Medical Cannabis and Inflammatory Bowel Disease

August 2016 Webinar Recording

Medical Cannabis and Inflammatory Bowel Disease

Crohn’s Disease is a chronic inflammatory disease of the small and large intestine affecting more than 1 million U.S. citizens. According to the CDC, “The majority of Crohn’s patients will require surgery at some point during their lives.” Watch this LIVE discussion of how medical cannabis can help manage Crohn’s symptoms and progression.

Medical Cannabis and Inflammatory Bowel Disease Text

  1. Delivery Methods and Dosing: Making the most of your medicine Medical Cannabis and Inflammatory Bowel Disease Special Guest, Patient and WCM Member David R. Host: Becky DeKeuster, M.Ed, Director of Education Producer: Ben Gelassen, Marketing Associate An introduction for patients, families, and caregivers
  2. Does my GI disorder qualify me for #mmj? §2422, 2.E.: “Post-traumatic stress disorder, inflammatory bowel disease, dyskinetic and spastic movement disorders…” §2422, 2.B.: “A chronic or debilitating disease or medical condition or its treatment that produces intractable pain, which is pain that has not responded to ordinary medical or surgical measures for more than 6 months…” Source: Maine Revised Statutes Title 22, Chapter 558-C: Maine Medical Use of Marijuana Act, http://www.mainelegislature.org/legis/statutes/22/title22sec2422.html
  3. GI Disorders – An Overview (Inflammation and ulceration of inner lining of GI tract) Ulcerative Colitis (UC) Crohn’s Disease Collagenous and Lymphocytic Colitis Irritable Bowel Syndrome All IBDs involve damage to the actual bowel tissues While it can be painful and debilitating, IBS does not involve damage to the bowel tissue itself • Affects only colon • Continuous pattern • Pain, bleeding, changes in stool • Affects entire GI tract • Discontinuous pattern • Pain, nausea, vomiting, loose stool, weight loss Inflammatory Bowel Disease • Quite rare • Also called microscopic colitis
  4. Ulcerative Colitis & Crohn’s Image source: National Library of Medicine, https://ghr.nlm.nih.gov/condition/crohn-disease
  5. Common Treatments Source: Mayo Clinic, http://www.mayoclinic.org/diseases-conditions/crohns-disease/basics/treatment/con-20032061 •Sulfasalzine, mesalamine, corticosteroids •Sulfas now considered of limited benefit; steroid side effects problematic Anti-inflammatory drugs •Imuran, Purinethol, Remicade, Humira, Cimzia, Rheumatrex, Stelara •Many were originally approved for use w/rheumatoid arthritis, psoriasis Immune system suppressors •Cipro, Flagyl •No strong evidence of effectivenessAntibiotics •Anti-diarrheals, pain relievers •Iron, calcium, Vitamin B-12 and D supplements •Nutrition therapy to allow bowel to rest Other
  6. Why Might Cannabis Help? Image source: David Guzman, “The Endocannabinoid System” CB1 receptors help regulate intestinal movement and secretions CB2 receptors help regulate immune response and inflammation by limiting the amount of white blood cells sent to a perceived threat
  7. Why Might Cannabis Help? Your ECSInflammation Visceral Pain Secretions Digestive Motility THC CBD CB-1 CB-2
  8. Promising Cannabis Research “The effects of (THC) and cannabidiol alone and in combination on damage, inflammation and in vitro motility disturbances in rat colitis.” Jamontt et al, British Journal of Pharmacology June 2010 • Rat modeling with sulphasalazine as control group • THC and CBD proved beneficial in a dose-response relationship • Alone or together • Optimal dose 10mg “In this model of colitis, THC and CBD not only reduced inflammation but also lowered the occurrence of functional disturbances. Moreover, the combination of CBD and THC could be beneficial therapeutically, via additive or potentiating effects.”
  9. Promising Cannabis Research “Cannabis induces a clinical response in patients with Crohn’s disease: a prospective placebo-controlled study.” Naftali et al, Clinical Gastroenterology and Hepatology October 2013 • 21 human patients, unresponsive to traditional therapies • Placebo-controlled • 5 of 11 subjects in the cannabis group had complete remission • 3 were weaned from steroid dependency “…a short course (8 weeks) of THC-rich cannabis produced significant clinical, steroid-free benefits to 10 of 11 patients with active Crohn’s disease, compared with placebo, without side effects.”
  10. But Remember…. Brain cells with Alzheimer’s being grown in a Petri dish (www.discovermagazine.com) Female cannabis flowers are covered with small crystals which contain dozens of active therapeutic compounds
  11. Cannabis Side Effects Cannabis has no known LD50 No known negative drug interactions Euphoria Motor coordination problems Short term memory loss Red eyes Dry mouth Low blood pressure Heart palpitations Anxiety/panic/paranoia Hallucinations Remember, while unpleasant, too much cannabis alone is not fatal. Time, water, food, and a relaxing environment all help. Remember: Start low, Go slow
  12. Methods of Administration Inhalation Ingestion Topical 30 sec – 1 min. Smoking/Vaping Easy titration Wide variety: Tincture, foods, beverages 5 to 10 min20 to 120 min. Can be helpful for neuropathic pain, psoriasis Can be difficult to titrate No psychoactivity Flower & concentrated oils
  13. What is the process? 1. Talk to your primary or specialist doctor Any MD, DO or NP can certify Some work for practices or groups that do not allow them to certify. Their patients must go to a cannabis specialist doctor. Be prepared to educate
  14. What is the process? 2. Choose a provider • Grow at home • Designate a dispensary • Designate an individual to be a cannabis “caregiver” A quality provider should: • Offer many options (product & potency) • Be able to coach and explain products clearly • Lab test all products • Give receipts, track inventory, charge sales tax • Use no pesticides • Make you feel safe
  15. Further Reading Massa F, Monory K. “Endocannabinoids and the gastrointestinal tract.” Journal of Endocrinological Investigation, 2006. Di Marzo V, Piscitelli F. “Gut feelings about the endocannabinoid system.” Neurogastroenterology and Motility, May 2011. Volz MS, Siegmund B. “Efficacy, tolerability, and safety of cannabinoids in gastroenterology: A systematic review.” Schmerz (Berlin, Germany), Feb 2016.
  16. Resources www.pubmed.com www.ccfa.org/maine Support groups, education, care providers and more www.safeaccessnow.org
  17. Delivery Methods and Dosing: Making the most of your medicine Thank you for your time and attention! What are your remaining questions & concerns?

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Medical Cannabis and Inflammatory Bowel Disease