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CBD Oil and Cannabis for Ulcerative Colitis and Crohn's: Is it Effective?
Many members of MyCrohnsandColitisTeam have been curious about the effectiveness of cannabidiol (CBD) oil and cannabis, or medical marijuana, in treating ulcerative colitis and Crohn’s disease. To shed some light on this topic, MyCrohnsandColitisTeam spoke with Dr. Jami Kinnucan, a specialist in inflammatory bowel disease at the University of Michigan. In her practice, Dr. Kinnucan focuses on the diagnosis and management of Crohn’s disease and ulcerative colitis, as well as the use of cannabis in treating IBD. She currently serves as the chair for the Patient Education Committee for the Crohn’s and Colitis Foundation.
In this Q&A interview, Dr. Kinnucan explained how some people with Crohn’s or ulcerative colitis use CBD oil and cannabis, what the risks and benefits are, and why you should always consult your doctor before trying them. (Responses have been edited and condensed for clarity.)
Can you explain cannabis and CBD oil? How are they different?
Cannabis has become a hot topic, especially in the last couple of years, because of its increasing legalization nationally. Cannabis is what most people refer to as marijuana.
Typically, it is primarily derived from the Cannabis sativa plant, although there is a second plant called Cannabis indica. Cannabis is composed of hundreds of phytocannabinoids. Phytocannabinoids are plant-based cannabinoids. These act on the endocannabinoid system, which is located in the body and in the gut.
Two of the most recognized phytocannabinoids are delta-9-tetrahydrocannabinol (or THC, in short) and cannabidiol, which is CBD. The main difference between CBD oil — which is something that patients come in asking about — and cannabis is that CBD often lacks any component of THC. [CBD is] truly a derivative of just cannabidiol. THC is a substance that’s most likely responsible for the psychoactive effects that are experienced by cannabis users.
What are the different forms of medical cannabis?
Cannabis can be in many formulations, and CBD oil is the most commonly marketed form of CBD. We’ve published an article in an IBD journal on cannabis and IBD, which goes into more depth.
The formulations that patients can have access to are:
- CBD only
- CBD with various percentages of THC
- THC alone
Those are the three classes that we break it down to. But there are many more ways to take cannabis: by inhalation, orally, in an oil, and some companies make it in a suppository form.
From the results of various studies, it appears that THC in addition to CBD has the greatest impact in terms of patients’ symptoms. But again, I think there are more studies and more research that we need to do, and until it’s federally legal, it’s very challenging to do that in a meaningful way.
How effective is cannabis for managing the symptoms of Crohn’s and ulcerative colitis?
Let’s jump into the data. I’m going to [discuss] ulcerative colitis and Crohn’s disease [together], although they have been studied separately. The data from a 10,000-foot view looks very similar. They’ve looked at various formulations: CBD only, CBD with THC at various percentages, as well as THC alone.
What they found is that there is no significant impact on patients’ inflammation. However, these studies have shown that patients with ulcerative colitis and Crohn’s disease have improvement in their symptoms — especially for patients with Crohn’s disease. There have been benefits in terms of improvement in abdominal pain, nausea, an increase in appetite, and weight gain, as well as reported improved quality of life when patients incorporate cannabis or cannabis derivatives with their medical therapy.
None of these studies have looked at cannabis as a substitute for medicines. All of these studies have looked at cannabis as an addition to already stable FDA-approved medical therapy for treatment of both ulcerative colitis and Crohn’s disease.
I think the challenging thing that the audience needs to understand is that it’s hard to blind these studies, because if they do include a THC component, there are psychoactive effects that are clearly recognized by a user. And so, it’s hard to blind these studies like you would in a larger clinical trial.
In animal studies, if we directly target the endocannabinoid receptors (not give animals cannabis, but target the receptors), we seem to have a greater impact in terms of inflammation in these particular models. It’s not that cannabis can’t and won’t be beneficial, but in its current studied state, it has not shown the impact that we would expect in terms of improving inflammation.
So the bottom line is, it can be as useful, and some of our patients have used it as an adjunct therapy (which means they use it in addition to their medical therapy) while working with a health care provider to help control ongoing symptoms.
Can cannabis ever be a substitute for prescription medication?
We have no data to support that it replaces traditional medical therapy. And I think that what’s lacking in our current state is an open conversation between a treating provider and a patient. We know that many patients don’t disclose cannabis use to their providers, and we know that many providers don’t ask about cannabis use with their patients. I’d like to help change that conversation and make sure that we’re having an open dialogue about it and understand why patients are using it.
If I have a patient with ulcerative colitis that has no symptoms — is feeling well but using cannabis — I often ask them why they’re using cannabis. Then they’ll say, “Well, it actually improved my appetite.” That’s OK.
