Cannabis use in IBD patients was linked to more ER visits, hospitalizations, and opioid use but not more surgeries or deaths | Research

The takeaway

In a propensity-matched population study, IBD patients who used cannabis had significantly more ER visits (2.1x), hospitalizations (1.9x), corticosteroid use, and opioid use compared to non-users, though surgery and death rates were not different.

Gastroenterologists managing IBD patients who use cannabis; patients with IBD considering cannabis for symptom management.

2x more ER visits and 1.9x more hospitalizations in cannabis-using IBD patients

What the researchers found

After propensity score matching, cannabis-using IBD patients had increased risk for ER visits (RR 2.143), hospitalizations (RR 1.925), corticosteroid use (RR 1.095), and opioid use (RR 1.35). No increased risk of IBD-related surgery or death. Crohn's disease patients specifically showed increased corticosteroid and opioid use, while ulcerative colitis patients showed similar patterns for ER visits and hospitalizations.

Why it matters

Many IBD patients use cannabis for symptom relief, but this large population study suggests cannabis use is associated with markers of worse disease management, raising questions about whether cannabis helps or hinders IBD outcomes.

The numbers in context

ER visits: RR 2.143 (95% CI 2.034-2.257). Hospitalizations: RR 1.925 (95% CI 1.783-2.079). Corticosteroid use: RR 1.095 (95% CI 1.021-1.174). Opioid use: RR 1.35 (95% CI 1.14-1.6). All p<0.05. No significant difference for surgery or death.

How the study worked

Retrospective propensity score-matched study using the TriNetX Diamond Network. Separate analyses for IBD overall, Crohn's disease, and ulcerative colitis. Baseline differences controlled through matching.

What this study cannot tell us

Cannot determine whether cannabis use causes worse outcomes or whether sicker patients are more likely to use cannabis. Administrative data cannot capture disease severity, cannabis dose, or symptom burden. Propensity matching may not capture all confounders.

How to read the evidence

Large propensity-matched database study with disease-specific subanalyses, though retrospective design cannot establish causation.

When this study was published

2024 study

The bigger picture

The paradox of increased healthcare utilization without increased surgery or death suggests cannabis users may have more poorly controlled disease (or seek care more often) without necessarily having worse long-term structural outcomes.

Questions still open

Are cannabis-using IBD patients sicker to begin with? Could cannabis be masking symptoms that delay appropriate treatment?

Common questions

Should people with IBD avoid cannabis?

This study shows associations, not causation. Cannabis users may have more severe disease that drives both cannabis use and healthcare utilization. The absence of increased surgery or death suggests cannabis is not causing catastrophic harm.

Why might cannabis users have more ER visits?

Possible explanations include that cannabis users have more severe baseline disease, that cannabis may mask symptoms leading to delayed treatment, or that cannabis users may have lower thresholds for seeking emergency care for other reasons.

Read the original research

The Impact of Cannabis Use on Clinical Outcomes in Inflammatory Bowel Disease: A Population-based Longitudinal Cohort Study.

Inflammatory bowel diseases, 30(7), 1055-1061

View on PubMed ↗Publisher’s paper ↗

Citation

Glickman, Danny; Dalessio, Shannon; Raup-Konsavage, Wesley M; Vrana, Kent E; Coates, Matthew D. (2024). The Impact of Cannabis Use on Clinical Outcomes in Inflammatory Bowel Disease: A Population-based Longitudinal Cohort Study.. Inflammatory bowel diseases, 30(7), 1055-1061. https://doi.org/10.1093/ibd/izad151