Using CBD for Ulcerative Colitis
Lindsay Curtis is a health writer with over 20 years of experience in writing health, science & wellness-focused articles.
Verywell Health articles are reviewed by board-certified physicians and healthcare professionals. These medical reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more.
Robert Burakoff, MD, MPH, is board-certified in gastroentrology. He is the vice chair for ambulatory services for the department of medicine at Weill Cornell Medical College in New York.
Ulcerative colitis (UC) is a chronic disease that affects the large intestine (colon), causing inflammation and small sores (or ulcers). UC symptoms include diarrhea, abdominal cramps and pain, bloody stool, and the need to pass stool frequently.
There is no cure for ulcerative colitis, so treatment prioritizes symptom relief and reducing flare-ups. Many people with ulcerative colitis turn to alternative treatments, such as cannabidiol (CBD), to take control of the disease and improve their quality of life.
Read on to learn more about how CBD may be a useful supplemental therapy in the management of UC symptoms.
Tinnakorn Jorruang / Getty Images
Inflammation, CBD, and Ulcerative Colitis
Cannabis plants contain chemicals called cannabinoids, which are compounds unique to the plant. The two primary cannabinoids are:
- Tetrahydrocannabinol (THC), which has psychoactive effects that make a person feel “high”
- Cannabidiol (CBD), which has no psychoactive effects but can provide a number of therapeutic benefits
Both CBD and THC interact with the endocannabinoid system (ECS) in the body. The ECS is a complex biological system that regulates cardiovascular, nervous, and immune system functions.
CBD binds to and activates receptors in the brain that create a therapeutic effect in the body, helping users find relief from painful symptoms without feeling impaired.
CBD has many therapeutic properties and is a known anti-inflammatory, antimicrobial, and antioxidant. Thanks to its anti-inflammatory properties, CBD may be a potential therapeutic treatment for ulcerative colitis.
CBD for Ulcerative Colitis Symptoms
CBD has been explored in several studies as a potential treatment for ulcerative colitis. Research shows that CBD may potentially help reduce inflammation in the gastrointestinal system caused by inflammatory bowel diseases (IBD), such as ulcerative colitis.
One study found that participants with UC who took 50 milligrams (mg) of CBD oil twice a day, increasing to 250 mg per dose if needed and tolerated, experienced significant improvements in their quality of life. However, more research and follow-up studies are needed.
Another study analyzed the efficacy of CBD use in adults with ulcerative colitis. The study concluded that CBD extracts may help alleviate symptoms of IBD and UC.
Although more research is needed, current study results show promise that CBD may be beneficial for treating symptoms of ulcerative colitis.
Are There Any Side Effects?
Though CBD is generally well tolerated, you may experience some side effects. Common side effects include:
- Changes in mood (e.g., irritability)
- Decreased appetite
- Dry mouth
CBD and Your Liver
CBD is metabolized by the liver, and large doses may lead to liver toxicity. Talk with your healthcare provider before using CBD. If you are on any prescription medications, they may recommend regularly monitoring your liver through bloodwork to ensure CBD is safe for you.
How to Use CBD for Ulcerative Colitis
While CBD won’t cure ulcerative colitis, it may help make your symptoms more manageable and help reduce flares.
There are many different forms of CBD, and you may need to try different delivery methods before finding the one that is right for you.
CBD is available in:
- Edibles (e.g., gummies, CBD-infused beverages)
- Plants (to be inhaled/smoked)
- Capsules and pills
- Tinctures and oils
- Topicals (e.g., lotions, creams)
To date, CBD has only been approved by the Food and Drug Administration to treat epilepsy. As a result, there is no standard recommended dosage of CBD for treating ulcerative colitis.
Shopping for CBD
When shopping for CBD, you will notice different types available. These include:
- Full-spectrum CBD: Contains all the natural components found in the cannabis plant, including terpenes, flavonoids, fatty acids, and cannabinoids. Full-spectrum CBD products contain trace amounts of THC. These compounds work in synergy in the body to obtain the desired therapeutic effects.
- Broad-spectrum CBD: Similar to full-spectrum CBD, broad-spectrum CBD contains compounds in the cannabis plant, but with all traces of THC removed, so you will not experience any mind-altering effects.
