Medical Marijuana for Digestive Disorders: High Time to Prescribe?

Abstract

The use of recreational and medical marijuana is increasingly accepted by the general public in the United States. Along with growing interest in marijuana use has come an understanding of marijuana's effects on normal physiology and disease, primarily through elucidation of the human endocannabinoid system. Scientific inquiry into this system has indicated potential roles for marijuana in the modulation of gastrointestinal symptoms and disease. Some patients with gastrointestinal disorders already turn to marijuana for symptomatic relief, often without a clear understanding of the risks and benefits of marijuana for their condition. Unfortunately, that lack of understanding is shared by health-care providers. Marijuana's federal legal status as a Schedule I controlled substance has limited clinical investigation of its effects. There are also potential legal ramifications for physicians who provide recommendations for marijuana for their patients. Despite these constraints, as an increasing number of patients consider marijuana as a potential therapy for their digestive disorders, health-care providers will be asked to discuss the issues surrounding medical marijuana with their patients.

The Impact of Marijuana Policies on Youth: Clinical, Research, and Legal Update

“…53 Two recently published review articles on medical marijuana for digestive disorders and select neurologic disorders generally noted small numbers of studies and mixed results. 54,55 There are no published studies on the use of cannabinoids or marijuana to treat health conditions in children or adolescents.…”

Severity and outcomes of acute alcoholic pancreatitis in cannabis users

“…Both CB1 and CB2 receptors are weakly expressed in the normal pancreas, but this expression increases in the setting of inflammation. CB1 receptor activation has shown to induce fibrosis while activation of CB2 receptor is linked with antifibrogenic effects in the pancreas (1,20). Matsuda et al (24) showed that down regulation of endocannabinoid system by AM251 (a CB1 receptor inhibitor) improved survival in rats with severe AP.…”

“…Most data of the effect of cannabis on AP comes from mice experimental models but the evidence of this data is conflicting (20). There are two G proteincoupled cannabinoid receptors in the human body, CB1 and CB2 receptors.…”

“…Cannabis has been used for medicinal purposes for the treatment of severe cancer pain, chemotherapy-related nausea and vomiting, diarrhea and chronic abdominal pain (1,20). Cannabis has been found to reduce the disease related symptoms in inflammatory bowel diseases (21) and currently research is underway to see if it can modify the disease course as well.…”

Autophagy activation by novel inducers prevents BECN2-mediated drug tolerance to cannabinoids

“…[1][2][3][4] However, long-term administration of cannabinoids for either medical or recreational purposes induces rapid development of tolerance (a demonstration of physical dependence), which is a limitation and concern of its medical use and may lead to addiction and withdrawal symptoms. 5,6 Clinical data showed that 9% of adult cannabis users, and 17% of adolescent users, develop dependence and addiction after repeated dosage, 6 which is not trivial given the widespread usage of illicit cannabinoids in many countries.…”