In addition to risks of using medical marijuana, there is the potential that it might help some symptoms of IBD without treating the underlying disease. The marijuana plant Cannabis sativa and its derivatives, cannabinoids, have grown Inflammatory bowel disease (IBD) is a chronic inflammatory condition. In a small study, participants with Crohn's disease saw symptoms dissipate after they began using cannabis oil.
Inflammatory (IBD) Oil Disease CBD for Bowel
THC is well known for its psychotropic effects, and CBD for its anti-inflammatory and immunomodulatory effects. Cannabinoids act at CB1 and CB2 receptors. CB1 is mainly expressed in the brain, where it causes its well-known psychotropic effects, and the enteric nervous system.
In contrast, CB2 is absent in the brain but is still found in the enteric nervous system, immune cells macrophages and plasma cells , and gastrointestinal epithelial cells.
Although the mechanism of action of CBD is not specific, some of its downstream effects are potentiated through the prevention of reuptake of endogenous anadamide. Activation of the endocannabinoid receptors using CB1- and CB2-specific ligands results in decreased inflammation in animal models of colitis. Concentrations of CB1 and CB2 receptors increase in the human gut in the settings of colon cancer, diverticulitis, and celiac disease. This may be due to small heterogeneous cohorts, lack of subclassification of disease types and activity, and variable tissue sampling sites.
Contrary to some other more recent studies in patients with chronic abdominal pain, administration of synthetic THC to healthy subjects has resulted in increased visceral sensitivity. There have been limited studies of cannabis in IBD. There have been several studies showing improvement in symptoms associated with IBD, leading to an improvement in quality of life.
Cannabis use is common among IBD patients, with the majority of patients using cannabis to control IBD-related symptoms including pain, nausea, poor appetite, and sleep disturbances. In 1 study of US patients, In this study, current users noted significant improvement in abdominal pain, poor appetite, nausea, and diarrhea.
Lahat and colleagues performed an uncontrolled observational study of IBD patients refractory to conventional therapy. Patients reported significant improvement in general health perception, social functioning, ability to work, pain, and depression. In addition, patients noted improvement in disease-specific symptoms measured through the Harvey Bradshaw Index HBI , including general well-being, abdominal pain, and loose stools.
Although there was no improvement in objective disease measures such as C-reactive protein CRP , patients were able to gain weight from below an appropriate body mass index to normal or near-normal.
There are several limitations to this prospective study, including lack of standardization of cannabis type and dosing and lack of a control group. These studies suffered from multiple limitations, including selection bias, lack of standardized dosing and route of administration, absence of blinding, recall bias, and lack of a control population. There was a standardized dose and administration among the treatment group.
The CDAI was calculated using 7-day recollection and recording of multiple weighted parameters including number of liquid stools, abdominal pain, general well-being, use of antidiarrheal agents, change in weight, hemoglobin, and the presence of abdominal mass.
However, there were no differences in biochemical assessments, including hemoglobin levels and CRP. All patients in the treatment group were able to stop steroid-based therapy during the study. Importantly, cannabis use was associated with improved abdominal pain and quality of life scores. It is notable that all patients had clinical relapse within 2 weeks after discontinuation of cannabis. After 8 weeks of treatment, there was no significant reduction in CDAI scores between study patients and controls.
Changes in laboratory parameters blood count, liver and kidney functions were not significantly different. Limitations to this study include the small sample size, the relatively low dose of cannabidiol used, route of administration ingestion vs inhalation , and the use of a single cannabinoid which minimizes the potential anti-inflammatory synergistic effects that have been suggested with use of a combination of cannabinoids.
A systematic review and meta-analysis evaluating the use of cannabinoids for other chronic medical conditions, including neuropathic pain, cancer, diabetes, fibromyalgia, multiple sclerosis, musculoskeletal problems, and chemotherapy-related pain, showed moderate-quality evidence to support the use of cannabinoids for relief of chronic pain. The underlying theme of the limited available evidence is that cannabis use may offer symptomatic benefit and improved quality of life when patients have poor or incomplete response to standard therapy.
However, none of the available data demonstrate improvement in biochemical or disease activity scores. There is increasing attention by the pharmaceutical industry to therapeutic manipulation of the endocannabinoid system.
This has not been tested in IBD patients. The long-term safety profile of chronic cannabis use has not been well defined, mainly due to the heterogeneity of preparations, varying routes of administration, and the lack of controlled studies addressing safety, especially in IBD patients.
