A large body of research points to potentially therapeutic substances in marijuana that could help with Crohn’s symptoms, and some studies have even found a direct link between marijuana use and certain benefits in people with Crohn’s. But many experts still urge caution. “There really isn’t data to tell us that it’s effective for Crohn’s disease,” says Mark Gerich, MD, a gastroenterologist and the clinical director of the Crohn’s and Colitis Center at the University of Colorado in Aurora. That means that while using marijuana may improve your appetite or reduce your perception of pain, there’s no clear evidence that it actually reduces the gut inflammation at the core of the disease, he says. What’s more, using marijuana has been associated with certain worse outcomes in people with Crohn’s disease. So before using this drug, it’s important to understand its potential risks and benefits to the best of your ability. Here’s what you should know about marijuana and Crohn’s. There have been a few studies of marijuana in people with Crohn’s disease in recent years. But because different studies have looked at different doses of different chemicals from the plant, it’s hard to draw firm conclusions about how this drug may or may not help with Crohn’s management. In one review of three different studies, published in November 2018 in the Cochrane Database of Systematic Reviews, the authors found that overall, the effects of marijuana on Crohn’s disease were unclear or mixed. Some beneficial effects were found in individual studies, such as a greater likelihood of reduced Crohn’s disease activity in people who smoked marijuana containing THC compared with those who smoked a version with the THC removed. But certain risks also emerged from the three studies, such as a higher likelihood of sleepiness, nausea, and difficulty concentrating among marijuana users. Some other studies have simply looked at people with Crohn’s disease who already use or don’t use marijuana, instead of randomly assigning participants to be in one group or the other. One such study, published in October 2019 in the journal Digestive Diseases and Sciences, compared hundreds of otherwise similar marijuana users and nonusers with Crohn’s disease between 2012 and 2014. It found that marijuana users were less likely to have active fistulizing disease or an intra-abdominal abscess, or to require a blood product transfusion, parenteral nutrition, or a colectomy. But a larger study with a similar design, published in June 2019 in the journal Annals of Translational Medicine, had more mixed results. It found that while cannabis users with Crohn’s disease had lower risks for colorectal cancer, anemia, and needing parenteral nutrition, rates of active fistulizing disease or intra-abdominal abscess formation were actually higher in this group.
The Risks of Marijuana for Crohn’s Disease
Most studies on marijuana and Crohn’s disease have had major flaws, such as a small number of participants or a brief follow-up period, according to Waseem Ahmed, MD, who coauthored a review article on the topic — published in November 2016 in the journal Gastroenterology & Hepatology — as a resident in internal medicine at NYU Langone Medical Center in New York City. What’s more, marijuana use also comes with certain risks. For one, its symptom-soothing effects may actually mask ongoing inflammation in Crohn’s disease, making people think their disease is in remission when it’s not, according to the article by Dr. Ahmed. And a study published in the journal Inflammatory Bowel Diseases found that using marijuana for more than six months at a time to help with symptoms was a strong predictor of needing surgery in people with Crohn’s disease. Of course, it’s possible that people with worse symptoms and more advanced disease were more likely to use marijuana, so this doesn’t mean the marijuana contributed to the risk of needing surgery. Marijuana use also carries risks of dependence, psychosis, and — with long-term use — neurocognitive impairment, says Ahmed. He therefore suggests considering it to help control pain or other Crohn’s symptoms only if you don’t respond well to other types of treatment.
Obtaining Medical Marijuana to Treat Crohn’s Disease
Even if you might be inclined to try marijuana for your Crohn’s disease, you may face legal or logistical barriers in acquiring it depending on where you live in the United States. In a November 2018 statement, the Crohn’s & Colitis Foundation warned that both patients and healthcare providers “need to be aware of the unique state laws pertaining to prescribing and use of cannabis,” and that your employer’s policy regarding marijuana use should also be a consideration. As of October 2019, 33 states plus the District of Columbia, Puerto Rico, Guam, and the U.S. Virgin Islands have comprehensive medical marijuana programs — but each program works differently. You can find out whether your state or territory has such a program, along with certain details about how each specific program works, at the National Conference of State Legislatures website. Ultimately, though, your best resource for discussing the medical and practical reasons for and against using marijuana for your Crohn’s disease is likely to be your doctor. If you think cannabis might be an option worth considering, bring up the topic at your next appointment. Additional reporting by Quinn Phillips.
