Medical Cannabis and IBD (Inflammatory Bowel Disease)

In recent years, the use of medical cannabis has expanded globally, including in Israel. This article examines the use of medical cannabis as a treatment for inflammatory bowel diseases (IBD), such as Crohn's disease and ulcerative colitis. We will review various studies and reviews on the topic, recommended treatment methods, where to obtain a prescription, dedicated pharmacies, consumption methods, and the difference between the active cannabis compounds THC and CBD.

Medical Cannabis

Medical Cannabis as a Treatment for IBD

The use of medical cannabis as a treatment for IBD has gained serious attention in recent research. Numerous studies on patients with Crohn's disease and ulcerative colitis have found that medical cannabis can alleviate pain, reduce inflammatory responses, and even improve the quality of life for patients (Naftali et al., 2013; Irving et al., 2018). However, further research is needed to confirm these results and understand the mechanisms of action of medical cannabis in treating IBD.

Recommended Treatment Methods

In Israel, the use of medical cannabis is recommended as one of the options for treating IBD. Of course, every treatment must be conducted under medical supervision and with prior approval from a specialist doctor. This treatment may include a combination of THC and CBD in various ratios, depending on the patient's needs and individual response to the different compounds.

THC vs. CBD

THC (tetrahydrocannabinol) and CBD (cannabidiol) are the two main active compounds in cannabis. THC is known for its psychoactive effects, causing the "high" associated with cannabis use, while CBD is not psychoactive and is known for its medical benefits, including pain relief, anti-inflammatory properties, and anxiety reduction.

In treating IBD, a combination of both compounds may provide maximum therapeutic benefits, with THC often helping with pain management and calming the nervous system, while CBD can reduce inflammatory responses and aid in the healing of inflamed intestinal tissue. However, each patient may respond differently to these compounds, so personalizing the ratio for each patient may be necessary.

Consumption Methods

For IBD patients, especially those with ulcerative colitis and Crohn's disease, smoking medical cannabis is not recommended. Smoking may cause additional irritation to inflamed tissue and generally disrupts the digestive process. The harmful components of smoking may also worsen the patient's medical condition. Therefore, there are other consumption methods more suitable for IBD patients:

1. Vaporization: In this method, cannabis is heated to the point where the active compounds (THC and CBD) are vaporized without burning the plant material. Vaporization spreads the active compounds using a heating element, unlike smoking, which uses fire to burn the plant. Vaporization is less harmful to lung health and reduces the amount of harmful compounds entering the lungs.

2. Cannabis Oil: Cannabis oil is a liquid form of cannabis containing the active compounds (THC and CBD) in various concentrations. Cannabis oil can be administered as drops under the tongue or as capsules. Using cannabis oil allows patients to determine the correct dosage for them and often provides a longer therapeutic response. Cannabis oil can also be dripped onto foods or drinks, making it convenient for use in various situations.

3. Edibles or Solid Products: Medical cannabis can also be consumed in the form of edibles or solids such as snacks, cookies, and more. This method allows patients to receive the medical benefits of cannabis through familiar food consumption. Note that the onset time of cannabis in edibles can vary and may take longer to feel the effects.

4. Topical Creams and Gels: For patients experiencing localized pain or external inflammation, cannabis-infused creams and gels can be a therapeutic option. Applying the cream delivers medical cannabis through the skin, acting directly on the problem area.

It is important to remember that with any of these methods, the onset time, effectiveness, and individual results may vary from person to person. Therefore, working closely with the treating physician and having in-depth discussions about the patient's specific needs are crucial in understanding the most appropriate treatment. Additionally, it is important to remember that in some cases, conventional treatments, such as medications or physical exercises, may be combined with medical cannabis to achieve the best therapeutic results.

Conclusion

Medical cannabis is used as an adjunct treatment for various diseases, including IBD (such as Crohn's and ulcerative colitis). Preliminary studies indicate that using medical cannabis can alleviate pain, reduce inflammatory responses, and improve the quality of life for patients. However, further research is needed to confirm these results and understand the mechanisms of action of cannabis in treating these diseases. Treatment with medical cannabis should be conducted under medical supervision and according to the instructions of a specialist doctor. A prescription must be obtained from a specialist doctor and filled at a dedicated pharmacy authorized by the Ministry of Health.

Regarding the different cannabis compounds, it may be necessary to adjust the ratios between THC and CBD for each patient based on their needs and personal response to each compound. The fact that smoking medical cannabis is not recommended for IBD patients (or in general) does not preclude the possibility of treatment with cannabis. There are other consumption methods that provide the medical benefits of cannabis while maintaining patient health and meeting their specific needs. Always consult with the treating physician about this topic and find out which consumption method is most suitable for the patient's specific medical condition.

Ultimately, medical cannabis may become part of future medical solutions for IBD patients, but it is important to remember that each patient is different and the appropriate treatment will vary. Therefore, maintaining cooperation with the specialist doctor and being aware of the patient's individual needs and responses is crucial.

Research on Medical Cannabis and IBD

1. Naftali, T., Bar-Lev Schleider, L., Dotan, I., Lansky, E. P., Sklerovsky Benjaminov, F., & Konikoff, F. M. (2013). Cannabis induces a clinical response in patients with Crohn's disease: a prospective placebo-controlled study. Clinical Gastroenterology and Hepatology, 11(10), 1276–1280.e1. https://doi.org/10.1016/j.cgh.2013.04.034 This study found that cannabis use can induce a clinical response in patients with Crohn's disease.

2. Irving, P. M., Iqbal, T., Nwokolo, C., Subramanian, S., Bloom, S., Prasad, N., Hart, A., Murray, C., Lindsay, J. O., Taylor, A., Barron, R., & Wright, S. (2018). A randomized, double-blind, placebo-controlled, parallel-group, pilot study of cannabidiol-rich botanical extract in the symptomatic treatment of ulcerative colitis. Inflammatory Bowel Diseases, 24(4), 714–724. https://doi.org/10.1093/ibd/izy104 This study examined the effect of a cannabidiol-rich cannabis extract on the treatment of ulcerative colitis symptoms.

3. Couch, D. G., Cook, H., Ortori, C., Barrett, D., Lund, J. N., & O'Sullivan, S. E. (2019). Palmitoylethanolamide and cannabidiol prevent inflammation-induced hyperpermeability of the human gut in vitro and in vivo—a randomized, placebo-controlled, double-blind controlled trial. Inflammatory Bowel Diseases, 25(6), 1006–1018. https://doi.org/10.1093/ibd/izy095 This study investigated the effect of palmitoylethanolamide (PEA) and cannabidiol (CBD) on gut permeability in inflammatory conditions.

4. Storr, M., Devlin, S., Kaplan, G. G., Panaccione, R., & Andrews, C. N. (2014). Cannabis use provides symptom relief in patients with inflammatory bowel disease but is associated with worse disease prognosis in patients with Crohn's disease. Inflammatory Bowel Diseases, 20(3), 472–480. https://doi.org/10.1097/01.MIB.0000439067.48725.25 This study examined the use of cannabis for symptom relief in IBD patients but reported that such use may be associated with worse disease prognosis in Crohn's disease patients.

5. Kafil, T. S., Nguyen, T. M., MacDonald, J. K., & Chande, N. (2018). Cannabis for the treatment of Crohn's disease. Cochrane Database of Systematic Reviews, 2018(11), CD012853. https://doi.org/10.1002/14651858.CD012853.pub2 This review analyzed various studies regarding cannabis treatment for Crohn's disease, noting that more studies with larger samples and higher research quality are needed.