In addition, there are population-based studies that have demonstrated an increased risk for motor vehicle accidents 46 and cannabis hyperemesis syndrome. A Canadian multicenter retrospective study of patients presenting to the emergency department for vomiting found that For example, cannabis ingested in an edible form is more difficult to titrate, unlike vaping or inhaling, as the effect may be delayed, and therefore higher doses may be consumed, leading to intoxication.
Heavy use may cause impaired memory for at least 1 week after abstinence, hyperemesis, and withdrawal symptoms. Acute psychotic symptoms during intoxication also have been reported. The investigators acknowledge that the defined 1-year washout period and the 5-year postlegalization period are relatively short to clearly define the legalization effect on these trends.
Furthermore, the findings are based on administrative diagnosis codes and may be confounded by increased transparency in patient-reported symptoms after the legalization and decriminalization of cannabis. Along with the increase in use intensity, there has been a steady decline in perception of risk with regular use. Addiction risk may be higher for those beginning heavy use in adolescence, and this behavior may predict progression to harder drugs.
The role of the endocannabinoid system ECS in reproduction has been widely investigated, with evidence suggesting that cannabis use alters the female menstrual cycle and endometrial proliferation at the cellular and molecular levels. A web-based prospective cohort study Pregnancy Study Online [PRESTO] was conducted in North America whereby women between the ages of 21 and 45 years were enrolled, and their male partners were invited to participate.
The American College of Obstetricians and Gynecologists does not recommend or endorse the use of cannabis in pregnant patients because observational data show that cannabis use was associated with low birth weight and preterm delivery.
However, a recent meta-analysis that compiled data from 31 observational studies looking at maternal cannabis use found no difference in rates of low birth weight, preterm delivery, or perinatal death when controlling for tobacco use and other confounding variables.
The authors concluded that maternal cannabis use is not an independent risk factor for adverse fetal outcomes, citing tobacco use as the main driver for poor outcomes. Analysis of breast milk from mothers using cannabis detected THC up to 6 days after last use; the concentrations were directly related to the intensity and frequency of use, and the authors suggested that this may influence brain development during this period.
As of January , 30 states plus the District of Columbia have legalized medical cannabis, 74 and 16 states have legalized high-cannabidiol CBD , low-THC forms of cannabis or hemp oil. Nine states and the District of Columbia, all with medical cannabis programs, have gone a step further and legalized recreational cannabis for adults over 21 years of age Fig.
At the same time, the possession or sale of cannabis remains illegal under federal law. Over the last several years, the federal government has mostly not enforced its cannabis prohibition, particularly against individuals acting in compliance with state laws, for 3 reasons. For many years, the federal government has not prosecuted medical cannabis patients who were not growing or selling cannabis.
Sessions wrote that the previous guidance on cannabis law enforcement was unnecessary, given the well-established principles governing federal prosecution that are already in place. As a result of the Sessions Memorandum, federal prosecutors may now be free to utilize their prosecutorial discretion to decide whether to prosecute even state legal adult-use cannabis activities.
Third, through the Rohrabacher-Blumenauer Amendment to omnibus spending bills, Congress has precluded the DOJ from interfering with state medical cannabis programs, including prosecuting anyone in strict compliance with state law. The protection was recently renewed in the fiscal year omnibus spending bill and remains in place. Future changes in federal enforcement are difficult to predict.
Each medical cannabis state has a unique program with its own rules, some of which have been changing regularly. For example, different states have different rules about the following: Accordingly, patients should not assume that an activity that is legal in 1 state will be legal in another. In addition, only certain states provide reciprocity to patients licensed by another state.
A useful guide to the laws regarding how patients get approved to use medical cannabis under state laws can be found here: Canada permits the use of medicinal cannabis and recently voted to legalize recreational use as well. This law will go into effect in October of European laws are varied; the following European countries have legalized medical cannabis in some form: The following additional countries have legalized medical cannabis: They have different levels of permissiveness.
Spain has legalized cannabis for private use in private spaces. The Netherlands and Portugal are very permissive under decriminalization. For example, state laws differ with respect to who may certify a patient, the extent of the medical relationship with the patient, what kind of exam is required, and the form of any written certification. State laws also differ on protections for medical professionals who help a patient administer medical cannabis, and whether and how patients may use cannabis in hospitals.
A medical professional must assure compliance with state law, any medical malpractice insurance policy, and any policies by associated hospitals, medical groups, or institutions.
Some malpractice insurance only covers the use of Food and Drug Administration FDA —approved medications and treatments. Under federal law, physicians are protected from prosecution for recommending or suggesting that a patient use cannabis. They are also protected under the Rohrbacher-Blumenauer Amendment, as long as they are complying with the state medical cannabis law.
