Cannabis for Inflammatory Bowel Disease

Abstract

The marijuana plant Cannabis sativa has been used for centuries as a treatment for a variety of ailments. It contains over 60 different cannabinoid compounds. Studies have revealed that the endocannabinoid system is involved in almost all major immune events. Cannabinoids may, therefore, be beneficial in inflammatory disorders. In murine colitis, cannabinoids decrease histologic and microscopic inflammation. In humans, cannabis has been used to treat a plethora of gastrointestinal problems, including anorexia, emesis, abdominal pain, diarrhea, and diabetic gastroparesis. Despite anecdotal reports on medical cannabis in inflammatory bowel disease (IBD), there are few controlled studies. In an observational study in 30 patients with Crohn's disease (CD), we found that medical cannabis was associated with improvement in disease activity and reduction in the use of other medications. In a more recent placebo-controlled study in 21 chronic CD patients, we showed a decrease in the CD activity index >100 in 10 of 11 subjects on cannabis compared to 4 of 10 on placebo. Complete remission was achieved in 5 of 11 subjects in the cannabis group and 1 of 10 in the placebo group. Yet, in an additional study, low-dose cannabidiol did not have an effect on CD activity. In summary, evidence is gathering that manipulating the endocannabinoid system can have beneficial effects in IBD, but further research is required to declare cannabinoids a medicine. We need to establish the specific cannabinoids, as well as appropriate medical conditions, optimal dose, and mode of administration, to maximize the beneficial effects while avoiding any potential harmful effects of cannabinoid use.

Microbial Neuro-Immune Interactions and the Pathophysiology of IBD

“…Recent studies in humans and animals have identified a new strategy for the endocannabinoid system, whereby targeting of the enzyme FAAH can prove to be a better approach due to the potentially less side effects when compared to the currently available CB compounds [86][87][88]. Overall, the preclinical findings indicate that manipulating the endocannabinoid system can have beneficial effects in IBD patients, and therefore, the use of Cannabis sativa has also been studied, although further research is necessary in this context [89,90].…”

Endocannabinoids

“…Experimental evidence suggests that cannabinoids exert pharmacological actions in the gut potentially beneficial for a number of diseases, including gastrointestinal reflux disease, IBS, IBD, and colon cancer. Notably, preliminary clinical evidence suggests that Cannabis use is beneficial for IBD patients (Naftali et al 2011(Naftali et al , 2014Lal et al 2011;Ravikoff Allegretti et al 2013). Cannabinoids are also beneficial in urinary diseases including chronic pelvic pain conditions such as interstitial cystitis and chronic nonbacterial prostatitis, as well as chronic neurological conditions that affect bladder function such as multiple sclerosis and Parkinson's and Alzheimer's diseases.…”

Δ9-Tetrahydrocannabinol (THC) enhances lipopolysaccharide-stimulated tissue factor in human monocytes and monocyte-derived microvesicles

“…Marijuana is proposed for pharmacological interventions for either HIV-1 infection or IBD [11, 12]. The psychoactive component of marijuana, Δ 9− tetrahydrocannabinol (THC), has immunomodulatory properties, although most studies showing that THC is anti-inflammatory were performed in animal models, murine cells or transformed human cell lines [13].…”