- CBD isolates: All other cannabinoids, terpenes, and flavonoids are removed to create a 99% pure CBD product.
For the best results, look for broad-spectrum or full-spectrum CBD products. These may combine the effects of multiple cannabis compounds that work together in synergy, creating an “entourage effect” to offer the most health benefits.
Because CBD is still a relatively new therapeutic option for managing different health conditions, including inflammatory bowel diseases, there is currently no recommended standard dosage.
In one study, patients with ulcerative colitis were given 50 mg of CBD oil twice a day. Some participants were able to increase to as much as 250 mg twice a day for a period of 10 weeks.
Another study also recorded dose ranges of 50 mg to 250 mg CBD capsules twice daily. Many participants were able to tolerate the higher dosage and saw improvements, though the study authors suggested that more research is needed.
As with many medications, it’s best to start with a lower dose and gradually increase the amount of CBD to determine the appropriate dosage.
Talk to Your Healthcare Provider
It’s important to talk with your healthcare provider before adding any supplemental therapy, such as CBD, to your ulcerative colitis treatment. They will be able to determine if CBD will be beneficial for your individual case and can recommend the right dosage.
How to Buy CBD
With so many different options available, it can be daunting to shop for CBD. CBD is generally safe and well tolerated, but the industry is poorly regulated, and consumers should be aware of what to look for before purchasing CBD.
You’ll want to carefully read the label of any products you are considering and look for:
- Amount of CBD per serving
- Suggested use/dosage
- Type (full-spectrum, broad-spectrum, or isolate)
- List of ingredients
- Manufacturer and distributor name
You’ll also want to consider:
- Cannabis source: Ensure the product you are purchasing is sourced from a company that ensures the quality and safe cultivation of their plants. Look for products that come from organic cannabis/hemp plants when possible.
- Certificate of Analysis (CoA): CoAs are conducted by independent, accredited labels that verify third-party testing of the products.
- Customer reviews: Testimonials from other users can tell you a lot about a product’s efficacy.
Avoid products and vendors that make broad, definitive statements or promises of a “cure” for something. If you are currently taking any other medications or supplements for your UC, speak with your healthcare provider before using CBD, as it may interact with other medications you are taking.
A Word From Verywell
People with ulcerative colitis may want to consider alternative treatments such as CBD to help manage their symptoms. It’s important to remember that while CBD may help improve your symptoms, it will not treat or cure the condition.
CBD is best used as a supplemental therapy alongside conventional treatments recommended by your healthcare provider, as well as dietary modifications. As with any supplement or medication, talk with your healthcare provider before trying CBD.
Frequently Asked Questions
Cannabinoids have anti-inflammatory properties that may make them helpful in managing symptoms of gastrointestinal diseases like ulcerative colitis. Research suggests CBD is a promising therapeutic for inflammatory bowel diseases, helping reduce mucosal lesions, ulceration, and inflammation associated with IBD. CBD may also help manage gastrointestinal pain, as well as secondary symptoms that come with IBD, such as anxiety, nausea, and sleep disturbances.
The cannabis plant (to be smoked/vaped) comes in different strains, with varying CBD and THC levels. CBD-dominant cannabis strains may provide the best relief for inflammation. These strains tend to be high in the terpene called myrcene, which helps reduce inflammation.
There are many delivery methods for CBD, including edibles (e.g., gummies), flowers, oils, tinctures, topicals, and suppositories. Finding the right one for you may require a little trial and error. The best method for you depends on personal preference and how quickly you may need relief. For example, you may get relief from painful symptoms sooner by vaping oil vs. consuming an edible. Start off with smaller doses and gradually increase the amount you use until you find the amount that offers you relief from your symptoms. Make sure to talk with your healthcare provider before you begin use.
CBD Oil for Ulcerative Colitis: How It Works and Dosage
Ulcerative colitis and Crohn’s disease are the two most prevalent types of inflammatory bowel disease (IBD). While the two conditions may involve similar symptoms, they have different causes and should be approached from different angles.
