Inflammatory Bowel Disease (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC) are conditions that are characterised by chronic inflammation of the gastrointestinal (GI) tract. It is estimated that around one in 123 people in the UK may be living with one of these conditions. Common symptoms of IBD include abdominal pain, bowel habit changes, fatigue, and a variety of extraintestinal manifestations involving the joints, skin, or eyes. Inflammation due to IBD can have a significant and detrimental impact on patient quality of life with one or more problematic symptoms often persisting even through periods of remission.
The cause of IBD is unclear, but it occurs when a person’s immune system attacks their bowel, causing inflammation and other symptoms. Treatment of IBD commonly involves the use of anti-inflammatory drugs or steroids to help symptom management. Diet and lifestyle changes may also be recommended. In more severe cases, some patients may undergo surgery to remove part of the bowel. However, a growing body of research indicates that many patients with IBD may turn to cannabinoids for symptomatic relief.
What is the Relationship between Cannabis and IBD?
Humans have utilised cannabis for its therapeutic properties for thousands of years. In recent years, a growing number of countries, including the UK have legalised medical cannabis for use in the treatment of a wide range of conditions and diagnoses, including refractive epilepsy, chemotherapy-induced nausea and vomiting, and chronic pain. Some evidence indicates that compounds contained within cannabis may affect the function and inflammation of the guy. These findings have prompted an increased interest in the potential application of cannabinoids in treating major digestive disorders, including IBD.
Nonetheless, it remains unclear how safe the use of crude cannabis may be in the treatment of IBD. This is, in part, due to differences methodologies and the use of relatively small patient cohorts in previous studies. However, two retrospective case control studies found that cohorts of several hundred CD and UC in-patients who used cannabis leading up to their admissions were less likely to require surgery, develop complications, and had shorter hospital stays. In contrast, another retrospective case control study involving 1,401 IBD patients indicated that the relative rate of visiting the emergency department was higher in cannabis users.
To address this disparity, the authors of a recent population-based retrospective cohort study aimed to “evaluate the impact of cannabis use in IBD in relation to several key clinical outcomes (including those previously investigated) in order to further clarify the relative safety of cannabis use in these patient populations.”
Design and Methods of the Study
Using the TriNetX Diamond Network, researchers assessed de-identified patients with IBD recorded in their electronic medical record (EMR) data between 1st January 2016 and 31st December 2016. Patients with IBD were then divided into two cohorts: cannabis users and non-users. Patients were included in the cannabis user cohort if the following terms appeared in the EMR between 6 months and 2 years after their IBD Diagnosis: Cannabis-related disorders, cannabinoids, natural, or Cannabinol.
The researchers then compared the relative rates of the following clinical outcomes in each cohort: emergency department (ED) visits; hospitalisations; corticosteroid use; new opioid use; IBD-related surgery; and death.
Findings of the Study
After propensity score matching, the researchers identified 5,075 individuals in each cohort who met the study criteria. The data assessed in this study indicated that IBD patients who used cannabis were more likely to experience corticosteroid use, ED visitation, hospitalisation, and opioid use. There was no statistically significant difference in the relative risk of IBD-related surgery or death. The researchers note that some of these findings are similar to those highlighted by previous studies.
The authors note that there are a variety of potential explanations for the findings of this investigation. While it is possible that cannabis-using IBD patients may be at increased risk of missing important signals indicating that damage is occurring in the gastrointestinal tract, there may also be other factors driving risk for these poor outcomes. As such, it remains unclear how specific these risks are to IBD itself
The findings of this study indicate that cannabis use may be associated with an increased risk of poor outcomes in IBD. However, the authors accept several limitations to this study which should be considered when assessing these results. For example, some patients may not have told their providers about their cannabis use, reasons for hospital and emergency department visits were not categorised, and importantly, a cause-and-effect relationship between these outcomes and cannabis use cannot be defined.
Sapphire’s Response to These Findings
In response to these conclusions, Simon Erridge, Head of Research at Sapphire Medical Clinics, and Mikael Sodergren, Chief Medical Officer at Curaleaf International, wrote a letter to the Editors of Inflammatory Bowel Diseases.
In this letter, they note that whilst the authors suggest cannabis may be the reason for the poor outcomes in patients with IBD who consume cannabis, they fail to account for the possibility that it is individuals with more severe IBD who may be more likely to turn to cannabis, particularly if they have failed to gain sufficient benefit from first-line medications.
Furthermore, while there was no significant difference in the incidence of IBD-related surgery or mortality between cohorts, the authors of the letter suggest that this is likely due to the limited follow-up length (1 year). The authors of the Letter to Editor end by noting the importance of assessing evidence objectively to avoid worsening stigmatisation of medical cannabis patients.