What is Crohn's disease?
Crohn's disease is an inflammatory intestinal auto-immune disease that causes gastrointestinal symptoms all the way from diarrhoea and chronic pain to malabsorption and intestinal bleeding.
How does cannabis help?
There's a theory that Crohn's disease is caused by an underlying deficiency in the endocannabinoid system. Cannabis might help by restoring the endocannabinoid system and therefore reducing symptoms of Crohn's. Cannabis is also anti-inflammatory, and it's noted that cannabis helps to improve quality of life for chronically ill people.
What does the research say?
In one small study, 40% of patients went into remission after using cannabis, in another, 90% reported a reduction in abdominal pain, 76% in cramping, and 28% in diarrhoea.
Small intestine diseases have ravaged human history for a very long time, many of which don’t have obvious cures. Crohn’s disease is one of those treatment-resistant inflammatory bowel conditions. We don’t know what causes it, and biomedicine is far from reaching a cure for Crohn’s. But research about the endocannabinoid system’s involvement in Crohn’s disease, and the consequential effect of cannabinoids on Crohn’s disease is exciting.
Before 1932, all problems of the small intestine were thought to be caused by intestinal tuberculosis. That’s how elementary a lot of our knowledge of human anatomy is — a hundred years. We’re now making discoveries about our own anatomy that would never have been available to our ancestors — like the fact that endocannabinoid receptor expression is highly implicated in individuals with Crohn’s disease.
Of course, there’s still a lot we don’t know. Like how cannabinoids might be used in the clinical context for Crohn’s disease — or how typical Crohn’s medications interact with cannabis. What we’re learning is that:
- The function/dysfunction of the endocannabinoid system has a role to play in the development of Crohn’s disease
- Cannabis helps patients with symptom relief and,
- Cannabis might help to improve quality of life, which is a commonly skipped parameter in the investigation of non-terminal diseases
In this article, we’re checking out some of the science for and against the use of cannabis for Crohn’s disease and how it’s been investigated in the clinical setting.
Clinical endocannabinoid deficiency (CECD) and its potential role in Crohn’s disease
Clinical endocannabinoid deficiency (CECD) is a term coined by cannabis researcher, Dr. Ethan Russo. Russo brought the term to the medical community in 2001 as a possible way of explaining the underlying mechanism of a handful of treatment-resistant conditions including Crohn’s disease. His underlying premise is that a dysfunction of cannabinoid receptors or endogenous cannabinoids may underpin some diseases.
Crohn’s disease is characterised by persistent inflammation of any part of the GI tract, although it typically happens in the small and large intestine. Symptoms include chronic gastrointestinal pain, diarrhoea or constipation or alternating between the two, and bleeding. Naturally, persistent inflammation leads to complications such as cancer, poor nutrient absorption and therefore malnutrition, etc. So it’s extremely important for Crohn’s patients to properly manage their disease.
What Ethan Russo proposed in 2001 is backed by some other observations made in other research. For example, in one study, researchers found elevated serum levels of anandamide (an endogenous cannabinoid) in patients with Crohn’s Disease. In other research, the CB2 receptor has been implicated in intestinal inflammation. Finally, in a 2017 study, researchers found that the CB2 receptor was downregulated in mice with chronic Crohn’s dIsease.
So Russo’s theory might not be far off the mark. There is a lot of evidence that suggests that the endocannabinoid system is at play in Crohn’s disease. It’s obvious that we’re not completely clear on what that relationship is. But the fact that a relationship exists at all helps to explain why, in some of the studies we’re about to show you, patients have described relief from Crohn’s disease symptoms after using cannabis.
A handful of clinical studies on cannabis and Crohn’s disease
There isn’t a lot of clinical research that confirms a lot of the preclinical knowledge we just mentioned. At the same time, the overwhelming consensus among Crohn’s disease patients is that cannabis may help with symptomatic relief and quality of life.
A small-scale 2011 Israeli observational study found that of the 30 patients reviewed, 21 patients displayed significant results. Researchers used the HBI (Harvey Bradshaw Index) to measure the activity of the disease state. It uses common parameters for measuring the severity of Crohn’s disease.
The same research group performed the first randomized, placebo-controlled clinical trial on cannabis and Crohn’s Disease. It also had a small sample size (30 participants). Of the group that received cannabis, 45% went into remission, compared to 10% of the control group. And of all of those treated with cannabis, 90% demonstrated a positive response.
In one, anonymous, questionnaire-style study, patients of Crohn’s disease using cannabis reported the following:
- 83.9% reported improved abdominal pain
- 76.8% reported improved abdominal cramping
- 48.2% reported improved joint pain
- 28.6% reported improved diarrhoea
In another 2013 study, researchers observed overall symptom relief and better ratings in quality of life from patients with Crohn’s disease using cannabis therapeutically.
The potential for more
There are no doubt a lot of Crohn’s disease patients out there self medicating with cannabis successfully. But it’s still outside of the realm of science to prescribe cannabis for Crohn’s disease. At the same time, it is, quite obviously, something worth investigating further.
As we mentioned earlier, there are a lot of things we still don’t know. A really big one is how cannabis interacts with typical medications used for Crohn’s disease. Can the two be used together? Does using one mean you can’t use the other?
There is a lot of potential for more research in the field of cannabis and Crohn’s disease, at a clinical level and at a molecular/scientific level.
Remember to always chat with your cannabis-friendly doctor before choosing to medicate with cannabis!
Have you used cannabis for Crohn’s disease? We would love to hear from you in the comments.