The study comparing cannabis oil capsules to placebo found no difference in remission rates at 10 weeks. Twenty four (7/29) percent of cannabidiol participants achieved clinical remission compared to 26% (8/31) of placebo participants. The study also showed higher self reported quality of life scores in cannabis oil participants compared to placebo participants. More side-effects were observed in the cannabis oil participants compared to the placebo participants. These side effects were considered to be mild or moderate in severity. Common reported side effects include dizziness, disturbance in attention, headache, nausea and fatigue. No patients in the cannabis oil group had any serious side effects. Ten per cent (3/31) of the placebo group had a serious side effect. Serious side effects in the placebo group included worsening ulcerative colitis and one complicated pregnancy.
What did the researchers investigate?
The researchers evaluated whether cannabis or cannabis oil (cannabidiol) was better than placebo (e.g. fake drug) for treating adults with active ulcerative colitis or ulcerative colitis that is in remission. The researchers searched the medical literature extensively up to 2 January 2018.
The second study comparing two cannabis cigarettes (23 mg THC/day) to placebo cigarettes showed lower disease activity index scores in the cannabis group compared to the placebo group. C-reactive protein and fecal calprotectin levels (both measures of inflammation in the body) were similar in both groups. No serious side effects were reported. This study did not report on remission rates.
Two studies including 92 adult participants with ulcerative colitis were included. Both studies assessed cannabis therapy in participants who had active ulcerative colitis. No studies that assessed cannabis therapy in participants with ulcerative colitis in remission were identified. One study (60 participants) compared 10 weeks of treatment with capsules containing cannabis oil with up to 4.7% D9-tetrahydrocannabinol (THC) to placebo in participants with mild to moderately active ulcerative colitis. The starting dose of cannabidiol was 50 mg twice daily which was increased, if tolerated, to a target of 250 mg twice daily. The other study (32 participants) compared 8 weeks of treatment with two cannabis cigarettes per day containing 0.5 g of cannabis, corresponding to 11.5 mg THC to placebo cigarettes in participants with ulcerative colitis who did not respond to conventional medical treatment.
“If you are having regular abdominal pain, you need to look at the disease,” she says. “Often it’s untreated or undertreated. You don’t want to use cannabis as a Band-Aid.”
“Providers have no idea what to tell patients who say, ‘OK, I want to start cannabis. What should I do?’” Kinnucan says. “There’s limited guidance about how to advise patients.”
What the Studies Say
The Crohn’s and Colitis Foundation’s official position statement on medical cannabis notes that while there’s some evidence the cannabinoids found in our bodies naturally might help with inflammation, it’s less clear that similar compounds from cannabis do. There’s some evidence that cannabis may help with symptoms, but its use is limited by other concerns about side effects and safety.
People who use cannabis may be more likely than those who don’t to stop traditional therapy. And there are risks when you stop the treatment you need. “One of the biggest risks of relapse is hospitalization requiring steroids or surgery,” Kinnucan says.
Some people with inflammatory bowel diseases (IBD), including Crohn’s, are using cannabis of one type or another for symptom relief. There’s also a little bit of evidence that cannabis may help with some symptoms of Crohn’s, including improving appetite and sleep. But there’s a lot to consider first before you run out to try it. For one, while some people do seem to feel better when using cannabis, it’s isn’t clear it helps with their disease.
Kinnucan says more doctors and patients should talk about cannabis, including how and why patients might be using it on their own. But for now, it’s difficult for doctors to know how to advise people with UC about how they might use cannabis safely. Studies of cannabis for inflammatory bowel diseases including UC are ongoing, so more data is coming.
In one small clinical trial, people with UC who took CBD capsules containing a small amount of THC for 10 weeks weren’t any more likely to go into remission than those taking a placebo. Smoking two marijuana cigarettes a day didn’t lower signs of inflammation either.
The Journal of Clinical Investigation: “Intestinal P-glycoprotein exports endocannabinoids to prevent inflammation and maintain homeostasis.”
Weigh the Risks
Clinical Trials.gov: “Cannabis for Inflammatory Bowel Disease,” “Cannabidiol for Inflammatory Bowel Disease.”
“If you do blood work, imaging or stool samples, patients’ numbers don’t change,” Kinnucan says. “While they may feel better, their inflammatory burden isn’t improving.”
Cochrane Database of Systematic Reviews: “ Cannabis for the treatment of ulcerative colitis.”
But it’s too soon to say whether it sometimes helps in other ways and how safe it is.