Looking ahead, “what we need is to really start doing large, multicenter, randomized, controlled studies to examine the effects on IBD, using specific forms of cannabis at specific doses,” Tishler says. Until more is known, the onus is on patients to take precautions. For one thing, if you’re interested in trying it, find out what the laws are in your area: while some states have fully legalized marijuana, others allow it only for medical purposes, and still others continue to treat it as fully illegal. You’ll also want to find out what your employer’s policy is regarding medical marijuana use, in case there’s a chance that you may be drug-tested. “With chronic use, marijuana stays in your system for a long time,” Vaughn says.
There’s also a concern that people with IBD and other gastrointestinal disorders might stop using other treatments that have been approved by the FDA for their condition. “Because they feel better, they may have a false sense that they are better,” Kinnucan says. “It’s important to continue medical therapy to prevent progression of the disease. We know that medication non-adherence is associated with clinical relapse of IBD and could have implications on future disease outcomes.”
And while the mechanisms of action aren’t completely understood, this much is clear: the human body has an endogenous cannabinoid system—one that originates inside the body—that comprises cannabinoid receptors, endogenous cannabinoids (lipids that engage cannabinoid receptors), and enzymes that are involved in the synthesis and degradation of the endocannabinoids. In particular, CB1 receptors are abundant in the central nervous system, while CB2 receptors are more prevalent throughout the gastrointestinal tract, explains Dr. Jami Kinnucan, an assistant professor of medicine in the division of gastroenterology and hepatology at the University of Michigan in Ann Arbor.
A little background about cannabis: while it contains hundreds of compounds, the most well-known are THC and CBD. THC is responsible for marijuana’s psychoactive effects (that “high” sensation), whereas CBD is not psychoactive but seems to modulate the effects of THC, explains Dr. Christopher N. Andrews, a clinical professor of gastroenterology at the University of Calgary.
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As far as inflammatory gastrointestinal disorders go, the greatest symptom benefit seems to come from preparations that have a combination of THC and CBD, Kinnucan says. This is partly because while CB1 receptors are activated by THC, CBD and THC have a synergistic effect on CB2 receptors. “In patients with inflammatory bowel disease, studies have shown that the combination improves abdominal pain and decreases bowel movement frequency,” she says. What’s more, cannabis use appears to decrease emptying of the stomach and gastric-acid production, as well as reduce the movement of food throughout the gastrointestinal tract, notes Dr. David Poppers, a clinical professor of medicine in the division of gastroenterology and director of GI Quality and Strategic Initiatives at NYU Langone. As a result, cannabis use may improve the diarrhea-predominant form of irritable bowel syndrome (IBS), he says.
In 2018, he decided to try something different as an adjunctive treatment, with his gastroenterologist’s blessing: medical marijuana in the form of cannabidiol (CBD) and tetrahydrocannabinol (THC) capsules that he was able to purchase after getting a New York City medical-marijuana license. “Within an hour and a half of taking them, I felt better,” Silverman says. “The bloating and pain went down, and my appetite came back.”
If you’re already using marijuana, whether for medical or recreational reasons, it’s important to tell your doctors—regardless of whether it’s legalized where you call home.
In recent years, there has been growing interest in the use of medical marijuana for gastrointestinal disorders, such as inflammatory bowel diseases (IBD) like Crohn’s and ulcerative colitis (UC). In a study in the December 2013 issue of the journal Inflammatory Bowel Diseases, researchers surveyed 292 patients with IBD at a major medical center in Boston about their use of marijuana and found that 12% were active users and 39% were past users. Among current and former users who used marijuana products for their symptoms, the majority felt that it was “very helpful” in relieving their abdominal pain, nausea and diarrhea. More recently, a 2018 study in the Journal of Pediatrics found that among 99 teen and young-adult patients with IBD, nearly one-third had used marijuana—and 57% of the users endorsed its use for at least one medical reason, most commonly relief of physical pain.
Even so, “I didn’t feel well—my mind was cloudy and I was in pain,” says Silverman, now 47, the co-founder of the PSMC5 Foundation, which is dedicated to beating rare genetic disorders like the PSMC5 gene mutation (which his son has). So in 2013, he tried a new approach: he began getting intravenous infusions of an immunosuppressive drug at four- to eight-week intervals to reduce inflammation in the lining of his intestines. “It helped, but I still had nausea, brain fog, discomfort and trouble sleeping,” says Silverman.
This article was co-authored by Jamie Corroon, ND, MPH. Dr. Jamie Corroon, ND, MPH is the founder and Medical Director of the Center for Medical Cannabis Education. Dr. Corroon is a licensed Naturopathic Doctor and clinical researcher. In addition to clinical practice, Dr. Corroon advises dietary supplement and cannabis companies regarding science, regulation, and product development. He is well published in the peer-review literature, with recent publications that investigate the clinical and public health implications of the broadening acceptance of cannabis in society. He earned a Masters in Public Health (MPH) in Epidemiology from San Diego State University. He also earned a Doctor of Naturopathic Medicine degree from Bastyr University, subsequently completed two years of residency at the Bastyr Center for Natural Health, and is a former adjunct professor at Bastyr University California.
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