IBD patients who use cannabis report more symptoms but do not have worse underlying disease

Cannabis users (7.8% of the cohort, average 2.7 times/week) were more likely to report abdominal pain (83.3% vs. 61.7%), gas (66.7% vs. 45.6%), tenesmus (70.0% vs. 47.6%), and arthralgias (53.3% vs. 20.3%) compared to non-users. However, they did not have more frequent active disease or IBD-associated complications on endoscopy.

Retrospective cohort study of 383 IBD patients from a consented natural history registry at a single tertiary center (2015-2020). Current cannabis use, frequency, demographics, clinical characteristics, endoscopic severity, and validated symptom surveys compared between users and non-users with logistic regression.

The disconnect between more reported symptoms and no worse disease activity in cannabis users suggests these patients may have greater symptom sensitivity, more extraintestinal manifestations, or may be using cannabis to manage symptoms that standard IBD treatment does not address.

This finding challenges the assumption that cannabis helps IBD symptoms: cannabis users reported more symptoms, not fewer. This may reflect reverse causation (sicker patients turn to cannabis) or cannabis's inability to address certain symptom types.

Retrospective, single-center study. Small number of cannabis users (n=30). Self-reported cannabis use. Cannot determine whether cannabis is ineffective or whether sicker patients self-select into use. Cross-sectional comparison.