What is ulcerative colitis?
Ulcerative colitis is a chronic, long-term illness that causes inflammation of the colon and rectum. Symptoms may include diarrhea, rectal bleeding, passage of mucus, and abdominal pain. It is characterized by periods of acute flares when people experience symptoms as well as periods of remission when symptoms stop.
What are cannabis and cannabinoids?
Cannabis is a widely used recreational drug that has multiple effects on the body via the endocannabinoid system. Cannabis contains multiple sub-ingredients called cannabinoids. Cannabis and cannabis oil containing specific cannabinoids can cause cognitive changes such as feelings of euphoria and altered sensory perception. However, some cannabinoids, such as cannabidiol, do not have a psychoactive effect. Cannabis and some cannabinoids have been shown to decrease inflammation in animal and laboratory models which suggests it may help people with ulcerative colitis. For example, cannabidiol is one such cannabinoid that has shown anti-inflammatory activity in mice.
What did the researchers investigate?
The researchers evaluated whether cannabis or cannabis oil (cannabidiol) was better than placebo (e.g. fake drug) for treating adults with active ulcerative colitis or ulcerative colitis that is in remission. The researchers searched the medical literature extensively up to 2 January 2018.
What did the researchers find?
Two studies including 92 adult participants with ulcerative colitis were included. Both studies assessed cannabis therapy in participants who had active ulcerative colitis. No studies that assessed cannabis therapy in participants with ulcerative colitis in remission were identified. One study (60 participants) compared 10 weeks of treatment with capsules containing cannabis oil with up to 4.7% D9-tetrahydrocannabinol (THC) to placebo in participants with mild to moderately active ulcerative colitis. The starting dose of cannabidiol was 50 mg twice daily which was increased, if tolerated, to a target of 250 mg twice daily. The other study (32 participants) compared 8 weeks of treatment with two cannabis cigarettes per day containing 0.5 g of cannabis, corresponding to 11.5 mg THC to placebo cigarettes in participants with ulcerative colitis who did not respond to conventional medical treatment.
The study comparing cannabis oil capsules to placebo found no difference in remission rates at 10 weeks. Twenty four (7/29) percent of cannabidiol participants achieved clinical remission compared to 26% (8/31) of placebo participants. The study also showed higher self reported quality of life scores in cannabis oil participants compared to placebo participants. More side-effects were observed in the cannabis oil participants compared to the placebo participants. These side effects were considered to be mild or moderate in severity. Common reported side effects include dizziness, disturbance in attention, headache, nausea and fatigue. No patients in the cannabis oil group had any serious side effects. Ten per cent (3/31) of the placebo group had a serious side effect. Serious side effects in the placebo group included worsening ulcerative colitis and one complicated pregnancy.
The second study comparing two cannabis cigarettes (23 mg THC/day) to placebo cigarettes showed lower disease activity index scores in the cannabis group compared to the placebo group. C-reactive protein and fecal calprotectin levels (both measures of inflammation in the body) were similar in both groups. No serious side effects were reported. This study did not report on remission rates.
The effects of cannabis and cannabis oil on ulcerative colitis are uncertain, thus no firm conclusions regarding the effectiveness and safety of cannabis or cannabis oil in adults with active ulcerative colitis can be drawn. There is no evidence for cannabis or cannabis oil use for maintenance of remission in ulcerative colitis. Further studies with a larger number of participants are required to assess the effects of cannabis in people with active and inactive ulcerative colitis. Different doses of cannabis and routes of administration should be investigated. Lastly, follow-up is needed to assess the long term safety outcomes of frequent cannabis use.
The effects of cannabis and cannabidiol on UC are uncertain, thus no firm conclusions regarding the efficacy and safety of cannabis or cannabidiol in adults with active UC can be drawn.There is no evidence for cannabis or cannabinoid use for maintenance of remission in UC. Further studies with a larger number of patients are required to assess the effects of cannabis in UC patients with active and quiescent disease. Different doses of cannabis and routes of administration should be investigated. Lastly, follow-up is needed to assess the long term safety outcomes of frequent cannabis use.
Cannabis and cannabinoids are often promoted as treatment for many illnesses and are widely used among patients with ulcerative colitis (UC). Few studies have evaluated the use of these agents in UC. Further, cannabis has potential for adverse events and the long-term consequences of cannabis and cannabinoid use in UC are unknown.
To assess the efficacy and safety of cannabis and cannabinoids for the treatment of patients with UC.
We searched MEDLINE, Embase, WHO ICTRP, AMED, PsychINFO, the Cochrane IBD Group Specialized Register, CENTRAL, ClinicalTrials.Gov and the European Clinical Trials Register from inception to 2 January 2018. Conference abstracts and references were searched to identify additional studies.
Randomized controlled trials (RCTs) comparing any form or dose of cannabis or its cannabinoid derivatives (natural or synthetic) to placebo or an active therapy for adults (> 18 years) with UC were included.