Although the law is not entirely settled on whether writing a certification under state law could expose a medical professional to federal prosecution, the federal government has not prosecuted any medical professional merely for certifying a patient.
Certifying medical professionals have faced prosecution only where there were exacerbating circumstances, such as a physician laundering drug money. Medical professionals should be careful about submitting government claims relating to medical cannabis certification or treatment, because those particular claims may not be covered. Recommending or certifying a patient for medical cannabis does not violate federal law.
More research is needed on the potential medical benefits and the short-term and long-term effects of cannabis use. Substances are listed in Schedule I if they meet all 3 of the below criteria. Because cannabis is considered a Schedule I drug, cannabis research is subject to additional registrations and security protocols compared with nonscheduled compounds.
For example, 1 hurdle is the obtainment of research-grade cannabis from an authorized provider. In addition, it has been suggested that the scheduling of cannabis has led to stigma, making it difficult for researchers to find funding for research on the potential health benefits of cannabis, rather than the detriments.
Below is a discussion of several research barriers, including regulatory hurdles, difficulties in obtaining research-grade cannabis, and availability of research funding:. To legally study cannabis in human subjects, a researcher must complete many steps with several federal and state entities.
This process has been described as onerous, and many have argued that it has limited medical research on cannabis, thus limiting the availability of important information for policy decision-makers, medical professionals, patients, and other stakeholders. The process includes the below steps: Submit a research protocol to the DEA including security details for storing and dispensing cannabis.
Security requirements may vary based on the amount of cannabis and the jurisdiction of the DEA office. As of this writing, the University of Mississippi is the only licit provider, which has led to limits on the type and quantity of cannabis that researchers can obtain.
As state-regulated cannabis has become more varied and potent, research-grade cannabis has remained limited and less potent. In response to concerns from the research community, the government took several steps to ease access to research-grade cannabis for approved researchers.
In , the DEA increased the aggregate production quota of cannabis; in , the DEA increased the number of private entities allowed to provide research-grade cannabis; in , NIDA released a Request for Information ROI on the strains and varieties of cannabis that researchers would want to access.
The National Academies of Sciences NAS asserts that not enough research funding on cannabis is spent on the potential benefits of cannabis. Cannabinoids interact with the endocannabinoid system ECS , which is composed of nerve receptors scattered throughout your body. The two most common receptors are the CB1 and CB2 receptors. Both the CB1 and CB2 receptors play a pivotal role in regulating physiological functions that include memory, mood, appetite, sleep, digestion, the modulation of pain, and many others.
Unlike THC, the infamous chemical responsible for the psychotropic effects of marijuana, CBD is not a psychoactive substance. However, keep in mind that this is 33 times less than the amount required to produce any sort of psychoactive effect.
Today, thousands of folks are using CBD oil to treat different conditions that range from severe seizure-inducing disorders to chronic body pain. But, large-scale controlled studies need to be carried out in order to determine the efficiency of CBD as an actual treatment option.
Besides working as a general anti-inflammatory, studies suggest that CBD is also a great treatment for intestinal inflammation. While the research was carried out on mice, the results indicate that CBD oil can help reduce inflammation in the colon and small intestine without unwanted psychotropic effects.
CB1 and CB2 receptors are in charge of the vast majority of the functions in this list, and appetite is no different. Because of the way CBD interacts with these receptors, it can help regulate appetite and help your body crave food again. One of the main reasons why medicinal cannabis was first legalized in California in the mids is because the plant is a powerful analgesic. Moreover, the research suggests that CBD oil delivered through oral route may pose a reliable alternative to treat chronic and IBD-related pain.
Preclinical research also indicates that CBD, if dosed properly, can have antiemetic effects. CBD may pose a viable option for the treatment of insomnia, while THC may actually impair sleep quality long-term. You can also give us a call or check out our online store and get your favorite supplements delivered straight to your home! Information supplied by our team should not be considered medical advice.
Using CBD Oil for Crohn’s Disease: What You Need to Know
Medical Cannabis and IBDGIST+ a few years ago, an inflammatory bowel disease (IBD) patient asked about the use of marijuana to treat his as well as a number of other foods such as hemp oil and hemp butter. G&H Currently, how common is medical cannabis use in IBD patients? The first small observational study in Crohn's disease (N=30) was conducted by . at moderate to severe Crohn's disease patients using CBD-THC oil for 8 weeks, and. What is Crohn's disease? Crohn's disease is a long-term condition that results in inflammation of the gastrointestinal tract, occurring anywhere.