Sara Asher, a 28-year-old with severe ulcerative colitis (UC) from Eugene, Oregon, starts her day by taking a capsule containing cannabis oil to help reduce inflammation and stimulate her appetite. Throughout the day, if she experiences breakthrough symptoms like severe pain or abdominal spasming — or if nausea prevents her from keeping her capsule down — she smokes cannabis for quick relief. She takes another capsule of cannabis oil before bedtime, which helps her keep her to better control her symptoms.
“I take it in a capsule because it lasts in your system much longer than smoking ever would,” Asher tells HealthCentral in a phone interview. “[But] when you ingest cannabis, it takes 90 minutes to kick in. The smoking — that will give you the instant relief on the exhale.”
Asher started using cannabis for symptom relief shortly after being diagnosed with UC four years ago.
“My friends at the time were like, ‘You know what really helps with stomach pain and nausea? Cannabis,’” she says. “I laughed at them. [But when I tried it], the next day, I went from 50 bowel movements a day to 15. A huge difference.”
Little research has been published on cannabis or marijuana usage for inflammatory bowel disease (IBD), including UC. But anecdotally, many patients find that it helps relieve their symptoms.
How cannabis compounds affects the body
Cannabis oil contains different levels of chemical compounds called cannabinoids, which may affect the body differently. The chemical compound cannabidiol (CBD) has been found to reduce inflammation. The chemical compound delta-9-tetrahydrocannabinol (THC) has been shown to reduce nausea and improve appetite. THC has also been associated with the “high” feelings that marijuana is known for; CBD, however, does not have this association.
“There are [Food and Drug Administration (FDA)]-approved THC-based products for nausea and vomiting — for patients with cancer chemotherapy, and for anorexia, [and] for patients with AIDS,” said Ed Hoffenberg, M.D., director of the Center for Pediatric Inflammatory Bowel Diseases at Children’s Hospital Colorado, in an e-mail interview. “THC can decrease nausea and increase appetite, [and] so it’s not surprising that IBD patients use THC for these indications.”
Using cannabis for IBD is mostly uncharted territory
Some doctors may prescribe medication containing CBD or THC off-label to patients with UC. If patients seek guidance from their doctors about smoking medical marijuana or ingesting cannabis oil capsules, though, the physicians may not have enough information to feel confident making recommendations.
“There is little data on IBD, and currently, the benefit is theoretical,” Hoffenberg says. “A number of patients have reported perceived benefit from CBD, but there is no consistency in the product used, dose, frequency, [or] route of administration. Potential mechanisms include reducing inflammation, but there are possibly other mechanisms as well. As an example, for the CBD product Epidiolex — just approved for children with severe seizure disorders — the mechanism of action is not known.”
Most UC patients who use cannabis rely upon trial and error to determine the right dosage, method of administration, and frequency of administration that’s right for them.
“[There’s] no data and little consistent anecdotal reports,” Hoffenberg said.
Asher purchases empty capsules and fills them with cannabis oil.
“I fill it halfway, but a lot of people do [an amount equivalent to] a grain of rice,” Asher said. “Put a little in the capsule at first; then people can see what works best for them.”
Doctors may be wary of discussing cannabis for IBD
Some doctors, including UC specialists, may feel uncomfortable discussing cannabis because it isn’t prescribed the same way as FDA-approved drugs.
“Medical or recreational marijuana through dispensaries is much less regulated, or minimally regulated, compared to FDA products,” Hoffenberg said.
Some doctors may not want to discuss cannabis products with UC patients because of the “high” that’s associated with THC. While CBD isn’t associated with negative effects (it doesn’t get you “high”), research in adolescents and adults under age 25 have shown that THC has been associated with impaired judgment, impaired driving, magnified impairment if combined with alcohol, psychosis when taken in high doses, withdrawal symptoms, and the potential for addiction or use of other drugs, according to Hoffenberg.
Positive effects of cannabis for UC patients
Although the research is limited, some studies have shown that cannabis can be helpful for people with UC.
“There is a disease-modifying effect of CBD or cannabis,” Hoffenberg says. “There are many factors that show short-term improvements in IBD — both Crohn’s and ulcerative colitis — like diet, antibiotics, but few interventions that show long-term response.”
Hoffenberg’s own research on cannabis usage in adolescents and young adults with IBD has shown some positive results.
“Although scores for pain, appetite, and disease activity were similar to non-users,” Hoffenberg says, “cannabis oil users perceived a positive impact in sleep quality, nausea, and appetite.”
Anecdotally, many people living with IBD and UC find relief with cannabis.
“I have more severe ulcerative colitis,” Asher says. “Cannabis helps me eat. I’ve been able to get off of 16 other medications.”
UC is not a qualifying condition for medical marijuana
To qualify for medical marijuana, your doctor must certify that you have a qualifying condition, but ulcerative colitis is not on the list. Designations vary by state, but if you have UC, you may qualify for medical marijuana if you have chronic or severe pain.
Asher has a medical marijuana card to legally use cannabis in Oregon, but she’s petitioning the Oregon Health Authority to include IBD as a qualifying condition.
“I fall under the category of severe pain and severe nausea,” Asher says, “but I want IBD to have its own category, among cancer, PTSD, [and others]. We have the same immunosuppression as [people who have] AIDS. We take the same drugs as cancer patients. It’s very odd to me that IBD does not have its own category, when cannabis can improve quality of life.”