disease (IBD), which are characterized by recurring and remitting bouts of inflammation in the digestive system. Although its exact causes have not been pinpointed, inflammatory bowel disease (IBD) seems to be caused by a combination of environmental and genetic factors that leads to a dysregulated immune response. Aminosalicylates, antibiotics, corticosteroids, immunomodulators, and biologic therapy are examples of conventional treatments for inducing and maintaining remission from inflammatory bowel disease (IBD). Due to the lack of effective treatment choices and the well-documented negative consequences of long-term usage, surgical resection of the diseased intestine is often used to treat individuals whose conditions have failed to respond to more conservative treatment. 9 Many IBD patients are interested in trying complementary and alternative medicine (CAM) approaches, and doctors should be informed with these options so they can provide safe recommendations.

For hundreds of years, anecdotal evidence has pointed to cannabis’ potential medicinal use in the management of IBD. There is a 1990 case study that discusses how cannabis usage helped IBD patients keep their illness in remission. 10 Research into cannabis as a therapy option for IBD has been prompted by its usage as a medicine even before the ECS was discovered. Some people with inflammatory bowel disease (IBD) have claimed success in using cannabis to treat their condition’s symptoms, such as stomach discomfort, joint pain, cramps, diarrhea, poor appetite, weight loss, and nausea, and this trend is getting increasing attention in the media as time goes by. 11,12 Despite fears of federal punishment and a shifting political position, marijuana usage cannot be ignored, and doctors must learn more about the drug’s potential benefits and drawbacks if they are to treat patients responsibly. 3 This article discusses the endocannabinoid system (ECS) and its function in digestive physiology, as well as population studies on the efficacy of medical cannabis for IBD patients, the outcomes and pitfalls of therapy trials involving the use of cannabis for the treatment of IBD, and general safety concerns regarding acute and chronic cannabis use.