Annual colonoscopies, daily medication, periodic flare ups requiring extended treatment and, often, hospitalization. Excessive weight loss, bloody diarrhea, painful cramping, loss of bowel control. This is life with Inflammatory Bowel Disease (IBD), suffered by 1.4 million Americans and for which there is no cure--only treatment options that sufferers find costly, lacking in efficacy, and with unpleasant, even dangerous, side effects.
I was diagnosed with ulcerative colitis, one of the types of IBD, when I was 25-years-old. I was in my first year of teaching middle school, often running to the student bathroom at the end of the hall in the middle of class, unable to make it all the way to the staff facilities. After months of seeking medical help, I ended up in the emergency room because I couldn’t stop vomiting and passing bloody diarrhea.
After a week of not being allowed to eat solid food, I received a sigmoidoscopy (similar to a colonoscopy but not as extensive) which confirmed my doctor’s suspicions: I had IBD. For the past 15 years, I have undergone extremely intrusive rectal scopes. I take maintenance medications that often fail, and I’m back to running for the bathroom again. I am at an exponentially higher risk for colon cancer, hence the yearly test. I have tried various holistic treatments such as meditation and aloe pills, but inevitably I experience another flare up.
One particular alternative treatment that is unavailable in my state, yet investigated by a growing number of IBD sufferers, is the medicinal use of cannabis.
During the second half of this decade, medical marijuana is gaining legal ground in the United States. While federally still illegal, many states have passed laws allowing for prescription pot as treatment for a wide variety of illnesses. California lead the charge, legalizing medical marijuana 20 years ago; since that time, medical practices dedicated to the use of cannabis have flourished.
Medical marijuana is now legal in 25 states as well as the District of Columbia. Four of those states, as well as DC, have legalized recreational use. In spite of increased legality, however, official advocacy groups such as the Crohn’s and Colitis Foundation of America are hesitant, if not entirely opposed to endorsing its usage, which is more than likely the result of the still-existent federal ban on medical marijuana.
While weed may be most commonly recognized as an alternative treatment for nausea, particularly for chemotherapy patients, its usage as an anti-inflammatory is gaining ground as researchers learn about stimulating the body’s naturally-occurring cannabinoid receptors. By studying how cannabinoids relieve nausea and pain, researchers discovered the physiological effects in addition to the known psychoactive properties.
“There are an abundance of cannabinoid receptors in GI tissue, both on immune cells and GI cells, says Dr. Jordan Tishler. “Cannabis has been very effective in inflammatory disorders at treating both the underlying disease as well as the symptoms.” At his Boston-area medical practice, Inhale MD Health and Wellness, the Harvard-educated Dr.Tishler utilizes cannabis to treat his patients for any number of illnesses, both physical and psychological, including Inflammatory Bowel Disease (IBD).
Inflammatory Bowel Disease, not to be confused with Irritable Bowel Syndrome, is a chronic illness that causes inflammation of part or all of the digestive tract. Since there is no cure for IBD, the most that sufferers can hope for is management of symptoms, which include severe diarrhea, nausea, cramping, fatigue, rectal bleeding, malnourishment, weight loss, skin ailments, and eye inflammation. People with IBD experience periods of remission in between often debilitating, even life-threatening, flare-ups.
There are two kinds of IBD: Ulcerative colitis (UC) and Crohn’s disease. Ulcerative colitis is restricted to the large intestine and rectum, whereas Crohn’s affects the entire digestive tract, from mouth to anus. Conventional medical treatment involves steroids, biologic therapies like Remicade and Humira, and bowel resection or removal--all of which have serious side effects. Often the side effects are just as hard or harder to manage than IBD itself. As many as 1.4 million Americans suffer from IBD according to the Crohn’s & Colitis Foundation of America, (CCFA) the leading organization in funding and research. Patients are typically diagnosed before reaching the age of 30, which often greatly impacts daily life.
Using cannabis as a treatment, according to Dr. Tishler, is less harmful. “Side effects are real, but I can count the number of patients who’ve failed cannabis therapy due to intolerance of side effects on one hand. Careful regimen planning, patient compliance, and regular follow up, just like with any other medicine, can effectively overcome these issues.”
Dr. Tishler and others who prescribe cannabis seek to minimize the impact IBD has on the daily lives of those who have it. Taking into account the symptoms of each individual patient, Dr. Tishler recommends a range of preparations.
