With advancing research and promising changes to legislation, the cannabis plant has the potential to help millions of patients across the world. Medical cannabis has even been shown to target an impressive number of the symptoms associated with inflammatory bowel disease, providing a viable alternative to conventional treatments for the 1 in 123 people living with Crohn’s and colitis in the UK.
A brief introduction to inflammatory bowel disease
Inflammatory bowel disease (IBD) is the term used to describe a group of conditions characterised by inflammation of the digestive system. The two most common forms of IBD include Crohn’s disease and ulcerative colitis (UC), the key difference being that inflammation is limited to the colon with UC but can occur in any portion of the gut with Crohn’s. Both conditions cause similar symptoms, which can be both painful and debilitating, and typically include:
- Stomach pain and cramps
- Severe diarrhoea
- Fatigue
- Appetite and weight loss
- Rectal bleeding
- Nausea
IBDs are relapsing-remitting conditions, meaning that symptoms come and go every few weeks or months in the form of flare-ups. There is currently no known cause or cure for either Crohn’s or UC, so their treatment aims to relieve symptoms and prevent future relapses.
Current therapies aim to target inflammation in the gut. These include steroids, immunosuppressants, antibiotics, and other biological therapies. For up to 75% of people with Crohn’s who experience severe symptoms and the 1 in 5 people with UC that do not respond to treatment, surgery may also be necessary.
Due to the potent anti-inflammatory properties of cannabinoids, there is mounting evidence to suggest that cannabis-based medicines could be an effective novel treatment for IBD.
Can medical cannabis help IBD?
Early research on the effects of medical cannabis on IBD is quite promising, but there is still a lot to uncover about exactly how it affects the progression of Crohn’s and UC. According to the Crohn’s & Colitis Foundation, “there is currently no evidence that medical cannabis can reduce IBD inflammation or improve disease activity,” but there is robust evidence for using cannabis to alleviate other IBD symptoms.
In a randomised controlled trial of CBD-rich cannabis oil (160/40 mg/ml CBD/THC) on 56 patients with Crohn’s disease, 65% of patients with moderate to severe symptoms were in full remission after 8 weeks. In the group of patients given the placebo drug, this figure was only 35%. Dr Timna Naftali, the study’s lead author, told Healthline that “cannabis oil can slow the movement of food through the gut and reduces intestinal secretions, which reduces diarrhoea”.
In another randomised controlled trial, this time with 21 patients with Crohn’s disease, 45% of the participants achieved clinical remission after 8 weeks of smoking cannabis with 115 mg of THC twice daily, compared to only 10% of the placebo group. Three participants also found that cannabis reduced their dependency on steroids.
In a double-blind, randomised, placebo-controlled trial of cannabis flower (80mg THC) for 32 patients with ulcerative colitis, “short-term treatment with THC-rich cannabis-induced clinical remission and improved quality of life in patients,” the authors claim. Researchers did, however, note that patients did not see significant anti-inflammatory improvement.
From these findings, it is likely that cannabis can reduce IBD symptoms and subsequently improve the quality of life of patients. Sophie Hayes, a clinical nurse at Integro Clinics, says cannabis-based medicines “appear to be quite effective in the management of symptoms such as appetite stimulation, nausea, pain management and sleep, as well as low mood and anxiety often associated with the condition.”
How does it work?
The two major cannabinoids in the cannabis plant, CBD and THC, both interact with our body’s endocannabinoid system (ECS), a complex cell-signalling network that helps to regulate our mood, sleep, immune activity, appetite, energy levels, and even our gut health.
Research into inflammatory bowel conditions has shown that ECS disruption is characteristic of IBD, with one study noting that patients with inflamed gut tissue exhibit lower levels of the endocannabinoid anandamide than healthy participants.
Although much of our knowledge of cannabinoids and gut health remains largely theoretical, there is evidence to suggest that the activity of cannabinoid receptors, CB1 and CB2, in the GI tract can modulate inflammation. This provides one mechanistic explanation for why cannabis-based medicines appear to alleviate IBD symptoms.
Can I get cannabis on prescription in the UK?
According to the Crohn’s & Colitis Foundation, 15-20% of IBD patients currently use cannabis to manage their symptoms, and over 50% would be interested in using cannabis if its legal status were to change. But what 84% of the British public doesn’t yet know is cannabis flower is available on prescription in the UK.
In 2018, UK law was changed to permit doctors on the General Medical Council’s specialist register to prescribe cannabis-based medicines for a number of qualifying health conditions.
Patients living with a number of gastrointestinal (GI) disorders may be eligible for a medical cannabis prescription if first- and second-line therapies have been unsuccessful. Qualifying GI conditions include:
- Crohn’s disease
- Ulcerative colitis
- Irritable bowel syndrome (IBS)
Is medical cannabis safe?
Understandably, there are some risks and side effects that come with using medical cannabis, as there are with any medication. Though, fortunately, many studies have noted that side effects are typically resolved with persistent use.
The most common side effects of medical cannabis include dizziness, fatigue, dry mouth, appetite changes, and nausea. Since these potential side effects are similar to the symptoms of IBD, medical cannabis may not be a suitable treatment for all patients. Any concerns can be discussed with a qualified medical practitioner in a consultation.
Possible side effects of medical cannabis use are said to be mild in comparison to existing IBD treatments, which could increase a patient’s susceptibility to infection, as well as increase the risk of autoimmune disease and even lymphoma.
It is, however, worth noting that there are much fewer risks associated with licensed cannabis medicines than with unregulated cannabis products, where there is no guarantee of their quality or contamination with harmful substances.
I think I’m eligible – what next?
As it stands, NHS medical cannabis prescriptions are currently reserved for patients with the following conditions:
- Rare, severe forms of epilepsy
- Vomiting or nausea caused by chemotherapy
- Muscle stiffness and spasms caused by multiple sclerosis (MS)
That said, any eligible patients with Crohn’s disease or UC may be eligible for a private prescription through one of the UK clinics. You can either apply to a clinic directly or through your GP. In the initial consultation, a doctor will look at the patient’s medical history and what medications they have tried in the past in order to assess the patient on an individual basis.
Costs will vary between clinics, with consultations ranging between £50 and £200, and the average prescription being around £150-£250 per month. For patients involved in schemes such as Project Twenty21, prescriptions are capped at £150 per product per month in exchange for participating in ongoing studies.
For more information on the process, take a look at our guide to getting a medical cannabis prescription in the UK.
