Introduction

Overview of crohn's disease

Definition and symptoms

Crohn’s disease is a type of inflammatory bowel disease that causes your digestive tract to become swollen and irritated (inflammation). It mostly affects your small intestine and the beginning of your large intestine.¹ However, the disease may affect any part of your digestive tract, from your mouth to your anus. Symptoms can vary, ranging from mild to severe.

This can include:

• Stomach ache
• Fatigue and fever
• Severe diarrhoea
• weight loss and malnutrition
• Mouth sores
• Blood in the stool (rectal bleeding)

Other symptoms include:

• Anaemia
• Skin changes, such as red, tender bumps under the skin
• Kidney stones
• Nausea

Prevalence and impact on quality of life

Crohn’s disease is most commonly seen in Europe and North America, with prevalence rates of over 322 cases per 100,000 people in Europe and 319 cases per 100,000 people in North America. These figures show how frequently the condition is diagnosed in these regions compared to other parts of the world.¹

Living with Crohn’s disease goes beyond managing physical symptoms—it has a significant impact on quality of life. People with Crohn’s often face challenges in their day-to-day lives, including difficulty maintaining work, school, or social activities due to the unpredictable nature of the disease.²

Purpose of comparison

As interest in alternative treatments like medical cannabis continues to grow, it’s important to understand how it measures up against traditional options. This comparison aims to help patients and carers make informed choices by exploring the strengths and limitations of each approach.

Traditional treatments for crohn’s disease

Crohn’s disease is typically treated with a combination of medication and, in some cases, surgery. The approach depends on the severity of the disease and how well the patient responds to different treatments. Although there is currently no cure for Crohn’s disease, these treatments can help control and reduce symptoms, improving quality of life. In some cases, surgery may be recommended when medications are no longer effective.

Pharmaceutical treatments

Anti-inflammatory drugs

Drugs like mesalamine and corticosteroids are commonly prescribed to reduce inflammation. Corticosteroids are particularly effective in quickly controlling flare-ups, but they are usually taken for short periods due to potential side effects such as weight gain, mood swings, and increased risk of infection.

Immunosuppressants

Immunosuppressants can help control symptoms when steroids aren’t enough. They are often used as a long-term treatment to prevent symptoms from returning. Azathioprine and methotrexate are commonly used in Crohn’s disease treatment. They may be needed for several months or years to help manage the condition effectively.

Biologics

Biologic drugs like adalimumab and infliximab are often used in severe Crohn’s disease. These drugs target specific parts of the immune system to block the inflammatory process. They are typically given by injection or IV and can be highly effective in reducing symptoms and preventing flare-ups in those who do not respond well to traditional treatments like steroids.

Antibiotics for complications

If Crohn’s disease leads to infections or abscesses (a localised collection of pus within the body, usually caused by a bacterial infection), antibiotics may be prescribed. These help to treat any infections that arise as a result of the disease and prevent further complications.

Surgical interventions

Resection of diseased portions of the intestine

Surgery may be necessary when medication isn’t enough or if complications occur. The most common surgery involves removing the affected part of the intestine. This is typically done through keyhole surgery (small incisions). It’s performed under general anaesthesia, and recovery usually takes a few months, though you may stay in the hospital for about a week.

Limitations

Side effects

While effective, many of these treatments come with side effects. Immunosuppressive drugs, for example, can increase the risk of infections because they lower the body’s ability to fight off pathogens. Steroids can cause weight gain, mood changes, and increased susceptibility to infections.

Variable efficacy and potential resistance

Not all patients respond to treatments in the same way. Some may not find relief with a particular medication, or they may develop resistance over time. This can make managing the disease challenging and require adjustments to the treatment plan.

High costs and accessibility issues

Biologics, in particular, can be expensive, and not all patients have easy access to these treatments.

Medical cannabis as a treatment option

Composition and mechanism

Active compounds (THC, CBD) and their anti-inflammatory and analgesic properties

Cannabis contains active compounds like THC (tetrahydrocannabinol) and CBD (cannabidiol),  which have shown potential in managing Crohn’s disease symptoms. THC is known for its psychoactive effects, which can provide pain relief, while CBD, which doesn’t cause a “high,” has anti-inflammatory properties. These compounds interact with the body’s endocannabinoid system, which regulates inflammation, including in the gut.

Interaction with the endocannabinoid system and effects on gut inflammation

The endocannabinoid system plays a crucial role in regulating immune function and inflammation. By interacting with cannabinoid receptors in the gut, cannabis can help reduce inflammation, a hallmark of Crohn’s disease.

