Cannabis for Crohn’s disease

Crohn’s disease is a chronic inflammatory bowel disease (IBD) that affects the digestive tract. Our immune systems are designed to attack foreign invaders such as bacteria and viruses, but in people who suffer from Crohn’s disease, their immune systems attack harmless, everyday bacteria, causing inflammation in the intestines that does not go away.

There is no known cure for Crohn’s disease, and it’s impossible to predict how the disease will affect a particular person. However, thanks to studies conducted by Tikun Olam Israel, the use of cannabis in treatment has been shown to offer sustained symptom relief and hope for remission better than many medical treatments currently available.

The Problem

IBD affects an estimated 3 million people in the United States, yet the causes of Crohn’s disease are not well understood. Research suggests a hereditary component because up to 20% of people with IBD have a first-degree family member who also suffers from the disease. The disease is chronic, which means most patients will experience continual symptoms and flare-ups, or attacks, that range from mild to life-threatening.

These include reduced appetite and weight loss, fever, fatigue, abdominal pain and cramping, diarrhea, bleeding, and in more severe cases, inflammation of the skin, eyes, and joints, and liver and bile ducts. Complications from Crohn’s disease range from ulcers and bowel obstruction to an increased risk of colon cancer and other health issues, such as skin disorders, osteoporosis, and liver disease.

Crohn’s disease is currently treated through medication and diet, and often steroid use. Certain medications work by suppressing the immune system, which can increase the risk of infection. Corticosteroids are used for more severe symptoms and to control flare-ups, but can only be taken for short periods of time because they increase the risk of bone fractures, cataracts, glaucoma, diabetes, and high blood pressure, among other negative effects. Even with proper medication and diet, as many as three-quarters of people with Crohn’s disease will require surgery at some point during their lives.

Medical Cannabis: A Solution

The cannabis plant contains more than 60 different compounds, collectively referred to as cannabinoids. Cannabinoids have a profound anti-inflammatory effect. In gastroenterology, cannabis has been successfully used to alleviate symptoms related to anorexia, emesis, abdominal pain, diarrhea, intestinal inflammation, and more. Due to this, the non-conventional medical community has recommended cannabis for patients with IBD. While medical cannabis research in the United States has been challenging due to its legal status, Israel approved the use of medical cannabis back in 2007. The scientists at Tikum Olam Israel have been conducting studies ever since.

Tikun Studies

In an observational study of cannabis as a treatment for Crohn’s disease, Tikum Olam found that cannabis use did indeed result in significant positive effects on the symptoms of the disease, including the number of bowel movements, quality of bowel activity, and abdominal pain. It also significantly reduced the need for other medication and steroid treatment. All of the patients in the study stated that consuming cannabis had a positive effect on their disease activity.

Observational Study: Key Results

  • 70% of patients improved significantly
  • Mean bowel movement reduced from 8 to 5
  • Number of patients needing steroid treatment reduced from 26 to 4

The success of the observational study led to an official clinical trial. In the world’s first randomized, placebo-controlled, double-blinded study of its kind, Dr. Naftali and a team of researchers used Tikun Olam’s Erez strain to produce dramatic clinical results. The entire cannabis group reported significantly less pain, with improved appetite, sleep, and quality of life, all without negative side effects.

Clinical Trial: Key Results

  • 45% of patients achieved complete remission
  • Over 90% of patients achieved substantial improvement
  • 27% of patients weaned from steroid dependency

Observational Study: Research Methods and Results

In the observational study, 30 patients with Crohn’s disease who were using cannabis were interviewed. Most of the patients in the study cited that the reason they turned to cannabis was due to ineffective conventional treatment. Six patients reported using cannabis due to intractable pain. The time period for cannabis use ranged from three months to nine years.

Researchers reported on disease activity before and after cannabis treatment using the Harvey Bradshaw index. Additionally, the study assessed the patients’ general well-being and related disease complications before and after use on a visual analog scale that ranged from zero (very poor) to 10 (excellent). This number increases from an average of 3.1 to 7.3, indicating a significant improvement.
In addition to reducing bowel movements by almost 50%, notable is the significant reduction in steroid use to manage Crohn’s disease during cannabis use by 85%.


Clinical Trial: Research Methods and Results

The clinical trial studied 21 patients whose Crohn’s Disease Activity Index (CDAI) scored greater than 200 (scores ranged from 200 to 450). These patients were not responding to therapy with steroids and immune-suppressing medications. Patients were assigned randomly to groups that received either cannabis or a placebo of cannabis flowers from which the THC had been removed. Disease activity and laboratory tests were assessed during eight weeks of treatment, as well as two weeks afterward.

After eight weeks of cannabis use, the mean CDAI in the study group decreased dramatically (from 330 +/- 105 to 152 +/- 109) while the placebo group reduced only slightly (from 330 +/- 105 to 306 +/- 143.)

5 participants in the cannabis group and 1 in the placebo group achieved complete remission. A clinically relevant improvement, or a CDAI reduction of greater than 100, was achieved in 90% of the study group. In contrast, 3 patients in the placebo group experienced worsening symptoms, and 3 showed only  mild improvement. Notably, the mean CDAI increased back to higher levels in the study group (up to 331 +/- 155) in the two weeks after cannabis use stopped.

Cannabis Treatment a Success for Crohn’s

The observed benefits in the studies are largely attributed to the anti-inflammatory properties of cannabis, but there are additional effects of cannabinoids that could also play a role. Cannabinoids have been shown to produce gastrointestinal motility and have an anti-diarrheal effect, in particular. Moreover cannabis is known to create a feeling of general well-being, which could also contribute to patient improvement. This general effect can wear off with time as the patient’s tolerance increases, but the positive effects of cannabis use was maintained for an average of 3.1 years in the observational study. In the clinical trial, the relapse in CDAI in the study group after cannabis use stopped indicates that cannabis may have a direct effect on mitigating the inflammatory effects of Crohn’s disease.

With study participants reporting significant reductions in pain and disease activity, with improved appetite, sleep, and quality of life, and often eliminating the need for steroid use–it’s hard to argue the benefits of using cannabis to treat major symptoms of Crohn’s disease.