Is Marijuana an Effective Treatment for Crohn’s Disease, Ulcerative Colitis, or Other Inflammatory Bowel Diseases?
General Reference (not clearly pro or con)
The Centers for Disease Control Prevention, an agency of the United States Department of Health and Human Services, provides the following definitions on its website cdc.gov(accessed Mar. 26, 2013):
“Inflammatory Bowel Disease (IBD) is a broad term that describes conditions with chronic or recurring immune response and inflammation of the gastrointestinal tract. The two most common inflammatory bowel diseases are ulcerative colitis and Crohn’s disease.”
Ulcerative colitis is a chronic gastrointestinal disorder that is limited to the large bowel (the colon)… The first symptom of ulcerative colitis is a progressive loosening of the stool. The stool is generally bloody and may be associated with cramping abdominal pain and severe urgency to have a bowel movement… Loss of appetite and subsequent weight loss are common, as is fatigue.”
Crohn’s disease is a condition of chronic inflammation potentially involving any location of the gastrointestinal tract, but it frequently affects the end of the small bowel and the beginning of the large bowel… Symptoms include persistent diarrhea (loose, watery, or frequent bowel movements), cramping abdominal pain, fever, and, at times, rectal bleeding… Two-thirds to three-quarters of patients with Crohn’s disease will require surgery at some point during their lives.”Mar. 26, 2013 - Centers For Disease Control (CDC)
The Crohn’s & Colitis Foundation of America (CCFA) Patient Education Committee stated the following in the Jan. 2012 “CCFA Medical Position Statement on Medical Marijuana,” emailed to ProCon.org on Mar. 4, 2013:
“Experimental evidence suggests that endocannabanoids, molecules found in the body that closely resemble compounds found in the cannabis (marijuana) plant, may play a role in limiting intestinal inflammation. IBD patients have been found to have higher levels of cannabinoid receptors in their colonic tissue. Several small studies have shown that a significant proportion of patients with IBD report smoking marijuana to relieve IBD-related symptoms, particularly those patients with a history of abdominal surgery, chronic abdominal pain, and/or a low quality of life index. However, the medicinal use of marijuana is limited by potential side effects, the risk of smoking, and the lack of direct scientific evidence of clinical effectiveness for intestinal inflammation.
The CCFA does not endorse the smoking of marijuana by IBD patients, any current state-based medical marijuana programs, or the legalization of marijuana. The CCFA does support the calls by the various health organizations urging review of marijuana’s status as a federal Schedule I controlled substance, with the goal of facilitating the conduct of clinical research and the potential development of cannabanoid-based medications.”
Jan. 2012 – Crohn’s & Colitis Foundation of America (CCFA)[Editor’s Note: Prior to CCFA’s Not Clearly Pro or Con position, the organization held a Con position as indicated in its Aug. 4, 2005 statement below:]
“CCFA’s medical leadership does not support the use of ‘medical marijuana’ in people with IBD [Inflammatory Bowel Disease].
While marijuana might temporarily reduce pain and nausea, there is, as yet, no evidence that it can control chronic intestinal inflammation–the underlying cause of these symptoms in Crohn’s disease or ulcerative colitis…
CCFA’s expert consensus remains: The harmful side effects of marijuana far outweigh its potential benefits.”Aug. 4, 2005 - Crohn's & Colitis Foundation of America (CCFA)
Adi Lahat, MD, Doctor at the Institute of Gastroenterology and Liver Diseases, Chaim Sheba Medical Center (Israel), et al., stated the following in their Jan. 2012 Digestion article, “Impact of Cannabis Treatment on the Quality of Life, Weight, and Clinical Disease Activity in Inflammatory Bowel Disease Patients: A Pilot Prospective Study”:
“In the present preliminary prospective study, we have found that treatment with inhaled cannabis improves quality of life in patients with long-standing CD [Crohn’s disease] and UC [ulcerative colitis]. Treatment was also shown to cause a statistically significant rise in patients’ weight after 3 months of treatment, and improvement in clinical disease activity index in patients with CD…
Moreover, the data demonstrated a statistically significant improvement in almost all aspects of patients’ daily life. After 3 months’ treatment with inhaled cannabis, patients stated an improvement in their health status, their ability to perform daily activities and their ability to maintain social life. Patients reported a statistically significant physical pain reduction during treatment, as well as improvement in mental distress…
None of our patients complained of any side effect that disturbed their working ability. In fact, as was shown in the results, there was a statistically significant improvement in patients’ ability to work after treatment.”Jan. 2012 - Adi Lahat, MD
Bruce Buckner, a Crohn’s disease patient, wrote the following in the article “Crohn’s Disease” (accessed Mar. 1, 2013), available at rxmarijuana.com:
“I have several relatives with Crohn’s Disease. Every one of them has had major surgery. Every one of them has had complications from the steroids and immune suppressors they have been prescribed… I am firmly convinced that I would be in the same condition as my relatives with Crohn’s, if I hadn’t used pot. The medical use of marijuana has saved my colon and my quality of life.”Mar. 1, 2013 - Bruce Buckner
