The endocannabinoid system plays a major role in gastrointestinal (GI) health. Cannabinoid receptors are located throughout the body, including in the brain, immune system and the GI tract. Several GI issues stem from immune system disruptions, deficiencies or weakness. Medical marijuana can provide relief of some of these GI disorder symptoms such as inflammation, nausea and vomiting.
Patient interest in using medical marijuana to treat gastrointestinal disorders is rising, according to Healio Gastroenterology. Multiple states already include some type of GI disorder on their medical marijuana qualifying conditions list. Some of those disorders include severe and persistent nausea, hepatitis C and inflammatory bowel syndrome.
Dr. Mark E. Gerich of the University of Colorado Anschultz Medical Campus said, “The endocannabinoid system’s endogenous signaling molecules and receptors are present throughout the body, and specific to GI, they’re present in the immune system and in the GI mucosa, both in the luminal GI tract and also in other digestive organs. The plausible premise is that through the use of exogenous compounds, many of which are present in cannabis, the endogenous system could be modified to potentially ameliorate GI disease or symptoms related to other diseases.”
Dr. David T. Rubin of the University of Chicago Medicine said, “Medical marijuana has reached the mainstream in terms of patient interest. For the most part, it’s my younger patients who are asking about it, and fewer physicians are resistant to the idea now that they’ve learned more about how the process works. Most gastroenterologists who take care of patients with chronic nausea or IBD will be asked about it at some point, and they have a responsibility to understand what treatment options are available for patients, what the limits of those options are, what the risks are, and how to appropriately support and provide them when they can.”
Doctors are adamant about more research being needed in able to determine just how beneficial medical marijuana can be for GI disorders.
“In terms of high-quality evidence, most of what we know is extrapolated from clinical trials of THC, predominantly for nausea and vomiting and AIDS-related conditions,” said Dr. Gerich.
Clinical trials have resulted in the formulation and FDA approval of several synthetic forms of THC such as Marinol, Cesamet and Syndros. The primary uses for these synthetic options are to treat those with HIV/AIDS or chemotherapy-related nausea, vomiting and anorexia.
Dr. Gerich pointed out that those with Crohn’s disease may benefit from using medical marijuana for more significant symptoms.
When it comes to gastrointestinal disorder relief, much of determining the effectiveness of a medication, alternative treatment or procedure is based off of patient reporting. Dr. Gerich said, “There are anecdotal reports from IBD patients suggesting that cannabis may alleviate certain symptoms, but we have yet to see convincing evidence that cannabis can change the course of the illness in terms of inflammatory markers, biopsy findings or endoscopic disease severity, so we’re still in the domain of subjective response. It’s plausible that cannabis can have therapeutic benefits in the disease, but it’s also plausible that cannabis can cause some harms in the disease.”
Despite the lack of scientific evidence, between 16 to 50 percent of IBD patients said they’ve used marijuana to treat their symptoms. Some patients have an incomplete response to traditional treatment options, Dr. Timna Naftali and Dr. Fred M. Konikoff say. Corticosteroids have side effects making them less than ideal for long-term use. It’s said that 50 to 60 percent of those using corticosteroids are likely to achieve remission, however, this is a low rate. With Crohn’s disease, nearly 70 percent of patients will have to have surgery at some point in their lives based upon the efforts of traditional medicine.
Because patient interest regarding medical marijuana for treating gastrointestinal disorders has increased, Dr. Naftali and several colleagues chose to dig deeper. They found, in 2011, that a study was conducted which included 30 Crohn’s disease patients. Of those patients, 21 that used medical marijuana found relief and a decrease in symptom severity. Their reliance on traditional medication decreased as did their chances for requiring surgery in the future.
Dr. David T. Rubin believes medical marijuana should be used to complement traditional treatment when it comes to gastrointestinal disorders, not replace it. He said, “I try to be very clear with patients that we want to optimize their existing therapies, use appropriate strategies to manage their condition, and support the idea of cannabis as a complementary treatment to enhance symptom control. We cannot ignore that we want their disease to be under control because frankly, symptom management in the absence of appropriate disease management is a losing battle. It will spiral into progressive complications and lead to problems that we can’t get under better control.”
When a patient wants to use only medical marijuana to treat IBD, Dr. Rubin suggests the “treat-to-target” method. This method uses negotiated short term trials of some alternative approaches, including medical marijuana.
In combatting the chronic pain associated with some gastrointestinal disorders, doctors do question the effectiveness of cannabinoids for visceral pain. Dr. Itai Danovitch said, “One question is whether they are indeed effective for chronic visceral pain, and another question is whether they can help lower reliance on opioid analgesics and therein reduce opioid related harms.”
Opioids aren’t always a good option for those with pain associated with IBD. Dr. Rubin believes that if medical marijuana is helping someone with chronic GI pain and gets them off of the narcotics then it’s a good idea. He said, “We know that narcotics have an adverse effect on people with IBD. Those who need narcotics for managing their IBD are a challenging group of patients, and those who are narcotic-dependent are a very challenging group of patients. Every study that has listed adverse outcomes, whether it’s infection or even death, has demonstrated that narcotics are associated with the worst outcomes. Therefore, treatments that enable us to avoid narcotics or get patients off narcotics are extremely important and helpful.”
When it comes to medical marijuana working for those with gastrointestinal disorders, it can be very individualized. Furthermore, the type of marijuana strain and method of delivery both play a role, as does dosage, but, it appears that marijuana does seem to be helping many people heal.