Medical Cannabis - Crohn’s Disease
In Australia, Crohn’s Disease (under the umbrella of IBD) is becoming more prevalent, more complex, and more severe, according to a PricewaterhouseCoopers report. It affects approximately 1 in 250 people aged 5-40. Almost 75,000 Australians have Crohn’s Disease or ulcerative colitis, with this number projected to increase to 100,000 this year (2022)
“The marijuana plant cannabis is known to have therapeutic effects, including improvement of inflammatory processes”
Crohn’s disease is an inflammatory bowel disorder of unknown origin. Also called ileitis or enteritis, it usually affects the lowest portion of the small intestine, but it can occur in other parts of the digestive tract, from the mouth to the anus. Crohn’s disease causes inflammation that extends deep into the lining of the intestinal wall, frequently causing cramps and abdominal pain, diarrhoea, rectal bleeding, loss of appetite, and weight loss.
A common complication of the disease is blockage of the intestine caused by scar tissue that narrows the passageway. The disease may also cause sores, or ulcers, that break through to the surrounding tissues. These tunnels are called fistulas, and while they can be treated using medication, surgery is sometimes required. People with Crohn’s disease also suffer from nutritional deficiencies.
Crohn’s disease affects men and women equally and tends to run in families. This disorder affects people in all age groups and can be difficult to diagnose because its symptoms are similar to those of other intestinal disorders. Symptoms can also appear intermittently, occurring every few months to every few years for some people. In rare cases, the symptoms may appear once or twice and not return. If the disease continues for many years, bowel function gradually deteriorates. Left untreated, it can become extremely serious, even life-threatening, and it may increase the risk of cancer.
Since there is no cure for Crohn’s Disease the goals of treatment are to control inflammation, relieve symptoms, and correct nutritional deficiencies – all of which can help keep Crohn’s Disease in remission.
“Case studies report that many of the symptoms and complications of Crohn’s Disease can be alleviated by medical cannabis use”
Israel, October 2018 – TREATMENT OF CROHN’S DISEASE WITH CANNABIS: An Observational Study
Cannabis improves symptoms of Crohn’s Disease despite having no effect on gut inflammation…
In the first study of its kind, cannabis oil has been show to significantly improve the symptoms of Crohn’s Disease and the quality of life of sufferers but, contrary to previous medical thinking, has no effect on gut inflammation.
In a randomised, placebo-controlled study, researchers from Israel have shown to significantly produce clinical remission in up to 65% of individuals after 8 weeks of treatment, but that this improvement does not appear to result from a dampening down of the underlying inflammatory process.
Lead researcher, Dr Timna Naftali explained, “Cannabis has been sued for centuries to treat a wide range of medical conditions, and studies have shown that many people with Crohn’s Disease use cannabis regularly to relieve their symptoms. It has always been thought that this improvement was related to a reduction in inflammation in the gut and the aim of this study was to investigate this.”
The Israeli team recruited 46 people with moderately severe Crohn’s Disease, and randomised them to receive 8 weeks of treatment with either cannabis oil or a placebo. Symptom severity and quality of life were measured before, during, and after treatment using validated research instruments. Inflammation in the gut was assessed endoscopically and by measuring inflammatory markers in blood and stool samples.
After 8 weeks of treatment, the group receiving the cannabis oil had a significant reduction in their Crohn’s Disease symptoms compared with the placebo group, and 65% met strict criteria for clinical remission (versus 35% of the placebo recipients). The cannabis group also had significant improvements in their quality of life compared with the placebo group.
“We have previously demonstrated that cannabis can produce measurable improvements in Crohn’s Disease symptoms, but to our surprise, we saw no statistically significant improvements in endoscopic scores or in the inflammatory markers we measured in the cannabis oil group compared with the placebo group,” said Dr Naftali. “We know that cannabinoids can have profound anti-inflammatory effects but this study indicates that the improvement in symptoms may not be related to these anti-inflammatory properties.”
