cbd for ibd

Cbd for ibd

There has been a recent increase in the consumption of foods containing cannabis (edibles) in both the recreational and medicinal setting. 82 The most significant difference between ingestion and inhalation of cannabis is the delayed onset of action associated with ingestion. 64 This may lead to greater than intended consumption of the drug before it has taken effect, resulting in serious adverse effects, overdose, and even death. 82 –84 To promote safe use and prevent adverse effects, it is important to educate patients on how edibles affect the body.

Keith A. Sharkey, Hotchkiss Brain Institute and Snyder Institute for Chronic Diseases, Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, AB, Canada.

Sherman Picardo, Inflammatory Bowel Disease Unit, Department of Gastroenterology, Cumming School of Medicine, University of Calgary, AB, Canada.

Table 1.

Cannabis contains over 100 different constituents, with Δ 9 -tetrahydrocannabinol (THC) and cannabidiol (CBD) being the most prominent and best characterized. 16 These act on the endocannabinoid system (ECS), 17 and have demonstrated analgesic and antinociceptive activity in several animal and human models. 18 –21 The primary clinical use of cannabis has been in the management of acute and chronic pain. It may be useful in reducing the use and dependence on opioids in the management of pain. The constituents of cannabis, however, also act on a number of other central and peripheral receptors, and can impact cytokine and immunoglobulin production as well as control immune cell migration. 22 –24 Cannabis has been demonstrated to have anti-inflammatory effects, and therefore may be useful in the treatment of a number of chronic inflammatory conditions including IBD. 25,26

In addition to CB1 and CB2, other molecular targets for the cannabinoids have been identified, including the G-protein coupled receptors 18, 55, and 119 (GRP55 and GRP119); the peroxisome proliferator-activated receptor (PPAR); the serotonin-1A receptor (5-HT1A); and the transient receptor potential vanilloid 1 (TRPV1.) 38,54 –56 The administration of cannabis, through its interaction with the various receptors of the ECS, modulates the gastrointestinal system by increasing appetite and reducing nausea, gastric secretions, intestinal contractility, peristalsis, visceral sensation as well as intestinal inflammation ( Figure 1 ). 38

Footnotes

GGK holds the Canadian Institute of Health Research Embedded Clinician Research Chair.

Patients with IBD often turn to complementary medications, including various forms of cannabis, to combat symptoms related to their disease. Patients have reported using cannabis to relieve symptoms of abdominal pain, nausea, diarrhea, anorexia, as well as to improve mood and quality of life. 57 –59 In an anonymous questionnaire-based study, IBD patients reported that cannabis improved abdominal pain (83.9%), abdominal cramping (76.8%), joint pain (48.2%), and, to a lesser extent, diarrhea (28.6%). 57

Cbd for ibd

The plant Cannabis sativa has been used in medicinal practice for thousands of years. 6 The pharmacologically active constituents of the plant are termed cannabinoids, of which at least 70 are known today. Phytocannabinoids (cannabinoids derived from the plant), synthetic cannabinoids (artificial compounds with cannabinomimetic effects), and endocannabinoids (endogenous compounds with cannabinomimetic effects) act together on the endocannabinoid system (ECS), which regulates various functions in the body. 7

The Endocannabinoid System and Its Role in Gastrointestinal Physiology

Naftali and colleagues’ subsequent placebo-controlled trial 35 generated significant media attention regarding the therapeutic use of cannabis in IBD; however, the study was met with an equal amount of criticism in the scientific community. 37 – 39 Critics claimed the trial was underpowered, with only 21 subjects studied over 8 weeks with a 2-week follow-up. The authors measured disease activity using the CDAI, an accepted score system for disease activity in literature, although without specific variable results. The CDAI, similar to the Harvey-Bradshaw index, has subjective parameters, including stool pattern, abdominal pain, and general well-being; a patient with poorly controlled irritable bowel syndrome could appear as a poorly controlled IBD patient via CDAI measurement, as these parameters are the main drivers of the score. 37 Two weeks after cannabis treatment was stopped, the mean CDAI score in the treatment group increased. Naftali and colleagues argued that these results demonstrate a therapeutic role of cannabis; however, it may be that subjects were experiencing central effects of cannabis treatment, ameliorating symptoms during the study rather than actual treatment of inflammation, or were experiencing withdrawal symptoms after completion (although the authors noted that patients denied having withdrawal symptoms after discontinuation of cannabis). Importantly, there were no significant changes in CRP levels during the study; thus, the only parameter of objective treatment efficacy was inconclusive. Endoscopic studies to correlate treatment effect were not performed. While the study attempted to be double-blinded, the authors mentioned that the psychotropic effects of the drug made blinding difficult; at the end of the study, all participants except 2 in the placebo group were able to correctly differentiate whether they had received cannabis or placebo. Critics also noted that patients in remission, defined by a CDAI score of less than 150, can still have significant inflammation on endoscopy. Vu and colleagues suggested that although the authors tried to standardize treatment via distribution of similar quantities of cannabis, the lack of testing of blood levels of cannabis is an additional flaw and hypothesized that unreported additional drug use such as alcohol may affect intrinsic THC levels. 39 The studies by Naftali and colleagues 33 , 35 were supported, and researchers were employed, by the Tikun Olam Organization, the largest and foremost supplier of medical cannabis in Israel, which openly advocates for use of medical marijuana in many medical conditions and whose website contains data regarding the beneficial effect of medical cannabis.

Table 4.

The safety profile of cannabis is not well established, and use is associated with psychosocial disease and acknowledged physiologic effects. Whereas cannabis use in the United States is illegal by federal law, its legality for medical or recreational use varies by state law, allowing for poor regulation in its preparation, potency, ratio of contents, and route of usage, with variations in requirements for product labeling and testing. 3 Furthermore, Storr and colleagues reported that 36% of patients with IBD who did not use cannabis were worried about side effects of its use. 12