“Oral preparations (edibles) give much longer coverage, whereas for intermittent symptoms, I typically prefer vaporized flower,” he said. For those patients requiring additional treatment, he will sometimes combine an oral regimen with vaped flower, the loose leaf form of marijuana versus a concentrate. “As with all medicines, there are risks and benefits to cannabis,” Dr. Tishler said, “and the aim is always to find and use the lowest dose possible to get the best benefit and the fewest side effects.” He also emphasized that a medical regiment vastly differs from a recreational one.
Dr. Rashna Patel is a licensed physician in the state of California who runs her own medical marijuana practice. Known as “The Medical Marijuana Expert,” Dr. Patel treats IBD using cannabis with much success. “I’ve found that it helps [my patients] in a couple of ways,” she said. “It helps reduce abdominal cramping, nausea, and it also helps to stimulate the appetite.” Since IBD sufferers often have issues with weight loss, using cannabis can help with appetite and weight management.
The most recent breakthrough in Crohn’s disease research inadvertently supports cannabis as not just a treatment for symptoms, but for the disease itself. The study, conducted by an international team led by Case Western University School of Medicine, found that the fungi and bacteria normally present in the human body have atypical interactions in the body of Crohn’s patients. Additionally, by studying the fecal matter of both healthy and Crohn’s patients in the same family, researchers found that in comparison with the healthy family members, Crohn’s patients had a higher level of two bacteria and one fungus, which worked together to create a slimy, inflammation-causing film in the intestines.
This discovery, combined with the identification of cannabis’ antifungal and antibacterial properties, has the potential to bring about new treatments and perhaps even ultimately a cure for Crohn’s and other IBD sufferers. By cultivating various strains of cannabinoid with these properties, researchers are attempting to maximize the antifungal and antibacterial properties for both topical and internal applications.
But while doctors like Tishler and Patel prescribe medical marijuana to their patients, the Crohn’s & Colitis Foundation has repeatedly cautioned against its usage. In its most recent statement released this month, CCFA spoke more favorably than in the past, but still said, “CCFA does not endorse the use of marijuana in any form by IBD patients, any current state-based medical marijuana programs, or the legalization of marijuana.”
It continues, “CCFA does support the calls by various health organizations urging review of marijuana’s status as a federal Schedule I controlled substance, with the goal of facilitating the conduct of clinical research and the potential development of cannabinoid-based medications.” This call for research is a marked change from earlier statements which concluded that there were no compelling reasons to even explore cannabis as a treatment option.
Samantha S., who lives in a non-legal state and is quoted under an assumed name, self-medicates her IBD symptoms with cannabis.
“I’ve used it recreationally for a long time, but I didn’t connect the two until about five years ago, when I realized how it treated my nausea better than anything else,” she says. She also notices the positive effect of cannabis on her other IBD symptoms. “When I’m going through a flare up, nausea is overwhelming and I vomit frequently if I don’t have cannabis to help.”
Since she lives in a non-legal state, Samantha doesn’t have regular access to edibles, but notices a huge difference in pain relief when she is able to use them. She hopes that her state will one day legalize cannabis as she has had a positive experience managing her symptoms with it.
In England, where cannabis is legal for medicinal purposes, 37-year-old Steve Alexander of Manchester started vaping with a device called the Medipen. He was diagnosed with ulcerative colitis four years ago, and after exhausting several standard and alternative treatment options, he is trying cannabis.
“I have been using it a week now, and to be totally honest, I feel better. I think it helps slightly with cramps and most importantly with the stress [ulcerative colitis] brings,”he says.
England’s current law allows for a maximum concentration of 20 percent cannabis oil, and Alexander is on this regimen as a last gasp effort to avoid steroids. In conjunction with high strength probiotics, he hopes the cannabis will get the symptoms under control. “I’m an engineer and father of two young children,” he says, “and my life/work becomes quite difficult if I’m constantly using the toilet.”
Dr. Tishler is encouraged by CCFA’s progress on medical marijuana, but remains frustrated by their conclusion. “They lend too much weight to the idea of side effects, many of which are simply not seen with any frequency in cannabis users, and overlook the reality that all medication have side effects, and are not going to be safe and effective for all patients.”
Whether a change to the federal law might mean a change to CCFA’s position cannot be predicted, but that is the hope of doctors who support medical marijuana. And it is certainly the hope of those patients who are desperate for better treatment options.