A large body of research points to therapeutic substances in marijuana that could help with Crohn’s symptoms, and some studies have even found a direct link between marijuana use and benefits in people with Crohn’s. But many experts still urge caution. “I think there’s a decent number of IBD patients using cannabis and noticing symptomatic improvement,” says Kian Keyashian, MD, a gastroenterologist and IBD specialist at Stanford Health Care in California. “But we absolutely need more research in this area because what we haven’t been able to show is that marijuana provides an improvement in disease activity and objective markers of inflammation.” An overview of cannabis-based treatment in Crohn’s disease, published in 2020 in the journal Expert Review of Gastroenterology & Hepatology, estimated that about 15 percent of patients with IBD use cannabis to alleviate disease symptoms such as abdominal pain, diarrhea, joint pain, poor appetite, anorexia, nausea, and fatigue. And while there is growing evidence that highlights its potential positive effects, marijuana has also been associated with worse outcomes in people with Crohn’s. So before giving it a try, read on to find out about its risks and benefits.
Evidence Is Still Spotty
Cannabis — or marijuana, pot, or weed — is a group of plants that can be used medicinally in a number of ways, including smoking, ingesting edibles, using a vaporizer (vaping), and applying topically. Cannabis contains nearly 500 chemicals, of which more than 100 are known as cannabinoids. These chemicals cause druglike effects all through the body, including the central nervous system and the immune system. The two most prominent cannabinoids in marijuana are delta-9‐tetrahydrocannabinol (THC) and cannabidiol (CBD). THC is a psychoactive substance that’s primarily responsible for the effects of marijuana on a person’s mental state, making a person feel high. CBD is also psychoactive, but it binds to receptors in a different way than THC so it doesn’t necessarily produce the same sensation. As Harvard Health Publishing reports, CBD may help with anxiety, insomnia, chronic pain, and addiction. While the U.S. Food and Drug Administration has not given the green light on using the cannabis plant for medicinal purposes, the agency has approved drugs that contain individual cannabinoids. These include Epidolex (cannabidiol), a treatment for epileptic seizures that contains a purified form of CBD, and Marinol (dronabinol) (PDF) and Syndros (dronabinol), which contain a synthetic THC that helps with nausea and vomiting related to chemotherapy. People with HIV/AIDS have also found that it stimulates appetite. Although cannabis isn’t officially recommended for Crohn’s treatment, a few studies have indicated that the substance could ease IBD symptoms. Still, because different trials have looked at different doses of different chemicals from the plant, it’s hard to draw firm conclusions about how this drug may help with Crohn’s management. “Cannabis use has been reported to increase quality of life in Crohn’s disease and ulcerative colitis patients, but published studies lack standardization regarding the variety of the part of the plant used and dose,” says Dawn Beaulieu, MD, an associate professor of medicine and the director of the Functional Medicine IBD Clinic at Vanderbilt University in Nashville, Tennessee. “I have seen that it can relieve symptoms in my patients who chose to use it short term.” Dr. Beaulieu, who is also an American Gastroenterological Association spokesperson, stresses, however, that there is no evidence that marijuana can actually reduce gut inflammation. “It is just masking active disease instead of really treating the root problem,” she says. “Using marijuana may help with your nausea and abdominal pain, but we’re not fixing the underlying trigger that’s causing all the symptoms to happen, and when you do that, you’re not actually treating the disease itself.” Although marijuana may have some medicinal properties and therapeutic potential in the future, Beaulieu emphasizes that it’s still illegal under federal law, so she doesn’t recommend it to her patients. A meta-analysis of six studies, published in 2021 in the journal Cureus, confirmed the improvement of general well-being, weight gain, and reduced clinical complications after patients with IBD received cannabis treatment. Varying doses and forms of cannabis were used in these studies, including cigarettes containing 50 grams of dry-processed plant per month, cigarettes with 0.5 grams of dried cannabis flowers equivalent to 11.5 milligrams THC, a low-dose of CBD oil, and hard gelatin capsules containing 50 milligrams of CBD-rich botanical extract. The average duration of treatment with cannabis