Marijuana Use for Symptom Control in Inflammatory Bowel Disease

Marijuana Use for Symptom Control in Inflammatory Bowel Disease: Patients’ Perceptions and Patterns of Use

Source / Quelle: https://karger.com/mca/article/9/1/211/951948/Marijuana-Use-for-Symptom-Control-in-Inflammatory

Abstract

Introduction: Many patients with inflammatory bowel disease (IBD) use marijuana for disease-related symptoms. Data regarding reasons for usage, impact, and perceptions on its effects is lacking. Our study aimed to understand patterns of marijuana use, underlying symptom response, and beliefs about marijuana in patients with IBD. Methods: An anonymous REDCap survey comprised of 39 questions on demographics, disease features, patterns of marijuana use, symptoms, quality of life, and true/false statements about marijuana was administered to 108 participants recruited from University of Florida (UF) IBD clinic. Results: Participants were 47.2% male and 51.9% female. While a significant percentage of subjects reported co-morbid depression/anxiety (61.1%), the percentages for PTSD and ADHD are both 19.4%. Patient characteristics are compared among three reasons of marijuana use (Recreational, Medical and Combination). There was a notable shift in reasons for use with both age (p = 0.0074) and duration of IBD diagnosis (p = 0.006): recreational use is more common among younger patients and those with a shorter duration of IBD diagnosis, medical use becomes predominant in middle-aged patients and those with an intermediate duration of diagnosis, and combination use increases among older patients and those with the longest duration of IBD diagnosis. Comparisons are also conducted based on the frequency of marijuana usage. Associations were found between marijuana use frequency and symptom relief. Daily or near-daily marijuana use was associated with self-reported relief of nausea/vomiting (82.1%; p = 0.003), arthralgias (81%; p = 0.013), and insomnia (80%; p = 0.02). Additionally, marijuana use was linked to an improved ability to live independently (p = 0.0075) and current employment (p = 0.04). Patients with a history of bowel surgery were more likely to report marijuana use lasting longer than 5 years (OR 21.94, CI [2.91, 250.18], p = 0.0059) and using marijuana at least once weekly (OR 11.13, CI [1.78, 97.69], p = 0.0163). Notably, 59.3% of respondents believed marijuana use had reduced their opioid consumption. Marijuana users with a history of IBD-related hospitalization had higher odds of reporting depression/anxiety (OR 14.3, CI [2.34, 143.2], p = 0.009) and diarrhea symptoms (OR 13.3, CI [2.2, 128.9], p = 0.01). When asked how marijuana use affected their ability to live independently, 61.3% of participants reported “improved.” Similarly, 87.6% respondents reported improvement in their quality of life with marijuana use. Conclusions: Marijuana can be helpful for symptom control, reducing reliance on opioid pharmaceuticals, and may improve quality of life in patients with IBD. Participants demonstrated good insight regarding the role of marijuana in the management of their disease.

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Introduction

Inflammatory bowel disease (IBD) is a chronic, inflammatory autoimmune disease with a relapsing and remitting course. It comprises two phenotypes, Crohn’s Disease (CD) and Ulcerative Colitis (UC) [1]. Patients can experience debilitating symptoms including abdominal pain, nausea, weight loss, bloody bowel movements, poor appetite, and sleep, all of which can impact patient quality of life (QOL) [1]. Over time, complications such as severe uncontrolled UC, bowel strictures and fistulas associated with CD, or bowel malignancy can lead to the need for surgical resection. Immunosuppressive medications are the mainstay of therapy with the target of mucosal healing of the bowel [2]. Despite the beneficial effects of these medications, disease-related symptoms persist in many patients, affecting their QOL. These medications themselves can also cause side effects such as nausea, insomnia, and loss of appetite [3]. Patients struggle with a variety of symptoms due to the compounded physical, emotional, and psychological burden of the disease [4].

Use of medical and recreational marijuana has increased in the USA following its legalization in 38 of 50 states for medicinal use and 24 states for recreational use [5]. Patients with IBD sometimes use marijuana for disease related symptoms [6]. Previous studies have examined characteristics of marijuana use and their associated patterns of symptom relief in patients with IBD [7]. Among the few clinical trials examining marijuana use in IBD, data suggest overall improvement in quality-of-life scores, with minimal efficacy in reducing inflammatory markers or achieving disease remission [7, 8].

Medical marijuana and its derivatives have become increasingly popular in the USA for management of chronic pain and anxiety. Inadequate pain control in IBD often leads to chronic narcotic use, which has the added risk of developing dependence [9]. This makes marijuana a promising alternative for symptom management. Patients with IBD report marijuana use for management of both gastrointestinal and non-gastrointestinal symptoms such as diarrhea, nausea/vomiting, bloody stool, fatigue, fever/chills, joint pain, insomnia, anxiety, poor appetite, and weight loss, which may persist even in the setting of endoscopic remission [8]. CD is also an approved indication for medical marijuana in the state of Florida. There is a paucity of data on patterns of marijuana use and disease outcomes in IBD patients, particularly in the young adult population, and hence limited information regarding the risks and benefits. Our study aimed to assess the attitudes, modes, profiles, and impact of medical marijuana use in IBD patients via survey tools. We will address a key knowledge gap on the factors encouraging or deterring marijuana use by patients with IBD, their patterns of use, impact on prescription medication use, QOL, and activities of daily living.

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