While Crohn’s disease may show up in any part of the digestive gut, ulcerative colitis is exclusively referred to as inflammation of the colon. Another name for this condition is the ‘large intestine.’ Unlike Crohn’s Disease, ulcerative colitis causes inflammation only in the inner lining of the gut.
Current treatments for inflammatory bowel diseases are expensive and may have dangerous side effects when taken regularly. For this reason, many people have started to seek out alternative methods of treatment, with CBD standing at the forefront.
If you’re flirting with the idea of taking CBD oil for ulcerative colitis, this article will give you a detailed look into the scientific research on this subject on top of sharing some handy tips for using CBD.
What Is Ulcerative Colitis?
Ulcerative colitis (UC) is a chronic inflammatory condition affecting the colon and causing persistent ulcers, or sores, in the digestive tract. It falls into the category of inflammatory bowel diseases (IBD) along with Crohn’s disease and irritable bowel syndrome (IBS).
The disease causes damage to the inner lining of the large intestine, which may lead to frequent bowel movements. Ulcerative colitis commonly affects adults aged thirty to forty years old and generates up to $15 billion in government spendings on healthcare in the United States (1).
The cause of inflammatory bowel diseases such as ulcerative colitis or Crohn’s disease isn’t fully understood. However, scientists suspect that hereditary factors are the major players in the development of these conditions.
Causes & Symptoms of Ulcerative Colitis
The cause of inflammatory bowel diseases such as ulcerative colitis or Crohn’s disease isn’t fully understood. However, scientists suspect that hereditary factors are the major players in the development of these conditions. These are autoimmune diseases, meaning the immune system attacks healthy cells instead of potential “intruders,” causing chronic inflammation. But like we said, the “why” behind the development of chronic inflammation in the gut is yet to be discovered.
Ulcerative colitis symptoms include:
- Abdominal pain
- Loose and frequent bowel movements
- Loss of appetite
- Low energy and fatigue
- Persistent diarrhea
However, these symptoms aren’t chronic in nature; a person with ulcerative colitis may go several months without any symptoms, only to be taken aback by severe flare-ups from time to time.
How Is Ulcerative Colitis Typically Treated?
Ulcerative colitis is theoretically incurable, but doctors may prescribe different medications to reduce the inflammation and manage the abdominal pain. These medications include aminosalicylates — the go-to treatment for the majority of IBD cases — but a physician may also prescribe antibiotics or corticosteroids.
In more severe cases of ulcerative colitis, surgery may be required to remove the parts of the large intestine that are most damaged. Sometimes, the disease can be cured with surgical removal of the colon, but it may seriously compromise a person’s daily functioning, not to mention the risks of such surgery, especially among elderly sufferers.
Can CBD Oil Help Ulcerative Colitis?
Researchers hypothesize that CBD may be an effective alternative for ulcerative colitis due to its remarkable anti-inflammatory properties.
According to the National Institute of Health, CBD has both analgesic (pain-relieving) and anti-inflammatory effects on the gastrointestinal tract without causing intoxication.
Furthermore, few people are aware that the U.S. government holds a patent on CBD and other non-psychoactive cannabinoids as strong antioxidants and anti-inflammatory agents (2).
The patent says, “Cannabinoids have been found to have antioxidant properties… [making them] useful in the treatment of a wide variety of oxidation associated diseases, [including] inflammatory and autoimmune diseases.”
The human endocannabinoid system (ECS), which keeps the body in the state of internal balance (homeostasis), has high concentrations of cannabinoid receptors in the digestive system — including the colon’s lining.
Although there have not yet been clinical trials that would investigate the use of CBD oil for ulcerative colitis, preliminary research carried out for the last decade shows promising results.
Studies Exploring Use of CBD for Ulcerative Colitis
- A 2011-2016 Israeli study examined the correlation between cannabis use and inflammatory bowel disease (IBD). The researchers monitored 127 patients, using the Harvey-Bradshaw index to collect data from each subject. All patients have reported positive results with minimal side effects, including dry mouth and short-term memory problems (3).
