Can Marijuana be an effective treatment for ulcerative colitis?
To ensure a complete understanding of this piece of article, we are going, to begin with, defining some key terms that will keep reoccurring.
What is ulcerative colitis?
Ulcerative colitis is a chronic, long-term disease that causes inflammation of the colon and rectum. The symptoms of Ulcerative colitis which often comes slowly, mild and then severe normally include diarrhoea mixed with blood, rectal bleeding, passage of mucus, and abdominal pain. In some cases, weight loss, fever, and anaemia may also occur. It is also characterized by periods of severe flares when the patient is experiencing the symptoms as well as periods of remission when symptoms stop.
The causes of Ulcerative colitis are unknown, however, some theories suggest that immune system dysfunction, genetics, changes in the normal gut bacteria, and environmental factors can lead to the development of Ulcerative colitis.
What is marijuana?
Marijuana also known as Cannabis is a common recreational drug that alters sensory perception and elicits feelings of euphoria (Tibirica 2010).
It is often promoted as a treatment for various illnesses including cancer and autoimmune disorders (Hill 2015).
However, Cannabis also modulates the endocannabinoid system which acts on the nervous system and immune cell function (Klein 2006). It is postulated that Cannabis and its products may work through this pathway to exert a therapeutic effect on Ulcerative colitis (Schicho 2014; Tibirica 2010).
Marijuana is derived from the leaves and flowering tops of the plant and is prepared in various forms such as cigarettes, hash oil and edible formulations (Mello 2012). it contains over 300 compounds and has numerous products called cannabinoids (Mello 2012) (1).
Although delta 9‐tetrahydrocannabinol (THC) is the main psychotropic derivative of Marijuana, there are other derivatives such as cannabidiol that show anti‐inflammatory effects in animal models without psychotropic effects (Klein 2006).
Marijuana is rapidly absorbed into the body system due to its lipophilic nature, but then it is sequestered into tissues and very slowly cleared from the body through faeces (Mello 2012).
While there are data identifying an increase in short‐term adverse effects of associated with Marijuana such as dizziness and diarrhoea, there is a rareness of studies and data related to the long‐term benefits and harms of cannabinoids (Whiting 2015).
Background
There is a greater prevalence of cannabis use among patients with Inflammatory Bowel Disease (IBD) compared to the general population (Weiss 2015) (3). Cannabis has proven to have the potency of relieving symptoms of Ulcerative colitis such as abdominal pain, reduced appetite, and diarrhoea (Lal 2011; Weiss 2015).
However, it is yet unknown if these potential benefits are related to centrally acting psychotropic effects or to anti‐inflammatory properties as suggested by animal studies (Hasenoehrl 2016; Klein 2006; Singh 2012).
Studies looking at Ulcerative colitis in animal and laboratory models have found benefit in attenuating inflammation (Borrelli 2009i; Leinwand 2017). However, in humans, there is evidence that Marijuana may be linked with harm and adverse effects such as dizziness and diarrhoea (Whiting 2015) (4).
Preliminary results from the first randomized, double‐blind, placebo‐controlled study in humans looking at the use of a cannabinoid in ulcerative colitis were published in 2015 (Irving 2015). This study posed important questions regarding whether cannabis and its derivatives can ameliorate symptoms of ulcerative colitis. For example, can marijuana objectively reduce inflammation in Ulcerative colitis? If so, is this benefit clinically significant in the absence of psychotropic effects? Further, what is the safety and side‐effect profile associated with these agents?
How using marijuana might work
Some hypothesis suggests that Marijuana affects disease activity in ulcerative colitis via the endocannabinoid system (Hasenoehrl 2016). The endocannabinoid system affects the nervous system, peripheral tissues, and the immune system (Tibirica 2010). It is composed of cannabinoid (CB) receptors 1 and 2, endogenous endocannabinoids, and associated enzymes (Hasenoehrl 2016; Klein 2006). It is hypothesized that modulating this system may therapeutically decrease inflammation in the gut (Hasenoehrl 2016).
CB1 receptors are found in the central nervous system, peripheral tissues and gastrointestinal system (Hasenoehrl 2016; Klein 2006). Activation of these receptors may help reduce intestinal transit time and reduce colon propulsion and enhance epithelial wound closure in the colon (Pinto 2002; Wright 2005). There is evidence that these receptors play a physiologic role in protecting the colon during excessive inflammation (Massa 2004). In the central nervous system, CB1 receptors are associated with effects such as reduction in pain and nausea (Klein 2006; Tibirica 2010).
CB2 receptors are found in the myenteric plexus, immune cells and in epithelial cells in ulcerative colitis (Hasenoehrl 2016; Klein 2006; Marquez 2009). Cannabis is thought to influence immune cells through various pathways. For example, CB2 receptor activation may lead to T‐cell apoptosis, decreased T‐cell proliferation in colitis, decreased recruitment of leukocytes to the inflamed colon, and may also help reduce the release of cytokines ( Klein 2006; Lahat 2012; Singh 2012).
The endocannabinoid system also has other pathways that may be activated by cannabis and cannabinoids. For example, non‐psychotropic cannabinoids such as cannabidiol may reduce inflammation through the peroxisome proliferator‐activated receptors and transient receptor potential cation channels subfamily V receptor pathways (Hasenoehrl 2016).
Marijuana doctors in Florida
As of April 1st, 2019, there are 2,106 certified doctors in Florida that can recommend the use of marijuana as a medical treatment option for Qualifying Conditions. You can view the doctors that have registered with Florida Dispensaries.
For patients who want to access the marijuana treatment option in any of the approved centers located in Florida, he/she must follow the following procedure:
- Make an appointment online – this is a 100% money back guarantee process in a situation where you do not qualify. A doctor will evaluate your intake form to ascertain if you are eligible for marijuana treatment.
- Apply for a State ID card – following the success of your application, your name will be added to the registry and you will be informed on the process for applying for a state ID card. This ID will be used when ordering for marijuana treatment.
- See a certified doctor in one of the Florida locations – the marijuana doctor in Florida will issue a medical order for you and re-evaluate your condition after a maximum time of 7 months.
- Fill medical order with a Dispensary – after you have been added to the registry by a doctor, you can now fill all or part of the order at any legal Florida marijuana dispensary.
Qualified Patients must meet all legal and medical criteria to be eligible for a medical marijuana Recommendation, as described by the State of Florida and diagnosed and documented by the treating physician.