Cannabis use in IBD needs to be an ‘open discussion’ without prejudice

ORLANDO, Fla. — To best treat patients for inflammatory bowel disease, providers need to know the status of cannabis use, and they must approach the conversation without prejudice, according to a presenter at Advances in IBD 2017.

“You have to have an open discussion with your patients. That’s why we decided to put it as a check box on our list. We include cigarette smoking, so we do the same for marijuana use,” Betty J. White, NP-C, RN, BSN, MSN, from the Digestive Health Specialists, Tacoma, Wash., said during her presentation. “You really have to set your prejudices aside. You can’t think about what it was 10 years ago. You have to think about what it is today and what it might be helpful for.”

Washington state legalized medical marijuana nearly 8 years ago, White said, and with the more recent legalization of recreational cannabis, she rarely encounters a patient who does not use cannabis in some form before they come into her practice. Yet, the studies to justify its use or make a case against it are limited.

While the media makes a splash of cannabis-based studies, “There is really very little hard data,” White said.

She showed various studies, usually small, that showed risks and benefits of cannabis use in various medical conditions. Cannabis users were less likely to abuse narcotics, for instance, and benefits of cannabis for gaining weight, anti-inflammatory properties and nausea control are well known. But it can cause palpitations, hypertension, seizures, depression, risk of bleeding, diarrhea, indigestion, hyperemesis and possible lung cancers down the road, White said. Other studies showed that nearly 30% of cannabis users will cultivate an addiction, she added.

“There’s lots of risks and benefits and you have to think about that. The updated cannabinoids are likely safe ... when used directly for specific disease states and for a limited time,” White said.

Health care providers in IBD should be aware of their state’s laws and their practice’s or institution’s guidance when they encounter patients already using or requesting a prescription for cannabis, she said.

“When things changed in our world, we had to think about that because patients started asking us for prescriptions and our group, in particular, decided we weren’t going to write prescriptions, but we wanted to know about our patients, if they were using it or not, so we asked it on the questionnaire,” White said. – by Katrina Altersitz

Reference: White BJ. Session VB: Case Presentations and Interactive Discussion. Presented at: Advances in IBD; Nov. 9-11, 2017; Orlando, Fla.

Disclosures: White reports being on the speaker’s bureau for AbbVie and Takeda.