- In a 2011 report published in PLOS One, the authors claimed that CBD has the potential to become a ‘new therapeutic strategy’ in treating inflammatory bowel disease. The aim of the study was to observe the effects of CBD on the samples of intestinal biopsies from patients who had ulcerative colitis. The research team concluded that the anti-inflammatory properties of CBD may help treat a range of IBDs, including ulcerative colitis (4).
- A 2018 study analyzed the efficacy of CBD in adults 18 and older with ulcerative colitis. Although the remission rates between those using CBD and the placebo group were nonexistent, the study suggested that CBD extracts may alleviate the symptoms of IBD (5).
- A clinical trial performed on mice showed that the topical use of CBD can improve colonic inflammation associated with ulcerative colitis (6).
Can CBD Oil Help with Crohn’s Disease?
Now that we’ve established CBD can help with ulcerative colitis, you’re probably wondering if it can have similar effects on Crohn’s disease. After all, this condition, too, belongs to the IBD group.
It’s time to elaborate on the aforementioned study from Israel. The study observed and evaluated the effects of cannabis use on patients with different types of IBD, including Crohn’s disease. The research team gathered 127 medical cannabis patients and closely monitored them using several assessment methods. These included forms of cannabis consumption, the use of other medications, side effects, and the long-term effects of cannabis use. The authors also took into consideration the exact THC and CBD levels the study’s subjects consumed.
After 42 months of treatment, researchers used the said Harvey-Bradshaw Index to assess the effects of medicinal cannabis on the symptoms and overall well-being of the patients. A lower score on the index meant a decrease in the symptoms of Crohn’s disease. For cannabis users, the index score went down from 11 to 5, and the patients experienced a decrease in their bowel movements — from 7.0 to 3.4 on average. The participants also reported a considerable reduction in pain.
The results of the study were encouraging, with 78% of participants reporting no harmful side effects. Some patients experienced very mild side effects, such as dry mouth and short-term memory decline. However, these patients also noted that the improvements in their symptoms outweighed these minor reactions.
The authors of the study (Naftali et al.) concluded that cannabis can induce clinical improvements in people with IBD and that it can lead to decreased medication use and weight gain. They also noted that the subjects responded well to a dose of 21 mg THC and 170 mg CBD per day.
CBD vs THC: Which Is Better for IBD Symptoms
This question is difficult to answer due to the current state of scientific knowledge on using cannabis for IBD. In other words, the majority of studies suggest that using whole-plant extracts with various ratios of CBD and THC appear to provide the best results for ulcerative colitis and Crohn’s disease. No clinical trial has yet investigated the safety and efficacy of isolated CBD and THC for IBD.
Let’s take a look at these cannabinoids from a more practical point of view.
As mentioned, CBD has remarkable anti-inflammatory and painkilling effects. On top of that, it can modulate the inflammatory response of the immune system by improving communication between its cells. Numerous studies have mentioned these qualities in relation to a wide range of health conditions, including IBD and its symptoms.
However, studies also show that the anti-inflammatory and analgesic effects of CBD are enhanced when you introduce some THC to an extract (along with other cannabinoids and terpenes). Researchers argue that even 1% of THC in a cannabis strain can significantly improve the plant’s therapeutic potential.
THC is a potent anti-inflammatory and pain killer as well, but on top of that, it produces a set of psychoactive effects known as a “high.” This “high” feeling usually elevates the user’s mood provided that they take it in moderate doses. However, high doses of CBD are known for their backfire effect, which can lead to more anxiety and paranoid thinking patterns.
Now, when you take both cannabinoids together, CBD blocks the psychotropic potential of THC, preventing it from elevating anxiety, while THC amplifies the anti-inflammatory and analgesic effects of CBD. This mutual relationship is part of what scientists define as the entourage effect (6).
The entourage effect refers to synergistic effects between cannabinoids, terpenes, and other compounds found in cannabis. This synergy improves their therapeutic potential, making them work better as a whole than in isolation.
If your state or country has a medical marijuana program, you can try medical-grade CBD oil. For others, full-spectrum CBD oil from hemp is the closest they can get to evoking the entourage effect.
How to Use CBD Oil for Crohn’s Disease and Ulcerative Colitis?
