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Crohn’s Disease

How Cannabis Helps Alleviate My Crohn’s Disease

Diagnosed with Crohn’s disease at 15, musician Emma struggled with nausea and joint pain. She endured a long journey through western medicine leaving her on 8 horse pills a day and still suffering. When she discovered cannabis, she no longer needed as many medications, her joint pain faded, and she could return to playing guitar. Emma hadn’t felt motivated on the cocktail of prescriptions she was taking, but with the relief that marijuana gave her, she could again express her creativity.  Cannabis for Crohn’s holds great promise. 

The History of Inflammatory Bowel Diseases

Crohn’s disease was difficult to identify for many years. Along with ulcerative colitis, it’s one of two conditions classified under Inflammatory Bowel Disease (IBD) characterized by persistent diarrhea, abdominal pain, rectal bleeding/bloody stools, weight loss, and fatigue. Doctors struggled to determine the source of IBD, often leading to multiple misdiagnoses. The hallmark of IBD is chronic inflammation in the gastrointestinal (GI) tract that results in visible damage. The characteristics of IBD resemble Irritable Bowel Syndrome (IBS), but IBS symptoms exist without any visible signs of intestinal injury or disease.

Scientists eventually found the marker for the inflammatory arthritic disease, HLA-B27, in the blood tests of IBD patients beginning in the 1970s, having previously observed this antigen in other inflammatory disorders such as rheumatoid arthritis (joints), ankylosing spondylitis (spine), and psoriatic arthritis (skin). Doctors assumed all IBD was arthritis of the intestines, but as technology improved testing, they found that Crohn’s disease and ulcerative colitis were distinct problems affecting different parts of the digestive tract. Crohn's and Cannabis

Crohn’s & Ulcerative Colitis

Crohn’s disease can attack every part of the gastrointestinal tract. The damage appears in patches resembling a cobblestone road along the intestines when imaged. Ulcerative colitis, on the other hand, causes continuous, non-patchy damage restricted to the colon, the last section of the intestinal tract. There is no cure for IBD. The Centers for Disease Control and Prevention (CDC) states: 

“Several types of medications may be used to treat IBD: aminosalicylates, corticosteroids (such as prednisone), immunomodulators, and the newest class approved for IBD—the ‘biologics.’ Several vaccinations for patients with IBD are recommended to prevent infections. Severe IBD may require surgery to remove damaged portions of the gastrointestinal tract, but advances in treatment with medications mean that surgery is less common than it was a few decades ago. Since Crohn’s disease and ulcerative colitis affect different parts of the GI tract, the surgical procedures are different for the two conditions.”

Many IBD medications cause fatigue, decreased immunity, muscle pain, weight gain, depression, and mood swings. Others require uncomfortable procedures like repeated intravenous administration. For many patients battling IBD, their course of care is trial and error of drug regimens resulting in a combination that is often more about choosing the lesser of two evils than obtaining complete relief. Cannabis appears to be an unconventional treatment for both Crohn’s and ulcerative colitis to varying degrees. It’s unique among IBD medicines in that it is both natural and virtually side-effect free in clinical studies, and for those who it does benefit, it can be one of the few medicines that don’t have harmful interactions with other drugs. 

Case for Cannabis

In 2013 researchers analyzed a group of Crohn’s patients who did not respond to steroids, immunomodulators, or anti-tumor necrosis factor-α agents (conventional Crohn’s drugs). One group of the patients received real marijuana, and the other group was administered a THC-free placebo. Half of the participants who used cannabis experienced complete remission, and all but one improved. The doctors concluded, “THC-rich cannabis produced significant clinical, steroid-free benefits to patients with active Crohn’s disease, compared with placebo, without side effects.” 

A different study published in the Israel Medical Association Journal examined disease activity, use of medication, need for surgery, and hospitalization before and after cannabis use in 30 patients (26 males) with Crohn’s. 21 patients improved significantly after treatment with cannabis. The need for other medication was reduced. 15 of the patients had 19 surgeries over 9 years before cannabis use, but only 2 required surgery during the following 3 years using cannabis. 

Doctors at the University of Calgary found that the target of the cannabinoids in marijuana, the human endocannabinoid system, is “involved in the regulation of numerous gastrointestinal functions including motility, sensation, and secretion.” Multiple scientists theorize that a faulty endocannabinoid system is at the root of IBS, IBD, and other digestive diseases. In these cases, marijuana could help restore proper function to the endocannabinoid system. For example, Journal PLOS ONE published research finding that the cannabinoid cannabidiol could almost completely reverse the effects of lipopolysaccharides (LPS), substances that play an essential role in the inflammatory process of inflammatory bowel disease.

