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Profiles of Patients Who Use Marijuana for Inflammatory Bowel Disease

Abstract

Background

Marijuana is legal in a number of states for indications that include inflammatory bowel diseases (IBD), and patients are interested in its potential benefits.

Aims

We aimed to describe the legal use of marijuana in individuals with IBD in the USA who participate within the CCFA Partners internet-based cohort.

Methods

A total of 2357 participants who lived in states where prescription or recreational marijuana was legal, were offered the opportunity to complete a survey on marijuana use and IBD symptoms including perceived benefits of therapy. Bivariate statistics and logistic regression models were used to determine factors associated with marijuana use.

Results

Surveys were completed by 1666 participants (71%) with only 214 (12.8%) indicating they had asked their medical doctor about its use and 73 actually using prescribed marijuana (4.4%). Within the respondent group (N = 1666), 234 participants lived where both medical and recreational marijuana is legal and 49 (20.9%) reported recreational marijuana use specifically for IBD. Users reported positive benefits (80.7%), but users also reported more depression, anxiety, pain interference, and lower social satisfaction than non-users. Those prescribed marijuana reported more active disease, and more use of steroids, narcotics, and zolpidem.

Conclusions

Few IBD patients consulted their medical doctors about marijuana use or used prescription marijuana. Where recreational marijuana was available, usage rates were higher. Users reported benefits but also more IBD symptoms, depression, anxiety, and pain. Marijuana use may be higher in patients with IBD symptoms not well treated by conventional medical approaches.

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References

  1. Ananthakrishnan A, Kwon J, Raffals L, et al. Variation in treatment of patients with inflammatory bowel diseases at major referral centers in the United States. Clin Gastroenterol Hepatol. 2015;13:1197–1200.

    Article  PubMed  Google Scholar 

  2. Belendiuk K, Baldini L, Bonn-Miller M. Narrative review of the safety and efficacy of marijuana for the treatment of commonly state-approved medical and psychiatric disorders. Addict Sci Clin Pract. 2015;10:1–10.

    Article  Google Scholar 

  3. Ahmed W, Katz S. Therapeutic use of cannabis in inflammatory bowel disease. Gastroenterol Hepatol. 2016;12:668–679.

    Google Scholar 

  4. Allegretti J, Courtwright A, Lucci M, Korzenik J, Levine J. Marijuana use patterns among patients with inflammatory bowel disease. Inflamm Bowel Dis. 2013;19:2809–2814.

    Article  PubMed Central  Google Scholar 

  5. Naftali T, Schleider B, Dotan I, Lansky E, Benjaminov F, Konikoff F. Cannabis induces a clinical response in patients with Crohn’s disease; a prospective placebo-controlled study. Clin Gastroenterol Hepatol. 2013;11:1276–1280.

    Article  PubMed  CAS  Google Scholar 

  6. Lal S, Prasad N, Ryan M, et al. Cannabis use amongst patients with inflammatory bowel disease. Eur J Gastroenterol Hepatol. 2011;23:891–896.

    Article  PubMed  Google Scholar 

  7. Storr M, Devlin S, Kaplan G, Panaccione R, Andrews C. Cannabis use provides symptom relief in patients with inflammatory bowel disease but is associated with worse disease prognosis in patients with Crohn’s disease. Inflamm Bowel Dis. 2014;20:472–480.

    Article  PubMed  Google Scholar 

  8. Weiss A, Friedenberg F. Patterns of cannabis use in patients with inflammatory bowel disease: a population based analysis. Drug Alcohol Depend. 2015;156:84–89.

    Article  PubMed  Google Scholar 

  9. Long M, Kappelman M, Martin C, et al. Development of an internet-based cohort of patients with inflammatory bowel disease (CCFA partners); Methodology and initial results. Inflamm Bowel Dis. 2012;18:2099–2106.

    Article  PubMed  Google Scholar 

  10. Thia K, Faubion W, Loftus E, Persson T, Persson A, Sandborn W. Short CDAI: development and validation of a shortened and simplified Crohn’s disease activity index. Inflamm Bowel Dis. 2011;17:105–111.

    Article  PubMed  Google Scholar 

  11. Jowett S, Seal C, Phillips E, Gregory W, Barton J, Welfare M. Defining relapse of ulcerative colitis using a symptom-based activity index. Scand J Gastroenterol. 2003;38:164–171.