If you decide to try CBD for ulcerative colitis or Crohn’s disease, it’s important to choose a form that will be the most beneficial. CBD is available in oil drops, capsules, edibles, vapes, and topicals; each of these products has different bioavailability, addresses different problems, and suits different types of users.
Here are the most common ways people take CBD for ulcerative colitis:
- CBD oil: the most common product on the list, CBD oil comes in glass bottles with droppers attached to them for accurate dosing. To use CBD oil, you need to squeeze the desired amount with the dropper, transfer that dose under the tongue, and hold it there for up to 60 seconds before swallowing. Since the oil absorbs right into the bloodstream through the tiny blood vessels beneath the tongue, you should be able to notice the first signs of relief within 15–30 minutes after administration. The effects of sublingual CBD last for up to 6 hours.
- CBD pillsand edibles: CBD capsules and edibles are oral products that come with a premeasured amount of CBD in each serving. Convenience is the name of the game here. Capsules and edibles are easy to take, low-profile, and eliminate the problem of swallowing earthy-tasting oil. They have a slower onset than the oil, though, as the CBD needs to be processed in the digestive system before passing into the bloodstream. The effects take hold usually between 40–90 minutes after ingestion, lasting 8–10 hours.
- CBD E-liquid (vape oil): CBD e-liquid can be heated in a vape pen and then inhaled for fast results and high bioavailability of CBD. CBD vape oil starts to act after around 5-10 minutes from inhalation, lasting up to 4 hours. CBD e-liquid isn’t the same as CBD oil. Regular CBD oil cannot be vaped because it’s too viscous. CBD vape oil is thinned down with ingredients like vegetable glycerin or propylene glycol.
- CBD topicals:topical products, such as creams, gels, and lotions, address localized problems, such as pain or inflammation resulting from injuries or flare-ups. Some studies have found that using CBD cream may reduce abdominal pain associated with IBD. They absorb through the skin into the epidermis layer, which contains high concentrations of cannabinoid type 2 (CB2) receptors. The absorption rate, as well as the duration time of effects, may vary depending on the product’s formula, but usually, topicals need to be reapplied after several hours to maintain the relaxing effect.
CBD Dosage for IBD
There are no official recommendations when it comes to dosing CBD for ulcerative colitis and other inflammatory bowel diseases. If you want to get a decent point of reference, we suggest that you review the dosage of past human clinical trials to determine the safe amount for intake.
According to the studies mentioned in this article, patients with IBD respond well to amounts such as 50 mg of CBD twice a day. The participants who tolerated the compound well continuously increased their intake up to 250 mg twice per day for ten weeks — without dangerous side effects.
The study showed that patients who took CBD felt better and no longer experienced colitis symptoms. A few participants reported mild reactions, such as nausea and dizziness.
Other Remedies for IBD
Complementary therapies for IBD include herbal medicines. They are believed to alleviate the symptoms of inflammatory bowel disease.
For example, Italian complementary medicine mentions herbal therapies as frequently practiced by patients with IBD. In a similar manner, herbal remedies are recognized by Chinese literature that describes them as helpful in the treatment of ulcerative colitis.
These recommendations are based on the alleged anti-inflammatory benefits of specific herbs upon consumption.
Researchers mention Aloe Vera as a potential therapeutic agent in treating IBD, based on the positive outcomes of clinical trials on patients with the disease. Other herbs, such as Boswellia serrata and turmeric, are also reported to promote an anti-inflammatory response in the body.
Some CBD supplements are formulated with herbs such as Aloe Vera, Boswellia serrata, and turmeric. You can also mix different herbal remedies on your own, but we first recommend consulting a doctor knowledgeable about complementary medicine before you start your first trials.
Using CBD Oil to Treat Ulcerative Colitis: Does It Work?
Ulcerative colitis is an inflammatory disease of the colon that mostly damages the lining of the large intestine, causing people to experience flare-ups and frequent bowel movements. The condition is often confused with Crohn’s disease, and although these two may share similar symptoms, their nature is completely different and thus should be looked at separately.
There is no clear explanation of what causes inflammatory bowel diseases, and as of right now, scientists are still trying to find a cure for them.