Two authors independently screened search results, extracted data and assessed bias using the Cochrane risk of bias tool. The primary outcomes were clinical remission and relapse (as defined by the primary studies). Secondary outcomes included clinical response, endoscopic remission, endoscopic response, histological response, quality of life, C-reactive protein (CRP) and fecal calprotectin measurements, symptom improvement, adverse events, serious adverse events, withdrawal due to adverse events, psychotropic adverse events, and cannabis dependence and withdrawal effects. We calculated the risk ratio (RR) and corresponding 95% confidence interval for dichotomous outcomes. For continuous outcomes, we calculated the mean difference (MD) and corresponding 95% CI. Data were pooled for analysis when the interventions, patient groups and outcomes were sufficiently similar (determined by consensus). Data were analyzed on an intention-to-treat basis. GRADE was used to evaluate the overall certainty of evidence.
Two RCTs (92 participants) met the inclusion criteria. One study (N = 60) compared 10 weeks of cannabidiol capsules with up to 4.7% D9-tetrahydrocannabinol (THC) with placebo capsules in participants with mild to moderate UC. The starting dose of cannabidiol was 50 mg twice daily increasing to 250 mg twice daily if tolerated. Another study (N = 32) compared 8 weeks of therapy with two cannabis cigarettes per day containing 0.5 g of cannabis, corresponding to 23 mg THC/day to placebo cigarettes in participants with UC who did not respond to conventional medical treatment. No studies were identified that assessed cannabis therapy in quiescent UC. The first study was rated as low risk of bias and the second study (published as an abstract) was rated as high risk of bias for blinding of participants and personnel. The studies were not pooled due to differences in the interventional drug.
The effect of cannabidiol capsules (100 mg to 500 mg daily) compared to placebo on clinical remission and response is uncertain. Clinical remission at 10 weeks was achieved by 24% (7/29) of the cannabidiol group compared to 26% (8/31) in the placebo group (RR 0.94, 95% CI 0.39 to 2.25; low certainty evidence). Clinical response at 10 weeks was achieved in 31% (9/29) of cannabidiol participants compared to 22% (7/31) of placebo patients (RR 1.37, 95% CI 0.59 to 3.21; low certainty evidence). Serum CRP levels were similar in both groups after 10 weeks of therapy. The mean CRP in the cannabidiol group was 9.428 mg/L compared to 7.638 mg/L in the placebo group (MD 1.79, 95% CI -5.67 to 9.25; moderate certainty evidence). There may be a clinically meaningful improvement in quality of life at 10 weeks, measured with the IBDQ scale (MD 17.4, 95% CI -3.45 to 38.25; moderate certainty evidence). Adverse events were more frequent in cannabidiol participants compared to placebo. One hundred per cent (29/29) of cannabidiol participants had an adverse event, compared to 77% (24/31) of placebo participants (RR 1.28, 95% CI 1.05 to1.56; moderate certainty evidence). However, these adverse events were considered to be mild or moderate in severity. Common adverse events included dizziness, disturbance in attention, headache, nausea and fatigue. None (0/29) of the cannabidiol participants had a serious adverse event compared to 10% (3/31) of placebo participants (RR 0.15, 95% CI 0.01 to 2.83; low certainty evidence). Serious adverse events in the placebo group included worsening of UC and one complicated pregnancy. These serious adverse events were thought to be unrelated to the study drug. More participants in the cannabidiol group withdrew due to an adverse event than placebo participants. Thirty-four per cent (10/29) of cannabidiol participants withdrew due to an adverse event compared to 16% (5/31) of placebo participants (RR 2.14, 95% CI 0.83 to 5.51; low certainty evidence). Withdrawls in the cannabidiol group were mostly due to dizziness. Withdrawals in the placebo group were due to worsening UC.
The effect of cannabis cigarettes (23 mg THC/day) compared to placebo on mean disease activity, CRP levels and mean fecal calprotectin levels is uncertain. After 8 weeks, the mean disease activity index score in cannabis participants was 4 compared with 8 in placebo participants (MD -4.00, 95% CI -5.98 to -2.02). After 8 weeks, the mean change in CRP levels was similar in both groups (MD -0.30, 95% CI -1.35 to 0.75; low certainty evidence). The mean fecal calprotectin level in cannabis participants was 115 mg/dl compared to 229 mg/dl in placebo participants (MD -114.00, 95% CI -246.01 to 18.01). No serious adverse events were observed. This study did not report on clinical remission, clinical response, quality of life, adverse events or withdrawal due to adverse events.
Cochrane What is ulcerative colitis? Ulcerative colitis is a chronic, long-term illness that causes inflammation of the colon and rectum. Symptoms may include diarrhea, rectal bleeding,
Is CBD a Safe and Effective Treatment for IBD and What’s the Best Form to Use?
Inflammatory bowel disease (IBD) is a collection of inflammatory diseases affecting the digestive tract. IBD symptoms include severe cramping, bloating, and diarrhea. These symptoms can be painful and disruptive to your daily life.
