Conventional therapy using steroids, disease-modifying drugs, and biological drugs remains the cornerstone of treatment for patients with CD. Unfortunately, not all patients react to these medications; some develop severe side-effects, while others experience only partial remission, leaving them longing for more treatment options.
In recent years, the research of the possible therapeutic properties of cannabis in patients with CD has been on the rise, showing promising results, and giving patients seeking to supplement their treatment plan a possible way to improve their quality of life.
Reducing GI inflammation is crucial in treating Crohn’s disease. New insights into the effect of the ECS on GI inflammation and current clinical research lead us to the notion that cannabis may reduce GI inflammation and improve patient’s quality of life in CD patients, although more clinical research is required in order to obtain clearer and more conclusive results.
Cannabis is recommended to adult CD patients in order to relieve pain and symptoms, and can be used as a supplementary treatment at a relatively low cost, high safety profile, and may even act synergically with conventional therapy to reduce inflammation.
Cannabis is not recommended for children, according to the Canadian Association of Gastroenterology, due to possible structural changes in the developing brain.
- Acts as a pain reliever: Under conventional therapy, treating inflammation in CD may take time, requiring the use of analgesics in order to relieve acute pain
- Nausea, bloating, diarrhea – Cannabis has been to alleviate many of the symptoms that patients with Crohn’s suffer from.
- Increases appetite: Patients with CD suffer from decreased appetite, often due to nausea.
- Safety: Cannabis is generally considered safe. Serious adverse effects are rare and there’s never been a recorded fatality directly secondary to use.
- Cost: Although the cost of medicinal cannabis varies depending on the country, type of insurance and strain, its price is often much cheaper than some CD medications such as biological drugs. It is important to keep in mind that at this point, cannabis is used as a supplementary treatment
- Mind-altering: Impaired problem-solving abilities, memory, and balance in the short term, and possibly in the long-term.
- Smoke-induced lung and airway disease: Any type of smoking damages the lung, trachea, and mouth. This could be overcome by using other means of delivery other than smoking, such as using edible cannabis.
- Increases the risk of heart attack, chronic cough, and mental disorders.
- Possible addiction: Chronic and heavy use of cannabis may lead to addiction and dependence.
The Endocannabinoid System
The endocannabinoid system (ECS) consists of endocannabinoids, their receptors, and certain metabolic enzymes. It participates in countless biological processes, and is a major player in the regulation of different bodily functions such as normal brain activity, sleep, and digestion, just to name a few.
The ECS is an important player in the regulation of the gastrointestinal (GI) tract, ranging from simply controlling the rate of digestion to complex interactions with the gut flora and cells of the immune system. The wall of the GI is saturated with cannabinoid receptors, and we now know that many GI disorders are linked to dysregulation of the ECS which more often than not is associated with a decrease in the endocannabinoids.
The ability of the ECS to interact with the gut’s microbiome, immune cells, and functional
epithelium allows it to partake in the course of GI inflammation.
Both animal and observational studies have highlighted the importance of ECS dysregulation in
inflammatory bowel disease (IBD) such as Crohn’s disease (CD), as well as the benefits gained
from cannabinoid supplementation by using their anti-inflammatory effects.
Crohn’s & Cannabis
Cannabis has long been known for its therapeutic value in treating various symptoms and conditions, many of which are related to the GI tract. The plant’s effects are due to cannabinoids acting as an external supplementation, and exerting an inhibitory effect on many metabolic processes, such as the suppression of nausea, regulation of gut motility and reduction of smooth muscle contraction, and control of acid secretion.
The idea that cannabis may combat inflammation in CD stems from preclinical experiments that investigated the effect of the loss of cannabinoid receptors, the activity of cannabinoid receptor antagonists (blockers), and the effect of reduced number of endocannabinoids — all of which resulted in increased activity of the immune system, which was related to gastric inflammation.
A series of preclinical studies have demonstrated the protective effects of cannabis in intestinal inflammation.
- Although the “standard” cannabinoid receptors are thought to be exclusively CB1 and CB2 receptors, we now have evidence that cannabinoids can interact with other receptors as well; for example, GPR55 which is responsible for intestinal inflammation.
- Cannabis has been shown to have a protective effect against intestinal inflammation, as it acts as an inhibitor on such key regulators of intestinal inflammation.
- Cannabinoids help maintain the integrity of the intestinal barrier, making it less permeable to foreign matter
Cannabis has shown its effectiveness in clinical studies as well; unfortunately, however, most of these studies are statistically underpowered due to the low number of participants.
- The first study to investigate the direct effects of cannabis on CD, observed a great improvement in 21 of the 30 patients who participated in the study; the participants required less CD-specific medication, and the number of surgeries during the years of cannabis treatment reduced dramatically compared to previous period.
- A second study showed a significant improvement in the quality of life of IBD patients using cannabis during a 3-month trial. Patients reported less pain, depression, and overall better well-being, along with a decrease in disease activity.
- A study aimed to compare the effects of THC-rich versus THC-rich strands of cannabis as a treatment in patients with CD that did not respond to conventional treatment. The results showed reduced disease activity in both groups, with an advantage in the THC-rich group in which a few of the patients weaned off steroids and showed complete remission.
Children & Cannabis
A 2019 review published by the Canadian Association of Gastroenterology has made a strong recommendation against the use of cannabis as a treatment of CD in pediatric cases. According to experts, although cannabis is associated with several benefits in CD, the evidence was inconclusive. Also, the risks associated with the usage of cannabis during adolescence and its linked effects on the developing brain outweigh the potential benefit in children.
Potential side effects of cannabis use
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