While conventional treatments provide short-term relief from the symptoms of ulcerative colitis, they lose efficacy in the long run on top of having dangerous side effects.
Several studies have suggested that CBD and cannabis, in general, are possible medical treatment options for ulcerative colitis, Crohn’s disease, and other inflammatory bowel conditions. Researchers found that CBD could prevent injury in the colon’s lining as well as inflammation, which is the underlying cause of all IBD’s.
Experts believe that CBD exerts its anti-inflammatory and immunomodulatory actions by interacting with the cannabinoid receptors in the ECS.
However, researchers are yet to confirm whether the results from animal models and the preliminary findings from human subjects will be reflected in randomized controlled trials.
If you believe you could benefit from taking CBD for ulcerative colitis, visit a health provider experienced with CBD and cannabis oil.
- Cohen RD, Yu AP, Wu EQ, Xie J, Mulani PM, Chao J. Systematic review: the costs of ulcerative colitis in Western countries. Aliment Pharmacol Ther. 2010 Apr;31(7):693-707. doi: 10.1111/j.1365-2036.2010.04234.x. Epub 2010 Jan 11. PMID: 20064142.
- Naftali, Timna et al. “Medical cannabis for inflammatory bowel disease: real-life experience of the mode of consumption and assessment of side-effects.” European journal of gastroenterology & hepatology vol. 31,11 (2019): 1376-1381. doi:10.1097/MEG.0000000000001565
- De Filippis, Daniele et al. “Cannabidiol reduce intestinal inflammation through the control of neuroimmune axis.” PloS one vol. 6,12 (2011): e28159. doi:10.1371/journal.pone.0028159
- Irving, Peter M et al. “A Randomized, Double-blind, Placebo-controlled, Parallel-group, Pilot Study of Cannabidiol-rich Botanical Extract in the Symptomatic Treatment of Ulcerative Colitis.” Inflammatory bowel diseases vol. 24,4 (2018): 714-724. doi:10.1093/ibd/izy002
- Schicho, Rudolf, and Martin Storr. “Topical and systemic cannabidiol improves trinitrobenzene sulfonic acid colitis in mice.” Pharmacology Vol. 89,3-4 (2012): 149-55. doi:10.1159/000336871
- Russo, Ethan B. “Taming THC: potential cannabis synergy and phytocannabinoid-terpenoid entourage effects.” British journal of pharmacology vol. 163,7 (2011): 1344-64. doi:10.1111/j.1476-5381.2011.01238.x
Livvy is a registered nurse (RN) and board-certified nurse midwife (CNM) in the state of New Jersey. After giving birth to her newborn daughter, Livvy stepped down from her full-time position at the Children’s Hospital of New Jersey. This gave her the opportunity to spend more time writing articles on all topics related to pregnancy and prenatal care.
Leave a comment Cancel reply
Your email address will not be published. Required fields are marked *
Save my name, email, and website in this browser for the next time I comment.
Cannabis and cannabis oil for the treatment of ulcerative colitis
Ulcerative colitis is a chronic, long-term illness that causes inflammation of the colon and rectum. Symptoms may include diarrhea, rectal bleeding, passage of mucus, and abdominal pain. It is characterized by periods of acute flares when people experience symptoms as well as periods of remission when symptoms stop.
What are cannabis and cannabinoids?
Cannabis is a widely used recreational drug that has multiple effects on the body via the endocannabinoid system. Cannabis contains multiple sub-ingredients called cannabinoids. Cannabis and cannabis oil containing specific cannabinoids can cause cognitive changes such as feelings of euphoria and altered sensory perception. However, some cannabinoids, such as cannabidiol, do not have a psychoactive effect. Cannabis and some cannabinoids have been shown to decrease inflammation in animal and laboratory models which suggests it may help people with ulcerative colitis. For example, cannabidiol is one such cannabinoid that has shown anti-inflammatory activity in mice.
What did the researchers investigate?
The researchers evaluated whether cannabis or cannabis oil (cannabidiol) was better than placebo (e.g. fake drug) for treating adults with active ulcerative colitis or ulcerative colitis that is in remission. The researchers searched the medical literature extensively up to 2 January 2018.
