Cannabis use should be reserved for the control of symptoms in patients with severe inflammatory bowel disease (IBD) that does not respond to current standard of care, according to an article published in the Journal of Gastroenterology & Hepatology. 

Cannabis is used for therapeutic purposes by a significant proportion of IBD patients to relieve the symptoms of the disease such as pain, nausea and loss of appetite. However, the safety profile of cannabis has still not been clearly established and clinical trials have failed to demonstrate that its use is effective in improving the levels of endoscopy, biopsy and inflammatory markers.

“It has yet to be determined in human populations whether cannabinoids have therapeutic anti-inflammatory effects in IBD or are simply masking its many debilitating symptoms,” the authors of the article titled “Therapeutic Use of Cannabis in Inflammatory Bowel Disease” wrote.

Moreover, there have been concerns about the possible fibrosis-causing effects of cannabis, which need further investigation because fibrosis could have detrimental consequences in patients with diseases causing the narrowing of the bowel, such as IBD. Other adverse side effects of cannabis use include anxiety, panic, psychosis and tachycardia.

On the other hand, current options to manage IBD, such as corticosteroids, immunomodulators and biologic agents, could have long-term side effects, including the development of infections and even cancer.

Finally, there are concerns about the legality and preparation of cannabis. Because the legality of its use varies from one state to the other in the U.S., its preparation, potency, ratio of contents, route of usage and product labeling and testing can vary considerably.

The authors conclude that large-scale clinical trials testing the effect of cannabis in improving disease severity in IBD are needed before cannabis can be accepted and recommended as an IBD treatment option. These trials should be placebo-controlled and randomized where neither the participants nor the clinicians know who is getting cannabis and who is getting a placebo. The long-term safety profile and possible side effects of cannabis should also be assessed, the study authors said.

Although the use of cannabis for recreational and medicinal use is prohibited by federal law, its medicinal use for the treatment of chronic diseases, including AIDS, multiple sclerosis, post traumatic stress disorder, amyotrophic lateral sclerosis, glaucoma and epilepsy is legal in 24 states.