Preclinical data supports the use of cannabinoids for gastrointestinal inflammation, but does this translate into patient outcomes?

Part 1 of this series on cannabis for colitis outlined the preclinical data which evaluated the use of cannabis for inflammation of the GI tract. Although the preclinical data largely supports the use of cannabis in combating inflammation, part 2 of this blog will continue to explore cannabis in the context of colitis and inflammatory bowel disease (IBD). This second part of our series transitions from the preclinical insights discussed earlier to an examination of existing clinical data.

In this installment, we delve into patient surveys, retrospective reviews, observational studies, and clinical trials to provide a brief and objective overview of current research. This approach aims to present the available evidence on cannabis use in managing colitis and IBD, offering a clearer picture of what the clinical data reveals about its potential role in treatment. By focusing on the data, we seek to inform and engage readers with an impartial look at the scientific landscape surrounding this intriguing subject.

Patient Surveys:

Patient surveys across the US, Canada, and Australia provide insights into the use of cannabis for managing inflammatory bowel diseases (IBD) such as Crohn's disease and ulcerative colitis. Here's a summary of some the key findings:

US Survey Insights¹

In a survey of 292 US IBD patients, 12.3% were active marijuana users, while 39% had used it in the past. Among these, 16.4% used marijuana for symptom management, reporting relief from abdominal pain, nausea, and diarrhea. Younger age and chronic abdominal pain were significant predictors of current marijuana use. Interestingly, 50% of those who had never used marijuana expressed interest in trying it for pain relief if it were legally available.

Canadian Study Findings²

From an anonymous survey of 313 Canadian IBD patients, 17.6% used cannabis, primarily inhaled, to manage symptoms like abdominal pain, cramping, and diarrhea. Although symptom relief was noted, long-term use was linked to an increased likelihood of surgery in Crohn's disease, highlighting potential risks. Patients are advised to use caution until more clinical trials confirm safety and efficacy.

Australian Survey Results³

An online survey of 838 Australians with IBD showed that 25.3% used medical cannabis, with 18.1% as current users. Cannabis was mostly consumed through smoking or oral liquids. Despite experiencing more hospitalizations and lower medication adherence, users reported effective symptom relief, particularly for abdominal pain, stress, and sleep issues. Ulcerative colitis patients noted improved quality of life with cannabis use.

Canadian Cohort Study⁴

A prospective study at a Canadian care center found that 41% of Crohn's disease and 31% of ulcerative colitis patients recently used cannabis. However, less than half discussed this with their physicians. Recent users reported more abdominal pain and lower quality of life scores, suggesting a potential negative impact.

These surveys reveal a notable prevalence of cannabis use among IBD patients for symptom relief. However, they also underscore potential risks, such as increased surgical needs and lower quality of life, indicating the need for more comprehensive research to better understand the benefits and limitations of cannabis in IBD management.

Retrospective Reviews

Retrospective reviews have shed light on the potential role of cannabis in managing Crohn's disease (CD) and ulcerative colitis (UC). Here are the key findings from various studies:

Crohn's Disease Activity and Surgical Needs⁵

A study on 30 CD patients revealed significant improvements in disease activity, with the Harvey Bradshaw index halving on average. Cannabis use also correlated with reduced medication dependency and fewer surgeries, suggesting a positive impact on CD management, despite the study's small size.

Demographic Insights from NHANES Database⁶

Analysis of over two million IBD patients highlighted a higher incidence of marijuana use compared to controls. IBD patients typically began using marijuana earlier and consumed more daily. Older male IBD patients were identified as the most likely cannabis users.

Efficacy and Safety of Cannabis in CD⁷

A 2018 review evaluating cannabis for CD remission noted varied clinical responses. While some studies showed improved quality of life and clinical scores, results were inconsistent, and the evidence was deemed low in certainty. Mild adverse events like sleepiness were common, underscoring the need for further research.

Cannabis in Treating UC⁸

Another review focused on UC found uncertain effects of cannabis on clinical remission and response. With mild to moderate adverse events reported, the studies faced limitations such as participant bias and varied interventions, providing no conclusive evidence on cannabis efficacy for UC.