What did the researchers find?
Two studies including 92 adult participants with ulcerative colitis were included. Both studies assessed cannabis therapy in participants who had active ulcerative colitis. No studies that assessed cannabis therapy in participants with ulcerative colitis in remission were identified. One study (60 participants) compared 10 weeks of treatment with capsules containing cannabis oil with up to 4.7% D9-tetrahydrocannabinol (THC) to placebo in participants with mild to moderately active ulcerative colitis. The starting dose of cannabidiol was 50 mg twice daily which was increased, if tolerated, to a target of 250 mg twice daily. The other study (32 participants) compared 8 weeks of treatment with two cannabis cigarettes per day containing 0.5 g of cannabis, corresponding to 11.5 mg THC to placebo cigarettes in participants with ulcerative colitis who did not respond to conventional medical treatment.
The study comparing cannabis oil capsules to placebo found no difference in remission rates at 10 weeks. Twenty four (7/29) percent of cannabidiol participants achieved clinical remission compared to 26% (8/31) of placebo participants. The study also showed higher self reported quality of life scores in cannabis oil participants compared to placebo participants. More side-effects were observed in the cannabis oil participants compared to the placebo participants. These side effects were considered to be mild or moderate in severity. Common reported side effects include dizziness, disturbance in attention, headache, nausea and fatigue. No patients in the cannabis oil group had any serious side effects. Ten per cent (3/31) of the placebo group had a serious side effect. Serious side effects in the placebo group included worsening ulcerative colitis and one complicated pregnancy.
The second study comparing two cannabis cigarettes (23 mg THC/day) to placebo cigarettes showed lower disease activity index scores in the cannabis group compared to the placebo group. C-reactive protein and fecal calprotectin levels (both measures of inflammation in the body) were similar in both groups. No serious side effects were reported. This study did not report on remission rates.
The effects of cannabis and cannabis oil on ulcerative colitis are uncertain, thus no firm conclusions regarding the effectiveness and safety of cannabis or cannabis oil in adults with active ulcerative colitis can be drawn. There is no evidence for cannabis or cannabis oil use for maintenance of remission in ulcerative colitis. Further studies with a larger number of participants are required to assess the effects of cannabis in people with active and inactive ulcerative colitis. Different doses of cannabis and routes of administration should be investigated. Lastly, follow-up is needed to assess the long term safety outcomes of frequent cannabis use.
The effects of cannabis and cannabidiol on UC are uncertain, thus no firm conclusions regarding the efficacy and safety of cannabis or cannabidiol in adults with active UC can be drawn.There is no evidence for cannabis or cannabinoid use for maintenance of remission in UC. Further studies with a larger number of patients are required to assess the effects of cannabis in UC patients with active and quiescent disease. Different doses of cannabis and routes of administration should be investigated. Lastly, follow-up is needed to assess the long term safety outcomes of frequent cannabis use.
Cannabis and cannabinoids are often promoted as treatment for many illnesses and are widely used among patients with ulcerative colitis (UC). Few studies have evaluated the use of these agents in UC. Further, cannabis has potential for adverse events and the long-term consequences of cannabis and cannabinoid use in UC are unknown.
To assess the efficacy and safety of cannabis and cannabinoids for the treatment of patients with UC.
We searched MEDLINE, Embase, WHO ICTRP, AMED, PsychINFO, the Cochrane IBD Group Specialized Register, CENTRAL, ClinicalTrials.Gov and the European Clinical Trials Register from inception to 2 January 2018. Conference abstracts and references were searched to identify additional studies.
Randomized controlled trials (RCTs) comparing any form or dose of cannabis or its cannabinoid derivatives (natural or synthetic) to placebo or an active therapy for adults (> 18 years) with UC were included.
