A recent pilot study using Cannabis for Crohn’s disease is certain to attract a lot of attention (Clin Gastroenterol Hepatol 2013; 11: 1276-80). The side effects are definitely less frightening than many of the accepted treatments.
Background: Cannabis has a long record of medicinal uses; it contains more than 60 different compounds, though Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD) are thought to be the most active. Cannabis has known antiinflammatory properties and has been shown to reduce colitis in a mouse model.
Study design/characteristics: 21 of 51 screened patients participated; these patients had active Crohn’s disease despite thiopurines in 20 or 21 and anti-tumor necrosis factor (TNF) therapy in 18. These 21 patients were enrolled in a double-blind, placebo-controlled study. The average age in the cannabis group was 46 years compared with 37 in the placebo group. Both groups received cigarettes twice daily; the cannabis cigarettes had 115 mg of THC whereas the placebo group had cannabis flowers in which the THC had been extracted. Though this was a double-blind study and efforts were made to mask the psychotropic effects by recruiting patients naive to cannabis, nevertheless, by the end of the study most of the patients knew whether they were in the active group or the placebo group.
- Cannabis group had a 45% remission rate (5 of 11) with a CDAI of ≤150; the placebo group had a 10% remission rate. This did not achieve statistical significance.
- The response rate (CDAI drop of >100) was noted in 90% (10 of 11) of cannabis group compared with 40% in the placebo group.
- The mean CDAI reduction was 177 in the study group compared with 66 in the placebo group (P= .005).
- There were no significant laboratory changes (eg. Hgb, CRP, LFTs, kidney function).
- No significant side effects were noted. The study group reported less pain, improved appetite, and better satisfaction with their treatment.
In their discussion, the authors note that this is a small study. They chose the smoking route with THC-rich cannabis to achieve higher blood levels, but note that oral dosing may be effective. The 8-week duration of the study and lack of more objective markers of response precludes firm conclusions.
Take-home message: Cannabis should be studied further for its potential role in controlling inflammation. This study’s timing will increase the broader interest in medical marijuana applications.