Looking ahead, the research group plans to explore further the potential anti-inflammatory properties of cannabis in the treatment of inflammatory bowel disease. “There are very good grounds to believe that the endocannabinoid system is a potential therapeutic target in Crohn’s Disease and other gastrointestinal diseases.” said Dr Naftali. “For now, however, we can only consider medical cannabis as an alternative or additional intervention that provides temporary symptom relief for some people with Crohn’s Disease.
UK November 2021 - Oxford Academic Journal of Crohn’s and Colitis: Oral CBD-rich cannabis induces clinical but not endoscopic response in patients with Crohn’s Disease, a randomised controlled trial
Despite reports that medical cannabis improves symptoms in Crohn’s Disease, controlled studies evaluating disease response are lacking. This study assessed the effect of cannabidiol (CBD)-rich cannabis oil for induction of remission in Crohn’s Disease.
In a double-blind, randomised, placebo-controlled, single-centre trial 56 patients received orally either cannabis oil or a placebo for 8 weeks.
Conclusion: Eight weeks of CBD-rich cannabis treatment induced significant clinical improvement without significant changes in inflammatory parameters or endoscopic scores. The oral CBD-rich cannabis extract was well absorbed. In both the cannabis and placebo groups, inflammatory markers remained unchanged.
What the Studies Say
Experts generally agree that the data on cannabis for Crohn’s Disease is uncertain for now. The only data in people with Crohn’s Disease come from small clinical studies. Altogether, those studies include fewer than 200 people with active Crohn’s Disease.
More research is needed in more people with Crohn’s Disease, and there are studies ongoing. One reason it’s complicated is that cannabis comes in many varieties. The plant has two main active ingredients: THC and CBD. It’s the THC in marijuana that gives you a high. The CBD products you can buy usually come from hemp and shouldn’t have much if any THC. We need more time to study the various compounds found in medical cannabis.
The results indicate that cannabis may have a positive effect on disease activity, as reflected by reduction in disease activity and the need for other drugs and surgery. Prospective placebo-controlled studies are warranted to fully evaluate the efficacy and side effects of medical cannabis in Crohn’s Disease.
UNIVERSITY OF SYDNEY SURVEY 2020
NOT A CASE STUDY:
However results from the first Australian nationwide survey, conducted by the Lambert Initiative for Cannabinoid Therapeutics, and published in the journal Crohn’s & Colitis, expanded on previous surveys by accessing a larger patient population.
25% of the anonymous 838 respondents were using or had previously used medicinal cannabis to manage their symptoms.
University of Sydney principal investigator and academic director of the Lambert Initiative Professor Iain McGregor said” “The survey was inspired by the experiences of the Taylor family from the Blue Mountains: father Steven Taylor was arrested for growing cannabis to alleviate the suffering of his daughters Morgan and Taylor who suffered from severe IBD and found great relief from non-intoxicating cannabis leaf juice preparations.”
This case reflects the reality that many Crohn’s Disease patients do not have their condition adequately managed by existing drugs and so turn to alternative options, such as medicinal cannabis to manage their condition.
THE SURVEY REVEALED:
· Cannabis was predominantly obtained from illicit sources with only three respondents using legal pathways provided by the Australian government.
· More than 90% of patients reported that medicinal cannabis use improved their symptom management – with greatest benefits reported for abdominal pain, stress, sleep, cramping and anxiety symptoms.
· There were, however, fewer benefits to symptoms associated with disease pathology, such as rectal bleeding, obstructive symptoms and stool frequency/consistency/urgency.
· Patients with ulcerative colitis who use medicinal cannabis scored higher on measures of “quality of life” than non-users.
· Medicinal cannabis users reported less adherence to prescribed medications and were less likely to be engaged in specialist care for their IBD, which suggests low levels of clinical engagement in many of the cannabis-using patents
· Medicinal cannabis use was associated with some minor side-effects, mostly drowsiness/sedation and memory impairment.
· About half of the respondents who were actively using medicinal cannabis at the time of completing the survey also consumed cannabis recreationally, although less frequently than for medicinal purposes.
· Both cannabis-using and non-using patients expressed high levels of support for the use of medicinal cannabis in IBD and interest in participating in future clinical trials of medicinal cannabis products.
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The positive impact this plant has already had on the quality of life for patients and their families is nothing short of miraculous.
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