In recent years, there’s been growing interest in trying to manage these symptoms with cannabidiol (CBD), an active compound found in the Cannabis sativa plant.
Unlike the plant’s other active compound, tetrahydrocannabinol (THC), CBD has no psychoactive properties. This means it doesn’t get you high. CBD does, however, have some therapeutic qualities. It’s been used to help relieve conditions ranging from chronic pain and anxiety to side effects of cancer .
Though research is limited and study results are mixed when it comes to CBD’s effectiveness, it does appear to be generally safe for adults. In addition, people with IBD report improvements in symptoms and quality of life after using it.
More clinical research is needed to determine whether CBD can effectively treat IBD symptoms. In the meantime, CBD should not be considered a replacement for more comprehensive, traditional IBD treatment.
Keep reading to learn about the different forms of CBD, what types can be used to potentially alleviate symptoms of IBD, and how to determine dosage. We’ll also review potential risks and side effects.
While new delivery methods for CBD come on the market almost daily, most fall into the following categories:
|Forms of CBD||Description|
|oils, tinctures, and nasal sprays||Manufacturers infuse CBD in a carrier liquid such as olive or coconut oil. Oils placed under the tongue with a dropper or sprayed into the nose absorb quickly into the bloodstream.|
|soft gels or capsules||CBD pills contain a version of an oil or tincture. The time from ingestion to onset of effect can take a while.|
|topical creams, lotions, salves||Topical CBD creams are often applied to the skin to ease muscle or joint pain. They’re also used to treat skin conditions like acne or psoriasis. Most topicals do not enter the bloodstream. Instead, they affect local cannabinoid receptors in the skin.|
|transdermal patches||Patches typically penetrate the skin to reach the bloodstream. They may have an advantage over creams by providing a steady infusion of CBD for localized treatment, according to a review in the journal Molecules.|
|suppositories||Rectal and vaginal suppositories are typically made with cocoa butter. They’re claimed to treat a variety of conditions including menstrual cramps.|
|edibles||CBD is also infused into mints, gummies, lollipops, and other candies. Like capsules, time from ingestion to effect can take a while.|
|vaping oils||Inhaling vaporized CBD oil (with the use of vaping pens or e-cigarettes) is the fastest way to experience effects. Compounds are absorbed directly from the lungs into the bloodstream.|
The two main diseases that fall under the IBD umbrella are Crohn’s disease and ulcerative colitis.
Crohn’s tends to cause patchy areas of inflamed tissue, usually in the wall of the small intestine. Ulcerative colitis typically forms near the rectum and spreads up into the colon, also known as the large intestine.
While there are other differences between the two conditions, they share common symptoms, including:
- abdominal pain
- blood in the stools
- weight loss
- lack of appetite
Some of these symptoms may be alleviated by the use of CBD.
One small study found that CBD oil, taken in pill form, may help relieve Crohn’s disease symptoms. Other research suggests that CBD may help reduce inflammation caused by colitis.
Which forms to use
Forms of CBD that you can use to potentially relieve symptoms of IBD include:
- Pills and capsules. Daily use of CBD pills may help keep IBD symptoms at bay.
- Vaping. Vaporizing CBD may be helpful for sudden IBD flare-ups.
- Edibles. These gummy-like candies or chocolates are good options for those who have trouble swallowing pills.
- Oils and tinctures. These are typically placed under the tongue and absorb quickly into the bloodstream. Like edibles, they’re a good option for people who have trouble swallowing pills.
- Skin creams and lotions. Topical creams are designed more for treating joint problems and skin conditions, like eczema.
There are three main types of CBD you may consider for IBD treatment. But not all types may be right for you.
Full-spectrum CBD contains all the compounds from cannabis, including THC in varying amounts. It usually comes in oils, tinctures, vaping oil, edibles, and creams.
By law, full-spectrum CBD products can contain only 0.3 percent THC. However, CBD products aren’t as tightly regulated as standard medications, so the actual amount of THC may vary considerably from product to product.
Like full-spectrum CBD, broad-spectrum CBD contains other compounds from the cannabis plant. However, all THC has been removed. This type is less popular, and is usually sold as an oil.
CBD isolate is pure CBD. It’s usually derived from hemp plants and contains no other compounds. It comes in oil or tincture form, as well as small powdery products that can be eaten.
What the research says
A 2018 review of several small studies found that full-spectrum CBD oil, which contained some THC, helped improve quality of life and eased some Crohn’s disease symptoms.
Other research into various forms of CBD has been promising in treating IBD. However, more, larger clinical trials are needed before more doctors will feel confident recommending this treatment.
In recent years, there's been growing interest in using CBD to manage symptoms of IBD. Although research is limited, people with IBD have reported improvements in symptoms and quality of life after using it. Learn what the research says, along with how to use CBD for IBD, and its potential risks and side effects.