None of the currently published studies on cannabis as a treatment for inflammatory bowel disease or irritable bowel syndrome have 100% success rates, and success is different from patient to patient. Some experience no benefit. Others experience complete remission, and still, others just get relief. To date, most studies have used smoked marijuana, but researchers often point to the possible advantages of consuming cannabis orally. CBD oil for Crohn’s remains a relatively new natural treatment option being explored. 

The body processes cannabis differently when it passes through the digestive system instead of being smoked. Effects last longer, and some cannabinoids can be better absorbed. Individuals using marijuana to improve their inflammatory bowel disease should consider using different methods (smoking versus ingesting orally) and varieties (strains) that contain different concentrations of cannabinoids. Furthermore, various preparations of edible herb can alter the effects. In its raw form, eating THC does not get you high but is still beneficial to the endocannabinoid system. THC must be heated to have noticeable psychoactive effects. Some patients may benefit from raw THC while others may experience relief in the euphoria produced from activated THC. 

Because there is no cure for the inflammatory bowel diseases Crohn’s and ulcerative colitis, sufferers must determine the best type of therapy to cope with living with the disease. Preserving the best quality of life possible should always be the goal. If marijuana can make lives better, the sick should have access to any and all effective treatments. Finding the right medicine will hopefully result in more success stories like Emma’s. Cannabis for Crohn’s might just be that ‘right medicine’. 

 

Bibliography

“CDC -What Is Inflammatory Bowel Disease (IBD)? – Inflammatory Bowel Disease – Division of Population Health.” Centers for Disease Control and Prevention. https://www.cdc.gov/ibd/what-is-IBD.htm.

“Cannabis Induces a Clinical Response in Patients With Crohn’s Disease: A Prospective Placebo-Controlled Study.” NeuroImage. May 04, 2013. https://www.sciencedirect.com/science/article/pii/S1542356513006046.

“Cannabis Use amongst Patients with Inflammatory Bowel… : European Journal of Gastroenterology & Hepatology.” LWW. https://journals.lww.com/eurojgh/Abstract/2011/10000/Cannabis_use_amongst_patients_with_inflammatory.11.aspx.

“Crohn’s Disease.” Mayo Clinic. March 08, 2018. https://www.mayoclinic.org/diseases-conditions/crohns-disease/symptoms-causes/syc-20353304.

Naftali, T., L. B. Lev, D. Yablecovitch, E. Half, and F. M. Konikoff. “Treatment of Crohn’s Disease with Cannabis: An Observational Study.” Current Neurology and Neuroscience Reports. August 2011. https://www.ncbi.nlm.nih.gov/pubmed/21910367.

Naftali, Timna, Raphael Mechulam, and Fred M. Konikoff. “Cannabis for Inflammatory Bowel Disease.” Dermatopathology. June 23, 2014. https://www.karger.com/Article/Abstract/358155.

“Prednisone Oral : Uses, Side Effects, Interactions, Pictures, Warnings & Dosing.” WebMD. https://www.webmd.com/drugs/2/drug-6007-9383/prednisone-oral/prednisone-oral/details.

Russo, E. B. “Clinical Endocannabinoid Deficiency (CECD): Can This Concept Explain Therapeutic Benefits of Cannabis in Migraine, Fibromyalgia, Irritable Bowel Syndrome and Other Treatment-resistant Conditions?” Current Neurology and Neuroscience Reports. April 2008. https://www.ncbi.nlm.nih.gov/pubmed/18404144.

Slatech. “Israel Medical Association Journal.” IMA – Israel Medicine Association. https://www.ima.org.il/MedicineIMAJ/viewarticle.aspx?year=2011&month=08&page=455.

Storr, Martin, Devlin, Shane, Kaplan, Gilaad G., Panaccione, Andrews, and Christopher N. “Cannabis Use Provides Symptom Relief in Patients with Inflammatory Bowel Disease but Is Associated with Worse Disease Prognosis in Patients with Crohn’s Disease.” OUP Academic. January 08, 2014. https://academic.oup.com/ibdjournal/article-abstract/20/3/472/4578983.

Storr, M. A., B. Yüce, C. N. Andrews, and K. A. Sharkey. “The Role of the Endocannabinoid System in the Pathophysiology and Treatment of Irritable Bowel Syndrome.” The Canadian Journal of Chemical Engineering. July 18, 2008. https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2982.2008.01175.x.

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