Evidence from studies

Clinical trials and anecdotal evidence

While several studies have looked into cannabis as a treatment for Crohn’s, results have been mixed. Some clinical trials show that cannabis may help reduce symptoms like pain and nausea,3 and appetite loss, while anecdotal evidence from patients often reports improvements in quality of life. For instance, one small study found that cannabis oil helped improve Crohn’s disease quality of life scores, although further research was still needed to make a strong conclusion.⁴

Administration methods

Inhalation, oral tinctures, edibles, and topical applications

There are different ways to administer cannabis, including inhalations, oral tinctures, edibles, and topical applications.  Oral options like tinctures and edibles provide longer-lasting effects and are often preferred for sustained symptom management.

Potential limitations

Psychoactive effects (THC)

A significant limitation of cannabis is the psychoactive effect of THC. While this compound can help with pain relief, it can also cause dizziness, memory impairment, and difficulty concentrating. This can be a concern for some patients, particularly those who need to remain clear-headed during the day.

Lack of long-term studies

Despite the promising results from early studies, there is still a lack of long-term research on the use of cannabis for Crohn’s disease. Without more extensive trials, it’s difficult to fully understand the long-term benefits and risks of cannabis use.

Legal and regulatory barriers

In many places, cannabis remains a controlled substance, and its use is not universally approved. Legal restrictions can limit access, and patients may face difficulties obtaining cannabis treatments in areas where it’s not yet legalised.

Key comparison factors

Efficacy

How does each treatment impact symptom relief and remission rates

Traditional treatments like immunosuppressants, biologics, and corticosteroids are established in managing Crohn’s disease, with biologics offering remission in a significant portion of patients. However, some may experience a loss of response over time.

Medical cannabis, while showing promise in symptom relief, has not demonstrated significant improvements in disease activity, such as reduced inflammation. Cannabis may complement traditional therapies for symptom management but should not replace primary therapies.⁵

Safety profile

Side effects and risks of traditional drugs versus cannabis

Traditional therapies carry well-known side effects. For example, corticosteroids can lead to adrenal suppression and mood changes with prolonged use. Biologics and immunosuppressants suppress the immune system, increasing the risk of infections and, in rare cases, lymphoma.

Cannabis, on the other hand, has a different safety profile. THC, the psychoactive compound, can cause temporary dizziness, anxiety, or cognitive impairment in some people. CBD-dominant products, which are non-psychoactive, may help mitigate these effects, providing symptom relief without the mind-altering effects associated with THC.

Patient preference and quality of life

Lifestyle compatibility, stigma, and ease of use

Lifestyle considerations often influence treatment choices. Traditional therapies like biologics or immunosuppressants may require strict dosing schedules or periodic clinic visits, which can disrupt daily life. Despite these challenges, many patients prefer traditional treatments due to their established efficacy and close monitoring by healthcare providers.

Cannabis, in contrast, offers flexibility in administration. Patients can choose among inhalation, edibles, tinctures, or capsules based on their needs. However, the psychoactive effects of THC, as well as lingering societal stigma, may deter some people. Despite this, many individuals report improved quality of life when using cannabis, showing better symptom control and a sense of autonomy in their treatment.

Ethical and legal considerations

Medical cannabis legislation

The legal status of medical cannabis varies widely, creating confusion and limited access for patients. Even where it’s legal, restrictions on prescribing and inconsistent product quality pose challenges. A standardised regulation could help ensure safer access for those who need it.

Physician guidance and responsibility

Many physicians may lack training in medical cannabis, leaving patients without proper guidance. Supervised treatment plans are important to ensure safe use, right dosing, and compatibility with other treatments. Educated healthcare providers can bridge this gap and support informed patient decisions.

Social stigma

Despite growing acceptance, the stigma around medical cannabis still influences patient choices. Fear of judgment from peers or healthcare providers often discourages its use. Positive public narratives and research are gradually reducing the bias, but stigma remains a significant barrier for many.

Summary

Both traditional treatments and medical cannabis offer unique strengths for managing Crohn’s disease. Traditional therapies like biologics and corticosteroids are effective but may cause significant side effects, while cannabis shows promise for symptom relief, though more research is needed. Since no treatments work for everyone, a personalised approach is crucial, considering individual needs and preferences. With ongoing research and open conversations with healthcare providers, patients can find the best options to improve their quality of life.