Written by Anna Gomberg
Illinois legalized recreational marijuana on January 1, 2020, changing the landscape for many living with chronic digestive diseases already using medical marijuana to relieve pain or nausea. While these patients have experienced access issues and product shortages, this sea change in policy may have also reduced barriers to use—since legalization, applications for medical marijuana cards have only increased, up 34% in January as compared to December1. Medical cardholders do not have to wait in the same lines as recreational consumers, and dispensaries are supposed to have enough product on hand to meet medical cardholder demand. Patients with medical cards may also receive tax breaks.
Marijuana, or cannabis, from the plant Cannabis sativa, can be used to relieve the pain and nausea associated with many digestive diseases, specifically Crohn’s disease and ulcerative colitis (Crohn’s disease has been on the list of qualifying medical conditions for medical marijuana use in Illinois since 2015). But can it help decrease inflammation?
GIRF Scientific Advisor David T. Rubin, MD and colleagues, including GIRF board member and attorney Eric Berlin, describe the complexity of clinical evidence in a recent article published in 2019 in the journal Inflammatory Bowel Disease. They highlight mixed clinical evidence for the effectiveness of cannabinoids in treating inflammation, along with evidence showing that patients who use marijuana report relief of symptoms and improved quality of life, and underscore the legal difficulties associated with conducting research on illegal substances.
Cannabinoids are the components in cannabis that interact with endocannabinoid receptors, including those in the GI tract, and animal studies have found that when certain endocannabinoid receptors are activated, inflammation decreases. Many studies have found that patients report that using marijuana decreases pain, alleviates nausea, increases appetite, and helps with diarrhea. However, at present, there is no consistent evidence that cannabis use promotes remission defined as endoscopic healing or the improvement of standard biomarkers2.
As more patients choose marijuana for relief of GI symptoms, it is clear that additional rigorous and long-term research is needed. As Joel Pekow, MD, Associate Professor of Medicine at the University of Chicago IBD Center, explains, “It is very likely that cannabis use is effective for symptom relief for most patients. There is decent pre-clinical evidence to support its use in IBD therapy. But long term studies and data to support that its effectiveness as a monotherapy to treat active bowel inflammation are still needed.”
Likewise, as more patients try marijuana for symptom relief, it is important to recognize that like any treatment, it may have unexpected effects. Says Pekow, “The one cautionary tale on GI symptoms is that chronic cannabis use can have a paradoxical effect on nausea, where some patients develop cannabis hyperemesis syndrome, which is chronic nausea or vomiting that improves when stopping cannabis.”
1 Marotti, A. “Recreational weed is legal in Illinois, but applications for medical marijuana cards are up. Here’s why.” Chicago Tribune. January 22, 2020. https://www.chicagotribune.com/marijuana/illinois/ct-biz-medical-marijuana-card-increase-20200121-wicskyxhh5gj7jdna77qk7bxpm-story.html
2 Swaminath A., Berlin EP, Cheifetz A, Hoffenberg E, Kinnucan J, Wingate L, Buchanan S, Zmeter N, & Rubin DT. (2019). The Role of Cannabis in the Management of Inflammatory Bowel Disease: A Review of Clinical, Scientific, and Regulatory Information. Inflamm Bowel Disease. 2019 Feb 21;25(3):427-435. doi: 10.1093/ibd/izy319. https://www.ncbi.nlm.nih.gov/pubmed/30358848
3 Kinnucan, J. (2018). Use of Medical Cannabis in Patients With Inflammatory Bowel Disease. Gastroenterology & Hepatology Volume 14, Issue 10 October 2018, pp. 598-601. https://www.gastroenterologyandhepatology.net/archives/october-2018/use-of-medical-cannabis-in-patients-with-inflammatory-bowel-disease/