But if they’re telling me that they’re using cannabis to control their diarrhea, and the reason why they’re feeling well is because they actually are having diarrhea and the cannabis is improving their diarrhea (which it has been known to do, as it can slow down the motility of the colon), we need to first ask that most important question: Do they have underlying inflammation?
The cannabis may not be treating that inflammation. It may be improving the symptom, but they may have active disease that we really need to be addressing with their medical therapy. [Discussing cannabis use] opens up a conversation that really allows a provider and a patient to partner together.
Are there risks to using cannabis?
It’s important to note that cannabis is not risk-free. In addition to an increase in motor vehicle accidents with cannabis use, there have been some studies looking at poor outcomes in patients, particularly with Crohn’s disease. In a large study done in Canada, patients with Crohn’s disease that used cannabis — compared to those that did not use cannabis — were significantly more likely to require surgery for their disease. While there might be other explanations for this, it’s an important flag to stop and question what’s going on. And maybe we should be a little bit more cautious in using cannabis, because it’s not risk-free — just like many of the medical therapies that we use.
The most important thing I can stress to patients is that they need to talk to their provider about using cannabis.
Is there a pathway to using cannabis for treatment?
It’s really dependent on the patient and the symptoms that they’re trying to treat. It also depends on their state [of residence]. In some states, medicinal legalization is a high CBD-to-THC ratio. In those states, the formulation is mainly driven by a CBD component, compared to a THC component. But again, the studies that we have don’t really give us guidance on how to prescribe this treatment. It really requires a patient working with their provider.
This underscores your initial advice to always talk to your doctor about your symptoms and anything you’re doing to manage them.
Absolutely. I think many patients are afraid to [talk about cannabis] because they fear that their provider wouldn’t be accepting. But what we’ve seen is that more providers would be accepting — they just aren’t part of the conversation. And so starting a conversation is the most important thing that IBD patients can do.
When should people with IBD start thinking about cannabis as a potential treatment option?
For patients that are otherwise doing well on their medicines, there is no need to add cannabis, unless they are having issues with sleep onset, appetite, or abdominal pain. Sometimes there is a need to introduce cannabis for the purposes of improving sleep, although there have been studies showing that this could have a negative effect.
Patients with Crohn’s disease that have persistent abdominal pain and a decrease in appetite, despite their inflammation appearing to be under control, may benefit from cannabis. Again, these are patients [whose] disease is in a remission state, but their symptoms are still persistent. This is where many of my patients will introduce cannabis as an adjunctive therapy. They continue their medicines because clearly they’re working to keep the inflammation under control, but they’re using cannabis to improve their quality of life by managing their symptoms.
Some patients don’t get any benefits from cannabis, and they find that it doesn’t really help them. Instead, they experience more side effects, so they stop using it. Many of our patients that continue to use cannabis note the benefits for abdominal pain, diarrhea, mood, and sleep quality.
In light of different regulations across states and varying provider experience with cannabis, do you have any advice for our members on how to approach the conversation?
Some of my patients say, “Doctor, I know that you say that my Crohn’s disease is in remission. You’ve looked with a colonoscopy, and everything looks healed, but I’m still experiencing daily abdominal pain that’s preventing me from eating. I’m losing weight. I’m thinking about using cannabis to help me improve my abdominal pain and to help me improve my appetite. What do you think?”
And that’s where we have the conversation. I’ll say, “You’re right. You’re still having some symptoms that are clearly impacting your quality of life. Let’s see if using a therapy like cannabis can help.” Cannabis is one way, but there are lots of opportunities for us to help patients with persistent symptoms, despite their inflammation being under control.
If you use cannabis recreationally and not necessarily to manage your symptoms, it’s important to let the doctor know about it. Your medical record is a part of a sealed, completely confidential file, so you wouldn’t have to be worried about the information getting out there and impacting your job, for instance.
Your provider is there to partner with you. And if you don’t feel that your provider is on your side or is your partner, that’s an opportunity to seek a second opinion and find a provider that is there to partner with you. Our goals are the same: to make you feel better using all the tools that we can to do that. It’s not always just FDA-approved medical therapies; we have a lot of tools in our toolbox to do that. And there is a lot of data to support the use of various approaches. It’s not just one avenue. Having that conversation opens up so many opportunities for discussing alternative treatments and how you can incorporate those into your current medical regimen to improve your quality of life.
MyCrohnsandColitisTeam Members Talk About Cannabis
The use of CBD oil and cannabis products for ulcerative colitis and Crohn’s disease is a hot topic on MyCrohnsandColitisTeam. By joining MyCrohnsandColitisTeam, you gain a community of 132,000 people who understand your experience living with inflammatory bowel disease.
Have you used cannabis or CBD products to treat your Crohn’s or ulcerative colitis? Do you feel able to discuss cannabis with your health care providers? Share your experience in the comments below or post on MyCrohnsandColitisTeam.