Cannabis and Pediatric Inflammatory Bowel Disease

Abstract

The trend towards decriminalization of cannabis (marijuana) continues sweeping across the United States. Colorado has been a leader of legalization of medical and recreational cannabis use. The growing public interest in the medicinal properties of cannabis and its use by patients with a variety of illnesses including inflammatory bowel disease (IBD) makes it important for pediatric gastroenterologists to understand this movement and its potential impact on patients. This article describes the path to legalization and “medicalization” of cannabis in Colorado as well as the public perception of safety despite the known adverse health effects of use. We delineate the mammalian endocannabinoid system and our experience of caring for children and adolescents with IBD in an environment of increasing awareness and acceptance of its use. We then summarize the rationale for considering that cannabis may have beneficial as well as harmful effects for IBD patients. Finally, we highlight the challenges federal laws impose on conducting research on cannabis in IBD. The intent of this article is to inform health care providers about the issues around cannabis use and research in adolescents and young adults with IBD.

Cannabinoid Receptor-2 Ameliorates Inflammation in Murine Model of Crohn’s Disease

“…6 As of March 2017, 28 states and Washington DC have legalised cannabis for medical purposes, and limited observational studies have demonstrated that medical marijuana, through interaction with the endogenous cannabinoid system [ECS], can potentially be used to alleviate a number of IBDassociated intestinal symptoms including reducing nausea, stool frequency, and abdominal pain, while improving appetite and weight gain. 7 However, it is unclear if the symptomatic relief experienced by patients using cannabis in IBD is accompanied by improvement of intestinal inflammation or any real disease-modifying effect. 8 Indeed, one such study showed that the patients with Crohn's disease who used cannabis had worse disease prognosis and higher tendency toward surgical intervention.…”

Marijuana Use by Adolescents and Young Adults with Inflammatory Bowel Disease

“…34 However, human subject research involving cannabis remains uniquely challenging because cannabis is a schedule 1 drug under federal law. 3 Route of use of marijuana by participants with IBD may also be a factor in efficacy and safety. The majority in our study smoke marijuana, like most surveys.…”

“…2 Patients and families have advocated using marijuana for the treatment of medical conditions and ask care providers about it for treating their IBD. 3,4 Emerging understanding of the endocannabinoid system provides a rationale for considering the medical benefits of marijuana. 5 In addition to reducing pain, there may be effects on nausea, vomiting, gastrointestinal tract motility, and inflammation.…”

Potencial uso terapêutico dos compostos canabinoides – canabidiol e delta-9-tetrahidrocanabinol

“…O THC age como um agonista fraco do receptor CB1 e, por meio dessa via, também pode interromper a proliferação de células T, as mesmas células Th1 pró-inflamatórias que produzem IFNγ e estão fortemente envolvidas na patogênese da DII. O THC eleva as concentrações das citocinas IL-10 e TGFβ, responsáveis por regular as células T. Assim, o THC ao diminuir a proliferação de células T pode melhorar a regulação dessa função (Hoffenberg et al, 2017).…”