Cannabis effective in patients with Crohn’s disease?

Researchers at Tel Aviv University, in Israel, focus on the positive in this small study.

First, the details.

• 21 adults with Crohn’s Disease Activity Index (CDAI) scores greater than 200 were assigned randomly to groups.
  • Cannabis, twice daily, in the form of cigarettes containing 115 mg of delta 9-tetrahydrocannabinol (THC)
  • Placebo containing cannabis flowers from which the THC had been extracted
• These patients had not responded to therapy with steroids, immunomodulators, or anti-tumor necrosis factor-alpha agents.
• The primary outcome was remission.
• In addition, changes in disease activity and laboratory tests were assessed during 8 weeks of treatment and 2 weeks thereafter.

And, the results.

• Complete remission (CDAI score, less than 150) was achieved by 5 of 11 patients in the cannabis group (45%) and 1 of 10 in the placebo group (10%) — a nonsignificant difference in this size group.
• A clinical response (decrease in CDAI score of greater than 100) was observed in 10 of 11 patients in the cannabis group (90%) and 4 of 10 in the placebo group (40%) — a significant difference.
• Three patients in the cannabis group were weaned from steroid dependency.
• Subjects receiving cannabis reported improved appetite and sleep, with no significant side effects.

The bottom line?

The authors concluded, “Although the primary end point of the study (induction of remission) was not achieved, 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.”

This study supports results reported by researchers at the same university in 2011. That study was also small with just 30 patients studied retrospectively.

Both studies suggest that cannabis may induce symptomatic improvement in patients with Crohn’s disease, but whether there is any change in inflammation remains to be proven.

Dr. Timna Naftali is a Specialist in Gastroenterology at Meir Hospital and Kupat Holim Clinic (Israel), an expert on cannabinoid treatment, and about as free of bias as you will find in this area (according to ProCon.org). Dr. Naftali tells us, “Cannabis treatment is not free of side effects including euphoria, psychosis, anxiety, paranoia, dependence and abuse. Since the cannabinoid system is involved in many physiological and pathological processes, the therapeutic potential is great.”

Yes, “we must not be blind to the opportunity offered to us by medical cannabis just because it is an illicit drug.”

However, “nor should we be temped by the quick response of patients to the central effect of cannabis. More research is warranted to explore the full potential of cannabis as medicine.”

The primary objective of the study was not accomplished. Suggesting that other outcomes make this a successful study (as stated in the title) is misleading. They may be interesting but, as Prof. Naftali states, these data “require more research to confirm any cause and effect.”

The authors did not say this was a double blind study. That’s good because past studies show it’s not possible to hide treatment from the patients when a joint is used to deliver the cannabis.

10/9/13 21:20 JR