Two authors independently screened search results, extracted data and assessed bias using the Cochrane risk of bias tool. The primary outcomes were clinical remission and relapse (as defined by the primary studies). Secondary outcomes included clinical response, endoscopic remission, endoscopic response, histological response, quality of life, C-reactive protein (CRP) and fecal calprotectin measurements, symptom improvement, adverse events, serious adverse events, withdrawal due to adverse events, psychotropic adverse events, and cannabis dependence and withdrawal effects. We calculated the risk ratio (RR) and corresponding 95% confidence interval for dichotomous outcomes. For continuous outcomes, we calculated the mean difference (MD) and corresponding 95% CI. Data were pooled for analysis when the interventions, patient groups and outcomes were sufficiently similar (determined by consensus). Data were analyzed on an intention-to-treat basis. GRADE was used to evaluate the overall certainty of evidence.
Two RCTs (92 participants) met the inclusion criteria. One study (N = 60) compared 10 weeks of cannabidiol capsules with up to 4.7% D9-tetrahydrocannabinol (THC) with placebo capsules in participants with mild to moderate UC. The starting dose of cannabidiol was 50 mg twice daily increasing to 250 mg twice daily if tolerated. Another study (N = 32) compared 8 weeks of therapy with two cannabis cigarettes per day containing 0.5 g of cannabis, corresponding to 23 mg THC/day to placebo cigarettes in participants with UC who did not respond to conventional medical treatment. No studies were identified that assessed cannabis therapy in quiescent UC. The first study was rated as low risk of bias and the second study (published as an abstract) was rated as high risk of bias for blinding of participants and personnel. The studies were not pooled due to differences in the interventional drug.
The effect of cannabidiol capsules (100 mg to 500 mg daily) compared to placebo on clinical remission and response is uncertain. Clinical remission at 10 weeks was achieved by 24% (7/29) of the cannabidiol group compared to 26% (8/31) in the placebo group (RR 0.94, 95% CI 0.39 to 2.25; low certainty evidence). Clinical response at 10 weeks was achieved in 31% (9/29) of cannabidiol participants compared to 22% (7/31) of placebo patients (RR 1.37, 95% CI 0.59 to 3.21; low certainty evidence). Serum CRP levels were similar in both groups after 10 weeks of therapy. The mean CRP in the cannabidiol group was 9.428 mg/L compared to 7.638 mg/L in the placebo group (MD 1.79, 95% CI -5.67 to 9.25; moderate certainty evidence). There may be a clinically meaningful improvement in quality of life at 10 weeks, measured with the IBDQ scale (MD 17.4, 95% CI -3.45 to 38.25; moderate certainty evidence). Adverse events were more frequent in cannabidiol participants compared to placebo. One hundred per cent (29/29) of cannabidiol participants had an adverse event, compared to 77% (24/31) of placebo participants (RR 1.28, 95% CI 1.05 to1.56; moderate certainty evidence). However, these adverse events were considered to be mild or moderate in severity. Common adverse events included dizziness, disturbance in attention, headache, nausea and fatigue. None (0/29) of the cannabidiol participants had a serious adverse event compared to 10% (3/31) of placebo participants (RR 0.15, 95% CI 0.01 to 2.83; low certainty evidence). Serious adverse events in the placebo group included worsening of UC and one complicated pregnancy. These serious adverse events were thought to be unrelated to the study drug. More participants in the cannabidiol group withdrew due to an adverse event than placebo participants. Thirty-four per cent (10/29) of cannabidiol participants withdrew due to an adverse event compared to 16% (5/31) of placebo participants (RR 2.14, 95% CI 0.83 to 5.51; low certainty evidence). Withdrawls in the cannabidiol group were mostly due to dizziness. Withdrawals in the placebo group were due to worsening UC.
The effect of cannabis cigarettes (23 mg THC/day) compared to placebo on mean disease activity, CRP levels and mean fecal calprotectin levels is uncertain. After 8 weeks, the mean disease activity index score in cannabis participants was 4 compared with 8 in placebo participants (MD -4.00, 95% CI -5.98 to -2.02). After 8 weeks, the mean change in CRP levels was similar in both groups (MD -0.30, 95% CI -1.35 to 0.75; low certainty evidence). The mean fecal calprotectin level in cannabis participants was 115 mg/dl compared to 229 mg/dl in placebo participants (MD -114.00, 95% CI -246.01 to 18.01). No serious adverse events were observed. This study did not report on clinical remission, clinical response, quality of life, adverse events or withdrawal due to adverse events.