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Review cites therapeutic potential of medical marijuana for GI disorders
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Medical marijuana appears to hold promise as a potential treatment for gastrointestinal symptoms and digestive disorders, according to a recently published review. In response to the growing trend of medical marijuana use in the US, Mark E. Gerich, MD, division of gastroenterology and hepatology, University of Colorado, and colleagues have summarized current data that support the use of marijuana for digestive disorders, as well as the medicolegal considerations for physicians who consider recommending it to patients.
“The clinical benefit of marijuana or its constituent phytocannabinoids for digestive disorders is unclear but it appears to have some benefit, at the least, for gastrointestinal symptoms,” Gerich told Healio.com/Gastroenterology. “Moreover, although legitimate concerns exist about the long-term safety of marijuana use, the safety profile of marijuana compares favorably to legal intoxicants like alcohol, opioids, and some existing therapies for digestive disorders.”
Mark E. Gerich
Therapeutic compounds
According to the reviewers, the chemical compounds in marijuana that have the most clinical interest are 9-tetrahydrocannabinol (THC) and cannabidiol (CBD), which affect cannabinoid receptors that are partially implicated in the gastrointestinal tract. These receptors are thought to “promote an inhibitory effect on motility and secretory function via reduced acetylcholine release.” Numerous synthetic cannabinoids have been approved by the FDA, including dronabinol (Marinol, AbbVie), indicated for AIDS-related anorexia and chemotherapy-induced nausea and vomiting, and nabilone (Cesamet, Meda Pharmaceuticals), indicated for chemotherapy-induced nausea and vomiting unresponsive to antiemetics, the investigators wrote.
Efficacy
In a systematic review of limited literature to assess the effects of marijuana on gastrointestinal function, symptoms and disease, researchers identified five randomized controlled trials (RCTs). From these data investigators determined that oral THC analogs dronabinol and nabilone have comparable efficacy with dopamine antagonists for chemotherapy-induced nausea and vomiting. They also observed that data were mixed on the efficacy of dronabinol for cancer patients with anorexia and/or cachexia, with a modest benefit at best. For AIDS-related anorexia, however, data indicated improvement and weight gain with dronabinol. Conversely, data showed that nonsynthetic, smokeable marijuana with 2% to 4% THC smoked three to four times weekly increased food intake and weight gain in these patients, the researchers wrote.
For patients with hepatitis C virus infection, daily marijuana use has been found to increase steatosis and fibrosis, but other data suggested that synthetic cannabinoids and marijuana increased adherence to interferon-based treatment and sustained virologic response by reducing treatment-related symptoms.
The majority of patients with Crohn’s disease (CD) or ulcerative colitis reported that marijuana improved disease-related symptoms including poor appetite, nausea and abdominal pain. Research data indicated that more than half of patients who do not use marijuana would consider it if it were more widely legalized, according to the review. Study data also indicated that CD patients who smoke medical marijuana experienced improvement in symptoms, overall well-being and steroid use, with one RCT of 21 patients who smoked twice daily having significant improvement in terms of the CD Activity Index.
Legal
According to the review, current medical marijuana laws vary widely from state to state in terms of the administrative steps required to legally obtain a prescription, and approved conditions for which the treatment is indicated (cancer and HIV/AIDS are qualifying conditions in all states with medical marijuana programs). Most states with these programs have designed physician protections, such as requiring a certification of medical necessity, but the federal legal status of marijuana as a Schedule I controlled substance remains a liability deterrent for many doctors.
Although high-quality human study data on the clinical efficacy of marijuana is lacking, the researchers concluded, “It appears to hold promise as a modifier of gastrointestinal symptoms. As medical marijuana use continues to grow in the United States, physicians must take the lead in understanding the risks and benefits in order to provide accurate information to patients.” – by Adam Leitenberger
Disclosure: The researchers report no relevant financial disclosures.
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