Cannabinoids and Opioids in the Treatment of Inflammatory Bowel Diseases

Abstract

In traditional medicine, Cannabis sativa has been prescribed for a variety of diseases. Today, the plant is largely known for its recreational purpose, but it may find a way back to what it was originally known for: a herbal remedy. Most of the plant's ingredients, such as Δ9-tetrahydrocannabinol, cannabidiol, cannabigerol, and others, have demonstrated beneficial effects in preclinical models of intestinal inflammation. Endogenous cannabinoids (endocannabinoids) have shown a regulatory role in inflammation and mucosal permeability of the gastrointestinal tract where they likely interact with the gut microbiome. Anecdotal reports suggest that in humans, Cannabis exerts antinociceptive, anti-inflammatory, and antidiarrheal properties. Despite these reports, strong evidence on beneficial effects of Cannabis in human gastrointestinal diseases is lacking. Clinical trials with Cannabis in patients suffering from inflammatory bowel disease (IBD) have shown improvement in quality of life but failed to provide evidence for a reduction of inflammation markers. Within the endogenous opioid system, mu opioid receptors may be involved in anti-inflammation of the gut. Opioids are frequently used to treat abdominal pain in IBD; however, heavy opioid use in IBD is associated with opioid dependency and higher mortality. This review highlights latest advances in the potential treatment of IBD using Cannabis/cannabinoids or opioids.

Plasma endocannabinoids and cannabimimetic fatty acid derivatives are altered in gastroparesis: A sex‐ and subtype‐dependent observation

“…The plant Cannabis has two major active components, tetrahydrocannabinol (THC) and cannabidiol (CBD), which have been used for the treatment of GI disorders presenting with nausea, vomiting, abdominal pain, and inflammation 5,7,30‐36 . Based on recent studies, 11.7%‐46.7% of GP patients reported current or past use of cannabinoids including THC, dronabinol, and/or CBD.…”

Cannabinoids in Medicine: Cancer, Immunity, and Microbial Diseases

“…Crohn’s disease (CD) and ulcerative colitis (UC) are inflammatory bowel diseases (IBDs) of not well known etiology. One of the explanations of a structural damage of the intestinal mucosa is the immune response against bacterial antigens within genetically predisposed people [ 123 ]. Treatment of IBD, depending on severity of disease, is mainly based on anti-inflammatory drugs (aminosalicylic acid, corticosteroids), immunosuppressants (azathioprine, methotrexate), biological drugs (TNF-α antibodies, vedolizumab, ustekinumab), or combination therapy.…”

Cannabis and Canabidinoids on the Inflammatory Bowel Diseases: Going Beyond Misuse

“…Lahat et al 2012 [14] Open-label, prospective and single-arm trial/3 months/Israel 13 patients (4 women; 9 men); CD: 11 (28-62 y), UC: 2 (28-31 y) were instructed to use cigarettes with 50 g of dry processed cannabis (inhaled) whenever they observed pain. They were guided to take up to 3 inhalations from the prepared cigarettes each time for 3 months.…”

“…Besides that, there is still much controversy about the use of CS since the misuse of this plant can lead to serious health problems. On the other hand, the literature shows that it can be useful in the treatment of IBD patients that are refractory to conventional therapies [14]. Because of these reasons, this review aims to investigate the effects of CS on the treatment of UC and CD.…”