ranged from eight weeks to just over two years. When it came to establishing overall benefits and harms of cannabis use, however, researchers said the results were inconclusive. A broader analysis of 20 previous investigations, published in 2021 in the Journal of Clinical Gastroenterology, determined that cannabinoids significantly improved patient-reported symptoms and quality of life, but there was no improvement seen when it came to inflammation or clinical remission. Because patients with IBD have a higher chance of developing colorectal cancer, some researchers have looked into the possibility that cannabinoids could lower that risk. A University of South Carolina study indicated that THC inhibited the development of colon cancers in mice. The findings support the notion that inflammation and colon cancer are closely linked and suggests that THC could be beneficial for people at high risk of developing colon cancer. An analysis of seven prior studies, published in 2020 in the International Journal of Molecular Science, indicated that marijuana had anti-inflammatory and antioxidant properties. Oxidative stress, which may be destructive to the gastrointestinal tract, is an imbalance of damaging free radicals (unstable molecules) and the body’s ability to neutralize them. Antioxidants — such as cannabinoids, flavonoids, and terpenes found in cannabis — are chemicals that may fight these free radicals. Still, the study concluded that standardized trials are needed to determine whether cannabis and its derivatives have a therapeutic effect on IBD.
Marijuana Use Comes With Risks
While marijuana has symptom-soothing effects, doctors have pointed out that it may actually mask ongoing inflammation in Crohn’s disease — and this may convince people that their disease is in remission when it’s not. “The key is to make sure that the cannabis use doesn’t replace medical treatment because patients may have this idea that they’re feeling better and can go off their therapy,” says Dr. Keyashian. “I view it as complementary treatment, not a replacement for real medicine.” A study in the Cochrane Library (a collection of healthcare databases) notes that cannabis use may cause people with Crohn’s to experience weakness, dizziness, and diarrhea, as well as an increased risk of surgery. Of course, it’s possible that people with worse symptoms and more advanced disease are more likely to use marijuana, so this doesn’t mean marijuana contributed to the risk of needing surgery. Since marijuana may mask problems, Beaulieu says, “You’re not decreasing inflammation, so you’re not preventing the downstream complications of long-standing inflammatory bowel disease, which may require surgery.” The Mayo Clinic lists a number of side effects, including headaches, drowsiness, fatigue, disorientation, hallucinations, depression, and impaired judgment. But side effects vary according to how much and how often you use the substance. Even though marijuana may help with nausea and vomiting, Keyashian warns that overuse can cause a paradoxical increase in those symptoms called cannabinoid hyperemesis syndrome (CHS). “Although cannabis can improve symptoms associated with Crohn’s disease, its potential for cognitive, psychiatric, and respiratory side effects — as well as dependence and addiction after long-term use — are concerning when using marijuana as medical treatment,” says Beaulieu.
Medical Marijuana Isn’t Easy to Obtain
Even if you are inclined to try marijuana, you may face legal or logistical barriers in acquiring it, depending on where you live in the United States. In a statement, the Crohn’s & Colitis Foundation (PDF) warned that both patients and healthcare providers “need to be aware of the unique state laws pertaining to prescribing and use of cannabis.” Your employer’s policy regarding marijuana use should also be a consideration. “Both providers and patients need to remember that marijuana is still classified as a controlled substance by the Drug Enforcement Administration, and patients must be aware of their employer’s drug and drug-testing policies when they are considering cannabis as a medical treatment,” says Beaulieu. Currently, 37 states, three territories, and Washington, DC, allow the medical use of cannabis products, but each program works differently. You can find out whether your state or territory has such a program, along with details about how each specific program works, at the National Conference of State Legislatures website. Ultimately, though, your best resource for discussing the medical and practical reasons for using marijuana to help treat Crohn’s disease is likely to be your doctor. If you think cannabis might be an option worth considering, bring up the topic at your next appointment.