    Article  PubMed  CAS  Google Scholar 

  12. Irvine E, Zhou Q, Thompson A. The short inflammatory bowel disease questionnaire; a quality of life instrument for community physicians managing inflammatory bowel disease. CCRPT investigators. Canadian Crohn’s Relapse Prevention Trial. Am J Gastroenterol. 1996;91:1571–1578.

    PubMed  CAS  Google Scholar 

  13. Cella D, Yount S, Rothrock N. The patient-reported outcomes measurement information system (PROMIS): progress of an NIIH roadmap cooperative group during tis first two years. Med Care. 2007;45:S3–S11.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Kappelman M, Long M, Martin C, et al. Evaluation of the patient-reported outcomes measurement information system in a large cohort of patients with inflammatory bowel diseases. Clin Gastroenterol Hepatol. 2014;12:1315–1323.

    Article  PubMed  Google Scholar 

  15. Yost K, Eton D, Garcia S, Cella D. Minimally important differences were estimated for six patient-reported outcomes measurement information system-cancer scales in advanced-stage cancer patients. J Clin Epidemiol. 2011;64:507–516.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Naftali T, Lev LB, Yablecovitch D, Half E, Konikoff FM. Treatment of Crohn’s disease with cannabis: an observational study. Isr Med Assoc J. 2011;13:455–458.

    PubMed  Google Scholar 

  17. de Vries M, van Rijckevorsel D, Vissers K, Wilder-Smith O, van Goor H. Tetrahydrocannabinol does not reduce pain in patients with chronic abdominal pain in a phase 2 placebo-controlled study. Clin Gastroenterol Hepatol. 2017;15:1079–1086.

    Article  PubMed  CAS  Google Scholar 

  18. Massa F, Marsicano G, Hermann H, et al. The endogenous cannabinoid system protects against colonic inflammation. Mucosal Immunol. 2011;4:574–583.

    Article  CAS  Google Scholar 

  19. Borrelli F, Fasolino I, Romano B, et al. Beneficial effect of the non-psychotropic plant cannabinoid cannabigerol on experimental inflammatory bowel disease. Biochem Pharmacol. 2013;85:1306–1316.

    Article  PubMed  CAS  Google Scholar 

  20. Borrelli F, Aviello G, Romano B, et al. Cannabidiol, a safe and non-psychotropic ingredient of the marijuana plant Cannabis sativa, is protective in a murine model of colitis. J Mol Med. 2009;87:1111–1121.

    Article  PubMed  CAS  Google Scholar 

  21. Storr M, Keenan C, Zhang H, Patel K, Makriyannis A, Sharkey K. Activation of the cannabinoid 2 receptor (CB2) protects against experimental colitis. Inflamm Bowel Dis. 2009;15:1678–1685.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Kunos G, Pacher P. Cannabinoids cool the intestine. Nat Med. 2008;10:678–679.

    Article  CAS  Google Scholar 

  23. Wright K, Duncan M, Sharkey K. Cannabinoid CB2 receptors in the gastrointestinal tract: a regulatory system in states of inflammation. Br J Pharmacol. 2008;153:263–270.

    Article  PubMed  CAS  Google Scholar 

  24. Izzo A, Sharkey K. Cannabinoids and the gut: new developments and emerging concepts. Pharmacol Ther. 2010;126:21–38.

    Article  PubMed  CAS  Google Scholar 

  25. Sharkey K, Wiley J. The role of the endocannabinoid system in the brain-gut axis. Gastroenterology. 2016;151:252–266.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  26. Chaudhry H, Hengerer A, Snyder G. Medical board expectations for physicians recommending marijuana. J Am Med Assoc. 2016;316:577–578.

    Article  Google Scholar 

Download references

Funding

This research was supported, in part, by Grants from the Crohn’s and Colitis Foundation of American and by the National Institutes of Health P30 DK034987.

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Correspondence to Ann Marie Kerlin.

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The authors declare no conflicts of interest.

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Kerlin, A.M., Long, M., Kappelman, M. et al. Profiles of Patients Who Use Marijuana for Inflammatory Bowel Disease. Dig Dis Sci 63, 1600–1604 (2018). https://doi.org/10.1007/s10620-018-5040-5

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  • DOI: https://doi.org/10.1007/s10620-018-5040-5

Keywords

  • Marijuana
  • Ulcerative colitis
  • Crohn’s disease
  • Cannabis
  • Cannabinoids