Simon Lal, MD, PhD, Gastroenterologist at Spire Manchester Hospital and Spire Manchester Clinic Hale (England), et al. stated the following in their Oct. 23, 2011 European Journal of Gastroenterology and Hepatology article, “Cannabis Use amongst Patients with Inflammatory Bowel Disease”:
“Patients with UC [ulcerative colitis], in particular, reported using cannabis to improve diarrhoeal symptoms, and, again, this perceived benefit has received mechanistic support from studies that suggest that cannabinoids inhibit intestinal secretory responses… It is equally plausible to speculate that patients perceived benefit from using cannabis to reduce pain and/or diarrhoea because the drug has a direct anti-inflammatory effect on intestinal tissue… As in other diseases, a significant proportion of both UC and CD patients reported using cannabis to enhance appetite, and the drug’s orexigenic properties are well-recognized, with many individuals commonly reporting appetite stimulation or ‘the munchies’ after use.”Oct. 23, 2011 - Simon Lal, PhD, MD
Timna Naftali, MD, Specialist in Gastroenterology at Meir Hospital and Kupat Holim Clinic (Israel), et al., stated the following in their Aug. 2011 Israel Medical Association Journal article titled “Treatment of Crohn’s Disease with Cannabis: An Observational Study”:
“Of the 30 patients [with Crohn’s Disease] 21 improved significantly after treatment with cannabis…
The mean number of bowel movements decreased from eight to five a day and the need for other drugs was significantly reduced… the number of patients requiring steroid treatment was reduced from 26 to 4. Fifteen of the patients had 19 surgeries during an average period of 9 years before cannabis use, but only 2 required surgery during an average period of 3 years of cannabis use…
The observed beneficial effect in this study may be due to the anti-inflammatory properties of cannabis, but additional effects of cannabinoids may also play a role. Cannabinoids influence gastrointestinal motility and, in particular, have an anti-diarrheal effect.”
Aug. 2011 - Timna Naftali, MD
Jeff Hergenrather, MD, President of the Society of Cannabis Clinicians, stated the following in the Autumn 2005 O’Shaughnessy’s article titled “Cannabis Alleviates Symptoms of Crohn’s Disease”:
“[Crohn’s] patients described marked improvements with the use of cannabis.
Beneficial effects were reported for appetite, pain, nausea, vomiting, fatigue, activity, and depression. Patients also reported that cannabis use resulted in weight gain, fewer stools per day and fewer flare-ups of less severity…
Cannabis-using Crohn’s patients not only report significant relief of their symptoms, they are also able to reduce the amount of immunosuppressive medications that have been a mainstay of conventional treatment…
Crohn’s disease is so debilitating and life-threatening and so difficult to manage with conventional medications it is very encouraging to find that cannabis is proving to be an effective treatment for it right now.”Autumn 2005 - Jeffrey Hergenrather, MD
Marla C. Dubinsky, MD, Director of the Pediatric Inflammatory Bowel Disease Center at Cedars Sinai Medical Center (Los Angeles, CA), stated the following in a medical panel discussion about IBD (accessed Mar. 1, 2013) available at animatedpatient.com:
“At the moment, I don’t advocate smoking marijuana. That’s just not something I advocate. I do understand that all of these issues that may be improved by smoking marijuana may be something we can address by better treatments, understanding why you’re having these symptoms, and addressing more of that than, per say, saying at the moment there is clear evidence to support that cannabis – at some level – actually has an anti-inflammatory property.”Mar. 1, 2013 - Marla Dubinsky, MD
Jonathan Markowitz, MD, Assistant Professor in the Department of Pediatrics at the Children’s Hospital of Philadelphia, stated in the article “Cannabis and IBD: A Fragile Connection,” available at ccfa.org (accessed Aug. 4, 2005):
“I think it’s still safe to say that there is no evidence to date that cannabis is an effective treatment for IBD.”Aug. 4, 2005 - Jonathan Markowitz, MD
R. Balfour Sartor, MD, Chairperson Emeritus of the National Scientific Advisory Committee of the Crohn’s & Colitis Foundation of America, stated in the article “Cannabis and IBD: A Fragile Connection,” available at ccfa.org (accessed Aug. 4, 2005):
“Because IBD [Inflammatory Bowel Disease] is an illness that lasts a lifetime, patients and their physicians should concentrate on discovering the cause of symptoms and pinpointing a treatment that will control them without causing adverse side effects.
Using a substance such as marijuana to alleviate symptoms only masks the actual problem.”Aug. 4, 2005 - R. Balfour Sartor, MD
[Editor’s Note: In February 2013, ProCon.org emailed the American Gastroenterological Association, the Society of Gastroenterology Nurses and Associates, Inc., the American College of Gastroenterology, and the Crohn’s & Colitis Foundation of America (CCFA) and requested pro, con, or not clearly pro or con statements on our question “Is marijuana an effective treatment for Crohn’s disease, ulcerative colitis, or other inflammatory bowel diseases?” CCFA responded on Mar. 4, 2013. As of Sep. 29, 2014, the other three organizations have not responded to follow up phone calls and emails.]