Nationwide Inpatient Sample Analysis⁹

This study examined cannabis use impacts on hospital outcomes for CD and UC patients. For CD, cannabis users had lower rates of colorectal cancer and anemia but faced increased risks of fistulizing disease and abscesses. They also experienced shorter hospital stays and lower costs. In UC, cannabis use led to fewer infections and reduced hospital charges, though fluid and electrolyte disorders were more common.

These reviews suggest that while cannabis may offer benefits like improved disease activity and reduced hospital costs, there are also associated risks. The findings highlight the need for larger, more comprehensive studies to confirm these effects and optimize cannabis use in IBD management.

Clinical and Observational Trials

Recent clinical and observational trials have explored the potential benefits of cannabis and CBD in managing inflammatory bowel diseases (IBD), such as ulcerative colitis (UC) and Crohn's disease. Here's a summary of key findings from these studies:

THC-Rich Cannabis for UC¹⁰

In a randomized, placebo-controlled trial, THC-rich cannabis cigarettes significantly reduced the Disease Activity Index (DAI) in UC patients from 10 to 4, compared to a smaller reduction in the placebo group. While the Mayo endoscopic score improved in the THC group, changes in inflammatory markers like C-reactive protein were not significant. No serious side effects were reported, suggesting safety and potential clinical benefits.

CBD-Rich Extract for UC¹¹

A proof-of-concept study involving a CBD-rich botanical extract showed no significant difference in remission rates between the CBD and placebo groups. However, favorable outcomes were noted in total and partial Mayo scores and quality of life for those on CBD. Mild to moderate adverse events were observed, linked to THC content.

CBD-Rich Cannabis Oil for Crohn's Disease¹²

This trial demonstrated significant clinical improvement in patients taking cannabis oil, with CDAI scores dropping from 282 to 166. Although quality of life scores improved, inflammatory markers remained unchanged, indicating symptom relief without altering disease progression.

THC-Rich Cannabis on UC¹³

Another trial highlighted significant clinical improvement with THC-rich cannabis, as the Lichtiger index decreased substantially. Quality of life scores also improved, though anti-inflammatory changes were inconclusive.

Cannabis for Chronic Pouchitis¹⁴

An observational study on cannabis usage in chronic pouchitis patients showed improvements in disease activity indices and quality of life, with no adverse events, suggesting cannabis as a potentially viable symptom management option.

CBD for Crohn's Disease¹⁵

A study on CBD's effects on Crohn's disease indicated that while CBD was safe, it didn't significantly reduce disease activity, possibly due to low dosage or sample size limitations.

THC Cannabis for Crohn's Disease¹⁶

THC-rich cannabis led to a significant clinical response in Crohn's patients, with improved appetite and sleep, although complete remission was not achieved.

Long-term Medical Cannabis Use in IBD¹⁷

A long-term observational study found that licensed medical cannabis use in IBD patients improved clinical outcomes without adverse social or occupational impacts.

These studies underscore the potential of cannabis and CBD in improving symptoms and quality of life for IBD patients, though their effects on inflammation remain inconsistent. Future research should focus on larger, more comprehensive studies to better understand these findings and optimize treatment strategies.

Concluding Remarks

In conclusion, Part 2 of our blog series delved into the clinical data surrounding the use of cannabis for inflammatory bowel disease (IBD), examining patient surveys, retrospective reviews, observational studies, and clinical trials. The findings presented show a largely positive trend, suggesting potential therapeutic benefits of cannabis in managing IBD symptoms.

However, it is crucial to acknowledge that despite these encouraging signals, the current body of evidence remains insufficient for formal medical endorsements. More rigorous and well-designed clinical trials are essential to validate these initial findings and to establish clear guidelines for the therapeutic use of cannabis in IBD treatment. As research in this area continues to evolve, we look forward to more definitive conclusions that could potentially reshape treatment options for IBD patients.

References:

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